Chiropractors use resources such as trade shows, colleagues, patients, mailings, the Internet, and scientific studies to learn about new techniques and tools. But for Melina Youngs, DC, the idea of adding a decompression table to her practice came from an infomercial. While watching the commercial, she thought, "It would be really cool to do this." So did her patients, who were equally impressed by the same infomercial and pressed for her to add decompression to her menu of services.

That was 2 years ago, and decompression has become an integral part of practice. However, Youngs did not buy the decompression table that sparked the addition, because it was extremely expensive and was much larger than her 2,000-square-foot office could accommodate.

Youngs purchased two of the Saunders Group's 3D ActiveTrac decompression tables for her Cape Coral, Fla-based practice. The Saunders table came with a much lower price tag and, Youngs says, is better than the system offered on the infomercial because The Saunders Group has "learned from the earlier [vendor] and has better technology."

This "better technology" allows Youngs, among other things, to treat both neck and back patients: "That's a big advantage," she says.

The Saunders table also gives the option to treat patients in either the face-up or face-down position. This is a benefit, Youngs explains, because some patients cannot tolerate being treated in a face-down position.

The table also offers a greater level of flexibility. It can be set in a variety of positions. "You can really program the table according to the patient's needs," Youngs says. The table can be tilted up or down and rotated left or right—hence, the three dimensions indicated in the product's name.

The purchase of the decompression tables have been a hit with patients suffering from low back and neck problems, and serves as an entry point to other services.

The best advantage the decompression tables offer Youngs and her patients is individualized protocols in treating neck and low back problems.

Face Up or Face Down

More Than the Machine

Youngs also assigns patients home instructions such as stretching to help reinforce the good that the 3D ActiveTrac has done.

But she has found that the 3D ActiveTrac has been a good long-term option for patients. She disputes the idea that after 12 to 15 treatments the patient will be done with decompression treatments. "It doesn't work that way," she says.

Instead, she offers a "tune-up" schedule, where the patient will come in and have a decompression treatment to make sure everything is in proper alignment. "Those patients seem to do better in the long term," Youngs says. By using the 3D ActiveTrac, many of Youngs' patients have avoided surgery. She estimates that perhaps as much as 20% of her patients have been able to put off surgery due to decompression treatments.

Youngs says the 3D ActiveTrac has more than paid for itself. "We'll definitely be keeping it in the office," she says.

While the 3D ActiveTrac is an important part of her practice, Youngs offers a wide variety of treatments from traditional chiropractic adjustments to spa treatments.

Youngs uses the 3D ActiveTrac for various neck and back problems. These include disk bulges, protusions and herniations, osteoarthritis, lumbar facets syndrome, chronic headaches, and severe sciatica. About 60% of her patients receive back treatments and 40% receive neck treatments on the 3D ActiveTrac.

Youngs thoroughly examines the patient before treating him or her on the 3D ActiveTrac, including administering x-rays or MRIs. Patients are not automatically prescribed treatment on the decompression table. It is on a case-by-case basis.

Once it is determined that the patient is a good candidate for treatment with the 3D ActiveTrac, the patient will begin a series of treatments to correct the problem. Treatments typically last about 20 minutes.

Patients treated for neck problems are put on the table face up. They are attached to the cervical headpiece by a strap that goes over the forehead. The headpiece is adjustable and is typically set at 15° to 25° of flexion. During the treatment, the patient experiences a straight pull from his feet to the top of his head. A series of wedges keeps the neck completely immobile. The table offers up to 50 pounds of force and does not use ropes or pulleys.

When Youngs positions a patient on the table, she also puts a pillow under his knees to make him more comfortable. The patient has access to a pain/kill button that will stop the machine if he experiences any discomfort. Though regularly monitored during their treatment, patients have an additional safeguard—a doorbell mechanism that will alert staff if the patient needs anything. During treatment, a flat-screen television plays soothing images.

With back treatments, the procedure is similar, but a little more individualized. Though patients have the option of being treated face up or face down, Youngs prefers to treat them face up. "It typically gives better results and is more comfortable," she says.

The patient is secured to the table with torso and pelvic straps. His hips are placed at a 90° angle, and a therapy ball is placed under his knees. This allows for a more direct result, focusing the treatment completely on the spine. "Again, it's more comfortable, and the results are faster," Youngs says. The 3D ActiveTrac allows up to 200 pounds of force to be used for lumbar treatments.

