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1. {citation from Wikipedi} "a Spinal adjustment and chiropractic adjustment are terms used by chiropractors to describe their approaches to spinal manipulation , as well as some osteopaths , who use the term adjustment .

{citation from The World Chiropractic Alliance }The goal of the chiropractic adjustment is to correct the spinal subluxations detected during the examination. To do that, the doctor applies pressure to the bone and "unlocks" it from its improper position. The bone will then be free to align itself correctly.

{citation from SpineUniverse }During a back adjustment, your back undergoes quick, gentle stretching of the spinal joint, so you may hear a cracking or popping noise. This is caused by small pockets of air or bubbles, which are in the fluid that surrounds your joints. When joint tissues are stretched during a chiropractic adjustment, the pockets of air "pop," which creates that cracking sound you hear.

{citation from National College} Spinal adjusting is thought to gap the Z joints (14)


Spinal adjustment is the chiropractic term for a procedure otherwise known as spinal manipulation. When the tern is used by chiropractors following old philosophy from 1800s, it is specifically intended to correct vertebral subluxations . Spinal manipulation has documented use as far back as Hippocrates and the ancient Egyptians. The techniques were often handed down from generation to generation by families of bonesetters . The modern form of spinal manipulation techniques have characteristic biomechanical features , and are usually associated with an audible "popping" sound. There is strong evidence that this sound is the result of a phenomenon known as cavitation. Many adjustment techniques and methods have been developed through the years by chiropractors, not all of which involve high velocity low amplitude (HVLA) thrust manipulation.


In a section entitled "Spinal Manipulation: The Chiropractic Adjustment", chiropractic authors and researchers Meeker and Haldeman write that the core clinical method that all chiropractors agree upon is spinal manipulation , although chiropractors much prefer to use the term spinal "adjustment", a term which reflects "their belief in the therapeutic and health-enhancing effect of correcting spinal joint abnormalities." (p. 218) [ 1 ]

Defined as unique to chiropractic

Even though, the chiropractic profession would like ownership of the word "adjustment" Several professional also would adjustments like D.O., N.D., and P.T.'s. Chiropractic is a specialized field in the healing arts, and by prior rights, the spinal adjustment is distinct and singular to the chiropractic profession." [ 2 ] One author claims that this concept is now repudiated by mainstream chiropractic. [ 3 ] The definition of this procedure describes the use of a load (force) to specific body tissues with therapeutic intent. This ‘load' is traditionally supplied by hand, and can vary in its velocity, amplitude, duration, frequency, and body location (p. 218) [ 1 ] and is usually abbreviated HVLA ( high velocity low amplitude ) thrust. [ 4 ] [ 5 ]

Intention: to correct vertebral subluxations

The intention of a chiropractic adjustment is to affect or correct the alignment, motion and/or function of a vertebral joint. I like the term fixing joint restrictions Specifically, they are intended to correct "vertebral subluxations", the term given to the signs and symptoms that are said by chiropractors to result from abnormal alignment of vertebrae. (p. 218) [ 1 ] This intention forms the legal and philosophical foundation of the profession, and US Medicare law formulates it in this manner:

"Coverage of chiropractic services is specifically limited to manual manipulation of the spine to correct a subluxation... Medicare will not pay for treatment unless it is 'manual manipulation of the spine to correct a subluxation'." [ 6 ]

Adjustment methods

As the chiropractic profession engaged in the pursuit of improving health through adjustments to the nervous system, individual practitioners and institutions proposed and developed various proprietary techniques and methods. While many of these techniques did not endure, hundreds of different approaches remain in chiropractic practice today. Not all of them involve HVLA thrust manipulation. Most cite case studies, anecdotal evidence, and patient testimonials as evidence for effectiveness. These techniques include:

