In my last article, I covered a general introduction and description of decompressive traction (spinal decompression) and its move into the chiropractic market. In this article, I’m going to discuss the research literature and our clinical experience as it relates to both proper patient selection and reasonable outcome expectation. The elimination of pain is typically the main priority in a chiropractic practice. It is how we, collectively, have built our reputation. However, like all things in life, there is no 100% successful procedure, and it is simply dogmatic to believe that we are now doing all that ever needs to be done. If we are rational in our approach, we regularly search for new or expanded means of offering an improved, cost effective outcome. That is exactly what spinal decompressive traction can offer your practice. Like all procedures, though, choosing the right equipment and understanding proper patient selection are the first steps.
The traction literature offers us numerous and varied protocols and procedures and that, perhaps more than anything else, contributes to its subsequent inconsistent performance and poor reputation. Add to that the antiquated equipment of the past and enthusiasm for this modality diminishes. We need to separate mechanized traction as just another mobilizing technique, whose outcomes are often more amenable to hands-on procedures, and focus on the specific job of decompression of the disc, whose outcome is improbable without mechanical means. Decompression of the disc aims to create an enhanced diffusion, fibroblast activity and blood supply contact. It is these phasic effects that are consistently mentioned as a source of healing.
Ultimately, the inherent systemic health and healing ability of the individual is what is revealed with therapeutic intervention, and time. As Byron said, “Circumstances don’t make the man, they reveal the man.” This is an important, yet paradoxical, point to chiropractic and health care in general. If a patient fails to improve, is it an inherent property of their constitution or the misapplication (or lack of application) of the proper therapy? I have discovered that it is more a misapplication of the appropriate therapy and, in many cases, misapplication goes hand in hand with adequate product design. Fortunately, today the research and subsequent product design has raised decompressive traction to a previously unseen efficiency and ease of application. Not to mention that it doesn’t require a second mortgage to deliver it.
Decompressive Traction Systems are available to any chiropractor today for a fraction of the cost of previous devices. By implementing and incorporating a specific, limited number of parameters, outcomes have been improved dramatically with a relatively short learning curve and modest equipment costs.
|Specific parameters of Decompressive Traction Therapy include:
|1) a non-slipping, circumferential harness allowing the best possible focus of force application, as opposed to side-to-side harnesses, wrap-overs or ankle straps.
|2) The pull vector needs to be adjustable in angle and pull pattern must be graduated and stepped to elicit no an-ticipatory muscle guarding.
The pull pattern cannot be taken lightly. We are basically sneaking up on the body, with the intention of creating segmental separation without awakening the muscle-guarding giant that stands ready to limit our every move. The equipment must be designed to incorporate all of the utilitarian functions that increase the probability of separating the spinal segments. It appears, from numerous studies and reviews, that sufficient vertebral distraction is a key to creating decompression. Thus, a focused restraint and specific positioning with slow, graduated force application limiting muscle guarding are key factors.
Chen, et al., showed that a decrease in disc pressure was related to distraction distance. Paradoxically, in their study of forty-seven prolapsed discs, prior to therapeutic traction application, 62% had negative pressure and only 19% had positive pressure. 64% showed a further reduction with traction. Ramos and Martin showed initial pressures in three surgical candidates to be +60 to +70 mmHg,, which reduced to negative ranges when a threshold traction tension was reached (about 60 lbs.).
Proper patient selection is paramount. A patient’s poor fitness/posture, loss of local muscle control, and past trauma added to pain sensitization deep into the disc ultimately spell a clinical nightmare! Certainly, these patients warrant a multifaceted approach. And, obviously, we must know when our intervention will be of limited value and referral is necessary. Improving signs and symptoms from a reasonable trial of the two most potent mechanical spinal treatments, manipulation and decompression, can help us determine this.
We are basically sneaking up on the body, with the intention of creating segmental separation. Sufficient vertebral distraction is a key to creating decompression.
The so-called sub-ligamentous, single level protrusion/ hernia, with limited degeneration, will show the best outcome. The greater the annular damage or extrusion of the nucleus, the more nebulous the outcome. Additionally, extensive degenerative changes and diffuse, central bulges—especially multiple levels—tend to reduce success. Of course, the safety (first do no harm), ease of use and comfort to the patient make decompressive traction a viable passive therapy to try even in difficult cases. As a chiropractor, I am convinced (as were Cyriax, Farfan, and Mathews, among others) decompressive traction should be seen as an obvious companion to manipulation and, in cases of sciatica, often the more reasonable approach.
Henrik Weber, MD, writing on the natural history of disc herniation (Spine (19) 1994) points out the lack of concise answers for back and leg pain. However, he points to research that suggests the evolution of a hernia (compressed disc) is associated with clinical symptoms, and the decrease in size is seen in many of the successfully treated patients. Over 90% of patients have satisfactory outcomes from herniation at one-year follow-up with conservative treatment including traction. Deyo, et al., suggest, from their review, traditional type traction is of limited value except that sciatic patients treated with it had a greater chance of avoiding surgery. (Not an inconsequential outcome!) Could you imagine what the outcomes could have been if they had access to the much improved products that are now available. Minimize the misapplication and your results will improve exponentially.
As stated earlier the literature tends to paint a poor picture of traction methods. We’re attempting to change that. I contend that when done in a codified manner, with clear intent and indications, decompressive traction is a vital addition to a chiropractor interested in that multi-faceted approach. Few therapies can lay claim to the direct, phasic effects of axial decompression, both physiologically and neurologically. I have used it for years as a diagnostic tool to judge potential outcomes. Leg pain patients typically “centralize”; patients intolerant, or unresponsive to manipulation can still be offered a viable treatment option, prone or supine; and, of course, much of this relates to the cervical spine as well. Today there is no excuse why decompressive traction shouldn’t be part of your chiropractic artillery. With dramatic product improvements and a price within reason, the most powerful adjunct in your arsenal is often available for the price of a good adjusting table.
Dr. Jay Kennedy has been practicing Chiropractic Biophysics (CBP) in Western Pennsylvania since graduating Palmer College in 1987. In the last eight years, he has owned and operated several decompression systems treating over 2000 patients on them in his multi-disciplinary clinics. He lectures extensively and has authored various articles on axial decompression. You may contact him by e-mail at [email protected]