Is Conservative Care Right for Your CTS Patients?
Written by Rebecca S. Fischer, D.C.   
Tuesday, 14 November 2006 16:11

Published research shows treatment options for carpal tunnel syndrome (CTS) are mixed and often conflicting. In general, there are a number of accepted treatments for CTS that range from invasive (surgical and steroid injections) to non-invasive (manipulation, splints, topical patches, laser light) or combinations of all of the above. The American College of Rheumatology states, “Despite the prevalence of CTS and its considerable economic impact—in terms of both worker absenteeism and compensation claims—there is no universally accepted therapy.”

Previously, surgery was the standard of care, but now is the time for the chiropractic profession to step up and share the medical researchers’ findings about the effectiveness of non-surgical options. The truth is that, when given the choice, patients prefer conservative treatment alternatives over surgery, which makes certain types of chiropractic care the best option for early symptoms of CTS.

The good news for chiropractors is that carpal tunnel syndrome is now classified as a musculoskeletal disorder, and categorized as Repetitive Stress Injuries (RSI’s).  RSI’s occur when the body’s natural ability to heal itself is overpowered by factors of stress and fatigue.  Repetitive movements cause a reduction of the natural lubrication levels within the tendon sheaths, leading to a buildup of friction, producing swelling, and, ultimately, the growth of fibrous tissue, which then constricts the movement of the tendons.  This narrows the carpal tunnel, creating an entrapment neuropathy, the true definition of CTS.

Recognizing the causal factors, it would make sense that the following occupations are included as risk factors for developing CTS:

•  Food processing (meat/poultry workers)
•  Manufacturing (seamstresses)
•  Logging
•  Construction
•  Pneumatic tools
•  Jackhammer
•  High Repetition (bar code testing in supermarkets)

Accepted Treatments Get Mixed Reviews

Even with those promoting surgery or injection there is conflicting information about the effectiveness of one treatment method over another. Published in Neurology, June 2005, “Decompressive surgery and steroid injection are widely used forms of treatment for CTS but there is no consensus on their effectiveness in comparison to each other.”

Thus, a recent randomized controlled trial (RCT) of surgery versus a single steroid injection for CTS was performed. Patients were followed up at six and twenty weeks.  Attwenty weeks, patients who underwent surgery had greater symptomatic improvement than those who were injected; they had greater improvement in nerve conduction studies, but there was an interesting mix of findings. The surgery group actually had a loss in grip strength by 1.7 kg, compared with a gain in the injection group of 2.4 kg. 

Even though carpal tunnel release procedures can be “curative,” many patients experience postoperative complications, such as scar sensitivity, pillar pain, recurrent symptoms, and grip weakness, regardless of whether the release was done through an open, mini-open, or endoscopic approach.  Release of the carpal tunnel has an effect on carpal anatomy and biomechanics, including an increase in carpal arch width, carpal tunnel volume, and changes in muscle and tendon mechanics.

A year-long clinical trial was conducted and published in Arthritis & Rheumatism, February 2005.  The research suggested that “local steroid injection is just as effective as surgery for the long-term symptomatic relief of CTS—for a year, at least—and actually more effective over the short term.”  Eleven of the 101 randomized patients in the surgery group rejected the treatment, leading one of the authors, Dr. Domingo Ly-Pen to note, “This finding coincides with our daily clinical practice, in which patients usually prefer conservative therapies.”

