Whether you are looking for a traditional chiropractic adjusting table or a decompression table, you have a lot of studying to do. Many options are out there, but technological innovations have resulted in great choices that offer the best results and patient comfort.

To delve more into the various options available to chiropractors, Chiropractic Products spoke to four knowledgeable representatives in this area. Christopher J. Colloca, DC, is CEO and founder of Neuromechanical Innovations. Colloca commissioned Tri-Wg to create instrument adjusting tables for his practitioners. From that, the Neuro™ line of tables began. Gib Heyblom is sales manager for Track Corporation. Steve Stormes is sales manager for Metron Medical. Fred DiDomenico is a coach for Disc-Ease.

Describe the types of cervical pieces and other features that should be available on a table to maximize a patient's comfort.

Colloca: A table should hold the cervical spine in the neutral position so that the neck muscles can relax and not offer resistance to the adjustment. The table slot for the nose should also extend far enough to accommodate everyone from children and pro basketball players. To maximize comfort, the Neuro tables are high-low so the patients can be lowered from their standing posture to the prone position. This, along with high-density foam and upgraded coverings like Ultraleather® and Ultrasuede®—the same coverings used in luxury yachts—give patients a first-class experience during their adjustment.

Heyblom: The efficacy of the headpiece is a work of balance: firmness and softness, comfort, and design. For comfort, a balance in foam density is essential—firm enough to support the adjustment, yet soft enough to cushion the patient's facial configuration. In design, a balance of stability for patient support with fluidity of motion in specialized headpieces for techniques like flexion-distraction with long-Y-axis decompression is essential. Such headpieces move in the lateral, flexion, extension, rotation, and circumduction modes for treating stenosis and disk herniation as available on the seventh-generation design of The Cox® Table.

Stormes: The cervical pieces should be adjustable in a number of ways to allow complete comfort and positioning of the patient. The cushions should be firm without being overly dense to allow for patient comfort. Other features include double-adjustable foot and ankle rests, allowing patients of different heights to fit on the table. Also, breakaway thoracic cushions or alternatively adjustable-height pelvic cushions are available to accommodate pregnant women.

The NeuroOne table has high-low features, an instrument holder, and electrical outlet all mounted directly on the table.

DiDomenico: On most decompression tables, we have found that the typical cervical distraction devices concentrate all the decompression force under just the atlanto occipital junction. That can make it quite uncomfortable if there is sub-occipital muscle spasm. What you can do instead is to use a decompression occipital strap that is attached at the base of the skull and disperses the force from the sub-occipital region and disperses the force throughout the harness. This allows for more decompression force.

What tables are out there that offer the most benefit while being easiest on the chiropractor's budget?

Colloca: The NeuroOne™ table is our base table model that has the high-low features, instrument holder, and electrical outlet all mounted directly on the table. NeuroOne is less than $2,000 after the American Disabilities Act (ADA) tax credit is applied. NeuroTwo™ has all of these same features, but also has a vertical lift motor to enable the application of several different techniques. For instance, one can lower the table all the way down to 19 inches off the floor so that side-posture or anterior thoracic moves can be easily accomplished. NeuroTwo is under $4,000 after the ADA tax credit is applied.

Heyblom: The seventh-generation Cox Table for full-spine adjusting flexion-distraction and decompression includes all adjusting features. It has the best-designed headpiece for Cox Technic decompression adjusting of spinal stenosis and disk herniation and further supports the long y-axis adjusting of the thoracic and lumbar spines for the radicular and non-radicular patients. The Cox Table furnishes all adjusting benefits on one model at one valued cost.

DiDomenico: The P-SRT is the most cost-effective I know of. At the time of this writing, it sells for $9,999 but comes with a $10,000 tax credit from the ADA. One reason it can sell so low, but does such a quality job, is it uses Whole Body Vibration (WBV) technology. Because of the use of WBV technology, it doesn't need expensive computers as do other units. WBV relaxes muscle spasms.

How long should today's chiropractic tables last, and what warranty programs are offered?

Colloca: Chiropractic tables should last at least 10 years, in my opinion. I've had my tables from Tri-W-G for more than 10 years and have never had a problem. An unconditional one-year warranty is offered on the Neuro™ line of tables.

