HEDO and the Flying Seven

The adjustment sequence that you might receive at a chiropractic office can be similar whether you are being treated for a low back problem, whiplash, posture issue, or some other reason. This is because there are some standard methods of chiropractic treatment.

A chiropractor adjusts a patient on a white background
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Treatment uniformity is not isolated to each chiropractor’s office or one type of chiropractor. Rather, it tends to be the norm across the majority of offices.

Chiropractors have a couple of names for this type of practice. They are the “flying seven,” and HEDO. HEDO is an acronym that stands for “hit every damn one” and it specifically includes seven areas of adjustment. HEDO and “flying seven” refer to the same thing.

So what’s up with HEDO? Does chiropractic treatment consist only of the flying seven?

HEDO and the flying seven are not well studied or reported in the medical literature. This may be because chiropractic is considered a controversial and alternative treatment, and as such, may lack the comprehensive inquiry of more conventional treatments. 

Overview

HEDO refers to seven areas of the body that a chiropractor will treat for nearly every patient. The flying seven adjustments are made to the cervical (neck), thoracic (middle spine), lumbar spine (lower spine), and then to the lumbosacral area on either side.

The sequence is as follows:

  1. Back to front adjustment in the thoracic spine: Keith Innes, D.C., reported that "chiropractic students who visit(ed) the best doctors of chiropractic in the(ir) area and watch(ed) and record(ed) what was being done to each patient, said this adjustment (called the P A Thoracic adjustment) was given with no thought as to the location or direction of the thrust."
  2. An adjustment to the upper thoracic spine; This is the area of your upper back that is close to the bottom of the neck. This adjustment might be one of two types: One that chiropractors call a right and left combination, or another type, known as a straight arm adjustment.
  3. Upper Thoracic spine: The same as #2 to the other side.
  4. Lower spine: Either a right sacroiliac adjustment or a right lumbar adjustment or some type of combination of the two.
  5. Opposite side lower spine: The same as #4 on the other side.
  6. Neck adjustment: Using rotations, which is twisting on the right, while the patient is lying on their back.
  7. Neck adjustment: The same as #6 on the other side.

Adverse Effects

Innes says the students reported that none of the chiropractors observed made any attempt to screen for signs of vertebral basilar insufficiency before proceeding with the neck adjustments. 

Vertebral basilar insufficiency is generally caused by hardening in the vertebral arteries and/or the basilar artery. This problem can result in reduced blood flow to the brain. Symptoms include dizziness, vision problems, nausea and vomiting, slurred speech, tingling and numbness in hands or feet, sudden weakness, and more.

These arteries are located in the neck. A craniocervical arterial dissection is a traumatic injury affecting one of these arteries, and it is a noted complication of chiropractic manipulation. This injury can cause a stroke or bleeding in the brain, with potentially serious consequences and handicaps as a result.

Where Did the Flying Seven Come From and Where Is It Going?

One chiropractor said that the flying seven was originally taught in school as a way to hit all the important joints of the spine. He also said it was touted as a shotgun approach to help about 80% of patients.

But the HEDO technique can be rough, another poster points out, and that’s why some chiropractors have stopped using it. In fact, it may be associated with a higher injury rate, he adds.

HEDO and the flying seven are likely still going strong in chiropractors' offices all over the country, but as new techniques are developed, it may be that this profession will continue moving in the direction of individualized treatment plans based on qualified diagnoses.

As the chiropractic profession grows and expands, this practice may be slowly changing. In fact, studies examining chiropractic techniques are beginning to rate the benefits of specific chiropractic techniques in certain conditions, including uncomplicated low back pain, sacroiliac joint dysfunction, posterior joint/subluxation, and low back pain with buttock or leg pain.

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  1. Shannon ZK, Vining RD, Gudavalli MR, Boesch RJ. High-velocity, low-amplitude spinal manipulation training of prescribed forces and thrust duration: A pilot study. J Chiropr Educ. 2020 Oct 1;34(2):107-115. doi:10.7899/JCE-18-19

  2. Albuquerque FC, Hu YC, Dashti SR, Abla AA, Clark JC, Alkire B, Theodore N, McDougall CG. Craniocervical arterial dissections as sequelae of chiropractic manipulation: patterns of injury and management. J Neurosurg. 2011 Dec;115(6):1197-205. doi:10.3171/2011.8.JNS111212

  3. Gatterman MI, Cooperstein R, Lantz C, Perle SM, Schneider MJ. Rating specific chiropractic technique procedures for common low back conditions. J Manipulative Physiol Ther. 2001 Sep;24(7):449-56. PMID: 11562653.

Additional Reading
  • Amaro. The Chakras and the Flying Seven. International Academy of Medical Acupuncture website. May 1993.

  • Chiropractic. Reddit.

  • Innes K. What If... Dynamic Chiropractic. September 1992.