CTS & Chiropractic

With patients pushing for conservative care and conflicting data plaguing invasive options, we see insurers like Blue Shield of California, who posted the following about chiropractic and holistic approaches that may be helpful: “A small, preliminary trial assessed a chiropractic treatment program consisting of exercises, soft tissue therapy, and manipulation of the wrist, the upper extremity, the spine, and the ribs. The treatment resulted in improvement in grip and thumb strength, muscle function, flexibility, and overall function, as well as a decrease in pain among people with CTS. In a follow-up study six months later, most of the improvement had been maintained. A controlled clinical trial compared traditional medical and chiropractic care for CTS. People with CTS received either standard medical care (ibuprofen and nighttime wrist supports) or chiropractic care (manipulation of the wrist, elbow, shoulder, neck, and spine, as well as massage to the soft tissues). Ultrasound and nighttime splints were also used in the chiropractic treatments. People in both groups improved significantly and similarly in terms of pain reduction, increased function, and improved finger sensation and nerve function, but the chiropractic group reported fewer side effects.” (See References: Bonebrake AR, Davis PT)

The best outcomes occur with early detection.  The most reliable clinical prediction rule (CPR) consists of the question, “Does shaking your hand relieve your symptoms?”  In a recent study, this CPR was more useful for the diagnosis of CTS than any single test item, which included Phalen’s Test and Tinel’s Sign. By using this question as the diagnosis for CTS, treatment was utilized quicker and resulted in better outcomes with posttest probability changes of up to fifty-six percent.  The next main consideration in evaluating the patient is the symptoms must occur along the distribution of the medial nerve. (Figs. 1 & 2.)

Conservative treatment is where we, as chiropractors, are the best, and research is recommending combinations of conservative treatments. Consider the randomized controlled trial of nocturnal customized splints for active workers with symptoms of CTS that were worn for six weeks, with benefits maintained at twelve months. The results in the splinted group showed improvement in terms of hand discomfort, regardless of the degree of median nerve impairment; whereas, the controls showed improvement only among subjects with normal median nerve function. Results suggested that a short course of nocturnal splinting may reduce wrist, hand, and/or finger discomfort among active workers with symptoms consistent with CTS.

Other new published research indicates the surgical, invasive treatment of CTS is only necessary if the symptoms persistently interfere with the normal lifestyle (for a period of at least several months), and if the diagnosis has been established beyond reasonable doubt.

Conservatively, utilizing The Activator Method is an excellent way to determine where and when to adjust a patient with CTS. By using Activator Method’s prone leg checks and Isolation Tests, the specific carpals, upper extremity involvements and related cervical vertebrae can be targeted for your CTS patients. The controlled force of the Activator enables a safe, effective adjustment for the carpals, cervicals and any other areas of nerve entrapment, more so than manually performed adjustments.

New tools

Chiropractically, we can add a new product that works like an anti-inflammatory, instead of an injection or drug, by utilizing a Theraderm® topical patch. Additionally for CTS, a wrist splint/support, the Wristivator®, can aid healing by maintaining warmth and the benefits of new far-infrared technology. Information on these new products can be accessed at

By combining conservative care, as research recommends, you will provide your patients with the level of care and peace of mind they seek. The Activator Method incorporates Isolation Tests, Stress Tests, and Leg Length Analysis to determine specific contact points and Lines of Drive in the corrections of neuro-biomechanical dysfunctions with the Activator Instrument. The Activator Method is unique as a chiropractic technique because there are post-adjustment analysis procedures that give the doctor peace of mind and confidence in their adjustive treatment of the patient. The 2006-2007 Activator Methods Seminar season includes advanced, concentrated studies on the subject of carpal tunnel syndrome and headaches.

The Structural Fingerprint™ Exam: Bill Rodgers, Marathon Runner
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Written by Tim Maggs, D.C.   
Tuesday, 14 November 2006 16:04

In the past ten years, I’ve received many emails from injured athletes.  Injuries are part of all athletes’ lives but, when the injury prevents them from participation, they get crazy.

Except one:  Bill Rodgers, the famed marathoner who’s finished first four times each in both the Boston Marathon and the New York Marathon.  He’s run fifty-eight marathons, and, to this day, still logs sixty miles per week.  Except for a spiral fracture of his right tibia two years ago, Bill has been blessed, at the very least, with great genetics.  He’s suffered with short bouts of plantar fascitis and achilles tendonitis but, all in all, the leg fracture was the most severe injury he’s ever had. 

