Mechanical traction has been judged as a reasonable and logical treatment method for spinal pain for centuries. Since compressed discs are often a source of chronic back and leg pain, stretching the spine is an intuitive remedy.1,2 However, it has never gained widespread popularity in the chiropractic profession, nor have its results been consistent in clinical trials.3 Cumbersome equipment, time consuming and uncomfortable procedures and its historical connection to physical therapy have kept it out-of-favor with perhaps the one profession best suited to its unique capabilities.
Within the last decade, however, traction has been making a reemergence in our profession. It has taken on a new name and a new efficient profile. It is now called decompression.4
Decompression or decompressive traction refers to a decrease in intradiscal pressure (and the resultant circulatory improvement and phasic healing concomitant with it).5 Specific protocols and systematic procedures reduce misapplication and the haphazard nature of previous methods. In effect, decompression is best thought of as a hybrid traction method.
Several decompression units have entered the chiropractic market in the last ten years, most with a plethora of bells and whistles and extremely high price tags. In the era of managed health care, lower equipment costs and lower overhead are the key to profitability, yet many DC’s have opted to purchase these units on the promise of dramatic outcomes and huge reimbursements.
Excellent results and patient satisfaction have always been the fuel that has powered the successful practice. The promise of extraordinary results and reimbursements of $150 per treatment can be very persuasive in our competitive marketplace.
Many chiropractors looking for a niche have discovered that, very often, patients unresponsive to manipulation or flexion do respond to the proper application of axial decompressive traction (that these units work is not really at issue). They have discovered, additionally, that offering “…non-surgical decompression for disc problems” is an excellent means to attract new patients.6 This is due to its safety and comfort vs. traditional methods, not to mention the reduced strain on the busy doctor’s body!
However, the extremely high costs have often created undo financial stress on many practices. The per-treatment reimbursement must be very high to validate the cost of equipment that leases for $1500+ a month for sixty months, or a charge of $50 each time you turn it on!
Many insurance companies are now enacting post-payment audits of DC’s billing decompression. Any billing code other than traction (97012) can result in repayment, fines and penalties. There is actually no decompression code, and rarely is an insurance company willing to pay $150 per treatment simply because the doctor paid $50-125,000 for the equipment.7 I’ve owned several of these expensive decompression units over the last eight years and have been subjected to two audits u u resulting in six-figure reimbursements. Of course, having the ability to up-sell a cash patient (or doing several additional modalities to generate $150 per session) begs the question, why not simply utilize an equally effective device costing one-tenth the price and watch your profits rise exponentially?
Recently, such equipment has become available. One system which I particularly favor includes not only the unit, but also supportive diagnostic, and low-tech therapeutic devices. Moving from passive to active procedures is a vital step in outcome-based care. The included low-tech rehab device allows monitored exercise in the vital segmental stabilizers (the so-called local muscle system).8 Additionally, there are two methods of cervical traction and carpal distraction quickly and efficiently accommodated, all at a price around $10,000. It becomes apparent to the experienced user that it’s the necessary utilitarian features, not the price, that allows for effective treatment.
An honest and objective analysis of the phenomenon of decompression brings us to the realization that it is an outcome that can be consistently produced by the adherence to several utilitarian characteristics and protocols. It is probably not an overstatement to say, they are absolutely necessary for the most consistent, effective therapy. We contrast decompressive traction (i.e., decompression) from traditional mobilization traction methods by these characteristics.9 See Table 1.
These characteristics work in synergy to enhance the efficacy of Y-axis traction. The synergistic effect of these characteristics is patient comfort and relaxation. They reduce conscious and sub-conscious anticipatory guarding. It has been suggested that muscle guarding reduces the ability of traction to distract the vertebrae sufficiently to decrease the internal pressure of the disk for a pre-determined time so healing can occur. Thus, a slow, graduated application of tension and exact, reproducible forces make up a substantial aspect of decompression.12 It should be obvious that roller type tables and automated axial elongation on a flexion table have no ability to deliver real decompression. Continued use of a traction code for that type of treatment can also lead to post-payment insurance troubles.
I can tell you from personal experience, it is unnecessary to spend extraordinary amounts of money in order to offer this beneficial therapy in your clinic. Decompression therapy is now available for the cost of a quality adjusting table. Look around!
Dr. Jay Kennedy has been practicing Chiropractic Biophysics (CBP) in Western Pennsylvania since graduating Palmer College in 1987. In the last eight years, he has owned and operated several decompression systems treating over 2000 patients on them in his multi-disciplinary clinics. He lectures extensively and has authored various articles on axial decompression.