Heyblom: Chiropractors seek the best value for their investment. The chiropractic table is the primary and most essential investment the doctor must make. A quality-built table could potentially last the full career with proper use and maintenance care. In today's world, though, new features come to market that encourage doctors to step up to the newest innovations. Those innovations need be supported by clinical outcomes to make the investment worthwhile. A doctor wants to be the most up to date he can be, with his table, his technique, and his clinical outcomes. As for warranty programs, a full year parts and labor program to 5 years with phased-out covered features are available. A year's parts and labor warranty gives a year for resolution of manufacture and learning curve issues. Should service be needed, it's important to understand where and by whom the warranty work will be done. The person doing the warranty work is key. He or she needs to be familiar with the instrument and its design.

How should a table be designed to reduce a chiropractor's chances of developing carpal tunnel syndrome?

Colloca: In my opinion, carpal tunnel syndrome can only be prevented by switching to instrument adjusting with an electric adjusting instrument. We have many doctors with hand and wrist problems from using spring-loaded activation-type adjusting instruments, and others who come to us looking to switch to instrument adjusting to prolong their career due to their back pain or shoulder problems. The beauty of instrument adjusting is not only that it is easy on the doctor in its application, but the doctor can stand upright while applying the adjustments, as opposed to leaning over a table all day. The Neuro™ table is perfectly suited for the chiropractor looking to extend his or her career.

Heyblom: A doctor's professional lifetime can be shortened by carpal tunnel syndrome. The answer to its prevention is to avoid extension of the wrist. James M. Cox, DC, has developed his flexion-distraction instrument and protocol with adjusting ability not requiring wrist extension. The movable tiller bar, tiller bar ball handle to dissipate the force across the hand, table height adjustment, and doctor hand-placement when adjusting are all important for preventing median nerve injury. A part of training by the manufacturer and/or technique protocols should include such preventive approaches.

In what areas do chiropractic tables currently need the most improvement?

Colloca: The beauty of us working with Tri W-G is its 40 years of experience in the table manufacturing business. Tri W-G has evolved and changed to improve its tables over the years and when we found that the chiropractic tables needed to accommodate the doctors' adjusting instruments, Tri WG added an electrical outlet and instrument holder to the tables. No other table has that.

Heyblom: The efficacy of today's tables in meeting the demands of the aging patient needs the most addressing with table design that allows for gentler adjusting protocols. Research leads the way with clinical outcomes of research-proven, gentler techniques for comparison and directs table design as well as doctors' choice of technique. Table manufacturers must be astute research students.

DiDomenico: I think in decompression you have to ask, "Is the unit affordable? Does it do its job?" If you are able to answer in the affirmative to both, then that is an improved area. Also, finding ways to reduce muscle spasms is crucial. The body naturally resists being "pulled apart" and once the spasms kick in, you can't perform therapy.

What new, state-of-the-art technologies can we expect in the future?

Colloca: What you'll see debuting in the very near future is our complete computerized adjusting station, featuring computer-assisted instrument adjusting with a computer monitor and voice recognition software all interfaced into the adjusting table, or adjusting station as we like to call it. Fully integrated with a documentation software program powered by DocumentPlus®, we are developing a chiropractic system that we believe will take the profession to the next millenium.

The seventh-generation Cox Table for full-spine flexion-distraction decompression manipulation includes all adjusting features.

Heyblom: The future holds exciting technological possibilities along the lines of research-outcomes-driven technology. Research will suggest and ultimately dictate the extent to which technology will be implemented in technique protocol and in table design. The most appreciated will likely be those technologies that allow the doctor to show the patient his or her own spine under adjustment and relate it to published research outcomes of the specific technique the doctor is using. Technology for this visualization is evolving. To measure adjustment force application, computerized force plates and hand transducers will be used. It is a hope, too, that such technology will demonstrate the efficacy of the chiropractic adjustment not only to the patient, but also to third-party payers who may come to see the benefit of the chiropractic adjustment as it is applied with established, published, research-documented, and evidence-based protocols that may fall outside their dictated number of visits allowed and payment schedules for some patients.

Stormes: The soon-to-be-released Metron Medical FD Table will come standard with variable height and four crisp drops along with manual flexion distraction. It will also feature hinged cervical section, caudal rotation and adjustable-height pelvic cushion as standard features. All these features at an economical price.

DiDomenico: I think the continued development of using Whole Body Vibration (WBV) to relax muscle spasms in the spine and body. There has been extensive research conducted over the last decades proving the efficacy of WBV for quick and effective reduction of muscle spasm. In dealing with spinal rejuvenation, reducing muscle spasms is critical. Also, using WBV has therapeutic benefits that will accelerate the rehabilitation of injured disk tissue as well as enhance spinal correction.