The Power Assisted Micro-manipulation equipment comprises a handset and four pistons powered by compressed air. The unit is capable of delivering three manipulation programmes called Spasm, Reflex, and Mobilisation.

The speed of the unit’s pistons is controlled manually from the handset shown above and are sized and spaced to align with the transverse processes of the vertebrae. Pneumatic effects allow feed-back to the practitioner as it responds to any resistance allowing s/he to vary the programme appropriately. Such is the effect that some practitioners refer to it as a "bionic" hand.

Shown here (right) being applied in Spasm mode, the pistons all move very quickly and lightly touch the spinal muscles helping them out of spasm as the handset is moved up and down the spine. This is a relaxing and pleasant treatment to receive and is used to start and end a treatment session.

When used in Reflex mode spinal reflexes are stimulated. This helps to relieve the spine of stress. The pistons behave like small patellar hammers and hit the spinal muscles on the transverse processes stimulating the stretch reflex, kicking the muscle and thereby realigning the vertebrae. By producing so many reflex stimuli so quickly, PAM is more likely to hit the correct sequence to stress-relieve the network of interacting strain reflexes.

In Mobilisation mode adjacent vertebrae are counter-rotated to help to restore supple mobility to the spine. The practitioner produces counter-pressure against the pistons' movement, and so is able to produce a counter-rotational movement on the vertebrae as the pistons push on the transverse processes of the vertebrae above and below. Because the pistons are powered by compressed air, if the joint will not move the piston will respond to this resistance, and the practitioner will be immediately aware of this.

The practitioner may then choose to increase or lessen the pressure of the pistons. These are subtle movements and require a good deal of training and experience to perfect.