Karen Silva – S12085480 – CHIR13009 - PCP2 – Reflection 2
IDENTIFY A CENTRAL CONCERN:
A chiropractor’s hands are their most essential tool. We aim to master the
art of palpation to feel what the patient’s body is doing and any restrictions.
Then, we combine tactile feedback with clinical knowledge, client history,
presenting symptoms, clinical observations and examination findings to
determine the best treatment option for that patient at that time. A central
concern is: Do I trust my palpation and diagnostic skills to decide on the best
adjustment technique, line of drive and thrust magnitude?
RESEARCH A STRATEGY TO ADDRESS THE CENTRAL CONCERN:
A study conducted by Descarreaux et al. (2013) considered the dose of
spinal manipulation (SM) as the preload and thrust forces and their relative
timing. Spinal manipulation consists of a mechanical thrust event with a relatively
brief duration, approximately 150 ms in the thoracic spine (Gelley et al.
2015). The temporal nature of the intervention requires that the magnitude of
the thrust be predetermined with no ability to make corrections during the thrust
itself (Gelley et al. 2015). Many factors contribute to the clinician’s decision
regarding the appropriate magnitude of thrust, including assessment of the spine
and palpation of intervertebral joints (Jull et al., 1988). Although spinal joint
palpation is a common technique used by manual therapists, little is known
regarding how or whether feedback from tactile assessment modulates decision
making related to the output delivered by the clinician (Passmore et al., 2019).
The acquisition of complex information by the touch system is limited by tactile
attention (Lloyd et al., 1999) Tactile perception can be modified by cognitive or
contextual factors (Hollins, 2010).
Passmore et al.’s (2019) study evaluated whether chiropractors could
modulate the thrust characteristics of spinal manipulation based on the tactile
perception of pressure and volitional thrust intensity. Tactile exploration of low-
fidelity thoracic models led to a change in how clinicians interacted with the
model. As the pressure of the thoracic spine models increased, the clinicians
increased their preload and thrust forces (Passmore et al., 2019). Clinicians were
also able to modulate their force dependent on their intended thrust intensities
(ie, least intensity–lightest force, moderate intensity–intermediate force, and
greatest intensity–highest force) (Passmore et al., 2019). As the chiropractor’s
intended thrust intensity increased, we observed greater hand displacement,
which was more pronounced on the models of lower pressures (Passmore et al.,
2019). This observation is consistent with a study that demonstrated that
chiropractic students could modulate their manipulative thrusts to create varying
levels of force input (Owens et al., 2016).
The data from Passmore et al.’s (2019) study are supportive of
chiropractors being able to modulate their thrust force and acceleration in the
delivery of spinal manipulation. Furthermore, a dose of SM is delivered
independently of the constant rate of the thrust and the resulting hand
displacement, which is in accordance with our primary objective in determining
the consistency of the chiropractors’ ability to deliver a SM thrust based on the
differing tactile contexts of the low-fidelity models (Passmore et al., 2019). SM
thrust dose is modulated by the clinician’s tactile perception of model pressure
and volitional intensity (Passmore et al., 2019). Modulation of HVLA dose has less
to do with timing, because temporal parameters are constant, and more to do
with volitional changes in intensity and the clinician’s perception of the pressure
of the model (Passmore et al., 2019).
IMPLEMENT CHANGE STRATEGY TO ADDRESS CENTRAL CONCERN:
The results Passmore et al.’s (2019) study could be applied practically in the
training of future chiropractors. Deliberately directing a student’s cognitive
attention to the tactile characteristics of a model or patient can assist their
decision making as they are contemplating the thrust intensity they wish to
deliver.
The more spines I palpate, the more confidence I will have in my skills. I
intend to consciously palpate as many spines as possible. Focussing on
understanding what the malposition and tension feels like will help me determine
which adjustment techniques and line of drive the patient requires. I can also ask
my tutors to give me tips on what they are feeling for and compare their tactile
perception to my interpretation.
REASSESS IF CHANGE STRATEGY HAS BEEN SUCCESSFUL:
Overtime, I feel that this strategy will help me develop my skills and
understanding of the overall tone, malposition, restriction, and tension that I am
palpating. This will help me determine the adjustment and thrust intensity I
intend on delivering. I will reassess this strategy in the future to determine if it
has been successful.
WORD COUNT: 746
REFERENCES:
Descarreaux, M., Nougarou, F., & Dugas, C. (2013). Standardization of Spinal
Manipulation Therapy in Humans: Development of a Novel Device
Designed to Measure Dose-Response. Journal Of Manipulative And
Physiological Therapeutics, 36(2), 78-83.
https://doi.org/10.1016/j.jmpt.2012.12.007
Gelley, G., Passmore, S., & MacNeil, B. (2015). Acceleration of clinician hand
movements during spinal manipulative therapy. Manual Therapy, 20(2),
342-348. https://doi.org/10.1016/j.math.2014.10.010
Hollins, M. (2010). Somesthetic Senses. Annual Review Of Psychology, 61(1), 243-
271. https://doi.org/10.1146/annurev.psych.093008.100419
Jull, G., Bogduk, N., & Marsland, A. (1988). The accuracy of manual diagnosis for
cervical zygapophysial joint pain syndromes. Medical Journal Of
Australia, 148(5), 233-236. https://doi.org/10.5694/j.1326-
5377.1988.tb99431.x
LLOYD, D., BOLANOWSKI JR, S., HOWARD, L., & McGLONE, F. (1999). Mechanisms
of attention in touch. Somatosensory & Motor Research, 16(1), 3-10.
https://doi.org/10.1080/08990229970609
Owens, E., Hosek, R., Sullivan, S., Russell, B., Mullin, L., & Dever, L. (2016).
Establishing force and speed training targets for lumbar spine high-velocity,
low-amplitude chiropractic adjustments*. Journal Of Chiropractic
Education, 30(1), 7-13. https://doi.org/10.7899/jce-15-5
Passmore, S., Gelley, G., Malone, Q., & MacNeil, B. (2019). Tactile Perception of
Pressure and Volitional Thrust Intensity Modulate Spinal Manipulation
Dose Characteristics. Journal Of Manipulative And Physiological
Therapeutics, 42(5), 335-342. https://doi.org/10.1016/j.jmpt.2018.11.017
