Discs can become damaged so that they bulge or tear. If a tear is large enough, the gelatinous material can leak out, a condition referred to as an extruded or "ruptured" disc, which can press against a spinal nerve and cause pain and loss of nerve function.
Proponents of nonsurgical spinal decompression assert that over time, negative pressure from spinal decompression therapy may cause bulging or herniated disks to retract, though this is in dispute. It is also argued that this mechanical action can take pressure off the nerves and other structures in your spine. This in turn, helps promote movement of the spine, which has been shown to decrease pain. The mechanical concept of traction is logical, however outcomes of current research using traction as a primary treatment have not been definitive. It is the opinion of many healthcare providers that traction as part of a multi-modal treatment may be helpful in the reduction of symptoms. In other words, Spinal Decompression / Traction is not as effective in reducing symptoms and returning function if used in isolation. Other treatment is often required in conjunction with Spinal Decompression to achieve goals established by you and your health care provider.
If an intervertebral disc is extruded, it is likely that traction will not be an effective treatment but rather surgical intervention may be needed. Health care providers have used nonsurgical spinal decompression in an attempt to treat:
• Back or neck pain or sciatica, which is pain, weakness, or tingling that extends down the leg below the knee
• Bulging or herniated discs or degenerative disc disease
• Worn spinal joints (called posterior facet syndrome)
• Injured or diseased spinal nerve roots (called radiculopathy)
How Is Nonsurgical Spinal Decompression / TractionImplemented?
You are typically clothed comfortably during nonsurgical spinal decompression / tractiontherapy. You are fitted with a harness around your pelvis and another around your trunk. You either lie face down or face up on a computer-controlled plinth/treatment table. A providerprograms the equipment, customizing treatment to your specific needs. Treatment of this type is occasionally accompanied by infrared “LASER” treatment, which uses infrared light to heat subcutaneous tissue. There are benefits of infrared light however, in multiple studies, specific exercise has been shown to be a superior modality for increasing blood flow to injured tissues as well as producing desired outcomes of decreasing pain and disability. Therefore Active Lifestyles Physical Therapy offers infrared light therapy as part of symptom management though your treatment plan will likely include specific beneficial exercises due to the robust evidence of benefit found in current medical research literature.
Buyer Beware: What are the Facts of Nonsurgical Spinal Decompression / Traction?
Common Misleading Claims and Appropriate Use
Although the device can reduce weight bearing forces on the spine, the term "decompression" could be misleading, since this is generally used to refer to surgical decompression of the spinal cord, which nonsurgical spinal decompression / traction does not do. Physical therapists utilizewhat has been termed Evidence Based Practice, which incorporates expertise, the values and goals of the patient, and evidence. Evidence is derived from legitimate, higher order research carried out across the globe and presented in peer reviewed medical journals. In other words, evidence-based practitioners tease out non-bias facts regarding the effectiveness of an intervention, and differentiate this data from opinion no matter how common a conventionally held belief. All too often, healthcare providers will exaggerate the effectiveness of a treatment in order to attract individuals to their business. It is strange to think of doctors, therapists or chiropractors
using marketing strategies otherwise used by non-medical corporations, though the truth is, in the United States, healthcare is no different than other industries. Healthcare consumers must ask questions related their care and beware of providers acting in their own interest. Careprovided at Active Lifestyles Physical Therapy incorporates perspectives of the patient, reflecting the interests, values, needs, and choices of the individuals we serve. At Active Lifestyles Physical Therapy we pride ourselves in educating our patients regarding their condition and the treatments we provide, serving to reduce obstacles in making better healthcare choices.
To supply the consumer with information regarding non-surgical spinal decompression without a tedious, lengthy review of the hundreds of research articles on the topic, we have compressed the current body of evidence into “buyer beware” bullet points. The following are evidence supported guidelines regarding common deceptions about the use of spinal decompression / traction in health care. If your provider is suggesting that their use of spinal decompression will yield the following results, we suggest looking into the treatment further prior to proceeding:
• Claims that herniated discs are corrected with spinal decompression / traction should not be made without substantiating, high level evidence
• Claims that specific devices used for spinal decompression / traction therapy is "unique" is incorrect because research has not proven that specific devices differ from other lumbar traction devices
• Claims that spinal decompression / traction is effective for "almost all patients suffering from the common causes of low back pain and sciatica" are incorrect
• Spinal decompression / traction may reduce pain but may not be claimed to relieve "neurological deficits" or any type of damage to the nerves that control movement
• Claims for the use of spinal decompression / traction as effective maintenance therapy are incorrect
At this time the consensus within the medical community is that more research is needed to better establish the effectiveness of nonsurgical spinal decompression. To know how effective it really is, researchers need to compare spinal decompression with other alternatives to surgery such as nonsteroidal anti-inflammatory drugs (NSAIDs), other treatment protocols in physical therapy and exercise.
Cost
Spinal decompression is often falsely advertised as a unique modality, commonly recommend for 20 or more sessions of 30-45 minutes, with a total cost to the patient of several thousand dollars. The truth is that spinal decompression is synonymous with mechanical traction, a CPT (Current Procedural Terminology) coded modality that if billed through health care insurance is typically reimbursed at a per application rate of under $30. If traction were billed through healthcare insurance as an individual mode of treatment and the patient attends twenty treatment sessions, reimbursement of the healthcare provider would likely not exceed $600 for that specific billing code over the entire course of care. This serves as a motivation for some providers to charge patients a much higher self-pay rate in advance of treatment sessions. While in some circumstances, such as high-deductible plans or seeking out the best providers, a self-pay option is beneficial, paying thousands of dollars on a single mode of treatment is not advisable. (For more information regarding self-pay vs. insurance benefits, please see our Insurance Information Page).
At Active Lifestyles Physical Therapy we do not utilize the modality of spinal decompression / traction unless indicated through the unique presentation of your condition relative to the most current research. Active Lifestyles will tailor an appropriate treatment plan to best address your condition with respect to your goals. If traction is indicated, you will not be required to pay for treatment sessions as a “treatment package” in advance of actual treatment. As noted above, the use of spinal decompression / traction is not used as an isolated treatment. Following a thorough assessment of your condition and symptom presentation your therapist will develop a plan of care with you, which may include several combined modalities in order to achieve your treatment goals. In some cases, spinal decompression / traction may not be indicated as an incorporated modality.
References:
1. Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure. Journal of Neurosurgery 81:350-353, 1994.
2. Wang G. Powered traction devices for intervertebral decompression: Health technology assessment update. Washington Department of Labor and Industries, June 14, 2004.
3. Daniel DM. Non-surgical spinal decompression therapy: Does the scientific literature support efficacy claims made in the advertising media? Chiropractic & Osteopathy 15:7, May 18, 2007.