Archive for category Activator Methods Chiropractic Technique: General Articles

Abstract

OBJECTIVE:

To rate specific chiropractic technique procedures used in the treatment of common low back conditions.

DESIGN AND METHODS:

A panel of chiropractors rated specific chiropractic technique procedures for their effectiveness in the treatment of common low back conditions, based on the quality of supporting evidence after systematic literature reviews and expert clinical opinion. Statements related to the rating process and clinical practice were then developed through a facilitated nominal consensus process.

RESULTS:

For most low back conditions presented in this study, the three procedures rated most effective were high-velocity, low- amplitude (HVLA) with no drop table (side posture), distraction technique, and HVLA prone with drop table assist. The three rated least effective were upper cervical technique, non-thrust reflex/low force, and lower extremity adjusting. The four conditions rated most amenable to chiropractic treatment were noncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain.

CONCLUSIONS:

The ratings for the effectiveness of chiropractic technique procedures for the treatment of common low back conditions are not equal. Those procedures rated highest are supported by the highest quality of literature. Much more evidence is necessary for chiropractors to understand which procedures maximally benefit patients for which conditions.


J Manipulative Physiol Ther. 2001 Sep;24(7):449-56. [PMID:11562653]

Author information: Gatterman MI, Cooperstein R, Lantz C, Perle SM, Schneider MJ.

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Abstract

In a previous article, the author discussed current trends in utilization rates of chiropractic “Name Techniques” in Canada, and provided recommendations for their inclusion into the curriculum at the Canadian Memorial Chiropractic College. In this article, a review of the literature on “Name Techniques” was conducted, with interpretation and synthesis by the author. One hundred and eleven articles were found. These were: technique discussions (N = 39), case studies (N = 25), case series (N = 5), experimental studies (N = 25) and clinical trials (N = 17). The literature suggested that prone leg length testing and some x-ray mensurations may have acceptable inter and intra-rater reliability. In addition, there are several case studies that reported significant clinical benefits by patients receiving Activator, Alexander, and Upper Cervical treatments. Patients also reported improvements in quality of life while under either Upper Cervical or Network Spinal Analysis care. This information may help develop professional practice guidelines, and it may have implications for chiropractic research and education.

J Can Chiropr Assoc. 2001 Jun; 45(2): 86–99. [PMCID: PMC2505043]

Author information: Brian J. Gleberzon. Canadian Memorial Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, Canada M4G 3E6.


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Abstract

Since its establishment in 1945, the Canadian Memorial Chiropractic College (CMCC) has predominately adhered to a Diversified model of chiropractic technique in the core curriculum; however, many students and graduates have voiced a desire for greater exposure to chiropractic techniques other than Diversified at CMCC. A course structure is presented that both exposes students to a plethora of different “Name techniques” and provides students with a forum to appraise them critically. The results of a student survey suggested that both of these learning objectives have been successfully met. In addition, an assignment was designed that enabled students to recommend which, if any, “Name techniques” should be included in the curriculum of the College. The recommendations from these assignments were compiled since the 1996/97 academic year. The results indicated an overwhelming demand for the inclusion of Thompson Terminal Point, Gonstead, Activator Methods, Palmer HIO and Active Release Therapy techniques either as part of the core curriculum or in an elective program. These recommendations parallel the practice activities of Canadian chiropractors.


J Can Chiropr Assoc. 2000 Sep; 44(3): 157–168. [PMCID: PMC2485519]

Author information: Brian J. Gleberzon. Canadian Memorial Chiropractic College, 1900 Bayview Avenue, Toronto, Ontario, Canada M4G 3E6.


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Abstract:

Activator Methods Chiropractic Technique (AMCT) has based its methods on a systematic protocol developed to determine the functional short leg or the “pelvic deficient side” Relative changes in leg length must be observed accurately by the examiner in order to be certain that the diagnosis and correction of subluxation were effective. Research has been conducted in the past to evaluate interexaminer reliability of prone leg-length assessment, with findings that reliability can be fair to good. Motion palpation and misalignment palpation have been determined to have poor to moderate reproducibility. However, these remain the gold standard of analysis at chiropractic colleges. The objective of this study was to determine if the AMCT procedures for determining leg-length discrepancy could be taught effectively by observing for reproducibility between examiners in a student population.

