Activator Methods: Analysis and Adjustment

F or more than one hundred years, the science of chiroprac­tic has had a "400-pound gorilla in the room." and you can sum up his gigantic presence in a single question: how do we find a subluxation and fix the subluxation? After more than fifty years of clinical observation of the chiropractic adjustment and its effects. I find myself often returning to one truth: the human body is marvelously complex. Dealing with that human complexity in an honest and scientifically careful way demands that we turn to research to make a case for the validity and ef­fectiveness of any instrument or technique we use to perform an adjustment. Adding a personal note here. I will point out that I"vc intended for many years to write this article in the hope of sharing my observations as a caution­ary note. You see. during the course of my now long-running career. I have seen chiropractors who far too often run from one technique to another without paying attention to the evidence published in peer-revicwed journals. Equally disturbing is having witnessed other instrument techniques/com­panies quote Activator research and apph it to their own techniques, attempting to transfer the validity achieved with Activator adjusting instruments to their own products. That's something akin to a drug company "borrow ing" the research on another drug and apply­ing it to their own dnig without any trials. Activator Methods International has been involved in re­search for more than twenty-scven years, with more than one hundred peer-reviewed publications that range from intcr-tcsting reliability in leg length analysis to studies validating our isolation testing. (Table 1.) In both intcr-tcsting reliability in leg testing and our isolation testing, we have shown clinical utility in at least 17 peer-reviewed publications. (Table 2.) The majority of these published papers were the results of studies performed by researchers in multi-site testing facilities. Activator has been shown to have the clinical equivalence of manual adjusting as published in a systematic review of the literature preformed at the Canadian Memorial Chiropractic College and published in the Canadian Journal of Chiroprac­tic. Activator Methods has just completed its sixteenth clinical trial this month on the Activator analysis and adjusting instru­ments showing clinical utility. (To the best of my knowledge. Activator is the only instrument adjusting technique that has any clinical trials.) As further evidence of having done the hard work that under­scores Activator's efficacy, ifs important to note that Elscvier/ Mosby has published two Activator Methods textbooks, and that the Activator Method chiropractic technique (AMCT) is taught in 13 chiropractic colleges in the United States and in 13 international universities. I hope the chiropractic students of today will ask the cor­rect questions and will not be as naiVc as prior generations of chiropractors. At a presentation at the Research Agenda Conference in April 2011. we learned that college clinics now require student doctors to research clinical prediction rules for treatment effectiveness prior to adjusting their clinic patients. Research is required to substantiate the mode and type of treat­ment for their patients. All chiropractic students and doctors should be aware of the published research available to support their selected treatments based on the hierarchy of evidence. (Table 3.) Ncurophysiological effects on animals and humans will continue to support our treatment of the subluxation com­plex. (Table 4.) I've learned there is a reason that those who promote other non-AMI techniques quote our research when selling their instruments. Simply, it takes many years of hard work and a lot of money to research the validity and effectiveness of any type of analysis or piece of equipment used to perform an ad­justment. Activator has been willing to make that investment while others have not. I once wrote an article entitled "Dogma vs. Data." It caused an uproar with some accusing me of not being a "subluxation-bascd" chiropractor. Let me assure you. if you arc ever called into court for malpractice, you will be very happy to have the "data" because "dogma" docsn"t earn the day. At AMI. we remain hopeful and excited. We continue to foster research because there is so much more