What is decompression therapy?
It is a non-invasive therapy which is a type of traction utilized to decrease neck, low back pain, as well as, radiating arm, scapular region, leg, and buttock pain. Decompression is the “outcome” of the traction. Decompression therapy differs from traditional traction with the ability to adjust the treatment to multiple settings and patient positions. These settings allow a gradual, gentle ramping up, increasing comfort therefore decreasing muscle guarding and decreasing the necessary traction load to achieve the desired effect. Decompression has been theorized to improve circulation and healing of damaged disc.1,2,4
How does it work?
A gentle gradual distractive force is administered to your neck or low back/pelvis region while you are lying down. This distractive force has been recorded to create a negative intradiscal pressure.5,6,7 The negative pressure has been reported to decrease/reduce the disc derangement, increase the osmosis of nutrients to the disc, and decrease the sensory input contributing to the pain syndrome. This force is determined by your Physician or Physical Therapist to isolate a specific level in your spine which is the origin of the pain and inflammation.
How do I know if it is appropriate for me?
Decompression/traction therapy is effective for treating pain of disc origin or spinal stenosis. Diffuse neck or low back pain of mechanical or postural causes have been documented to respond more effectively to other means of treatment i.e. manual therapy, core stabilization, and flexibility exercises.
How many treatments are required and will I need a maintenance decompression sessions as time passes?
This varies in the literature and there isn’t a randomized controlled study that indicates a specific number of sessions based on specific diagnosis. It is commonly recommended by chiropractors, medical and osteopathic physicians, and physical therapists that 20 sessions of 20-40 minutes. Our recommendation is 10-12 sessions of 20-30 minutes in conjunction with exercise emphasis on core trunk stabilization, stretching exercises to include dural mobilization, manual therapy, and patient education on proper body mechanics with activities of daily living and lifting. If pain or function has not improved at that time, we recommend additional diagnostic testing or minimally invasive
injections. These injections are diagnostic and therapeutic to determine the origin of the pain and most effective treatment starting with the most conservative and progressing through our treatment algorithm.
Synopsis of Research on Cervical and Lumbar Decompression/Traction
Onel, D et al.: CT Investigation of the effects of Traction on Lumbar Herniation. Spine 14:82-90,1989. 30 patients with lumbar herniations. Underwent traction in a CT scanner at >50% body weight for 20 minutes. Herniation retraction occurred in 70% and good clinical improvements were seen in over 93%. The authors concluded improved blood flow was the source of healing and that the traction did not create negative intradiscal pressure due to inadequate traction force.
Tilaro F. Canadian Journal of Clinical Medicine. 5:1-7,1998. Decompression therapy significantly reduced intradiscal pressure. Promoting retraction of the herniation, improving diffusion gradient into the disc that allows nutrients and healing.
Note: controversy whether decompression actually occurs and if occurs how functional is it once the patient stands or sits and weight bearing reoccurs.
Nachemson A. Intradiscal pressure. Journal of Neurosurgery 82:1095,1995. Criticized Tilaro experimental setup saying that there wasn’t a control group, patients were not randomly assigned, and lacked follow-up scores. Reported the study was not clinically meaningful due to these flaws.
Saal,JA Saal,JS: Nonoperative Treatment of Herniated Lumbar Disc with radiculopathy (leg pain). Spine 14 (4):431-437,1989. 58 subjects, 86% had good-excellent results with inclusive conservative program to include traction and trunk stabilization exercises.
Mathews JA et al.: Manipulation and traction for Lumbago and Sciatica. Physio Pract 4:201,1988. 85% reported substantial relief with a controlled trial of traction combined with manipulative therapy. Traction force applied at 100lbs. for 20 min.
Constatoyannis C, et al.: Intermittent Cervical traction for Radiculopathy Due to large volume Herniations. JMPT,25 (3) 2002. 4 subjects displayed complete resolution of symptoms after 3 weeks of cervical traction.
Erhard R et al.: Intermittent Cervical traction and Thoracic Manipulation for Management of Mild Cervical Compressive Myelopathy Attributed to Cervical Herniated Disc: A Case Series. JOSPT,34 (11) 2004. Intermittent cervical traction and manipulation of the thoracic spine was useful for the reduction of pain scores and level of
disability in patients with mild cervical compressive myelopathy attributed to herniated disc.
Shealy N, Leroy P: New Concepts in Back Pain Management.AJPM (1) 20:239-241 1998. The application of supine lumbar traction altering the angle of pull from 10°-30° and progression to peak force enhanced distraction at specific levels in the lumbar spine. Increase distraction at L5/S1 with 10° angle of pull and L3 with 30° angle of pull.
Weatherall VF:Comparison of electrical activity in the sacrospinalis musculature during traction in two different positions. J Ortho Sports Phys Ther (8):382-390,1995. EMG electrical activity shown to be similar in the prone vs. supine positions.
Letchuman R, Deusinger RH: Comparison of sacrospinalis myoelectric activity and pain levels in patients undergoing static and intermittent lumbar traction. Spine 18 (10): 1361-1365,1993. Improved comfort and less muscle guarding noted in the intermittent traction group.
Nanno M:Effects of intermittent cervical traction on muscle pain. EMG and flowmetric studies on cervical paraspinals. Nippon Med J; April 61 (2):137-47,1994.
Intermittent cervical traction was shown to be effective in relieving pain, improving blood flow and increasing myoelectric signals in the effected muscles.
Chung TS, Lee YJ et al:Reducibility of cervical herniation: evaluation at MRI during cervical traction with a nonmagnetic device. Radiology Dec; 225 (3) :895-900, 2002. 29 patients and 7 healthly volunteers had intermittent cervical traction while in MR. Substantial increase in vertebral length was seen. Full herniation reduction in 3 patients and partial reduction in 18 was reported.
Hseuh TC et al: Evaluation of the Effects of Pulling Angle and Force on Intermittent Cervical Traction. J Formos Med Assoc 90 (12):1234-1249,1991.
Traction under 30° created longest gap C4-6 and under 35° created longest gap at C6-T1.
Gionis TA, Groteke E. Spinal decompression. Clinical study evaluating the effect of nonsurgical intervention on symptoms of spine patients with herniated and degenerative disc disease. Orthopedic Technology Review. Nov-Dec 2003;5 (6):36.
86% of 219 subjects reported completed resolution of symptoms and 84% of this group remained pain-free for 3 months.
1. Gustavo Ramos, William Martin:Effects of Vertebral Axial Decompression on Intradiscal Pressure. J. Neurosurg 81:350-353. Sept. 1994.
2. Onel,D et al.: CT Investigation of the Effects of Traction on Lumbar Herniation. Spine 14:82-90,1989.
3. Nachemson A. Intradiscal pressure. Journal of Neurosugery 82:1095,1995.
4. Tilaro F, Miskovich D. The effects of vertebral axial decompression on sensory nerve dysfunction in patients with low back pain and radiculopathy. Canadian Journal of Clinical Medicine 6(1):1-8, 1999.
5. Ramos G, Martin W. Effects of vertebral axial decompression on intradiscal pressure. Journal of Neurosurgery 81:350-353, 1994.
6. Mathews JA et al.:Manipulation and traction for Lumbago and Sciatica. Physio Pract 4:201,1988.
7. Chen YG, Li FB, Huang CD:Biomechanics of traction for lumbar disc prolapse. Chinese Ortho;Jan (1): 40-2,1994.
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