Low-Force Chiropractor in Louisville, CO | Apex Chiropractic

By Dr. Shane Kurth, D.C., BCN

Medically reviewed by Dr. Shane Kurth, D.C., BCN · Last reviewed: July 2026

This article explains what Torque Release Technique (TRT) is, how the Integrator™ instrument works, and how Apex Chiropractic’s assessment-driven protocol operates in clinical practice. It also covers candidacy honestly — including who should speak with their physician before starting chiropractic care. It is not a substitute for an individual clinical evaluation.

Low-force chiropractic refers to any adjusting method that delivers a corrective impulse to the spine without the high-velocity manual thrust — the twist, crack, or pop — used in traditional spinal manipulation. At Apex Chiropractic in Louisville, the specific method is Torque Release Technique (TRT), delivered with an FDA-cleared handheld instrument called the Integrator™. Before any adjustment is performed, Dr. Kurth conducts a surface electromyography (SEMG) and heart-rate variability (HRV) scan. If that assessment shows the nervous system is already balanced, no adjustment is delivered that visit. TRT is supported by a development-phase randomized clinical trial and a body of published case-study research; larger comparative trials remain an active area of inquiry.

What Is Low-Force Chiropractic — and How Does It Differ from a Traditional Adjustment?

The term “low-force” describes a family of chiropractic approaches that forego the classic high-velocity, low-amplitude (HVLA) thrust — the manual spinal manipulation that produces the familiar audible pop. To be clear about that pop: it is gas releasing from the synovial fluid inside a spinal joint, not bone cracking. HVLA is safe and effective for most healthy adults and carries a strong–moderate evidence base. The 2017 American College of Physicians clinical practice guideline — Qaseem et al., Annals of Internal Medicine, 2017;166:514–30 — recommends spinal manipulation as a first-line nonpharmacologic option for acute and subacute low back pain. That recommendation applies to spinal manipulation as a broad category.

Low-force methods work differently. Rather than a manual thrust, they use sustained contacts, drop-table mechanisms, or handheld instruments to deliver a controlled impulse below the auditory threshold. Common examples include the Activator Method, NUCCA, Cox Flexion-Distraction, and TRT. No single technique has been proven superior to the others across all patient populations.

The clinical case for low-force approaches rests on specific circumstances: a patient with osteoporosis or osteopenia, where HVLA carries a meaningful fracture risk; a patient with post-surgical spinal hardware, where thrusting over an instrumented segment is typically contraindicated; a pregnant patient for whom prone positioning and pelvic torque need to be minimized; a pediatric patient whose spinal anatomy is still maturing; or a patient with anxiety-driven muscular guarding who tenses every paraspinal muscle the moment they anticipate an adjustment. A tense muscle absorbs an HVLA force rather than transmitting it. With TRT, there is nothing to brace against.

Apex Chiropractic uses one low-force method — TRT — and chose it for specific clinical reasons covered in the next section. You can also explore our full range of chiropractic services for context on how TRT fits alongside other care options at the clinic.

Torque Release Technique: The Method Dr. Kurth Uses at Apex Chiropractic in Louisville

TRT was developed by Jay Holder, D.C., in the late 1990s as a systematized, tonal chiropractic method. “Tonal” is worth unpacking: it refers to optimizing the baseline tension and responsiveness of the nervous system — the neurological tone that regulates how your body coordinates, adapts, and responds to stress. This is distinct from purely structural chiropractic models, which focus primarily on joint position.

The core clinical logic of TRT is sequence-driven correction. The method identifies specific spinal segments — called “primary subluxations” in TRT terminology, meaning sites where neurological tension is greatest along the spinal cord — and addresses them in a defined neurological order. The lowest tension point is corrected first. The principle is that correcting primary sites allows compensatory patterns elsewhere to resolve, rather than chasing secondary patterns that may self-correct once the primary site is addressed.

What makes TRT distinct from other low-force methods is three features working together: the pre-adjustment scan determines whether a correction is warranted and where (assessment-gated); the order of corrections follows a defined protocol based on neurological findings rather than symptom location alone (sequence-driven); and the instrument used is the Integrator™, not finger contacts, drop pieces, or other handheld devices (instrument-specific).

In our Louisville clinic, patients often ask why we scan at every visit rather than simply adjusting. The answer is that the scan tells us whether the nervous system has held its previous correction or whether a new input is indicated. Adjusting without that information means making decisions based on the calendar rather than on what the nervous system is actually doing. Apex’s 3 Part NeuroTech Exam explains the full assessment protocol for patients who want to understand every component before their first visit.

