Expert: Dr. Victor Dolan, DC, DACBSP - 6/5/2008

Question
QUESTION: Dr. Dolan,

I am 60 years old and hurt my back in the lumbar region lifting something incorrectly (i.e. with the back rather than with the legs) about 1 year ago. Because my back remained painful and disfunctional after 2 months, I went to my family physician who sent me to a rehab clinic.  The rehab treatment which consisted of massage, ultrasound, and core strengthening exercises improved the condition but it remains and has worsened recently when I bent over a few minutes to work on my computer. I have been considering alternative treatments to the rehab exercises and spinal decompression has come to my attention. I have met with a chiropractic doctor who specializes in this treatment and he has taken X-rays which show level 3 narrowing in two lumbar disks and one cervical disk. He has recommended a series of decompression treatments. Because the treatments are very expensive ($5000) and there is not much science to back up the treatment method (I have done a literature search), I would like to ask your opinion as to whether the expense is justified. The expense would be justified if the treatment is has a high probability of being effective in both the short term and the long term. Also are there other alternative treatments which are just as effective but less expensive? Finally are there any steps that I can take to slow down the degenerative process of these disks?  I thank you in advance for your reply.

Maury Hull

ANSWER: Hello Maury,

Sorry to hear of your condition, and of your failed treatment regimen.

Spinal Decompression, Low Back Pain, Herniated Disc ?

Spinal Decompression is a relatively new treatment option in the care of low back pain (and now with additional devices for neck pain, headache, cervical-brachial neuritis, radiculitis, pinched nerve ).

Lower back pain, sciatica, herniated disc, degenerative joint disease, paravertebral muscle spasm; there are many conditions that cervical or lumbar spinal decompression treatment is now in vogue for.

I should say 'in vogue' or use the word 'trend' because it may be viewed as derogatory.  I do not mean it to be derogatory.

Years ago I became the first Doctor of Chiropractic in a Hospital in New York State.  The Governor, city council, congressman, state senators and state assemblyman all recognized the achievement.  When I first was granted hospital privileges I did not perform Manipulation under anesthesia (spinal MUA).  As a matter of fact, I was probably anti- Spinal MUA.  BUT, as a new chief of a department in a hospital, it was my duty to study new, different techniques.  I did research, took certification from TWO separate organizations,,,, and became a big PROponent of spinal MUA, and performed hundreds in the hospital setting.

Years ago non-surgical spinal decompression started to become popular. Again, this old-time Staten Island Chiropractor was a stick in the mud,,, and probably  ANTI-spinal decompression,,,,

Well, after referring tough cases out to fellow DC's who have the spinal decompression equipment in their office,,, after studying the technique, the treatment, the equipment,,, I am actually awaiting delivery of  spinal decompression equipment in my office as we speak.

My Staten Island Chiropractic office will have a menu of traditional Chiropractic Adjustment therapy, Spinal manipulation Under Anesthesia (not performed in my office though), adjunctive physiotherapy, and now non-surgical spinal decompression.

Spinal Decompression (SD) has a variety of tables, equipment, techniques and treatments.  Some Doctors seem to perform miracles with the SD, some doctors do not.  There are many tables out there; do not let the Doctor 'sell' you on any particular table or piece of equipment; the DOCTOR is the DIFFERENCE.  Certification courses are now available in SD, experience matters in SD; go by word of mouth and reputation rather than a big advertisement,,, go by your gut feeling with the Doctor and the office.

Is the SD absolutely necessary for correction in your case? , , ,
Well you say you went to a physician and a rehab clinic,  I do not know if that means a Doctor of Chiropractic or not.  I admit my bias - I am a family Doctor of Chiropractic, and my opinion is that in things SPINAL :  low back pain, neck pain, sciatica, headache, pinched nerve, herniated disc;  the DC is the specialist I would go to.

You may try a trial of conservative in-office conscious chiropractic.
Traditional in-office chiropractic is often covered by insurance.  Give 'regular' chiropractic a try.  IF, and that is a big IF, if you are compliant with the DC's treatment plan and receive 'regular' chiropractic care as a treatment regimen ('regular' chiropractic care includes massage, stretches, adjustment, adjunctive physiotherapy, passive therapy, active rehab, home exercise, and perhaps some nutritional counseling), IF you are compliant- you may achieve your goals with this 'regular' regimen at a much lower cost.