I recently traveled to Boston for the sole purpose of performing a Structural Fingerprint™ Exam on one of the greatest athletes ever.  The purpose of this biomechanical exam was not to determine the diagnosis of an injury identified by an ICD code that will produce re-imbursement.  The purpose of this exam was to determine the biomechanical status of his structure, to see what effect fifty-eight marathons and fifty-eight years with a lifetime of stress has done to his body, and then to design a proactive program to help Bill biomechanically improve and correct the defects we find.  In essence, how can he preserve his structure to maintain a future of running?

The Structural Management™ Program
This program is designed to guide the practitioner through a step-by-step procedure to determine biomechanical defects, which have been shown to lead to injuries, perpetuate injuries and accelerate degenerative changes.  Once the defects are determined, a corrective program is designed to help the athlete reach “maximum biomechanical improvement,” a status all athletes should aspire to reach and maintain. 

Once the biomechanical defects are determined with The Structural Fingerprint™ Exam, the corrections can be made by any or all of the following modalities: custom orthotics, chiropractic adjustments, extremity adjustments, rehabilitative exercises, cold laser therapy, nutritional support, physical therapy, weight management, conditioning exercises, etc.  The doctor chooses the best combination of actions for each patient, based on the findings of this exam.  These, in combination with time, will produce results.

Bill Rodger’s Structural Fingerprint™ Exam
The exam begins with a history, to determine if the patient has been through a biomechanical exam recently, asks if the patient wears custom orthotics, checks if the patient has had recent standing X-rays as well as other relevant biomechanical questions.  The concerns go way beyond any current injury.

Bill was excited to go through this exam, as he’s had questions regarding imbalance and left hip issues for many years that no one has been able to answer. 
“I lean to the left when I run, and I know that’s not right, but no one has been able to give me answers when I ask them”.  Imagine that, the greatest marathoner of all time, and no one can tell him why.

We first looked at Bill’s feet, and determined he was a supinator in his younger life; however, his left medial arch has now begun to fall (Fig. 1), as seen on the digital scanner (Fig. 2).  This begins the kinetic chain imbalance.  His leg lengths were uneven, as he had an anatomical 5/8” shortness of his left leg (Fig. 3).  Bill determined on his own recently that he needed a lift in his left shoe, so a ¼” lift was worn during his standing X-rays.

Upon further examination, it was noted he had restriction in the low back on extension.  This is typical with the aging process; however, loss of mobility contributes to the acceleration of degenerative changes and encourages compensation; therefore, the goal is to restore mobility and flexibility as much as possible.

It is also important to examine the wear of an athlete’s shoes, as the wear patterns should be more evident than the wear patterns on everyday shoes.  In Bill’s case, the wear patterns show a significant difference, right vs. left (Fig. 4).

When evaluating the left hip, there were signs of restrictions in and around that area.  The right hip showed no tightness or restrictions.  In Fig. 5, we rotate inward both feet/toes, and the left foot rotated inward further than the right.  This is suggestive of a variety of possibilities, including a rotation of the pelvis, a tightening of the major hip flexor muscles, and/or other less possible biomechanical changes.

In Fig. 6 (See Pg.44), we rotate the hip joint by using the ankle as a lever, both inward and outward.  Again, this will show if either hip joint has lost mobility, especially compared with the opposite hip.  In this case, the left hip has a significant restriction of mobility, as compared to the right, when rotating the thigh inward.

When performing Patrick-Fabere, the right knee easily reaches the table, while the left knee is restricted (Fig. 7).  The reason the left leg rotated in further than the right (Fig. 5) and the reason the knee will not go down to the table on P-F Test is due to a pelvic rotation as seen on the A-P L-S X-ray. The yellow line represents the symphysis pubes, while the red line represents the center of the spine.  The same line should bisect both points. Another important part of the exam is to check the major muscle groups for trigger point activity.  Trigger points are produced by repetitive activity, trauma, and increased demands on a muscle.  We find that the left piriformis muscle is tighter and more tender (Fig. 9), most likely as a result of the pelvic and foot imbalance.  Both quadratus lumborum muscles of the low back were involved, while both calves were negative for involvement (Fig. 10).

