1. Biomechanical Commonalities of manual treatments
Flip Class with Dr. Simon Wang

2. What do you see?

3. Today
Expected to have watched videos on the top 7 techniques that chiropractors use in practice
In small groups we will
list the similarities and differences of the techniques
discuss and record any personal experiences that we have had with the 7 techniques
As a class we will discuss what the name techniques offer the practitioner, patient and public
Individually you will each add today’s small group, whole class and individual notes to your portfolio. This will account for 5% of your grade.
Please sign attendance sheet

4. Core vs Complementary Chiropractic Procedures
Core – may defined as follows
1. More common methods in use
2. Consistent with the model of care
3. Supported by theoretical foundations and mechanisms
4. Focuses on manually applied procedures with or without mechanical assistance

5. Core vs Complementary Chiropractic Procedures
Complementary – may be defined as follows
1. Alternative approaches involving mind-body foundations
2. Mechanisms as yet undefined or outside the model of care

6. Most common techniques in use
Diversified
Activator (Arlan Fuhr)
FAKTR (Tom Hyde)
COX Technique (Jim Cox)
Thompson Technique (John Minardi)
Gonstead
ART - Active Release Therapy

7. Break into small groups of 3

8. Small group work List the characteristics of Diversified technique

9. Diversified Technique characteristics
Evidence based
Difficult to define as a distinct field of practice
Adaptable
Treatmetns based on individual needs (patient centered)
Open to interpretation (no a if this than that treatment method)
HVLA with or without drop
Lacks an ideology
Broad scope
Most popular
Only method taught in Canada
Constantly evolving
Diverse
Not standardized
Both a technique system and a technique of movements
FREEDOM!!!!!! To chose depending on…
Steal from other techniques

10. Small group work
List the characteristics that are common and uncommon between the 7 named techniques
holykaw.alltop.com

11. Technique characteristics
Common
Uncommon
All MSK interventions
Passive treatments (or combo)
Patient comfort?
Drug free
Aim to restore motion and function
All have evaluation protocols (even if they’re different from each other)
Hands on
Practitioner comfort
Believe method improves patient symptoms
Work through mechanotransduction
Require instruction/certification
Tools/no tools
Tables different
Amount of force (varies)
Scientific justification varies
Patietn management of care different
Patient exposure to radiation (x rays)
Root cause of pain believed to be different
Duration of treatment
Purpose of intervention (intention)
Some have dogmas/ideologies
Velocity varies
Strain & effort on doctor

12. Technique characteristics
Common
Uncommon

13. What is the theoretical intent of each chiropractic technique?
Individually list in point form what practitioners of each technique are trying to do
Refer to the videos assigned, technique websites, Google, Wikipedia, and personal knowledge
thenextweb.com

14. Theoretical Intent Diversified Activator
Restore normal joint motion or neuro function
HVLA
Could be scar tissue disruption
Relieve pain
Resetting muscle spindle fibers
Reduce inflammation of joint and synovial fluid.
Leg length
Spinal alignment
Targeting subluxations
Provide patient comfort
Psychological comfort (gentle, no crack)
Reduce doctor effort

15. Theoretical Intent COX Thompson Leg length discrepancy Drop table
Relieve pain
Traction
Decompress spine
Flexion distraction
Stretched tight muscles
Gentle oscillation
High amplitude low velocity
Special table
Influenced by osteopathy
Leg length discrepancy
Drop table
Require less force
Pelvic alignment
Distract joint with adjustment

16. Theoretical Intent Gonstead ART Remove the subluxation Use xrays
PA motion (Thoracic), ( rotation in cervical, sometimes lumbar)
Knelling table (thoracic)
Monitor temperature gradients
High low tables
Thrust and hold
Restoring fascial interactions
Breaking adhesions within fascia
Stretching muscles active and passive
Increase mobility
Recycle/flush tissues to remove fluid
Restore length and strength of muscle

17. Theoretical Intent FAKTR Reset muscle activation
Work within painful range
Brushing and tapping on muscles to activate, during exercise
Reactivate inflammation process
Inflammation brings the healing factors to the injury
Tools (metal) – similar to graston

18. Personal experience
In your small group, discuss and record any personal experience you have had with a named technique
What technique
What was the experience (does not have to be direct treatment)
What did you like about the experience?
What did you not like about the experience?
aquaviva-munster.com

19. Personal experience Diversified Activator
Liked combo of everything, patient specific
Liked that could ask for something that seems to work.
Not afraid to try and if it didn’t work, try something else.
No manual SMT
5 min (not full screen)
No explanation

20. Personal experience COX Thompson
Seen it done, patients seems to like, low back pain relief from traction
Dad’s experience – left on the table too long (Decmpression table)
Helped mid and low back stuff, quick, didn’t mind that.
Didn’t feel cavitation (liked cavitation), but felt better leaving
1st chiro experience, helped low back pain, mix of adjustments and drop table
Non “Thompson” chiro, but uses drop pieces.

