The chiropractor’s adjusting table.

The chiropractor’s adjusting table. Even though it is used worldwide, including by one of Canada’s fastest-growing professions, and is the most notable of this doctor’s treatment equipment, little has been written about it. How did this device evolve? How does it serve DCs in treating their patients today, both in clinics and on the road? What are some considerations and recommendations surrounding purchasing and owning one of these tables?

Whether you are a seasoned DC, or just out of college, your table is of paramount importance to your practice. Advertisement

The aim of this article is to track some answers to these questions. Although this overview is not meant to serve as advertising for manufacturers or distributors of these devices, the mention of a few companies will be inevitable.

A look at the early years
The first chiropractic table, used by DD Palmer, was a flat bench much like a workman’s table. Termed “the nosebreaker,” it called for innovation to accommodate the comfort, safety and the logistics of various adjustment techniques that were evolving. Table innovations began with padding and progressed to include segmentation to facilitate delivery of new techniques; slots to allow for anatomical elements such as the nose and male genitalia; and support for the abdomen of the pregnant or obese patient. Spring-loading was soon introduced to provide additional tension needed for successful delivery of some adjustments.₁

Eventually, mechanical tables began to enter the landscape. The first of these, developed by Bert Clayton of Davenport, Iowa, in 1910-11, worked on compressed air. Soon after, Dossa Evans, a Palmer Chiropractic College student, along with a chiropractor named Dr. Stiles (first name not available) developed a “hy-lo” table with an electric lift that was operated by motor. After this, chiropractic tables became a dynamic and quickly evolving piece of equipment – and manufacturing them became a viable industry. Manufacturing companies often began with chiropractic students recognizing a need for an innovation, creating a table and selling a few models to fellow students. Upon entering practice, these new graduates would no longer occupy themselves with making tables.₂

However, one of these students did not fade into chiropractic table obscurity. In 1963, Dr. Lloyd Steffensmeier, then a Palmer student, began his career as a reputable and successful table manufacturer by filling the void for portable tables.₃ Following this, he also designed a chiropractic table for smaller patients and, before long, his table manufacturing setup, originally a hobby, mushroomed into a profitable company that is still in business today. For almost 50 years, Dr. Steffensmeier has produced innovations in table designs. Many of these have been at the request of clinicians who required a customized accommodation to a table for their practice.

But the distinction of the oldest chiropractic table manufacturer still in business goes to the Williams Manufacturing Company. This venerable designer and purveyor of adjusting tables was started by William B. Williams, DC, in Moline, Illinois, in 1916.₄

“Tables of the earlier years started as garage projects, says John Triantos, president of Techniques Tables, a table design and manufacturing company located in Toronto. “The first ones had a flat bench and evolved from there.”

Purchasing a table
Whether you are a seasoned DC, or just out of college, your table is of paramount importance to your practice – and buying a table is always a major event! The growing number of manufacturers and the increasing variations in tables offer an opportunity to explore many designs, but can also be confusing and rife with the possibility of making a wrong, and costly, decision.

“Some of the features of today’s tables are designed to enable access from all heights,” says Dr. John Minardi, who is a DC, writer and instructor of chiropractic techniques. “As well, hydraulic tables are not necessarily the best way to go, yet may be marketed that way.”

“However,” he continues, “clinics with five or six doctors are better off with a pump lift mechanism rather than the electrical lift because the electrical design has the greater propensity to break down over time.” Still, a chiropractor may have a preference – in other words, one table type or the other may not be better, but just better suited to that chiropractor and his/her practice. It is important to identify what you need before venturing out to buy a table, and then purchase one that suits your needs.”

Drops Have Improved
Dr. Minardi specializes in the Thompson Technique, a technique requiring drop tables. For him and his practice needs, these are the most appropriate tables in which to invest.

“Thanks to innovations in engineering, the mechanical drops have improved to be just as good as the hydraulic drops,” he says. “That’s where most of the ingenuity has been put into by making the mechanical elements as smooth as possible.”

