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How does a chiropractor know where to adjust?

You’ve probably been to a chiropractor who adjusted you and you hopped off the table feeling like a million bucks. Or maybe you watched some YouTube videos of chiropractors adjusting their patients. You can tell that they are being specific with their contact hand that the direction they deliver the adjustment. But, how do they now where that segment is?

An overview the spine and how things go wrong.

Your spine has 24 moving segments from the top of your head to your tailbone. Your neck has 7 segments, your middle back with the ribs has 12 segments and 12 pairs of ribs, and your lumbar spine has 5 segments.

Your spine needs to be mobile, but at the same time, it needs to brace and support all f your movements. And most importantly, your spine protects the core of your nervous system, wrapping around your spinal cord. Things can get injured.

Whiplash injuries can bruise the supportive soft tissues in your neck and low back. Lifting injuries can tear and herniate the discs in your low back. Woking at your desk can cause the muscles in your upper back to brace, tighten, and hurt.

After an injury, the parts of your spine may not move so well. And treating these parts is the job of your chiropractor.

Low back pain is the number one cause of disability in working adjusts. Neck pain is the number 4 cause of disability. It affects your quality of life.

The key to great chiropractic care is getting movement back into the spine. And good movement involves mobility and strength.

But there are reflexes involved too. Injuries to the discs or facet joints in your spine will rigger a neurological reflex from the injured tissue to the surface of the skin. At the surface of the skin, these nerve reflexes will cause the blood vessels at the surface to dilate, and this makes your skin red and slightly puffy.

Scanning your spine for surface skin changes

Chiropractor will touch your skin to see where they need to adjust you. Those pain reflexes from the joints in your spine to the surface of the skin will cause the area to become red and boggy. The you have irritation to your upper back, it’s easy to see where parts next to the spine get red after being touched. You can also run your finger down the trough of your spine to find some skin that has lost its tight, smooth consistency. This usually indicates some failure in the movement and health of your spine.

Feeling the consistency of the skin on the spine is chiropractic 101, and it even applies to olde timey Osteopaths who do spinal manipulation. Look for alterations in the surface of the skin. It tells you something.

And this also points to the intimacy of the reflexes involving the spine with the autonomic nervous system, and all that can be changed with a little spinal irritation.

Feeling for heat at the surface of the skin

At the same time, changes in the surface of your skin through reflexes can make surfaces of your skin have hot spots. Chiropractors use to use thermography to graph the skin on the spine looking for alterations of heat. I use to have a device that I held in my hand, where I would run it up and down your back looking for temperature differences from one side to the other. It got stolen when someone broke into my car while in chiropractic college, and I never replaced it.

Feeling changes in normal muscle tone around your spine

When you are injured, your muscles will either tighten to brace the injured area, or they will go flaccid to protect too much tension on the area.

Your chiropractor will feel for tightness in the muscles surrounding your spine to see where he needs to adjust you. Sometimes muscles will be very restricted. Other times, muscles will only be very mildly tight, and in certain directions. The small muscles in your spine might be trying to pull the segment of the spine in the right direction when there’s a misalignment, and this can be a very nuanced thing to palpate.

You can often feel in the base of your skull where the muscles are tight and they are trying to pull it all back. These suboccipital muscles are pretty easy to feel.

Feeling of restricted motion

A big part of a routine chiropractic visit is that feeling or restricted motion. Chiropractors use motion palpation, a technique to identify what segments of your spine is moving well and what segments are not. I like to feel how the ribs do or don’t move when I do my famous upper back rib adjustment. When a patient is in her side-lying position for a lumbar adjustment, I’ll check the movement of each segment to identify what part doesn’t move.

Feeling for painful areas on your spine

And when a segment doesn’t move well, it’s going to be a little painful. Sometimes a lot painful.

Loss of movement causes metabolic wastes to build up. These painful enzymes and acids in the soft tissue will cause the lining of the bone to be sensitive. One segment in your mid back might feel fine when someone touches you, but the next one could light you up in pain.

And these tender segments have all of the other signs. They’ll be tight. They’ll be tender. They’ll have braced muscles. And if you felt the temperature with a thermography machine, you might see some temperature differences.

What about all of these computerized tests?

I love technology. As a matter of fact, I use the Kinetisense system for evaluating movement patterns in my athletes and injured patients. it measures symmetry, mobility, strength, and posture. At the end of a KAMS evaluation, it will give you a score that you can use to measure your improvement. It will tell you where certain parts are stuck and what parts need to be strengthened.

Some chiropractors have bought into systems of technology that will measure heat or muscle tone. This is cool technology that measures a nice before and after patient care when you are managing cases.

Some chiropractors also rely heavily on x-ray technology, which was pioneered and developed by chiropractors early in the invention of x-ray technology 100+ years ago.

However, all of this technology is no substitute for the visit by visit assessment of a patient when he comes in for routine care. You would never want to do a computerized spinal assessment of a patient on every visit, and you certainly wouldn’t x-ray on every visit.

Feeling for changes after the adjustment

Palpation is king. Feeling for those movement and reflexive characteristics of your spine is what an experienced chiropractor can do before, during, and after an adjustment. I can feel a stuck segment before I adjust it, and I can also feel how much it improves afterward.

Sometimes the difference is night and day. Sometimes the changes are a little more subtle. But the biggest change of all is one that I didn’t mention: It feels great to have an adjustment. No better feeling in a doctor’s office than to have that pressure taken off your spine.

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