b'Does Specicity Matter TECHNIQUE CouncilWhen Delivering anAdjustment?By Dr. David GraberChair, Council on Technique and Clinical ExcellenceIn chiropractic college I was taught that one of the key featurestransmitted to the cervical spine, and affect neurological that make the chiropractic adjustment unique among otherstructures there as well. \x13\x0e\x0b\x0f\x07\x13\x07\x0f\x14\x11\x04\x08\x0c\x07\x0b\x08\x04\x11\x14\x0c\x08\x06\x11\x04\x0748"6\x07\x11\x0f\x07\x06\x16\x08\x06\x07\x11\x063\x0f\x07\x0f\x14\x03\x11\x05&\x078\x14\x03\x11\x05\x07\x06\x07 Regional interdependence is neurological as well as \x02\x06\x16\x07\x06\x16\x03\x07\x0f\x03\x12\x0b\x03\x04\x06\x07\x06\x07\x02\x03\x07\x0e\x0e\x03\x06\x03\x18\x10\x07\x0f\x14\x03\x11\x05\x07\x06\x07\x06\x16\x03\x07\x04\x06\x08\x06\x07\x14\x11\x04\x06\x07 biomechanical. MRI studies have shown that supraspinal \x04\x07\x06\x16\x03\x07\x19\x03\x0e\x06\x03\x02\x0e\x08\x10\x07\x08\x04\x18\x07\x0f\x14\x03\x11\x05\x07\x11\x04\x07\x06\x16\x03\x07\x0c\x11\x04\x03\x07\x13\x07\x18\x0e\x11\x19\x03\x07\x13\x07\x06\x16\x03\x07\x06\x16\x0e\x0f\x06\x07\x0e\x07 mechanisms may be associated with thoracic thrust \x11\x0b\x14\x0c\x0f\x03&\x07\x1c\x16\x03\x07\x12\x08\x0c\x07\x1d\x08\x0f\x07\x06\x07\x02\x03\x07\x08\x07\x0f\x04\x11\x14\x03\x0e\x07\x0f\x14\x03\x11\x05\x07\x0b\x08\x0e7\x0f\x0b\x08\x04\x10\x07\x08\x0f\x07 manipulation and hypoalgesia. 1\x1f\x071\x7f\x07 They found reduced opposed to using a shotgun approach of general manipulation. activation to areas within the healthy brain related to pain In over three decades of practice and teaching, I haveperception following thrust manipulation to the thoracic spine.come across many approaches to chiropractic adjusting that \x02\x06\x16\x07F\x03\x0f\x06\x11\x04\x07\x06\x16\x03\x07\x08\x0f\x0f\x0b\x14\x06\x11\x04\x07\x13\x07\x0f\x14\x03\x11\x05\x11\x06\'\x10\x07\x08\x04\x18\x07\x0f\x14\x14\x0e\x06\x07its value. While there are some techniques which promote millimeter precision and highly controlled force delivery in the adjustment, there are others which are more global in their application. As an old school Motion Palpation Institute trained chiropractor, I lean strongly on the side of adjustment \x0f\x14\x03\x11\x05\x11\x06\'&\x07?\x06\x10\x07\'\x03\x08\x0e\x0f\x07\x13\x07\x03*\x14\x03\x0e\x11\x03\x04\x03\x07\x08\x04\x18\x07\x08\x07\x0e\x03\x19\x11\x03\x1d\x07\x13\x07\x06\x16\x03\x07research have expanded my view. Here are some of my ndings:Specicity is by Level, Segment and ContactIt has been shown multiple times in research studies that more than one segment or joint is mobilized when an adjustment is given, or that a segment other than the one intended has been mobilized. 1\x07\x1e\x07~\x07\x07\x1f\x07\x7f\x07:\x07The concept of moving one and only one \x02\x04\x03\x07\x19\x11\x08\x07\x08\x07\x0f\x14\x03\x11\x05\x07\x08\x18G\x0f\x06\x0b\x03\x04\x06\x07\x11\x0f\x07\x03\x0f\x0f\x03\x04\x06\x11\x08\x0c\x0c\'\x07\x04\x0f\x14\x14\x0e\x06\x03\x18&\x07Multiple joints, rather than a single one, mobilize and/or cavitate during a manipulation, even when it is attempted to \x02\x03\x07\x0f\x14\x03\x11\x05\x07\x06\x07\x08\x07\x0f\x03\x12\x0b\x03\x04\x06&\x07#\x04\x18\x03\x0e\x0f\x06\x07\x18\x03\x0b\x04\x0f\x06\x0e\x08\x06\x03\x18\x07\x1d\x11\x06\x16\x07\x02\x11\x14\x0c\x08\x04\x08\x0e\x07 Force Delivery is Dissipated by AnatomicalX-ray during the performance of cervical SM both the targetedStructuresand adjacent joints (three joints) were gapped and hadWhen considering line of drive during a manipulative thrust, increased ROM. 9 much of the forces delivered are dissipated by the skin, fascia, That being said, contacts at the target vertebra of appliedmuscle and connective tissue overlying the particular segments 8"\x10\x07\x02\x06\x07\x04\x06\x07\x08\x06\x07\x08\x04\x07\x08\x18G\x08\x03\x04\x06\x07\x19\x03\x0e\x06\x03\x02\x0e\x08\x10\x07\x16\x08\x19\x03\x07\x0f\x16\x1d\x04\x07\x0f\x11\x12\x04\x11\x05\x08\x04\x06\x0c\'\x07 targeted for SM. 1:Bereznick and Ross have shown that during decreased average spinal stiffness measured at the targetthoracic spinal manipulation, one cannot direct a force vector vertebra. 1+\x07 Furthermore, contact points on the spinous processto a thoracic vertebra at a given angle or direction by simply and the lamina of the targeted vertebra also show greaterdirecting their thrust in that direction. 1Utilizing torque or reductions in spinal stiffness than other contact sites. Contactsa hook on a bony process had a negligible effect on the on the target vertebra also demonstrate increased muscledirection of the force applied. While delivered in a three-spindle activity more compared to adjacent vertebra. 11\x071\x1e dimensional manner, the primary direction of SM appears to be posterior to anterior. 1!Regional Interdependence This also applies to palpation. A recent study by Kawchuk Beyond segmental effects, the force of a SM cannot beand Miazga has called into question the ability of clinicians to assumed to be limited to the region its applied to. Studiespalpate detectable small alterations in spine stiffness. In their have found that forces imparted to thoracic spine during\x0f\x0b\x08\x0c\x0c\x07\x0f\x06\x18\'\x10\x07\x03*\x14\x03\x0e\x11\x03\x04\x03\x18\x07\x0c\x11\x04\x11\x11\x08\x04\x0f\x07\x14\x0e\x0c\'\x07\x11\x18\x03\x04\x06\x11\x05\x03\x18\x07\x16\x08\x04\x12\x03\x0f\x07\x11\x04\x07high-velocity low-amplitude spinal manipulative therapy werespinal stiffness as measured by an objective instrument. 2022 I Winter 2020 www.anjc.info'