Spinal Decompression

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1 Spinal Decompression Spinal decompression is just one more tool we have to treat radiculopathy. With appropriate education and exercises, this modality has been proven to assist in the resolution of symptoms in a select subgroup of patients suffering from back or neck pain with or without radiculopathy. The nonsurgical, noninvasive procedure of spinal decompression has been used for hundreds of years. We now have studies that help us determine who would benefit the most from this procedure. The following variables were associated with better outcomes with spinal decompression therapy: i) Leg symptoms below the knee ii) Signs of nerve root compression iii) Peripheralization during lumbar extension movements iv) Positive crossed straight leg raise test (i.e. pain down the symptomatic leg while raising the asymptomatic contralateral leg We have access to computerized systems that will cycle through preprogrammed patterns, ramping up and down the amount of spinal decompression allowing for higher levels of traction and disc rehydration. During spinal decompression therapy, a negative pressure is created within the disc. Because of that negative pressure, disc material that has protruded or herniated can be assisted back within the normal confines of the disc, and permit healing to occur. Pressure is released off of inflamed nerve roots allowing the inflammation to subside. By adjusting the height of the table and therefore the angle of pull a specific force predetermined by your physiotherapist gently separates the bones of the lower back or neck. This relieves the pressure on the outer fibers on the disc. With repeated treatments over a period of time this allows for the outer fibers to heal and hold the gel-like material back in the center of the disc. Additionally, this negative pressure forces nutrients and fluid into the disc to assist with rehydration and healing of the disc. By altering the position of the traction pull and the height of the table we may also localize the traction force to a particular segment of the spine and in a specific direction. Treatments are painless. In fact some individuals get immediate relief from their pain once decompression takes place. In addition to traction it is important that you comply with the specific home exercises prescribed by your physiotherapist at the clinic to minimize the stresses on the disc,

2 and partake in an appropriate strengthening and stabilization program when appropriate. Your McKenzie trained physiotherapist can assist you with this. As physiotherapists we have been trained to diagnose and treat mechanical disorders of the spine. We do not use drugs or surgery, but maintain lines of communication open with your family doctor and specialist should we think you could benefit from such options. Spinal decompression therapy is just one tool we as physiotherapist use to treat back pain, and although it is highly effective in some circumstances, it also needs to be followed up with an appropriate education, strengthening, and home maintenance program. At Great Lakes Physiotherapy Clinics you can be assured that you will leave with the information and tools you need to maintain a healthy back and prevent recurrences. Spinal Decompression assists in the resolution of symptoms due to: Bulging, prolapsed, or herniated discs Spinal stenosis Spinal Arthritis Sciatica Facet syndrome Degenerative disc disease Neck pain Pain radiating down the arm "Pinched nerves" Spondylosis The Spinal Decompression Machine Computer Monitoring Our machines are calibrated regularly to ensure the amount of forces generated on your spine are accurate. These forces are predetermined by your physiotherapist and will be dependent on your condition, body weight, and the level being treated. These forces are monitored such that should any

3 variance occur, such as during muscle guarding, jerking, or sudden changes in tension, the machine will accommodate these and alert the physiotherapist. Computerized Controls Programmed by your physiotherapist to suit your individual condition the computer will cycle through various pull/release settings to maximize disc rehydration and circulation of nutrients to the healing tissues. Decompression Cable and Pelvic Harness The angle of pull by the cable will determine precisely the level that the decompression forces need to be directed. using the pelvic harness we can tilt the pelvis to the correct angle for treatment. With precise positioning we can maximize the effect of treatment. Knee Support The amount of knee support will be dependent on the positioning we require to target the particular problem area. The knee support adds comfort to the process while also helping to alleviate pressure on the discs. Hydraulic Separating Table By altering the height of the table and therefore the angle of pull, we can more effectively direct the forces exactly to the area that needs it. Utilizing the feature that separates the table we can minimize forces of friction and enhance the vacuum effect on the disc, separating the vertebrae and relieving pressure on nerves and other pain sensitive structures. Cervical Decompression Attachment We are also able to accommodate those with spinal arthritis, and disc problems of the cervical region. This also uses the above components, gently separating the vertebra without undue pressure on the temporomandibular joint. This technique does not involve any of the risks of vertebral artery damage and stroke that have been associated with spinal manipulation or adjustments. Who can benefit?

