b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSINSURANCE Update INSURANCE Update Legislative UpdateTECHNIQUE Update Factors of Effective HVLA Adjustments:By Dr. David GraberPatient RelaxationMedicareQ&AMedicare Update This is the first in a series of short articles onsure patients are comfortable on the table.Are the cushions OUR HEALTH either too soft and worn, or too rigid and uncomfortable?Is the key factors that make up the delivery of effective high velocity low amplitudethe material easy to move on?Does the footrest adjust for (HVLA) adjustments or manipulations.Thisboth tall and smaller patients?Tables which have adjustable one addresses patient relaxation.Futurehead pieces, abdominal release sections, and/or the ability articles will cover other elements suchto bend in multiple directions can all be utilized for patient as adjusting the most fixated segments,comfort and relaxation. specific contact points, the directional plane or line of drive,Since patient comfort follows doctor comfort, your posture pre-thrust positioning, engagement of the restrictive barrier,and positioning need to be as effortless as possible.The speed of application, peak load amplitude and duration,table must be matched and be the right height to work on a depth of penetration or displacement, and post-adjustmentpatient.Your attire should allow you to move with ease, and neuromuscular, re-education and rehabilitation procedures.your footwear should give you good grounding and stabilityThe more relaxed the patient, the smoother and more efficient the adjustment.Tense patients have muscular rigidity giving resistance to any adjustive thrust.If you have ever had the experience of bouncing off a patient when delivering an HVLA adjustment, or feel like youre adjusting a wall, you appreciate how much patient tension can be counterproductive. Patient relaxation is needed for all four phases of an adjust-ment: the pre-adjustment phase, the set-up phase, during the adjustment, and after its delivery.First and foremost, its important to recognize that your presence matters throughout all phases of the adjustment.Your head and heart need to be focused on the betterment of the patient, and you must stay in the moment.The phrase Patient Time Consciousness, or PTC, was what I learned back at NYCC to describe this state of mind.ItWhen setting up, talk patients through the process, especially means to be fully present with the patient all the time yourein their first few visits.Many people need to be guided with the patient.No distractions or lapses of attention.Justthrough the process in a step-by-step manner, even after being 100% with a patient is nurturing and healing for them,repeated visits.Use touch prompts and verbal instructions to and for the doctor-patient relationship.Its essentially the Zenget them to relax different body parts.Contract-relax PNF of chiropractic care. techniques can ease neuromuscular tension while getting to Pre-adjustment, there are various strategies to ease patientsan end range joint position.All of this is to get the patients tension short of them having a glass of wine.Having thebody to the ideal point of tissue tension, while simultaneously patient relax and breathe on the table for a few minutes,keeping them in the state of the most neuromuscular especially with a hot pack on them, is a simple and low-techrelaxation.method that works great.Preliminary adjunctive therapiesDuring the actual adjustment its critical to have a healers such as electrotherapy, mechanical massagers, intersegmentaltouchgentle, firm, caring, and confident.Non-verbal cues traction, etc. can also be used.There are certain manualare transmitted through your hands in a surprisingly powerful therapy techniques that can serve as a good preliminary to anmanner.Patients can feel your sense of authority, compas-HVLA manipulation.These include Logan Basic Technique,sion, and even your mood through your contact with them.cranio-sacral therapies, SOT blocking, and myofascial releaseThey will respond to your touch and presence.If they sense techniques.If you do rehabilitation in the office, doingthey can trust you and let down their guard, they will.exercises before the adjustment can be very helpful to reduceYou will frequently need to coax patients to fully relax verbally their tension.For those who have a massage therapist(e.g., let it go, relax, deep breath in and out) and on staff, tag teaming with them is a highly desired patientphysically by pre-thrust rhythmic oscillation.This cant be option! rushed as we are looking for the window of opportunity and During the setup and positioning, its important to makethe optimum timing to deliver the adjustive thrust or impulse.12 I Spring 2021 www.anjc.info'