Intuition. In philosophy and logic in particular, this is not superstition. It refers to the things that we know without having to reason them out. Some things cannot be proven or justified.They simply are.
In chiropractic, it has always been intuitively obvious that speed is a desirable element to the adjustment. The adjustment is simply more comfortable and precise the faster it is. This has been preached in every style of technique.
Instruments have also been around since the beginning. From the use of mallets (did B.J. really kill that elephant?) to spring loads, adjusting machines and percussors with computer readouts, it is an attempt to move faster than our muscle and bone. I've seen those old silent black-and-white films of B.J. and his students practically falling over the patient in the attempt to be so precise and fast in their toggle recoil. Perhaps you've seen them, too.
The chiropractic premise is essentially a low-tech one: Remove interference between the brain and body. For decades, my preference was "hands and spine only" for the adjustment. In the past few years, I have worked with several instruments to enhance the patient experience and to become more objective in my treatment. The premise is the same, but high tech can help. Strangely, FMS (fibromyalgia syndrome) was the catalyst. Fibro is frustrating. The muscles work strangely. Everything helps a little and nothing seems to help much.
I read an article about rapid percussion slipping past the defenses in that joint tissue nociceptors (unmyelinated pain receptors) are less likely to fire while the mechanoreceptors still give their pain-relieving cascade. It occurred to me that this might be a novel approach to FMS – and I had inherited a popular handheld percussor – so off I went. Like most things, it helped fibro a bit; but with everyone else, the results were obvious (even with my "hands only" bias).
Research and Trials
So, now I am familiar with the research, I know some of the researchers and have tried a number of the instruments out there. This is my view of the usefulness of percussion in practice. Why use it? It is more comfortable for the patient (fewer tissues are stressed). It is safer and often more efficient. It can be more consistent and objective. Research has shown that it has a superior effect in many cases. A big issue is that people who would never come in for standard chiropractic (and that's a lot!) will give this a try. It is easier on the doctor's hands. Bottom line: it works.
In research settings, it has been shown that the instruments strike at 30-100 times faster than we can move with our muscle and bone. Basically, the tissues don't know what to do with that. In nature, if something hits that quickly, the muscle might tear. So the mechanoreceptors want to "drop the load" and let go. If the body is not fighting us, each thrust accumulates. If you strike 10 times at 15 lbs, you get a 150 lbs of force delivered incrementally and fast. No discomfort. I always stress to the patients that this is not some esoteric "energy flow to the quantum level molecular base." It is straight-ahead mechanics and physics. We are moving the bones.
I use three different instruments. The primary one I use has a computerized system that measures the elasticity of the joint before, during and after treatment. Each of the three instruments has a different price range. Spring-loaded devices may be under $200. Multiple percussion devices with a sensor and computer readout with systems to prevent overstimulation are over $30,000. No matter how expensive, they don't do everything. I tell the patients that even my ($30K) machine is very precise in what it does, but it doesn't make coffee (and for that price, it should!). You have to use your experience and clinical judgment. They are all quality instruments if you get trained and apply that training. Too often it seems the application is lax.
Let me say at this point that no modality is the be-all and end-all. I use diversified technique (DT) a lot. Wikipedia says that DT is the most generic chiropractic technique. Using high-velocity, low-amplitude thrusts. It is safe and effective.
I have used DT for over 30 years. As a rule, it is actually quicker to apply than proper application of the percussion. Often I use it in combination with percussion.
Percussion is especially good at straight A-P mobilization. While it is very helpful in recruiting the joint tissues into action during motion, there are times when manual rotation or combination moves speed the process. The physics of mass x acceleration = force is basic. The spring-loaded devices are workable, but they are not my first choice today.
Please be careful to be cognizant of the joint planes, your landmarks and the contact point. It is awfully easy to be "clicking" soft tissues only.
Dr. John Faye, following Henri Gillet through the Motion Palpation Institute, emphasized the centrality of motion to chiropractic results. This all dovetails perfectly with percussion therapy. The hand-held multiple percussor is a very useful tool.
The doctor maintains a lot of control over the force and duration of the treatment. I use this a lot. Very good with active treatment while the patient is performing motions. This recruits their muscles and ligaments into the action. As noted above, combining the multiple percussion with a computerized system to measure the joint restriction before and after treatment lends itself to objectivity. An autostop feature when the action is completed minimizes overtreatment.
There are active protocols for every condition, and more. You can print or save sequential treatments for comparison. I have worked with other devices with some of these same features, but I consider them unsatisfactory in some measure.
The Bottom Line
For many years I have called myself "a plain old chiropractor." In my opinion, "plain old" is awesome when it comes to chiropractic. But take it from an old coot in the profession: The addition of high-tech tools can definitely enhance your practice!
Dr. R. Daniel Pendergraft practices in Redondo Beach, Calif. He can be contacted with questions and comments by e-mail: