Invest in Success: Choosing the Right Equipment for Your Niche
In this 20‑minute Practice Builders Podcast episode, Dr. Vince Leone and Dr. Kyle Pankinen walk listeners through the process of selecting clinical equipment for four high‑value chiropractic niches—chronic back/disc pain, chronic knee pain, chronic foot pain (plantar fasciitis/neuropathy), and neuropathy. They break down the market tiers, price points, space requirements, and training support for each major modality: spinal decompression tables, Class 4 (robotic) lasers, shockwave devices, knee‑specific decompression units, and electro‑analgesia machines. The hosts stress the importance of choosing equipment that offers a “wow factor,” provides robust training, and integrates into a multi‑modal protocol. They share concrete pricing ranges (e.g., entry‑level decompression tables $5‑7 K, mid‑range $25‑35 K, high‑end $40‑70 K; Class 4 lasers $45‑80 K; shockwave systems $28‑80 K with varying maintenance costs), discuss ROI through package pricing (gold vs. silver), and highlight how equipment investments increase practice valuation and patient perception. Real‑world anecdotes (e.g., tracking 100 shockwave patients with 98 % success) illustrate efficacy, while cautions about Medicare billing and maintenance expenses round out the practical advice.
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Welcome to the Practice Builders Podcast, hosted by Dr. Vince Leone and Dr. Kyle Pankinen, your source for building cash services. Let's dive in. Hello and welcome everybody to the Practice Builders Podcast. Welcome back. I'm Dr. Vince Leone.
Yeah, I'm Dr. Kyle Pankinen.
Hope everyone's having a fantastic today— day today. And we are going to cover the what is the best equipment For your respective niches, and so we're going to cover our niches. What we cover at specialized practice: we teach and treat chronic back pain, disc, etc., chronic knee pain, and chronic foot pain, neuropathy, or plantar fasciitis. So what we're going to do is we'll go through each niche. By the way, we're trying to keep these episodes around twenty minutes, so that way, you know, it's like we can fit it in in a short. You know, car ride or whatever, but without kind of going too long in the tooth. So, we're going to go niche by niche. We'll talk about the different therapies that we use, and we'll try to kind of go into the range of like, hey, you know, what are the different offerings and rough price points? And we don't have the to-the-dollar price points, guys. So, you know, do your own research. But, you know, we'll give you the kind of the rough numbers. So, let's dive in. We'll start with— Decompression. And Doc, give us a little summary of the offerings out there.
Yeah, so I think you can divide up the decompression tables on the market kind of as the low, middle, and high end as far as price goes. So an entry-level table is going to be probably your Triton or maybe your KDT. You're probably looking at about $10,000 to $16,000, somewhere in that range.
By the way, KDT now has a new table called the Touch, I think it is, and I think it's $25K. But they bumped that up. I think they still have the kind of the older one. And I think that's like, like you said, like around $12K. And you guys, if you really want to go cheap, you could get that Triton, which is the same as a Chattanooga, right?
Yep.
I think you can get that for like $5K to $7K, right? So if you, if you wanted to kind of dive in super cheap, That's— that is available out there. And again, we have doctors that use this table with great success. So, not poo-pooing the Chattanooga. It's just, it's not quite as impressive looking as some of the other options out there, you know, Doc?
Absolutely. So, yeah, so I totally agree with that. You can get in at a pretty minimal price, entry-level table, and Like you said, you can have success with those. Not the most impressive looking tables. Probably your more middle of the road tables are going to be your Doc or your Hill DT table, and those are going to be in that $25,000 to $35,000 price range. And then you have what I guess would call your more high-end tables. That would be like the Accuspina The DRX 9000. I know when DRX 9000 was first out, they were $90,000 to $100,000. I think now they're more in the $40,000 to $60,000 range. And I think the AccuSpina is in that range as well. With the AccuSpina, the DRX 9000, they're bigger tables. They're very impressive looking. If you— if somebody walked in, they would, they would kind of have the wow factor. With those, but they take up quite a bit of room and obviously more expensive than with those middle-of-the-road ones. They're nice-looking instruments, the, uh, the Dock and the Hill DT, uh, not as big of a fingerprint as far as taking up room. And then you have, of course, the little bit the lower end as far as the price, and they also don't look quite as impressive. So Those are kind of the ranges and the variabilities that you would have as far as price, looks, and how much room they would potentially take up in your clinic. Any other thoughts with that, Doc?
Yeah, I mean, it's always kind of a— it's like some doctors really want to have the wow factor, right? Um, and we had 4 DRX-9000s. Uh, I think they're a little more expensive these days, by the way. Um, So, Salim over at Excite Medical, um, I believe he is actually now manufacturing them. So, in other words, he's creating new tables, whereas before, I think he was just buying tables, refurbishing them, making them look— kind of upgrading the look and, and making sure they obviously work properly. Um, I think they're more like $60,000, $70,000. I, I'm not totally sure.
Oh, wow.
And I think AccuSpine is up in that neighborhood as well. Price point-wise, I know that you know Accuspina they have Dr. Sheely, so they have you know a lot of really good research there. And I believe Excite's doing quite a bit of research as well, which is good. We need research. We have good research though on you know, and they're all they all have the same FDA kind of whatever license or whatever you want to call it clearance. And so it's like every doctor I talk to with every table, they all say they have good results. So I don't you know. They all seem to get good results if you have the right protocol and you know how to, you know, use the table properly and you have, you know, some good clinical expertise. So, I think it comes down to, like we talked about in the past episode, how much space do you have and what's your budget? You know, so, you know, that's— I don't think it's super too much more complicated than that. We like the Hill. You know, Kyle, you got the Hill. I had the DRX. I think you do your due diligence, talk to the people and get a sense of what's going to work best for you, you know, in your office space-wise and then your budget.
The only other thing I would add, and then we can go on to the knee, I think, is that some companies are going to sell you a decompression table and they literally are going to ship it to you and drop it off and say, good luck.
Yeah, we don't like that.
Some companies are going to have a robust training available for you that you can get certification in and, and have a chance to interact with a doctor or 2 that can train you either one-on-one or through an online module. And so that is important when you're picking out a table. Is there some type of training to back this up that you can that can support you clinically? And that's actually one of the reasons I went with the Hill because they had a training module. Actually, I had a doctor come literally to my office and spent an entire day with myself and my staff. And so I'm not saying that that makes them better than another company necessarily as far as results or anything, but that was important to me in my consideration is to. I needed that extra training so that I knew this is how to do decompression, how to make it work in your practice, and how the table works, and some of the research behind it.
100%. And, you know, shout out to Hill and Dr. Burkhardt because, like, I have some clients here in Seattle, um, the— they're called Tangello. And so they bought 2 tables, they have 2 clinics, and they said, you know, they offer online training, but they also have an option where Dr. Burkhardt can come out and spend a day with you in the clinic. I I don't know what it's, $3,000 or $5,000, whatever. Um, I'm like, get Dr. Burkhardt out there. He's one, a fantastic human being, but two, um, you will love that training and you'll feel— be so much more confident on using the table and all that type of stuff. So they did, and they were like, oh my gosh, Vince, thank you so much for recommending that. That was such a big deal for us and our staff to be able to know exactly how to use this table and, and You know, the ins and outs and all that type of stuff. So yeah, the support with these tables is key because again, you know, you just don't want to like have a table land and you're like, well, what do I do next? And you're like looking through a manual. It's like, that's just not a great way to, you know, to start a niche and to maximize your investment. You know, if you're going to drop $40K or whatever the number is, make sure that you, you know, invest in yourself as well. Right. Obviously we have the training, um, on our coaching side, and it's, you know, to me, the investment in yourself is just as important as the investment in the equipment. So great point there on that. Um, okay, let's jump into knee. Uh, what do you want to say? Something else there, Doc?
