At A Sterling Clinic, we have unique tables, devices, and exercise machines that allow us to maximize our results.
An informed team member is likely to get well quicker and achieve a higher level of function, so here are a listing of most the equipment used in our office, along with an explanation of what they are designed to accomplish.
1. Traction and Distraction Devices
We have 5 specific different modes of traction. They are among the most effective we could find anywhere.
The granddaddy of them all is the McManis Table. It was first patented at the turn of last century by an osteopathic-inventor and was the most commonly used osteopathic table of the time. As osteopathic manipulative therapy decreased the table’s use contracted until recently when it was rediscovered by chiropractors. Manually operated though with a pneumatic assist, it can take the patient through distraction (which is a special form of traction either greater than or less than 180 degrees depending on your orientation), while side-bending and twisting the trunk. It simultaneously allows the pelvic piece to lower, which often allows a considerable drop of tension on the lumbar spine. These combinations allow the greatest low back motion possible, short of manipulation under anesthesia, something we do not do. The table is also capable of drop cervical, and drop thoracic actions as well as having an atlas or first cervical recoil mechanism.
The Leander Table of which we have two, is used for mechanical distraction and side bending also. It was developed by a chiropractor, who felt a totally manual approach, was too limited. It is motorized and allows the operator to use both hands directly on the patient. The scoliosis package combines distraction and sidebending, with straps creating tension lines, therefore encouraging spine straightening. Finally, it has mechanically preloaded drop pieces in the cervical, thoracic, and lumbar areas that make large spinal excursions pleasant.
Duane Saunders, an internationally known physical therapist, designed this unit. It allows intermittent and continuous traction to the lumbar spine. It is motorized and uses a pulley mechanism attached to a harness, that allows specific lines of pull. Over the years we have found intermittent setting to be superior by allowing us ramp up and down the pulls into the spine creating gradual changes but profound effects.
There is a cervical traction device that is a jewel. It is preferable to other tractions, because it creates a pull without compressing the tempero-mandibular joint. Similar to the lumbar traction unit, line of pull can be customized to create a pull in the offending segment while even laterality can be fine tuned.
Finally, we have the Walking Carpet. This was developed as an off shot of the research of Dr. Fred Illi, arguably the greatest chiropractic researcher of all time, and the man who proved the sacroiliac joint was moveable. Dr. Illi, a Swiss citizen noticed that people with scoliosis often felt better when hiking along a soft trail and were worse when trekking on a hard surface. The device is a motorized treadmill with a soft tread you allow you drop into it, not dissimilar to walking on a trampoline. The patient becomes unweighted in a mirror image to how they are distorted. For example, if a right shoulder was low and forward (anterior) and the left leg short, we treat by unilaterally increasing the upward tension on the right harness and pulling the shoulder back (posterior), while simultaneously putting an ankle weight on the left foot. It reorients the body so it can freshly experience upright and re-learn this optimal position.*
2. Electrical Stimulators
There are 6 predominant types of electro-stimulation in use today. They are pre-modular, interferential, microcurrent, high volt, Russian current, and VMS.
Pre-modular is a popular form of current because it is exceptionally comfortable. It induces a current on the other side of the skin (epidermis) by turning on and off thousands of times in a minute. This jumps the epidermis, which normally act as a resistor, and then has to be over powered. By using this approach there is little pain, or heat build up. The patient can feel the effect of the current without any adverse sensations.
When you take pre-modular and cross it with a second pre-modular, you create a zone of interference. This zone is unique in that the net charge in it is 0, while the surrounding tissue carries a healthy charge. Normally, the limiting factor in electro-therapy is how much current you take through the most sensitive tissue. By placing the compromised tissue in the interference zone, it is no longer the limiting factor. How much current you can tolerate through the healthier surrounding tissue sets new limits. By definition healthy tissue can take a good deal more current, so the net amount of electricity is markedly increased. This is known as interferential current, and is effective pain control.
