Before getting started with the HALO:
As with all other forms of active rehabilitation, in order for patients to qualify for active rehabilitation with the Halo system, they MUST be free of acute pain with activities of daily living (ADLs).
Ideally, they should have 25% or more of normal range of motion in the cervical spine, in all directions with little or no pain during movement, BEFORE starting Halo protocols.
***It goes without saying that the Halo system is contraindicated with acute disc patients, acute sprain/strain injuries and anyone whose symptoms increase whilst performing the Halo protocol.
Halo Posture and Halo Rejuvenator head weights come in various sizes and range in weight from 1 pound to 5 pounds. There are a number of factors that will determine the proper weighting for yourself and your patients.
Physical fitness, age, sex, frame size, strength, degree of dysfunction, symptoms, body awareness, balance and coordination must all be taken into account when making your clinical decision about what size Halo to use.
That being said, below you find a general guideline:
- For children and small adults we start with a 1 lb. or 2 lb. Halo - head weight only
- For men under 170 lbs. and most women we start with a 2 lb. Halo and a 5 lb. anterior chest weight
- For men over 180 we start with a 3 lb. Halo and either a 8 lb. or 10 lb. anterior chest weight
***REMEMBER, the above chart is only a guideline. Some patients can handle more weight and for others, you may have to reduce the weight. The poorer the patient’s physical condition the longer the process of posture correction will take.
***When in doubt, USE LESS WEIGHT and/or time. You can always add more weight later but if the patient becomes very sore they will not be excited to try it again.
Most common "escape" patterns:
- Neck buckling with chin jutting forward - head goes further into forward head posture (MUST reduce the weight - the patient is being crushed)
- Hyperextension of the lumbar spine – severe atrophy of antigravity musculature, usually with hip flexor and lumbar erector dominance (MUST cue patient into proper position)
The issue of timing is much more straight-forward than sizing. The frequency of treatment needs to be enough to force an adaptation while avoiding excessive wear and tear.
- Almost all patients will begin at 2 minutes per day, two to three times per week.
- Treatment time is typically increased by one to two minutes per week. Some patients can handle greater increases in time and for others you'll have to back it down.
- The long-term time goal is 20 minutes per day, seven times per week (until forward head posture has been eliminated at which point the patient can shift to a maintenance schedule).
*** Keep in mind that we want to keep patient soreness to an absolute minimum or, better yet, avoid it all together.
*** Most often, the patient will work up to 10 minute Halo sessions during his/her office visits (with the cueing that is sometimes necessary to achieve the correct position) before transitioning to daily use at home.
As the patient transitions to performing active care at home, their daily training time is typically cut in half while increasing the frequency. If they were up to 10 minutes per day, 2 times per week (for a total weekly training load of 20 minutes) and we go to 5 minutes per day, 6-7 times per week (for a total weekly load of 30 to 35 minutes). With this, their weekly training load has nearly doubled while giving them the feeling that they're getting a little break.
***The Halo protocol MUST ALWAYS be performed with bare feet. Not only will bare foot contact with ground increase proprioception but, elevated heels work against the patient by pushing the head further into forward head posture.
Within a typical session, soft tissue work is performed first, the patient is then adjusted, as only joints that are free from subluxation (substitute any word you prefer for "subluxation" if that word upsets you - it's the concept that matters) are able to provide the necessary afferentation to the cerebellum then, the Halo protocol which follows may be employed.
Most patients will begin with standing in place. As comfort level, body awareness, balance, strength and physical fitness increases, the patient can slowly progress up the proprioception continuum. These positions and movements drive increased proprioception to the brain and may be added PROVIDED the patient can maintain PROPER POSTIONING AT ALL TIMES.
The Proprioception Continuum:
- Standing on one foot
- Standing on a wobble board or inflatable balance disc
- Walking backward
It is strongly recommended that in a addition to having the patient fill out and update the standard neck disability index questionnaires, that doctors video record (with the patient's permission , of course) the BEFORE and AFTER postural assessment, range of motion and functional testing with all patients using the Halo system. They will, no doubt, notice that daily tasks become easier for them as their posture improves and they become stronger but, it's very powerful to show them on video just how dysfunctional they were when they started (which they may not remember in great detail).
***If the patient EVER returns for a follow-up office visit complaining of soreness, simply cut the last time they used in half (and/or reduce the training weight by 1 pound). You can always go up again at another appointment.
***The MOST IMPORTANT skill for doctors to develop when starting a patient on the Halo system is OBSERVATION. If the weight forces the patient to buckle, or to try and "escape" out from under it AT ANY TIME DURING THE PROCESS, the weight (and, often times, the training time) will have to be reduced. That patient should also be monitored and cued THE ENTIRE TIME they are performing the protocol until they have built up a decent base level of body awareness and strength in their postural system.
***Having the patient perform the Halo protocol in front of a mirror can be a tremendous aid in developing body awareness and can save the doctor a significant amount time which would otherwise be spent monitoring the patient.
***REMEMBER the key to the Halo system is CONSISTENCY OVER TIME. We are working against the unrelenting force of gravity and it’s affect on the human frame. Each minute spent using the Halo system is building up the body’s resistance mechanisms and moving the patient towards optimal function.