Is it safe?
Yes. The distraction is produced by a FDA approved, computer-controlled device using forces that are usually about 50%-65% of the patient's body weight, and therefore well within safe limits.
Is it painful?
No. Distraction force is always set within the patient's pain tolerance. In fact, most patient's comment that it "feels good." There are cases where patients are sore after the treatment. This is usually temporary, and is a result of the necessary healing process. In the rare case that a patient is sore after treatment, this discomfort typically reduces with continued treatment and tissue healing.
Will it work?
Individual results vary based on the severity of each patient's condition, however, distraction is effective in about 84% of patients.
How many times will I have to come?
Usually about 20 sessions are required to produce the desired results. Accomplishing the distractions in a relatively short period of time is important to appropriately heal the injured disc. This may mean that distractions are done 3-4 days a week for 4-6 weeks. This may seem frequent, but is sometimes necessary to produce the optimal results.
How much does it cost?
Your cost will depend on your response to care and insurance coverage. Please call our office for exact figures, but for your reference the typical cost for this therapy ranges between $1500 - $2500. Remember, payment plans are always available.
Do I need an MRI ?
Maybe. It varies case by case, but having an MRI is preferred. If you've already had an MRI , bring copies with you to your first appointment. If you've never had an MRI , we'll discuss your clinical need with you after your examination. (MRI 's are not available at our facility, but are referred to local radiology centers.)
Is this procedure supported by clinical research?
Yes. Here are some brief abstracts with references:
77 patients verified on pre-post MRI with signs and symptoms of herniation, underwent non-surgical intervention including pelvic traction. Changes in herniation and good-excellent symptomatic improvements were noted in over 82%. The authors draw the conclusion improving the disc's contact with the blood supply accounts for healing of herniation and there is an excellent prognosis for herniation with conservative treatment.
- Komari H, et. al.: The Natural History of Herniated Nucleas with Radiculopathy. Spine. 21: 225-229, 1996.
Three weeks of the described traction method to large volume herniations resulted in complete resolution of symptoms in all 4 patients.
- Constatoyannis, C. et. al. Intermittent Cervical Traction for Radiculopathy Due to Large-Volume Herniations. JMPT. 25(3) 2002.
29 Patients and 7 healthy volunteers had intermittent traction done while in MR. Substantial increase in vertebral length was seen. Full herniation reduction in 3 and partial reduction in 18 of the patients was reported.
- Chung, TS; Lee, YJ, et. al. Reducibility of Cervicial Herniation: Evaluation at MRI during Cervical Traction with a Nonmagnetic Traction Device. Radiology. Dec, 225(3):895-900, 2002.
30 patients with lumbar herniations axial disc decompress in a CT scanner at 58% body weight for 20 minutes. Hernia retraction occurred in 70% and good clinical improvements were seen in over 93%. The authors concluded improved blood flow was the source of healing. Additionally, they speculated previous studies showing traction doesn't create negative intradiscal pressures perhaps used too light a force.
- Onel, D, et. al.: CT Investigation of the Effects of Traction on Lumbar Herniation. Spine. 14: 82-90, 1989.
The application of supine lumbar traction with adherence to several specific characteristics including gradual progression to a peak force and altering the angle of 'pull' from 10 degrees (L5-S1) to 30 degrees (L3) enhanced distraction at specific levels and patient outcomes.
- Shealy, N.; Leroy, P. New Concepts in Back Pain Managment. American Journal of Physical Medicine. (1)20:239-241, 1998.
A retrospective analysis of over 770 cases, many assumed to be unresponsive to previous therapies, showed a 71% good-excellent success rate with 20 treatments on the prone Vax-D traction device. All patients treated prone with 65-95lbs. of force 3-5 times per week.
- Gose, E.; Naguszewski WR. Vertebral Axial Decompression for Pain Associated with Herniated and Degenerated Discs or Facet Syndrome: An Outcome Study. Journal of Neurological Research. (20)3,186-190, 1997.