21. Personal experience Gonstead ART
Liked grab trigger point and stretched out (specific)
Painful, but only thing that helped knee pain

22. Personal experience
FAKTR

23. Whole class discussion

24. Dr. Wickes - How we look at the body, where research takes us
Dr. Wickes Inaugural Address clip – 7:00 research

25. Advantage Disadvantage
What are the advantages and disadvantages of thinking about science and health through a reductionist view? MSK problems, joint problems, etc.
Advantage
Disadvantage

26. Advantage Disadvantage
What are the advantages and disadvantages of thinking about science and health through a systems biology view? Viewing the body as a whole integrating all systems.
Advantage
Disadvantage

27. Whole class discussion: CMCC Model of Care
Chiropractic is a primary contact health care profession with expert knowledge in spinal and musculoskeletal health, emphasizing differential diagnosis, patient centered care and research.
How well does each named technique fit into the CMCC Model of Care?
What can we learn from the named techniques?

28. How well does each named technique fit into the CMCC Model of Care?
primary contact
expert knowledge in spinal & MSK health
differential diagnosis
patient centered care and research

29. What can we (practitioner) learn from the named techniques?

30. Translating into practice
Understanding that it is difficult to have an informed opinion without having personal experience I encourage you to shadow and talk to practitioners who practice a specific technique
From the videos and your small group discussions can you think of a time when
Utilizing 1 technique would benefit the patient?
Utilizing more than 1 technique would benefit the patient?
irisexecutives.com

31. Translating into practice – Benefits of
Utilizing 1
Utilizing more than 1

32. Applications to practice
What factors might influence:
technique selection?
Patient configurations/positions for treatment?
Chiropractor configurations/positions for treatment?

33. What factors might influence: technique selection?

34. What factors might influence: Patient configurations/positions for treatment?

35. What factors might influence: Chiropractor configurations/positions for treatment?

36. Scenario
45 year old female walks into a chiropractic office with an acute onset of low back pain (3 days ago).
Lets assume this patient walked into 7 different clinics, all utilizing different techniques.
Lets assume this patients’ pain and disability reduces to zero after a series of visits over 4 weeks.
What commonalities do all these visits/encounters have that might explain why this patient improved?
topadjustablebed.com

37. What commonalities do all these visits/encounters have that might explain why this patient improved?
Actual time line of low back pain was expected to resolve in 4 weeks
Going and being proactive about health may make you feel better
Some sort of proprioceptive input (touch and movement of tissues)
Elicted mechanotransduction
Someone is there caring for you, your doctor patient interaction
Patient education

38. What if the patient only got better with one type of treatment
What if the patient only got better with one type of treatment? Why could this be?

39. Therapeutic factors Survey of mechanotransduction disorders (Chap 6, Triano) The Science and Clinical Application of Manual Therapy (King 2011)
Exercise’s usual intension is to:
increase compliance of tissues (fascia, ligament, tendon, muscle), increase ROM and functional motion
Increase strength, stabilize joints/whole body
Manual therapies (may have different theoretical constructs) are all designed to
Alter tissue strain
Promote normal function
Permit symptom resolution and healing

41. Translating techniques to patient understanding
What would you say when someone asks you
“does Activator work”
“should I try Thompson technique?”
“my last chiropractor used ART, and it hurt, do you believe in ART?”

42. “does Activator work”
reinerchiropractic.chiromatrixbase.com

43. “should I try Thompson technique?”
williamshealthcare.com

44. “my last chiropractor used ART, and it hurt, do you believe in ART?”

45. Translating techniques to public understanding
What might the public gain?
What might the public lose?

46. Translating techniques to public understanding
We will be revisiting this more later in the course
My hope is that you will keep you mind open to what you hear, read and see about techniques to begin to form a “working opinion”

47. What do you see?

48. Individual work

49. Please grow your portfolio
Reflection assignment:
Please take some time and reflect on this class discussion
Answer this question: How could it be possible that people with back pain get better seeing different chiropractors that use different techniques?
Also add this to your portfolio:
small group notes
whole class notes
Any individual notes or thoughts that you made (in class)
Please submit your link via KIRO assignments by September 20, 2016
This will account for 5% of your grade.

50. Cook vs Chef
If we say that a cook follows a recipe and a chef creates recipes, how could this statement relate to chiropractic techniques?
Please reflect on this.
Please reflect on the entire flip class and what you got out of it.
foodclipart.com