THE ACTNATOR METHODS

.. ART Managing Sports Injuries With the Activator Methods Technique AMCT allows the chiropractor to provide adjustments immediately to posttraumatic patients, properly screened, whose range of motion has been compromised and who are therefore unable to be taken to joint tension. By John DeLuca, D.C., C.C.S,p. THE ACTNATOR METHODS Chiropractic Technique is a process of analysis and cor-. rection that produces a clinically safe, non-traumatic and systematic method of evaluation and care of the vertebral subluxation complex and other neuromechanical dysfunctions. The technique is designed to evaluate and affect the nervous system and its reflex mechanisms. It is not simply a method of manipulation. AMCT uses functional arthrokinetic reflex tests that do not depend on palpation, although palpation can certainly be used to confirm the findings. THE ADJUSTING INSTRUMENT The Activator Adjusting Instrument is a patented, FDAapproved, hand-held adjusting device designed to generate reproducible and controlled impulsive force, displacement and acceleration, with specific lines of correction to affect the neuro-orthopedic physiology of the body. The Activator Methods technique attempts to eliminate the enormous variability inherent in chiropractic practice in general, and manual adjusting in particular. Adjustive thrusts generate forces from 3 to 28.5 lbs.' at,50 to 60hz, acceleration of 1.79 meters/see in 2 milliseconds with 0.5 degrees of rotation and 1 mm of translation at the level of the adjustment, with lesser coupled movements being noted at adjacent vertebral levels,' The duration of the Activator thrust, which is between 2 to 4 milliseconds, is 5 to 10 times shorter than the stretch reflex. The stretch reflex of the intrinsic muscles of the spine may be unable to oppose the impact of the force produced by the Activator and therefore cannot resist its effect on contacted articulations.' PURPOSE OF THE TECHNIQUE The neurological involvement of a functional lesion is determined by specific reflex testing (isolation tests). The tests consist of specific active movements by - page 52 NovemberlDecemher 19961...

patients in order to contract and stretch various muscles or muscle groups that originate from different areas of the spine. Neurological involvement demonstrates reflex changes in muscle tone called facilitation, or hyperirritability. When a muscle group is facilitated, its response to stretch or contraction may be both excessive or prolonged.' Such alterations of muscle response apparently affect the functional leg lengths and result in transitory alteration of the relative leg lengths.' These mechanisms are objective subluxation indicators and are apparently clinically reproducible." In contrast, inter- and intraexaminer reliability of palpation has been studied, and some studies have concluded that the findings are unreliable.7,8 Activator adjusting is ideal for areas with compromised range of motion. The Activator Methods adjustment is thought to work by rebalancing the arthrokinetic reflex, as proposed by Bernard and Cassidy." The thrust produces normal or improved joint Today s Chiropractic kinematics and beneficial changes in afferent patterns from joint lesions, which results in a reduction of pain, altered muscle tone and increased mobility. Activator Methods is a standalone technique, but practitioners have the option of supplementing it with soft tissue techniques, such as Nimmo or Active Release, or taping procedures. Adjunctive modalities mayor may not be used according to your own philosophic inclinations. page 53

r TECHNIQUE ADVANTAGES The Activator technique eliminates much of the discomfort, resistance, fear and anticipation that may accompany many high-velocity adjustments, and it allows the chiro- ~ praetor to provide adjustments immediately to post-traumatic patients, properly screened, whose range of motion has been compromised and who are therefore unable to be taken to joint tension. Thus, the technique provides a greater margin of safety than conventional adjusting. Is Activator adjusting really chiropractic? of chiropractic If your definition includes removal of nervous system dysfunction, then the answer is yes. Chiropractic is much more than delivering a force to produce "audibles." The speed of the adjustment seems to be more important than the amount of force" or a joint cavitation" being heard. Even D.D. Palmer wrote: "I am well aware that the majority of chiropractors that an adjustment requires great force. think It is not necessary to use a sledgehammer to drive nails, or a pounder on the keys of a piano to create music nor the jamming down on typewriter keys to write a legible letter. In all conditions, make the adjustment with as little force as possible. the move, the less force required." 