Decompression therapy remains a hot buzz phrase throughout our profession today. Although it's been performed for years by chiropractors, "spinal decompression" is something that is now hitting the consumer mainstream; you see ads in print and on T.V. that refer to "spinal decompression" with somewhat of a reverence, creating a buzz with consumers. Offering a new technology gives you a second chance with people who may have decided against seeing chiropractors due to their past experiences or initial impressions. In other words, people don't say "yes" after they have said "no." But they will say "yes," if you offer something different and effective. Where have we been? Our profession has been criticized— both fairly and unfairly—for not providing permanent, measurable results. It's ironic, since chiropractic's philosophy is to treat the root cause as opposed to addressing the symptom. But, ironic or not, there is some truth to it: There is plenty of research that shows chiropractic adjustments alone may help with acute low back pain, but do little for chronic back conditions and certainly will not cause predictable spinal correction. Chiropractic adjustments and decompression alone, respectively, offer only temporary "relief." If it is our goal to address the core cause of symptoms (abnormal biomcchanical dysfunction), then we should pursue and offer protocols that provide as much "core" improvement as possible. I hope and believe we can all agree on that. Where are we headed? Decompression has made its mark in our profession and will continue to provide relief and value to the patients. So. how does a decompression table strengthen the spine to prevent a disc problem from coming back? Is it true that spinal decompression—using a table that causes axial distraction of the spine—will give patients temporary pain relief? If muscles support the strength of the spinal curves and disc problems are the result of structural weakness of spinal curves, the reality is decompression, without proper muscle strengthening and rehabilitation along with curve correction, is actually just a very expensive band-aid. As a doctor that coaches rehabilitation for accelerated spinal and curve correc- tion, I am continually fielding calls from doctors all over the country who have received patients or have patients returning to them that have spent thousands of dollars for decompression therapy and have had their symptoms return within three to six months. Again, decompression therapy is a very powerful tool, highly recommended and, when appropriately used, can help some patients that have failed in other systems, including traditional chiropractic. However, it is the rehab that creates the stability and correction to enhance and stabilize the benefits of spinal decompression. The next question is, "What type of"rehab has been proven to be the most effective for spinal strengthening and curve correction?" When it comes to rehabilitating the spine, certain specific factors must be considered and kept in the forefront of your mind. First of all, tra- ditional, conventional physical therapy of performing resistance exercises through a range of motion (i.e., weights, machines, thcrabands) along with electro-therapeutic machines (i.e., electric muscle stimulation), often recommended, do not address this problem. The reason is they are working the fast twitch muscle fibers. Fast twitch muscles will make you strong, but will not change the structure of the spine and remove the underlying cause of the disc injury. They will help you to carry your groceries while the spinal structure continues to degenerate and your body becomes sick. The muscles that support spinal structure and determine the stability, shape of spinal curves and the future of your health are postural, slow twitch muscles. Slow twitch muscles that support spinal structure require isometric, sustained contraction exercises and are very different from conventional physical therapies that are usually recommended by some companies selling decompression tables. In addition, this therapy includes rehabilitative protocol that can predictably re-hydrate a degenerative disc. "What would it be like to teach a patient how to rejuvenate a degenerative disc?" These specific and effective spinal corrective exercises are found in The Spinal Rejuvenation Therapy (SRT) Rehabilitative protocol. Another question to consider is, "Doesn't the whole spine function as one unit?" In other words, "When there is an injury or weakness in one area of the spine, isn't the whole spine affected?" The answer is, "Yes." In fact, even medical studies show that patients with low back pain also have neuro-musculoskeletal problems in the cervical and thoracic spine, as well as in the extremities. The Pettibon Institute, developed for the continued research and development of effective spinal corrective therapy, has determined that, to more permanently correct the lumbar spine, at least a 60 percent correction of the lordotic curve in the cervical spine must be present to stabilize the lumbar lordosis. In other words, if you want to fix their back, you have to fix their neck or it won't hold. This is another reason why decompression therapy, without full spinal corrective rehab, will not produce more permanent correction. Another perspective of decompression therapy in your practice is a billing perspective that can create a potentially dangerous situation with medical and insurance reimbursement. Many table companies are recommending that you use exercise codes like 97110 or 97530 for the time a patient is on the decompression table. These exercise codes are for active exercises; i.e., the patient is actually moving his/her own body, rather than someone or something else moving the body. The aurgument put out by these table companies is that the patient is being stretched during the process, so you can use the