Microcurrent uses electric current that is 1/1000th of the other currents. Although it can produce anesthesia, it is mostly used to change the biochemical nature of the treated tissue. The limiting factor for tissue repair is often the amount of ATP or cellular energy in the damaged tissue. Microcurrent has been shown to increase this 6 fold. It seems to work well with acupuncture meridians too.
High Volt is a modification of an older approach called Galvanic current. In the older approach there was often a net charge build up by the electrodes that was either very alkaline or acidic, damaging the body in either case. Using a similar type of current but by reversing fields rapidly there ends up being no net charge build up. It is effective in getting muscles to contract rhythmically to pump accumulated fluid out of the injured area, therefore reducing swelling and pain. For years, that was all many practitioners used, and it worked well, although some patients do not like the accompanying sensation.
Russian Current is effective in strengthening muscles and can be useful for pain control. It is particularly effective when someone has had a fracture and you want a co-contraction of the previously fixated muscles. Unfortunately, many patients find Russian current uncomfortable. As the name suggests it was developed by the Russians, to help their athletes.
VMS or variable muscle stimulation is a specialized premodular current that is designed to engage muscle fibers. It both strengthen muscles as well as ridding extra fluid by pumping them away. Generally, VMS is comfortable. If there is a musculature component to the patients’ problem, VMS is often indicated.
Generally ultrasound is broken down into either pulsed or continuous. Either way cavitation is often created. This is a type of boiling at room temperature. Pulsed ultrasound gives a micromassage but does not allow heat to accumulate. It is on for a portion of a second and then off for an equal or greater time. Continuous ultrasound creates a heated area but by moving it around the heat dissipates.
4. Laser and LED Devices
Laser and LEDs (light emitting diodes) produce a form phototherapy that works similarly to microcurrent. It creates additional ATP (energy molecules) that then can help the body repair itself.
5. Exercise Equipment
There are 4 main approaches we use in terms of exercise. They are calisthenics, weights, resistant bands, and isokinetics. Calisthenics uses your own body weight and include stretching as well as strengthening techniques. As long as they are done carefully with slowly with good form they are safe and effective.
Sometimes, additional approaches are appropriate. Free weights, also called isotonics, create additional resistance for muscles. The limiting factor is the arc of motion tends to have stronger and weaker portions. When lifting a weight, the highest usable weight corresponds to weakest part of the strength arc. This will strengthen the weakest parts but will have little effect on the stronger portions.
Resistant bands or Theraband, is convenient and effective especially for very weak muscles. It can help isolate given muscles or movements allowing stretching and strengthening. Their resistance increases proportionally to how far it is stretched. This is not always advantageous.
Finally, isokinetics use computer guided hydraulic equipment that maintain the same speed while accommodating to the change of force the muscle and joint generate. It is slow tends to be safe as long as good body mechanics are observed. It strengthens and stretches the muscles of the entire movement. It is strictly done at the office, but generally not more than once a week. After such a complete exercise, it takes time for the body to generate new muscle and connective tissue.
6. Systems Survey Computer Analysis
When you look to develop enhanced physiology rather than treat pathology, there is a paradigm shift. A Systems Survey includes symptoms and signs that might not ordinarily be significant, but become so, due to a weighted formulas. This information seen through a nutritional filter can reveal nervous system dysfunction, sugar handling symptoms, digestive potency problems, and endocrine imbalances have nutritional etiologies.
As you get a clearer picture of the patient’s physiology, patterns emerge, suggesting nutritional deficiencies, toxic accumulation, and immune burdens. We couple these findings with the Seven Pillars of Health as developed by Dr. Stuart White. They are endocrine, glycemic, pH balancing, immune and inflammatory, circulatory, digestive, and cellular vitality. Each one can be systematically treated so the patient can better achieve their genetic potential.