X-Ray Exam
The biomechanical X-rays, which provide seventy-five percent of our information, were very interesting.  Starting with the lateral L-S (Fig. 11), we found tremendous balance and great biomechanics, which probably has a lot to do with his good genetics.  The center of gravity (Ferguson’s Line) originates at the center of L3 and bisects the anterior third of the sacral base.  This suggests the weight in the low back is being handled efficiently.  In addition, the disc spaces in the low back are plump and full, despite the amount of stress his structure has endured over the years.

We also wanted to look on the low back X-ray to determine the status of his hip joints, especially the left hip (Fig. 12) (Pg.44), due to the restrictions we found on the exam.  Fortunately, the left hip joint showed minimal wear, as the joint space looked healthy.

The standard X-ray series on The Structural Fingerprint™ Exam also includes an A-P open mouth and a lateral cervical.  The results of Bill’s neck X-rays were generally good, however, the lateral cervical (Fig. 13) showed some reduction of normal curve, an anterior weight bearing line and also some wearing of the fifth cervical disc space.

Bill’s overall biomechanics are excellent as compared to the average fifty-eight year old, but even more so in light of the miles he’s run in his life.  With that being said, there are definite biomechanical improvements that must be made in an effort to preserve both the musculoskeletal system as well as the neuromusculoskeletal function. 

In this case, the anatomical short left leg has most likely contributed to the dropping of the left medial arch over time, which then begins the process of changing the normal centers of gravity in the entire kinetic chain.  If not addressed, this progressive change will accelerate the potential breakdown of one or more joints in his body.  The muscle tenderness we found is typically a result of these muscles working harder than desired, almost like guy wires on a leaning flagpole.  With Bill running sixty miles per week, these imbalances, left unattended, are more likely to lead to muscle/tendon injuries.

The rotation of the pelvis, causing the left hip to sustain more stress than the right hip, also predisposes Bill to premature breakdown, which was seen last November with the injury he sustained to that hip.  Specific changes need to be made in his overall biomechanics in an effort to reduce the abnormal stresses on that joint.

The 3 goals of The Structural Management™ Program are
To improve structural balance,
2) To increase joint mobility,
3) To improve muscle flexibility.

These goals are a never-ending effort, and the following recommendations are designed to help Bill reach his ceiling of biomechanical potential.  Once there, we then want to help him stay there as long as possible.  This improvement will ultimately help reduce the likelihood of both future injuries and degenerative changes.

• Custom fitted orthotics, with a progressively increasing heel lift on the left.  We will use flexible orthotics that were measured in the weight bearing position (on our digital scanner).  We will begin at a ¼” lift, and progress up to 3/8” and possibly ½”.  These orthotics should be worn in as many shoes as possible, not just when running.  The balancing of the feet will help to improve the structural imbalances above, as well as minimize future dropping of the medial arches of the feet.  As you can see from the Figure 14, there is a chain reaction with imbalances in the arches of the feet.

• Continue his once per week full body massage, with special attention shown to the left gluteal/hip region.

•  Begin a once per week program to receive chiropractic adjustments, which will help to increase mobility in the joints of the feet (left big toe), knees, hips, pelvis and spine, as the narrowing of the C5 disc space is directly proportionate to a loss of normal joint mobility.  The restriction in the low back on extension will also improve with full structural adjustments.  Finally, his body will better tolerate daily stresses, such as with each step of running, when there is normal and full mobility in all joints of the body.

• Consider two nutritional supplements, including a glucosamine supplement, which is food for the joints, in an effort to feed and preserve them, as well as a proteolytic enzyme, an all-natural anti-inflammatory supplement that also works to accelerate soft tissue recovery, especially from the demands of running. 
• There are specific rehabilitative exercises that can be done for both balance and mobility, especially in the neck and low back. 