4 We have been using this specialized state of the art technology for over 20 years and have a proven track record of success. 80 % of people with discogenic back pain go on to suffer from recurrences. What they need is to be educated on the cause of their pain and how to manage it. We will address their issues of dysfunction, nerve root compression, weakness, postural control, and patients will be given a home exercise regime along with education that will minimize their risk of recurrence. At our clinic you will be fully assessed to determine if you are a suitable candidate for spinal decompression. A 1989 study published in Spine, involved 30 patients with herniated lumbar discs who were treated with lumbar traction. The patients received traction of 45 kg force for 40-minute periods, daily for one month. Computed tomography (CT) before and after treatment showed retraction of the disc herniation, which correlated with clinical improvement in 28 of the 30 patients. Frequently Asked Questions about Spinal Decompression Therapy What is the cost of spinal decompression therapy? Your total costs will depend on several factors: chronicity of your condition, underlying dysfunctions (stiffness), whether you smoke (smoking decreases oxygenation of healing tissues and reduces elasticity of connective tissues) Some people feel complete relief of their symptoms within 4 to 6 treatments, others can require treatments. Cost is on a per treatment basis and at our clinics is the cost of a regular physiotherapy treatment. Patients should be wary of clinics that want to charge an up front fee of thousands of dollars to sign you up for a series of treatments. At our clinics treatments are customized and accompanied by appropriate physical therapy and education. How does spinal decompression therapy help my back pain? Non-surgical spinal decompression is a non-invasive procedure done in the clinic. The therapy uses traction that pulls the vertebrae apart in cycles called distraction and relaxation. During the whole process, the machine and the physiotherapist closely monitor the patient. The procedure is generally well tolerated and patients usually do not complain of any problems following the procedure. Some patients get immediate relief and fall asleep on the table. Decompression is the term describing the relief of pressure on nerves and other pain sensitive structures during the procedure. The discs do not have a very good blood supply so this allows the flow of water and nutrients to take place, facilitating healing and rehydration of the disc. This procedure has shown great results for facet syndrome, spinal arthritis, spondylosis, herniated and bulging discs.

5 Patients are placed on a table where straps are placed on the neck or back. During the procedure patients are positioned so as to direct the forces of distraction at the level needed, the back is slowly stretched. Generally, the procedure has to be repeated several times for the complete benefits to take effect. However, unlike traditional invasive surgery, non-surgical spinal decompression has a high success rate and a very low risk rate. Patients seeking a non-invasive treatment are flocking to this therapy in droves. Is spinal decompression therapy covered by health insurance? Most of our patients have their spinal decompression therapy covered by their extended health insurance plans. Because of privacy legislation, your insurance company will not tell us your coverage details. You must call them to find out if there is a limit on your coverage for physiotherapy. If you have coverage for drugs, then chances are you have coverage for spinal decompression performed by our physiotherapists. Is there research to support the use of spinal decompression therapy? Journal of Neurosurgery, Effects of Vertebral Axial Decompression on Intradiscal Pressure. The object of this study was to examine the effect of vertebral axial decompression on pressure in the nucleus pulposus of lumbar discs. Changes in intradiscal pressure were recorded at resting state and while controlled tension was applied. Intradiscal pressure demonstrated an inverse relationship to the tension applied. Tension in the upper range was observed to decompress the nucleus pulposus significantly, to below -100mm Hg. Canadian Journal of Medicine, January Effects of Vertebral Axial Decompression on Sensory Nerve Dysfunction in Patients with Low Back Pain and Radiculopathy. The data from this study implies that spinal decompression is capable of influencing sensory nerve dysfunction associated with a compressive radiculopathy. Motor dysfunction returns before sensory dysfunction in compressive radiculopathies so it is rather striking that they observed total remission in 64% of the cases with sensory dysfunction. It is possible that reduction of intradiscal pressure by spinal decompression significantly alters the biomechanics and biochemistry of the disc and nerve root. Journal of Neurological Research, October Dermatosomal Somatosensory Evoked Potential Demonstration of Nerve Root Decompression After Spinal Decompression Therapy. Reductions in low back pain and referred leg pain associated with a diagnosis of herniated disc, degenerative disc disease or facet syndrome have previously been reported after treatment with spinal decompression. The object of this study was to use dermatomal somatosensory evoked potentials (DSSEPs) to demonstrate lumbar root decompression following spinal decompression therapy. Seven consecutive patients with a diagnosis of low back pain and unilateral or bilateral L5 or S1 radiculopathy were studied. All patients