How the Integrator™ Works: Precision, Speed, and Instrument Design

The Integrator™ is an FDA-cleared, handheld, spring-loaded adjusting instrument. According to the instrument’s developer, it fires a precisely controlled impulse at a speed of approximately 1/10,000th of a second. The practitioner does not manually thrust; the instrument auto-releases when a preset contact pressure is reached. That consistency ensures reproducible force delivery that does not vary with the clinician’s hand strength, body weight, or fatigue level — and makes TRT adjustments more amenable to research measurement than manual techniques where force profiles vary by practitioner.

What distinguishes the Integrator™ from earlier handheld instruments — including the Activator, which delivers a single-axis thrust — is adjustable torque. The Integrator™ incorporates a rotational component (adjustable left or right torque) combined with a recoil motion, producing a three-dimensional impulse. According to its developer, Jay Holder, D.C., this three-dimensional delivery is designed to replicate the dynamic properties of a skilled manual toggle-recoil adjustment. This is a developer description of mechanical design — not a proven statement of clinical superiority over other instruments.

The development history is worth noting accurately. The Integrator™ was engineered from a randomized, blinded, placebo-controlled research design developed by Robert Duncan, Ph.D., biostatistician at the University of Miami School of Medicine, in collaboration with the Holder Research Institute. This makes the Integrator™ the only chiropractic adjusting instrument whose development included a controlled research protocol with placebo design — a meaningful engineering and methodological distinction, separate from any claim about clinical outcomes for musculoskeletal pain.

The adjustment itself feels like a light, quick tap — similar to a finger snap against the skin. No neck rotation. No table drop. No audible pop. Patients remain fully clothed; the Integrator™ is placed at the identified contact point and fires in under a second. To understand how TRT fits into Dr. Kurth’s full neurological chiropractic approach, see our Torque Release Technique service page.

Before Every Adjustment: What Your HRV and SEMG Scan Actually Measures

Two scans happen before every adjustment at Apex — not as a formality, but as the actual clinical basis for the decision about whether and where to adjust.

Surface electromyography (SEMG) measures the electrical activity of the paraspinal muscles — the muscles that run alongside and support the spine. These muscles should fire symmetrically on both sides of the spine and at appropriate intensity for a person’s activity level. When a spinal segment is under neurological stress, the paraspinal muscles at that level often show asymmetric or elevated electrical activity on the scan. SEMG is a well-established measurement technology used across rehabilitation medicine, orthopedics, and physical therapy, with reliability documented in peer-reviewed literature.

Heart-rate variability (HRV) measures the variation in time between consecutive heartbeats — not heart rate itself, but the beat-to-beat variability. This variability is a marker of how flexibly the autonomic nervous system (the body’s automatic regulatory network governing heart rate, digestion, immune response, and stress adaptation) is operating moment to moment. Higher HRV generally reflects a nervous system that is adaptable and resilient; sustained low HRV can indicate the system is under prolonged stress. HRV is widely studied and applied in cardiology, sports medicine, and stress physiology research.

At the start of each visit, both scans are completed before any adjustment is considered. The SEMG shows where along the spine paraspinal activity is asymmetric or elevated; the HRV reading contributes a picture of overall autonomic tone at that moment. Together, they inform three clinical decisions: Is an adjustment warranted today? If so, at which segment? And with what instrument setting?

One important point about assessment-gated care: if the scans show that the nervous system is holding its previous correction — paraspinal activity is symmetric, HRV is within the patient’s established normal range — no adjustment is delivered. The patient may receive other indicated care, or simply be rescanned at the next visit. This is a clinical decision driven by objective data.

Baseline scans taken at the new-patient exam create a starting point. Follow-up scans at reassessment intervals track objective change over the course of care — independent of pain scores alone. The 3 Part NeuroTech Exam includes the digital X-ray component of the initial workup alongside the HRV and SEMG baselines.

Who Is a Strong Candidate for Instrument-Assisted TRT Care?

TRT is not the right tool for every patient — and we will say so directly. Here is who tends to do well with instrument-assisted care in our Louisville clinic and throughout the Boulder County area, and why.