7. Graston Instruments
Graston instruments were developed in order to break up scar tissue or other connective tissue blockages that normally cannot be detected by hand. It literally lets out a vibration when going over fascia that has defects in it. There are six different instruments each with a specific advantage. Some of the instruments have colorful names such as the handle bar, tongue depressor, protractor, boomerang, and can opener but they all have specific uses.
First you apply the emollient, then as you move the instrument over the problem area, the edge detects and helps removes underlying fascial asymmetry. Graston along with touch, allows an analysis of this hidden but very important matrix of the body. Virtually all cells connect to the fascia, all it has been said, that you get sick through the fascia and also get well through it.
8. Acupuncture Needles, Tiashin, Tsubo, Moxabustion and Cupping
Acupuncture theory is predicated on using points near the body surface to balance energy. Most people associate it with the use of specialized needles, and we do indeed use such needles much of the time. Our needles are single use, pre-sterilized ones, that are manufactured in Japan. Generally, the Japanese people are close to the American people in not wanting pain when experiencing acupuncture. Certain other Asian groups prefer stronger stimulation, but we use with our patients what we ourselves prefer Seirins. Seirin needles, use the finest stainless steel available and can be manufactured to the smallest thicknesses imaginable, considerable smaller than a hair’s diameter. They come in an assortment of lengths and thicknesses depending where and how they are to be used.
Needles are an extension of fingers with some advantages. Needles because they can be inserted and left for a period of time and in combination they can be used for a prolonged period of time. Additionally, because of the depth of insertion, different strata can be affected. There are different forms of manual stimulation including pecking, pistoning, and rotation that can be added to straight needling.
Other forms of non-piercing approaches include Tiashin and Tsubos. Tiashin is a probe that Japanese acupuncturists have developed that act as a non-piercing needle. They are spring loaded and depress the skin. They can be stimulated similarly to a needle. Tsubo is the Japanese name for an acupuncture point, and a Tsubo is a small vibratory device that can be used to stimulate a point. The advantage of Tiashins and Tsubos is they are non-piercing, but the disadvantages are you cannot control depth of treatment and can only treat one point at a time. Point combinations are not an option with these.
Another form of thermal stimulation used, is moxabustion, which burn moxa or artemesia vulgaris over the point. It can leave a blister and is considered a particularly strong and long lasting form of acupuncture stimulation.
Additionally, often at the end of needling we will stimulate acupuncture points by meridian bending. This is a powerful way to balance the meridian which is the whole line of related points where the energy or qi, flow sequentially.
Cupping is in some ways the opposite of acupuncture and other pushing techniques. When you cup, you create suction and the deeper tissues are pulled out to the surface. It can result in bruising, although while it is being done, it is often seems completely innocuous. It has shown merit in respiratory conditions particularly as one is “getting sick” and from the opposite side of the spectrum, for chronic musculoskeletal conditions. There are two basic varieties of hot cupping and vacuum cupping. We tend toward vacuum cupping, because control of the suction is greater.
9. Hot or Cold Application
Heating devices are broken down into wet or dry heat. For the wet heat, we use hydrocollator packs. These are pre-heated cloth containers of clay that have been immersed in hot water. They are additionally contained in a cloth cover and usually have a towel between them and the patient’s skin. They have a tremendous ability to bring heat to deep tissues. Our chief form of dry heat is TDP lamps, which are a Chinese invention where porcelain is heated than allowed to radiate to the body. In China where it was discovered workers in a porcelain factory had a lower rate of absenteeism, than expected. A researcher discovered there was something special about the frequencies of what was given off by the heated porcelain. His initials when transliterated to English are TDP.
For cold applications we use ice packs but often prefer frozen Dixie cups. This allows us to both cool the area to be treated and force the extra fluid out. The rule of thumb is ice acute and heat chronic conditions, but when in doubt ice rarely causes additional complications. The exception to that is frostbite or when there is impaired sensation in the area, which makes both applications inappropriate. If you cannot feel, you can easily do tissue damage.