METHODS:

In a chiropractic college technique classroom setting, prior to training in AMCT procedures, 80 student patients were instructed to lie in the prone extended position. Each was instructed to wear shoes with welts or surgical boots and to remain motionless throughout all evaluative procedures. A chiropractor rated at advanced proficiency in AMCT used leg-length analysis to evaluate each student patient for leg- length discrepancy. The procedure includes observation of the shoe welt in the prone extended position; cupping the lateral malleoli with the examiner’s palms; and a “6-point landing” which involves positioning the index and middle fingers of the examiner around the lateral malleoli and the thumbs on the patient’s heels. Each student patient was assessed to have a right short leg, a left short leg, or even leg lengths. The results were recorded by the examiner and concealed. Immediately following, 80 untrained student doctors evaluated each of the student patients based on their prior knowledge of leg-length analysis. Results for each were recorded on a ballot and concealed from the next student doctor in an envelope as they rotated to the next student patient until all 80 were evaluated. The envelopes and ballots were collected and the student doctors’ results were compared to the AMCT doctor. Approaching the end of the Basic AMCT course, the procedure above was repeated by both the AMCT doctor and the trained student doctors. The data were analyzed and interexaminer reliability was calculated based on the student doctors’ results compared to the AMCT doctor’s results pre- and post- training

RESULTS:

Pre-training analysis revealed an average of 69.9% between the students and the AMCT examiner in the 80 subjects, whereas post-training analysis revealed an average of 82.2% agreement. Overall improvement was found in 67% of the cases upon post-training analysis. Results were consistent in both pre- and post-training analysis in 14% of the cases and agreement declined in 19% of cases. Forty-three percent of students were in 100% agreement with the AMCT examiner after course training, compared to only 14% prior to course training. Sixty-six percent were at or above 80% agreement post-training, compared to 45% pre-training; 78% were at or above 70% agreement post-training, compared to 57% pre training; and only 10% were below 50% agreement after being trained in AMCT leg-length analysis, compared to 24% prior to being trained in AMCT leg checks.

DISCUSSION:

The data collected indicate that leg-length analysis utilizing the AMCT protocol can be effectively taught in order to generate reproducible results. When a standard procedure is utilized, the results of interexaminer reliability remain most consistent. Therefore if leg-length analysis is going to be used in practice, it should be recommended that AMCT leg checks be taught in chiropractic colleges to improve reliability in the field. Although leg-length evaluation is used only for functional deficiencies, there was no exclusion of student patients who have a structural short leg, as every student is a class participant. This inclusion may have skewed results. Students or doctors in training of leg-length analysis must be made aware of the need to evaluate for a structural short leg using Allis’ test, tape measure, or X-ray analysis of femur head heights during their initial examination. They should also know that patient history of childhood epiphyseal disease or fracture could indicate an existing structural problem. The reproducibility of AMCT is dependent on some variables, and in this particular study footwear was controlled. However, inappropriate tables and patient positioning could have resulted in lower reliability. It is standard with AMCT to utilize a hi-lo elevation table to eliminate active positioning; therefore, weight bearing distortions and postural asymmetries are preserved. This study does not address the validity or clinical significance of prone leg checks. Many field practitioners value leg-length assessment to determine pelvic obliquity, assuming abnormal loading results and affects spinal alignment.

CONCLUSION:

Pre-training analysis revealed an average of 69.6% agreement between the students and the AMCT examiner in the 80 subjects, whereas post-training analysis revealed an average of 82.2% agreement. Overall improvement was found in 67% of the cases upon post-training analysis. Results were consistent in both pre- and post-training analysis in 14% of cases and The AMCT leg check protocol appears to offer promise in consistency and interexaminer reliability. The results of this classroom study are encouraging and suggest that with further controlled studies, uniformity in leg-length analysis could be reached within the chiropractic profession.


Author information: Janeen Wallace, DC, New York Chiropractic College

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2251. COVERAGE OF CHIROPRACTIC SERVICES

2251.1 Manual Manipulation.–Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of hands. Additionally, manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine. However, no additional payment is available for use of the device, nor does Medicare recognize an extra charge for the device itself.

No other diagnostic or therapeutic service furnished by a chiropractor or under his or her order is covered. This means that if a chiropractor orders, takes, or interprets an x-ray, or any other diagnostic test, the x-ray or other diagnostic test, can be used for claims processing purposes (see §4118.C.2(d)), but Medicare coverage and payment are not available for those services. (Of course, this prohibition does not affect the coverage of x-rays or other diagnostic tests furnished by other practitioners under the program. For example, an x-ray or any diagnostic test taken for the purpose of determining or demonstrating the existence of a subluxation of the spine is a diagnostic test covered under §1861(s)(3) of the Act if ordered, taken, and interpreted by a physician who is a doctor of medicine or osteopathy.)

Effective for claims with dates of service on or after January 1, 2000, an x-ray is not required to demonstrate the subluxation. However, an x-ray may be used for this purpose if the chiropractor so chooses.

The word “correction” may be used in lieu of “treatment.” Also, a number of different terms composed of the following words may be used to describe manual manipulation as defined above:

  • Spine or spinal adjustment by manual means;
  • Spine or spinal manipulation;
  • Manual adjustment; and
  • Vertebral manipulation or adjustment.