12 The quicker Table 1: Paraspinal/ Extraspinal Evaluations BONE OR JOINT Calcaneus Navicular Talus 1st Metatarsal/l Fibula Metatarsal heads Head of Tibia Fibula Patella Greater Trochanter Trochanter Pubic Bone Sacrum Coccyx Ilium Ischial tuberosity Ribs Humerus Scapula Clavicle Carpals AC Joint TM Joint st cuneiform SPORTS INJURIES What makes Activator Methods ideal for sports injuries is its specificity. With the reflex testing procedure, you can verify not only which bone or joint is dysfunctioning neurologically, but also in which specific direction the "Correcting force should be applied. What is also advantageous is that you can immedi- DIRECTION OF MISALIGNMENT POSSIBLE Anterior-Superior Anterior-lateral Inferior Superior, Inferior, Lateral Inferior lateral External, Internal, Anterior, Posterior, Internal, External Superior, Inferior, lateral Superior, Inferior, Anterior Superior, Inferior, lateral Lateral Medial, Lateral lateral lateral Lateral Medial-superior, Lateral-inferior Posterior, Anterior-inferior, Lateral, External Medial, Medial, Lateral, Inferior, Superior Lateral, Inferior, Superior Anterior, Posterior Lateral/ medial Superior, Anterior-inferior, Lateral ately retest and make sure normal neurological function has been restored. Table 1 has a partial list of the anatomical parts and directions that can currently be evaluated. II AMCT analysis can identify dysfunctions in areas that would be quite sensitive or embarrassing to palpation. For example, pelvic subluxation, such as the pubic bone, which I page 54 NovemberlDecember 1996..-

Dr. DeLuca delivers an adjustment with the Activator instrument. is common in the martial arts or in any sports where the athletes are prone to falling, is a lesion that might lead to patient misunderstanding if the doctor tried to locate it in the traditional way. The coccyx is another such area. While it is possible to analyze virtually every bone or joint in the body, you don't have to do so on every visit. Start off with what is known as the basic scan 13 to give a general biomechanical evaluation (Table 2). You can then go ahead and further evaluate any specific areas of complaint or concern. This allows you to quickly and thoroughly analyze and provide care for a patient, or many ath- page 56 letes if working a sports event. Efficiency is very important, especially if you have a busy practice or if you are providing care for the whole team. We know that a problem in one area can lead to serial distortions up or down the kinetic chain. With AMCT you can evaluate any axial or appendicular kinetic chain specifically. For example, if a scapula isn't functioning properly, you will see a misalignment of functional distortion down the kinetic chain of the upper extremity. We have seen athletes with elbow or wrist complaints that have been cleared when we addressed the scapular dysfunction. AMCT allows you to manage the extra spinal structures that make up the bulk of sports injuries. While there is substantial research on the Activator applied to the spine, extraspinal topics are starting to emerge. To date, there have been case studies in the literature reporting favorable outcomes from Activator Methods in the management of shoulders," knees 15 and sacroiliac joints." I arbitrarily break up the population into four types of athletes: competitive, non-competitive, recreational and industrial/workplace. Competitive athletes can run the gamut from professional to Little League. An example of non-competitive NovemherlDecemher 1996

