Gym and rehab equipment are broadening the abilities of chiropractors.

Fitness and rehabilitation may not seem synonymous with chiropractic. But historically, fitness and exercise was at the heart of the profession from its inception. "Actually, B.J. Palmer [son of chiropractic pioneer D.D. Palmer] had a huge exercise gym, so exercise and rehab is very much a part of traditional chiropractic," says Donald R. Murphy, DC, DACAN, clinical director of the Rhode Island Spine Center in Pawtucket.

A plethora of equipment is available to chiropractors to help them literally get their patients back on their feet and back to their lives. This equipment is used, for the most part, as an adjunct to chiropractic adjustments, allowing the patient to see continued results and solidify the proper alignment that the treatment affords.

Though exercise has been a part of the chiropractic treatment arsenal since the earliest days of the profession, there has been a change in the timing of this treatment. "It used to be that you'd adjust the patient and wait to [fully] stabilize them before beginning exercise. Now, exercise and rehab are begun earlier as the patient becomes stable enough to work out," says Robert Johnson, DC, Robert Johnson Chiropractic and Century City Chiropractic, Century City, Calif.

While it has been long recognized that exercise and rehabilitation are key to helping chiropractic patients get and stay healthy, and the equipment market has responded in kind, creating many tools for the chiropractor and his or her patient to use, there is a clear split between low-tech and high-tech solutions.

The Stretch Disk from Stretchwell Inc is ideal for lower back, pelvic, and weight shift exercises, as well as those for balance or ankle exercises when stood on..

Low-Tech Solutions

Murphy, who uses an evidence-based approach in his practice, says that the medical literature has "suggested that low-tech [equipment] is as or more effective" as the high-tech equipment.

To that end, he uses a variety of low-tech approaches to help his patients. These include gym balls, walkers, and wobble boards, which create an unstable surface that helps the patient build their balance. Murphy says that he has used these devices for years for a simple reason. "They are effective," he says.

This dovetails with his evidence-based approach, which he says aims for the most clinically and cost-effective results, and starts from the beginning of treatment. Murphy uses the McKenzie system to assess the patient's spine.

Johnson, like Murphy, uses low-tech approaches to help his patients for much the same reason—they are cheap and effective. For instance, Johnson uses Therabands and tubing from Foot Levelers Inc, Roanoke, Va, and Hygenic Corp, Akron, Ohio. "I like these because they're inexpensive, relatively easy to use, they're progressive—you can increase the resistance by using more or doubling up the bands or tubing," he says. "I also like the diversity of exercises. It's a cliché, but the exercises are only limited by your imagination."

Johnson likes the low-tech approach for another reason. "I think a lot of rehab is going from high tech to low tech," he says.

In addition to tubing and bands, Johnson uses FitBALL exercise balls from Ball Dynamics, Longmont, Colo, and Gymnic, Italy. He, like Murphy, uses rocker and wobble boards—the latter from OPTP, Minneapolis, and Perform Better, Cranston, RI—balance disks, and Airex balance pads to aid in proprioception.

He also has taken a page from the past and uses medicine balls. "The benefit in throwing the balls [which range from 1 to 10 pounds] back and forth while standing on wobble boards is that it aids proprioception," he says. "What these all have in common is that they add an element of proprioception challenge. I first get the patient used to catching the balls on the ground and then add the unstable surface challenge [later]."

While Johnson and Murphy use low-tech equipment because of preference or the evidence, other chiropractors may need to use this approach because of the realities of their practice environment. For Kirk Lee, DC, CCSP, Albion Chiropractic and Sports Injury Clinic, Albion, Mich, his location precludes prescribing a lot of high-tech equipment to his patients. "For the most part, they're not going to have access to high-tech equipment," he says. "The nearest gym might be 20 miles away, so it's not feasible access."

Lee says that his key piece of in-office exercise equipment is the Triflex from Foot Levelers. The system is made up of three products—the NECKSYS, the BACKSYS, and the Thera-Ciser.

The NECKSYS is designed to treat cervical spine problems. It is adjustable and can be attached to a wall with a permanent mount. The in-office version includes a cervical collar and disposable slipcovers.

The BACKSYS is designed to enhance thoracolumbar spine and pelvic performance, improve postural distortion, and reduce back pain. The professional model includes 60 inches of linear track of anodized aluminum mounts on wall studs, a fast-lock adjusting clamp, and BACKSYS and BACKSYS Lite surgical tubing.

