Shaking Up Your Profit Centers

Vibration exercise has become increasingly popular among chiropractors. Doctors are becoming more educated and understand the differences in quality among the various vibration platform manufacturers out there. However, there is a lack of information on how to implement vibration training  within a chiropractic office.

Patient Benefits

The underlying principle of vibration exercise is simple: The vibration platform drops a certain distance (amplitude) several times a second (up to 50 times per second). By working through the stretch reflex, muscles are contracted at a high rate through an involuntary mechanism, similar to a knee tendon tap reflex.

Research suggests a wide range of benefits, from arthritis and low back pain reduction, to improvement in balance, strength and flexibility for seniors and those suffering from MS, stroke, spinal-cord injury and Parkinson's. In addition, there have been reports and studies on fitness and beauty applications such as weight loss, lymphatic drainage and cellulite reduction. Those unable to engage in conventional exercise are now able to receive a strength training effect, with minimal impact to the joints.

Clinic Benefits

With so many applications, it's not hard to get confused about exactly how to implement vibration exercise into your practice. Do you use it for weight loss or rehab? Can it be integrated into a decompression program? What about the ability to establish a fitness program with vibration? All these things are feasible and are known to be successful. However, before we talk about specific applications, there are some key points to be aware of:

• Vibration exercise should initially be an extension of your own practice. If you are primarily interested in rehab, begin using it for rehab. You can then expand into other areas once you and your staff understand its applications
  


• Don't spend too much money on external advertising in the initial stages. Vibration exercise is one of the only modalities that we know has a significant "wow" factor. Patients talk about it to other patients and to their friends and relatives. Be prepared to internally market it from the very beginning, offering an open-house launch, mail or e-mail blasts, and setting up a weekly or biweekly seminar. Word of mouth has been a very effective advertising method. Eighty percent of your referrals after the initial stages should be coming from word of mouth.
  


• Do your research into the type of vibration machine to get. The quality of these devices varies widely. The ability of a platform to mimic the same parameters as used in research is also very rare. Ask the tough questions. Does the company have experience with chiropractors? Can the product handle a wide number of patients per day? Can the platform handle a 400-pound patient? If you are looking at vertical platforms, ensure the amplitude levels are sufficient to actually elicit a muscle contraction (some machines in the marketplace are nothing more than massagers disguised as vibration). If you are looking at pivotal machines, ensure the frequency actually goes to 28-30 Hertz. Most machines on the market don't go past 14 Hertz.
  


• Talk to other doctors about their experiences.

Billing as a CPT code

There are a wide variety of ways to generate revenue through vibration exercise.

If you are in a state that allows billing of exercise services, there are a few codes you can utilize. Payment varies by state. All of the following codes require direct, one-on-one patient contact. [Special thanks go out to Bharon Hoag from ACOM Solutions ( ) for these coding recommendations.]

Procedure codes:

97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength, endurance, range of motion and flexibility.

97112 – Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities.

97530 – Therapeutic activities, direct (one-on-one) patient contact by provider (use of dynamic activities to improve functional performance), each 15 minutes.

Please note that code 97112 is primarily used for neuromuscular re-education in the physical-therapy world. Unless you have used this code before for chiropractic care, I suggest you stick to the simpler 97110.