Dr. Bard and I have found in our 40+ years (almost 80 collectively) of chiropractic that chiropractors are continually looking for the magic ad, or the magical way to get new patients. We all know if you do the same thing the same way, you get the same results. The key to successful marketing is for the consumer to understand the brand. Today, chiropractic goes by so many names: wellness, functional medicine, stem cell, weight loss. But what really is our brand?
The brand must explain who you are and what you do. A good brand has to have a pure identity and a pure concept that tells a story. Mercedes has a brand, as do McDonald’s, Wendy’s, Disney World, and Apple. I could go on and on in discussing the importance of the brand. But what the brand does is, it supplies consumer confidence. Having taught nonsurgical spinal decompression, that many people that have tables do not know how the tables actually work. Yes, there is a difference in tables, and yes, you need to know the science. This is why we write these articles - because we are trying to build better doctors, not just better marketers.
Let’s review some facts. It is estimated that approximately 80% of adults experience lumbar pain at least once in their lifetime and 80% of structures causing lumbar pain. We believe that this pain may often be related to intervertebral discs. Disc herniation is multifactorial, frequently related to degenerative processes and mechanical effects, and mostly occurs due to external injuries of the spine, such as spinal bending and stretching, spinal rotation exercises, and abrupt posture changes. Both surgical and conservative treatment methods are considered for intervertebral disc herniation. Conservative treatments by most medical doctors include medication, exercise therapy, and physical and rehabilitation methods. Among them, one of the most widely used methods is traction therapy. Traction therapy reduces the pressure caused by gravity and soft tissues, and sufficient tension extends spinal separation and the intervertebral disc. Negative pressure within the intervertebral disc increases its hydration and reduces pressure on the nerve root by removing the force applied to the vertebral pulp. A study by Shealy and Borgmeyer outlined the difference between fraction and decompression:
“Eighty-six percent of ruptured intervertebral disc (RID) patients achieved ‘good’ (50-89% improvement) to ‘excellent’ (90-100% improvement) results with decompression. Sciatica and back pain were relieved.” “Of the facet arthrosis patients, 75% obtained ‘good’ to ‘excellent’ results with decompression.”
C. Norman Shealy, MD, PhD, and Vera Borgmeyer, RN, MA. Decompression, Reduction, and Stabilization of the Lumbar Spine: A Cost-Effective Treatment for Lumbosacral Pain. American Journal of Pain Management Vol. 7 No. 2 April 1997
Spinal decompression therapy is now making its move in the back world. Working with my partner Dr. Perry Bard along with my son Dr. Jason Kaplan and my daughter-in-law Dr. Stephanie Kaplan, we have consistently observed how conservative treatment for intervertebral disc herniation and IDD therapy along with decompression is setting a new standard. Spinal decompression therapy reduces the pressure on the intervertebral disc by supplying nutrients and oxygen to the intervertebral disc. This creates a state of non-gravitation or negative pressure by adjusting the direction and angle of traction to suit the location of the intervertebral disc, which is the target of the treatment. This, in turn, reduces the pressure inside the intervertebral disc by gradually and softly increasing a specific part of the intervertebral disc through the decompression of a precise part of the lesion. This was first done by video fluoroscopy, which is included in the Ramos and Martin study.
Spinal decompression therapy resolves problems with the disc and removes the pressure applied to the disc by supplying nutrients and oxygen. This creates a state of non-gravitation or negative pressure within the spinal canal and reduces pressure inside the intervertebral disc by softly increasing a specific part of the disc through the decompression of a precise part of the lesion. The Boxell and Martin study states, “the disc has the ability to repair itself.” Is this not simply the beauty, the paradigm, the essence of chiropractic? The power that creates the body has the power to heal the body. Sometimes, we need to utilize a thrust or an adjustment. Sometimes, we need to utilize proven modalities, like nonsurgical spinal decompression, initially developed by Dr. Alan Dyer, Canada’s minister of healthcare, who also developed a defibrillator. He went on to study decompression, conduct numerous research studies, and continue his work in conjunction with Dr. Norman Shealy, M.D, Ph.D., a neurosurgeon who taught at Harvard University. Collectively, they worked on millions of dollars of research that is often utilized by doctors and manufacturers throughout the world.
