Spinal decompression, traction, spinal stabilization. For Jack Dolbin, DC, CSCS, Pottsville, Pa, all of these terms mean the same thing for his patients: mobility. Dolbin uses Hill Laboratories Co's Hill Anatomotor Table to stabilize patients' spines as part of his continuum of care in his practice, Pottsville Sports Rehabilitation Center. The multidisciplinary facility employs two DCs, one MD, two physical therapists, and support staff.

The motorized traction table has been part of his treatment arsenal at varying points in his nearly quarter century as a chiropractor. He first used it from 1985 until 1990, trading it in for a flexion-distraction table, and then reconnected with the company 3 years ago when he bought the table he is currently using.

Though there had been a 15-year break in the relationship, Dolbin is highly satisfied with the table—as he had been when he had used it in the mid-1980s—finding that, in its fundamental principles, the table has changed little. According to Dolbin, most of the improvements to the original machine veer to the cosmetic and ease of use. The company has added some new controls and has made the lumbar and pelvic harness easier to use.

Compared with other machines on the market, at $4,500, the Anatomotor is significantly cheaper than similar devices. But it wasn't the difference in price that motivated Dolbin to purchase a new Anatomotor. "We looked at those [more expensive] tables, and it wasn't the cost that scared us off," he says. "I just couldn't figure out how attaching a computer to the table could improve patient outcomes. I went in with my eyes open. The bottom line is results. You don't treat benefits, you treat patients; and you have to be able to show results [on patients]."

Dolbin also dismisses the distinction that spinal decompression and traction are two different things. "Decompression is more of a marketing term; now it's just a synonym for motorized traction," he says.

The Anatomotor not only offers motorized traction, but it gives the practitioner various options to help the patient.

Anatomy of the Anatomotor

The Anatomotor is a table covered with durable vinyl. It comes in various colors, and its fixed height ranges from 22 inches to 32 inches. The surface of the Anatomotor moves with two sets of adjustable rollers massaging and mobilizing the patient's spine, preparing him or her for the traction treatment. Traction is achieved by attaching the patient to the Hill Traction Control Unit. The gliding top pulls against the controlled resistance of the traction unit. Traction force can be regulated from zero to 200 pounds, and can be applied in several different ways from cervical traction to full lumbosacral traction, which can be applied with constant or intermittent traction. "The benefit of the Anatomotor is that you're getting spinal mobilization with traction," Dolbin says.

Though the Anatomotor is flexibile in how it can be used, Dolbin does not use the device on all of his patients. "Not everybody who walks into my office is a candidate for the Anatomotor," he says. Among the conditions that are effectively treated with the Anatomotor are low back pain, spinal stenosis, sciatica, and nonsurgical disks (protruding or herniated disks as long as they are not extruded).

To determine whether a patient is a candidate for the Anatomotor, Dolbin does an initial examination on him, taking a history and his vitals, and makes an orthopedic and chiropractic assessment. If necessary, Dolbin will consult with the practice's medical doctor and order further imaging studies and follow-up. "An accurate working diagnosis is the key to any treatment protocol," Dolbin says.

Treatment on the Anatomotor can come anywhere in the course of a patient's treatment plan. At the appropriate time, Dolbin will introduce the patient to the Anatomotor, educating the patient about the process and what he should expect.

A typical treatment for mechanical low back pain will consist of placing the patient in a supine position on the Anatomotor. The harnesses are secured in the desired location to maximize the effect. Typically, resistance is set at 25% of the patient's body weight and increased as the treatment progresses, always remaining below the pain threshold. The roller system is then adjusted to both flex and mobilize the spine during the traction process. Treatment time ranges from 7 to 15 minutes.

Jack Dolbin, DC, CSCS, sets a patient up for cervical traction on the Hill Anatomotor Table.

As symptoms ease, Dolbin begins using the intermittent settings and then moves to flexion-distraction, using the Hill Airflex table to mobilize the spine in lateral flexion and rotation.

