Acting as a human guinea pig to experience advanced spinal mobilisation capability of IDD Therapy

IDD Therapy is the fastest growing conservative spinal treatment.  Thoughts about the application of spinal mobilisation got me thinking about how we might make use of the parameters of treatment for different therapeutic objectives.  

In this video I act as a human guinea pig to set a treatment with an increased level of spinal mobilisation and extended duration of distraction.  That sounds more dramatic than it was since treatment is very safe, although I was slightly nervous!

IDD Therapy is a programme of treatment involving a series of one minute distraction and mobilisation cycles to decompress targeted spinal segments.

Part of the mobilisation is a patented oscillation capability at the point when the joint is distracted. Typically, this oscillation force is set at 10lbs and applied for one minute at a moderate frequency.

The computer software in IDD Therapy gives clinicians the unique ability to adjust the oscillation in line with principles of manual therapy, whether Maitland, Harmonics etc.

Oscillation Frequency & Amplitude

Differing frequency and amplitude of oscillation/mobilisation (60 seconds)                                                               Low Freq’cy      Moderate Freq’cy          High freq’cy               10lbs oscillation            20lbs oscillation

In this video, I explore what a higher oscillation force feels like by increasing the oscillation force from 10lbs to 20lbs (amplitude) at the point when the joint is distracted under tension.

Since the oscillation force has a bigger distance to travel between high tension and low tension, it is necessary to decrease the frequency, ie the number of cycles, to allow time for the distraction force to go up and down within the range of the oscillation.

This reduces the number of cycles of oscillation in a 60 second high distraction. Therefore the duration of the oscillation at the high distraction is increased from one minute to 90 seconds.

Thus the joint is opened for longer and at the same time, the joint and surrounding soft tissues are exposed to more significant distraction and mobilisation forces.

I have received many IDD Therapy treatments and observed that the combination of longer distraction at high tension and greater degree of oscillation results in a greater feeling of decompression.

The treatment feels more powerful and remains comfortable. The next day after treatment, I could feel greater range of movement, improved posture and less stiffness in the lower back.

Whilst IDD Therapy is typically given as a course of treatments for chronic disc-related conditions, IDD Therapy is used as a tool when clinicians need something more than hands alone to increase range of motion and soft tissue function in the lumbar spine.

Author: Stephen Small
Director Steadfast Clinics Ltd

Exercise compliance – Insights from using Yoga DVDs at home to instill discipline and motivation in patients.

I leave the clinicians to work out what the best exercises are, my interest is improving compliance.  

Knowing exercises is one thing, doing them is another! 

For a few years I have had a growing feeling that I need to preserve joint mobility, particularly in my lower back!   So I have toyed with the idea of doing yoga (also for a few years!).


At the end of the summer I bought a box set of yoga DVDs and over the last couple of months I have started to use the Yoga videos in the morning, at least twice a week.

They really help and now, I would probably be happy to join a class because I understand that “Cobra” is not a beer brand we have with a curry!

The point is, I did know what a sun salutation was but I never bothered doing them on my own.

With the DVD there is a framework and time structure.  From 30 minutes to 45 minutes.  ie it’s doable and someone is there with you.

Many patients leave a clinic with a set of written or verbal exercises to do. That is not going to work for most.  It DOESN’T work for most people!

I have written about exercise diaries, wall planners etc, my strong recommendation is to find a DVD that you like and sell it to patients for them to do at home (and record when they do it in their exercise diary!)

Then tell them to do the exercises at least 3 times a week or daily or whatever is appropriate.

The APPI do a video for back pain which I believe you can buy at trade prices

but there are many others.

IDEA – Why not put on a “back class” at your clinic or elsewhere, get a local videographer to record it and then give that to patients as your own-branded DVD, give complimentary copies to GPs etc etc, then who’s the local daddy?!

If you do hear yourself saying to patients “do try to do your exercices” you know that most won’t bother. Try the DVD route, it can can only help and you will stand out from the masses.

