On December 4, 2006, Reuters Health out of New York released information that affects every chiropractor presently treating patients.

Reuters wrote, "Continuous passive motion (CPM), a rehabilitation technique used after various orthopedic operations, stimulates chondrocyte production of proteoglycan 4 (PRG4), a molecule found in synovial fluid with putative lubricating and chondroprotective properties."

The article continued, "The researchers believe the findings could have important implications for growing joint tissue for transplantation.

"CPM is known to promote joint healing, but the cartilaginous effects of the technique were unknown. Recent evidence from in vivo and in vitro studies suggests that CPM may affect PRG4 metabolism," according to the report in the November issue of Osteoarthritis and Cartilage.

The researchers found that CPM did, in fact, increase chondrocyte production of PRG4. Moreover, in joint regions continously or intermitantly exposed to sliding motion, chondrcyte biosynthesis of PRG4 was greater with CPM than without it.

Every time you place a patient on a motorized flexion table and turn the table on, you introduce motion into the joints of the spine and pelvis, hip joints, and even shoulder joints. And according to researchers from the University of California, you are increasing the "Slide in the Glide" for those patients. Why would you not want to improve that patient’s well-being?

After checking the patient’s leg length and lowering the center cushion of the table, you can energize the flexion of the table.

The Leander Technique has been around our profession now for 24 years. At first, the technique was concerned with specific decompression to the lower lumbar vertebral segments and the intervertebral disks that were creating compression. As more patients experienced the beneficial results of being adjusted during flexion-distraction, it became apparent that a whole new protocol was needed, and I chose to call it Leander Technique.

The method of creating the motion in the spine was by means of flexion-distraction. Because the flexion created "Y" axis decompression, the segments within the entire spine benefited and the chiropractor was assisted in his attempt to make specific adjustments even to the cervical vertebra.

Having said that, let me say that flexion-distraction cannot stand alone.

Your college professors may have tried to convince you otherwise, but flexion-distraction is not a technique any more than diversified is a technique.

Cox, Markey, Lloyd, Leander, Anthony, and Tranter all have variations of flexion-distraction techniques and they deserve to be recognized for their contributions to our profession.

Using an F-D Table

The Leander Technique is not difficult, even though it requires a flexion-distraction table.

The patient is asked to lie facedown on the table. The doctor’s first observation is to check the leg length and make a note of any imbalance.

Then, the table’s center cushion is lowered to allow the lumbar spine to assume its normal curvature.

Then and only then you can energize the flexion of the table. The best speed setting for the average patient is 29 rpm. Any less speed allows the patient to offer too much pulling resistance, and your results will vary.

As the patient relaxes on the table during flexion, the specific intersegmental palpation yields a considerable amount of information to the chiropractor.

When I adjust a thoracic segment, I choose to have the patient turn his face toward the side of spinous laterality for that specific segment. That allows me the opportunity to correct the rotatory component of the subluxation.

The corrective thrust is then directed slightly toward the skull and into the distracted spine as the flexion reaches the bottom of the stroke. Continue to evaluate the spinal subluxations, turning the head as needed and making adjustments until you have corrected the thoracic and lumbar spine, then turn the flexion off and prepare to correct the cervical subluxations.

The Leander technique requires a flexion-distraction table such as the New ZENITH®-Eckard Motorized Decompression F/D Table Model.

I prefer to make my cervical adjustments with the patient in the prone position. After successfully adjusting the patient and checking leg length for balance, I ask the patient to get up from the table.

I have adjusted more than a million spinal subluxations since my days at Palmer in 1959 and my years as a student at Cleveland in Kansas City, and I have developed a simple spinal evaluation: When a patient presents with a short leg, the ilium on the same side will be posterior and the atlas will be subluxated to the same side as the short leg. The lower cervical vertebrae will be compensated to the opposite side, and the patient will present with forward head posture. The lumbar body rotation will be to the same side as the short leg. So it is important to measure leg length.

When D.D. Palmer made his first chiropractic adjustment on Harvey Lillard back in 1895, he had old Harvey stretch over a couple of wooden kitchen chairs (or so the story goes).

Long before Palmer’s time, history books portray the medieval technique of tying the patient to the rack. By means of a large wheel and gears, they introduced segmental traction to most of the segments of the spine. I suspect that was prior to third-party pay. Eventually, the practice was discontinued, until recently, when third-party insurers decided they might pay some physicians for a similar technique called "decompression."

The Designer’s Thinking

Starting from the top, first the segmented face cushions are normally hinged in such a way as to allow the space between them to be changed, allowing for different sizes of faces.

