Adjusting to Neutral is a neurophysiologically grounded clinical framework that changes not just how you adjust — but how you understand every patient who walks through your door.
Keep me informed Enrolment opens 2027 · Qualified practitioners and final-year students onlyEvery chiropractor knows the pattern. You find the restriction, the adjustment is well delivered, the patient feels better — and a week later, the same segment is back.
Adjusting to Neutral began with that question. Over nearly three decades of clinical work, much of it with neurological, sports, and performance cases, Dr. Russ Hornstein found that the answer lay less in the joint than in how the nervous system controls it — whether the deep, slow-twitch stabilising system can hold the joint at neutral, and how much the rest of the system has to compensate when it can't.
A2N is the clinical framework that grew from that work. It brings biomechanics, proprioception, motor control, and neurology into one line of reasoning — so that what you observe, what you test, what you adjust, and what changes are all connected.
Instead of only asking where the restriction is, A2N teaches you to ask:
Built on tonic congruence, gain modulation, and the neurophysiology of the proprioceptive system — A2N is a complete clinical lens, not a technique add-on. It integrates with everything you already know and do.
How responsive the nervous system is to its inputs. In A2N, gain is the single variable that ties the assessment together — you assess it, localise its source, and measure how it changes after an adjustment.
The slow-twitch postural system provides the stable reference that all movement is built on. The fast-twitch system produces movement. A2N assesses how well the two hand over as speed and load increase, and where that handover breaks down.
Joint dysfunction is not only restriction — it's a failure of stability in a specific direction. Identify that direction, and both the assessment and the adjustment change.
The position in which a joint's control is most coherent. Every A2N adjustment is directed toward it.
A2N addresses the loss of control that lets a joint fall back into dysfunction, not only the restriction you can feel. When the stabilising system can hold neutral again, the correction has something to keep it in place.
The A2N adjustment is translational, directed toward neutral, and never taken beyond the joint's range — one joint, one vector. Working within range makes it comfortable for patients, including those who are apprehensive about being adjusted.
You learn to separate the segment that is failing from the compensation built around it, so you treat what is driving the pattern rather than everything that feels restricted.
Every A2N intervention is tested before and after, using muscle gain, eye movement, and pupillary responses. You no longer have to assume an adjustment worked because the joint moved — you and your patient can see what changed.
When assessment, treatment, and reassessment follow one line of reasoning, it becomes straightforward to explain what you found, why you treated it, and what changed.
The goal is not simply more range of motion — it's movement with stability: restoring deep control around neutral so the patient no longer has to rely on compensation to function.
"It will change your practice in a way where, rather than getting slow gains and having to explain to your patients that it takes time — you are actually resolving the key issues. And with every adjustment, you are bringing people to higher and higher levels of performance." — Dr. Russ Hornstein, creator of Adjusting to Neutral
Evaluate gain, posture, eye movement, and joint control.
Find the joint and the direction in which stability has failed.
Separate the primary dysfunction from compensation and choose what to treat.
Adjust one joint along one vector, toward neutral.
Retest immediately to confirm what changed.
Learn the system.
Develop the skills.
Demonstrate the complete approach.
10 modules of information, each with an assignment that's reviewed individually — so you get personal feedback as you progress.
Hands-on technique instruction in a small-group setting. Assessment, palpation, adjusting — applied to real clinical scenarios under supervision. You'll need to have completed at least the first 4 modules of the online programme before attending.
Refinement of skills. Demonstrate competency in the A2N framework across assessment, reasoning, and technique — and leave with your A2N Certification. Requires the entire online programme and the introductory practical seminar first.
Access to a private practitioner community for case discussions, peer learning, and continued development. The only people in the room are practitioners working within the same framework.
Structured coursework, case logs, and application assignments — designed to embed the framework into your clinical practice from day one, not just in theory.
Why joints return to dysfunction, why neutral matters, and gain as the master variable of the nervous system.
In practice: observational assessment, the Quick Gain Index (QGI), and an introduction to pupillary assessment.
How corrupted proprioceptive input (dysafferentation) distorts control, and how the body keeps its positional signals in agreement through congruence and calibration.
In practice: cardinal eye signs, smooth pursuits, and VOR ×1 as a palpation-led assessment of cervical muscle gain.
