Why and how to choose a table.

Writers have pens and computers, carpenters have hammers and nails, and chiropractors have hands and tables. Without these tools, writers might find it difficult to record a story, carpenters would find it challenging to build a house, and chiropractors would find it tough to treat patients. "Besides our hands, the treatment table is the most widely used piece of equipment in the office," says Douglas J. Taber, DC, DAAPM, FACSP, a chiropractor with Orthopedic Associates in Binghamton, NY.

As such, choosing the right table is extremely important for a doctor of chiropractic and impacts not only the health of patients but also that of the chiropractor. There is a wide selection of tables on the market today, and chiropractors can make smart choices by keeping in mind important factors that can impact table use and performance.

Ergonomics

Before a doctor can care for a patient, he must take care of himself. "The safety of certain tables in the area of ergonomics and biomechanics for the doctor cannot be overemphasized," says Taber, who speaks from experience. In 2005, Taber suffered a full-thickness rotator cuff tear while performing a side-posture adjustment on a patient's lumbar spine. "The patient was large, and I did not take the time to appropriately position the table to minimize the stress on my shoulder. As a result, my arm was elevated, biomechanics were poor, and an injury resulted," Taber says.

While the table itself was not to blame for Taber's injury, ergonomics should be considered when making a table choice. Safety features can include motorized movement, specific button placement, and foot switches, and many manufacturers offer these items on their tables.

The line of Leander Chiropractic Tables was originally developed in response to one chiropractor's experience with carpal tunnel syndrome. According to the company Web site, Leander Eckard, DC, invented a motorized version of the Thompson/Cox/McManis tables to enable a simpler approach to full spine adjusting and eliminate the movements on the manual table that aggravated his repetitive motion injury. Eckard also later contributed to development of the Zenith/Eckard Flexion table available through Williams Healthcare Systems, Elgin, Ill.

"Chiropractic is a very physically demanding occupation, and practitioners need to be able to maintain their technique throughout their careers. The table needs to help keep the doctor in good condition," says Julie Cox-Cid, a consultant with Track Corp, Spring Lake, Mich.

Considering Decompression

Randy Reed, DC, knows that choosing the right decompression table can make a difference in how a chiropractor approaches decompression therapy. As a decompression therapy educator, Reed travels across the country teaching other doctors of chiropractic how to use it through his Better Doctor Seminar Series. Experienced in axial spinal decompression, Reed has been offering decompression for 4 years.

When he first started out, Reed says he was "confused about the price range of the tables. Some were cheap, some expensive. I went to look at a few expensive ones. I started out buying a Chattanooga, then had a Dynatronics, and now I have the Evolution from Hill Labs."

The Evolution DT is just one of many table styles offered by Hill Laboratories, Frazer, Pa. Howard Hill, the company's third-generation president, notes that the Evolution table allows doctors of chiropractic to purchase a decompression table at one-third the cost, while also being able to bill out to the patient at a lesser cost.

Hill Laboratories manufactures a flexion-distraction table with an automatic long axis decompression feature. They also manufacture the Hill Anatomotor table with back massage rollers and traction. The Anatomotor has been a standard in the industry for over 55 years.

While both of these tables are very effective, decompression is a means to bill as a cash practice since there are no CPT codes for decompression.

"The nice thing with decompression is how many patients a doctor can attract who would normally not be chiropractic patients," says Hill. "The fees that the doctor charges by keeping a patient from having surgery is not only a huge benefit to the patient but then allows the doctor to advertise for a greater return on his investment."

With the Evolution, however, Reed says he obtains better, faster results. "My patients do so well … there is no other tool [decompression table] a DC can get that can refer more patients than that tool," says Reed, who notes that his decompression patients refer others like crazy.

As he gears up to purchase another table, Reed is looking at Hill Laboratories' new Repetitive Motion Table (RMT). Howard Hill explains that the RMT follows the principles of McKenzie, and allows a DC to move patients into passive rehabilitation.

"It stabilizes the patient … on the RMT, we can do anywhere from 200 to 300 repetitive movements," Hill says.

So will Reed purchase an RMT? "Either that, or I will get another Evolution decompression table," says Reed, who goes on to say, "It's been great for us, and we are really happy."

The Cox7 Table (top) and Evolution DT from Hill Laboratories Inc (below) address patients with back pain and disc conditions.

Treatment Technique

The table also needs to keep patients in good condition, and treatment can be maximized through use of a table that matches technique. "When people think of chiropractic, they think of one name, but it is actually 100 different techniques. The doctor has to know what technique he is doing or what combination of techniques he will be doing to get the best table," Cox-Cid says.

