Submitted by:
Dr. Nicholas Langley Boden, Chiropractic Physician, 2001 graduate in Chiropractic from Durban University of Technology in South Africa. [1]
The Chiropractic Profession is steeped in a tradition of innovation. Not only in its philosophy and approach to care but also in the use of specially designed equipment and tools that are used in the application of adjustive care or manipulation in correcting mis-aligned joints that influence the function of the nervous system. The chiropractors basic equipment has always been an ‘adjusting table’ and this may come as a simple bench, or as an expensive and complicated table with drop pieces, flexion distraction and a myriad of other moving parts designed to isolate, open and impart the necessary force of a corrective adjustment to a subluxation somewhere in the body.
As an example the tool of the practitioner utilizing ‘Activator Technique’, pioneered as co-inventor by Dr Alan Fuhr [2] is an expensive but technologically advanced instrument specifically designed for the application of this method on his or her patients. The instrument may look simple but its effective use requires extensive training.
Chiropractors make use of many other technologies, amongst them being advanced computerized traction tables, electrotherapy devices, electro-mechanical massage machines of various shapes and sizes and machines providing auxiliary therapeutic options for practitioners, the use of which may be dictated by the philosophical approach adopted by the individual practitioner.
It is a fact that besides designing adjustment tables and chairs a number of electro-therapy devices claimed to be “Physiotherapy Equipment” were invented and developed by members of the chiropractic profession. [3]
Technology is utilized not only for treatment, but also for diagnostic purposes. Surface Electromyography (SEMG) scanning devices, advanced computerized activator programs are not only used for diagnosis but also to treat. The use of Magnetic Resonance Imaging (MRI), foot analysis devices, postural scanning programmes and specialized computer software designed to assist in the reading and analysis of x-ray films are all examples of the integration of Chiropractic with high level technology. Practitioners of allopathic medicine used decadent techniques in their practice for many years yet over the last 30 years they also have embraced new digital technologies that assist them in the diagnosis and treatment of their patients’ conditions.
There are ever increasing areas where technological advances have increased the effectiveness of chiropractic practice both in the area of diagnostic skills and in the development of more effective and “patient friendly” treatment procedures. The following have created a better environment for both the patient and the practitioner:
a) Diagnostics
Surface Electromyography (SEMG) scanners (which measure the amount of what is termed “electrical activity” being generated through muscle tension) integrated into advanced activator technology has spawned a whole new protocol of treatment where following the diagnosis of abnormal muscular tension through spinal ‘passes’ using digital activators, the patient is treated and then reassessed immediately to ascertain the degree of improvement. A graphic ‘before and after’ display is generated by the Computerized SEMG showing clearly any change in the pathophysiological state. This record provides both qualitative and quantitative data to the practitioner. [4]
Digital X-ray imaging and image manipulation tools, with pre-set curve and vertebral angles allow for accurate measurements of sagital and frontal curves to objectively illustrate loss of normal lordosis/ kyphosis as well as the measurement of what is known as “Cobb’s angle” [5] in dealing with the scoliotic patient. The reports that are generated provide accurate medico-legal data allowing for clear and determinable outcomes of care.
Open MRI imaging allows for comfortable and cost effective soft tissue imaging for diagnosis of disc pathologies and various types of soft tissue injuries such as those often encountered with injured athletes or in patients involved in other sporting pursuits.
b) Treatment
As indicated above, technological advances have also changed the design of chiropractic tables, allowing for provision of and usage of smoother and more comfortable treatment tables. Many tables now come equipped with pneumatic, electrical and hydraulic devices, which in some cases raise the table to a vertical position for ease of positioning the injured patient and also to minimize stress on the practitioner. [6]
Supportive forms of therapy, such as electro-therapy, ultrasound and laser devices continue to integrate various diagnostic tools into their interfaces allowing for muscle testing before and after therapy. Therapeutic super pulsed laser devices have been developed, which are used throughout the world to treat acute/chronic pain, bursitis, back pain, carpal tunnel, arthritis pain, tennis elbow, muscle strain, tendonitis, and other conditions. Chiropractors are among the major practitioners using these devices.
Out-moded traction tables which were seldom “patient-friendly” are now being replaced by computer-controlled traction tables with specific algorithms of traction, such as the Chattanooga Groups Triton DTS. [7]Whereas ultra-sound and other common electro-therapeutic devices have been upgraded there are other developments where the chiropractic profession is involved. Shockwave therapy, although not new (developed in Europe in the 1970s introduced in Canada in the mid-1980s) has been a boon in the treatment of previously complicated sporting injuries, allowing rapid resolution of such conditions as achilles tendonitis, tennis and golfer’s elbow, plantar fascitis and shoulder tendonitis. In the last 10 years, over 300 articles and abstracts have been published and written regarding the efficacy of shockwave therapy[8][9][10]
The Spinecor dynamic Brace, developed in Canada is the first and only dynamic brace for the treatment of idiopathic scoliosis. Unlike hard moulded braces it is comfortable to wear can easily be concealed beneath clothing and is flexible. This allows the patient to be involved in sporting activities without discomfort. [11]
c) Patient/Practice management systems
In this day and age there is provision within most Health Care Professional educational courses for some instruction on business practices and principles. At times representatives from firms involved with business management may be invited to attend the institution as guest lecturers or it may be that the professional association will send a representative to give an informative lecture or just an informal talk pointing the way to organisations who will eagerly look to the young practitioner to purchase their management system or the offer of ongoing mentoring. [12]
It is true that by far the greatest leap in the technological field for many Chiropractors has been the need to embrace a system of electronic patient records, patient management systems, so called “SOAP notes” (an acronym for “Subjective, Objective, Assessment and Plan) and a comprehensive administrative system. To some this has been a challenge as a leap into the world of ever increasing electronic technology. To the graduates of today this is second nature.
