The many techniques available to us as chiropractors have collectively formed a war chest against time. As the ages go by, not just for individuals, but for our profession, we will be tasked with maintaining adjusting standards while integrating our craft into modern environments. It may sound like an old versus new afterschool fight, but the challenge that I propose we confront is closer to home.
Somewhere between our hands and the constant downward force of gravity, it’s possible—no, it’s necessary—to provide specific solutions to subluxation as opposed to some of the repetitive modes we fall into. We can become so effective at delivering a certain range of adjustments that we may not explore all avenues of adjustments. Issues we may be glossing over could affect which vertebrae to adjust or which lines of correction to pursue. By embracing a more specific indicator-based approach to adjusting we can remain progressive while patients remain in a state of corrective change.
We have quite a few different art forms, or techniques— each with a different way of analyzing the spine. Maybe you can even think of them as different languages providing different ways of describing subluxation. Ultimately, we’re talking about the dynamics of the same anatomy, whether neurology, biology, or physics.
One of the things I’ve observed is that most doctors perform a predominance of adjustments using a posterior-to-anterior (P-A) line of correction. Furthermore, most doctors adjust the cervical and lumbo-pelvic region; again, the majority are performed P-A. No one would debate that the posterior elements of the spine are more accessible as adjusting levers (the difference being less so in the cervical spine) than the anterior features of the spine. It will be sufficient to say in this comparison that there are methods within our techniques to address vertebral fixation and misalignment from the anterior.
The most common observations among chiropractors, from both X-ray analysis and examination, include anteriority of the cervical and lower lumbar spine. So, why aren’t we addressing more anteriority? In other words, in the cases of excessively anterior regions of the spine, why aren’t we doing more A to P adjustments? How and when are we addressing anteriority?
The adjusting table itself shouldn’t be overlooked, as it provides stabilization and support for the patient against gravity in addition to counterpressure (A to P when prone) to adjustments. Our tables have evolved with the techniques—enabling the broad desired effect that adjustments can have. Regardless of where and how, whenever we are setting a bone in motion or “putting it in place,” we do give directive force and can do so with specificity.
When you think of A to P adjustments, the one that comes to mind is usually a thoracic spine maneuver. Nevertheless, the cervical and lumbar areas have, arguably, more neurological significance, there’s more range of movement to work with, and more techniques prioritize these regions. Although the anterior aspect of these regions may be less accessible, our techniques have ways of addressing the anteriority. The question is, are we going for the low-hanging fruit, or are we doing the difficult work needed for correction?
When you look at whole-body structures, functions, and gravity, prominent anteriority may need special attention in clinic: cranial work is concentrated on the anterior over posterior features of the skull; the psoas muscle is a common target to address anteriority given the connection to the lumbar and lower thoracic spine, affecting the pelvis, specifically SIjoint function. Cervical anteriors (adjusted supine or seated) are both common and easily accessible. Could we apply the law of depreciating gains to adjusting? Aren’t we getting great results with largely P to A lines of correction? Well, when we go back to our X-ray findings, we’re consistently finding this anteriority. In the lower back, one of the most common findings is pelvic tilting—in that area, you might also identify with facet syndrome, or hyperlordotic curvature. So, the better question may be how are we addressing the cause of this posture distortion phenomenon, and will spinal adjustments hold better when we do?
Overall, the spine and the body as a whole unit have to strive for balance. In some instances (e.g., foot pronation), the body has no choice—it’s an intuitive solution for the pelvis to tilt, and a natural progression of comfort and balance for the head to go forward. No matter how we address the vertebrae with our technique, does it foster correction of the cause of postural distortion?
In clinic, we look at anterior head carriage, pelvic tilting, and balance over the center of gravity in the examination. We can address these findings by utilizing less common lines of correction, although performing such adjustments may be more laborious. Furthermore, we can address soft tissues that undermine osseous correction, like psoas or diaphragm. These soft tissue relationships can contribute to perpetuation of the most common subluxation patterns that we all see routinely in practice in the form of anteriority of the head and the pelvis.
The challenge for every doctor is to show results—we can show that improvement through the lower back and through the feet. Could doctors who address the feet have a lot to say about the neck? Could they talk about the fact that reducing pronation and stabilizing it with custom flexible orthotics that support all three arches of the foot possibly minimize the need for anterior head carriage? Can they demonstrate it? Can they show it on X-ray and/or posture scans? Can they show it with balance testing? This is where we all can lean on the technique war chest. There’s even greater room for improvement in chiropractic to take our spinebased care and address the related areas, especially restoring healthy foot function to stabilize the entire body. By looking at the feet, we can address the spine and build creative solutions that can reflect the true complexity of our anatomy.
I don’t believe it is anyone’s place to tell a chiropractor how to address the issue, but I do believe we can ask each other, “have you addressed the cause of the issue?” Results to a practitioner may be different than a patient’s view, given they may be satisfied with just reducing pain. They also might take comfort in a bigger vision around functional improvements—the activities they can do, improvements in endurance, improvements in strength. Certainly, one of the most common things that I hear when people get off the table is they can stand up straighter or they can breathe better, deeper. They report not only greater ease of performing the same exercise they were previously struggling with, but achieving new personal bests.
So, the vision is bigger; how you get there, whichever technique, is the beauty of chiropractic. If you can get there by adjusting one bone, great. If you can do it by addressing the posteriority, no problem. But there are common findings we see all the time, and if we’re going to grow as a profession, I think we should aim for correction without concern that patients won’t understand all the connections to the spine or may improve too quickly. Reach a bit further, and trust that patients will come back for prevention when we have achieved correction. So, it might be a challenge to make that transition, but if you look to the technique manuals, it’s all there. We can all reach for a higher standard.
A graduate of Life University in Atlanta, Georgia. He is the owner of Bajaj Chiropractic in New York City. Dr. Bajaj serves on the executive board of the New York Chiropractic Council and is the chair of their Neuroscience