The Thera-Ciser helps enhance joint stability, relieve pain, and loosen adhesions. It also is designed to build muscle strength and reduce the risk of reinjury. The professional model includes all three levels of resistance tubing (standard, light, and extra), two arm bands and three leg bands, and a fast-lock adjusting clamp. "The Triflex gives me a lot of options to do a lot of things," Lee says.

In addition to exercise and rehab, Lee helps his patients in nondynamic situations, such as with ergonomic issues at work, assisting them to sit, stand, and work in the most effective, least hazardous manner. "I look at how the full spine is engaged and work to enhance that," he says.

Sleeping is another potentially hazardous activity that Lee evaluates. He makes sure, for instance, that the patient is using a good pillow that supports their head and neck correctly.

While low-tech equipment remains the fundamental component of the chiropractor's rehab and fitness toolbox, high-tech equipment has its place as well.

The FitBALL Peanut from Ball Dynamics International is one of several low-tech rehab products available.

High-Tech Solutions

Murphy uses the BackStrong, from BackStrong International, Brea, Calif. The device was invented in 1997, and Murphy describes it as a "variable-angle Roman chair apparatus." "It is a nice way to train and strengthen the extensor muscles," he says. The device also can be used for spine injury rehabilitation and prevention. The BackStrong is an FDA-registered product, and it comes complete with manuals, marketing materials, and protocols.

Much of the exercise rehabilitation at the Rhode Island Spine Center is performed by the organization's physical therapist. The center has an exercise bike, exercise machines, and free weights for the patients to use while rehabilitating on-site.

Lee evaluates his more athletic patients at the running lab at nearby Albion College. The patients are observed, among other ways, while running in a pool, which allows him to see them in nonweight-bearing situations and gives him insight into what their natural imbalances may be. From this come strategies on how to help them.

Lee also uses treadmills to evaluate and analyze patients' gait patterns.

Johnson uses nothing that could be termed "high-tech" in his practice. Indeed, he has no gym space at all. Instead, he works with his patients' fitness or gym trainers. "Nowadays, training and certification of fitness trainers has come to a higher level, so I can refer my patients to them with confidence," he says, adding that he works directly with the trainers in a team approach.

While fitness and rehab equipment can help patients get better, adjustments and subluxations still form the core of chiropractic treatment.

Chiropractic and Rehab

Johnson may not use high-tech rehab methods in his office, but he uses instrument adjusting—primarily Activator—exclusively. Most of his patients are young (ages 23 to 50) white-collar workers, and include some athletes. He tends not to treat workers' comp patients.

Therabands from Hygenic Corp are inexpensive, easy to use, and progressive in that one can increase the resistance by using more or doubling up the bands.

Murphy uses a variety of techniques while adjusting, including Cox (for disk herniation and stenosis, among other conditions), flexion-distraction, diversified, and some Gonstead (though he does not use a Gonstead chair).

Lee uses a DTS distraction table to perform his adjustments. While in-office sessions are important to getting patients better, what patients do outside the office is key to getting them healthy as well.

Home Programs

Lee's home program is geared toward postural exercises and stretches. He provides bands, such as those from Stretchwell Inc, Warminster, Pa, for doing extensions. He also has the patients use exercise balls at home. "This helps them to learn to stabilize and maintain balance. It's a great way to exercise the core muscles," he says.

In addition to helping patients, Murphy has authored two booklets designed for practitioners who do not want to or cannot add exercise equipment into their practices. "It's a way to make it easier to incorporate fitness into the patients' treatment regimen," he says. The booklets include descriptions of exercises and spaces for the practitioner to fill in specific instructions for the patient.

Exercise software, such as Exercise Pro from BioEx Systems Inc, Smithville, Tex, is also an option that chiropractors may consider for creating custom home exercise programs. With 2,200 exercises available, including those that use weights, elastics, and medicine balls, Exercise Pro allows for the creation of active, controlled exercise programs that can be printed and handed out to patients.

While there are numerous tools for chiropractors to prescribe to patients, ultimately this equipment, whether high-tech or low-tech, is only a tool to help the practitioner help the patient. There is an even more fundamental task that has to be achieved in order for any of this to help. "The key is to empower the patient," Murphy says. "They have to direct themselves … that makes the exercises much more effective."

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