• It is recommended he employ the use of The Stick in combination with a stretching program, and the “Instructions” can be found on my website (, under Muscle Management, found on the Structural Management™ Pyramid.  This should only take ten to fifteen minutes per day; however, the increased flexibility will dramatically help our overall goals.

• I would recommend “cushioned” running shoes, as Bill’s high arches typically are more rigid with less shock absorption capability.  Additionally, the large toe on the left foot should tolerate cushioned shoes much better.

• If any injuries do occur while undergoing this program, they should respond to treatment much quicker.

• I would recommend re-evaluation in six months to see if we are on course with our goals.  We will re-scan the feet, perform the (+) finding tests again, and re-take one or more X-rays for comparison.

This type of program would benefit every athlete out there, and would dramatically increase the desire for our athletic communities to seek out chiropractic care.  We must get away from only providing medical model assistance, and begin raising the awareness of applicable biomechanics in the form of Structural Management™.

Are you missing an important subluxation?
Written by Ted Koren, D.C.   
Tuesday, 14 November 2006 16:02

Doctor: "You feel tired much of the time, don’t you?"

Patient: "Yes, I feel exhausted all the time. How did you know?"

Doctor: "Your femur heads are anterior. Most of your energy is being used to hold your body up."

One of the most fascinating subluxations is of the femur heads. The femur head is ball-shaped and located at the top of the thigh (femur) bone. It fits into the acetabulum, a cup-shaped cavity in the hip made up of the ilium, ischium and pubis.

Head and sacral alignment

Dr. Lowell Ward, developer of Spinal Column Stressology, analyzed lateral full-spine standing and sitting (14" x 36") X-rays. He studied the relationship between the center of the head (as measured at the anterior arch of atlas) and the center of the pelvis (as measured at the anterior border of the sacral base).

Ward consistently found that people who sat and stood with their head anterior to their pelvis were the most sick, with deteriorating physical and psychological health. (See Fig. 2)

Day-to-day observation reveals this is so. Watch people walking down the street. Those who are healthiest have relatively straight postures while the sickest and weakest are bent forwards. Isn’t the bent-forward man or woman our cultural image of sick old age? As one wit observed, "They are leaning toward their graves." There is some sad truth to that observation.

So what’s going on?

Our femurs respond

Ward observed that, when the spine was under a lot of anterior stress, the femur heads would first move posterior to resist the displacement.

After awhile, however, as energies were depleted (in accordance with Selye’s stress breakdown theories), defenses would break down. First, one femur head would move anterior and, eventually, the other would.

With both femur heads anterior, much energy would be devoted to preventing falling forwards.

Anterior = decreased health


Ward’s observation was underscored by a 2005 paper in Spine, where researchers X-rayed 752 people and looked for a relationship between anterior head carriage and health status. Each subject’s health status was evaluated using the Scoliosis Research Society patient questionnaire, MOS short form-12, and Oswestry Disability Index.

The authors consistently found that even minor head anteriority was detrimental; the severity of symptoms (increased pain, decreased function) increased in a linear fashion with progressive increase of anteriority.

They concluded: "All measures of health status showed significantly poorer scores as [anterior] deviation increased." [Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S. The impact of positive sagittal balance in adult spinal deformity. Spine. 2005;30(18): 2024-2029.]

Anterior femur heads and anterior body carriage

If both femur heads are anterior, the problem is more serious. It means that the body’s defenses are exhausted and the person is deteriorating ("breaking down"). Patients with this double anterior femur head pattern often feel they are getting worse.

Fetal posture


The most extreme example of anterior breakdown is when the cervical and lumbar lordotic curves completely reverse—the spine then assumes a fetal position. By this time a person is both physically and emotionally curled up in the deathbed, completely helpless and dependent on others for existence—like a fetus.

