As more patients seek natural solutions in recovering from injuries, rehab is becoming a growing area of concentration in chiropractic practices.

As the field of rehab has grown, so has the prominence of rehab products. Chiropractic Products spoke to four representatives in the area of chiropractic rehab to find out more about the latest trends. Joe Mannella, DC, is CEO of Neck Orthotic Inc. Burl R. Pettibon, DC, FABCS, FRCCM, is founder of the Pettibon System Inc. John K. Hyland, DC, MPH, consults, advises, and trains chiropractors in the concepts of spinal rehabilitation. Fred DiDomenico, DC, is a coach for Disc-Ease.

What are some of the latest technological advances in rehab products?

Pettibon: Some examples include: the Wobble Chair with controlled vibration that fatigues muscles 50% faster, and vibration platforms that reduce time involved in muscle training and rehabilitation; repetitive traction for home care; patented weighting system for neuromuscular re-education and spine and posture correction; patented, affordable, vibrating decompression traction tables that utilize gravity rather than computers to control the amount of traction while at the same time fatiguing muscles 50% faster; and home care products that include cervical and lumbar traction equipment.

Hyland: Most of the recent advances in rehabilitation have been in the use of the products, rather than the technology itself. Many rehab products that have been around for a while can now be used more effectively, since we understand better the importance of protocols designed to retrain more efficient neuromotor patterns. Over the past 20 years of doing chiropractic rehabilitation, my focus has shifted from the technology to the patients' activities and spinal loads.

DiDomenico: The latest is the decompression table, and those tables that use vibration are also leading edge. Vibration exhausts the muscle quicker, kind of like pre-exhausting a muscle in weight lifting. With quicker fatigue comes quicker impact. As the supporting muscles strengthen, they become effective at keeping the proper curve in place, which is a long-term solution to a healthy spine. If the muscles are developed to keep the proper curve in place, the results will be lasting. Vibration also helps in healing injuries and relaxing muscle spasms. You can spend 15 minutes in a vibration platform. It has been used for decades to advance athletic performance. Using vibration with decompression, you not only decompress, but also strengthen muscles.

Which rehab products are most helpful toward postural stabilization?

Mannella: I believe that any rehab product with a purpose to improve or correct the spine to its correct mathematical design will create the most postural stabilization. Math is math. And when you improve the "math" associated with someone's spine, you have the greatest odds of stabilization and efficiency.

Pettibon: The patented weighting system is the only product we have found that has the ability to correct and stabilize the spine and posture. They are demand exercises that cause the nervous system to reflexly align with gravity and are automatically controlled rather than consciously attempting to hold the person in his normal, upright posture.

The Disc-Ease decompression table uses whole-body vibration for reduction of muscle spasm, healing of injured tissues, and increasing the strength of postural muscles supporting the spine.

Hyland: Regaining postural stability requires corrective exercises designed to improve the efficiency of our patients' postural neuromotor patterns. This means having them train in an upright, weight-bearing position—which is the position of function for the spine and pelvis. Low-cost products that patients can use at home and on the road are the most helpful for this, since they empower our patients to actually do their corrective exercises. I'm a fan of using exercise tubing to stimulate the neuromotor system—this easily increases the neural drive to all neuromuscular components needed for postural stabilization.

DiDomenico: Body weighting. It uses the nervous system's balance system to not only correct posture but act as an isometric exercise to strengthen the muscles that hold that posture in position.

Which rehab products are best for patients with little or no gym experience?

Mannella: Just about all rehab products can be introduced to patients on a gradient basis so that they can work into the rehabilitation. Some products like orthotics are passive and could be introduced without any prior experience and tolerated very well with maximum benefit.

Pettibon: The primary focus of the gym experience is to hypertrophy muscle to make the person look good. Rehabilitation exercises should be for the purpose of making the musculoskeletal system function better and to make it to where the doctor can focus on re-establishing bilateral symmetry and function in the patient's body. Research on runners found that spinal disks dehydrate with resulting shrinkage, pain, and loss of height. The rehab products that produce loading and unloading cycles of the white tissue of the spine, ligaments, and disks are the most effective. Pettibon Cervical Traction and the Wobble Chair require little instruction, are easy to use at home, and are affordable. They can go anywhere with the patient, and patient compliance is excellent due to how they feel when they use it.

Hyland: Unfortunately, many of our patients have little or no experience with a regular exercise program, and they are easily overwhelmed by equipment. That's why I recommend simple, low-tech equipment that can be used consistently at home and reviewed in the office. The best products are simple to use but also include adequate home-use instructions.

Which active rehab products are most helpful to herniated disk patients?

Pettibon: Speaking as an individual who has two MRI-diagnosed herniated disks, a large hemangioma in my cervical spine, and old compression fractures, I can personally state that the only thing that has completely eliminated pain and restored function is the Pettibon Cervical Repetitive Traction Protocols, Vibrating Wobble Chair, DPD Vibrating Decompression Tilting Traction Table, and the patented body weighting system. I am presently 74 years old and still ski, ride dirt bikes, and play golf pain free as long as I perform at least 15 minutes of rehab at home on a daily basis.

Hyland: The scientific evidence is now very strong that most herniated disks will heal (resorb), if given appropriate motion and nutrition. So, specific rehab products for herniated disks are not necessary. I have found that these patients can use the same functional spinal protocols that are used with all patients (with slight modifications in the early stages).

How can rehab products help workers minimize their lost-worktime injuries?

Mannella: The No. 1 way is that rehab products shift responsibility to the patient. This shared responsibility creates the right attitude and functional outcomes, which in turn will minimize worktime injuries.

Pettibon: Americans can take a lesson from Japan by having all workers warm up prior to starting their workday by stretching and taking their spine through full range-of-motion exercises. A designated area of each business would hold the equipment, and workers would be required to do this as part of a prevention program. With relatively inexpensive products to keep the spine and soft tissue supple and functioning at home as well as on the job, it is easy to conclude that injury in the workplace would be drastically reduced.

Hyland: Just as with athletes, injured workers must be assessed for their performance and their neuromuscular efficiency. Once areas of poor efficiency are identified, a corrective exercise program can usually be designed using inexpensive home-based equipment. The sooner this program is implemented, the quicker the workers will be able to tolerate the stresses of their occupational requirements and return to full work activities.

DiDomenico: In any injury, you have to put the injured area into motion. It used to be "rest and ice," but now we know the injured area has to be put into motion. You have to strengthen the muscles. Rest and immobilization does not work.

What will the rehab products of the future look like?

To read about using Pilates products for rehab, go to the April 2007 article titled, "Core of the Matter."

Manella: Some of the best rehab products will never change because of their authentic nature, while some products surely will be created out of improving and creatively enhancing functional outcomes.

Pettibon: The future is here. It is equipment that the patients can use and control to their pain tolerance. It is designed to stretch and rehabilitate white tissue rather than pump the red tissue. The equipment is designed for the white tissue and the postural muscles of the red tissue that are time-dependent. The exercises will activate the postural muscles rather than attempt to hypertrophy the phasic muscles, and they will primarily impact and stimulate the autonomic nervous system and its reflex components.

Hyland: Until we move off this planet and into space, we will need to deal efficiently with gravity. Those who have less effective neuromuscular strategies for handling this constant stress will eventually experience tissue failure and symptoms. They will need to be provided with exercises that will reprogram their neuromotor pathways. So, I really don't foresee any radical changes in rehab products. We just need to use the products that are already available in more effective protocols.