Activator Methods Chiropractic Technique Where, When and When Not to Adjust

TODAY, WITH MORI: AND MORE STUDIES CONCLUDING THAT THE standard methods of chiropractic analysis are unreliable and not reproducible, many doctors of chiropractic are looking for a way to analyze the spine and extremities that can give them assurance. Activator Methods Chiropractic Tech­nique (AMCT) utilizes a protocol incorporating leg length analy­sis, pre- and post-adjustment, to determine exactly where, when and when NOT to adjust. Therefore, this protocol not only helps to assure the doctor has found the affected spinal level but also enhances their confidence that the adjustment was successful. Research has been conducted to evaluate interexaminer re­liability using experienced chiropractors to measure reproduc-ibility of prone leg length assessment and concludes that reli­ability of prone leg checks can be consistent.' In comparison, static and motion palpation fall below what is clinically accept­able in terms of reliability. AMCT utilizes prone extended leg length assessment (Position 1, Figure 1) to determine the func­tional short leg of the patient or pelvic deficient (PD) side, either the AS or PI ilium. Once the pelvic deficiency is corrected using precise contacts and lines of drive via the Activator ad­justing instrument, the leg lengths become equal. (Figure 2). ISOLATION TESTS: With the pelvis now balanced, screening for areas to adjust involves the use of active muscle tests called isolation tests. (Figure 3) Each isolation test corresponds to a specific vertebral segment. The patient performs the requested motion and the doctor observes for any changes in leg length on the side that was originally the PD side. If a change occurs, the doctor flexes the knees to 90 degrees (Position 2) and ob­serves any change in the PD leg to determine which side of the spine to adjust. If the PD leg lengthens in Position 2. the doc­tor adjusts the PD side of the corresponding segment on a specific contact (example, the mammillary or transverse pro­cess) with a precise line of drive utilizing the Activator adjust­ing instrument. Correction will be observed in a post-adjust­ment leg check as the legs balance again. If the patient's leg lengths remain equal after the isolation test, no adjustment is required and the doctor moves on to test the next level of the spine. AMCT conceives that the leg reactivity observed after an isolation test is due to facilitation as a result of nerve inlerfer- cnce at the affected spinal level. Accord-i n g to Malik Slosberg, DC, "nor­mal muscles respond to normal, innocuous movements by ap­propriately contract­ing brielly to perform the requested move­ment and then relax­ing." Therefore, in unaffected areas, these movements do not ap­pear to alter relative leg lengths. He goes on to say, "When a muscle group is facilitated, its response to stretch or contrac­tion may be both excessive and prolonged. Such alterations of muscle response apparently affect the functional leg length and result in alteration of relative leg lengths."2 If facilitation is present, an exaggerated contraction of paraspinal muscles occurs and leg reactivity is observed. De­cades of documented clinical observation from doctors of chi­ropractic internationally have culminated into this protocol for analysis. In one reliability study, 72 subjects were examined by two DCs, for upper cervical subluxation, using a chin tuck isolation test. Good reliability between examiners was found.1 Drs. Warren Lee and Arlan Fuhr founded instrument adjust­ing over 35 years ago. Not only does an instrument allow the doctor to passively adjust the patient, but it also provides a specific contact, force, speed and line of drive so that you can be as- sured to affect the joint as efficiently as possible. The latest Activator adjust­ing instrument. Activator IV (Figure 4), has a reproducible preload and four precision force settings that have been studied in independent labora-tories.The minimal force setting starts at approximately 19 lbs and the in­strument ranges up to a maximal force setting of approximately 55 lbs. Today, the Activator is still the fastest adjusting instrument. It is over 300 times faster than a manual thrust.4 At this speed, the doctor is affecting the involved joint be­fore the muscle spindle reflex is initialed. To compare the ef­fects of manual adjusting to instrument adjusting, we can look at a bone movement study where a manual lumbar side-posture adjustment using 540N offeree moved L4 1.1 mm.5 In a similar study, the Activator adjusting instrument moved L4 1.6 mm with a force of 140N.6 STUDY IN CLINICAL SETTING: The following is a case series that will help illustrate the effectiveness of the AMCT protocol and adjustments in a clinical setting. The purpose of this paper was to determine if there was a basis for the treatment of Tem-poromandibular disease (TMD) using the chiropractic proto­col developed by Activator Methods, Inc. The study was set in a private, solo practice of an Activator advanced proficiency rated chiropractor with 15 years experience. Nine adult volun­teers with articular TMD were recruited from the practice of the treating clinician. Change was measured from baseline to fol­low-up using a Visual Analog Scale (VAS) for temporoman-dibular joint (TMJ) pain and maximum active mouth opening without pain. AMCT protocol for full spine and TMJ analysis and adjusting (Figure 5) was followed. Participants were typi­cally seen three times per week for two weeks and, according to individual progress, thereafter for six more weeks. The results showed a median VAS decrease of 45 mm (range 21-71) and all experienced improvement. The median increase of mouth open­ing was 9 mm (range 1-15) with improvement in all. The results of this prospective case series indicate that the TMD symp­toms of these participants improved following a course of treat­ment using the AMCT protocol.7 AMCT is now taught in almost every chiropractic college in the United States. With over 140 peer-reviewed articles and conference presentations published, doctors of chiropractic can be assured that, by choosing AMCT as their primary method of analysis and adjustment, they are offering their pa­tients an effective and safe treatment and will have fewer doubts about where, when and when NOT to adjust! References /. Ajiiroi. el al.. JMPT 1999: 22(V):.Vo-9. 2. Malik Slmheijt PC. MS. in Today's Chiropractic I7:I7.I99X. .). Yomijiquixt. el al.. JMPT 19X9; 12:91-97. 4. Keller, el al.. JMPT 1999; 22(2):7.US6. 5. Maigne. Cuillnn. JMPT 21100; 2i:?M-M6. 6. Nailum. el al.. JMPT 1994: !7(7):4}l-44. 7. Delmhi. el al.. JMPT 21)03: 26(7): 421-425. h'or more information, contact Activator Methods. International. 2950 ,V. Seventh St. Suite 200, Phocni.x. A'/. X5UN; or call (602) 224-0220. www.activator.com Figure 1. Position 1 Figure 2. Pelvic Adjustment Figure 3. T12 Isolation Tests Figure 4. Activator IV Figure 5. TMJ Adjustment