Impulse Adjusting Instrument™ FAQs
Index of FAQs
Features and Proper Usage of Impulse™
Q: What force settings should I use on the different regions of the body?
A: Impulse™ has three distinct force settings (low, medium, and high) that are achieved by means of the three-position switch located just above the handle grip. Selection of the appropriate force setting is essential for safety and achieving the best results with patients. Prior to applying the instrument to the patient, first thrust into your own hand to get a feel for the thrust that the chosen force setting produces. Below are some general guidelines
Q: How do I know how hard to press the instrument into the patient prior to adjusting?
A: Prior to adjusting, pressing too hard into a patient can reduce the amount of bone movement that will occur, while conversely, not pressing hard enough will cause the force to be absorbed by the soft-tissues rather than the target vertebra. Research has shown that about 20 Newtons of preload is utilized by chiropractors performing manual adjustments (Herzog et al., Spine 2001;26(19):210510) . Impulse is equipped with a 20 Newton spring in the nosepiece of the instrument that is ideal for just the right amount of tissue compression (tissue pull) prior to thrusting. You’ll notice when you preload the instrument, the red LED adjacent to the force-adjustment switch will turn green signaling that appropriate preload has been achieved. Note that the instrument will not fire unless the stylus is preloaded.
Q: How do I get Impulse™ to fire once versus multiple times?
A: Impulse™ is equipped with an electronic trigger that interfaces with an internal optical sensor that enables you to perform single or multiple pulse thrusts for accomplishing the chiropractic adjustment. After preloading the stylus, the red LED will turn green indicating that proper preload has been achieved. Pulling the trigger once and immediately releasing it causes the instrument to thrust once. Pulling the trigger and holding it causes the instrument to enter the multiple pulse mode and the instrument will thrust 12 times in a row over 2 seconds (6Hz). You can release the trigger at any you feel is clinically indicated allowing you to perform number of thrusts you desire ranging from 1-12.
Q: When should I use the multiple pulse feature?
A: Generally speaking, one thrust is recommended for articular adjusting, whereas the multiple pulse mode is commonly used for excessively fixated segments or for neuromuscular applications. Our research has shown that multiple pulses can increase the vertebral motions by 25%. Thus, in areas you desire to create greater mobility, engaging the multiple pulse mode will enable you to create more vertebral motion than is capable with a single thrust. Please note that applying more than 12 thrusts on a segmental contact point is contraindicated. In many instances you will observe clinically that only 3 or 6 thrusts are necessary to achieve your desired adjusting objectives. Over adjusting is more work for the doctor, can cause excessive soreness for the patient, as well as can shorten the lifespan of the instrument.
Q: When do I use the dual styluses?
A: Cervical and Lumbar Dual Styluses can be interchanged with the single stylus for accomplishing greater control during multiple thrusts and for instances desiring greater posteroanterior directed forces. Dual styluses are often used in addressing hypolordosis or kyphotic spinal configurations or retrolisthesis subluxations. Further training on the use of dual styluses is provided in our seminars.
Q: What's the fastest way to become educated on how to use the products?
A: The fastest way to become proficient in instrument adjusting is to purchase an Impulse Adjusting Instrument and review the DVD that comes along with it and get started incorporating instrument adjusting into your practice. Neuromechanical Innovations also provides specific training on instrument adjusting and rehabilitation at its seminars that are offered nationwide and around the world. Instrument Adjusting is taught along with rehabilitation protocols for the most common conditions presenting to chiropractors, along with structural and new functional adjusting protocols.
Q: Sometimes adjusting instruments wear out my hands and arms if I use the product long enough. Any tips on preventing this?
A: The Impulse Adjusting Instrument was specifically designed to reduce the recoil of the instrument thrust into your hand. With less recoil and a shock-absorbing grip, It won’t hurt your hands or wrists. Because there is no heavy spring to cock like in other instruments, you won’t wear out your hands, wrists, and elbows with instrument adjusting.
Q: What research has been done documenting the effectiveness of adjusting instruments and methods?
A:Over the past 20 years, a myriad of research has been conducted into the effectiveness of chiropractic adjusting instruments. This research began with attempts to prove that the thrust of a modified dental instrument (used to split impacted wisdom teeth) could actually move a bone in a dog.1,2 In the years that followed, research aimed at quantifying the forces, speeds, vertebral motions, and neurophysiological responses was conducted in human subjects and published in the scientific literature.3-12 Collectively, this research has demonstrated that hand-held chiropractic adjusting instruments indeed, created bone movement, spinal nerve root and neuromuscular reflex responses that are widely held as responsible for the mechanisms of the therapeutic effects of chiropractic adjustments.
Clinical research into the effectiveness of instrument-delivered adjustments have been compared to manual chiropractic adjusting methods.13-16 This research has shown a positive clinical outcome in both patient groups receiving manual or instrument delivered adjustments and no difference in patient outcomes between patients receiving either technique.
