The attitude toward using adjusting instruments in the chiropractic field has changed dramatically since the 1970s, when Veronica Slaughter, DC, was in chiropractic school. At that time, when a classmate adjusted her with an Activator instrument during clinic, both students were asked to leave for violating the school's "hands only" policy.

Today, Slaughter exclusively uses the Activator Method in her Brentwood and Palm Desert, Calif, practices—and she's not alone. Activator is now one of the most widely used techniques in the field, second only to traditional diversified adjustment.

Todd Goldman, DC, uses both the Activator Method and the Impulse Adjusting Instrument from Neuromechanical Innovations, Phoenix, in his Medford, NY, practice, noting the benefits of faster adjustments with less force found with instrument adjusting.

These methods, together with other adjusting instrument advances, are reaching new heights in the chiropractic field. But whether a doctor of chiropractic favors one adjusting instrument over another boils down to personal preference, positive results, and favorable patient response. In looking at recent data that puts adjusting instruments as the number two most favored adjusting method, it is no wonder that adjusting instruments are garnering more acceptance than ever.

An Adjusting Instrument Is Born

The Activator Method is one of the most well-known adjusting instruments. The handheld, spring-loaded Activator instrument weighs in at less than 3 pounds. Featuring four adjustable settings, it can deliver forces of between 10 pounds and 37 pounds of pressure.

The Activator Method was cofounded by Arlan W. Fuhr, DC, who now serves as president of the Phoenix-based Activator Methods International. The technique involves a low-force, high-speed adjustment, which proponents argue results in less soreness for patients than traditional methods. The gentleness of the approach was a deciding factor for Slaughter. "The body is a very complicated machine, and my feeling is that you don't need a lot of force to put it right," she says.

Christi Chism, DC, of Chaparral Family Chiropractic, Scottsdale, Ariz, adopted the Activator technique after witnessing positive results firsthand. During her internship at Parker College of Chiropractic, Dallas, she adjusted half of her patients manually and half using the Activator Method. "[With Activator,] I found that people got well much quicker and got better results with less soreness than with manual adjusting," she says.

Thomas De Vita, DC, of De Vita Chiropractic Office, PC, Acton, Mass, has been using the Activator technique for 30 years. He explains that both traditional diversified adjustments and Activator adjustments produce nearly the same amount of movement—traditional adjustments are usually in the 1- to 1.5-mm range, while the movement using an Activator instrument is between 1 and 1.6 mm. "I tell patients we're accomplishing the same thing, it's just less forceful," he says.

Today, adjusting instruments are now part of the curriculum in every chiropractic program in the country. Even Slaughter's alma mater invited her back to teach the technique.

The Adjusting Instrument Evolves

"The body is a very complicated machine, and my feeling is that you don't need a lot of force to put it right," says Veronica Slaughter, DC.

After 12 years of being involved with instrument adjusting, Chris Colloca, DC, founder/president of Neuromechanical Innovations, created the Impulse Adjusting Instrument. He saw a need to help chiropractors who were hurting their hands by pulling spring-loaded adjusting instruments but who still liked the results they achieved.

"Activator really set the pace, and was a pioneer in the field of instrument adjusting years ago," says Colloca, who set out to develop an adjusting instrument that could be used all day without compromising the doctor's hands and wrists.

Colloca conducted extensive research and development of the Impulse design, which uses more speed, rather than more force, to perform the adjustment. Because of its speed, a doctor can put the Impulse on the area that is dysfunctional and pull the trigger. The result is that the Impulse gets in and out before the patient can tighten up and resist the adjustment.

"With speed, we can stimulate nerves and neuropathways, sometimes better than manual adjustments, and cause more bone movement than slower thrusts. With Impulse, we have done the research and published it. We have actually measured how much the bones move and how the nerves fire," Colloca notes.

Goldman knows firsthand the advantages of instrument adjusting. While practicing with his chiropractor father, Goldman used the Activator Method because he wanted a more repetitive type of adjustment. However, much to his father's chagrin, he kept breaking the instrument. But it was when Goldman suffered a torn ligament in his hand, making regular adjusting difficult to do without aggravating the injury, that he sought out other adjusting instruments.

"I saw a number of these instruments, but never called up. And then I looked at the picture in the ad [for Impulse] and saw Chris Colloca was in it. I graduated with him. I thought, ‘I'm going to get it,'" says Goldman, who sees a considerable amount of patients per week. With the Impulse Adjusting Instrument, he is able to quickly and effectively treat patients while controlling the instrument's tension.