The frame of the headpiece tilts, lowers, or raises to flex or extend the cervical spine by moving those same face cushions. Doctors need to take time to accommodate the patient’s cervical condition and position the cervical spine to the extent necessary.

The armrests are not just a place to rest the arms while the patient is on the table. They should be ample in strength so as to afford the patient a platform to lift himself off the table or roll over to a different position.

These cushions should also be ergonomically positioned to provide comfort when the patient is prone, opening the thoracic scapulae for chiropractic access.

The next cushion adjacent to the face cushions would be named the chest/abdominal or thoracic cushion. For lumbar vertebrae to assume a natural lordosis as the patient is in the prone position, the thoracic cushions need to hinge down at the front end. This is most important for positioning of pregnant patients (and guys with "Dunlaps" syndrome. Dunlaps is the effect where the patient’s stomach "done-laps" over his belt.)

New tables allow the abdominal cushion or chest cushions to actually be split lengthwise into two individual cushions, allowing doctors with advanced training to better correct scoliosis. These side-by-side cushions can be elevated at the cervical end to 30° and are mounted to an independent drop feature to aid the doctor in his quest to make a more complete scoliosis correction. Chiropractors are using specialized motorized flexion tables to correct idiopathic scoliosis curvatures of severe proportions (90° or more) down to 60° in 5 days. For more information go to the CLEAR Institute website, where Dennis Woggon, DC, and his staff are making miracles happen. Everyone should learn as much as possible about the advancements and discoveries about scoliosis care. When I first started treating patients with scoliosis, there were very few mentors to assist me.

Most importantly, the pelvic cushion is considered to be the foundation of the entire table and the largest cushion on the segmented table. On the new Zenith-Eckard table, the pelvic section can be one or two pieces. Today, most tables have at a minimum a pelvic drop for the pelvic cushion. Actually, it is for the doctor to make a specific high-velocity, low-force adjustment to the pelvic area. We pay tribute to the maker, J. Clay Thompson, DC, whose farsighted changes have affected everything we know as chiropractic.

But the pelvic cushion may now be split to enable the treating physician to adjust only one portion of the pelvis without affecting the other segments.

Each of the split dual-segmented cushions has its own specific drop mechanism and elevation to enable swift and targeted style of treatment.

In my own experience, I prefer to incorporate the benefits of automated flexion in the pelvic section to complement my style of treatment, which has brought many patients to me for chiropractic care. Based on the records we have kept in our sign-in books we use at the various seminars around the world since 1981, I have adjusted more than one million spinal subluxations and I’m working on the next million. All I need is for the first million to come back.

Flexion-Distraction History

The first chiropractic tables were actually osteopathic tables used by bonesetters and chiropractic healers.

One such table was named after its inventor, and we still know it as the McManis Table. McManis designed and built the first flexion-distraction table. James Cox, DC, DACBR, later popularized the benefits of flexion-distraction in the chiropractic profession (at least in my lifetime). Cox must have realized in the late 1970s that the market was greater than the availability of used McManis tables and looked for a solution. After several manufacturers had tried to develop reliable flexion tables, the McManis brand was eclipsed by the Zenith-Cox® Table in 1984. It had a totally new, exciting look and many new ergonomic features that have allowed it to be extremely popular.

During this time, as the marketplace was rapidly evolving, an inventor/chiropractor was building a totally new and controversial flexion table.

In the fall of 1981, as an ambitious young doctor who had developed carpal-tunnel syndrome from the manual flexion table I was using, I was forced to either discontinue a successful technique or devise a means to flex the distraction table automatically by the use of a motor.

Hence, my first Leander Table was born. For 12 years, I built and sold the Leander AutoFlexion Table.

I sold the Leander Table Company to an employee who has continued to build and sell the original tables under the name of "Leader."

After several years of modest success and thousands of chiropractic adjustments at hundreds of seminars, I joined forces with Williams Healthcare, Elgin, Ill, and the table has become the Zenith/Eckard Flexion Table.

During the early 1900s, the Zenith® Chiropractic Adjusting Table was developed by William Williams, DC, founder of Williams Manufacturing Company. The Zenith brand was developed and promoted exclusively to the chiropractic profession. The first table sold was a segmented stationary bench and later was a "hylo" table. For nearly 100 years, the Zenith table has maintained its esteemed title role within the profession for durability, form, and function.

Any adjusting table used in the chiropractic profession is in some way just a variation of the Zenith table. The Zenith tables had been designed with anatomically suited cushion segments instead of just an ordinary flat top.

Yet, when you look back at all the designs that have stood the test of time, you will see contoured, segmented cushions on that table.

Leander Eckard, DC, is the inventor of the motorized flexion table. Contact him at .