to know and many more topics deserving of research and publication. For our progress so far. please visit www.activator.com and click the research tab. ► Table 1 Summary of AMCT published papers (not a complete list). Based on the seven clinical research designs. Anthony Rosner. PhD. FCER. adding the pinnacle to the clinical research designs as systematic reviews of the literature. ► Table 2 Inter-cxamincr Reliability Titles Intcrcxaminer Reliability of the Prone Leg Length Analysis Procedure. Intcrcxaminer Reliability of Relative Leg Length Evalu­ ations in the Prone Extended Position. Optoclcctric Measurement of Changes in Leg Length Inequality Resulting from Isolation Tests. Comparison of Leg Length Inequality Measurements Methods as Estimators of the Femur Head Height Dif­ ference on Standing X-ray. Intcrcxamincr Reliability of Actuator Method's Relative Leg-Length Evaluation in the Prone Extended Position. Reactivity of Leg Alignment to Articular Pressure Test­ ing -Evaluation of a Diagnostic Test using a Randomized Crossover Clinical Trial Approach. Leg Length Inequality and the Side of Low Back Pain -APilot Study. Optoclcctric Measurement of Leg Length Changes Before . During, and after Isolation Tests. Measurement of Soft Tissue strain in Response to Cos- cncutivcly Increased Comprcssivc and Distractive Loads on a Friction-Based Test Bed. Optoclcctric Measurement of Leg Length Changes Be­ fore. During and After Isolation Tests. Inter-and -intra examiner rcliabilty of leg -length dif­ ferential measurement: a prcmilinary study. Responsiveness of leg alignment changes associated with articular pressure testing to spinal manipulation: the use of a randomized clinical trial design to evaluate a diagnostic test with a dichotomous outcome. Precise measurement of functional leg length inequality and changes due to cervical spine rotation in pain free students. Intcrcxamincr Reliability of Eight Evaluative Dimen­ sions of Lumbar Segmcntal Abnormality. Motion Analysis as a Means Objectify Changes in Ap­ parent ( Prone) Leg Length Inequality Intcrcxamincr Reliability of a Leg Length Analysis Pro­ cedure Among Novice and Experienced Practicioncers Intcrcxamincr Reliability of the Prone Leg Length Analvsis Procedure. ► Table 4 Titles of AMCT Physiological Effects Ncuropln siological Response to Intraopcrativc Lum- bosacral Spinal Manipulation Reflex Responses Associated with Activator Treatment Mechanical Force Spinal Manipulation Increases Trunk Muscle Strength Assessed by Elcctromyography: A Comparative Controlled Clinical Trial 4. Elcctromyographic Responses to Mechanical Force. Manually Assisted Spinal Manipulative Therapy Stiffness and Ncuromuscular Rcilcx Response of the Human Spine to Postcroanterior Manipukitivc Thrusts in Patients with Low Back Pain Lumbar Erector Spinac Reflex Responses to Me­ chanical Force. Manually- Assisted Thoracolumbar and Sacroiliac Joint Manipulation in Patients with Low Back Pain Muscular and Soft-Tissue Contributions of Dynamic Postcroanterior Spinal Stiffness Effects of Altered Afferent Articular Input on Sensa­ tion. Proprioception. Muscle Tone and Sympathetic Rcilcx Responses. Spinal Manipulation Alters Elcctromyographic Activity of Paraspinal Muscles: A Descriptive Study Effects of a Manually Assisted Mechanical Force on Cutaneous Temperature Relationship between Preload and Peak Forces during Spinal Manipulative Treatments. Heart Rate Variability Modulation after Manipulation in Pain-Free Patients vs. Patients in Pain Measuring the Effects of Specific Cervical Chiropractic Adjustments on Blood Pressure and Pulse Rate: A Ran­ domized Controlled Trial A Randomized Controlled Trial to Measure the Effects of Specific Thoracic Chiropractic Adjustments on Blood Pressure and Pulse Rate Inflammatory Response Following a Short-Tcrm Course of Chiropractic Treatment in Subjects with and without Chronic Low Back Pain Cerebral metabolic Changes in Men after Activator for Neck Pain Changes in PPT and BEA after Instrument-Assisted SMT in Asymptomatic Participants: A Randomized. Controlled Trial Dr. Arlan Fuhr travels extensively to chiropractic semi­nars, conferences and events around the world. He will be providing his insights and perspectives from these visits as a regular guest commentator for The American Chiroprac- lor. You can reach him at 602-445-4230 or email [email protected].