After Terry Peterson, DC, had carpal tunnel surgery 3 years ago, the Mesa, Ariz-based chiropractor looked at severely reducing his practice volume. He was no longer able to easily use manual or mechanical techniques. That was until his friend Christopher J. Colloca, DC, from nearby Phoenix dropped off an electromechanical adjusting device of his own design. That was 3 years ago, and the device has allowed Peterson not only to continue practicing, but to continue at a high volume.

The device—the Impulse Adjusting Instrument® from NeuroMechanical Innovations in Phoenix—is an electric adjusting instrument that is easy to use and effective, Peterson says. As soon as he used the Impulse, Peterson, who had been a practitioner of the Activator Method, found the electric device caused him no discomfort from the recoil. "It’s a very light instrument. It fires so fast that there is no recoil," he says. "It’s much more comfortable to use because of its speed."

Though he originally used the Impulse because it promised to be more comfortable for his use because of the nonexistent recoil, Peterson found it to be an immediate hit with his patients, who clamored for it to be used in their treatment. Peterson’s practice, Leisure World Chiropractic, soon had purchased three more Impulse units, and, to this day, it has four of the devices ready for use in each of its adjusting rooms.

The Impulse has an ergonomically designed handgrip and comes with a stylus that is interchangeable with dual ones. These dual ones come in two designs: for the lumbar and cervical spine. The dual attachments serve specific purposes, Peterson explains. "They are the width of the facets in the lumbar and cervical spine," he says. The Impulse also comes with a 10-foot power cord, and in a carrying case.

Use of Force

The Impulse has three force settings: low, medium, and high. These settings are among the things that make the device unique, Peterson says. The lowest setting has a force of 75 Newtons, or 17 pounds—making it ideal for use on the upper cervical spine, occiput, and any areas of tenderness that the patient might have. The low force of this setting makes it ideal for pediatric and geriatric patients. The medium setting puts out 150 Newtons, or 34 pounds of force. This setting is used on the lower cervical, thoracic, and lumbar spine, and the extremities. The highest setting has 300 Newtons, or 67 pounds of force. This adjustment is ideal for the lumbar spine, sacrum, sacroiliac joint, and hips. "What’s nice about the Impulse is that it’s very versatile," Peterson says. "The 67 pounds of force is about the same as a manual adjustment, just much faster. The Activator can only deliver about half of that [high] setting."

The variable force settings are not the only thing that makes the Impulse different from spring-loaded devices. It also features a preload function, which sets the device to deliver its thrust. A light-emitting diode (LED) indicates whether the device is ready to fire. When the light turns from red to green, it is ready for operation. The Impulse can deliver both single and multiple thrusts.

The Impulse is computer controlled, which means that it delivers the same amount and frequency of thrust from patient to patient. This is different from the more mechanical and manual spring-loaded devices. "Springs wear out," Peterson explains.

And the Impulse is not just a pretty package. Patients have felt the difference with the Impulse. "The very first time I used the instrument on a patient, he told me that it was the first time he felt bone move—that’s very significant," Peterson says.

Peterson was most impressed with the research data that Colloca and others have amassed about the device.

Scientific Data

As soon as Terry Peterson, DC, used the Impulse, he found the electric device caused him no discomfort from the recoil.

Once Peterson was sold on the Impulse’s effectiveness through day-to-day use, he started to look more at the research that backed up the device’s efficacy. Among the innovations the Impulse has used is the ability to measure the frequency at which the patient’s bones oscillate. The device is tuned to the body’s natural or resonant frequency and Peterson says published research shows that other instruments aren’t. "The research is very impressive," he says.

He knows firsthand how impressive some of this research is. Peterson has been involved with a project in which a patient is adjusted with the Impulse while inside a 1,000-hz digital-motion x-ray machine. The patient’s range of motion is then measured. Through an ongoing research study—one that is both very thorough and complicated because of the huge mass of data a 1,000-hz digital machine can record—Peterson says that the Impulse has been shown to help increase range of motion "quite dramatically."

Peterson has been involved in several other studies conducted by Colloca.

But the research data is just the objective proof of the device’s effectiveness, which Peterson sees on a daily basis.

Effective Modality

Peterson has a very demographically diverse patient population. However, most of his patients—70%—are senior citizens. This means many of his patients have more complicated conditions, though he describes the breakdown of his treatments as typical, with the majority being low-back injuries.

