There may have been hundreds of techniques with some claim to uniqueness since the inception of chiropractic. One recent listing included 95 (Bergmann, TF: Various forms of chiropractic technique. Chiro. Technique, 1993, 5(2):53-55.)

Leading examples were included in the following survey:

Source: National Board of Chiropractic Examiners. Job Analysis of Chiropractic. Greeley, CO: NBCE Publications, 1993 and 2000.

Although 18 techniques are listed as “adjustive”, several do not involve classic chiropractic maneuvers, or force techniques, incorporating a dynamic thrust, directly targeting the skeleton [typically high velocity-low amplitude but occasionally low velocity-high amplitude].

Given that the percentages add up to over 500%, it would seem that the average chiropractor may make use of 5 different techniques.

These techniques may have been acquired at college, or in post-graduate courses.

A recent survey by Leone showed that students attending two colleges within the same state (Texas) may receive a totally different exposure to techniques: (Table 1 Leone, A: Relationship between techniques taught and practice behavior: education and clinical correlation. JMPT 1999 Jan, 22:1, 29-31.)

Table 1 provides the number of total required hours taken by students for each of the procedures.

From this table, it is apparent that College 2 provides a more diverse series of required manual therapies.

Parker Chiropractic College generally lists 9 techniques, including: Activator, Applied Kinesiology, Diversified, Gonstead, Thompson and Upper Cervical. By a process of elimination Texas Chiropractic College covers 3 techniques during undergraduate courses.

It may be prudent to recall White’s Law and seek to refine the number of available options:

“The effectiveness of a therapy for a disease is inversely proportional to the number of therapies available to treat the disease.” 

However, a letter to Medscape succinctly states a graduate’s views: (Bob Smith, DC)

“Graduates leave school with either technique "indigestion" or cult-like blind association with a particular method...” 

Thus, what the patient is seeking, in a kind of “Holy Grail” is an appropriate treatment for their particular complaint.

Sadly, while on one hand, any treatment can appear to work some of the time, based upon the placebo effect; many of the complaints that are likely to end up in a chiropractor’s office are difficult to identify, especially those related to chronic back pain and/or disability.

Without a definitive diagnosis, how can there be a definitive treatment? Or does the supervising chiropractor simply run through the treatments until success is achieved (“Pop and pray”) or the patient becomes dissatisfied, or the (insurance ?) money runs out, or both?

One cannot conclude whether the complaint suffered by an individual patient is going to be alleviated by chiropractic treatment, or not. Nor whether the same patient, or similar patients will find relief from a wide range of chiropractic techniques, or just one. The inference at this time must be twofold:

Consumers need to be educated about both their condition and the health care professionals who, at least, profess to cater to it; and secondly,

Consumers need to take an active part in their course of treatment rather than allowing themselves to be passive “guinea pigs” under the care of the first doctor on their list.

By all means ask the staff questions.

E.g.

Today many clinics will have this information on their website. You can search, in your own time, impersonally and non-confrontationally, from the comfort of your own home.

If they don’t have time, or show any unwillingness to provide the information, ask for a recommendation to another clinic in the area.

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