Central Concern:

Force application changes required when adjusting different body types

What is the real problem? Do I have the skills/knowledge to address the central concern?

When I’m adjusting I’m struggling with changes in force application when swapping between treating
bigger and smaller patients.

Where do I find the information and skills I need? Can I trust the new information source?

The best place for me find information on this topic would be through previously studies. I should look
through PubMed and other journals making sure to choose articles that are peer review as to ensure they
are reliable and up to date.

Do I need a team approach to this? Who do I recruit into my management team?

A study written by Loranger et al. (2016) found that clinical experience was one of the biggest factors in the
correct application of high velocity low amplitude spinal manipulations. With that in mind, if I am to
improve my skills I will need co-operation of my fellow students as currently they are the only individuals
who I have readily available to practice my skills.

How can I be sure this new approach has addressed the central concern OR resulted in a positive
change.

Myers et al. (2012) found that using pressure plates was an effective tool in recording force, however I
don’t have those readily available and some manipulations such as the rotation adjustments cannot be
recorded in regards to the force that is applied to complete the manipulation. However, I do have my peers
and as mentioned by Loranger et al. (2016) expertise was the biggest factor in correct application of force
in adjustments. Therefore my best option is to work with as many different body types as possible, rather
than practicing on the same five to ten individuals I am comfortable adjusting. In addition to this, I must
make an emphasis to discuss with them throughout the adjustment process if they felt I was using too
much force or not enough, encouraging them to give me a much feedback as possible.

Apply my renewed approach to a similar situation

Overall it seems clear that ultimately practice makes perfect. The best way to become proficient is to make
sure I continuously change between patients of different sizes so I can gain a better appreciation of what is
required in relation to force. To do this I practiced the same regional adjustment on a large patient and
then a smaller patient and vice versa. For instance when a found a thoracic restriction on a large patient I
would adjust them then find a smaller patient and find a restriction in the same region, while
simultaneously asking them throughout the procedure if it feels comfortable from their end. With
emphasis on the thrust component of the adjustment. Ensuring to take on their constructive criticism as
their experience is a great tool to help improve my skills. After doing this for a few sessions I found that I
was able to feel far more effectively what force was required as a placed the patient into position and
gained tissue slack. It eventually got to the point where I was placing far less force on even the larger
patients as I could almost instinctively tell what the joint required to achieve the adjustment.
Reference list:

Loranger, M., Treboz, J., Boucher, J., Nougarou, F., Dugas, C., & Descarreaux, M. (2016). Correlation of
expertise with error detection skills of force application during spinal manipulation learning.
The Journal of Chiropractic Education, 30(1), 1-6. DOI: 10.7899/JCE-15-4

Myers, C, A., Enebo, B, A., Davidson, B, S. (2012). Optimized Prediction of Contact Force Application During
Side-Lying Lumbar Manipulation. Journal of Manipulative and Physiological Therapeutics,
35(9), 669-677. https://doi.org/10.1016/j.jmpt.2012.10.010