If you do not feel improvement if a couple of weeks (not TOTAL improvement, but heading in the right direction), after 5 - 6 treatments;  THEN progression to spinal MUA ($10,000 - $15,000 cost, usually at least partially covered by insurance)  or  progression to non-surgical spinal decompression ( staten island chiropractic office charges run from $4000 - $8000) could be a treatment option.

The SD and/or the MUA treatment regimen should also include in-office treatment of adjustment, adjunctive physiotherapy, passive and active modalities.  Spinal decompression AND adjunctive therapies can usually be had for $5000 - $7000 in most areas, but is usually NOT covered by insurances.

An interesting website you may want to check for a Doctor of Chiropractic near you is
http://www.lifechangingcare.com   
Doctors affiliated with this site often do SD and additional Tx's.

Spinal Decompression is actually a vast improvement on the hospital based traction treatments of decades ago.  Straight, static traction was the rule 25,  30,  40 years ago for in hospital low back traction therapy.  Sometimes successful, sometimes not.

Computers.  Electronics.  Technological advances.

Computers,  Electronics,  Technological advances have differentiated spinal decompression from simple traction.  The tables allow the patient to be positioned specifically for their individual problem.  Decompression Traction heads are computerized to allow a ramping up, ramping down, progressive increase, progressive decrease, intervals of pull/ relaxation:  these improvements have made this an effective treatment.

Insurance, ever seeking to raise premiums (money in) and lower benefits (payments out) has decided that decompression is 'experimental' and often does not cover the service.  That leaves the payment responsibility to the patient.

SD is safe, effective, cost effective.  It does work.  There are studies out there claiming excellent treatment results; 80% success, 86% success, 90% success rates.  Short and Long term successes are reported.

IF your condition bothers you enough I would do it.

If you are doubtful or very patient, I may try a trial of 'regular' chiropractic for a few weeks - - but be compliant with treatment recommendations.

SD could work well for you.  Get word of mouth referrals, evaluate the Doctors in your area, evaluate ALL of the services included in that SD regimen.  Visit that website http://www.lifechangingcare.com .

"slow down the degenerative process of these disks"
Proper posture, proper movement patterns, proper alignment through chiropractic adjustment, proper nutrition for the discs: calcium, magnesium, glucosamine, chondroitin, SAMe, msm all may be helpful.
Degenerative discs = osteoarthritis = the book "The Arthritis Cure" by Theosadakis MD.

As always, this article is not prescriptive or specific in recommendation.  This article is for discussion purposes only, information and education.  Specific evaluation, DX, RX, TX, PX can only be made by a treating health professional in person.

Well, I wish you luck and good health naturally.

Victor Dolan, DC
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com  (email newsletter)  




---------- FOLLOW-UP ----------

QUESTION: As a follow-up question, in addition to the spinal decompression machine, one of the tools used by the chiropractic doctor that I have consulted is called the ProAdjuster. I have done a Pubmed search to try and learn more about the technology behind this tool and also whether it is effective for manipulation but I can find no references under this term. What is your opinion of this tool and can you point me to any scientific articles which describe the technology of this tool and it's effectiveness?

ANSWER: Hello again Maury,

The previous discussion spoke on improvements in technology changing, improving  treatment approaches.  This is similar.

Nineteenth Century doctors of chiropractic used their hands only and often left their patients with bloody noses from lying prone upon wooden benches when treated.  Then an improvement was made- cushioning and face cut outs (nose holes) were placed on chiropractic treatment tables.  We would be involved in lawsuits today if we were sending people home with bloody noses.

Doctors of Chiropractic were among the first to incorporate Xray into their patient evaluation techniques ( see the history of Dr. BJ Palmer, Palmer College of Chiropractic).

Spinal decompression is now widely accepted throughout chiropractic, due to changes in technology.

For the last 100 years adjustment DEVICES have also been studied and implemented.  The most common adjustment devices are SOT (sacro-occipital technique) pelvic blocks, and the Activator Adjusting instrument.