Other femur head listings


The femur heads can subluxate anterior, posterior, lateral, medial, superior and can have inner rotation (more common) and outer rotation.

KST and the femur heads

Using Koren Specific Technique (KST), we can easily determine if your patients’ (or your) femur heads are subluxated anterior, posterior or in any other position and quickly and easily correct them—all in a few seconds. This is usually done with the patient standing. Clinically, the patient begins to report more energy, better balance and improved health status when the femur heads are adjusted and the spine is unsubluxated.



Health & Hydration
Written by Tedd Koren, D.C.   
Thursday, 28 September 2006 22:30

waterWhy isn’t this patient holding her adjustment?” I wondered.

Koren Specific Technique (KST) practitioners are happy to find that their patients hold their adjustments for longer periods and rarely return with the same subluxation pattern.

That is why I was so startled to find a patient whose subluxations returned. Why wasn’t she holding her adjustment? Her chronic migraines had decreased only a little and her sphenoid, occiput and upper cervical subluxations had returned.

The groundbreaking book Your Body’s Many Cries for Water: You’re not sick, you’re thirsty, by F. Batmanghelidj, MD, inspired me to ask her body about her water needs.

Ask her body?
Your body has many biofeedback “devices” that react in predictable ways when confronted with a challenge. This phenomenon is employed in a clinical environment by Applied Kinesiology™ (AK) as the weak muscle response, by Toftness™ as an autonomic change in finger perspiration, and by Directional Non-Force Technique™ (DNFT) as the short leg reflex. Activator™, a derivative of DNFT, also employs the short leg reflex. The biofeedback device that KST uses is the Occipital Drop (OD), which was originally discovered by Lowell Ward, DC, the developer of Spinal Column Stressology.

The Occipital Drop
Simply stated, in response to a challenge, a muscle goes weak (AK), the leg shortens (DNFT), the skin sweats (Toftness) and the occipital bone (along with the mastoid process of the temporal) appears to drop or lower on the left side (KST).

These are all binary systems, yes-no indicators, by which we can easily access the body’s wisdom. Although the mechanism of action remains unknown, these are amazing, highly accurate tools that we can use to great advantage in helping patients.

All I did was ask
“Is this person dehydrated?” I asked her body. Immediately she responded with an OD—her occipital bone and mastoid dropped lower on the left side when compared to the right side.

“Is she one glass low?” The body responded with an OD.

“Two glasses?” (OD); “Three glasses?” (OD). At “six glasses,” I stopped getting an OD; she was five glasses low. That’s pretty dehydrated.

I put her on a re-hydration program and she began to hold her adjustments.

Distilled water
One of the most dehydrated patients I’ve had to date said, “But I drink large quantities of distilled water all the time.”

I told her to drink spring or filtered water instead. Within two weeks, she rehydrated and her chronic complaints disappeared.

Critics of distilled water claim that it is biologically dead, unnatural and leaches minerals from the body. Also, ice water does not re-hydrate the body as well as room temperature or hot water.

The most dehydrated patients I’ve encountered are alcoholics and former alcoholics. Ten or more years may have gone by since the last drink, but the dehydration remains. Alcohol is a diuretic, a drug that increases urination and flushes fluids from the body. (By the way, drinking coffee the following morning will only increase this problem, as coffee is also a diuretic.)

One of my former alcoholic patients started drinking more water, but still remained dehydrated. “What’s going on?” I wondered.

I consulted with a toxicologist who said that with alcoholics, “Liver detoxification is an absolute. Moreover, ethanol is going to denaturize proteins on the cell membrane. Use digestive enzymes, especially proteases, to help her to get amino acids into her systems for repair. Gelatin is good, as well. Once these processes recover a bit, her dehydration issue will subside a little bit. She still needs to be vigilant in getting herself hydrated. She needs to drink good filtered water.”1

I’ll never forget one severely dehydrated individual who had a drinking problem who told me, “I hate water; I never drink it.”