PERSPECTIVE
Doctors, back pain is a difficult situation for everyone. Patients who enter your office are often experiencing sharp, debilitating pain. This pain is not like your standard muscle soreness. This, in my opinion, is nerve pain. Many patients complain of the feeling of getting electric shocks, pins and needles, or burning sensations along their back or legs. It’s gotten to the point where they are beginning to lose function in their daily life.
They can barely make it through the workday, let alone something physically demanding, like going for a hike. They aren’t able to play with their kids or grandkids. They go and get checked out by a doctor. After a whole battery of testing, it is determined that they have nerve impingement, disc herniation/degeneration or spinal stenosis. These are the most typical cases that we see. As chiropractors, are you prepared to handle them? We work with our doctors in over 39 states to understand the diagnosis and treatment of bulging and herniated discs.
Often, patients go to their primary care provider or an ER Center. At this point, most doctors are going to give them treatment options like medication to temporarily mask the pain or physical therapy. In some instances, the patient will get injections, which often leads them to have spinal surgery to decompress their nerves. With the increasing normalcy of sedentary lifestyles, as well as the baby boomer generation advancing in age, rates of chronic back pain have continued to rise. From 20002007, the total number of adults in the U.S. suffering from chronic back pain increased by 64% (approx. 7.8 million to 12.8 million), with the average age of patients rising from 48.5 to 52.2. (Baber et al 2016). As a result, the number of surgeries has also increased over the same time period - 170% for spinal fusions (Rajaee et al 2012) and 11% for laminectomies (Parker et al 2015).
What follows is some information to help answer questions about your options when it comes to decompressive surgery, as well as a possible alternative to effectively treat conditions. Typically, the first step is pharmaceutical. Prescription muscle relaxers, painkillers, and anti-inflammatory medications are usually tried. The next step is physical therapy. Exercise is essential for optimal health; however, exercise often exacerbates the pain if you have nerve compression. The last step before surgery typically is steroid injections. While they may provide temporary relief for inflammation, they rarely offer lasting relief for nerve compression. In the conventional medical treatment model, all that remains is spinal surgery.
If the patient continues to try conventional care and medicines, the merry-go-round of drugs and addition surgeries also continues. Spinal surgery often consists of many procedures, some of which are performed at the same time. These include a procedure to remove the tissues causing the nerve impingement as well as spinal fusion.
The most common type of decompressive surgeries are laminotomies and laminectomies. These procedures sound very similar, as they both involve the lamina of your spine. Each individual vertebrae in your spine have a lamina on either side of the posterior aspect which creates a bony arch that encases your spinal cord. A laminectomy involves complete removal of this bony arch as the lamina is totally removed, whereas a laminotomy will only remove a portion of bone that is causing the nerve impingement. The type of surgery you receive will be dependent on the extent of nerve compression and whether other procedures will need to be completed. To perform both a laminectomy and a laminotomy, an incision is made at the vertebral level where the nerve compression is occurring. The tissue is opened, cutting through skin and dissecting muscle to expose the bone of the spine. In a laminectomy, the spinous process and lamina are completely removed from the vertebra in order to relieve the pressure caused by these structures on the nerve roots or spinal cord. With a laminectomy, removing these significant portions of bone creates the potential for instability in that region of your spine. In addition, some of the intrinsic muscles that are the primary stabilizers of the spine attach directly onto portions of the vertebra that are removed. Also, the surgeon has to cut through the paraspinal muscles to access the disc and lamina. These muscles are responsible for helping your back straighten out, rotate, and keep you upright. As a result, a laminectomy is often combined with a spinal fusion at that level, which requires the surgeon to drill screws into the vertebra above and below the affected level and connect them with steel rods. This hardware is required to maintain stability. This in turn creates a block of bones that can severely restrict normal ranges of motion, meaning that even if the surgery is successful in reducing nerve compression, it comes at the cost of a permanent loss of normal movement. The result of this restriction can accelerate degeneration of the discs and joints above and below the fusion site, resulting in pain, inflammation, and potentially additional surgeries (Ma et al 2019).
