Spinal Decompression

19 Nov

The main rationale for intermittent traction in the treatment of disc disease is that vascular blood does not directly supply the disc. The blood supply is even worse in the case of loss of disc material.  In clinical practice this means that or on-going lower back pain takes a long time to resolve.  Once it was realized that the healing process can be speeded up by pumping the disc with intermittent traction it became relatively simple to construct the necessary mechanical apparatus that can be controlled with computers and electronics.

All the new tables offer the basic mechanism of action of intermittent traction which consists of delivering two pulls of different strength.  The times and strengths of the pulls are set electronically and can be programmed.  In treatment of the lumbar spine, the initial pull is usually set at 45 pounds for 50 seconds and the force of the second pull is set below 30 pounds for 10 seconds.  Depending on patient comfort and feedback, the strength of the first pull is gradually ramped up to 60 to 80 pounds.  The strength of the second pull normally remains static.  The bigger the difference between the strengths of the first and second pulls makes intermittency more discernable.

 Length of treatment also has to be taken into account.  Longer treatment times are roughly equivalent to more pressure.  Rule of thumb physics dictates that more force requires less treatment time.  The length of the treatment is normally 15 to 20 minutes. Experience has shown that it best to be conservative initially especially on pull strengths which when too strong can aggravate an already sore back.  Brief vibration of the lower back after the treatment appears to help relieve soreness. Some practitioners also apply passive physical therapies such as electric stimulation, ice or ultrasound after the treatment to consolidate gains. It is strongly recommended that heavy manual labor or exercise be avoided for the rest of that day following treatment because the area being treated has been placed in a temporary state of weakness from being stretched out.  

 The classic rationale for prescribing intermittent traction is the loss of disc space.  In clinical practice degenerative disc disease is so common that other factors must be taken into consideration.  A suggested protocol is trying manipulation of the lower back first to gauge patient response.  In the case that manipulation results in great relieve it is probably not necessary to apply traction which could aggravate a condition that has already been corrected.       

Spinal decompression is easily administered and highly effective for the lumbar spine.  Specific joints are targeted the changing the angle of pull which is usually accomplished by raising or lower the table on which the patient usually lays face up. The pelvis is captured with a belt attached with a rope that is pulled by an electronic device at the end of the table. While the lower body is pulled in one direction the upper torso is held in place by a belt located below the rib cage attached to the other end of the table.  The resulting distraction of the discs is facilitated by a split in the table that prevents body drag.   Since active resistance of the distal pull is not required, the patient is encouraged to relax so that the vertebrae of the lower back can be easily separated.  Some tables also come with posts positioned under the arm pits to further stabilize the upper torso. 

Modern tables can also be used for the cervical spine, but the capturing device is slightly more uncomfortable.  Luckily manipulation is usually very effective for neck pain because of the absence of discs between the top two vertebrae of the spine. In the case that traction is used for the neck strength of pull is dramatically less and for shorter times because of the smaller and more delicate structures involved. In cervical traction, the body provides sufficient counter weight to make stabilization with belts unnecessary.

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