To help you enhance your practice and increase your bottom line, Dynamic Chiropractic PracticeINSIGHTS asks practicing doctors of chiropractic, like you, for ideas and solutions that have been tested in real-world environments.In this issue, we asked: "Given your practice style, what features on your chiropractic table do you find most useful when treating your patients? How have you used these features in unique ways that other DCs should know about? If you were looking for a new table to suit your practice style, what are the 'must-have' features?"
While readers clearly stated that the most useful features of chiropractic tables had to do with table adjustments, many of you varied in the types of adjustment features that were must-haves.
James Joseph Lehman of Bridgeport, Conn., named three features of most importance for very specific reasons. Lehman writes: "The most important features on a chiropractic table include vertical lift, a wide, firm surface, and the ability to flex, extend and lengthen the lower half of the table. As a chiropractic orthopedist practicing spinal distraction as taught by Drs. Cox and Leander, I preferred to treat patients suffering with spinal sprains, strains, discopathy, degenerative joint and disc diseases, and spinal stenosis.
"The vertical lift feature enables me to perform evaluation and management procedures in a comfortable position. Dr. Richard C. Ackerman taught me to make certain the doctor and the patient were in positions that properly presented the patient and provided comfort to both parties. The vertical lift feature should provide a horizontal position that enables the physician to examine the patient with appropriate ergonomics.
"A wide and firm table surface provides the patient with more comfort and security. Many patients have complained of a fear of falling off the table due to the narrow surface. In addition, I treat patients suffering with coccygodynia with internal rectal treatment that requires patients to assume a lateral lithotomy position with the knees and hips flexed. The wider and firmer surface enables me to perform the exam and treatment while the patient feels secure and comfortable.
"Finally, I enhance my chiropractic manual treatments by performing spinal traction with multiple features that include flexion, extension, rotation and lateral flexion, in order to decompress the spine. These multiple movement features enhance the decompression effects and results of care by enabling me to treat difficult disc and joint conditions based upon the patient's specific needs. The above-mentioned features are must-haves for my style of chiropractic spinal treatment," Ackerman said.
Dan Batchelor of Roswell, Ga., kept his words concise with two must-have features including: a comfortable face piece; and flexion distraction ability. He added that he uses his table in a unique way to flex the lumbar spine while the patient is prone in order to more efficiently separate L5-S1.
Ron Burman of Ontario, Canada, had some more customized features that were of most importance when looking for a new table. Burman writes: "Tilt function; drop center; headpiece safety elevation; a place for women's breasts; longer-lasting material; and much lighter weight."
Drops and Height
Armando Garza of Honolulu prefers tables that are a specific height with specific drop features. Garza writes: "For me, a table with drops are a must. About five years into my practice, I rediscovered the power of the toggle-recoil atlas adjustment. I now use the table for even extremity adjustments when applicable. Also for me, the height of a table is so important for the longevity of the doctor. I have adjusted on a few different tables, and I found with those that were too short or too high for me, I suffered, and the patient did not get the best adjustment I was capable of giving. I had a table that I had to activate it manually by lifting it up with my hands. This was very difficult if I had a large person. I did hurt myself a few times as well. Since then, I have this table with foot pedals to activate the drop pieces. This has been less strain on my back, and it rises easily without much strain on the foot."
Height and drop features were also important to Kurt Kuhn of Waterloo, Iowa, when he has considered purchasing a table but he includes other must-haves on his shopping list. "Practice considerations should include efficiency to provide quality care in a timely manner, biomechanical advantage to minimize wear and tear on the doctor, and the ability to perform a variety of techniques on it so as to provide the widest selection of tools to help the patient," he said. "I like a table that has flexion/extension capability to speed motion palpation in addition to the therapeutic capability. I also like a table that laterally bends which when combined allows one to optimally use biomechanics to make a more comfortable adjustment for the patient, as well as reduce wear and tear on the doctor.
"Drops make a very quick way to adjust, as does a neck piece that lowers. These methods allow care to be provided that minimizes the movement of the patient, which is what slows down a visit and robs time that is otherwise productive in improving the quality of the encounter because the patient isn't focusing on what you are saying while they are moving.
"In addition to the technique considerations above, SOT blocks or instrument adjusting are also easily used. One final feature is adjustable height. Though infrequently used, it is nice to be able to adapt the height to ease the patient's ability to get on or off as well as to modify the height for the doctor's mechanical advantage."