athletes would be most people who work out at a health club. Recreational athletes would be people who bowl weekly or the typical "weekend warriors." Industrial/workplace athletes would be the typical manual laborers or diversified adjusting chiropractors. These categories are non-exclusive, and much overlapping occurs between them. A person could be in all categories at once. Our primary responsibility as sports chiropractors is to prevent injuries. We do that by training the neuromusculoskeletal system to function optimally and by educating the athlete on how to avoid injuries. Our secondary responsibility is to provide care for and rehabilitate injuries, whether they are acute, sub-acute, repetitive/overuse or chronic. Activator Methods technique can be applied to all types of athletes and injuries without exception. GEnlNG STARTED To begin employing the technique, first find a chiropractor in your area who uses Activator Methods exclusively or predominantly and holds certification." Spend a few hours with the D.C., observing how adjustments are made on various parts of the body. Once you are convinced of the efficacy of the technique, enroll in a seminar. In this way, you can properly learn the most up-to- page 58 date corrections and analysis. You can then purchase the instrument at the seminar, if you haven't done so already. We have to differentiate the instrument from the technique. Just because you have the instrument doesn't mean you are able to practice the technique any more than owning a scalpel makes you a surgeon. For the doctor's comfort, I would suggest a table designed for the Activator Methods technique. A regular adjusting Table 2: The Basic Scan Pelvis Knees Pubic Bones T6 L5/L4 L2 C7 Tl2 C2/C1 T8 Occiput T4 Tl C5 table will probably be too low or narrow, creating much wear and tear onthe doctor and lessthan-adequate results for the patient. The higher table will also make it easier to do any ancillary work on the patient. CASE STUDIES Anyone who deals with sports injuries will tell you that the overwhelming majority of complaints are not spinal in nature. The majority of occupational complaints are spinal. Elbows, shoulders, wrists, hips, knees and ankles make up the majority of sports injuries." The more quickly you can start restoring biomechanical integrity to an injured joint, the faster the recovery process takes place and more organized scar tissue will develop. AMCT provides a comprehensive way to quickly evaluate and care for sports injuries. Here are examples of cases where the Activator Methods technique has been effectively utilized: 1. Audrey J., a 38year-old mother of five children who holds a brown belt in Isshinryu karate, presented anterior hip/groin pain of five months that was aggravated by certain kicks. Activator analysis revealed a superior and externally rotated trochanter, as well as a superior and anterior pubic bone. The care plan was specific correction with the Activator instrument. The pain resolved and function increased over five weeks to full resolution. 2. Mike K., a 37-year-old bodybuilder, presented with left shoulder pain that was aggravated by some weight training exercises, particularly bench presses. Activator analysis revealed acromio-clavicular joint dysfunction (separation), anterior, inferior, lateral clavicle and posterior humerus. Care included specific correction with the Activator instrument, as well as instructions to NovemherlDecember 1996

avoid aggravating exercises. The patient responded slowly over three months due to his inability to "train around" the injury by continuing to perform heavy bench presses. 3. Ron R., a 16-year-old high school football player, presented with recurrent bilateral anterior and posterior leg pain aggravated by running. Activator Methods analysis revealed externally rotated and posterior tibias, anterior and inferior proximal fibulas, knee, ankle and foot dysfunctions. Care involved specific correction with the Activator instrument as well as icing the anterior tibias. This patient usually clears in one to two visits as he is highly motivated and complies with home icing instructions. 