Introduction to DPPP-SAA Treatment Protocol


     I am currently implementing the Dynamic Patient Positioning Protocol – Sensory Assisted Application (DPPP-SAA), as the main treatment protocol in my Chiropractic clinic. This is a specific and unique treatment procedure which I have personally designed and improved throughout my 25 years of clinical experience. This protocol is based upon Flexion / Distraction technique, applicable to variety of spinal column Inter-Segmental Dysfunctions (ISD), discopathy, as well as structural and functional spinal deformities.

      The DPPP is a protocol that allows for specific individualized treatment procedure based on patient’s presentation. It is important to note that, even so, there are similarities in patient treatment procedures, yet in this system each treatment protocol is tailored specifically for each individual patient. For example, in patients with discopathy in addition to standard examination procedures and imaging, it is also the bio-mechanical diagnosis that is taken into consideration, leading to selection of the appropriate treatment procedure.

      More specifically, even the morphology of the affected disc itself is considered a consequential component in this selection. It is important to emphasize that the DPPP specific treatment procedure, for example, a far lateral disc herniation, is rather different from the treatment procedure for a posterior lateral herniation, or even a hyper bulge disc.

      Consequently, it is the specificity of the treatment protocol that allows for a safer more effective treatment, which also significantly improves long-term prognosis. In fact, during this treatment protocol, I routinely order MRI studies within the first three months, six months, and a follow-up one-year study in order to monitor patient prognosis.

     The Sensory Assisted Application is referred to the S1-Active Locus Monitoring Instrument. This instrument which I have also designed and patented, not only allows for live monitoring of the specific treatment procedure, but it also records precise detail for each treatment session, which has proven highly useful for later comparison. Furthermore, specific treatment procedures for patients with similar presentations, can be compared for the purpose of clinical observation, teaching, and future research.

     As a basic principle, patients with localized, or even radicular pain are expected to respond to DPPP-SAA within the first few sessions of treatment. Response to treatment is measured by reduction of pain up to 30%, and appropriate functional improvement detected on the S1-Active Locus Monitoring Instrument.

       It is important to emphasis that patient selection is just as significant as the treatment protocol itself. Generally speaking, patients with stable ISDs and discopathy without a progressive neurological deficit can be considered potential candidates for this treatment protocol. It is important to note that stability in this respect is referred to bio-mechanically stability. In fact, bio-mechanical stability does not necessarily correspond to the severity of structural pathology seen on the imaging study. Case in point, a large herniation or even a focal extrusion may be more stable from the bio-mechanical perspective, than a desiccated degenerative, hyper-bulge disc.

   Therefore, a high-quality MRI imaging study, which in some cases must also be complimented by stress or bone window studies, is necessary for establishing an accurate bio-mechanical diagnosis, and subsequent correlation with clinical neurological findings.   


     Furthermore, it is important to note that because DPPP-SAA  treatment protocol is applied along the axial plane with well controlled decompression components, eliminating the rotational movement, it is considered safe, even in discopathy with substantial disc pathology.

     Please note that some of the pre and post treatment comparison results can be viewed in the Case Reports section of this site.

 H. Sabbagh D.C.