In Dolbin's practice, the Anatomotor is located in a separate room, but staff is nearby at all times to attend and to check on the patient throughout the treatment. If a staff member is not in the room with the patient, an alarm will alert them if there is a problem and they will return to the room immediately. As an added safety step, patients are instructed how to operate the table's "kill" switch. They are told to activate it the moment they feel any pain or discomfort. Dolbin says that the patient should feel no pain while undergoing a session. "Lots of times the patients say they don't feel anything—and that's not a bad thing," he says.

In the entire history of his use of the machine, only one patient was unable to use the Anatomotor, and that had to do with the fact that the patient had claustrophobia and not because of any pain issues.

Dolbin uses the Anatomotor for more than spinal decompression. The practice's physical therapist uses it to help patients who have had joint-replacement surgery, using the Anatomotor in the same way they would use a continuous passive motion machine. Dolbin also uses it for lumbar traction, passive mobilization of frozen shoulder, single-leg traction for sciatica, and cervical traction for whiplash injuries; and he uses the rollers alone for joint mobilization.

Dolbin says the Anatomotor increases the effectiveness of treatment. For instance, he says that traditional treatment for spinal stenosis has a 30% rate of improvement. Treating the same symptoms using the Anatomotor or flexion-distraction is 80% effective in improving symptoms.

He also believes that there are other long-term benefits to using the Anatomotor. "If people live long enough, they will get arthritis in their spine," Dolbin says. "If you can get them on a program of joint mobilization and exercise, they will get relief." He adds that this is more cost effective than surgical or long-term use of medications, other options that are more typically pursued.

Even though the Anatomotor is effective, it is not a panacea. Dolbin uses it as part of his continuum of care.

Active Rehab

Patients who are candidates for care with the Anatomotor follow three stages of treatment. The first stage is mobilization. "If they can't move the fixated joint or spinal segment, then they can't be in rehab," Dolbin says.

Kelly Wagner, DPT, performs a PNF stretch on a patient.

Once the patient has some level of mobilization, then he or she will be treated using the Anatomotor. Joint mobilization must precede traction. The final step is active care, the key to Dolbin's treatment. This includes stability ball training and resistance exercises performed on isotonic variable resistance exercise equipment. "Without active rehab, the patient will plateau," he explains. "Passive care will only get you so far."

This attitude is a result of Dolbin's experience as a wide receiver with the NFL's Denver Broncos. "Back in the 1970s, there was a double standard. If a non-athlete had an injury, they would go to the hospital, stay a few days, and go home. If a professional football player was injured, they would be treated and then would receive active rehab," he says. "Without the rehab protocol, we just place the patient in a position where they can be re-injured." He says the tensile strength of the injured tissue must be increased throughout the entire range of motion. This involves addressing the nervous system and the musculoskeletal system.

This belief in active rehab underlies Dolbin's entire approach, maintaining that diet, rest, and exercise are keys that patients need to remain healthy. He does not offer "maintenance" adjustments, though he does have a fitness program that he runs through the practice. Patients pay $50 per month, out of pocket, and they receive access to a full gym and a fitness trainer in one-on-one or small group settings. He notes that his active care approach could be seen as being a little bit "outside the box." However, if a patient experiences any sort of recurring symptoms, he or she is encouraged to come in for a checkup and possible course of care.

Dolbin's ability to get results with the Anatomotor is part of the reason he is a member of Pennsylvania's Worker's Compensation Panel for 111 companies in his region.

The Bottom Line

Dolbin says the practice has never had any problems getting reimbursed for Anatomotor treatments. "If we had had any trouble, I would have heard about it," he says.

He says that the key to getting reimbursed is documentation. The insurance providers require good documentation and proof that the Anatomotor is not being used to duplicate care. It also helps that Dolbin is able to demonstrate his outcomes. Because of this, he is able to get "very good reimbursement" from the insurance carriers.

Even though he has had no significant problems, he admits that working with insurance companies "can be difficult, and they can be very discriminating. We as chiropractors are held to a higher standard than our medical counterparts."

Demonstrating good outcomes with the Anatomotor is not the only thing that has helped to build his practice. Dolbin's background as a professional athlete has helped as well, building a niche in local and international competitive sports.

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