Now time for some Cobras … I’ll do my yoga in the morning 😉

Author: Stephen Small, Director Steadfast Clinics

Steadfast Clinics is the international distributor of IDD Therapy spinal decompresion, SDS SPINA, Accu SPINA and Thermedic Infrared Therapy Systems. We’re on a pain relief mission !

‘Sarcopenia’, my holiday and insights for back pain patient exercise compliance

Sarcopenia is my favourite word.  I heard it a few years ago when I discovered that, like everyone else, I was suffering with it.  The gradual reduction in skeletal muscle mass as we get older (0.5%-1% per year after age 25), the stuff middle aged-crises are made of!

I have always played sports and been active.  As a 42 year old (I count that as young!), I still run, swim and go to the gym once or twice a week.  No major injuries and, touch wood, no back pain issues which is the subject I deal with the most at Steadfast.

I got back from a 2 week holiday in Spain last weekend.

Aside from a little swimming, my activity levels dropped enormously as I tucked into tapas and the odd glass of Rioja!  Now 3 weeks on, I feel a noticeable, alarming reduction in what muscle mass I had before I went away.  Use it or lose it I think is the saying.

However the other thing I notice, which is what got me thinking about back pain patients, is that my will power to return to doing exercise is at rock bottom!

I now have no desire or motivation to go to the gym or do anything.

My principal personal reason for exercising is that my body stagnates when I don’t do anything, so I have to crank things up. Yesterday I did manage to win a herculean mental battle and take myself off for a run but it was painful (run = jog/ run any slower and you’ll be stationary).

It was also depressing because I realised how much pace, strength and stamina I had lost in such a short space of time!

All clinicians prescribe exercises to their patients and patients expect (are resigned) to walk out of a clinic with a list of exercises.

For people who perhaps haven’t had a habit of exercising for a long time, who have pain and particularly those who are overweight, is it any wonder that they find it so difficult to comply with an exercise programme?

And when someone fails to comply with an exercise programme and they remain in pain, doesn’t it reinforce a negative mindset?  Those ‘depressed’ feelings about themselves and what they are (not) capable of are extremely demotivating.

I have written a couple of articles about taking lessons from other industries to improve exercise compliance.

E.g clinicians can use exercise diaries for personal exercise accountability, wall planners as visual reminders and clinicians can link up with personal trainers to create short programmes to help patients with exercise compliance.  There must be other ways too … group classes etc etc.

Given that chronic back pain is the #1 musculoskeletal cost to society, there has to be a case for putting in place more robust systems to help patients and back pain sufferers in particular overcome inertia and progressively develop a habit of activity and exercise.

Otherwise, people will never get off the chronic back pain merry-go-round and, for the reasons outlined here, certain financial inefficiencies will persist as money is spent on treatments when there is limited long term benefit.

PS It’s 8.30 Saturday morning as I write this.  The gym is open for business, there is bacon in the fridge and I feel the battle already in my brain.  Battle won …. I’m getting back on the virtuous circle … though I might I have some bacon when I get back!

Stephen Small linkedinBy Stephen Small
Director Steadfast Clinics Ltd

Steadfast Clinics is expanding the availability of IDD Therapy spinal decompression for disc-related back pain and Thermedic Infrared Therapy systems for joint pain relief and soft tissue injury rehabilitation.

The Number 1 Mistake Clinicians Make When Seeking To Establish Relationships With GPs

For most clinicians getting GPs, or indeed any other clinician, to refer to them seems highly desirable.  However I consistently hear the age-old complaint from clinicians that ‘GPs just aren’t interested in them’.  Why is that?

The answer is not that GPs are interested per se, rather the fundamental problem is that most clinicians simply fail to establish relationships with their local GPs.

In this post I will tell you the Number One mistake clinicians make when seeking to establish relationships with GPs and outline 3 steps which MAY create the relationships you seek (and in turn get you referrals).

So if you want to engage GPs there are two important questions –

1/ Why should they be engaged by you? 
2/ How are you going to get your message to connect with them?

To begin with I’ll assume you have a compelling reason for GPs to be interested in you, but if you don’t, you can still establish a connection as the first choice treatment provider in your field.

Whatever your engagement means, the number one mistake clinicians make is to give up on establishing a relationship too soon.  