Due to the invasive nature of the procedure and risks associated with anesthesia, surgery is not an option for some patients. To us, it should be the last option when all others have failed. Complications often are due to a patient’s age, immune competency level, etc. If surgery is not an option, patients are often told the only treatment available to them are pharmaceuticals to try to manage their pain. It is our job as chiropractors to educate patients that there is an alternative. We also need to recommend that patients continue to trust us as their primary treating doctors in the treatment of disc care. Failed back surgery is now reaching epidemic levels. We need to take responsibility for any patient that goes for surgery prior to trying nonsurgical spinal decompression.
According to studies, somewhere between 10% and 74% (Nguyen et al 2011) of back surgeries fail. In the words of Dr. Steven Atlas, associate professor of medicine at Harvard Medical School, “Your pain is typically decreased by 50%.” Dr. Atlas also says, “...There are very few people who really have no pain after spinal fusion. The relief may last only a few years before the condition worsens again.”
According to Neuroradiologist Dr. Robert Burke, these surgeries often result in a tremendous amount of scar tissue that attaches to nerves and causes chronic pain.
Surgery is essentially an all or nothing event. The surgeon can’t go in, shave off a bit of bone, sew you up, and “see how you do.” The only reason that would even be considered an option is if your condition is complicated enough to warrant multiple surgeries to correct the issue. Finally, a 2017 article from World Neurosurgery found that one-fifth of patients 65 and over who received a spinal surgery had to be readmitted to the hospital due to complications (Aodgwa et al 2017).
Now, in 191 clinics and 39 states, we are seeing results that are nothing short of miraculous on a daily basis. Non-surgical decompression is the chief treatment for nerve compression and disc conditions. As explained previously, spinal decompression machines milk the spine, creating a vacuum inside the discs and joints. The negative pressure can reduce disc bulges, draw nutrients and water into the disc, reduce swelling and inflammation, and improve joint motion. One study that reviews this in detail was conducted by Dr. Edward Eyerman pre-and post MRIs.
Below are basic MRI images of a patient with a disc herniation at L5-S1. The before picture clearly demonstrates the disc bulging into the spinal canal. The after picture was taken following a course of treatment including spinal decompression and shows a reduction of the herniation.
Non-surgical decompression machines are not the same as inversion or traction units. With inversion, traction force is generated by hanging from your ankles or knees, The only control over the force is the angle at which you are hanging. Harvard studies do not recommend inversion therapy.
Dr. Jason Kaplan states, “When you reverse the load with weight on the disc, you’re increasing the disc pressure, which could create a greater chance of herniation or a sequestered disc. With decompression, the force is static unless you move. With a spinal decompression machine, the force is controlled and directed.” Dr Shealy and Dr. Leroy were influential in the development of a fixed tower to be more specific on the angle of the pull. The rate of application of pressure, the maximum and minimum levels of force and length of pressure application are all programmed into the machine. The cycling of the pressure, like a sign wave, produces a pumping action that improves circulation. This is particularly important where disc conditions are concerned since discs do not have a direct blood supply.
In addition to being effective, spinal decompression is safe and pain-free. Our decompression machines are FDA-cleared and can be turned off by the patient if they have any discomfort. For most patients, decompression is so comfortable and relaxing, they can take a nap during their treatment. If you have a decompression table, you need to know what to do in a Logarithmic index, a Sinusoidal index, oscillation, or what algorithm the manufacturer utilizes. You wifi also need to have a copy of your FDA clearance documents to look up indications of usage.
During 34-plus years as business partners, Dr. Eric Kaplan and Dr. Perry Bard have developed Disc Centers of America, Concierge Coaches, and the first national certification program for non-surgical spinal decompression a 12 CEU credit event. Being held for the 10th anniversary on November 5,6. This event has been sold out for two years running.
Dr. Jason Kaplan is a Parker University graduate practicing in Wellington, Florida with his wife, Dr. Stephanie Kaplan. Jason also is an Instructor for Disc Centers of America and teaches techniques for the National Certification Program at Life University. To learn more, call 888-990-9660 visit thechiroevent.com or decompressioncertified.org.