The computer has worked it's way into chiropractic spinal adjustment techniques. The proadjuster ( you can see the company website at http://www.pro-adjuster.us/   ) is a device that uses a percussive impact and a computer to adjust the spine.

The device 'taps' the spinal segments, checks mobility, then either imparts a treatment (one or more stronger 'taps') or moves on to the next segment for testing.  Spinal vertebral subluxation (the chiropractic lesion) usually has fixation, or hypomobility of the joint involved. This would be considered a low force chiropractic approach like SOT, Activator or other techniques.  There is also a similar device called the   pulstarfras device (see http://www.pulstarfras.com  ).  

Technology changes.  Technological changes initiate treatment changes in medicine, dentistry, and chiropractic.

If you prefer the instrument type of adjustment, activator, proadjuster, pulstarfras may be your 'cup of tea'.  If you enjoy a hands on type of adjustment, you ae looking for a chiropractor that performs 'osseous' type adjustments.

The technologies are expensive, so often a Doctor of Chiropractic utilizing such equipment may have a higher visit fee then the DC who utilizes his/her hands.  Viewing the websites of the companies involved will give you a look at the company research, and perhaps allow a portal to objective published research as well.  At this time I do not utilize the computerized adjusting devices.  I do use the activator device upon some patients, SOT blocks on some patients, Hands-on for many patients.

Hope this helps.  Of course, this Staten Island Chiropractor wishes you good luck and Good Health Naturally !

Dr. Victor Dolan, DC
http://www.GoodHealthNaturally.info
http://www.DocDolan.net
http://drvictordolan.chiroweb.com

---------- FOLLOW-UP ----------

QUESTION: Would a lumbar back brace be useful towards unloading the lumbar spine, slowing the degenerative process, and relieving pain? If so, then could you recommend some models that would be comfortable to wear for periods of several hours particularly when doing manual labor including working bent over as in cutting wood with a chainsaw.

Answer
Hello Maury,

I rarely recommend braces.

Braces, supports, aids, 'crutches', are useful when the patient needs them.  When the patient is in an acute stage, when the patient is in pain, when the patient is acutely inflamed.

Use of braces for 'prevention' has not shown to be efficient.  Actually bracing can become a crutch where the joints and muscles atrophy and degenerate.

Degeneration of the joints is best prevented by avoiding injury.  Whether major injury or repetitive stress injury of improper posture or improper movement patterns or overuse cause degeneration of the joints (osteoarthritis).

Among the best anti-inflammatory, anti-degeneration, anti-aging approaches are proper nutrition and chiropractic.

"The arthritis CURE" by Theosadakis MD talks about Glucosamine and Chondroitin.  A great anti-arthritic supplement.  Add some SAMe, MSM, calcium, magnesium, vitamin D, Vitamin C, Bromelain, proteolytic enzymes and a good multiple vitamin, and nutritionally you will slow degeneration of the joints.  Avoid NSAIDS. NSAID medication has been shown to stop the pain, but accelerate joint damage.

The nutritional support above will slow or stop joint degeneration.  Nutrition works on the chemical end of things.

Structure.  If you drive a car you know preventive maintenance calls for keeping the front end aligned.  When properly aligned tires easily go 50-60,000 miles, parts last longer.  Improper alignment causes faster deterioration (degeneration) of all of the parts.
Your joints are similar.  Proper alignment allows longer life and less trouble for the parts.  Chiropractic keeps your spinal joints properly aligned.  Pain indicates a problem, whether from a big specific trauma (ie car crash), or small repetitive trauma
(poor posture).  Unfortunately people often take non steroidal anti inflamatory drugs (nsaids) which kill the pain, do decrease inflammation, but allow and hasten joint degeneration.

To prevent further joint degeneration see your local family Doctor of Chiropractic for the preventative adjustments that may be necessary, and take a supplement regimen that supports the joints.

Do not utilize bracing unless absolutely necessary.

As always, this discussion is for informational and educational purposes only.  Specific evaluation, DX, TX, RX, PX can only be made by the treating Doctor of Chiropractic or other health professional in person.

This Staten Island Chiropractor wishes you good luck and good health naturally.

Victor Dolan, DC
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com    (email newsletter)
http://www.DocDolan.net