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Re: spinal decompression?
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Re: spinal decompression? - September 11, 2005 2:42:00 PM
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Diane
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Greg, how would you rule out the possibility that you are feeling your own skin, being pulled from the feet down, and/or against the surface upon which you are lying, and/or against underlying layers of your surface tissues of your back, e.g., thoracolumbar fascia?
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Re: spinal decompression? - September 12, 2005 2:38:00 AM
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chiroortho
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I'm sure that has a lot to do with it. I suppose the sensation of traction could come entirely from the skin but I don't think so. It's really hard to know for sure.
Relative to the decompression units, I have seen video of the joints under fluoroscopy that demonstrates movement of the vertebrae themselves (if I recall correctly it was Vax-D but I'm not sure). The question for me is do these various decomp machines do so much better of a job than vanilla traction to justify the price (to the patient and for the equipment itself).
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Greg Priest, DC, DABCO
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Re: spinal decompression? - September 12, 2005 3:36:00 AM
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JLS_PT_OCS
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Great question, Greg.
That's something we're all interested in.
Unfortunately, many (if not all) these machines are developed and rushed to production and sales (sometimes even including mandatory CEU courses before it is purchased) without good trials supporting it's use. We can quickly see whether the manufacturer/inventor is more intersted in money or outcomes by seeing where he/she places their emphasis early on. With this litmus test, how does this device hold up?
I have had good anecdotal experience in providing relief to those with extremity pain by using positional decompression positions, so I find the concept to have some validity. Shacklock talks about a lot of these in his Clinical Neurodynamics book, and makes a good case for the treatment of someone with extremity symptoms with a decompression type treatment, at the proper stage in their course (usually while still sensitive).
Example: someone has a L sided leg symptoms and/or L sided LBP. Place them in R sidelying, first with pillow under spine to "open" involved side, then drop bottom leg off table, then both legs off table. This "decompression position" has been a favorite of Saunders for many years and has helped me with several patients with actual or supposed disc dysfunction and/or sensitized Lx or Cx nerve root.
While we have a standard Saunders type traction (Lx and Cx) in the clinic, I use it rarely, but find the concept worthwhile, and if there were any convincing research to back Cox or the DRX device, I would consider investing in one. But like Greg said, the issue is whether they provide a superior outcome. I'm not sure they do.
I don't think allowing for the possibility of skin stretch mechanism discounts any possible decompression effects, either.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: spinal decompression? - September 12, 2005 7:30:00 AM
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Shill
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If the traction is done in prone, without a strap, such as through long leg traction, I dont think the skin over the spine would move much at all. Only the skin in contact with the table or a belt should actually move, right?
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Steve Hill PT
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Re: spinal decompression? - September 12, 2005 3:23:00 PM
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drbuddy
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Re: skin stretch
If it were only the skin stretching, why would there be palpable and audible pops during the traction? If those are present, isn't it reasonable to conclude that those joints were indeed seperating?
Then again, I may be misinterpreting the question. I came in on this late, but was someone trying to say that the results are due to neuromodulation from skin receptors and that we are not causing any traction other than at the skin?
Thanks,
Buddy
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Re: spinal decompression? - September 12, 2005 4:41:00 PM
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Diane
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[QUOTE]If it were only the skin stretching, why would there be palpable and audible pops during the traction?[/QUOTE]There can be audible pops and cracks during the course of relaxation. People clunk in the back sometimes when I'm working on their lower legs. Clunking isn't that big a deal. The patient's own body can clunk, without introduced force into what you assume to be spinal joints, as part of a motor outflow/relaxation phenomenon. (When it happens, I look up and say, "I didn't do that. Your nervous system just let go of something." And they say, "Yeah, I know..")
[QUOTE]If those are present, isn't it reasonable to conclude that those joints were indeed seperating?[/QUOTE]Maybe, maybe not.
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Re: spinal decompression? - September 12, 2005 5:02:00 PM
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drbuddy
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Here is something I saw while searching for effects of traction:
J Neurosurg. 1995 Jun;82(6):1095.
Effects of vertebral axial decompression on intradiscal pressure.