Pricing Chiropractic Tables
Drop table prices can range from $1,500 to $15,000. However, Dr. Minardi suggests that it may not be necessary, or even practical, to go for the luxury of a high-end table. He states, “You do not have to spend $15,000 to get a good quality table that will do everything you need. Depending on the table manufacturer, you can get everything for the new chiropractic doctor for about $3,000. The only time you would pay more is when adding hydraulics, drops and electrical components, and you would only add these if they become relevant to your practice over time.”

More savings can be realized by purchasing used or reconditioned tables. Depending on the features required by a chiropractor in his/her specific practice, refurbished tables may work just as well and assist in staying within budget.

New or recent grads are advised to establish a price range before they visit a table distributor. At the Canadian Memorial Chiropractic College (CMCC) Supply Centre and Bookstore, price lists with table features are provided for students and alumni so that they can learn about what is available to them and decide where they want to begin.

With 10 years in the profession, John Triantos also counsels new grads: “Start with the least complex table – i.e., with drops or some kind of elevation – and add what you need over time.”

Financing Your Table
Chiropractic adjusting tables, whether new or used, can be bought or leased, depending on which arrangement is best for you. Payments can be made up front, of course, but manufacturers/distributors may have financing programs that the chiropractor can tap into.

Financial assistance is available for new graduates from Canadian banks such as the Royal Bank of Canada and Scotiabank. RBC offers graduates the Royal Credit Line for new graduates with a professional designation. In this program, new grads can borrow between $40,000 and $150,000. Scotiabank’s program offers a Scotia Official Line of Student Credit to chiropractic program graduates.

A colourful idea
Traditionally, chiropractic tables were black. In recent years, however, colour has become another option that can be considered when choosing the right table for your practice. Studies have shown that the design and décor in your clinic can impact your patients’ therapeutic experience.₅ It can also have an effect on staff productivity and morale, which, in turn, will influence how your staff interact with your patients.₆

John Triantos relates that, in the earlier years of chiropractic table manufacturing, the fabrics used to upholster the tables varied widely in durability and quality – and colour was often not an element that commanded much consideration. Older tables, then, might clash with contemporary clinic décor – not to mention that they may not meet infection control requirements for cleaning and surface maintenance, a topic that will be discussed later in this article.

Triantos goes on to say that starkly bright colours may also present somewhat of a shock-element for patients entering an adjustment room and suggests that chiropractors who wish to explore contemporary colour possibilities – other than black – consider lighter, more soothing colours.

He cautions, however, that although lighter colours may blend with your décor and be pleasing to the eye, they may stain easily and make maintenance more of a challenge.

The rub on keeping it clean
Health-care workers, including those in non-acute settings such as chiropractic clinics, are required to observe infection control guidelines in practice.7 This means chiropractic tables may require frequent and rigorous cleaning, whether or not sheets and/or slipcovers are used.

Because of this, Triantos also recommends that, when purchasing an adjusting table, cleaning regimen of the table cover must be considered. Important questions a DC needs to ask: is the table easy to clean and what is the moisture resistance of the material?

There are tests designed to assess upholstery. A good one for table coverings in health-care settings is called the “double-rub” test and can help monitor how long the upholstery will last from being rubbed in the clinic. Basically, notes Triantos, the higher the double-rub rating – that is, the more rubs the upholstery can withstand before its fibres begin to break – the longer the life that can be expected from the material. Scores can usually be found on manufacturers’ swatch samples.

Be reminded, however, that along with rubbing down the table, you should provide every new patient with a fresh sheet or slipcover so as to avoid bringing that patient in contact with pathogens from a previous patient.

Safety and Maintenance
To avoid injuring patients, chiropractic table elements are constructed with safety in mind.

“Safety issues are usually governed by Health Canada, a government agency that classifies chiropractic adjusting tables as Class 1 medical devices. This means they represent the lowest risks,” says Gary Holub, media relations officer at Health Canada.

