Practitioners of the Pettibon System use Pettibon products to fight the effects of gravity and other damage, creating permanent positive changes in misaligned spines.

"It’s not the why, it’s the how," says Jeffrey Ptak, DC, with the Ptak Spinal Wellness and Rehabilitation Center in Los Angeles, comparing the Pettibon System with conventional chiropractic methods. And it’s not the why but the how that led to the development of a line of products by The Pettibon System Inc, Gig Harbor, Wash. They range from basics, such as the adjusting table, to Pettibon-specific tools, like the Negative Z and Multiple Digital Toggle (MDT) Adjusting Instrument. All are designed to help chiropractors treat their patients.

The goal for a Pettibon practitioner is the same as that of a conventional chiropractic doctor: to return a misaligned spine to a normalized position and remove subluxations, eliminating pain and other related ill-health side effects. However, this is achieved through more gradual methods intended to create permanent change rather than immediate adjustments that may offer pain relief with no real long-term spinal correction or spinal normalization. Neurological exercises combined with isometric weights and balancing tools, such as the Pettibon Weighting System, are often part of this plan.

The Pettibon Tendon Ligament Muscle Stimulator removes muscle splinting, increases blood flow and metabolic activity, and facilitates toxin removal.

Using the Pettibon System, Ptak has seen permanent improvements in patients’ spines, which he had not been able to achieve consistently using traditional chiropractic methods. "During my 21 years of practice, I have never seen anything this successful. My patients may have felt better energetically, but the images of their spines did not improve and in some cases worsened," Ptak says. A line of products helps to direct exercise and treatment for both the chiropractor and the patient.

X-ray Assistants

To be sure that positive change is happening, the Pettibon patient will be x-rayed at particular points in care—for instance, during the initial evaluation and at the end of the acute care phase. At their initial consultation, patients are x-rayed in a seated position. "Seated films capture more stress on the spine," Ptak says, noting that interdiskal pressure is increased by 35% when patients move from a standing to seated position. Ptak has patients sit in a chair designed for this use but notes that others are happy to use a standard stool chair.

Specific measurements, which will be repeated throughout treatment, are taken. Some, such as the lower spinal displacement, use the head as the origin. "The skull is the most important vertebrae," Ptak says. To ensure its exact position every time, practitioners use the Pettibon Self-Centering Headclamps.

The lightweight clamps mount easily into any pre-drilled buckey or grid. The aluminum skull-alignment rod can remain during exposure, and the plastic patient-contact pads are removable for easy cleaning.¹ The head clamps are particularly useful in determining correction methods for anterior to posterior spine.¹

Ptak also uses the x-ray goggles to complete his x-ray series. They help to ensure film accuracy by determining the relationship of the outer canthus of the eye and the outside of the goggles.¹ The resulting x-ray images allow Ptak to calculate measurements that help determine the patient’s adjustment schedule.

Warm-up Tools

The Therapeutic Wobble Chair helps the patient warm up and stretch the spine and muscles.

During the acute care and rehabilitation phases, patients can be scheduled to come in as often as three times per week. Each visit to Ptak’s office begins with hydration and warm-up exercises. "We ask our patients to drink two to three ounces of Himalayan saltwater, which delivers minerals to the body’s tissues and helps loosen soft muscles," Ptak says.

The patient then performs exercises intended to further warm up and stretch the spine and muscles. "We never adjust a cold spine," Ptak says. Warm-up programs often start on the Therapeutic Wobble Chair. Ptak prescribes six designed exercises that take about 6 to 10 minutes. An additional 8 to 12 minutes are spent completing another series of four different types of exercises on the chair. These are intended to rehydrate disks; strengthen disks, ligaments, and tendons; decrease the potential for injury from adjusting forces; lubricate the spinal joints and nourish cartilage; and prevent adhesions and improve joint integrity.¹

There are several models of the chair (such as with armrests and without, child, portable), but they are all designed to facilitate the entire spectrum of exercise motion needed to achieve these goals. The patented, height-adjustable stool sports a seat that allows 360° of rotation, 40° of side-to-side flexion, and 35° of front-to-back flexion.¹ The prescribed exercises may be similar between patients but are often modified to ensure they are pain- free.

The Pettibon Weighting System features head, shoulder, and hip weights held in place with harnesses for simultaneous use.

Ptak’s patients next complete warm-up exercises using the Repetitive Cervical Traction device. It is designed for use throughout treatment and can be hung on a wall or door. Patient use permits the loading and unloading cycles that impact white tissue, reducing resistance to adjusting force and warming up the muscles and spine. "We may ask patients to perform up to 60 cycles of neck traction. The motion will get the cerebral spinal fluid moving and imbibe water back into the disk," Ptak says.

During the acute phase of treatment, which typically takes two to three weeks, patients next move into a treatment room where they continue their warm up with the Pettibon Tendon Ligament Muscle Stimulator (PTLMS). The vibrating treatment removes muscle splinting, increases blood flow and metabolic activity, and facilitates toxin removal.¹ A caregiver will set the PTLMS at the appropriate wavelength and apply it to the patient’s body. "The PTLMS further prepares the tissues for adjustments and helps to detoxify the body," Ptak says.

After performing six-way cervical spine stretches and any other stretches needed for the low- to midback, patients then undergo examination and adjustment.