Ramos G, Martin W.
Department of Neurosurgery, Rio Grande Regional Hospital, McAllen, Texas.
The object of this study was to examine the effect of vertebral axial decompression on pressure in the nucleus pulposus of lumbar discs. Intradiscal pressure measurement was performed by connecting a cannula inserted into the patient's L4-5 disc space to a pressure transducer. The patient was placed in a prone position on a VAX-D therapeutic table and the tensionometer on the table was attached via a pelvic harness. Changes in intradiscal pressure were recorded at resting state and while controlled tension was applied by the equipment to the pelvic harness. Intradiscal pressure demonstrated an inverse relationship to the tension applied. Tension in the upper range was observed to decompress the nucleus pulposus significantly, to below -100 mm Hg.
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Re: spinal decompression? - September 13, 2005 4:35:00 AM
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JLS_PT_OCS
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Buddy-
Nice. That's an interesting piece of info. I wonder what the N value and stats were on that. I think it's reasonable to conclude that if the study was good, we can say that VAX-D does produce distraction at the disk.
The other side of that question is: does such distraction help people who have back and leg pain?
I think an outcomes study would be the next obvious step, and that's where a decision to buy/not buy comes from. At least for me.
I haven't checked into the background on standard traction Saunders-style to see if it's different. That can also be done in prone or supine with different sidebending biases, etc.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: spinal decompression? - September 13, 2005 4:51:00 AM
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chiroortho
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Jason that's the key. Post hoc ergo propter hoc. I know it's aggravating to see that constantly posted but with observations of such decreases in intradiscal pressure, logically we say heck yeah it helps discs, but do we know that it does really? In other words, I have treated patients with lumbar disc herniations that came to me after failed treatment elsewhere, MRI in hand. We treat them and they go back to the surgeon who orders another scan. Disc herniation is gone. Now did my treatment fix it, or did the disc fix itself independent of me? How would I know? I don't.
I keep a little teaching file of films like this, with reports from the radiologist. They are especially compelling when the rad has access to the earlier study, which is almost all the time because the patient is sent back to the original MRI center.
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Greg Priest, DC, DABCO
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Re: spinal decompression? - September 13, 2005 5:19:00 AM
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JLS_PT_OCS
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Good point Greg.
We shouldn't get too excited about biologic plausibility in the absence of good outcome studies.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: spinal decompression? - September 13, 2005 8:40:00 AM
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apolipo
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As an added little bit, I just read some work by Bogduk as well as some by a group of scientists in China that have demonstrated an ingrowth of nerve fibers into the nucleus pulposus of "bad" discs in people with chronic LBP. The ingrowth seemed to be through fissures in the annulus without any herniation present. If you tugged on a disc like this, how would you expect it to respond?
mike t
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Re: spinal decompression? - September 13, 2005 9:14:00 AM
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JLS_PT_OCS
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Perhaps....OUCH!
I know from experience there is a subgroup of patients whose symptoms will worsen with traction also, but I do not know by what criteria they may be identified.
J
_____________________________
Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: spinal decompression? - September 29, 2005 3:45:00 PM
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3.5fig
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We had a Vax-D table in the office for about 6 months as a pilot project that an insurance company wanted us to do....the results were not that bad. This was a year ago and my memory isn't that great, but we treated about 10-15 people and the success rate was around 85%. Success was measured both Subjectively and Objectively with Oswestries and ADLs. The patients were all that had failed conservative care...manip, exercise...etc... and had positive MRI studies for lumbar discs. A few of the patients were painfree at the end and returned to full duty at work with no residuals.
My main problem with it is that it is totally passive. If the patient does not take part in a serious exercise program for the back, then you are left with a very deconditioned spine.
Myself and our clinic director, a DO, flew to Florida to the Vax-D plant to meet the people that run the company. They were nice and did not seem sleazy and did not do a hard sell on us at all. The inventor of Vax-D was the former deputy prime minister of health in Canada and if I remember correctly he was the developer of the heart defibrillator(sp). I believe that their intentions are good and the machine can really help people...it just should not be seen as the final solution...
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