“There is also a yearly routine required for medical devices,” continues Holub, “whereby their manufacturers must ensure they have appropriate post-market procedures in place for distribution records, compliant handling, mandatory problem reporting and recalls.”

He adds that to hold a valid medical device establishment licence, establishments must submit an application, with fee for annual review, to Health Canada every April 1.

What does this mean to the chiropractor who purchases the table? The manufacturer and/or distributor of your chiropractic table must have checks and balances in place to ensure that the table you purchase comes with the assurance of safety, in order to protect you and your patients.

Another yearly process involves table maintenance and may be provided by the manufacturer or distributor of your table. Checks should be made annually for leaks on air and hydraulic lines. Grease and lubrication frequency depends on the manufacturer. Less expensive tables will need more oil and grease.

For the best care, practitioners should ask the manufacturer what type of maintenance their table needs, and if cleaning and maintenance is provided by the manufacturer. Alternatively, a DC can ask the repair centre how to clean the table and its components and what issues might arise during cleaning.

As well, consideration must be given to the location of repairs for electric and hydraulic tables – that is, does someone come in and clean it, or does the table need to be sent out. If the table needs to be sent out, the DC must make provision for this, either by cancelling patients or by having another table available while one is out for repair.

Finally, the chiropractor will have costs for maintaining the table in coming years – and these need to be considered, as well, when purchasing the table. These may include, but are not limited to, repairs beyond warrantly and reupholstering.

Some closing thoughts
Triantos counsels young chiropractors to make their first table their main table. The second table in a two-room clinic can help as an overflow table . . . and so forth.

As well, doctors who are shopping for their first table when opening a clinic, or changing their décor in their treatment rooms, are warned that shopping only two weeks before opening may not give them enough time.

In short, when looking for a table – be it the first table or a new one to add to a growing clinic – DCs are advised to plan ahead, establish needs and budget, understand safety and maintenance guidelines, and consider costs of unexpected repairs.

Next to his/her hands, the chiropractic adjusting table may be the single most important piece of equipment that a DC uses in practice. It can leave a patient with an impression of what your practice is all about. Shop around, choose wisely and don’t hesitate to turn to the experts in this field for advice. Speaking with other chiropractors and some industry leaders can help you get a good overview of what’s available and what’s right for you.

References

1.   
Wells,
D. From Workbench to High Tech: The Evolution of the Adjustment Table.
Chiropractic History. Vol. 7, No. 2. 1987.  p. 35-39.

2.   
Ibid.

3.   
Ibid.

4.   
Ibid.

5.   
Joseph
A., Keller A., et al. Improving the Patient Experience – Best Practices for
Safety-Net Clinic Redesign. Report prepared for the California Health Care
Foundation. March 2009. Internet source, www.chcf.org, searched August 20, 2012.

6.   
Ulrich,
R., Zimring C., et al. Role of the Physical Environment in the Hospital of the
21^st Century. Article on the website for The Centre of Health
Design, http://www.healthdesign.org/chd/research/role-physical-environment-hospital-21st-century,
searched on the Internet, August 20, 2012.

7.    
Infection
Control Standards Task Force for Non-Acute Institutions – Final Report, March
2004. Internet source, searched August 20, 2012. http://www.health.gov.on.ca/english/providers/program/pubhealth/sars/docs/docs3/report_taskforce_non_acute_031104.pdf

Linda Gutri is a freelance writer living in the Greater Toronto Area and a graduate of the Ryerson University School of Journalism. She has published articles in Canadian Grocer Magazine, Canadian Secretary, Hamilton This Month, Canadian Computer Reseller, Credit Union Way, The Illustrated News of Dofasco (Shareholder Publication), The Torch and HRPAO Magazine for Human Resource Professionals. She achieved honourable mention for a team effort for The Kenneth R. Wilson Memorial Award. Linda returns to the world of freelance writing after taking time off to raise her son.