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Q: Is there any research comparing Impulse to other chiropractic adjusting instruments?
A: A 2005 study published in the Journal of Manipulative and Physiological Therapeutics compared the forces, speeds, and frequency area ratio of six commonly used chiropractic adjusting instruments including Impulse™. The study reported a broader range of forces and a superior frequency area ratio among electromechanical adjusting instruments over traditional spring-loaded activation devices specifically favoring the Impulse Adjusting Instrument™. Impulse™ was also found to be twice as fast as the spring-loaded activation devices examined on all settings. These findings provide a scientific rationale supporting the anecdotal reports of better results with patients by clinicians using Impulse.
Comparison of Adjusting Devices
Q:How do electromechanical adjusting instruments compare to traditional spring-loaded activation devices?
A: In the 1980’s and 1990’s spring-loaded activation devices flooded the chiropractic market and attempts were made to improve the frequency characteristics of instrument delivered thrusts as adjustments given at the right frequency can create more bone movement with less force.9 Unfortunately, despite design changes and significant price increases in spring-loaded devices, research demonstrated that the second, third, and fourth generation activation devices still didn’t have the desired range of forces or thrust at the desired frequency.17 Born out of the decades of research was an electromechanical adjusting instrument with improved forces and speeds that is tuned to the natural frequency of the body, the Impulse Adjusting Instrument®.
A recent study17 reported a broader range of forces and a superior frequency area ratio among electromechanical adjusting instruments over traditional spring-loaded activation devices specifically favoring the Impulse Adjusting Instrument®. In this research, Impulse® was found to be twice as fast as compared to the spring-loaded activation devices, and had a wider range of force settings for clinicians to choose from (a lighter low setting, and a higher high setting).
To validate just how the improved forces, speeds, and frequencies actually affected vertebral motions, the Impulse Adjusting Instrument® was compared to two popular spring-loaded activation devices. Impulse® was found to create two to three times the amount of spinal motion as the other instruments.18 More recently, new research for the first time has recorded what happens during multiple-thrusts, and the 6 Hz frequency of the Impulse® multiple-thrust mode.19 This research reports a 25% increase in vertebral motions during multiple-impulse thrusts. In all, the new developments in instrument adjusting are exciting and on the cutting-edge of chiropractic research.
Click here for references.
Q:Has the Impulse Adjusting Instrument been compared to the other 2 adjusting instuments, Adjuster by IMPAC and Arthrostim by Erchonia? If so, what is the difference between yours and theirs? What is the difference between the IMPAC and Erchonia instruments?
A: The Impulse Adjusting Instrument has not been formally compared to the Adjuster or Arthrostim. In fact, I'm not aware of any research ever being published on these other devices. Unfortunately, I'm not sure of the difference between the two instruments and this question would be best placed to the manufacturers.
Q: Is there a return/satisfaction guarantee policy with the purchase of the Impulse instrument?
A: We offer a 30-day, no-questions-asked, money-back guarantee on the purchase of the Impulse Adjusting Instrument. In addition, the instrument has a one-year warranty as well.
Instrument Adjusting and Medicare
Q: What is Medicare’s position on the use of adjusting instruments in chiropractic practice?
Medicare’s coverage of chiropractic services can be found in the Centers for Medicare & Medicaid Services Carriers Manual, Part 3, Chapter II Coverage and Limitations (2251) found online at http://www.cms.hhs.gov.
2251. Coverage of Chiropractic Services
2251.1 Manual Manipulation. - -Coverage of chiropractic service is specifically limited to treatment by means of manual manipulation, i.e., by use of hands. Additionally, manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine. However, no additional payment is available for use of the device, nor does Medicare recognize an extra charge for the device itself. …
Medicare does not “approve” any specific chiropractic adjusting device, rather, states that the thrust of chiropractic adjusting instruments must be controlled manually. The force of the Impulse Adjusting Instrument™ is controlled manually by means of a three-position force selection switch. In fact, new research has demonstrated a greater range of forces for electromechanical devices over their spring-loaded counterparts (Colloca et al. J Manipulative PhysiolTher, July/August, 2005).
Q: My instrument won’t fire
A: First, make sure that the instrument is properly plugged into the wall. If the instrument is plugged in the power/preload LED next to the force adjustment switch should be illuminated red. If the LED is not illuminated red and you are sure that the instrument is plugged in properly, call our customer service department to arrange for repair.
Q: My instrument won’t fire and the LED is blinking red.
A: If the power/preload LED adjacent to the switch begins blinking red, this indicates a voltage error that has been detected either from a voltage spike, or overuse and the instrument must be rebooted. Simply unplug the instrument and let it rest for a few seconds prior to use again.
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