CF 265: Where To Adjust & Types Of Adjustments


Today we’re going to talk about knowing where to adjust and different types of spinal manipulation

But first, heres that sweet sweet bumper music


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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.   I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at   If you haven’t yet I have a few things you should do.

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

 You have found yourself smack dab in the middle of Episode #265   Now if you missed last week’s episode, we talked about potential early diagnosis of spondylolysis as well as clinical guides on low back pain treatment.

Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Alright folks, I just got back from Fort Lauderdale hanging out with my MCM Mastermind family of chiropractors. What a good time. We have some new practitioners in the group. Fresh blood! New docs to learn from and new docs to teach.   It’s such a diverse group but all evidence-based. No vitalistic voodoo. Which is why it’s the right spot for me.   We learned from Ray Tuck. Now, Ray has around 9 clinics and his talk was about being the CEO of your company and let’s face it, I’m the worker mule in mine so it hit home with me and gave me some inspiration and some great ideas.  

If you’ve been following along with the podcast, I’ve had a hell of a Fall this year. Numbers down, staffing issues, two deaths in the family…..just lots of stuff piling up that isn’t normally part of our existence.   On the staffing stuff, I lost my office manager that’s been with me 5 years. That was 3 weeks ago. Then, her bestie that works for me quit. That was 2 weeks ago. Then, while I was in Florida, their other bestie that works here sent me a text. It was a Friday night and she decided that she had just completed her last day of work. No two weeks notice. I guess that would show too much respect or gratitude. Lol.   Anyway, if you’re keeping count, that’s 3 employees gone in 3 weeks. I only have 4 full timers to start with. To say it’s a challenge this week is to minimize things. It’s a big thing.  

BUT I have a super hero wife who is here today and who is killing it just like she kills anything she does. I’ve been slow since September. I’ll promise you, with my wife up front, I’m going to be so busy I’m not going to know what the hell to do with myself.   Then, we have two new girls. One is on her 3rd week here and one is on her 2nd week here. We just ran about 32 in one morning and they knocked it out of the park.   So……the story is, we’re OK and if you have a lot of turnover, you’re going to be OK.

We can only do our best. I’ve done everything I know to be good to my staff, treat them like my family, be so good to them and foster an environment that is so fun and positive that they’d never dream of leaving.   Yeah, that doesn’t work. I am who I am. I’ll always treat my people well and take care of them and feel protective of them.

But no more backflips trying to hold onto people. Not anymore. There are so many lessons available to us if we just make sure we’re paying attention.  

That’s the negative. The positive is this; I have a true opportunity to re-set. To put my values and culture out there for the new staff to buy into and understand. I can cultivate what I want this place to always be without any old baggage preventing the message from hitting home.  

What are my values? I’m glad you asked:

  • Customer Service
  • Evidence based
  • Patient centered
  • Honesty
  • Ethical
  • Morals
  • Character
  • Trustworthiness
  • Authentic
  • Kind
  • Supportive
  • Responsible
  • High level
  • Family and
  • Loving

  It’s vital this new crop of staff members understand these things. Understand who we are as owners.   Another thing I learned from Ray Tuck this weekend is don’t be afraid to open up the books and show your staff. You don’t have to show what you’re making each year or any of that but make sure they understand that you’re not buying a yacht while you bitch at them about the things you need from them. Show them your margins are much thinner than they might have imagined.

It has an impact on them.   Also, we are considering hiring two part-timers rather than one full-timer. That will cut down on burn out, they’ll get to see their kids more, they can cover each other’s shifts, and if one quits, there is built-in redundancy to prevent any freak outs. The one staying can simply train the next part timer. Sounds like a solid solution to me. That right there is one benefit of being in a mastermind. Smart people giving you thoughts that are a little out of the box but that are working for them.   So, with my wife in control until new hires are up to speed, we about to kill it and you’ll all be happy to never hear me bellyaching about having a light schedule. Lol.    

Item #1  

The first on today is called, “Review of methods used by chiropractors to determine the site for applying manipulation” by Triano et al and published in Journal of Chiropractic & Manual Therapies on 21 October 2013.   Why They Did It   The authors did the study to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.  

How They Did It  

  • Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives,
  • The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate.

  What They Found  

  • A total of 2,594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favored clinical application of the diagnostic methods reviewed.
  • The most convincing favorable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region.
  • There was also high-quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality.
  • Evidence of mixed quality supported the use, with limitations, of postural evaluation.
  • The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays.
  • The evidence was of mixed quality, but unfavorable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement

Wrap It Up  

  • A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favorable to strongly unfavorable in regard to using these methods.


  • In general, the stronger and more favorable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination.


  • Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.

    Before getting to the next one,   Next thing, go to That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.     I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. and the discount code is HOTSTUFF. Go do it.    

Item #2  

Our last one this week is called, “Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain” by Michael Schneider and published in PubMed on February 15, 2015. Hot potato!    

Why They Did It  

This study was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).  

How They Did It  

  • A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: manual-thrust manipulation, mechanical-assisted manipulation, or usual medical care. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale).


  • Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in usual medical care were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.


What They Found  

  • Linear regression showed a statistically significant advantage of manual-thrust manipulation at 4 weeks compared with mechanical-assisted manipulation and usual medical care.


  • Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in manual-thrust manipulation (76%; 50%) compared with mechanical-assisted manipulation (50%; 16%) and usual medical care.


  • Similar between-group results were found for pain: manual-thrust manipulation; mechanical-assisted manipulation; and usual medical care. No statistically significant group differences were found between mechanical-assisted manipulation and usual medical care, and for any comparison at 3 or 6 months.


Wrap It Up  

It was found that manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain scores compared with usual medical care or mechanical-assisted manipulation.     Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.   Let’s get to the message. Same as it is every week.  

Store Remember the evidence-informed brochures and posters at    

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.   When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.   It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.   And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!  

Key Point:

At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints….   That’s Chiropractic!  

Contact Send us an email at dr dot williams at and let us know what you think of our show and tell us your suggestions for future episodes.   Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.   We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.  


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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    


Schneider M (2015). “Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial.” Spine Feb 15; 40(4): 209-217.  

Triano, J. J., Budgell, B., Bagnulo, A (2013). “Review of methods used by chiropractors to determine the site for applying manipulation.” Chiropr Man Therap 21(36).      

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