  • Toggle Drop - this is when the chiropractor, using crossed hands, presses down firmly on a particular area of the spine. Then, with a quick and precise thrust, the chiropractor adjusts the spine. This is done to improve mobility in the vertebral joints.
  • Lumbar Roll (aka side posture) - the chiropractor positions the patient on his or her side, then applies a quick and precise manipulative thrust to the misaligned vertebra, returning it to its proper position.
  • Release Work - the chiropractor applies gentle pressure using his or her fingertips to separate the vertebrae.
  • Table adjustments - The patient lies on a special table with sections that drop down. The chiropractor applies a quick thrust at the same time the section drops. The dropping of the table allows for a lighter adjustment without the twisting positions that can accompany other techniques.
  • Instrument adjustments - often the gentlest methods of adjusting the spine. The patient lies on the table face down while the chiropractor uses a spring-loaded activator instrument to perform the adjustment. This technique is often used to perform adjustments on animals as well.
  • Manipulation under anesthesia (MUA) - this is performed by a chiropractor certified in this technique in a hospital outpatient setting when the patient is unresponsive to traditional adjustments.

Adjustment techniques

There are many techniques which chiropractors can specialize in and employ in spinal adjustments. Some of the most notable techniques include:

  • Activator Methods - uses the Activator Adjusting Instrument instead of by-hand adjustments to give consistent mechanical low-force, high-speed clicks to the body. Utilizes a leg-length analysis to determine segmental aberration.
  • Active Release Techniques - soft tissue system/movement based massage technique that treats problems with muscles, tendons, ligaments, fascia and nerves.
  • Bio-Geometric Integration - a framework for understanding the body's response to force dynamics. Can be utilized with many techniques. Focuses on the body's full integration of forces and on assessment for choosing the most appropriate adjustive force application, ranging from light pressure to traditional joint cavitation, for each particular case presentation.
  • Blair Upper Cervical Technique - an objective upper cervical technique focusing primarily on misalignments in the first bone of the spine (Atlas) as it comes into contact with the head (Occiput).
  • Cox Flexion-Distraction - a gentle, non-force adjusting procedure which mixes chiropractic principles with osteopathic principles and utilizes specialized adjusting tables with movable parts.
  • Hole-in-one technique - developed by B.J. Palmer. He, at some point, claimed that the "pure, unadulterated & straight" chiropractors should only treat the upper two cervical vertebrae (C1-C2) , which is the cause of most, if not all, disorders by being misaligned.
  • Directional Non-Force Technique - utilizes a diagnostic system for subluxation analysis consisting of gentle challenging and a unique leg check allowing the body to indicate the directions of misalignment of structures that are producing nerve interference. A gentle but directionally specific thumb impulse provides a long lasting correction to bony and soft tissue structures.
  • Diversified - the classic chiropractic technique, developed by D.D. Palmer, DC. Uses specific manual thrusts focused on restoring normal biomechanical function. Has been developed to adjust extremity joints as well. Most common 80%
  • Gonstead Technique - Developed by an automotive engineer turned chiropractor, this technique uses a very specific method of analysis by the use of nervoscopes, full spine x-rays and precise adjusting techniques that condemns "torquing" of the spine, which may harm the Intervertebral disc.
  • Kale Technique (Specific Chiropractic) - gentle technique which utilizes a special adjusting table that helps adjust and stabilize the upper cervical region surrounding the brain stem.
  • Logan Basic Technique - a light touch technique that works to "level the foundation" or sacrum. Its concept employs the use of heel lifts and specific contacts.
  • NUCCA Technique - manual method of adjusting the atlas subluxation complex based on 3D x-ray studies which determine the correct line of drive or vector of force.
  • Orthospinology Procedure - is a method of analyzing and correcting the chiropractic upper cervical subluxation complex based on vertebral alignment measurements on neck x-rays taken from three different directions. The adjustment can be delivered by hand, hand-held or table mounted instruments along a pre-calculated vector using approximately 1 to 7 pounds of force. The patient is in a side-lying posture with a solid mastoid support. The procedure is based on the work of the late John F. Grostic, D.C.
  • Thompson Terminal Point Technique (Thompson Drop-Table Technique) - uses a precision adjusting table with a weighing mechanism which adds only enough tension to hold the patient in the "up" position before the thrust is given.
  • Toggle Recoil Technique - a quick thrust and release to the upper cervical vertebra, the recoil is to allow the vertebra to oscillate into its proper position.

Mechanisms and effects

All techniques effects ranging from decreased muscle tension to reduced stress. Studies show that most patients go to chiropractors for musculoskeletal problems: 60% with low back pain, and the rest with head, neck and extremity symptoms. (p. 219) The mechanisms that alter nervous system function and affect overall health , clinical trials have been conducted that include “placebo-controlled comparisons [and] comparisons with other treatments”.

