As I travel around the country, the great debate continues. Is it traction or is it decompression? There is a large dynamic in tables made and the cost of these tables. Tables range from $12,000 to $150,000, yet some sales people try to tell the consumer they are the same. Hopefully my article will let you decide, allow you to make the decision.
Decompression, first and foremost, has been great for our profession. Never, and I mean never, before have patients in droves come to chiropractors offices and paid cash in advance. This technology is so accepted now, hundreds of MD’s are buying decompression tables and treating discs. Yes, once again, while our profession decides the great debate, the MD’s are quietly moving into the back business. They are doing this, not with the $10,000 traction machines. They understand pure traction; this has been around for years and, alone, does not work.
Marketing. It's all about Perception
I have always stated, if you want a Rolls Royce Practice, you need to have a Rolls Royce mentality. A KIA will take you from point A to point B, as simply as a Rolls Royce; but quality and perception abound in the Rolls Royce. How your table looks is important to the consumer as well as function. We must not cheapen our profession. Decompression has done, marketing wise, for our profession what the term COSMETIC DENTISTRY has done for dentistry.
The appearance of your equipment is important to the consumer. The other component is the marketing. A personalized infomercial is the key. The generic ones just don’t work as well. Consumers like celebrity endorsements as well as real doctor testimonials.
Technology has advanced in every form of medicine, yet chiropractors try to remain as we have one hundred years ago. Some naysayers will say it is diluting chiropractic; I say, it is enhancing our profession. What percentage of your patients have cell phones? How about DVD players, I-Pods TIVO, DVR, or navigation systems in their cars? What about these same patients ten years ago, twenty years ago? Technology has changed our environment. Patients today demand the newest and the best. Decompression has been great for our profession, now we must not cheapen it.
Traction vs. Decompression
Traction has been in use for many years as a physical therapy modality. CPT offers a code for this as 97012. A variety of devices have been utilized to apply traction forces in novel ways, with basic electronic motors with winch and cable mounted on the table or in a separate column, bed traction with weights, split/floating tables, tilt tables, gravity inversion devices etc.
There is a big difference between traction and decompression. Traction has been around for hundreds of years. The problem with traction is that it is not always beneficial. Traction offers a straight pull. Consider that the lumbar and cervical spine offer a normal lordotic curvature. A traction device will pull all segments thus disrupting the normal lordotic curve. Quality decompression tables, can isolate the diseased disc by segment and not disrupt the normal lordotic curvature.
Forms of Traction have been around for centuries. In the past many naysayers took a hard line on traction. In 1998, the Scientific American rated traction to be of little or no value in the examination of treatments for low back pain. The Quebec Task Force on Spinal Disorders concluded that there was no scientific evidence to support the use of spinal traction in either the diagnosis or treatment of low back pain and discogenic disease. These findings are consistent with many studies that report traction alone can often times signal a pain splinting response and put a patient’s back muscles in spasm, resisting any attempts to effect a change in the disc. Traction fails, in many cases, because it causes muscular stretch receptors to fire, which then causes para-spinal muscles to contract. This muscular response often causes an increase in intradiscal pressure, creating more pain. Traction does not create a vacuum effect within the disc, allowing nutrients and oxygen into the disc, therefore, the disc does not heal.
Traction is performed in two distinctly different ways:
1. A continuous pull is exerted on the area concerned and held (called the rack and used for back treatment as well as torture in medieval days)
2. An on-off procedure of pull and release called intermittent traction.
Spinal Decompression, meanwhile, uses a computerized program with specific parameters, angles and weight of pull customized and retained in the software for each individual. The higher end decompression tables can document and store data by patient, by visit, and provide a printout. This is an important component for research and reimbursement not provided by the less expensive traction tables. True Decompression tables utilize a computerized program with specific times and weights used for each individual. This highly specialized computer modulates the application of distraction forces in order to achieve the ideal effect. The system uses a gentle, curved angle pull which yields far greater treatment results than a less comfortable, sharp angle pull. Distraction must be offset by cycles of partial relaxation.
The system continuously monitors spinal resistance and adjusts distraction forces accordingly. A specific cervical or lumbar segment can be targeted for treatment by changing the angle of distraction. This patented technique of decompression may prevent muscle spasm and patient guarding. Constant activity monitoring takes place at a rate of 10,000 times per second, making adjustments not perceived by the eye as many as twenty times per second via its fractional metering and monitoring system.
Genuine decompression also involves the use of a special pelvic harness that supports the lumbar spine during therapy. Negative pressure within the disc is maintained throughout the treatment session. With genuine decompression, the pressure within the disc space can actually be lowered to about -150 mmHg. As a result, the damaged disc will be rehydrated with nutrients and oxygen.
Some experts have called this procedure ramping, which slowly introduces the traction effect to the spine, then holds the segment and gradually increases the weight and pressure. In this manner the procedure can override the body’s natural segment at a specific angle to gain the event known as decompression. The key to this ramping effect is to offset the body’s natural defense mechanism of tightening the muscles in response to the external pulling. This causes a wider spacing of the vertebral discs which, in turn, creates a negative pressure (decompression) on this area. Bulging disc material can actually be pulled back underneath the vertebra and off the spinal cord or nerves they are irritating. Degenerative discs that have lost their height can be opened up to near normal heights, creating increased movement and decreased nerve pressure.
