Dr. Alex Jimenez DC introduces Dr. Brian Self DC, as he explains the procedures of how to treat patients that are dealing with back pain by using the DOC decompression machine. The DOC decompression machine is used for spinal decompression therapy as it utilizes traction by gently stretching the spine to allow nutrients and oxygen back to the compressed spinal discs and increasing the disc height for many individuals that are suffering from a herniated or bulging discs. If you want to learn more about spinal decompression therapy, this link will explain the benefits of spinal decompression and how it can alleviate low back pain symptoms. By referring patients to qualified and skilled providers specializing in spinal decompression therapy. To that end, and when appropriate, we advise our patients to refer to our associated medical providers based on their examination. We find that education is the key to asking valuable questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer
Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions, please call Dr. Jimenez at 915-850-0900.
[00:00:02] Dr. Brian Self DC: So the first thing we’re going to do is lumber supine. OK, so before the patient gets on the table, a couple of things for them to know, you want everything out of their front and back pockets, keys, wallets, cell phones, everything in their pockets. Have them take their belts off if they’re wearing belts, and then have them use the restroom before they get on the table. I don’t let patients use their phones on the table. I prefer that they relax and fall asleep if they can. The more relaxed the patient is on the table, the better the treatment will be. So when we’re doing a lumbar supine, this would be good for heavier or older patients who can’t lay on their stomachs. Also, flexion-based conditions would be the best supine. So spondylolisthesis or stenosis, or anything where flexion makes it better and the extension makes it worse. When we’re doing a lumbar supine, we’re looking for this red line at the bottom of this thoracic cushion. So we’re going to line this one up where we want it. And then, these two red tabs are equal to the distance from the top of the iliac crest to the lowest rib. OK, so as the patient gets taller, this will slide up. So on our shortest patient, these two red tabs will be touching each other just like that as the patient gets taller; this thoracic harness will slide up. So the pelvic harness always stays; the thoracic harness will slide up as needed. So a two to three-inch gap would be for a patient that’s about five foot four to about six foot tall. A four-to-five-inch gap would be about six foot to about six foot seven. So the shorter patient, this thoracic harness comes down, the taller the patient, the thoracic harness slides up to make more gaps here. So once we know where we want these harnesses, let’s say I’m treating somebody who’s a normal male height. I will put these harnesses exactly where I want them, and then I will tighten this. So that this one is not going to move, and then I’m going to grab one seat belt in each hand, and then I’m going to lay this down one time with the red line right at the cushion where we talked about. So I’m going to lay it down one time. So I’m not messing with the velcro, and I’m going to velcro it right here to kind of hold it in place. And then what I’m going to do is I’m going to spin around and hold everything with my left hand, with my right hand. I’m going to point to where I want the patient to sit, which is right about here at this angle. If they sit too low on the table, then the top of their iliac crest will only be about right here when they lay back. If I have them sit right when they lay back, the top of their iliac crest will be about where you want it, the top of the pelvic harness. So hold all these, so they don’t move around too much. Have the patient sit about right here and then have them lay back. Now, once they lay back, then what you’re going to do is you’re going to take this with your right hands. I think it’s easiest to grab this with your right hand, bring it across, tuck it under, reach across it with your left hand, and then bring it straight across so it’s nice and snug. And with my right hand, I tuck my thumb underneath there so my hands are not in the way. Next, we’re going to do the seatbelt. And we’re going to bring this across now; the easiest way to tighten the seatbelt is not to grab this and pull hard this way because that will move the patient if they’re in pain, OK? The easiest way is to grab this with your right hand. Grab this one with your left hand and feed it through, so you’re feeding it with your right as you’re pulling it with your left hand. So you’re feeding that through to get that nice and snug. And then what we want is this metal ring to be centered on the patient, OK? Now, when the patient sits down on the harness, this will bunch up, and there will be a lot of extra fabric under their rear ends. So what you want to do is grab this and pull it this way. Pull it away from the patient to get all the extra fabric out so that it’s nice and tight. You will go through this ring and back up and attach it to the bottom here. OK. So again, this is all nice and tight now, with no extra fabric in there. And then what we can do is put the knee pillows under. If we want the knee pillows to be taller, we can rotate them like this. So if we want more flexion in the spine, we can use the taller position. OK? So always do your lumbar harness first, and then do your upper harness last. So on our upper harness, we’re looking to come around and down to make an X pattern. OK. You want the patient’s lowest rib to be right in the middle here.
