More than a decade ago, researchers at the National Aeronautic and Space Administration (NASA) were among the first to investigate the effects of spinal decompression on intervertebral discs. They found that astronauts were relieved of low back pain in the antigravity state. In addition, they learned that disc height was increased during a space mission. By combining proven scientific principles with the latest technological developments, a decompression system was developed by a team of physicians and former NASA engineers. The automated system they developed has the capability of decompressing discs to relieve pressure on the spinal nerves caused by disc herniations, degenerative disc disease, sciatica, and posterior facet syndrome. The decompression system uses a mechanized traction device and it features the only FDA-approved cervical attachment. The system reportedly lowers pressures in discs using a combination of harnesses, air bladders, and disc angle pull adjustments to treat lower back pain in a non-invasive, non-surgical manner. The device differs from manual manipulation and traction devices by reducing intervertebral disc pressure within the spine. The decompression system’s distracting process has been shown by MRIs to widen disc height space, allowing a decrease in intradiscal pressure while helping the disc reposition itself. This apparently triggers herniation shrinkage, which educes or eliminates protrusions and pressure on surrounding nerves. According to the manufacturer (Axiom Worldwide), each treatment is centered on a logarithmic ramp-up, hold, and release protocol implemented by a computerized system designed to bypass proprioceptors that restrict ligaments and muscles when they sense movement at the disc. By comparison, spinal manipulation by physical therapy, traction, chiropractic or osteopathic adjustments cannot bypass the body’s protective proprioceptor lockdown response and therefore cannot create negative vacuum pressure for extended periods. In the New England Journal of Medicine, an article by Stephen J. Lipson, M.D. (“Spinal Fusion Surgery –Advances and Concerns,” February 12, 2004), says 151,000 spinal fusions are done each year in America. He advocates restraint because of the complications and typically modest benefits associated with surgery. In a recent study utilizing the spinal decompression system, of 219 patients with herniated discs and degenerative disc disease, 86 percent who completed the therapy showed immediate improvement and resolution of their symptoms; 92 percent improved overall; five patients (2 percent) relapsed within 90 days of initial treatment. (“Spinal Decompression,” Nov/Dec 2003, Vol. 5, No. 6, Thomas Gionis, M.D., and Eric Groteke, D.C., Orthopedic Technology Review.)
A study by the Department of Neurosurgery and Radiology, Rio Grande Regional Hospital and Health Sciences Center, University of Texas published in the Journal of Neurosurgery (Volume 81, September 1994) demonstrates another aspect of decompression therapy: 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 vertebral axial decompression therapeutic table and a tensionometer on the table was attached. Changes in pressure were recorded at a resting state and while controlled tension was applied by the equipment. Intradiscal pressure demonstrated an inverse relationship to the tension applied and tension in the upper range was observed to decompress the nucleus pulposus. The results of this study indicate that it is possible to lower pressure in the nucleus pulposus of herniated lumbar discs to levels significantly lower when distraction tension is applied according to the protocol escribed for decompression therapy.
In an another study of 778 patients, Gose et al recommend decompression therapy as a primary treatment modality for low back pain associated with lumbar disc herniation at single or multiple levels, degenerative disc disease, facet arthropathy, and decreased spine mobility. (“Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: An outcome study,” Neurological Research, April 1998). Researchers found that pain, activity, and mobility scores all improved after therapy. The researchers demonstrated a success rate ranging from 6 percent for facet syndrome to 72 percent for multiple herniated discs, and 73 percent for patients with a single herniated disc. The average successful outcome for all diagnoses was 71 percent. The authors concluded that for patients with low back pain, decompression therapy should be considered as a front-line treatment for degenerative spondylosis, facet syndrome, disc disease, and nonsurgical lumbar radiculopathy.
This is a randomized controlled trial performed at the University of Odense, Denmark by chiropractors and medical doctors.
From the abstract: Fifty-three [patients] suffering from frequent headaches who fulfilled the International Headache Society criteria for cervicogenic headache.were recruited from 450 headache sufferers from responded to the newspaper advertisements. .28 of the group received high-velocity, low-amplitude cervical manipulation twice a week for three wk. The remaining 25 received low-level laser in the upper cervical region and deep friction massage in the lower cervical/upper thoracic region, also twice a week for three weeks.
Results: The use of analgesics decreased by 36% in the manipulation group, but was unchanged in the soft-tissue group; this difference was statistically significant. The number of headache hours per day decreased by 69% in the manipulation group compared with 37% in the soft-tissue group; this was significant. Finally, the headache intensity per episode decreased by 36% in the manipulation group, compared with 17% in the soft-tissue group; this was significant. At a four-week follow-up, she remained pain free.
Nilsson N, Christensen HW, Hartvigsen J. J Manipulative Physiol Ther. 1997 (Jun); 20 (5): 326-330
Abstract
Background: Chronic constipation is a common condition as reflected in the $800 million yearly spent on laxatives in the United States. Constipation is such a common problem in the pediatric population that it is the second most referred problem to the pediatric gastroenterologist and accounts for 25% of all visits. Between 5-28% of all children experience great difficulty with elimination of food waste, which is often accompanied with pain, fear, and avoidance. The symptoms of constipation are defined as infrequent or difficult evacuation of the feces.
The ever increasing use of complementary and alternative medicine (CAM) in adults is accompanied by children. Parent CAM users are three-times more likely to use CAM for their children compared to non-CAM users. Chiropractic stands as the most popular type of CAM therapy for children and yet not reflected in the scientific literature. We describe the successful outcome of chiropractic care in pediatric patients with chronic constipation.
