rotation from the adjusting thrust and implementing additional instrumentation including X-rays, Gonstead Radiographic Parallel, a measuring device to undertake specific biomechanical analysis of the X-ray, and the development of Nervo-Scope, a device said to detect the level of neurophysiologic activity due to the existence of vertebral subluxation based on changes in skin temperature. Heat detector devices are unreliable and lack scientific evidence. The technique gained popularity in the 1960s. About 28.9% of patients have been treated with the Gonstead technique. Torque release technique Trigenics Technique Trigenics is a neurological-based manual or instrument-assisted assessment and treatment system developed and patented by Allan Oolo Austin. The technique is relatively infrequently used by chiropractors compared to other chiropractic techniques such as Diversified, trigger point therapy and Activator. Effectiveness Neuromusculoskeletal disorders Treatment is usually for neck or low back pain and related disorders. For acute low back pain, low quality evidence has suggested no difference between real and sham spine manipulation, and moderate quality evidence has suggested no difference between spine manipulation and other commonly used treatments, such as medication and physical therapy. National guidelines vary; some recommend the therapy for those who do not improve with other treatment. It may be effective for lumbar disc herniation with radiculopathy, as effective as mobilization for neck pain, some forms of headache, and some extremity joint conditions. A 2011 Cochrane review found strong evidence that suggests there is no clinically meaningful difference between spinal manipulation therapy and other treatments for reducing pain and improving function for chronic low back pain. A 2008 review found that with the possible exception of lower back pain, chiropractic manipulation has not been shown to be effective for any medical condition. Non-musculoskeletal disorders The use of spinal manipulation for non-musculoskeletal is controversial. It has not been shown to be effective for asthma, headache, hypertension, or dysmenorrhea. There is no scientific data that supports the use of spinal manipulation for idiopathic adolescent scoliosis. Cost-effectiveness Spinal manipulation is generally regarded as cost-effective treatment of musculoskeletal conditions when used alone or in combination with other treatment approaches. Evidence supports the cost-effectiveness of using spinal manipulation for the treatment of sub-acute or chronic low back pain whereas the results for acute low back pain were inconsistent. Safety All treatments need a thorough medical history, diagnosis and plan of management. Chiropractors must rule out contraindications to any treatments, including adverse events. Relative contraindications, such as osteoporosis