6 had at least 50% improvement in radicular symptoms and low back pain and three of them experienced complete resolution of all symptoms. The average pain reduction was 77%. From Anaesthesiology News, March Small, non-randomized follow-up study on the outcomes of decompression therapy on reducing chronic low back pain. Among 23 patients studied, 71% showed more than a 50% reduction in pain immediately after treatment, and 86% showed a 50% or better pain reduction at four years. After four years, 52% of respondents reported a pain level of zero. Does spinal decompression work for everyone? There are specific criteria that allow us to determine if you will benefit from spinal decompression therapy. Provided you have no contraindications we can try this modality on your first visit. Conditions such as severe spondylolithesis, spinal implants, prior spinal surgery, spondylolysis may preclude you from trying spinal decompression therapy. We have other ways to treat such conditions and that will be determined during your initial assessment. How many sessions does it take to feel pain relief? Some patients feel immediate pain relief, some require several visits. The relief obtained can be prolonged with an adequate home program of exercises. These are also specific to the individual condition and will be prescribed during you initial assessment. Are there any side effects to spinal decompression therapy? There have been no reported side effects of spinal decompression therapy. Does OHIP cover spinal decompression therapy? In order for spinal decompression therapy to be covered by government funding you must by 65 or older and attend a government designated clinic that has the machine. Call your community care access centre. Do I need a referral from a family doctor or surgeon to try spinal decompression therapy? You do not require a referral to receive spinal decompression therapy. In order for your insurance company to pay for the physiotherapy charges though they may require a note from your family physician.

7 Why hasn't my family doctor suggested this? Medical doctors are well educated when it comes to surgery and pharmaceuticals; however few know the specifics of what we do. It is up to the family physician to refer nonsurgical candidates for treatment by a physiotherapist trained in the mechanical diagnosis and treatment of the spine. We receive many referrals from family physicians to our clinic for treatment of spinal conditions such as arthritis, bulging and herniated discs, facet syndrome, spinal dysfunctions, spondylosis, etc. Is spinal decompression painful? Spinal decompression should never be painful. In fact many patients experience immediate relief and many enjoy taking the time out of their day to relax and fall asleep on our machine. References Ramos, G., & Martin, W. (1994). Effects of vertebral axial decompression on intradiscal pressure. Journal of Neurosurgery, 81 (3), Retrieved April 19, 2002 from PubMed database. Andersson GB, Schults AS, Nachemson AL.(1983) Intervertebral disc pressures during traction. Scand J Rehabil Med; 9:88-91 Earl E. Gose, William K. Naguszewski, and Robert K. Naguszewski. (1998),. "Vertebral Axial Decompression Therapy for Pain Associated with Herniated or Degenerated Discs or Facet Syndrome: An Outcome Study." The Journal of Neurological Research, Volume 20 Frank Tilaro, MD, Dennis Miskovich, MD., (January 1999). "The Effects of Vertebral Axial Decompression on Sensory Nerve Dysfunction in Patients with Low Back Pain and Radiculopathy." Canadian Journal of Clinical Medicine Fritz JM, et al Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial Spine Dec 15;32(26):E low back clinic Onel D, Mills S, Jenkins V, et al 1989 Computed tomographic investigation of the effect of traction on lumbar disc herniations. Spine;14:82-90 Fritz JM, et al Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical Trial Spine Dec 15;32(26):E

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