No, that's good. Go ahead.
Okay.
Yeah.
So let's dive into knee, starting with, you know, Class 4 laser.
Yeah, Class 4 lasers. So there's a lot of different lasers on the market, and Class 4 laser is a little bit newer. If you look at the research, there's way more research done on Class 3 laser. Only reason is it's been around longer.
Hmm.
Class 4 laser though really is picking up steam. Um, and for us, for our group, we generally nudge our doctors towards Class 4 laser. I know Dr. Vince had 4 of them in his practice. I have 5 of them now.
You have 5?
I have 5 now. Just keep adding to the collection, to the family.
It's like cars. I love it.
And so we both use the cutting-edge laser, the Multi-Wave Locked System, MLS laser. One of the reasons we like that is because it's robotic. And so the catchphrase in marketing laser is to call it deep tissue robotic laser. It kind of creates the wow factor. And that laser is a— it's a high-end laser. It looks impressive. It's sharp looking. It's fully robotic. And the beauty of that is your staff can set it up and they can walk away in most instances. And Almost all the other lasers out there, you gotta hold it, you gotta work it in there. So you got staff that are tied up doing it. So not speaking about results, you— can you get results with a Class 3 laser? Absolutely. But I think the, the depth of penetration and the tissue saturation that you can get in shorter amounts of time with a Class 4 When you're taking on some of these challenging cases like discs, knee osteoarthritis, peripheral neuropathy, chronic plantar fasciitis, you want the extra power, you want the extra tissue saturation that these Class 4 lasers— and I think it's just gonna give you that extra little bit of clinical difference as far as results that you're going to see. With a class four laser, and so if you're going to get into the world of niches, I think a class four laser. So I use a class four laser for all my niches, for from chronic neck and back, chronic knee, plantar, peripheral neuropathy. The laser is really, and for me, is the centerpiece that I build all my protocols around, and. I call it my laser decompression program, my laser knee program, my laser neuropathy program.
Mm-hmm.
And that's what people, when we market, we do a lot of laser marketing, that's what they identify. So in our judgment, you need to have a good high-end laser for most of these niches. It's everything that walks through your door, docs, is a potential laser candidate. And so we have a lot of strategies we can teach later on how to implement laser successfully into your practice. But bottom line is, if you're getting into the world of niches, having a good— we prefer Class 4 laser— is almost a must.
By the way, pro tip, if you have a Class 4 laser, or frankly any good laser, and it's not busy all the time, That's a problem. Okay, and I talked to Harold about this. So Harold's the co-CEO at Cutting Edge, and, um, I just— I never understand how doctors don't have lasers that are busy all the time. Because here's the thing, every single chiropractic patient is a laser patient. And the easiest way to help more people and make more money with laser is you offer 2 packages, gold and silver. So, Miss Jones, great candidate for chiropractic. I'm recommending X on X. Our silver package is chiropractic alone. Our gold package is chiropractic with laser. Now it's a little more expensive and it's cash-based, but you will most likely get results faster. Uh, and patients— most patients want to get better faster. It's totally up to you. What do you prefer, gold or silver? So you're not selling anything, you're just making an offer. You're just letting them know. Because by the way, they don't know that you have a laser in the back room because because then they're not in the back room, right? They're in your consultation room. So they don't know. What they don't know, they can't choose. Make the offer. If you have laser, just include it as an opportunity for them to heal faster, because laser is going to increase blood flow, decrease inflammation, accelerate the healing process. You know, I mean, it's such a win-win. Anyways, so yeah, Class 4 laser, um, critical. And there's, there's tons, right? There's obviously, there's Aspen, there's, uh, Cutting Edge, there's K-Laser. Um, I'm sure there's tons more, right? A lot of these companies just white label them, you know, they buy them in China and white label them. But the point being is, um, now I've heard good things about K-Laser, uh, I never used it, but again, not robotic. So if you want something that can maximize your staff's time and, you know, look, um, very impressive and is very effective, that's That's why we like the Cutting Edge. By the way, if you buy one, tell 'em Dr. Vince sent ya. 'Cause I'll get a check in the mail and we all like checks in the mail. Next. All right, so that's laser. All right, so let's talk about Shockwave.
