By: Jeffrey D. Olsen, DC
Among the options available, my low-force procedure of choice is Activator Methods Chiropractic Technique (AMCT). From my earliest exposure to AMCT, while taking the elective as a student at Palmer College, I had the impression that this is the most systematic approach to Chiropractic care. In our training and too often in practice, evaluations and treatments are frequently presented or performed segmentally. In contrast, AMCT offers a coordinated approach, combining a sequential evaluation and precise correction, backed by conclusive research.
To appreciate the segmented approach some may take, consider the experience of a recent new patient. Before coming to us, she had been under care in another Chiropractic office for a period of about four weeks. Her initial complaint and reason for seeking Chiropractic care was an acute exacerbation of chronic headaches and a stiff neck. She made the right choice and chose Chiropractic care! Unfortunately, but possibly for good reasons, her original treatment was confined to her low back. Although she did feel improvement in that area, she was surprised when, having asked the Chiropractor to evaluate her neck, he repeatedly said they would get to the exam and X-rays of her neck on a subsequent visit.
I fully understand that cervical problems can be effectively corrected by treating areas distant from the site of pain. However, the reason we have this new patient in our office today is because she didn’t!
For those who are unfamiliar with AMCT, let me briefly describe the two levels of Activator’s “full-body” approach to patient care: “Basic” and “Advanced Procedures.” For those already using AMCT, I would like to share how we integrate Foot Levelers’ custom-made, flexible orthotics and other supportive products to enhance our Basic patient care and minimize the need to use Advanced procedures.
Basic Scan Protocol
The Basic procedure relies on maintaining the patient’s standing postural distortions in the prone position—patient placement is critical and a hi-lo type table is preferred. The analysis begins by noting the patient’s footwear, the presence of excessive unilateral foot inversion or eversion, and the side of leg length inequality. These factors combine to provide the practitioner with his or her basis for analysis, the “reactive” short leg.
Once the short leg side is properly established, there is a series of tests, some initiated by the doctor (“stress”) and some performed by the patient (“isolation”), which help locate the areas of subluxation needing correction. The process begins at the feet, knees, and pelvis first, before proceeding to the spine and upper extremities. Only after ensuring that the foundation is cleared does the provider begin to work on specific key areas of the spine. Furthermore, on subsequent visits, the process, although generally abbreviated, is repeated, demonstrating to the patient that “no bone will be left unturned” in the process of relieving pain and providing correction.
After a series of adjustments using the Basic scan protocol, the doctor will often focus attention on more specific areas using additional stress and isolation tests. The need for these additional procedures is often due to traumatic disruption of joints or their supporting ligaments, chronic postural imbalance or in response to specific patient complaints. The complexity of the technique does not allow me to detail every specific procedure, but almost every joint complex can be evaluated and corrected while the patient remains relaxed and prone on the table.
Unfortunately, and this is the case for most techniques, although we perform miracles restoring proper joint alignment and nerve communication, even removing postural distortions, while patients are on our treatment tables, when they stand back up and reintroduce the force of gravity, everything changes. Regardless of technique preferences, anyone can relate to the situation where the patient returns for care showing the same patterns of subluxation and dysfunction. The following is an example using the AMCT protocols for a foot imbalance associated with knee pain and pelvic unleveling.
First, using the Basic scan and beginning with the feet, the doctor will test for and often find a misalignment of the talus and/or cuboid. These two structures are, respectively, major components of the foot’s arch/plantar vault system, including the medial and lateral longitudinal arches. Because of our closed Kinetic Chain arrangement, misalignment at one segment is often associated with compensatory changes elsewhere, so the protocol suggests correcting for a medial knee with a talus finding and for a lateral knee when the cuboid is found. It is also the unilateral arch collapse that accounts for distinct patterns of pelvic subluxation.
Frequently, because of trauma or ligament stretching, these same areas require repeated adjustments. However, it is well documented that once stretched, not even surgical reduction will restore the ligament to its original condition. This can be frustrating for the doctor and patient, and with time will often necessitate advanced procedures once the patient develops secondary conditions.
To continue our example, the repeated finding of talus and cuboid subluxations can lead to the more painful conditions of plantar fascitis, shin splints, and degenerative knee conditions. The Advanced procedures would offer the following corrections counteracting hyperpronation: medial calcaneus, inferior first cuneiform and first metatarsal, internal proximal tibia, and lateral patella for example. It’s nice having so many options, but supporting the feet during the Basic procedures makes better sense.
Foot Levelers’ functional orthotics (Fig. 1) is a perfect match with AMCT or any other technique, which looks to remove biomechanical stress from the posture foundation. Specifically, these custom-made orthotics support the three arches of the foot. Therefore, once the cuboid or talus is adjusted in Basic and supported by the orthotic, the extent of plastic deformation becomes irrelevant as far as its effect on the closed Kinetic Chain.
Orthotics are not a substitute for Chiropractic adjustments, and patients will continue to need the equivalent of both Basic and Advanced procedures. Remember that many of the Chiropractic techniques you use every day have protocols for the use of orthotics. In addition to others, Motion Palpation, Activator Methods, and CBP techniques include recommendations for the use of orthotic devices in the correction and stabilization of spinal conditions.1–3 In his text explaining the Motion Palpation Technique, R.C. Schafer, D.C. recommends the use of orthotics for pain relief, protection of weak, healing, or unstable structures, maintenance of equilibrium, and correction of structural deformity and unequal muscle pull. Furthermore, he states, “If a deficit exists at the distal end of the body’s axial kinematic chain, corrective and supportive foot orthotics become an important aspect of treatment.”3
Whether you use AMCT or not, your patients will easily understand the foot-spine connection as it relates to your treatment of their subluxations. Using orthotics, in our “toes-to-nose” approach, has produced satisfied patients sharing the benefits of long-term correction.
- Fuhr AW et al. Activator Methods Chiropractic Technique. St. Louis, MO: Mosby-Year Book, Inc., 1997:81, 135, 144.
- Smith RL. Pronation syndrome and global spinal posture. In: Spinal Biomechanics: A Chiropractic Perspective, 1992:116.
- Schafer RC. Motion Palpation and Chiropractic Technic—Principles and Dynamic Chiropractic. Huntington Beach, CA: The Motion Palpation Institute, 1989: 415.
About the Author
Dr. Jeffrey D. Olsen is a 1996 Presidential Scholar and summa cum laude graduate of Palmer College of Chiropractic. He has been in private practice, with his two brothers/partners since 1997, in Roanoke, VA. In addition to his practice, Dr. Olsen has instructed as an adjunct faculty member at the College of Health Sciences in Roanoke, teaching Anatomy and Physiology in the Physician Assistant department.