Salanki Proadjuster Article

Over the past 20 years, instrument-based chiropractic adjusting approaches have grown in
popularity within the chiropractic profession, to the point where more than half of all practicing
chiropractors routinely use some form of adjusting instrument in their practices. As this trend
continues, the allure associated with the latest technology-packed computer-assisted adjusting
approaches mushroom as a greater percentage of practicing chiropractors adopt these very
advanced analysis / treatment tools in their practices.
In addition to the obvious role computer-assisted mechanical adjusting instruments play in spinal
treatment and adjustment, these tools provide expanded interventional choices for a wide range
of associated acute and chronic pain disorders. These include extremity adjustment and
mobilization, myofascial trigger-point therapy, soft-tissue-release approaches, IVD disorders,
mechanoreceptor stimulation and Golgi tendon therapy. As more and more chiropractors move
to adopt this technology, it is imperative that we establish sound scientific rationale (beyond
vague references to subluxation and mobilization) for its use, including defining mechanisms
involved in acute and chronic pain modulation.
An impressive and well-established research basis supports both the clinical effectiveness and
neurophysiological mechanisms activated with mechanical assisted treatment.
Mechanically assisted treatment creates certain local and systemic neurological responses. These
include an increase in local perfusion, relaxation of local muscle tension, and descending
inhibitory responses including the release of specific pain-relieving neuropeptides such as
endorphins, GABA and serotonin.
Neuromodulation and neuroactive sites are fundamental to understanding mechanisms of

mechanical adjusting. Neuromodulation is the property of the nervous system to regulate its own
activity in response to exogenous or endogenous stimuli. We see this continually in the body as
responses such as vasoconstriction of skin vessels in response to cold reflex, or relaxation of an
antagonist with contraction of an agonist.
A neuroreactive site can be thought of as any area of the body where there is somatic
innervation. Since somatic fibers are found in spinal and peripheral nerves that innervate
muscles, joints and skin, neuroreactive sites are found over the entire surface of the body –
although some are more potent sites of stimulation than others. Sympathetic nerves innervate
arterial networks of the skin. Therefore, neuroreactive sites also have some sympathetic vascular
innervation. Mechanical stimulation directed toward specific proprioceptive targets found within
receptor-rich environments activates three specific spinal gate control mechanisms: sensory,
locomotor and autonomic. Consequently, computer-assisted mechanical adjusting results in
normalization of sensory-motor integration, normalization of vasomotor tone, as well as
improved perfusion of locally affected tissues.
Gillette (1987) speculated that 40 types of mechanoreceptive endings in the superficial and deep
paraspinal tissues could be activated by chiropractic adjustment including proprioceptors, low-
threshold mechanoreceptors and high-threshold nociceptors.
Many of the mechanoreceptive endings mentioned, including Ruffini end organs, Golgi end
organs, Pacinian corpuscles, muscle spindles and Golgi tendon receptors, are well-known and
commonly used neuroreactive targets. In addition, a number of authors including Chaitow,
Travell & Simons, and Melzack & Wall talk about proprioceptive reporting mechanisms to the
CNS. Fascia and skin are innervated by a rich variety of sensory receptors including Pacinian
corpuscles, Ruffini organs, small myelinated free-nerve endings (A delta or mechanoreceptors),
as well as unmyelinated free-nerve endings and C fibers that carry pain.
Computer-assisted mechanical treatment could be defined as: "the application of pulsed

percussive forces at specific frequencies over specific neuroreactive sites for purposes of
normalizing autonomic, sensory and/or motor neuroregulatory responses." Three common
empirical observations are seen following acupuncture and computer-assisted adjusting
approaches: 1) decreased pain; 2) increased strength of inhibited muscles; and 3) increased local
blood circulation.
How might computer-generated pulsed mechanical stimulation reduce pain? The widely
accepted neurological mechanism that has been credited for the positive effects noted with
various instrument-based approaches relates to the mechanical stimulation of large-diameter
afferent fibers. Stimulation of these large-diameter, slow-conduction fibers modulates pain by
silencing the activity of the smaller, faster-conduction nociceptive (pain-carrying) C-fibers. By
modulating both nociceptive and proprioceptive afferents, activation of sensory fibers modulates
activity of nociceptive fibers, resulting in decreased pain and sensory function normalization.
How can we explain the normalization of inhibited muscle strength and decrease in muscle
hypertonicity that we see almost instantly following application of computer-generated pulsed
mechanical stimulation? Similar to mechanisms mentioned above, neuromodulation of
proprioceptors alters the activity of motor neurons, resulting in decreased segmental muscular
tonus and increased strength of inhibited muscles.
Can increased local tissue perfusion also be attributable to computer-generated pulsed