Shockwave.
The latest, the latest, this is the new shiny object, Shockwave, but it's impressive.
Shockwave is very impressive. I added Shockwave to my practice in 2023. And I kept track of the first 100 patients I treated with shockwave, whatever it was.
This is why I love Dr. Pankinen. He keeps track of stuff. If you don't keep track, you don't know, right? Just like your numbers, just like your revenue, just like your stats.
If you—
what you focus on grows. Okay, let's hear it.
Yeah, so we kept track of the first 100 patients, and we had exactly a 98% success rate with those first. 98 out of 100 of them got at least 50% or greater Improvement with whatever we were treating with that. The laser last year, we had a 91% success rate with whatever we treat with it. So that might be anything from shoulder conditions to foot to spine to you name it. So shockwave is is is a big bright new shiny object, as Dr. Vince said, but it can be a game changer, especially for chronic. Laser shines for acute inflammation. Stimulating healing, but the more chronic it is, the more I start thinking about. No, don't get me wrong. Laser helps with chronic too, but the really tough, challenging chronic cases that you're like, ah, nothing is working, or I'm not getting results, or very slow progress. It's amazing how many times I like well, let's add shockwave to the protocol, or let's switch from laser to shockwave. And by golly, if that doesn't change the trajectory of the person's clinical result and get them over the hump. And the thing about shockwave, see, when you get laser therapy done, people really don't feel it. Maybe feel a little warmth or something like that.
True.
With shockwave, they feel it.
Yeah.
They can feel it working.
And a lot of times it's gonna tell you where to go, right? Because the patient will say, ooh, that hurts. Yeah, that's where we're supposed to do it.
Yeah. And if you're going over area and nothing, they're not feeling anything. If it doesn't hurt, in a sense, it's, it's not gonna work. There's Dr.— one of the great docs in our group, Dr. Abrams, says if it doesn't hurt, it's not gonna work. But if it hurts, it's gonna work because it's finding areas of restriction, adhesion, scar tissue, things like that, helping to loosen, breaking up adhesions, stimulating healing. And so Shockwave can be a real game changer. We have some doctors in our group that just, they don't even have or have barely used laser. They're using shockwave and getting truly phenomenal results. So I've been really excited about shockwave. So there's the, the big 3 that we see in our group are the piezowave, the stemwave, and the softwave.
And by the way, speaking of, I think we should do an episode just on shockwave, doc. And we should bring on— so we have a new client, Dr. Tony DiCesaro, and he used to be with Softwave. Now he's with Stemwave. He teaches— he's, he's taught like over 700 doctors, uh, on shockwave and sees like 30 doctors a month. This guy is so sharp on this stuff, so we should bring him in. But yeah, so we got 3, you know, kind of 3, um, different products: piezowave, uh, Stemwave, and Softwave. What I know, Softwave's around $80K. Stimwave's what, $45-ish?
$45K. And you can get the PiezoWave for— I got mine for $28K. And I think some companies sell it for about $28K to $35K, right in that range. So that's— it's a little lower end as far as the price range. As far as the results, I had a doctor that actually called or talked to me the other day, which of the 3 should I get? And we went through the prices, and then, you know, I told him what I did with the first 100 cases, and it's like, well, in the end, at the end of the day, says, why am I going to spend $30,000, $40,000 more when if I can't do much better as far as success rate than what that— what you're telling me, Dr. Kyle? And so he went with the piezo wave ultimately because of a little lower price range. But still getting excellent results. So every doctor I've talked to that has some type of shockwave loves it, and they love the results they're getting. The downside of the softwave is there's a lot of maintenance costs with it. Big time. Where the peso wave is not only cheaper, there's also much less maintenance costs with it. And I'm not quite sure what the maintenance costs on the Stemwave is, but we will have—
Stemwave is less. Stemwave is less. It's not— I think it's also in the middle of the road. It's maintenance on the Stemwave. And so, by the way, we're talking about maintenance. The heads need to be replaced. That's, that's the point. The heads of the Shockwave need to be replaced. And for Softwave, for whatever reason, they need to be replaced quite often. And it's not cheap. I mean, Dr. Abrams, I mean, I think he spent $22,000 in maintenance costs.