Clinical Features: All three patients were under the age of 2 years with bowel movements ranging from once per week to every 3-4 days. This was accompanied with straining, pain and rectal bleeding. Previous unsuccessful care involved medical advice with dietary changes (i.e., increase fiber and fluid intake) and the use of cod liver oil or mineral oil.
Intervention and Outcome: Following a trial of chiropractic care using a combination of high velocity low amplitude thrust type care and Activator Methods to sites of vertebral subluxations. The patients’ constipation resolved as demonstrated by an increased frequency in bowel movements once every 1-2 days without straining and pain.
Conclusion: This cased series provides supporting evidence on the effectiveness of chiropractic care in children with chronic constipation. We advocate for further investigations in this field.
Diane M Meyer, BSc, DC 1 and Joel Alcantara, BSc, DC 2
- Private Practice of Chiropractic, Oakville, Ontario, Canada
- Research Director, International Chiropractic Pediatric Association, Media, PA, USA and Private Practice of Chiropractic, San Jose, CA, USA
This study was funded by the International Chiropractic Pediatric Association, Media, PA, USA
Corresponding Author:
Joel Alcantara, BSc, DC
From the abstract: This pilot study included children from 27 days old to five-years-old, was on the effects of chiropractic adjustments on children with otitis media used tympanography as an objective measure.
Results: the average number of adjustments administered by types of otitis media were as follows: acute otitis media (127 children) 4 adjustments; chronic/serous otitis media (104 children) 5 adjustments; for mixed type of bilateral otitis media (10 children) 5.3 adjustments; where no otitis was initially detected (74 children) 5.88 adjustments. The number of days it took to normalize the otoscopic examination was for acute 6.67, chronic/serous 8.57 and mixed 8.3. the number of days it took to normalize the tympanographic examination was acute: 8.35, chronic/serous 10.18 and mixed 10.9 days. The overall recurrence rate over a six month period from initial presentation in the office was for acute 11.02%, chronic/serous 16.34%, for mixed 30% and for none present 17.56%.
Conclusion: The results indicate that there is a strong correlation between the chiropractic adjustment and the resolution of otitis media for the children in this study. Note: 311 of the 332 had a history of prior antibiotic use. 53.7% of the children had their first bout of otitis media between the ages of 6 months and 1 year and a total of 69.9% of the subjects in the study had their first bout of OM under a year of age. This is consistent with the findings of others.
Fallon, JM. Journal of Clinical Chiropractic Pediatrics Vol 2, No. 2 1997 p.167-183.
Herniated Disc Queens, New York (NY)
An Intervertebral Disc, or Spinal Disc, has two main components. The first, the annulus fibrosis, is the outer layer. This can be likened to the dough part of a jelly doughnut. The second, inner layer, comparable to the jelly portion of a jelly doughnut is known as the nucleus polposus. The inner nucleus portion functions primarily as a fulcrum for movement and as a shock absorber to handle the impacts of movement.
To better understand how a disc functions we often compare it to a jelly doughnut. If you put pressure on one end, say the front end, of a doughnut you could imagine that the jelly would migrate towards the back. If you put pressure on the back end, the opposite would occur, and the jelly would migrate towards the front. The same holds true for your intervertebral disc since it functions as a fulcrum. When the jelly starts to protrude from the confines of the annular fibers this is known as a prolapse. This can cause symptoms of sciatica or radiculopathy such as numbness and tingling down an extremity.
Herniated And Degenerative Disc Disease
As people age, the nucleus pulposus begins to dehydrate, which limits its ability to absorb shock. The annulus fibrosus gets weaker with age and begins to tear as a result of repetitive stress as well as the aging process. This doesn’t always cause pain for all people although it can for some.
In Medicine one generally refers to the gradual dehydration of the nucleus pulposus as degenerative disc disease or if accompanied by bony changes; spondylosis.
Once a tear has arisen within the annular fibers it is highly likely that the inner nuclear material will begin to make it’s way through that tear. This is termed a herniation. All along the sides of the spine are nerve roots and spinal nerves that make their way to organs, tissues and other body parts and they are at high risk of being infringed upon by herniated disc material. A pinched nerve is when this herniated disc material begins to make contact with one or more affected nerve roots and may cause severe radiating pain, numbness, tingling and reduced ranges of motion. One can also suffer pain as a result of a ‘leaky’ disc where the jelly simply oozes out of the tear and begins to cause inflammation in the adjacent soft tissues. If the pain is nerve related it’s usually deemed a radiculopathy.
Disc can become slipped, ruptured, or bulged. However, in medical terms it is more commonly referred to as:
1. Protrustion
2. Extruded Disc
3. Sequesteration
Up until a few years ago surgery was the only option for those who failed therapy. A gap between these two groups left no other options for those who failed therapy. Soon you will learn about a new option that bridges the gap between failed therapy and surgery.
Surgery should be considered if a patient has a significant neurological deficit, or if they fail non-surgical therapy. The presence of cauda equina syndrome (in which there is incontinence, weakness and genital numbness) is considered a medical emergency requiring immediate attention and possibly surgical decompression.
Regarding the role of surgery for failed medical therapy in patients without a significant neurological deficit, a meta-analysis of randomized controlled trials by the Cochrane Collaboration concluded that “limited evidence is now available to support some aspects of surgical practice”. More recent randomized controlled trials refine indications for surgery.
Surgical intervention should only be considered after all other forms of non-surgical intervention have been exhausted.
