The Chiropractic Adjustment from the Ground Up
FEATURE
Mark N. Charrette
DC
When it comes to chiropractic adjusting techniques, to say the least, a multitude of protocols and philosophies surround them. The indicators for the use of these techniques include X-ray analysis, range of motion, muscle testing, leg length analysis, symptomatology, instrumentation, and many more. In my career, I have had the privilege of being adjusted by many famous chiropractors who developed their own techniques, such as Drs. Thompson, DeJarnette, Gonstead, Pettibon, Grostic, Greenawalt, and Harrison. This has led me to incorporate many aspects of their techniques and viewpoints into the protocols I use to adjust my patients.
As a student at Palmer College in Davenport, Iowa, from 1978 to 1980, I had the privilege of training under and living with Dr. Monte Greenawalt, the founder of Foot Levelers. This showed me very early in my chiropractic training that the pedal foundation—the feet—are extremely important.
D. D. Palmer, trained by a Welsh bonesetter by the name of Root, adjusted the feet on a regular basis. In The Chiropractic Adjuster, he stated, “Chiropractors adjust any and all of the 300 joints of the body, more particularly the joints of the spinal column.” 1 He continued, “Chiropractors are the first to adjust the bones of the foot for the relief of corns.”2 He also stated, in the same book, “Why adjust the lumbar for displacements of the foot?” 3
In my chiropractic experience, five noticed most patients develop a foot condition called pronation, which develops slowly over many years and many heel strikes in an effort to help level the pelvis. As we know, pronation looks like an inward rolling of the feet, where all three arches of the feet decrease their weight-bearing height to some degree.
Analysis shows that most foot pronation is bilateral and asymmetrical. This asymmetry, projected superior in the functional human frame, will perpetuate some degree of pelvic tilting because the femoral heads will not be even. A point that needs to be brought to attention is that most feet that pronate do not have associated symptomatology. Therefore, most feet that need to be balanced and stabilized with orthotics do not (and probably never will be) symptomatic.
The integrity of the weight-bearing arches of the feet is primarily ligamentous in nature, not muscular. Therefore, adjusting the feet, in my opinion, is necessary but will not last or hold for very long after repeated heel strikes through the gait cycle.
The reason for this is most humans take somewhere between 7,000 and 10,000 steps per day, and in a walking gait, there is two-and-a-half times the body weight on every heel strike. Over a period of several years, the ligaments of the feet will plastically deform. This seems to be the reason why, after adjusting the foot and the patient walks several steps, the adjustment does not have a lasting structural effect. This is why, in my postgraduate courses and student lectures, I explain that the use of foot taping/strapping and the use of flexible stabilizing orthotics are not corrective. It is supportive. Once the tape is taken off the foot, or the patient walks without orthotics, the feet will return to nearly the same alignment. That’s why it’s also important to provide multiple orthotics, based on the patient’s shoe type and activity.
In my examination procedure, I do many things that are typical in a chiropractic evaluation. I take a complete history, perform ranges of motion on the spine and extremities, along with various orthopedic and neurological tests. Then the patients’ feet are digitally scanned in a functional position. I also take pelvic and cervical A to P and lateral views. The patient is then given a report of findings and a treatment program that nearly always includes orthotics for the feet.
Since the feet, like every other joint in the human body, are designed to move in a normal or optimal range of motion, I utilize a flexible orthotic. Orthotics that stabilize all three arches of the feet (medial longitudinal, lateral longitudinal, and anterior transverse) while allowing for the optimal range of motion and blocking excessive pronation.
With my approach to adjusting, I pay attention to the feet for mechanical/structural and neurological reasons. Dr. Gillette, the founder of motion palpation, stated, “The base of the spine is not the sacrum, it is the ischia in the sitting posture, and the feet in the standing position.” 4
We know that the chiropractic adjustment does multiple things neurologically. We know that putting motion into tissue, as in the high-velocity, low-amplitude thrust (HVLA), will facilitate the firing of type 1,2, and 3 mechanoreceptors. This will, in turn, inhibit type 4 mechanoreceptors (nociceptors) at a level of the spinal column. This is one explanation or mechanism that explains how the chiropractic adjustment can reduce pain and symptomatology since nociceptors are inhibited from creating an action potential in the sensory cortex, causing the sensation of pain.
Secondly, we know the accumulated firing of nociceptors will reflexively activate the sympathetic nervous system and increase indicators such as blood pressure, heart rate, respiratory rate, and cortisol levels.
Therefore, putting motion into any tissue of the body (the chiropractic adjustment) will facilitate the firing of type 1, 2, and 3 mechanoreceptors. This will cause the sympathetic nervous system to be inhibited to some degree. This is why, in general, our patients feel more relaxed after an adjustment than before an adjustment. “Life is motion” is truly an accurate statement.
I developed a series of extremity-adjusting protocols based on observing hundreds of motion X-rays of the feet, knees, hips, wrists, elbows, and shoulders. Though extremity joints subluxate in a variety of directions, my observations have shown me many common patterns. In the feet, the navicular, cuboid, cuneiforms, metatarsal heads, talus, and calcaneus subluxate in very predictable directions. It seems to me that the greatest distortions in the lower extremity, specifically the feet, can be seen at that part of the gait cycle where the heel and toes are in contact with a level surface known as midstance.
Charrette Whole Body Adjusting Protocols are based on indicators, not symptomatology. I examine the joints of the spine and extremities and observe indicators, then appropriately adjust the spine in a typical diversified style, then feet, knees, hips, wrists, elbows, and shoulders. The adjustments facilitate mechanoreception along with normal ranges of motion. Again, two known effects of the chiropractic adjustment are the reduction/ elimination of pain and symptomatology and the inhibition of the sympathetic nervous system.
In conclusion, I strongly recommend that the chiropractor considers analyzing the body structurally and appropriately balance the weight-bearing load, which usually includes the use of stabilizing orthotics that allow the normal ranges of motion of the feet. A stable pedal foundation is necessary to have all other joints of the body functioning optimally.
References
1.Palmer DD: The Chiropractor ,v Adjustor, The Science, Art, and Philosophy of Chiropractic. 1910, Portland Printing House, Portland, Oregon. P 228
2. Palmer DD: The Chiropractor s Adjustor, The Science, Art, and Philosophy of Chiropractic. 1910, Portland Printing House, Portland, Oregon. P 852
3. Palmer DD: The Chiropractor s Adjustor, The Science, Art, and Philosophy of Chiropractic. 1910, Portland Printing House, Portland, Oregon. P 854
4. Belgian Chiropractic Research Notes. 11th edition. H. Gillet, DC, M. Liekens, DC, Procedure manual by Charles M. Rollis, DC, 1984. MPI. P 85-86
Dr. Mark N. Charrette is a 1980 summa cum laude graduate of Palmer College of Chiropractic in Davenport, Iowa. He is a frequent guest speaker at many chiropractic colleges and has taught over 1,900 seminars worldwide on extremity adjusting, biomechanics, neurology, philosophy, and spinal adjusting techniques. His lively seminars emphasize a practical, hands-on approach. Dr. Charrette is a former All-American swimmer who has authored a book on extremity adjusting and produced an instructional video series. Having developed successful practices in California, Nevada, and Iowa, Dr. Charrette currently resides in Irving, Texas.