In one year?
In one— for one year. So that's no joke. Um, Stimwave's less, and then Piezo's, I think, less than that. So something to keep in mind. Amazing product. Um, but, you know, um, you gotta pay to play. I mean, that's the name of the game. You got— well, here's the thing, don't get caught up on, on maintenance or, or the price point or anything like that, because you're gonna be— you know, you put $1 in the machine, you get $5 out. So that's— as long as you are doing it correctly, you know, you have the proper marketing and the protocols and the clinical stuff, these things pay for themselves in, in, you know, in multiple, right? 5, 7x multiple. So don't worry about the cost. But if you can save, right, a little bit in that regard, that's why we're trying to give you this information to make a good decision.
Absolutely. So bottom line is either— so got to— if you're going to do decompression, you got to figure out your decompression table. If you're going to enter any of these niches, either need a good laser or a good shockwave, or in many instances both would be nice but not mandatory. You could pick one or the other. If I was choosing between laser and shockwave, I would still go with the laser because it's hands-free and you're still going to get great results and your staff can set that up and walk away. Where again, the shockwave, you're going to have to have somebody standing there And doing it. So couple other pieces of equipment. If you're gonna get into the knee world, we do recommend you look into getting a knee on track. It's the only dedicated knee decompression device on the market that I'm aware of anyway. And treatment times are short, about eight to ten minutes per knee. And You can we pair that with either this the shockwave or the laser. Most of the time the laser, and we get fantastic results with that. 86% success with our knee cases last year with those two and a few other little things in the protocol too. But those are the big thing. The neon track take up very little room, and they are not expensive either. A neon track I think is around. 8 to 10, something like that.
11.
11.
11. Went up a little bit, but yeah, good, nice piece to the puzzle. And again, you know, you're— the more robust you can make these protocols, again, if you're going to take someone's money, if you're going to take $4,000 or $5,000, you want to have a robust protocol that is going to give them the, you know, the absolute best chance at success. If, if you deliver, they love you. They'll never worry about the money as long as you deliver the results. So that's why, you know, I get a little frustrated when doctors kind of try to jump into these niches and they kind of shortchange people, or they try to only do like one therapy. And by the way, some of these laser companies, they're like, oh, you don't need, you know, all you need is a laser. It's like, no, no, no, no, no. It, it's best in conjunction with these other therapies.
I always tell people with these protocols we put together that they work synergistically.
Yeah.
There's no— there's— when you're treating a chronic pain patient, rarely is there what I call a magic bullet. And what I mean by that is a monotherapy that's just gonna take care of their condition. What you're looking for is, do you have a robust protocol, as Dr. Vince said, where all these component parts are working together, each helping in a— their unique and own way to produce the best possible result. So you stack these treatments together, like a knee. You do the neon track with class 4 laser, maybe a joint support supplement, a knee brace, good pair of custom-made orthotics.
Hey, don't give away our whole protocol, Dr. Kyle. Geez.
Oops.
But you know, he's— what he's saying is true. He said you got to have a robust approach. And address all aspects of it. Now we're we're we're we're pushing our twenty minutes. Let's quickly go into electroanalgesia.