The 3D ActiveTrac's effectiveness comes as much from the mechanism as it does from the attached computer system, which allows the practitioner to quickly program a treatment regimen designed specifically for the patient.

Computer Controls

The computer system consists of a touch-screen monitor that is attached to the table. Youngs explains that the system guides the practitioner through a series of questions, the responses to those questions bringing up an array of options.

The first question is whether the patient is receiving a cervical or lumbar treatment. If the patient is receiving cervical decompression, the force can be set from 10 to 50 pounds. If the patient is receiving lumbar decompression, the force can be set in a range from 10 to 200 pounds—it's typically set at about 40% of the patient's body weight.

For a lumbar treatment, the computer system will also query if the patient is to receive static or intermittent force. If the chiropractor sets the machine to perform in the intermittent mode, the computer will ask several other questions, such as the hold and rest times, which range from 15 seconds to just under 6 minutes. The hold and rest times are set at 5-second increments. For the intermittent treatment, it will ask what the force should be during the "rest" phase of the treatment. This is a percentage of the maximum force. Choices are 0%, 25%, 50%, or 75% of the maximum decompression force. "Some patients do better in a straight pull, whereas other patients do better with an intermittent pull, especially if they are in severe spasm," says Youngs, explaining how she determines the variables in an intermittent treatment.

All of the variables are presented in a way that makes using the machine a pleasure. "The computer is really easy to use, even my [chiropractic assistants] are able to master it," Youngs says.

The computer will also ask how long the treatment is to last. And, though Youngs says the average treatment is 20 minutes, the computer offers the option of from 1 to 60 minutes.

The computer also offers a "pause" function. This will stop the treatment while the clinician makes adjustments to the various procedure parameters—time and force. It will also allow for the repositioning of the patient. While the system is in the pause mode, all of the patient settings will be retained, saving the chiropractor from having to re-enter all of the patient's information. Once the adjustments to the treatment parameters have been made, the procedure can be resumed.

The position of the table, either flexed up or down or rotated side to side, is more a mechanical process, Youngs explains. A remote control is used to flex, extend, or tilt the table. These mechanical parameters are more of a function of the patient's posture and size. Youngs also uses the 3D ActiveTrac for flexion-distraction treatments.

Though the 3D ActiveTrac is easy to use, Youngs had to receive some training to use it effectively.

Learning the Ropes

Youngs was fortunate that the Florida Chiropractic Association was sponsoring a training seminar for the 3D ActiveTrac at about the time she was in the process of acquiring it. The seminar included real patients, so Youngs was treating patients while learning how to use the system. She estimates that it took no more than a couple of hours to learn the basics of the 3D ActiveTrac. "It's easy to use and self-explanatory," she says. "But like everything, you get better with using it and trying new things."

The system comes with an instructional DVD that can be used as a refresher.

Company Support

Youngs places a therapy ball under the patient's knees, focusing treatment completely on the spine.

The Saunders Group supports the 3D ActiveTrac in several ways. The table comes with a 1-year warranty, and the company offers training DVDs and clips on its Web site.

It provides clients with numerous marketing materials, including postcards, brochures, and advertisements—print, electronic, and television. The company will also design individualized Web sites for clients.

The company also is available to clinicians to answer questions about the 3D ActiveTrac. Saunders offers phone and electronic support. It offers in-office training at an additional fee.

Taken together, the 3D ActiveTrac has another distinct advantage for Youngs, because it has been classified as a Class II Medical Device by the FDA. It has received 510k clearance from the FDA.

This has allowed her to be able to bill for decompression treatments with many of her payors. "Most insurance companies do pay and pay well for traction," she says. However, Medicare, under chiropractic benefits, will not reimburse for treatments using the 3D ActiveTrac.

Menu of Services

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Though the 3D ActiveTrac is very effective in helping patients, it is not the end of treatment.

Youngs focuses both on chiropractic and general wellness.

Among the many chiropractic techniques she offers are diversified, Gonstead, Activator, and Cox flexion-distraction method.

She also has an aqua bed, offers muscle stimulation, ultrasound, physical therapy, massage, fitness, nutrition counseling, microdermabrasion, and facials. "It's one great place to get well," Youngs says.

C.A. Wolski is a contributing writer for  Chiropractic Products.