What one chiropractor might need, another may not. "Many techniques utilize a specialized table feature, such as drop pieces, distraction or y-axis/x-axis traction, side bending, or positional preference for the patient or doctor. Fortunately, many manufacturers have designed tables with multiple features for more versatility," Taber says.

Tables can focus on one technique or incorporate the ability to perform many techniques. Over time, different treatments become more widely accepted and/or supported, and related tables are easier to find. Some techniques endorse specific brands or manufacture their own tables. Popular types include flexion-distraction, hylo, decompression, elevation, and Thompson adjusting tables; some also may specify the body section, eg, full spine or cervical adjusting tables.

Taber uses the Chattanooga DTS Decompression System. "[It] allows me to administer spinal decompression and then unharness the patient and position the table for side-lying manipulation to the lumbar spine and pelvis. Because manipulation and decompression often work well together, I am able to maximize the use of the table and treatment room," Taber says.

One currently popular technique is flexion-distraction. Taber notes that most doctors of chiropractic have at least one flexion-distraction table; he uses a model from Elite Chiropractic Tables of Hagersville, Ontario, Canada. "Cox and Hill tables are also excellent choices from what I have heard from colleagues," Taber says.

Cox-Cid estimates there are about 15 companies producing these tables, of which the Cox Table produced by Track Corp is one. The Cox7 Table is the seventh generation of the company's technology and is designed for Cox Technic practitioners. Introduced in September 2001, the newest addition to the line eliminated the restraint system found on previous models.

"On the prior edition, occipital restraints were needed in order to do cervical spine flexion-distraction, and they could be claustrophobic and uncomfortable for the patient. The new table added a long y-axis to permit the doctor to focus on each segment individually while maintaining control," Cox-Cid says.

Even though technique specific, flexibility is built in. Cox-Cid notes the table can be kept flat for a treatment requiring high-velocity, low-amplitude while drop options permit drop techniques. "About 50% of those who buy the table also purchase the drop option," Cox-Cid says.

Some tables focus on variability rather than technique. One example is the A100-Zenith Full Spine Flexion Elevation with auto cocking air drops from Williams Healthcare Systems, Elgin, Ill. Designed to complement a wide range of adjusting techniques, features on the table include an exclusive cervical distraction headpiece with cervical flexion, extension, lateral flexion, and pivotal rotation tilting; a pivotal thoracic that locks in any position; a lateral flexion that locks in any position; an axial rotation that locks in any position; caudal flexion/distraction with leaf spring design and tension indicator; circumduction combining lateral and vertical flexion; and a lumbar roll.

Another example is the Chirotable All-in-One from Fysiomed NV-SA of Belgium. The table features six drops, a lateral swiveling head section that can be locked in any position, and adjustable height.

Durability

More versatile tables can meet the needs of practitioners who see a varied patient population, who perform different techniques, or who share the office with other chiropractors. "If there is more than one doctor using a specific table, the table itself needs to be more versatile and maneuverable. Different doctor sizes, variability in technique, and comfort come into play," Taber says. He notes that most doctors of chiropractic need tables that provide patient comfort in prone or supine positions, as well as elevation and lowering for the doctor.

Generally speaking, Cox-Cid believes that most chiropractors sharing an office will be like-minded and practice the same techniques, making sharing a table easier. Yet even then, more doctors means more patients and more use. "You need to make sure the table can withstand constant use," Cox-Cid says.

Tables must be disinfected after each patient (despite the use of face and chest paper), so the material needs to be long-lasting and resilient. Taber suggests that it should also not be too porous. He replaces the cushions on his tables every 3 years, "no matter what state they are in," he adds.

Science

More important than paper for cleaning, however, are papers that can illustrate the value and benefit of the table. "It's good to have the table looking safe, professional, and up-to-date, but chiropractors also want to be sure they can show what the table does as far as the research and science goes," Cox-Cid says, suggesting practitioners have the research available to patients on the waiting room table.

These materials can include published articles and textbooks. "Manufacturers should support the table with research and offer specific protocols for use of the technique the doctor will be using on that table," Cox-Cid says. Doing so can help to not only stress the scientific nature of chiropractic but can also provide patients with reasonable expectations.

For instance, research on the Cox tables provides information on the treatment length for maximum improvement. "When a patient walks in with a disk herniation, the doctor can show that 86% of patients are relieved from pain within 3 months, the cutoff for which a condition is considered chronic," Cox-Cid says.

The right table contributes to a chiropractor's image. "It says this is chiropractic. It is science and research-based. And we are offering you the most current state-of-the-art equipment and technique," Cox-Cid says. So laying it out on the table can help bring patients to the table.

Renee DiIulio is a contributing writer to Chiropractic Products. For more information, contact .