Dr. Brian Self DC explains how to set up the DOC decompression traction table for many individuals that are going in for a lumbar treatment. Lumbar treatment is used for many individuals who are suffering from low back pain and is treated by laying on their back.
[00:07:08] Dr. Brian Self DC: OK, so you’re coming across and down to encapsulate the patient’s lowest rib, and that should make an X if you did it correctly. Next, what we want to do is we want to choose the angle that we’re going to be treating. So we go to the computer, and then we’ll go to elevation in targeting. And then, we could do a pre-programmed level to hit L5 S1 on a computer and then begin targeting setup. And then, we can treat it at that predetermined angle. Now, suppose we don’t want to do the predetermined angle. We can constantly adjust the lumbar flex or lumbar flex down until we find the comfortable angle centralizing the symptoms. The most important thing is finding the angle that centralizes the pain, the numbness, the tingling. Anything that makes the pain go farther down the leg into the foot is making it worse. Anything that centralizes and brings those symptoms to the spine probably makes it better. So you’re looking for that comfortable position that centralizes the symptoms. Now, at this point, we could add some lateral flexion if we wanted. So if we go to the bottom of the table here? The table will flex left and right laterally if you squeeze just the left mechanism. OK, so this would be for a lateral bulging disk. The table will rotate left and right if we squeeze just the right one. When that comes into play, if you have a patient sitting in the waiting room and leaning like this to take the pressure off the nerve, you will recreate whatever lean they have on the table and treat it in that position. So if they’re in left lateral flexion with left rotation, you would put the table into left lateral flexion with left rotation. So, recreate whatever position and centralize their symptoms on the table itself. So whether that’s flexion or lateral flexion or rotation or a combination, you want to figure out what positions bring them relief and put the table into that position, OK? Or if they’re walking down the hallway and leaning to the left while they’re walking, then you would just recreate that position on the table and do the treatment in that position. So now that we’ve chosen our angle, we want to tighten everything down so we would come up here, pull this nice and tight, and then go up to this upper one up here. So we go up here for this one, nice and tight, making sure all the slacks are out of there, and then we would be ready to treat. And then so we would go here, go to our automatic decompression menu. If it’s their first week, we will select legacy number one. And then we’re going to hit confirm lumbar treatment; since we’re doing a lumber treatment. And then, we would choose their treatment kilograms, which will be based on one-third of the patient’s body weight for a lumbar or 10 percent for cervical. So we put in our kilograms and then select the number of cycles that we want to do. The number of cycles determines the amount of time that the treatment takes. I recommend starting with one cycle for the first visit and seeing how they do. And then going up one cycle per visit for the first five visits. So visit one, one cycle, visit two, two cycles, visit three, three cycles, visit four, four cycles, and then visit five, five cycles. And then that’s about the most you would want to do on legacy one because that’s going to be about a twenty-five-minute treatment that would allow you to do a 30-minute appointment time. And your treatment time is going to be about twenty-four minutes, which gives you six minutes to take the patient on and off the table and still maintain 30-minute appointment times. So around twenty-three minutes is about the most I would do on a lumber treatment. With your cervical treatments, you can get away with less time. You can do as low as 15 minutes on the cervical and get good results. Once we’re all set up here, once we’ve set up our treatment parameters in the computer, we would just hit start and start the treatment.
[00:12:36] Dr. Alex Jimenez DC: Remind me that we start on legacy one cycle one on the first day, correct?
[00:12:48] Dr. Brian Self DC: Correct.
[00:12:50] Dr. Alex Jimenez DC: And every day, one cycle.
[00:12:53] Dr. Brian Self DC: Correct, and only up to five cycles on that.
[00:12:56] Dr. Alex Jimenez DC: Five cycles. OK. And we should continue with those five cyles?
[00:13:07] Dr. Brian Self DC: Until you feel like they’re stable and until you feel like you’re not going to make them worse and they’re ready to go on to a more aggressive treatment, which would be K one if it’s a herniated or a bulging disc or K five if it’s a degenerative disc.
[00:13:28] Dr. Alex Jimenez DC: Well, I’ll clarify one thing. I’m just asking if we should maintain the five cycles after 14 days?
[00:14:00] Dr. Brian Self DC: Yes, unless you feel like you’re going to maintain those five cycles until you feel like they’re ready to progress to K1. Now, that might be after one week. It might be after two weeks, but do the five cycles until you feel like they’re ready to go to the following protocol.