OK, it’s not just kids, it’s everyone who doesn’t drink enough water. Dr. Batmanghelidj claims that most of us are chronically dehydrated and that drinking coffee, tea and sodas actually contributes to dehydration. Those fluids may temporarily assuage thirst but, in the long run, they increase dehydration. As we age, our ability to recognize thirst decreases and that’s why so many older people look so “dried up.”

Re-hydration, holding adjustments and depression

When patients start re-hydrating, wonderful things begin to occur. The most important thing, from a chiropractic perspective, is that their adjustments start holding. I’ve noticed that re-hydration often has a dramatically positive effect on depression. Interestingly, in Chinese medicine, water equates with the flow of energy.

Disc problems
Fully 75 percent of the weight of the upper part of the body is supported by the water volume that is stored in the disc core; 25 percent is supported by the fibrous materials around the disc…. [Water] provides the hydraulic support for the weight-bearing qualities of an intervertebral disc.2

In chronic dehydration, the discs begin to fray. They cannot keep up with the stress of subluxations (in addition to day-to-day wear and tear). Patients with disc problems respond very well to chiropractic and re-hydration.

Other conditions that respond to water
The list of conditions that Dr. Batmanghelidj found to respond to re-hydration includes migraines, high blood pressure (the blood is thickened due to water loss, so it takes more force to push it through the body), asthma, colitis, angina, back pain, arthritis, heartburn, early adult-onset diabetes, high cholesterol and many others.  Dr. Batmanghelidj claims that many of these conditions are part of the body’s early-warning system and, if not heeded, can progress to stroke, heart disease, cancer and other serious conditions.

How long does it take to re-hydrate?
According to Dr. Batmanghelidj, re-hydration takes about two weeks. His book has various protocols people should use. However, the beneficial effects of water are often noticed immediately. In my office I give patients water when dehydrated. Their adjustments hold better and they report multiple benefits.

Are your patients (or you?) dehydrated or re-hydrated? A great way to find out is to ask the body, of course.

Dr. Tedd Koren is the founder of Koren Publications and developer of Koren Specific Technique (KST), an Empirical/Vitalistic method of locating and correcting subluxations anywhere in the body that is easy to learn and is revolutionizing chiropractic practices.. For information on KST seminars, go to or call 1-800-537-3001. Write to Dr. Koren at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Note: Your Body’s Many Cries for Water is available from Koren Publications. To order go to or call 800-537-3001


Medical Manipulation or Chiropractic Adjusting?
Written by Tedd Koren, D.C.   
Monday, 28 August 2006 19:47

Chiropractic can be practiced either empirically or mechanistically. How could that be? Why is it important?

Chiropractic’s approach to healthcare is similar to the empirical approach of classical homeopathy, classical osteopathy and other “holistic” healthcare systems.

That approach, to balance or harmonize the individual within him/herself and to balance or harmonize the individual to his/her Source (soul, spirit, Tao, God), is the goal of the chiropractic adjustment.

The Triune of Life, chiropractic’s philosophical “heart and soul,” describes how matter, force (energy) and intelligence (consciousness) interact to create life and health. The goal of chiropractic is to permit intelligence to communicate through physical matter via the intermediary of force.

In homeopathy and osteopathy, we find an almost identical terminology and goal. Samuel Hahnemann (discoverer of homeopathy) and Andrew Taylor Still (discoverer of osteopathy) considered disease to be an incoordination between mind, energy and body.

Discovering and Releasing Obstructions/Subluxations

In more modern times, Robert Becker, MD, an orthopedic surgeon, wrote with chiropractic insight when he said: “The healer’s job has always been to release something not understood, to remove obstructions…between the sick patient and the force of life driving obscurely towards wholeness….”1

Care must be personalized to the individual; a person’s subluxation(s) or obstruction(s) must be located and corrected. How does this relate to how chiropractic is practiced today?