Yeah, final thing: if you're going to get into the world of neuropathy, you need a laser. But we like to pair that with electroanalgesia. Think of electroanalgesia as I like to call electrical stimulation on steroids. So. You have, say, an interferential machine, which most chiropractors are familiar with. We get trained on those in school. Usually that'll produce somewhere around 100 or 1 to 150 pulses per second of stimulation. Electroanalgesia machines will produce 6,000 to 10,000 pulses per second of electrical stimulation. So machines like the Neuromed, the Senexus, the Hockomed, The Tesla Max. There's one or two other ones out there. They all— there's several different companies that sell these machines, and but I'll fall under the umbrella of electroanalgesia. And for treating tough neuropathic pain, these can be big game changers. So regardless of the the company you get, they're all going to try to accomplish that same goal of. Decreasing pain, stimulating the nerves to fire appropriately to restore the signal in there and to heal. And you use that in combination with the laser, and that is a very powerful 1-2 punch for treating these neuropathy cases. We also have some doctors in our group that are using electroanalgesia for really tough back cases. As well, chronic knee. So these are some of the, the tools of the trade, if you will, docs. And, uh, electroanalgesia machines, they, I think, are somewhere in that $20,000 to $40,000 range.
Yeah, I think the Neuromed, Hocomed, you know, those are around $20,000. Synexis is, I believe, around $50,000, or at least it was before everyone got sued. That was billing Medicare wrong. Um, I'm not gonna Name names, but that was not good. Um, but you know, if you try to bill Medicare for something they don't cover, which is neuropathy, then obviously they're going to want their money back. Um, I have one client alone owes, I don't know, like half mil.
Wow.
So yeah, don't do that. Um, but, uh, great, great therapy to help with these neuropathy patients. I think that's it. Yeah, I think that's it. So, you know, you, as with anything in the financial world, guys, you want to look at this— and gals— you want to look at this as an investment. You know, hey, I want to put $1 in and what am I going to get out? So, and the more you invest in your company, your practice, yourself with the training, the more valuable it becomes. Right? So when you're trying to differentiate yourself, positioning, um, how can I be an expert? How can I be looked at differently? How can I, um, be seen as a specialist? And these investments add, right? They add that value. So not only now currently, as you— because you can charge higher prices and there'll be less resistance to experts, but also when you sell your practice, if you have the systems and the marketing and the expertise and the protocols, to help a super high-value patient, well, that's— and you have the equipment that you've invested in, that, that creates a higher value to your practice, um, and would be more attractive to a true business owner, right? Someone that is, is doing more than just a personality-driven chiropractic practice. So look at these as an investment, do your research, but there's these— these are phenomenal tools. We live in the Best time ever right now for healthcare because things are rapidly improving and changing. And, you know, they're all opportunities for us to expand what we do, how we help patients. And then, you know, obviously patients get great results. So any last words on, on the equipment side of things, Dr. Hankins?
Patients can tell the difference in a clinic that's living 20 and 30, 40 years ago in technology. In a clinic that is modern-day technology, I get people all the time say, wow, this is different here. You got—
You're in a town of 850 people.
I'm in a town of 850 people, and most docs around me are still using ultrasound and, you know, interferential and old, uh, intersegmental traction tables. And, you know, I'm not saying there's no value in that, but therapies and advancements have moved way beyond those therapies now. And if you want to modernize and update to these newer therapies, patients will be able to tell the difference, and you're going to attract a different level of patient.
Absolutely. Okay, so that's it for this episode, how to choose the best equipment for your niches. So thank you all for joining. I hope this was valuable. If it was, please share it with a colleague, or, you know, hey, Don't, uh, don't kind of hoard. Share the love. Let's get other doctors exposed to all these wonderful opportunities for us. There is no competition. There's more patients than anyone can ever treat. It's just a matter of do we have enough great doctors to treat them. So if this also, uh, was valuable to you, please like it, uh, subscribe, and write us a good review. Now if you have bad review, you can give that to someone else. But if you have a good review, you got a 5-star review, please, we would love that because that will help grow this podcast and we will be able to help more doctors help more people. So with that being said, Dr. Leone, Dr. Pankinen signing off. Have a wonderful rest of your day.