The slow-twitch postural system, its evolutionary origins, and its role as the reference for all movement, including the reflexive and voluntary tonic layers.
In practice: assessing tonic tone, refining VOR ×1, and introducing VOR ×0 placement.
The fast-twitch movement system, flexible gain, and the handover from tonic to phasic control as speed rises.
In practice: speed and force challenges, and recognising the loss of smoothness as speed increases.
Gaze, thresholds, and the four layers of control working together, bringing the first four modules into one assessment.
In practice: the head-and-eye sequence from eyes only through to VOR +1, leading into the P1 Test, palpation, and joint pairs.
Joint control, the muscular layers around each joint, composite motion, and the Vector of Failure.
In practice: palpation for neutral, joint pairs, and motion assessment.
Common chiropractic presentations traced back, through one line of reasoning, to the loss of control and the Vector of Failure behind them.
In practice: taking a history for the vector and localising the primary lesion.
How a local gain error spreads through the system: tonic dissonance, autonomic effects, and the difference between primary dysfunction and compensation.
In practice: distinguishing primary from compensation, and making the decision on what to treat.
Why the adjustment works: translation toward neutral, one joint and one vector, the neutralising vector, and the use of force and speed.
In practice: adjustment set-ups and delivery for the cervical, thoracic and rib, lumbar and pelvic regions, and the extremities.
The complete five-step sequence in practice, clinical reasoning in complex cases, and communicating findings to patients.
In practice: a full encounter from assessment to reassessment.
Open to qualified chiropractors and final-year chiropractic students. Upon enrolment you'll submit your credentials — registration number and body, or student number and institution.
The online programme is 10 modules, each with an assignment that's reviewed individually — you'll get personal feedback as you go. There's no fixed schedule — work through it at your own pace.
Two days of hands-on instruction in a small group. Technique, assessment, clinical reasoning applied practically. You'll need to have completed at least the first 4 modules of the online programme before attending. Live training is currently taught in London, Bern and Stockholm, with Spain, Atlanta, Minneapolis, and Kuala Lumpur planned for 2027.
Apply what you're learning in practice. Document cases, complete assignments, and bring your clinical questions into the practitioner community.
To attend, you'll need to have completed the entire online programme and the introductory practical seminar. This three-day seminar is a structured assessment of your clinical competency in the A2N framework — across assessment, reasoning, and technique. Pass and you receive your A2N Certification — the credential that demonstrates you can apply the methodology in practice. There's no requirement to attend if you don't need certification — the online programme and introductory seminar are valuable on their own.
A Student Pack with the module context, glossary, and pre-lecture questions, so you arrive knowing the questions the lecture will answer.
The science and reasoning, always brought back to what it means clinically.
Open notes, a module summary, and short-answer review questions.
A specific assessment or skill to use with your patients before the next module.
Video demonstrations of assessments, positioning, palpation, and adjustment set-ups, so live training is spent practising rather than watching.
Eligible students may join the Academy, with A2N Certification subject to professional qualification requirements. A2N gives you a framework that connects subjects you're currently studying separately.
Dr. Russ Hornstein DC has practised for more than 29 years, with a focus on neurological, sports, and performance cases. He developed Adjusting to Neutral and is the author of Tonic Congruence. He teaches A2N internationally, lectures in diagnostics and clinical reasoning at the Barcelona College of Chiropractic, and speaks at chiropractic conferences around the world. He maintains a practice in Lisbon, where he also sees patients from abroad.
Enrolment for the next intake opens in 2027 — here's what the programme costs.
10 modules of theory and clinical reasoning, each with an assignment reviewed individually, plus a full library of technique training videos and community access
Purchased separately, once you're eligible — complete both to qualify for certification, or just the one you need
You must complete at least the first 4 modules of the online programme before attending the introductory practical seminar, and the entire online programme plus the introductory seminar before attending the validation seminar. There's no fixed timeline — go at your own pace. If you don't need certification, the online programme and introductory seminar are valuable on their own.
Live training is currently taught in London, Bern and Stockholm. Planned additions for 2027 include Spain, Atlanta and Minneapolis in the United States, and Kuala Lumpur. Dates and venues will be announced as they are confirmed.
We're preparing the next intake of the A2N Certification Programme. Let us know you're interested and we'll make sure you hear first.
Keep me informed Qualified practitioners and final-year students only