Because the Impulse has multiple settings and fires so quickly—about 100 times faster than the human hand—the device is ideal for use on older patients, and Peterson gets many of his patients through medical referrals from physicians. "A lot of the people I treat need referrals—and this is the treatment they tell their physicians they want," he says. He credits this feedback to physicians—a by-product of managed care—as one of the reasons he has experienced a business boom.

Peterson credits the device’s effectiveness to its ability to break up fixation and improve mobilization. "We’re able to normalize movement [with the Impulse] in the spinal segment," he says. "We’re looking at spinal stiffness and degeneration, and this has more to do with fixation."

The versatility of the Impulse extends to its range of use. Peterson says that it can be used just as easily on extremity adjustments and nonspinal problems such as muscle spasms.

Ease of Use

Peterson was able to use the Impulse immediately with little instruction from Colloca. "I first used strict Activator technique," Peterson says. This included using only single thrusts and refraining from using the dual stylus. Colloca introduced him to multiple thrusts and the styluses, and he uses these on a daily basis now.

The inventor of the Impulse has developed a technique specifically for the Impulse: the Neuromechanical System. He teaches the technique in seminars to chiropractic audiences across the country and around the world. Peterson says that any chiropractor with a background in the Activator Method should not have a problem using the Impulse. The device also comes with an introductory DVD that explains the product’s features.

The Impulse also allows for the use of any of the different evaluative tests that are the standards of practice. "It doesn’t matter what analytical tests you perform—if you use the Impulse, you’re going to get good results," Peterson says. "It’s just an easier, more efficient way to [make adjustments]."

While the Impulse is effective in its present form, it is poised to be upgraded in the next few months. The next iteration of the instrument, Impulse IQ, detects the patient’s natural frequency and thrusts at that frequency, turning off when the maximum mobility has been achieved. The chiropractor will then set the pounds of thrust, per the patient or region they’re working on. Existing Impulse users will be able to upgrade their instrument to the new Impulse IQ.

The bottom line for Peterson is the results, and he believes that with the Impulse, results will be better. Another result that Peterson has seen from the Impulse is that it has probably added years to his ability to practice because it does not aggravate his carpal tunnel syndrome.

QUICK CHANGE

Terry Peterson, DC, uses the Impulse adjusting instrument mainly for its effectiveness. Patients report that their pain diminishes and they are back to their normal lives very quickly, compared to techniques he has used in the past. Peterson’s associate at Leisure World Chiropractic—Janeen Wallace, DC—demonstrated the Impulse’s effectiveness. Wallace was treating a new low-back-pain patient—a 26-year-old female—with the Impulse, and achieved virtually immediate positive, measurable results. The patient received interferential therapy to the lower thoracic and lumbar region bilaterally for 10 minutes at 35 mA. The Impulse was set on its highest setting, which delivers the equivalent of 67 pounds of force. Treatment included the pelvis; sacrum; and L5, L2, T12, and T8 vertebral levels. In addition, 5 minutes of vibrating massage was delivered to the affected area to increase circulation and reduce any adhesions. Wallace found that the patient tolerated the procedure very well, and prescribed home management with ice for 30 minutes, three times per day, to decrease inflammation. The patient was scheduled for follow-up 2 days after the initial procedure. Because her preliminary imaging study had the outline of a metallic object—a navel ring—which obscured the affected vertebrae, a second imaging study was scheduled. Upon returning for the follow-up visit, she was reimaged without any metallic items on her person. It was found that the lumbar curve had noticeably straightened. According to Wallace’s own analysis of the case, this was the first time a patient who was being treated with the Impulse device was imaged after only one treatment. The results were analyzed by a computerized x-ray analysis program that can objectively measure the biomechanical and misalignment improprieties related to vertebral dysfunction. It was found that the patient’s average vertebral body rotation was reduced 75% from the 10th thoracic level to the fifth lumbar. Vertebral body rotation present at the 10th thoracic prior to treatment was reduced to zero after the treatment. The other areas treated also showed significant improvement. Though the patient complained about stiffness and soreness during the follow-up visit, her symptoms may have been a result of the vertebrae realignment, according to Wallace’s analysis of the case. For Peterson, this case is strong evidence of the quick results that his patients experience with the Impulse adjusting instrument.

After interferential therapy, treatment with the Impulse, and vibrating massage, the patient’s lumbar curve had noticeably straightened two days later, as the before-and-after x-rays illustrate.

C.A. Wolski is a contributing writer for  Chiropractic Products. For more information, contact .