So many clinicians have the unrealistic expectation of getting an instant response or, for one or two letters (or other communication means)  to lead to the establishment of a meaningful relationship with their GPs.   Relationships don’t work like that.

The three pillars of any relationship are well documented – Know, Like, Trust. 

My brother-in-law is a GP and so are some of my old school friends.  They are snowed under with paper work, sales messages, drug company reps, government initiatives and of course patients!

If you want to engage GPs, you have to let them get familiar with you over time.

Here are 3 simple ways for you to engage GPs:

1/ Case History – If you successfully treat a patient, write to their GP with a brief case history. You should have their GP name in your notes, but if you don’t then make sure you get it! This will really set you apart from your competitors and the GP will remember your name and respect you.

Include a business card since whilst we tend to throw away mail, if we like the essence of a letter we will keep a business card.  Include an open invitation for them to visit the clinic at any time (they may need treatment themselves!).  So start by producing one patient case study a month and build from there.

Add the contacts to your database of “influencers” and send them a Christmas Card or Happy New Year card.  They get hundreds of Christmas cards so why not be different – send a Happy New Year card as in all liklihood yours will be the only positive message in the new year mail … be different!

2/ Newsletters – A 2 sided A4 newsletter sent quarterly should not be too much to ask of any clinic to produce.  All your contact details will be there and over time you will create familiarity if you have some interesting content.

3.a/ GP Talks – GPs need CPD and regularly get together.  If you have a compelling service, programme or something you are particularly good at, they will be interested in a short presentation (offer to bring lunch, they expect this!).  The talk is a great way to engage GPs but if what you offer is not discernibly different to what anyone else is offering, then you will probably get knocked back or more likely – ignored!

3.b/ Consistent marketing – If you can’t do talks, remember that GPs are residents of your community.  Whatever marketing you do in your community will be seen by the resident GPs.   Plus, patients go along to their GPs with information from the internet or newspaper so put interesting content out there consistently and people will notice you and talk about you.  That includes your community of GPs and healthcare providers.

Need a database of your local GPs, go to enter your postcode and you will get a list of all your GPs.

Some clinics will do better focusing on patients but if you do have something special to offer, then you have a good chance of being heard if you apply these principles.  PLUS, there will be very few, if any, of your competitors doing anything to engage with GPs.  

It’s an open field for you and yours will be the only voice heard!

Author: Stephen Small, ‘Mr IDD’ – Director, Steadfast Clinics Ltd
International distributor of IDD Therapy Spinal Decompression for herniated discs and sciatica plus Thermedic FAR infrared therapy systems for joint pain relief and soft tissue rehabilitation.

Exercise Compliance: Improving Exercise Compliance in Chronic Back Pain Patients Using a Pocket Diary.

This article examines the question of how to improve rehabilitation exercise compliance.  This is particularly important for patients who are recovering from chronic back pain who have lost the discipline of regular activity.

Assuming that the prescribed exercises are not unduly painful, the question is not “how do we help people to exercise more”, rather it is “how do we help people to develop self-discipline”.  

Evidence from other industries demonstrates that setting goals and keeping a diary of the new habit is the most effective way to maintain self-discipline to arrive at a goal.  I propose the use of pocket diaries as a key tool to improve rehabilitation exercise compliance for people with chronic back pain.

At the bottom of this post you can get a word document which explains to patients the purpose of the diary and how they can benefit from using the diary (you can have this in your patient info folder in reception or to give to new patients.)


How many clinics just give their patients a set of printed or hand written exercise instructions and essentially leave it to the patient to get on with it … or not?  I hear it all the time, patients don’t do their exercises.

Patients are people, who are also in pain.  Think of one thing you should do more of?  Why don’t you?

Is it to do regular exercise, weekly budgeting, retirement planning, investment evaluation, losing weight?

Whatever it is, it’s not about the thing, it’s about self-discipline.  To tackle exercise compliance therefore is to tackle self-discipline.

It is often said that the best innovation comes not from thinking “outside of the box”, but from thinking “Inside a different box”.  So let’s leave exercise and examine what other industries do to instill and create self-discipline.