Application must be segment specific, with proper isolation of the segment. In decompression, one size does not fit all.
Should a patient with multiple herniations be treated the same as the patient with a single herniation? Then which herniation should you treat first? Decompression is a science as well as a technique that must be respected.
The problems with many of the earlier and less expensive tables were numerous:
• non-specific for disc levels with its straight-line traction
• required patients to hold on with their hands, causing severe shoulder/arm problems
• inherent muscular resistance failed to achieve direct or specific decompression of the spinal column and the prone position was very uncomfortable for most patients, especially to women.
Now the engineers of many of the high end companies have solved these problems and improved the outcomes greatly:
• patients are placed supine wearing two harnesses to avoid holding on with their hands and, thus, avoiding the muscular resistance found in other tables.
• the amount of decompression can be targeted to the specific disc level by varying the angle of traction
• computers automatically gauge the amount of decompression for each patient.
True decompression tables, as stated, utilize a procedure called ramping, which is slowly documented and graphed by computer, and graduates the traction effect to the spine on a gradual and specific plane. By allowing this slow transition and by isolating the specific segment, the doctor is capable of creating the "Vacuum Effect" of decompression. The gradual ramping procedure allows the override of the body’s natural defense mechanism of tightening the muscles in response to the external pulling provided by simple traction of many less expensive table options. Yes, the age old adage is true: "YOU GET WHAT YOU PAY FOR."
Decompression, when instituted properly, causes a wider spacing of the vertebral discs which, in turn, creates a negative pressure, thus the "vacuum effect" we call decompression. There are numerous reports and articles written showing that bulging disc material can actually be pulled back underneath the vertebra and off the spinal cord or nerves they are irritating. Degenerative discs that have lost their height can be opened up to near normal heights, creating increased movement and decreased nerve pressure. As you do your homework and do your research, you will find that most of the research studies have been provided by the higher end, TRUE DECOMPRESSION equipment.
Decompression is created by a progressive event—a combination of specific vertebral restraint, specific angle position by level of bulge or herniation, and equipment engineering. One can experience traction without decompression, but not decompression without traction. Traction can be a machine, or just weights attached to your feet hanging over a bed as done in the past at hospitals. Decompression is a progressive event that is obtained by utilizing negative pressure, by vertebrae, on a specific angle, to achieve the "Vacuum Effect" or the event known as decompression.
Decompression is an FDA Cleared technology that relieves pain by enlarging the space between the discs. The vertebrae are gently and slowly separated methodically by software attached to the spinal decompression table. As the vertebrae are separated, pressure is slowly reduced within the disc (intradiscal pressure) until a vacuum is created within the disc. This vacuum effect literally "pulls" or "sucks" the gelatinous center of the disc back into the disc, thereby reducing the disc bulge, or disc herniation, we call this the "Vacuum Effect." Thus, disc bulge reduction removes pressure off the spinal nerves and treats the cause of the problem. This suction or "vacuum effect" allows much needed oxygen, nutrients and fluid into injured and degenerated discs, enabling the healing of the disc to begin.
Genuine spinal decompression is achieved by specific software and equipment that provides ongoing, monitored, gradual and calculated increases in distractive forces to spinal vertebrae, utilizing various degrees of distractive forces and calculated angles for the correct spinal segment. Decompression creates a slow "vacuum effect" within the disc that brings the necessary nutrients and oxygen to enter the disc, allowing the disc to heal. Traction does NOT create a "vacuum effect," which is what allows the disc to re-hydrate and heal and, ultimately, leads to pain relief.
How do you know what your or any table does provide? First, you must look to the FDA documents. If your equipment is approved for traction, it is not appropriate in the eyes of many boards to market for decompression. All machines must file a 510K with the FDA. In this document, they must also provide what the table is being utilized for. You will find the word traction, and traction alone, on many of the inexpensive tables. Others utilize decompression. CPT now offers a code for decompression. This code is different than traction. CPT and the FDA recognize the difference. Once again, the difference is in the equipment and the software.
So, where do you begin? In my opinion, follow the FDA; that is their job. Make sure that, if you are marketing decompression, your equipment is FDA Cleared with the language of decompression in the FDA documents.
Many companies will try to persuade you and say all 510K’s are the same. They are not. The language in the 510K must be specific, which is why each table manufacturer must provide detailed documents. The FDA does not simply approve because one table says it is similar to another. Each company must provide specific documents and then answer questions from the FDA. This is not a simple process. Do your homework, make your own decision. But, remember, if you want a Rolls Royce practice, you need Rolls Royce technology.
Dr. Eric S. Kaplan, is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide. Dr. Kaplan is the best selling Author of DYING TO BE YOUNG, www.dyingtobeyoung.net, and co-developer and President of Discforce the next Generation on Spinal decompression. For more information, call 1-561-626-3004 or visit www.discforce.com.