Rev. 1656/Page 2-101

 

Letter from Department of Health & Human Services stating Activator is a manual adjustment that is included in Medicare Coverage.

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Abstract

Statement of Intent:

Activator Methods Chiropractic Technique (AMCT) seeks to conduct a systematic analysis of basic body biomechanics, under the general belief that disturbed mechanics leads to disturbed function. A series of diagnostic provocative maneuvers and leg checks are used to identify the location of subluxation; the therapeutic goal is to restore proper body mechanics through the application of low-force adjustments. The use of the activator adjusting instrument is thought to promote increased safety for patient and doctor.

Overview:

According to Fuhr, AMCT is a synthesis of several analytic systems and low-force adjustive procedures, including Logan Basic, Derifield-Thompson leg checking and VanRumpt’s Directional Non-Force Technique (DNFT), the latter of which features thumb thrusts and a system of leg length analysis [1]. Subluxations, detected primarily by the leg check procedure, are addressed with a mechanical percussive tool (Activator Adjusting Instrument or, simply, “Activator”). The leg checking procedure also serves to establish correction of the subluxations.


Chiropr Tech 1997; 9(3):108-14.

Author information: Robert Cooperstein, MA, DC.  Associate Professor, Palmer College of Chiropractic West, San Jose, CA.

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From the Publisher

Introducing the first book published on this low-force adjusting technique! It offers a how-to approach to the AMC technique, guiding you from basic scan protocols through more advanced course work. Written in a clear, concise, and easy-to-follow form, it first introduces the technique and then discusses how it is applied to every region of the body. Also provides valuable clinical information on specific symptoms, ways to rule out particular conditions, contraindications, and treatment suggestions.


Author information: Fuhr AW, Colloca CJ, Green JR, Keller TS. Activator Methods Chiropractic Technique. St. Louis: Mosby, 1997

 

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Abstract

Overview:

The chiropractic concept of vertebral subluxation has served the purpose of unifying early DC’s by contrasting a unique approach to health problems offered by chiropractors to allopathic medicine. However, confusion over the use of this term, and the concepts surrounding it, has existed because of a lack of consensus among chiropractors. A variety of methods has been offered to identify and measure the effects of vertebral subluxation in order to provide evidence regarding its existence. How the chiropractic profession deals with its belief systems and model building in this era of increasing accountability may be more important than the search for the subluxation itself.

Approach:

In order to assist practitioners to cope with this dilemma, an overview of selected subluxation assessment procedures is provided including a qualitative review of relevant studies examining reliability and validity of the various approaches. Criteria for assessing technology are presented, and recommendations are made regarding the value of a number of currently available assessment strategies. A discussion of future technology assessment issues is offered.


Top Clin Chiropr 1996; 3: 1-9.

Author information: Osterbauer, PJ.

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From the Publisher

The distinguished editorial board chooses topics that are most critical and clinically relevant to improving patient care. Invited experts write original, comprehensive articles, summarizing the vital changes and critical issues, and give both the practitioner and student fresh, thorough viewpoints on the topics significance.

Excerpt

Perhaps no other technique has been the focus of as much overwhelming scrutiny and controversy as the Activator Methods Chiropractic Technique (AMCT). Until recently, the main question of whether a specific treatment is effective for a particular patient with a given condition has been neglected. However, developments in health care reform have put the process of technology assessment and dissemination on the fast track. This chapter serves  as a follow-up to an appraisal published in 1990. It reviews recent research efforts of Activator Methods, Inc. (AMI) and speculates about the future of what has become know as mechanical force manually-assisted (MFMA) chiropractic adjusting procedures.


Reference: Osterbauer PJ, Fuhr AW, Keller TS. Description and Analysis of Activator Methods Chiropractic Technique. In: Lawrence DJ, Cassidy JD, McGregor M, Meeker WC, and Vernon HT (Eds.): Advances in Chiropractic. Volume 2. St. Louis: Mosby, 1995, pp. 471-520.

 

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Abstract

Activator Methods Chiropractic Technique (AMCT) was developed by Warren Lee, DC and Arlan Fuhr, DC. In the evolution of AMCT, Lee and Fuhr drew on elements of several other techniques, including Logan Basic, Van Rumpt, Truscott and Derefield, and developed innovation equipment, such as the Activator adjusting instrument (AAI) and an adjusting table designed specifically for AMCT. Based on oral history interviews, this paper records the early lives of Lee and Fuhr, their entries into chiropractic, influences on their personalities, the development of their technique and the seminars which presented it to the chiropractic profession.


Chiropr J Aust. Mar 1994 (Mar); 24(1): pp.28-32.

Author information: Richards DM.

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