Patient Profile	Why TRT / Low-Force May Be Appropriate	Notes
Patients with osteoporosis or osteopenia	Reduced bone density raises HVLA fracture risk; instrument adjusting delivers force below the threshold that poses structural risk to fragile bone	Physician co-management recommended; bone density assessment advised before starting care
Post-surgical patients (rods, screws, fusion)	HVLA directly over instrumented or fused segments is typically contraindicated; TRT can work around hardware with precise contact points	Surgical records and clearance from the operating surgeon or spine specialist recommended before initiating care
Pregnant patients	Low-force positioning accommodates pregnancy; instrument adjusting avoids torque through the pelvis and abdomen	Coordinate with OB/midwife; see Apex’s prenatal chiropractic care
Pediatric patients	Children’s spinal anatomy is developing; the lighter force profile of the Integrator™ is well-matched to pediatric presentations	Parental consent; pediatric-specific assessment protocol
Patients with anxiety-driven muscular guarding	A patient anticipating a thrust will tense paraspinal muscles — a tense muscle resists HVLA force; with TRT, there is nothing to brace against	Common clinical pattern; helps patients who have had difficult experiences with traditional chiropractic
Patients with prior cervical or lumbar disc herniation	Low-force delivery reduces torsional load on already-compromised disc material	Imaging review required; additional approaches may be indicated alongside or instead
Adjustment-naive patients and first-timers	Comfortable introduction to chiropractic care; removes the anxiety barrier associated with anticipating a manual thrust	Assessment-first model gives new patients objective context before any treatment begins

If you are not sure whether TRT is appropriate for your specific history, the most useful first step is a new-patient neurological assessment — not a commitment to a care plan. A thorough workup tells us whether TRT is the right fit, whether another approach is better suited, or whether a physician consultation should come first.

Who Should See Their Physician Before — or Instead of — Chiropractic Care

There are conditions where chiropractic care of any kind — including low-force TRT — should not begin before physician clearance. These include: active spinal infection (osteomyelitis, discitis, or spinal abscess); suspected or confirmed spinal tumor or metastatic cancer involving the spine; acute vertebral fracture, including compression fractures in osteoporotic bone; severe or rapidly progressive neurological deficit such as new weakness, loss of coordination, or the bowel and bladder changes listed above; and cauda equina syndrome, which is a surgical emergency.

Conditions where physician clearance or concurrent co-management is strongly recommended before or during chiropractic care include: osteoporosis (to clarify bone density and fracture risk before any spinal intervention); prior spinal surgery (surgeon review of the operative report and current imaging); rheumatoid arthritis or other inflammatory arthropathies affecting the spine, particularly where cervical ligamentous instability is a concern; and patients on anticoagulation therapy who present with unexplained spinal pain.

Some patients arrive at Apex having already completed a full medical workup with their primary care provider or a spine specialist. Others arrive without that workup. If your pain is new, severe, unexplained, or accompanied by any of the red-flag symptoms listed above, we will refer you for medical evaluation before beginning any chiropractic care — including low-force care. That is not a limitation of TRT. It is basic clinical accountability. Dr. Kurth works alongside primary care providers, orthopedists, physical therapists, and other specialists — not instead of them. Co-managed care consistently produces better outcomes than either discipline working in isolation.

The Research Behind TRT: What the Evidence Shows — and What It Doesn’t Yet Prove

TRT has a research history that most technique pages either overstate or ignore entirely. Here is what the evidence actually shows, at what level, and what questions remain unanswered.

Evidence Source	What It Studied	What It Found	Evidence Level
Holder Research Institute / University of Miami (development phase)	The Integrator™ instrument — force delivery, reproducibility, placebo control design	Provided the controlled research setting from which the Integrator™ was engineered; not a treatment outcomes trial for musculoskeletal pain	Technique origin — not a clinical outcomes RCT for back or neck pain
Holder et al., Molecular Psychiatry (Nature), Vol. 6, Suppl. 1, 2001	Subluxation-based chiropractic (TRT) in residential addiction recovery	Statistically significant improvement in anxiety and depression scores; improved retention rates compared to control group	Single study, specific population; does not generalize to musculoskeletal pain conditions
SEMG reliability literature	Paraspinal SEMG intra- and inter-examiner reliability	High reliability documented in multiple peer-reviewed studies; supports SEMG as a consistent measurement tool	Supports SEMG as a reliable clinical assessment instrument; does not independently validate TRT treatment outcomes
ACP Clinical Practice Guideline (Annals of Internal Medicine, 2017)	Spinal manipulation as a category for acute, subacute, and chronic low back pain	Recommended as first-line nonpharmacologic option; strong recommendation for acute and subacute presentations	Strong–moderate for spinal manipulation broadly; does not specifically assess TRT or the Integrator™
Case-study and case-series literature	Various TRT case reports across presentations including depression, neuropathy, and pediatric cases	Positive outcomes in individual cases; no control group	Case-study level — hypothesis-generating, not conclusive

The ACP low-back-pain guideline — Qaseem A, et al., Annals of Internal Medicine, 2017;166:514–30, PubMed ID 28192789 — is the strongest piece of evidence relevant to this conversation. It recommends spinal manipulation as a first-line nonpharmacologic treatment for low back pain, applying to spinal manipulation as a broad clinical category — not to TRT or the Integrator™ specifically.