[00:14:22] Dr. Alex Jimenez DC: Is it normal to continue the cycles for one week or two weeks?
[00:14:29] Dr. Brian Self DC: Yeah, one to two weeks is usually average for most people.
[00:14:34] Dr. Alex Jimenez DC: Right.
[00:14:37] Dr. Brian Self DC: Now, if the patient is stable on their end, they’re not that bad every once in a while. You might progress a little bit faster. Or sometimes, patients are just prolonged to respond. And in that case, then you might want to do the legacy one, you know, for a lot longer. It just depends on the patient.
[00:15:03] Dr. Brian Self DC: OK, so that’s lumber supine.
[00:15:09] Dr. Alex Jimenez DC: So we continue the cycles for the next two weeks, and when we feel the patient is now ready to progress to the following protocol, can we go for the K1 protocol?
[00:15:43] Dr. Brian Self DC: Yes, you can go for K1 whenever you feel the patient is ready.
[00:15:49] Dr. Alex Jimenez DC: And how long is the K1 protocol?
[00:15:52] Dr. Brian Self DC: Generally that the whole rest of the treatment. So if it’s a herniated or a bulging disc, you would do K1 for weeks two through six, or if it’s a degenerative disc, you will do K5 for weeks two through six.
Dr. Brian Self DC explains how the DOC decompression is used for prone treatment. Prone spinal treatments are for many individuals that are suffering from posterior-lateral herniated or bulging disks and are treated by laying down on their stomachs either at an angle or flat on the DOC table.
[00:16:45] Dr. Brian Self DC: So next, it will be prone. Prone is suitable for younger patients with a posterior or a posterior-lateral herniated disk. So any patient that comes in between like 20 and 40 years old, that’s got a posterior bulging disk. And they say that flexion makes it worse. And extension makes it better; you’re probably going to put them prone. You would do prone because if they’re lying on their stomach on a poster bulging disk, the disk will be pointing up. Gravity is working in the direction you want the disk to go. So on a posterior bulging disc, prone is generally going to be a better treatment position. Now for prone, you’re probably starting with the table flat. So for prone, you’re probably going to start with the table flat, and then I’ll usually go up a couple of degrees per treatment if they can tolerate it. So for the first visit in prone, you don’t need these knee pillows, you would just lay them flat, and then you may come up into extension about two or three degrees per treatment. So as long as they can tolerate it, you can go up to extension with each treatment as long as they’re handling it. Now, it might not be super comfortable, but it can be more effective from a treatment standpoint, and then you can even add some extension here in the cervical. So this is putting them almost into like a MacKenzie type of protocol. And again, this is best for a herniated or bulging disc in a young patient where flexion makes it worse, and the extension makes it better. Now they may only be able to tolerate prone completely flat, and that’s OK. That’s a good position too. So just do prone, but completely flat. The only difference is with your armrests; you will have your armrests in the lower slots facing forward for a prone. OK, so your armrests are down there in the lower slots. Whereas supine, they’re going to be in the upper slots in line with the table.
[00:19:52] Dr. Brian Self DC: If the patient is supine, this would go in the upper slots just directly in line with the table there. OK, so that’s going to be supine, and then down here is where you put your armrests for your prone treatment.
[00:21:46] Dr. Brian Self DC: So there’s no predetermined angle for prone. Everything is going to be the same as supine. The only difference is you’re just going to manually go up or down depending on how much flexion or extension you are. You’re still going to choose legacy one and then confirm a lumber treatment.
Dr. Brian Self DC explains how the DOC decompression machine is used for cervical treatment. Cervical treatment is used for many individuals that are suffering from neck and shoulder pains. The DOC decompression machine gently stretches the neck for the individual to have relief.
[00:22:40] Dr. Brian Self DC: So next, I want to go over cervical. So for cervical, what you’re going to do is you’re going to take your pelvic harness. And I usually just drap it off the end of the table out of the way with your thoracic harness. You need to remember that you want to take this post out with a thoracic harness, OK? So never pull this through this clamp because most people will put it back in the wrong way, and then it doesn’t work. So always when you’re doing this cervical, always take this whole bar out with this and then just set it to the side. So what you’re going to do is you’re going to take your cervical headpiece, and the first thing you’re going to do is adjust the width of the head posts. So a number two on each side is about a small female neck, or a number three on each side would be like a larger female neck and a smaller male neck. So number three on each side. And number four on each side would be a large male head now, once you get up to number four. Then I recommend taking this pad out because if you have a really large head, you want it to sit a little deeper in there. So if you get a huge head and this is pulling out from underneath their head, then take this out so it can sink a little bit.
