Competing in the Brave New World: Does a Decompression table fit in?

A ldus Huxley coined the expression and titled his 1932 novel Brave New World to describe the twentieth-century transition into a hypertechnological era. His predictions have not come true in particular, but the conceptual framework that technology can potentially solve most of the worlds" problems is certainly the core of much of Western thinking. Chiropractic seems to posit itself as a bridge between the modem and the ancient: it is modem because we have to ex­ist among the hypcrtcchnology of pharmacology and surgery, yet also ancient because our core modalities predate written history. This is of course one of our strengths and a source of our continued appeal among the sick and injured. As Huxley "s predictions of the new era have not come tnic. the predictions of chiropractic's demise have similarly been "minors greatly exaggerated." However, chiropractic has not been immune to shifts in public opinion and scientific evidence. Custom orthot-ics. laser, ultrasound, diathermy, complex adjusting/impulse instruments, exercise machines, and sophisticated traction/ decompression tables continue to define the modem practice, and rightly so. Massage, manipulation, and traction have been used for thou­sands of years and obviously have contributed to the reduction of suffering for billions over the centuries. When the limitations of these interventions face us. though, fortunately we can turn to technology and receive some assistance. I"vc been involved with all the above modalities and treatment strategies during my near 30 years, and I can say that every year the puzzle continues to expand. Perhaps that is what makes it an enjoyable challenge to continue to sec patients each day, though. No one thing seems to hold all the answers, and even in combination, sometimes failure still faces us. However. I will contend that synergy of modalities seems to work better than the futile search for a silvcr-bullct. My experience tells me the gun that fires a silver bullet typically is pointed at your foot. Axial traction therapy/decompression has been a primary plug-in point for enhancing my practice and outcomes. It has been the arena where I have boldly staked my claim within the profession (a claim that ensnared me in a five-year legal battle with Chattanooga Group—a battle that I fortuitously only recently won). I also can unequivocally attest to this result (financial and patient outcome) in innumerable other chiropractic practices throughout the past 15 years that I"vc been chccrlcading for the treatment. In fact. I can think of no time where any chiroprac­tor completely abandoned decompression therapy after having implemented it for at least 90 days (and our surveys back this up). I"m sure Nutrisystem, Enzyte and Rogainc can't make the same claim. However. I spent five years and nearly $250,000 on various high-end decompression systems before realizing that the notion of a magic-machine was just claptrap. The es­sence of decompression itself is a syncrgistic phenomenon that requires education, not beguiling equipment. This synergy is with our other mechanical and physiologic treatments, and within the attributes and mechanisms of the actual machine. This isn't saying that some magic "technologically advanced" attribute creates the results, but having numerous attributes at your disposal and an understanding of how they fit in reduces the limitations and the misapplication of the therapy. So adding decompression to conditions to warrant it in com­bination with your other treatment modalities on a system that affords broad-based positioning options, simple pull-patterns, uncompromising belting and restraint, and exceptional patient comfort becomes an inevitable practice enhancer. In most competitive markets, laser therapy, drop-tables, adjusting instruments, and certainly decompression become impossible to compete against. You have it or you lose patients to those who do. In competitive markets, the key component to success is knowledge. Accurately assessing the patient's condition(s). the signs and symptoms indicating axial decompression is war- ranted, and how best to classify the patient position, pull duration, and posttreatmcnt strategics is indispensable. We have spent countless hours formulating an education program and treatment algorithm to make sure (as much as is possible) that decom­pression is dispensed to those who arc most likely to benefit. The table you choose to deliver it on is secondary to the patient classification: however, the classification relates to table attributes much the same as muscle strengthening requirements are linked in­extricably to exercise machine attributes. If you require direct strengthening of the extensors, a sit-up machine just won't cut it. If you assess a patient and discover a defincd-cxtension directional preference and chose to amend the patient for prone treatment, it only makes sense that your table affords that specific positioning op­tion in the most exacting way. When designing tables over the years. I have calibrated certain attributes as cither more or less important. Such things as mul­tiple (and confusing) "pull-pattern itera­tions" (scqucnccd pull and rest alterations). TVs. CD players, flexion cranial sections, and oscillation pull-patterns clearly fit in the "less important" category. Items that fit into the "more important" (if not "most important") category in­clude a powered caudle table section that elevates at the waist (instead of sternum): armrests that afford a full prone comfort position; a lateral slide motor for linear "offset" traction: eliminating awkward and bulky knee-bolsters and incorporating the leg support into the sliding table sec­tion; and a variable spring to control the often unwieldy pelvic sliding section. In fact, after 25 years of performing traction on thousands of patients, these attributes appear to be resetting the standard for ef­fective decompression treatment. There is no question that a well-practiced and research-driven doctor can certainly play any table like a finch tuned instrument: however, most will quickly agree that hav­ing to "work around" table limitations is no way to run an effective practice. Those of you who have run a decom­pression-based clinic don"t need much com incing to affirm the benefit it lias for a chiropractic practice. Those who haven't may not realize the amazing paradigm shift that decompression can create. Many doc­tors resist getting into decompression for years only to find that once they do. a full 80% of their patients classify for treatment with it. Unlike an adjusting table, a decom­pression system is a powerful marketing tool. It can become a focal point of patient education and referrals. After owning and operating seven different systems over the years. I"vc noticed that patients engage differenth with decompression tables than any other modality. We often hear patients telling friends and family. "That stretching table is in that room. You should sec if it can help you." We have at least one patient every week ask us to explain the therapy to a friend. Though I have dismissed myself from the idea that a decompression table needs to look like a B-2 or Raptor, it is certainly beneficial that it doesn't look like an age-old hospital traction bench. An aestheti­cally pleasing, modem look is undeniably part of the marketing appeal. From a practical safety perspective, I was convinced a pedestal lift was a necessity as I began developing table designs—not as part of the treatment at­tributes, but as part of clinical safety. Injust the past few years, several children have been injured and/or crushed to death under so-called scissor-lift traction/therapy/mas­sage tables. Since decompression is often an unattended modality (and busy clinics often lose sight of little kids), it becomes imperative to eliminate this risk by looking for column/ped­estal lift tables. Fortunately, the vast majority of such systems arc column lifts, and the majority of those use the safer hand-controlled type (versus a foot pedal). Finally, when implementing a decompression system/table into your practice, it is wise to consider cost versus features. Mam systems simply have very high profit margins and afford very limited clinical benefits and clinically relevant attributes. Often the least-expensive systems make the doctor spend ex­cessive time in preparation on each patient to amend the table to what is clinically necessary. Since I believe unbiased education is the key component to implementing decompression, being educated about the tables before you make a purchase decision might in fact save you time, frustration, and a lot of money in the long run. Dr. Kennedy has developed, tested and taught an effec­tive, easy lo learn decompression therapy technique. His protocols have been taught lo over 4.500 chiropractors and physical therapists. In over 20 years of practice, he has owned and operated most of the decompression therapy equip­ment offered by a range oj manufacturers. This has afforded him the position of having done 100 s of cross-comparison treatments with these units. He believes that it is imperative to "put the doctor into decompression therapy. " This is the major reason for offering this technique certification course, to focus on skills, information, and awareness. The Seminars have been approved for continuing education through Logan College of Chiropractic in various states.