above codes, as they have stretching as a component in their description. Compliance officers flatly reject this billing practice and recommend the use of the appropriate code S9090 as outlined in the latest edition of the AMA Code Book. Decompression may, in fact, be the wave of the future. But how we position ourselves on this wave is of primary importance. If we are effective in our ability to achieve muscular strengthening to aid in structural correction, we can achieve predictable disc rehydration and disc height restoration. If we are ethical in our billing practices, compliant in our insurance vs. cash plans, we can establish ourselves as the leading experts in Spinal Disc Correction throughout all of health care in this country. This country is starving for it. Now you will have the opportunity to tell the world the real chiropractic story of spinal health. How will that affect your practice, your patients' lives and the chiropractic profession? The next step after decompression: Can Rehab Therapy Restore Lordotic Curve and Disc Height? That was what we set out to discover in two case studies. (You can review the white paper in entirety at http://disc-ease.info/ articles.html.) We knew decompression could make 80-some percent of patients with lower back pain experience relief, but we also knew most of those same patients had the pain return not long after the traction. We believed, from an immense amount of past research, that a predictable, lasting condition could be achieved by applying a rehab protocol in addition to the decompression sessions. The purpose was to explore Spinal Rejuvenation Therapy™ (SRT) and its effects on range of motion, lordotic curve restoration, increased disc height and overall spinal function and health. KEYS TO THE PROTOCOL Our goal was to restore intradiscal height and lordotic curves. Patients who underwent the protocol experienced restoration of normal range of motion and lordotic curve, disc rehydration and increased core strengthening. The application focused on six steps which, when addressed in proper combination, had a lasting impact on the spinal health of the patient. 1 Water/Nutrition—The body is approximately 73 percent water. People who are dehydrated and have musculoskeletal problems are at about 55 percent water. The spinal disc nucleus is 88 percent water. Degenerative discs are dehydrated and have abnormal function. The doctor must begin with hydration to achieve disc rejuvenation and reduction of musculoskeletal symptoms. Patients must drink half an ounce of water per pound of body weight per day. There was also a consumption of one to two ounces of mineral salt water and sixteen ounces of fresh water infused with nutrients formulated to reduce inflammation and allow disc rejuvenation. 2 Muscles—Muscle spasm prevents motion of the spine, which will not allow spinal structural correction. You need to reduce red tissue adhesions and spasms, which begins the remodeling of scar tissue in old spinal injuries, reducing soft-tissue resistance to achieve structural change. 3 Discs—Alternating loading and unloading cycles are utilized to soften the hard gelatinous discs. Once rehab is applied to soften and temporarily remove the elastic energy from the disc, spinal change can occur. The loading and unloading cycles also cause disc rehydration for spinal rejuvenation. KEYS TO THE PROTOCOL cont'd 4 Motion—Spinal axial distraction (decompression) is applied only after the soft tissues have been prepared. Decompression is utilized to create motion throughout the entire spine. To be effective, decompression must be applied so that it affects the entire spine, all the way down to L5/S1. Spinal structural correction can only be accomplished with full spinal movement. Evaluate for chiropractic adjustments after decompression. 5 Muscle Balance—Body weights are used to retrain proprioceptive reflexes of the brain to allow structural and postural correction of the spine. Patients use weights while performing balance and proprioceptive exercises. This achieves structural correction of the spine while strengthening the muscles of the spine to hold the new structure. This accelerates structural correction of the spine. 6 Isometric Exercises—Muscle supports ! curves. Muscle supports the Iordotic curve. Once the correction has been made with the previous five steps, the patient can begin performing isometric exercises to strengthen the muscles that will allow curve correction. As the muscles gain strength, they will be better able to hold the new corrected curves. The benefits of spinal rejuvenation can be more effectively seen in individual case studies. A number of different studies reveal positive changes in range of motion, muscle strength, physical fitness, disc height and restored lordotic curve. Conclusion Decompression has been a boost to our profession and has allowed patients to experience an alleviation of pain. But achieving lasting results and addressing the core of the symptom is what chiropractic has always been about. Applying an effective form of rehab protocol with decompression allows for the restoration of the lordotic curve and lasting, predictable results. And isn't that what our profession has always sought? Dr. Fred DiDomenico tenches rehabilitation for accelerated spinal andcurve correction and has spent years in exploring solutions to restore the lordotic curve on a permanent, predictable basis. His work includes involvement with the Disc Ease seminars (www.disc-ease.info. 1-800-597-0368) and with Spinal Rejuvenation Therapy (SRT)™ I It is the rehab that creates the stability and correction to enhance and stabilize the benefits of spinal decompression. If you want to fix their back, you have to fix their neck or it won't hold. This is another reason why decompression therapy, without full spinal corrective rehab, will not produce more permanent correction.