[00:25:23] Dr. Brian Self DC: So next, what you’ll do is you’ll go ahead and place this in between the two face cushions. OK, so please don’t put it in the slot where you took the other post out; it will go in between the two face cushions there. Next, what you want to do is you want to come to the table and adjust the flexion that you want, depending on which disc we’re treating. So if you go into your elevation and targeting menu, you’ll see where it says cervical flexion angle. And then, you would go to your chart and know that negative 18 degrees is C6 C7.
[00:26:07] Dr. Brian Self DC: If we were treating C6 C7, we would take our cervical flexion angle on our computer until it says negative 18 degrees. Now what I like to do is just take a hand towel and put it over the cervical headpiece. Kind of tuck it down under.
[00:26:39] Dr. Brian Self DC: So tuck your towel in there, lay the patient down, and then you’re going to bring this up over their forehead start and then bring this just above their eyebrows. OK, so now the towel will keep all of the makeup, sweat, and everything off of your headpiece. OK, so that way, you don’t have to wipe everything down every time you can when the treatment is done. This covers everything.
[00:27:28] Dr. Brian Self DC: You can put the knee pillows under for comfort, for the knees, and then everything else would be the same except that your force will be about 10 percent of the patient’s body weight. So on the lumbar, we were about a third of the bodyweight. We’re going to be about 10 percent of the bodyweight on the cervical.
[00:28:11] Dr. Brian Self DC: You just go to the main menu and then elevation in targeting. And then just watch your cervical flexion angle in your bottom left-hand corner, and then you would look at your chart that I sent you, and then you would say, “OK, C7-T1 is negative.”
[00:28:34] Dr. Brian Self DC: You would look at the chart and say, “OK, C7-T1 is negative twenty-two degrees.” So you would just go up until your cervical flexion angle says negative twenty-two degrees.
[00:28:52] Dr. Brian Self DC: Or if it were C6 C7, you would go down until it says negative 18 degrees.
[00:29:19] Dr. Brian Self DC: So that’s it for cervical. And then you would just choose legacy number one for the first one to two weeks, and then you would go to K1 if it’s a herniated or bulging disc for weeks two through six or K5, if it’s a degenerative disc, for weeks two through six.
[00:29:39] Dr. Alex Jimenez DC: Now, what is the length or duration of treatment for cervical?
Dr. Brian Self DC recaps the number of sessions for spinal decompression using the DOC decompression machine. Whether it is for lumbar, prone, or cervical treatment, spinal decompression will provide instant relief for many individuals.
[00:29:50] Dr. Brian Self DC: You will probably do it every day for two weeks and then three times a week for two weeks and two times a week for two weeks.
[00:30:04] Dr. Alex Jimenez DC: And lumbar is every four weeks?
[00:30:06] Dr. Brian Self DC: Yes. The cervical will generally respond faster and easier, so you can get away with it three times a week for six or seven weeks if you have to on cervical. Now lumbar, I recommend every day, with cervical; you could do a little bit less and still get excellent results. Now I will tell you that patients don’t tolerate the cervical sometimes. They complain that it makes the area go numb back here or complain about a temporary headache over the forehead. Right? That’s OK. That’s perfectly normal. I tell patients, you know, just to be patient. The results will still be excellent, but it’s not comfortable for some patients. The other thing I forgot to tell you is if patients are wearing glasses, have them take off their glasses. If they have huge earrings like big hoop earrings, then have them take off the earrings. But other than that, it’s pretty straightforward.
[00:31:12] Dr. Alex Jimenez DC: So, if you feel some numbness on the back or have a headache on the forehead, what should be the way to manage the patient? I mean, if somebody is complaining, then how should we do that?
[00:31:26] Dr. Brian Self DC: You can add this if you want. So this will go in between the two black occipital posts. So you can add this, I wouldn’t say I like to use this if I don’t have to, but you can add that and then add the towel over that to make it a little more comfortable.
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Dr. Alex Jimenez DC, MSACP, CIFM*, IFMCP*, ATN*, CCST
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