"It helps with patients who are afraid of seeing chiropractors, and good for overweight patients who cannot be adjusted normally," says Goldman, who also notes, "It has a control over how much tension you can use over the cervical spine, thoracic spine, and lumbar spine. With other [adjusting instruments], you can control the adjustment, but not totally control it."

To help doctors continually give their patients effective, pleasant adjusting experiences, both the Activator and Impulse Adjusting Instrument are constantly being improved upon. With the Activator, the calibration of the velocity and force has been fine-tuned over the years, and the latest version reduced the amount of "backfiring" into the chiropractor's hand, which was causing some practitioners to develop carpal tunnel syndrome themselves.

"Every year, there's a new improvement on the instrument," Slaughter says of Activator. "So it allows me to be on top of my game all the time."

The Impulse is also being improved upon, with Neuromechanical Innovations receiving a patent and FDA clearance on its new technology, Impulse IQ.

"It can sense how much motion is taking place during the adjustment. We can thrust at a certain rate, and then tell the instrument to stop when the adjustment has been accomplished," says Colloca of the new technology, which detects a patient's natural frequency and thrusts at that frequency.

A Gentle Approach for Doctors and Patients

The Impulse Adjusting Instrument from Neuromechanical Innovations is tuned to the natural frequency of the body.

Chiropractors themselves also appreciate the gentleness of adjusting instruments on their own bodies, as they don't have to lean over the patients or throw their weight into a manual adjustment.

Nancy Haskin, DC, Frankenmuth, Mich, has used the Activator technique for 14 years, and plans to attend an Impulse Adjusting Instrument training course this fall. Pleased with the Activator and its results, Haskins decided to invest in the Impulse because, with its shock-absorbing grip, it offers less recoil than spring-loaded instruments and is less intense on her body.

"It is much easier on the doctor," says Colloca about the Impulse. "Instrument adjusting in general is easier on the doctor and easier on the patient. Doctors can prolong their practice careers and have more energy throughout the day, and patients who feel apprehensive to begin with embrace this low-force, high-speed regimen … this new wave of chiropractic."

The positive effect of adjusting instruments is also a huge benefit to patients, particularly those who want and need something more gentle than manual adjusting.

When De Vita began practicing the Activator Method, he introduced it gradually, starting with new patients. "Patients started responding, and within 3 months, I had turned my whole practice into an Activator practice," he says.

Both the Impulse Ad­justing Instrument and Activator can be used for any age group and for any condition that warrants chiropractic care, including pain from TMJ and injuries to the knees, ankles, or extremities. They are especially effective for geriatric patients as well as small children, who are typically relaxed with this method. "With geriatric patients with osteoporosis, you're not going to worry about injuring them or creating any type of fractures," says De Vita, whose patients range from infants to centenarians. "You can dial the instrument down to a lower setting to accomplish change without traumatizing the joints."

Slaughter has also seen success using the method to treat patients with Bell's palsy, who recover rapidly after an Activator adjustment. She even applied the technique to a patient with tic douloureux, whose physicians had recommended a surgery that would have cut the trigeminal nerve in her face to stop the pain. "She never had the surgery," says Slaughter, who suspects the root cause of the pain was a problem in the patient's neck. "I adjusted her twice, and the pain went away."

Growing More Popular

Both Colloca and De Vita note that in the latest survey from the National Board of Chiropractic Examiners, 72% of the profession said they used adjusting instruments to some extent in their practices. However, De Vita cautions that this does not mean all 72% are experts in the technique, which is why he recommends attending seminars annually.

"Anybody can have a hammer, but that doesn't make them a carpenter," De Vita says. "In the same way, anybody can have an instrument, but it doesn't mean they know what they're doing with it. It's the knowledge to apply the proper protocols so that you know what you're doing with it."

Of course, the use of adjusting instruments doesn't appeal to all practitioners. "Some really fabulous doctors just don't feel comfortable using an instrument," Slaughter says. "They'd really rather use their hands." She adds that the Activator Method hasn't eliminated human contact in her practice, however. "I hug my patients, I palpate my patients," she says. "But when it comes to the adjustment, I use the adjusting instrument.

"All chiropractic techniques are valid and wonderful," she says. "It's just that this technique works best for me. I would encourage every young doctor to check it out."

Ann H. Carlson is a contributing writer for Chiropractic Products. For more information, contact .