Sadly, it does not relate to how many DC’s practice. Too many DC’s think the subluxation is where the pain is. For example, has this ever happened to you? New patient with low back pain who has been to other DC’s is asked by his new chiropractor, “What did your last chiropractor do for you?”

“He cracked my lower back.”
“Did he check or adjust your neck?”
“No, just my lower back.”

Obviously, that DC wasn’t taught that the lumbars and cervicals (and cranials) are all connected and affect each other. Did this patient leave his last DC’s office with his cervical (and other) subluxations uncorrected? Probably.

The Flying Seven

When I heard about the “flying seven,” I pictured a trapeze act, like the “Flying Walendas,” doing weird things above a safety net. Instead, it has to do with chiropractors doing weird things without much of a safety net.

The flying seven is another name for “diversified” or “pop and pray” adjusting. Three “cracks” on the thoracics (upper, middle and lower), lumbar roll—left and right (that’s two), cervical break—left and right (that’s two). Total = Seven.

For this you have to go to school for four years? For the record, I’m not writing from some high horse; I used to practice like this.

Can you get results from pop and pray? You can, especially on new patients, because you’re breaking up long-standing stress patterns. But the subluxations often come back; the adjustments don’t hold.

That’s why there’s always something to “crack,” even a few hours later. And, if there’s a hot disc, ear infection, migraine or some other problem—you really don’t know….

The flying seven is quick and easy. Sometimes it really can do great things, but it has great limitations as well.

It’s financially rewarding, because patients keep coming back. But it’s beginning to backfire. You know the joke, “How many chiropractors does it take to change a light bulb?” Answer: “Just one but you have to go back fifty times.” Many people say it’s no joke and would rather swallow a pill at home than drag themselves in for care over and over.

A Dying Profession?

The preceding is one reason the percentage of the population seeing DC’s is decreasing and the number of students in chiropractic schools has fallen. The CCE and national boards are another part of the problem. They have forced up the cost of education so that new DC’s are $100,000 or more in debt upon graduation. Even worse, the CCE, et al., has medicalized chiropractic education. Because of all the medical subjects the CCE requires, there is less time for chiropractic; in some schools, philosophy, the most important aspect of any healthcare profession, isn’t even taught. Students graduate thinking they are limited to being back and neck pain doctors; they vaccinate their kids, take drugs….

The only thing saving chiropractic from extinction is that medical care is so dangerous and ineffective. Chiropractic remains a viable alternative—for now.

Medical Manipulation

The CCE, national boards and similar groups need to get back to their roots. DC’s need to get away from medical manipulation and get back to chiropractic adjustments. Giving (more or less) the same adjustment to every patient each time they come in—same segments, flying seven, pop and pray—is medical manipulation, little more than a glorified aspirin.

If your procedures are really working, the patient will not have the same subluxations each time you see them. Deeper subluxations may surface, retracing will appear, body structure and other objective changes will occur. The patients will heal physically and emotionally and release deep obstructions preventing them from properly connecting to their Source.


Where to begin? First, let’s start with our terminology. Chiropractic corrects subluxations; it does not “treat” conditions. When we refer to what we do as a “treatment,” we are using medical terminology. We analyze and “adjust” or “correct” causes with chiropractic care. The medical profession diagnoses and treats symptoms. We have a unique profession; our terminology is unique.

Is Your Care Consistent with Your Philosophy?

Our adjusting techniques must be consistent with our philosophy. Mechanistic procedures are not able to fully reveal the potential of chiropractic’s vitalistic approach to connecting the patient to his/her Source.

Our chiropractic techniques must, likewise, remain unique, respecting empirical or vitalistic philosophy, with the goal of locating subluxations and correcting them, wherever they may be. 

Dr. Tedd Koren is the founder of Koren Publications and developer of Koren Specific Technique (KST), an Empirical/Vitalistic method of locating and correcting subluxations anywhere in the body that is easy to learn and is revolutionizing chiropractic practices.. For information on KST seminars, go to or call 1-800-537-3001.  Write to Dr. Koren at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


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