Thinking Inside A Different Box

Here are some examples of how other industries develop self-discipline:

Personal Development: In order to develop habits to get you to where you want in life, it is universally acknowledged that we need goals.  Not just any goals, but WRITTEN down goals.  (See Tony Robbins, Jim Rohn, Bryan Tracey et al)

Financial: ‘Too much month, not enough money’? (Michael Heppel).  What is the first recommendation of any financial advisor when someone is having trouble making ends meet?  Write down and record everything you spend.  Then write down a budget and stick to it and record what you spend.

Weight Loss:  You’ve seen the programmes of people who have been clinically obese for years.  First they begin by recording everything they eat.  Then they measure and write down their key stats, then they set a diet/lifestyle plan and as they begin they monitor and write down what they did and how they progress.

School Homework:  My youngest daughter has a reading diary.  Her school expects her to read something every day and then write down what she read with comments from a parent.  In her mind, it is not an option for her to arrive at school without her teacher being able to see she has read something – even if that means reading in the car on the way to school!

The pattern is emerging and it isn’t rocket science.  What about exercise?

Olympic athletes: They write down and plan every training session and write down what they actually did in that training session.  It is impossible to reach that level without planning and recording.

Gym-goers: There are gym goers who arrive with a diary.  They have planned their exercise and they tick off what they do as they go around the different cardio and strength stations.  Whenever I do this myself, my workouts are 100% more effective … and fulfilling.


My principal interest is helping chronic back pain patients who have IDD Therapy Spinal Decompression treatment progress through their rehabilitation exercises.  However, this works for any patient who NEEDS to be doing exercise for rehabilitation.

Pocket Diary:  Patients should use a simple pocket diary to record their activity.  

GOAL: On the first page they should write down their goal, strictly with a timeframe but that can be difficult for certain patients and there is a balance of compliance and unrealistic patient expectation.

PLAN 1: Give your patient the exercises they need to perform and give each exercise a short name.  The patient will write down short names for each exercise they are going to perform in their diary.  It is important that THEY write them in THEIR diary to hardwire their brain into the process.

PLAN 2:  You should help them plan their first month of when and how many of each exercise they are going to do (this can include a walk to the shop to buy the paper).  Here you will identify the time slots when it is feasible for them to actually fit the exercise in.  Yes, we can all make time, but collecting kids from a swimming lesson or going to the pub with a friend creates excuse opportunities.

When you finish writing the plan, ask them one important question:  “Are you going to do it?”

HABIT: It is well documented that it takes 30 days to form a habit.  You need to hold their hand for that first month.  By setting achievable targets they are more likely to be able to ACCOMPLISH the targets.  That brings personal reward, fulfilment, belief and … self-discipline.

RECORD: Patient is going to write down EVERY activity they did and every exercise they did.  They have to write it down in their diary.

Exercise is self-discipline and comes from within.  If they need to get a buddy or partner involved, or even a personal trainer to help them, great, whatever works.


The killer point about the diary is the need to please others, ie you and not to lose face.

They have a written down plan and they have made a personal commitment to you and themself, verbally.

Tell them you want to see them in two weeks (or a month) and ask them to bring their (homework) diary.  You are holding them accountable and the inky plan on the pages of their diary is far more likely to hold them accountable to their activity than an idea floating in their head, some scribbles on a piece of paper or an exercise video sitting in their inbox.


You can get some branded pocket diaries very cheaply, or just have plain ones.  The cost is minimal so as a “value added service”, you can just give the diary to your patient or sell them at cost/ small profit.


Doing anything is always better than nothing.  The diary helps instill the self-discipline to do what is required to help resolve chronic back pain.

Doing what is required leads to improvement and reduced pain.  Improvement reinforces beliefs about what is possible.  Beliefs reinforce self-discipline.  Self-discipline leads to doing what is required, doing what is required leads to improvement …

Off the vicious and onto the virtuous circle. 

To receive a document which explains to patients the purposes of using the diary as part of your compliance process, complete the form below.

About the Author
Stephen Small is Director of Steadfast Clinics Ltd

Conflict of interest:  None

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