No large-scale independent RCT has directly compared TRT to HVLA manipulation or to sham treatment for common musculoskeletal pain conditions such as low back pain or neck pain. That research is needed, and stating so plainly is the honest state of the literature as of July 2026.

What this means for patients at Apex: TRT is used because the mechanism is sound, the instrument is reproducibly engineered, and the assessment-gated delivery model reflects how chiropractic care should work — driven by objective findings, not habit or appointment schedules. The pre- and post-care scan data gives you your own objective picture of whether your nervous system is responding.

Your First Visit at Apex Chiropractic in Louisville

The first visit at Apex is an assessment visit — not an adjustment appointment. Nothing is performed until the clinical picture is understood.

Visit / Phase	What Happens	Typical Timeframe
New-patient visit (Visit 1)	Intake, health history review, digital X-ray (if clinically indicated), 3 Part NeuroTech Exam (HRV and SEMG baseline scans)	45–60 minutes
Report of Findings (Visit 2, or same day by protocol)	Dr. Kurth reviews X-ray and scan findings, explains the clinical picture, and proposes an initial care plan	20–30 minutes
Initial care phase	Visits typically 2–3 times per week; each visit begins with a scan; adjustments delivered only where scan findings warrant	Weeks 1–4 (estimated; individual variation applies)
Reassessment	Repeat HRV and SEMG scans compared against initial baselines; care plan adjusted based on objective findings	Around weeks 6–8
Wellness / maintenance phase	Visit frequency reduced based on objective scan findings and patient preference; ongoing monitoring	Ongoing, individualized

These timeframes are general estimates based on typical care patterns. No specific number of visits or timeline of recovery is guaranteed for any condition.

For the scan portion, comfortable clothing works well. The SEMG sensors work best with brief skin contact along the spine; an undershirt may be removed for the scanning segment. The adjustment itself is performed fully clothed.

The adjustment moment: the patient lies face-down on a padded table; the Integrator™ is placed at the identified contact point; it fires in under a second. A light tap — no rotation, no pop. Many patients say they were not certain the adjustment had happened. Some experience mild soreness in the hours following their first few adjustments — a nervous system adaptation response, not an injury — that typically resolves within 24 hours. Staying well hydrated after a visit is useful.

Honest expectation: some patients notice significant changes within the first few visits; others take longer to respond, particularly with chronic presentations. If, at the six-to-eight-week reassessment, there is no objective improvement on the scans, Dr. Kurth will say so — and will discuss whether continuing care, modifying the approach, or referring to another provider is the appropriate next step. For a detailed walkthrough of the first-visit experience, see what to expect on your first day at Apex.

Frequently Asked Questions

Q: What is a low-force chiropractic adjustment?

A low-force chiropractic adjustment delivers a spinal correction without the high-velocity, low-amplitude (HVLA) manual thrust that produces the familiar crack or pop. Handheld instruments, sustained contacts, or specialized tables apply a precise corrective impulse at lower force levels and without manual spinal rotation. The NCCIH overview of spinal manipulation provides useful background on how instrument-assisted and manual techniques are classified. At Apex Chiropractic in Louisville, CO, the method is Torque Release Technique (TRT), delivered with the FDA-cleared Integrator™ instrument after SEMG and HRV scans confirm an adjustment is warranted.

Q: Is Torque Release Technique the same as the Activator Method?

TRT and the Activator Method are related but distinct low-force chiropractic techniques — both use spring-loaded handheld instruments, but the similarities end there. The Activator delivers a single-axis thrust; the Integrator™ adds adjustable torque and a recoil motion for a three-dimensional impulse. Beyond the instrument, TRT is a full tonal protocol: correction order is determined by neurological assessment findings, not pain location. And every visit is assessment-gated — the SEMG and HRV scan determines whether an adjustment is warranted before any correction is made.

Q: Does instrument adjusting work as well as manual chiropractic — and what does the research show?