The effects of spinal manipulation have been shown to include: relief of musculoskeletal pain, increased range of joint motion, changes in facet joint kinematics, increased pain tolerance and increased muscle strength. (p. 222) [ 1 ] Common side effects of spinal manipulative therapy (SMT) are characterized as mild to moderate and may include: local discomfort, headache, tiredness, or radiating discomfort. (p. 222) [ 1 ]


The World Health Organization states that when "employed skillfully and appropriately, chiropractic care is safe and effective for the prevention and management of a number of health problems." [ 8 ] As with all interventions, there are risks associated with spinal manipulative therapy (SMT). Common, but nonserious side effects include: discomfort, headache, and fatigue which will go away after 24 to 48 hours.


  • 1-5^ David Chapman-Smith (2000). The Chiropractic Profession: Its Education, Practice, Research and Future Directions . NCMIC Group. pp. 160. ISBN 1-89273-402-8 .
  • ^ A.Lisi, M.Bhardwaj. Chiropractic High-Velocity Low-Amplitude Spinal Manipulation in the Treatment of a Case of Postsurgical Chronic Cauda Equina Syndrome . Journal of Manipulative and Physiological Therapeutics , Volume 27, Issue 9, Pages 574-578
  • ^ Peter Gibbons, Philip Tehan. Manipulation of the spine, thorax, and pelvis: an osteopathic approach
14 Studies on the biomechanical effect of a spinal adjustment.Ergonomics and Joint Research Laboratory, National College of Chiropractic, Lombard, IL 60148-4583




Ryan Lambert, DC

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Dr. Lambert has worked with pediatrics, geriatrics, and professional athletes. Dr. Lambert is part of various state and national associations. Dr. Lambert summarizes his philosophy, When you get here it's all about you. You're the reason I am here. The entire visit is centered around giving you an experience uncommon in today's impersonal medical world. After all, you are a unique human being with specific needs that require talented people who truly care, delivered in a professional environment that is first class in every respect.

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"Life can be tough on the body," Dr. Lambert says. "Not only do we have to deal with our day to day stressors, but people like you are working harder and often longer hours. We always seems to be pushing just a little further and in doing so we rarely give our bodies the attention it needs and deserves. Here at Back in the Game it's our mission to treat each person holistically. We'll work with you so that together we are working smatter not harder. You don't have to be a professional athlete to receive the highest quality of care and rehabilitation. Whatever the cause of your pain, we are here to help. Dr. Lambert, a board certified chiropractic physician, who has training in sports medicine at Western States Chiropractic College (WSCC), heads Back in the Game. He currently teaches at the two universities and has been a physician for different community events. Before his doctorate degree, Dr. Lambert received his Bachelor of Science from Rocky Mountain College with a triple major in Chemistry, Philosophy, and Biological Sciences. Dr. Lambert has training in an intensive graduate program in pharmacology at University of Montana. His involvement in WSCC Sports Medicine led to an internship at one of Oregon's top sports injury clinics. Dr. Lambert has learned multiple soft tissue techniques while finishing his Doctorate. He credits his hands on experience with being in other health care arenas such as: Pharmacy Intern, Nurse Assistant and Physical Therapy Assistant intern. 



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“Growing up in Montana gave me a deep appreciation for the outdoors. I have always loved competing in mountain bike races, and since moving to Portland I have started running road races.” Though he sites several great accomplishments he states that this last couple of years has been the most remarkable yet! “I got married to an amazing woman, started my own clinic, we bought our first house, and now have our little boy Copper Gene (Golden Retriever).” “I am so excited to be working here, and am filled with gratitude to be a part of such a dynamic team with such outstanding professionals.”




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Chiropractic & Physical therapy to the Portland metro area: West Linn, Oregon City, Lake Oswego, and Tualatin. Owner & Chiropractor. Ryan Lambert Bellacov will give professional service to bring you pain relief. www.bigsportsmed.com; Dr. Ryan Lambert with years of experience working with athletics.

Chiropractic for the Portland Metro: West Linn, Oregon City, Lake Oswego, & Tualatin