4. Chris E, a 15-year-old high school baseball and ice hockey player, presented with right knee pain aggravated by playing or practicing. Activator analysis revealed an anterior and externally rotated tibia, and a superior and medial patella. Care included specific correction with the Activator instrument and tubing exercises. The patient's symptoms and dysfunction are usually removed in two to three weeks, but he has experienced occasional recurrences over the last two years. istration among the practitioners. There are two levels of certification: proficiency rated and advanced proficiency rated. Activator Methods is consensus based and keeps evolving. Input is taken from the field and integrated to yield new evaluation procedures and interventions. Chiropractors are required to attend at least 12 hours of continuing Activator Methods education annually to keep their certification.' This ensures that chiropractors are knowledgeable on the latest research and development findings and technical updates and that they can maintain high-level skills. 1989. 3. Slosberg, M., "Activator Methods: and Review," Today's Chiropractic 4. Osterbauer, page 60 P.l, and Fuhr, A.W, "The Current Status of Activator Methods Chiropractic Tichnique, Theory and Training," Chiropractic Technique 2(4): 168-175,1990. 5. Cooperstein, R., "The Derefield Pelvic Leg Check: A Kinesiological Chiropractic Interpretation," Technique 3(2): 60-65, 1991. 6. Fuhr, A. W, and Osterbauer, "Interexarniner Reliability Length Evaluations P.l, of Relative Leg- in the Prone, Extended Position," Chiropractic Technique 1(1): 13-18, 1989. 7. Mior, S.A., King, R.S., McGregor, M., and Bernard, M., "Intra and Inter-Examiner Reliability of Motion Palpation in the Cervical Spine," J ofcca 29(4): 195-198, 1985. 8. Tarr, R.S., Feely, R.A., Richardson, D.L., Mulloy, A.L., Nelson, K.E., Perrin, WE., Allin, E.F., Efursy, M.E., Greenstein, R.D., "A Controlled Diagnostic S.l., and Vatt, Study of Palpatory Procedures: Assessment of Sensitivity and Specificity," JAOA, 1987, pp. 296-301. 9. Bernard, T.N., "The Sacroiliac Joint as a Source of Low Back Pain: An Orthopaedic Perspective," ed. by Vleeming, A., Mooney, V, et ai., Proceedings ofthe First Interdisciplinary World Congress on Low Back Pain and Its About the author: John Del.uca, D. a 1990 Life College graduate, is a certified chiropractic sports physician, a certified strength and conditioning specialist and a Diplomate of the American Academy of Pain Management. He is an instructor for Activator Methods, Inc., and maintains private practices in Bayonne, NJ, and Cranford, NJ Inquiries should be directed to him at 754 Avenue C, Bayonne, NJ 07002. For more information about Activator Methods seminars or products, call (800) 598-0224. c.. c.c.s.e. Relations to the Sacroiliac Joint, Univ. of California, San Diego, Nov. 5-6,1992, pp. 117-144. 10. Herzog, W, "The Biomechanics Manipulative Treatments," of Spinal J Can. Chiro. Assoc. 38(4): 216-222,1994. II. Reggars, lw, Zygapophyseal Chiropractic and Pollard, H.P., "Analysis of Joint Cracking During J Manipulative Manipulation," 12. Palmer, D.O., The Philosophy, Art of Chiropractic, Science and Portland, Ore.: Portland Printing House Co., p. 671, 1910. 13. Seminar workbook, basic manual and seminar notes, Phoenix, Ariz.: Activator Methods, Inc., 1993. 14. Polkinghorn, RS., "Chiropractic Treatment of Frozen Shoulder Syndrome (Adhesive Capsulitis) Using Mechanical Force Manually J Assisted Short Lever Adjusting Procedures," & Physiol Ther 18(2): 105-115, Manipulative 1995. 15. POlkinghorn, RS., "Conservative Treatment of Torn Medial Meniscus Via Mechanical Force, Manually Assisted Short Lever Chiropractic Adjusting Procedures," 16. Osterbauer, & J Manipulative Physiol Ther 17(7): 474-484, 1994. P.l, DeBoer, K.F., et ai., and Biomechanical Assessment of Patients With Chronic Sacroiliac Joint References I. Duell, M.L., "The Force of the Activator Adjusting Instrument," Digest of Chiro Econ Syndrome," J Manipulative & Physiol. Ther 16(2): 82-90, 1993. 17. Referral Directory of Proficiency Rated 27(3): 54-59, Dec., 1984. 2. Smith, D.R, Fuhr, A.W, and Davis, RP., Doctors, Phoenix, Ariz.: Activator Methods, "Skin Accelerator Inc., 1995. Displacement and Relative Bone Movement of Adjacent Vertebra in Response to Chiropractic Manipulative & Physiol Ther 18(2): 65-71,1995. "Treatment KEEPING UP TO DATE Activator Methods certifies its practitioners via examinations to ensure a level of uniformity of technique admin- An Update 17: 4-5,1988. Percussive Thrust," J & Physiological Ther 12(1): 26-37, 18. Bucci, L.R., Nutrition Applied to Injury Rehabilitation and Sports Medicine, Boca Raton: CRC Press, 1994, p. 6. November/December 1996