Comparing instrument-assisted adjusting to HVLA manipulation is an active research area; a large-scale head-to-head RCT for TRT versus HVLA in musculoskeletal pain has not yet been completed. The American College of Physicians recommends spinal manipulation broadly — including both manual and instrument-assisted methods — as a first-line nonpharmacologic option for acute and subacute low back pain; you can review PMID 28192789 on PubMed for the full guideline text (Qaseem et al., Annals of Internal Medicine, 2017). TRT’s strongest published study (Holder et al., Molecular Psychiatry, 2001) involved an addiction-recovery population and does not generalize to musculoskeletal conditions. The honest answer: TRT is supported by sound mechanism and reproducible engineering; the larger clinical trials needed to compare it directly to other techniques for back and neck pain remain an open area of inquiry.

Q: What does a TRT adjustment feel like, and is it safe if I have osteoporosis or prior spinal surgery?

The adjustment feels like a light, quick tap — similar to a finger snap against the skin. There is no spinal rotation, no manual thrust, and no audible pop. According to the instrument’s developer, the Integrator™ fires in approximately 1/10,000th of a second — it is over before most patients register it began. For patients with reduced bone density, low-force instrument adjusting is generally considered more appropriate than HVLA manipulation, which carries higher fracture risk at fragile vertebrae. For post-surgical patients with rods, screws, or fused segments, HVLA over the instrumented area is typically contraindicated; TRT can often work around hardware with precise contact point selection. In both cases, Dr. Kurth recommends bringing relevant imaging and establishing clearance or co-management with the appropriate specialist before care begins. Individual situations vary — this is a clinical conversation, not a blanket guarantee.

Q: Why does my chiropractor sometimes say I don’t need an adjustment that visit?

At Apex, every visit begins with SEMG and HRV scans before any adjustment is considered. If the scans show that the nervous system is holding its previous correction — paraspinal muscle activity is symmetric and HRV is within the patient’s established normal range — no adjustment is delivered. The scan drives the decision, not the number of days since the last visit. Some patients leave without an adjustment and notice they feel better for it, because the correction from the previous visit is still active. This assessment-gated model is the clinical distinction that separates TRT from protocols that adjust as a matter of schedule.

Q: How do I book a low-force chiropractic appointment in Louisville, CO?

Apex Chiropractic offers a new-patient special for first-time visitors that includes your health history consultation, the 3 Part NeuroTech Exam (HRV and SEMG baseline scans), and digital X-ray analysis where clinically indicated. View current offers and book online at the new-patient specials page, or call the clinic directly.

Apex Chiropractic · 183 S Taylor Ave, Unit 162, Louisville, CO 80027 · (720) 328-1790
Mon–Thu: 11:00 AM–1:00 PM and 3:00–6:00 PM · Friday: Closed

Sources

1. Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. “Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians.” Annals of Internal Medicine. 2017;166:514–530. PubMed ID: 28192789. DOI: 10.7326/M16-2367. https://acpjournals.org/doi/10.7326/M16-2367
2. Holder JM, et al. “Increasing Retention Rates Among the Chemically Dependent in Residential Treatment: Auriculotherapy and Subluxation-Based Chiropractic Care.” Molecular Psychiatry. 2001;6(Suppl 1
3. Shaffer F, Ginsberg JP. “An Overview of Heart Rate Variability Metrics and Norms.” Frontiers in Public Health. 2017;5:258. PMC5624990. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5624990/
4. National Center for Complementary and Integrative Health (NCCIH). “Spinal Manipulation: What You Need To Know.” U.S. Department of Health and Human Services. https://www.nccih.nih.gov/health/spinal-manipulation-what-you-need-to-know

About the Author

Dr. Shane Kurth, D.C., BCN is the founder of Apex Chiropractic in Louisville, Colorado, and is board-certified in chronic intractable pain and neuropathy. A graduate of Auburn University with a degree in microbiology, Dr. Kurth has built one of Boulder County’s leading chiropractic practices around evidence-informed, neurologically-based care using the research-driven Torque Release Technique. Dr. Kurth is certified in TRT — a credential held by a small number of chiropractors in Colorado. He has been voted Best Chiropractor in Boulder County for ten consecutive years by the readers of Boulder Weekly.

Dr. Kurth approaches chiropractic care as evidence-informed, scope-honest, and coordinated with broader medical care. He treats patients throughout Louisville, Superior, Lafayette, Broomfield, Erie, Frederick, and the greater Boulder area — working in coordination with primary care physicians, orthopedic surgeons, neurologists, sports medicine MDs, OBs, and other specialists when patients’ cases warrant multi-provider care. He is an active member of the International Chiropractic Association (ICA) and the International Federation of Chiropractors & Organizations (IFCO). Learn more about Dr. Kurth →