Chiropractic Adjustive/Technique Procedures
Components of an adjustment
Know the elements: patient positioning, contact point, line of drive, preload, and a high-velocity low-amplitude thrust directed into the restricted motion, with a documented listing. Understand the major approaches - Diversified, Gonstead, Thompson drop, Activator, SOT, flexion-distraction - well enough to state indication and limitation, not to argue superiority.
Contraindications are heavily tested
Acute fracture or dislocation, unstable spondylolisthesis, bony malignancy, spinal infection, aortic aneurysm, severe osteoporosis, anticoagulation with recent trauma, inflammatory arthropathy with ligamentous instability (rheumatoid arthritis, ankylosing spondylitis), and cord compression with myelopathy. Relative cautions include acute disc herniation with progressive deficit, pregnancy positioning, and severe guarding.
Traps
Adjusting before imaging in a trauma patient; using rotational cervical thrust in a patient with drop attacks, diplopia, or vertebrobasilar symptoms; failing to document consent and post-treatment response; not recording transient adverse effects such as soreness or headache.
Worked example
A 68-year-old on warfarin with acute neck pain after a fall. The correct next step is cervical imaging and medical clearance - anticoagulation plus trauma makes manipulation unacceptable no matter how the segment feels.
Rule of thumb
No diagnosis, no adjustment. When the history suggests an unstable or destructive process, referral is the right answer.