Adjustment Devices

"Adjustments are made according to the exam," Ptak says. This involves a posture check, a coupling evaluation, and a neurological leg check. The findings direct the adjustment, which can be facilitated with a range of products. The Pettibon Adjusting Table is a flexible instrument and features a thoracic piece that can be laid flat or raised to a 40° angle. The table is also modifiable for height, lateral cervical adjustments, and anterior dorsal adjusting.

If a patient lacks a curve in the neck, Ptak will use the Negative Z. The instrument was created to hold the atlas while the skull flexes or extends. “Its primary purpose is to help restore lordosis of the cervical spine and adjust the skull out of extension,” says Ptak.

To adjust the mid-back, Ptak uses thoracic-specific tools, either the Dorsal Upper Dorsal (DUD) Thoracic Adjuster, or the Pettibon Waller. The first instrument is designed to adjust the upper dorsal spine from A to P.¹ The waller is an instrument that is used by a standing patient and leverages weight and position.¹

Ptak will then perform specific low-back adjustments, primarily to get motion in the sacrum. Once these treatments are completed, the patient’s spine is treated with the Multiple Digital Toggle (MDT) Adjusting Instrument. Tips of varied sizes allow the Pettibon practitioner to treat patients of all sizes, from babies to very large adults.¹

The electric solenoid driven instrument is lightweight and complements all adjusting techniques.¹ The doctor can choose single or multiple toggles timed at 3.3 seconds, faster than the muscle can react.¹ “This facilitates shared loading of the entire spine and—at the very least—the neck to assure that all the joints are participating in the curve,” says Ptak. And it does so at less risk to the doctor who would traditionally have accomplished the same adjustments with arms, shoulders, and hands.

To deepen the adjustment, patients then perform different types of exercises on either a vibrating or uneven platform. Another x-ray is taken at the completion of the acute care phase to assure the patient is ready to enter the next stage—rehabilitation and correction.

Rehab & Correction

“When entering this phase, patients are stronger—able to do many more exercises and hold their adjustments longer,” says Ptak. He estimates patients can start with about 5 minutes of exercises in the morning and 5 minutes at night and work up to 30 minutes in the morning and one hour at night.

Patient commitment is discussed during the initial office visit and report of findings. The Pettibon System requires patients to actively participate in treatment; the system will not achieve the desired effects if patients do not do their part. “Usually, by the time patients come to see me, they are so sick and tired of being sick and tired that they are willing to do the necessary work,” says Ptak. For patients unwilling or unable to commit, Ptak will not pursue a Pettibon treatment plan.

Those that do continue are required to purchase a home rehabilitation kit for about $480. This includes the Repetitive Cervical Traction, a portable Wobble chair, fulcrums, and the Pettibon weighting harnesses and weights. Patients use these same devices in the office and are trained during the acute care phase.

The fulcrums and weights are customized to normalize a patient’s spinal displacement. A five-piece fulcrum set features fulcrums for the neck and spine with lifters to advance both passive spinal molding as well as support lordosis while performing specific core strengthening exercises. The fulcrums are geared to help mold back lordosis through sustained forces.

The weighting system features head, shoulder, and hip weights held in place with harnesses for simultaneous use. Their purpose is to allow the body’s nervous system to become reprogrammed against gravity, bringing about permanent subluxation correction. The weights and harnesses are designed to train the body and work as complements to each other. “You can’t just use the head weight. You need something for it to work against,” Ptak says.

Because patients need to be strong enough to hold the weights in conjunction with exercises, such as walking, biking, and balancing, their use increases toward the end of rehabilitation. “The weights strengthen the body isometrically and tell the brain to hold the posture differently,” Ptak says.

In the office, patients perform additional isometric exercises using the Pettibon Linked Exercise Trainer. The 3-foot-by-3-foot device works a range of muscles, including the plantar flexors, quadriceps, gluteal and biceps femoris, abdominal and erector spinae, rhomboids and trapezius, pectoralis, TMJ and mastication muscles, and the anterior tibial.¹

Maintenance & Support

Patients move from the rehabilitation phase into maintenance and supportive care (or the stabilization phase) typically within three to six months. Progress is judged through a series of tests which check the strength of muscle groups. “For instance, a woman cannot advance to the weighting system until she can push 25 pounds of pressure and hold it for approximately 45 seconds three times in a row using her cervical neck flexor muscles. A man will need to push 40 pounds three times before advancing into the weighting system,” Ptak says.

Once patients pass their tests and are ready for stabilization care, the Pettibon System recommends reducing the frequency of visits to once a week for approximately one year.² “It takes 90 to 180 days to rehabilitate a muscle, and 18 months or more for ligaments,” Ptak says, who notes that many patients have undiagnosed ligament issues before coming in. A typical program will therefore run about 18 months, according to Ptak. Children may require less time.

Many of the same products, such as the Wobble Chair, the Repetitive Cervical Traction, and the Pettibon Weighting System, will be used throughout all phases of treatment. Weights and repetitions may increase as the patient becomes stronger. “The stabilization phase is the most important to avoid moving backwards,” Ptak says. Patient use of home kits becomes incredibly important even as commitment might wane. Ironically, patients must carry their own weights to remove the weight of the world.

Renee DiIulio is a contributing writer for  Chiropractic Products. For more information, contact .

References

1. The Pettibon System. The Pettibon System 2005 Product Catalog. 2006. Available at: www.pettibonsystem.com/products/index.php. Accessed January 19, 2007.
2. The Pettibon System. Key Components. Available at: www.pettibonsystem.com/system/key_ components.php. Accessed January 19, 2007.