mechanical stimulation – and by what mechanism? It seems pulsed mechanical stimulation
modulates regional autonomic components of pain by restoring circulation, a perpetuating factor
in regional chronic pain-sympathetic hyperactivity.
Local peripheral segmental levels (affected muscles and joints or their relevant nerves)
Paravertebral musculature at relevant segmental somatic levels (dermatome, myotome,
sclerotome)
Relevant segmental autonomic levels (reflex vascular areas in distal aspects of extremities)
Based on this, where should we best apply computer-instrument-generated mechanical forces to

optimize clinical response? Logic would say applying single or multiple percussive forces over
painful and affected joints and local structures would make most sense. Clinical experience
supports this suggestion. Receptor-rich structures such as muscle bellies, muscle-tendon
junctions, teno-periosteal attachments, joint capsules, ligaments, neurovascular bundles, motor
points and fascia yield very good response.
We should also consider the treatment of paraspinal muscles and structures at spinal levels
segmentally linked to the dysfunction. For example, consider treatment of mid- to lower-cervical
and upper-thoracic paraspinal structures in cases involving median nerve entrapment at the wrist.
These regions are desirable targets since they modulate both segmental and segmental autonomic
reflex activity related to the problem region.
Stimulation of segmental autonomic reflexes further reinforces positive response to treatment.
Stimulation of the first dorsal interosseus muscle of the hand or foot, or other strong reflex
systemic regulatory areas distal to the elbow and distal to knee, are particularly useful when
treating more chronic functional problems.
Moving Forward
When assessing the value of computer-assisted mechanical adjusting instrumentation for

different clinical applications, it is imperative to understand variables involved, including force,
frequency and duration, direction of application, location and rationale for its application.
To make the claim that one instrument is superior to another makes the assumption that certain
optimum forces and/or pulsed frequency combinations are more clinically useful than others. It
further assumes that we have reached full understanding of how each of these instruments
interacts with the human nervous system, influencing the neurophysiology of the pain
experience.
At this point in the evolution of chiropractic science, we are not yet there. Consequently,
research needs to address questions like these head on. These are promising areas for future
investigation and research and answers will surface as we continue to unravel the complexity
surrounding the effects of mechanical peripheral simulation provided by computer-assisted
adjusting technology.
Resources
Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques, 2nd Edition.

Edinburgh: Churchill Livingstone, 2008.
Elorriaga C, Fargas-Babjak A. Neuromodulation, an emerging acupuncture paradigm:
implications. Acu-Press, February 2003;4(1).
Ernst E, White A. Acupuncture: A Scientific Appraisal. Oxford: Butterworth-Heinemann, 2001.
Levy B, Matsumoto T. Pathophysiology of acupuncture: nervous system transmission. Am Surg,
June 1975;41(6):378-84.
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Dr. David Salanki is chief instructor and senior clinical lecturer of the contemporary medical
acupuncture program at McMaster University in Hamilton, Ontario, Canada; vice president of
the Canadian Contemporary Acupuncture Association; and president and CEO of Sigma
Instrument Methods.
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Over the past 20 years, instrument-based chiropractic adjusting approaches have grown in

Neuromodulation and neuroactive sites are fundamental to understanding mechanisms of

Computer-assisted mechanical treatment could be defined as: "the application of pulsed

Can increased local tissue perfusion also be attributable to computer-generated pulsed

Based on this, where should we best apply computer-instrument-generated mechanical forces to

When assessing the value of computer-assisted mechanical adjusting instrumentation for

Chaitow L, DeLany J. Clinical Application of Neuromuscular Techniques, 2nd Edition.

Page printed from:

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