How do you become the kind of chiropractor who can truly be called a expert adjuster -- one with the range of knowledge and mastery of technique required to assess and address the needs of a wide range of patients? 

To find out, we spoke with two experts: Dr. Michael Mestan, the president of Northeast College of Health Sciences, and Dr. Brett Carnevale, chair of the Integrative Chiropractic Therapies Department. They described Northeast's unique philosophy of what future doctors need to learn and how it is taught.

Dr. Mestan emphasized that one does not become a expert adjuster by trying to learn all available techniques. "Some schools are attracted to offering everything because they believe this is what students want," he told us. "They may even mix techniques that are not meant to be mixed. The result? From contextual and best practices perspectives, their graduates end up not being proficient in anything." 


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How Northeast College selects which chiropractic techniques to teach

Northeast College selects techniques to be taught based on two criteria. First, a technique must be used by most chiropractors, as determined by an annual study from the National Board of Chiropractic Examiners. And second, a technique must stand the test of time, backed by ample evidence that it is beneficial in a patient-centered practice.

How something is taught is, of course, as important as what is taught. That is why Northeast College offers students what Dr. Mestan described as "a consistent thread of learning, from when you first start in the Doctor of Chiropractic Program all the way through graduation. The core curriculum focuses on the Diversified Chiropractic Technique, building one skill synergistically upon another, while electives in specialized techniques allow students to diversify as individual practitioners. This approach prepares our graduates to be ready on day one of their careers to provide effective patient-centered care."

Three key areas of specialized chiropractic techniques

We next spoke to Dr. Carnevale, who in a previous article addressed the core curriculum at Northeast College, which focuses on the Diversified Chiropractic Technique. When we returned to discuss the specialized chiropractic techniques the school teaches, he outlined three categories:

  • Historical techniques
  • Low-force techniques
  • Soft tissue manipulation

The importance of historical chiropractic techniques such as Gonstead

Historically, chiropractic has been strongly shaped by individual innovators developing new techniques. As Dr. Carnevale told us, "When you have a profession that is so rooted in the historical context, naturally there will be many techniques and approaches appearing over time. It is important that our students understand which techniques have been substantiated with research and which have not. 

One such evidence-based technique that we teach as an elective is the Gonstead Technique. It has a rich history, and our students need to know where it came from, how it is progressed over time and how it is still related today to the core technique they learn. It is similar to the Diversified Technique, as it still uses a short-lever, high-velocity, low-amplitude thrust, but the assessments are a bit different, as is the approach to the misalignment of what needs correcting. 

Low-force chiropractic techniques

As essential as they are, high-velocity, low-amplitude techniques will not serve in all situations. "That may be contraindicated for certain patients," noted Dr. Carnevale. "Part of our job as chiropractors, when we first see a patient, is to do a thorough history, and an exam based on that, to understand what type of treatment is appropriate for that individual. We may have a geriatric patient, for example, with a concern about osteoporosis or density. These low-force techniques allow us to still mobilize and manipulate areas of the spine without putting as much force into that particular aspect of the spine."

One technique he described is called Activator. "Activator is an instrument-assisted technique. It uses a small, hand-held instrument with a fine, padded point at the end. It is a spring mechanism, and you change the tension on that instrument to be lighter or stronger, for a specific adjustment. There is a little force that goes into that region of the body, but it is considered a low-force technique because, while there's not necessarily less force at that specific contact, there is less manual force going into the patient. It is very effective for a variety of patients from pediatric to geriatric. It can also be used on extremities, including very small structures of the hand or foot where it may be hard to use our hands."

Another low-force technique taught at Northeast College is Flexion Distraction. As Dr. Carnevale explained, "This uses a specialized table which can move in various directions. Combining the table with the hand contact of the practitioner, we can isolate areas of the spine and essentially decompress it, creating motion in that area. We are also changing the pressure within those joints, which research suggests can help alleviate pain and inflammation at the cellular level. It is a very low-force technique because, other than our hand pressure on the patient's back, there is no force at all put into the spine. It's this stretching, this decompression mechanism that's mainly initiated by the movement of the table that creates the motion we're looking for within the spine."

Soft Tissue Manipulation

One more reason that Northeast College graduates emerge as expert adjusters is that the school goes beyond the osseous manipulation and mobilization that characterizes traditional chiropractic adjustment, also teaching "the other side" of manual therapy: soft tissue manipulation. "One thing I reinforce with my students," said Dr. Carnevale, "is that if we are only addressing the bony structures, we're probably missing a big piece of the puzzle with the muscular structures, because they're all connected. So, in our Doctor of Chiropractic Program, we have both core courses and electives that focus on specific techniques in soft tissue.

The first is called ConnecTX, an instrument assisted soft tissue therapy. A team of Northeast College researchers and doctors created this protocol and the instrument it uses to target soft tissue structures. It's taught as a core course, focusing on the spine and the muscular structures around the spine, and in the elective program, where students learn to apply it in the extremities.

Northeast College also teaches a manual soft tissue therapy call Nimmo. According to Dr. Carnevale, "Nimmo focuses on what we call Trigger Point Therapy. What happens with some muscles is that they bind up and develop an area of irritation, in some cases tightening the muscle. We teach our students how to find those trigger points and apply special types of pressure to help relieve them."

Learn more about becoming a chiropractor

At Northeast College, chiropractic is, however, about much more than technique. As Dr. Mestan said, "It's really about a passion for helping others." With its focus on creating expert adjusters, Northeast College equips students to live out that passion.

To learn more about the unique combination of core courses and electives that equip Northeast graduates to succeed as patient-centered practitioners, read the companion article, "Essential Techniques to Learn as a Doctor of Chiropractic," and explore our Doctor of Chiropractic Program.