After spending the better part of the last 6 years developing a seminar for Continuing Education Credits and speaking to over 2000 Chiropractors, Neuro & Orthopedic Surgeons, Osteopaths, and Physical Therapists on “Axial Decompression and Core Rehab for the Lumbar Disc Patient”, I am still amazed and intrigued by the one question that mainly chiropractors ask me. I am asked this one question at every seminar I teach. What is this magical question that haunts me you ask?
It is, “Doc, is there really any difference between Traction and Axial Decompression?” It reminds me of the T.V. commercial where the person says, “I can’t believe it’s not butter.”
Doctors have been using traction/distraction devices for decades trying to affect disc problems that present to their office on a fairly routine basis. They have had some success in their practices, although there has been limited success for traction in some clinical trials when compared to sham control groups.
Is it Traction or Decompression
This is how I now try to answer the question to my students and patients who ask me the question. I ask them, “Do you remember the rotary dial phone? Have you ever seen or used an IPhone?” They are both phones but the technology in the IPhone is advanced and because of this technology the IPhone can do so much more. All of the changes have happened so quickly we are sometimes overwhelmed by the benefits it gives us so we end up saying, “I can’t believe it’s a phone!” The phone has evolved.
Think of traction and decompression the same way. They both mechanically pull the spine apart, but we know from clinical studies that the effect on the disc may be different with each type. Because of technology, we can do more now. The decompression table that I am using in my practice uses actuators and very sensitive sensors that are designed to read the patient’s proprioceptive response in milliseconds to the stretch and pull on ligament, disc, and muscle tissue, so no lock down or spasms occur. The idea is that, through the use of these actuators, the pull of the force on the injured disc will stop when the muscles go into this spasm, simultaneously saving the muscles, discs and ligaments any damage as well.
In contrast, inversion boots and traction tables, forcefully overcome the body’s protective proprioceptor “Lockdown” reaction to the stretching of the injured disc. Therefore, these types of tables cannot create a negative vacuum pressure within the disc until the muscles, which have potentially become damaged through the uncontrolled spasming against the pull, have reached a level of exhaustion. After long periods of uncontrolled mechanical pulling, the muscles will give out, and the disc may undergo what has become known as decompression, inspite of what other damage may have occurred during the fight to hold the spine together. To give an example that you may have experience with, have you ever over-stretched someone on a flexion distraction table? If you have, then you know what I am talking about. These sensors monitor the stretching response by the patient and from Ramos’s research2 we know decompression can reduce the intradiscal pressure to -100mm HG. This decrease in intradiscal pressure has been shown on MRI studies and CT Scans to increase disc height and rehydrate the disc.2,5 The negative pressure allows the injured endplates in a patient suffering from disc syndrome to heal, thus reducing the heightened nocioceptive reaction to the bio-chemicals that are released by the injured disc.
The problem with the term “traction” that we see in research is that it has become a generic term meaning any form of mechanical pull. With the advancement in technology we must allow ourselves room to advance the early principles of traction.
In the late 70’s, Anderson and Nachemson placed pressure transducers in four subjects in the lumbar spine during autotraction and manual traction procedures.1 They found that the intradiscal pressures went up dramatically in both cases. They concluded that at no time was negative intradiscal pressure observed, and therefore the disc could not be sucked back in as proposed by Cyriax. This lead them to suggest that in order to produce a relative reduction in disc pressure, traction must be administered in such a way as to allow trunk muscle relaxation. Today’s true decompression systems circumvent sympathetic mechanoreceptors through the use of a table that has sensors that will stop the table from pulling on the spine when the muscles fire. Although decompression may happen with a (traction) cable table, it does not happen in a controlled manner. It first has to exhaust the muscles that have fired off to guard the body. Once this occurs, some decompression may take place. This patient will have instability when trying to stand from treatment, and in many cases will have a lot of soreness throughout the weeks of traction therapy. With true decompression, this soreness and instability does not occur. When your body fights against the pull through guarding muscles (lock down) which are then overcome by fatigue (exhaustion) the surrounding soft tissues end up being weakened and damaged, and ultimately more unstable and weak in that area of the spine.
We chiropractic physicians believe that, if we remove the interference, the body can heal itself. The axial decompression tables of today fit our philosophy perfectly. We are not talking about taking a patient back to pre-herniation states, but just stopping the progressive state the patient is in and allowing the body to heal the injured tissue. It works for the patient by reducing the nerve pressure, restoring nutrients back to the disc, and reducing biochemical releases from the injured disc. When we add proper nutritional and core rehab protocols to our axial decompression protocols, we have a formula for success for our patients.
The, “Is it traction or decompression ?” debate will continue to be the hot topic in physical medicine circles. One thing I am sure of is; this continued advancement of technology will allow us to be better doctors with our disc patients if we continue to expand our protocols based on those advancements. Are any of you still using a rotary phone?
Dr. Randy Reed has 22 years of clinical experience as director of Reed Chiropractic Clinic in Solon, Ohio. His expertise is treating scoliosis, sports injuries, Intervertebral Disc Syndromes through Axial Vertebral Decompression and enhancing athletic performance through plyometric training and manipulation under anesthesia. You can contact him at 1-888-330-3627 or visit www.betterdoctorseminars.net.
References
- Anderson G B, Ortengren R, Nachemson A 1977, Intradiscal Pressure, intra-abdominal pressure and myoelectric back muscle activity related to posture and loading. Clinical Orthop: 156-164
- Eyerman M.D., E L, St. Louis University of Medicine, MRI Evidence of Nonsurgical, Mechanical Reduction, Rehydration and Repair of the Herniated Disc, Journal of Neuroimaging Vol. 8/#2 April 1998
- Quebec Task Force on Spinal Disorders; Canada, 1987
- Ramos G., MD, Martin W., MD, Journal of Neurosurgery 81: 350-353, 1994 “Effects of Vertebral Axial Decompression On Intradiscal Pressure”.
- Sari H, Akarirmak U, Karacan I, Akman H, 2005, Computed tomographic evaluation of lumbar spinal structures during traction, Physiother Theory Pract. ;21(1):3-11.