The New Face of Instrument Adjusting Technology Innovation Solves the Basic Needs of Chiropractic Adjusting

A t the very core of any technology enhancement is the inherent concept of simply solving a need. Take for example the development of air-powered construction tools. We no longer need to swing a hammer four to five times to drive a nail. Today's nail guns harness the power of compressed air to generate the necessary force to drive a nail with the single pull of a trigger. Not only is the air gun less labor for a carpenter, it's also faster and more efficient, allow ing a contractor to do more work and cam more income in the same amount of time. The technology also docs a better job. By setting the air pressure on the compressor, we can drive the nail so that it can be recessed into the wood without any risk of marring the wood, which would commonly happen when using a hammer (side effects). The technol­ogy enhancement of air-powered constmction tools solved the need of more efficient constmction and revolutionized the commercial and residential build­ing industry. Likewise, for the first time, technology enhancement has enabled adjusting instruments to create adjustments that are more efficient and even rival the forces of traditional manual chiropractic adjustments. The future is now. A New Face of Instrument Adjusting Of course, adjusting instruments have been around for decades, and perhaps were most popular­ized within the chiropractic profession by spring-loaded activation devices. These instruments were branded as "low force" and heavily scrutinized for their ability to actually move a bone, driving a research agenda for not only investigation, but also their survival. Unfortunately, however, instru- merit adjusting traditionally has been associated with esoteric chiropractic analyses that have been challenged for their face validity. For instance, followers of the Activator method ana­lyze the feet looking for changes in leg lengths while asking patients to put their amis on their backs or over their heads to confinn a vertebral subluxation at a specified level. According to the method, these arm movements arc assigned to a particu­lar vertebral segment, and Hexing the legs supposedly tells the clinician which side to adjust and whether the adjustment was successful or not. Adapted from Directional Non-Force Tech­nique (DNFT). Activator technique is more closely related to network and applied kincsiology in theory (with its leg checks, pressure tests, and challenges), and this may be the reason that main in the profession have steered clear of it. Others may own an Activator, but don't practice the method. Recognizing the inherent dangers in being associated with other instrument adjusting approaches, our team set out to ac­complish our mission of legitimizing instrument adjusting not only within chiropractic, but also for the general healthcare community and the public. To this extent, we created a strategic plan to assess instrument adjusting utilization and perception, and to provide the improvements and enhancements necessary to advance the technique and the profession. Instrument-delivered chiropractic care can be broken down into two components: the instrument technology itself and the clinical application that the technique is based upon (Figure 1). Figure 1. Instrument adjusting includes the technology of the product represented by the instrument brand and the func­tionality or performance of the device, as well as the clinical application that is taught in the clinical training, which includes the indications to administer the treatment and the clinical deci­sion making accompanying the actual technique application. First, level strategic inputs to assess in legitimizing instrument adjusting include technology development and evaluation of the clinical applications. As shown in Figure 2. research and development drive these inputs, culminating in scientific journal publications that validate the developed technology. Medical device certifications ensure quality and further solidify the nicdicolcgal ramifications of using instrument-adjusting tech­nology in your practice. Through literature review, evidence-based technique development comprises the incorporation of clinical tests with the best evidence as inclusion criteria for adjustment clinical indicators, and clinical training and practi­cal testing arc incorporated to ensure clinical proficiency. Last, efforts to increase the awareness of the instrument-adjusting movement within chiropractic were created through a market­ing and business expansion effort to increase the utilization of chiropractic care by the public. Figure 2. Categorization of the strategic input drivers identified to legitimize instrument adjusting. Technology Inputs So. instead of starting with an instrument and then doing retrospective research the way instrument adjusting research traditionally has been approached, we set out to prospectivcly develop a new family of adjusting instruments to improve the performance and efficiency of chiropractic adjustments. The Impulse® and Impulse iQ® adjusting instruments were bom of this research. We quantified the forces and speeds that were necessary to maximize vertebral motions and ncuromuscular responses (1:2) and investigated how instrument-delivered thrusts differed among normal and pathological states, such as disc degenera­tion and muscle hypcractivity (2-4). We then compared our new technology to existing adjusting instruments in the market, and demonstrated the superiority of the biomechanical charac­teristics of the new Impulse R adjusting instruments (5:6). In this research, higher vertebral accelerations were recorded for thrusts with Impulse R for all three of its force settings com- pared to other instruments. We also critically examined the forces necessary to create vertebral motions (1:7) and compared manual to mechani­cal thnists. With this data, we created adjusting instruments that, for the first time, rivaled the forces of traditional manual adjustments, but 50 to 100 times faster. Just as manual thoracic spine adjustments produce approximately 200 N (8). so do the Impulse instruments (5). Enhancements of spinal motion were revealed during this research line (9) demonstrating the benefit of multiple impulse thnists over single thnists. Validation of a new non-invasive method of dynamic spinal stiffness assessment was also conducted that, for the first time, enabled validated monitor­ing of adjustment responses in real time during treatment (10). introducing a new objective measurement for assessing the biomcchanical outcomes of chiropractic adjustments that we now use in the Impulse iQ R and Impulse Adjust­ing Technique®. Medical Device Certifications. To meet the grow ing demand for our products. I began a new medical device manufacturing company to manufacture the devices to the required specifications. We created several new jobs that grew into a team of more than twenty and instituted a quality management system to drive ourbusincss that fostered our ISO 13485 medical device certification. Independent audits conducted in our facility ensure the safety and efficiency of our systems and procedures and our products" UL R listing attests to the high standards we hold. Our international growth pushed us to receive our Class II medical device certifications throughout the world. Manufacturing medical devices to the highest quality medical standards allows our equipment to be used in hospitals as well as private chiropractic clinics, further sen ing the purpose to legitimize instrument adjusting. Clinical Application Inputs In developing the Impulse Adjusting Technique® (the clinical application training accompanying our products), we knew that we needed to incorporate logical, clear, and readily acceptable objective assessments that were validated, accepted, and easy to perform. We embraced the Centers for Medicare and Mcdicaid Sen ices (CMS) mandated P. A.R.T. analysis to keep chiropractors incompliance with regulations and increase their reimbursements at the same time. Incorporating accepted orthopedic tests combined with static palpation, and range of motion assessment of the spine and extremities. Impulse Ad­justing Technique R considers the patients" response in terms of their pain response (P). asymmetries (A), restrictions in range of motion (R). and the texture and tone changes in the muscles (T) as clinical indicators. Combined with the patient history, initial examination findings, and daily visit analyses, the most valid clinical indicators are incorporated. Chiropractic adjustments with the Impulse® instruments are able to be delivered specifically over the spinal joints and extremities due to the 1 cm2 neoprcne stylus. Single stylus applications arc used to address rotational and lateral flexion dysfunction of the functional spinal units, while dual styluses are used to promote restoration of function in the postcroantc-rior and flexion-extension planes. An array of protocols have been developed for extremity adjusting from TMJ to plantar fasciitis—literally from head to toe with combination adjust­ments (multiple contacts involving the joint and its control­ling muscle origin and insertions). A straightforward patient encounter on each visit can subjectively and objectively track patients" progress consistent with the chiropractic standard of care toward defined outcomes and goals. Clinical training in the Impulse Adjusting System R is offered in most US cities and many international destinations. Didactic and practical sessions arc offered in the proper product usage and clinical applications training. A written and practical certifi­cation examination is offered to measure students proficiency. We have further developed a business and marketing expansion module to assist chiropractors in promoting and marketing their unique niche in chiropractic practice. References Colloca CJ. Keller TS. Harrison DE. Moore RJ. Gunzburg R. Harrison DD. Spinal manipulation force and duration affcel vertebral movement and ncuromuscular responses. Clin Biomcch. 2006Mar:21(3):254-62. Colloca CJ. Keller TS. Moore RJ. Gun/burg R. Harrison DE. Effects of disc degeneration on neuroph\ siological responses during dorsovcntral mechanical excitation of the ovine lumbar spine. J Elcctromyogr Kincsiol. 2008 Ocl;18(5):829-37. Colloca CJ. Keller TS. Moore RJ. Gun/burg R. Harrison DE. Intcn crtcbral disc degeneration reduces vertebral motion re­ sponses. Spine. (Phila Pa 1976 ) 2007 Scp 1:32(19):E544-E55O Keller TS, Colloca CJ, Harrison DE, Moore RJ, Gunzburg R. Muscular contribulions lo dynamic dorsoventral lumbar spine stiffness. Eur Spine J. 2()()7Fcb:16(2):245-54. Colloca CJ. Keller TS. Black P. Nor- mand MC. Harrison DE. Harrison DD. Comparison of mechanical force of manually assisted chiropractic adjust­ ing instruments. J Manipulative Physiol Thcr. 2005 Jul:28(6):414-22. Keller TS. Colloca CJ. Moore RJ. Gun- zburg R, Harrison DE. Harrison DD. Three-dimensional vertebral motions produced by mechanical force spinal manipulation. J Manipulative Physiol Thcr. 2006 Jul:29(6):425-36. Colloca CJ. Keller TS. Harrison DE. Moore RJ. Gun/burg R. Harrison DD. Spinal manipulation force and duration affect vertebral movement and ncu- romuscular responses. Clin Biomcch. 2006Mar.21(3):254-62 Forand D. Drover J. Sulcman Z. Sy- mons B. Hcr/.og W. The forces applied by female and male chiropractors during thoracic spinal manipulation. J Manipulative Physiol Thcr. 2004 Jaiu27(l):49-56 Keller TS. Colloca CJ. Moore RJ. Gun/burg R. Harrison DE. Increased mulliaxial lumbar motion responses during multiple-impulse mechanical force manually assisted spinal manipu­ lation. Chiropr Oslcopal. 2006:14:6. Colloca CJ. Keller TS. Moore RJ. Har­ rison DE. Gun/burg R. Validation of a noninvasivc dynamic spinal stiffness assessment methodology in an animal model of inicrvcrtcbral disc degenera­ tion. Spine. (Pliila Pa 1976 ) 2009 Aug 15:34(18): 1900-5. Dr. Christopher Colloca is the CEO and founder of Neuromechaiiical In­novations, an ISO 13485 certified medical device manufacturer of the Impulse® family of adjusting instruments, based in Chandler, Ari­zona. To learn more information about Neuromechanical Instruments online at www.neuromechanical.com.