Fundamentals of HVLA Thrusting - Part A
- Aug 17
- 2 min read
Part A: Hammer and Nail — Avoiding Common Errors
“If all you have is a hammer, everything begins to look like a nail.” — Dr. Neil Osborne, AECC.
In classic chiropractic technique — as I was taught — we often referred to the contact hand as the "nail" and the reinforcing hand as the "hammer." While this metaphor is helpful, it also highlights a major clinical pitfall: when technique becomes rigid or reactive, we risk reducing complexity to mechanical repetition.
One of the most uncomfortable things to witness in adjusting — and something I’ve likely done myself in early years — is slipping or worse, pounding. Both are symptoms of lost confidence, often seen in chiropractors returning after a period of absence or those caught in a cycle of clinical monotony and inefficiency.
Common Errors:
• Slipping occurs when the contact point is not appropriately anchored — the skin slack is missed, and the thrust lacks integrity.
• Pounding happens when the practitioner backs off the joint to “wind up” and then drives into it from a distance, creating an uncomfortable, often painful force.
Neither of these errors results in clean, safe, or neurologically efficient adjustments. Both erode patient trust and practitioner confidence.
Contact and Setup
The nail hand is the active contact. Whether using the pisiform, thumb, or index, it must be placed precisely at the point of fixation, exactly where your palpating finger was. You take Slack, anchor the contact, and maintain that connection throughout the thrust.
The hammer hand reinforces the contact, often stabilising or adding vector control, depending on the technique. The chiropractic arch — a slight concavity in the forearm and wrist—allows you to compress into a narrow, accurate vector without diffusing the force.
The direction of drive is not optional. Unless specific exceptions apply, it follows the restriction and should align with the joint plane.
Your setup determines your success.
Aidan - Enchiridion Chiropractic Training