Intervertebral pressure was recorded before and during traction. 62% of prolapsed discs showed a negative pressure prior to traction. 64% reduced in pressure with traction which was related to the distraction distance. In 19% of prolapsed discs the pressure actually increased, demonstrating the disruption to the hydrostatic mechanism occurring with annual damage and prolapse.
- Chen, YG; Li, FB; Huang, CD. Biomechanics of Traction for Lumbar Disc Prolapse. Chinese Orthopedics. Jan. (1): 40-2, 1994.
Cervical intermittent traction was shown to be effective in relieving pain, increasing frequency of myoelectric signals and improving blood flow in affected muscles.
- Nanno, M. Effects of Intermittent Cervical Traction on Muscle Pain. EMG and Flowmetric Studies on Cervical Paraspinals. Nippon Medical Journal. Apr;61(2):137-147, 1994.
The author's analysis shows loads not greater than those occurring in everyday life cause loss of stability of the disc and allow lateral nucleus displacement. The model indicates conservative therapy by traction may result in retraction of herniation by about 40%.
- Dietrich, M; et. al. Non-linear Finite Element Analysis of Formation and Treatment of Disc Herniation. Proc Inst Mech Eng; 206(4):225-31, 1992.
Significant negative pressure (-100mm Hg) was recorded at L4-L5 disc in 3 volunteers as axial decompression was administered. Negative pressure was observed at ~50lbs tension perhaps representing a minimum threshold force. Patients were prone and harnessed.
- Ramos, G.; Martin, WM. Effects of Axial Decompression on Intradiscal Pressure. Journal of Neurology. 81:350-353, 1994.
A controlled trial of traction with manipulative techniques. Traction force applied at 100lbs. for 20 minutes leading to substantial relief in over 85% of participants.
- Mathews, JA, et. al. Manipulation and Traction for Lumbago and Sciatica. Physiotherapy Practice. 4:201,1988.
58 subjects had an inclusive conservative program including traction (when initially shown to reduce leg symptoms). Overall, 86% had good-excellent results.
- Saal, JA; Saal, JS. Nonoperative Treatment of Herniated Lumbar Disc with Radiculopathy. Spine. 14(4): 431-437, 1989.
There is no scientific basis for the belief muscles are a source of chronic pain. However, controlled studies show how common disc and facet pain is accounting for more than 70% of chronic back pain.
- Bogduk, N,: The Anatomical Basis for Spinal Pain Syndromesl JMPT 6:Nov.-Dec. 1995.
3 patients with a ruptured lumbar disc had contrast medium and radiographic images taken during and after a lumbar traction procedure. The protrusions were shown to lessen considerably with the 30-minute prone traction sessions and dimpling of the outer annulus suggested a negative intradiscal force was created.
- Mathews, JA. Dynamic Discography: A Study of Lumbar Traction. Annals of Physical Medicine. IX(7), 265-279, 1968.
Intermittent supine traction with >50% body weight, ten 20-minute sessions with added exercises showed considerable improvement in over 90% of the 62 patients.
- Lidstrom, A. Zachrisson, M. Physical Therapy of Low Back Pain and Sciatica. Scandinavian Journal of Rehabilitative Medicine. 2:37-42, 1970.
40 patients with neurological signs treated with traction on a friction-free table at 55-70lbs. for 20 minutes. Good-excellent results were seen in 55%.
- Hood, LB; Chrissman, D. Intermittent Traction in the Treatment of Ruptured Disc. Physical Therapy. 48: 21, 1968.
Patients were subjected to a supine angled traction force of up to 100lbs. with x-ray examination. A rope angle of 18 degrees revealed separation greatest at L4-L5. A more acute angle of 10 degrees may cause greater separation at L5-S1. The separation was obvious up to T12-L1 with total elongation of the spine approaching +5mm. The vertebra separation is greater on the posterior aspect of the disc.
- Colachis, S.; Strohm BR. Effects of Intermittent Traction on Vertebral Separation. Archives of Physical Medicine and Rehabilitation. 50: 251-258, 1969.