Such systems do allow the modern Doctor of Chiropractic to accurately document treatment protocols while increasing efficiency and providing the patient with on demand educational feedback specific to their condition, diagnosis, prognosis and treatment. [13]
Final Comment:
The beauty of Chiropractic practice is that for the not so modern chiropractor (with a few decades in practice} even without technological advances, a simple but skilled adjustment can still be given with the most advanced technology we possess; the human hands.
SPINAL DISC DECOMPRESSION THERAPY (DTS)
Definition
DTS Therapy is a non-surgical and traction based therapy for treating low back, leg and cervical neck problems. It involves a computer controlled instrument that cycles through distraction (pulling) and relaxation phases that causes a vacuum effect within the discs that draws water and nutrients into the disc to speed its healing. In order to ensure maximum, lasting improvement, the treatments are prescribed by physician following specific protocols including a combination of static, intermittent, and cycling decompressive forces to relieve pressure on the structures that may be causing the pain.
Conditions treated with DTS
Specifically, the system provides a program of treatments for relief from pain for those patients suffering with low back and neck pain, as well as pain that radiates down the leg or arm. In addition to that, the DTS System treats a wide variety of conditions including:
- Disc Herniation
- Facet Syndrome
- Sciatica (pain down the leg)
- Discogenic Pain
- Spondylolisthesis (Grade 1)
- Spinal Stenosis
- Cervical Radiculopathy (radiating pain or pain down the arm)
- Degenerative Disc Disease
Contraindications for DTS
Even though DTS Therapy is considered an inherently safe procedure used for a wide variety of anatomical dysfunctions of the low back commonly associated with back pain, there are some patients with the following conditions who should not be treated with this therapy:
- Severe Osteoporosis
- Vertebral Fractures
- Spondylolisthesis (Grade 2 or higher)
- Spondylolysis
- Unstable Post Surgical Conditions
- Any kind of surgical hardware
Other patients who should be excluded from the use DTS Therapy are the ones presenting pathological lesions or congenital deformities of the vertebral column, such as fractures, tumor, severe osteoporosis, or spina bifida; and progressive disease or inflammatory processes of the spinal joints or muscles.
Therapeutic effect from DTS
Each DTS session lasts approximately in between twenty to twenty-five minutes and the treatments last about 6 weeks-. The typical patient starts feeling relief after the first 5 to 8 treatments. Pre and post treatment According to clinical studies, 86% of patients with disc problems have reported relief with this type of treatment. And MRIs have shown 50% reduction in the size and extent of herniations after 6 weeks of treatments.
Medical practitioners that use DTS Therapy System
Hundreds of doctors throughout the United States are relieving pain utilizing the DTS. Medical practitioners that use DTS include:
- Chiropractors
- Neurologists
- Neurosurgeons
- Orthopaedists
- Orthopaedic surgeons
- Rheumatologists
- Internists,
- Family practitioners, and
- Multidisciplinary practices. [14]
References
- Boden NL. Cutting edge technology and practices. 2010 Feb.
- Lawrence DJ, Cassidy JD, McGregor M, et al. Description and analysis of activator methods chiropractic technique: advances in chiropractic. Mosby-Year Book, Inc, St. Louis, MO; 1995. p.471-520. (vol 3)
- Wing Thomas W. Modern low voltage microcurrent stimulation: a comprehensive overview [Online]. 1989 [cited 2010 Feb]; Available from: URL: www.medcareservice.com
- Marcarian, David MA, A NASA-trained surface EMG researcher [Online] 2010 [cited 2010 Feb]; Available from: URL:http://www.myovision.com/
- Cobb’s Angle [Online] 2010 [cited 2010 Feb]; Available from: URL:www.e-radiography.net/radpath/c/cobbs-angle.htm
- Anrig C. The gonstead system: a specific biomechanical approach for the expectant mother, infant and child [Online] 2010 [cited 2010 Feb]; Available from: URL:http://www.dynamicchiropractic.com
- Yochum et al. Treatment of an L5-S1 extruded disc herniation using a drx-9000 spinal decompression unit: a case report. Chiro Econ; 53(2).
- Gordon, Robert MD, FRCS(C). The results of radial shockwave therapy [Online] 2008 Feb [cited 2010 Feb]; Available from: URL:http://www.canadianchiropractor.ca/
- Jan D, Rompe, Bernhard N, John P, Furia, Nicola M. Eccentric loading, shock-wave treatment, or a wait-and-see policy for tendinopathy of the main body of the tendo-achilles am. J Sports Med 2007 Jan 23;35:374.
- Gerdesmeyer et al. Radial extracorporeal shock wave therapy is safe and effective in the treatment of chronic recalcitrant plantar fasciitis: results of a confirmatory randomized placebo-controlled multicenter study. American journal of sports medicine ajsm preview 2008 Oct 1.
- SpinCor Home Page [Online] 2010 [cited 2010 Feb]; Available from: URL: http://www.spinecor.org/
- DC Mentors Chiropractic Practice Management Group [Online] 2010 [cited 2010 Feb]; Available from: URL:http://www.dcmentors.com/
- Medical Assistant Net [Online] 2010 [cited 2010 Feb]; Available from: URL: http://www.medicalassistant.net/
- Active Life. Decompression Therapy [Online]. 2010 [cited 2010 Feb]; Available from: URL:http://www.activelifemt.com/Decompression.htm#faq8
