Chronic Back Pain Treatment With IDD Therapy And The History of MRI Scan Usage

This article considers the role of the MRI scan when treating low back pain with IDD Therapy.

Herniated Disc TreatmentIt raises the possibility that early back pain studies conducted without MRI technology were in part flawed since without consideration of the underlying condition, how would it have been possible to create and direct an appropriate treatment regimen?

When back pain and neck pain remains unresolved, clinicians now use MRI scans to help diagnose or confirm the cause of someone’s pain.

As an example, IDD Therapy treatment providers take advantage of MRI scan technology for three reasons.

1/ Rule out contraindications to treatment
2/ Identify the underlying pathology
3/ Confirm the spinal level to be targeted for treatment 

IDD Therapy treatment uses a computer-controlled, cyclic pulling force to distract and mobilise targeted spinal segments in an axial plane.

sds spina treatment lrThe application of distraction forces is safe, however it is essential to ensure there are no contraindications, such as a vertebral fracture or metastasis (cancer).  (A full list is available by contacting Steadfast).

The scan helps to confirm whether IDD Therapy may be appropriate and the most common conditions treated include herniated discs and degenerative disc disease.  The MRI scan helps the clinician to select the level to be treated e.g L5S1 disc and to understand the severity of the condition.

IDD Therapy treatment protocols detail a set of angles which when applied, enable clinicians to distract targeted spinal segments.  Shealy & Bourmeyer 1997(1)  first observed that applying distraction forces at different angles enabled them to open the disc space 5mm-7mm.

Whilst dermatomes and clinical diagnosis help clinicians, without an MRI scan to confirm the diagnosis, it is very difficult for the clinician to be clear in the treatment plan.

Traditional traction had many flaws and the Cochrane Review confirms that traction as a single modality is not effective.  http://summaries.cochrane.org/CD003010/traction-for-low-back-pain

Common use of MRI scan technology developed long after use of traction was dismissed. Whilst traditional traction was never applied scientifically with measured angles, with sufficient force for sufficient time, significantly, traditional traction treatment was never applied with the knowledge of which level and what pathology was being treated.

If you are not aiming, how can you achieve your goal?   It would be like blindfolding an archer and pointing them in the general direction of the target.

So, with IDD Therapy it is, where possible, desirable to have an MRI to determine the condition being treated and then using the SPINA machine tool, to direct treatment to the targeted level.  Of course, if treatment is not responding adjustments can then be made.

The conclusion of the Cocchrane Review is interesting:

“A limitation of this review stems from the scarcity of high quality studies, especially those which distinguish between patients with different symptom patterns (with and without sciatica, with pain of different duration).”

Having spoken to hundreds of clinicians who used traditional traction, I am yet to meet a single one who used any kind of precise methodology in the application of the treatment (irrespective of the tool they were using).

Invariably it was, “we’d try a bit of traction and see what happened.”  Since they would not know the nature of the condition they were treating, how could they apply a method other than pull and hope?

This quite frankly is useless and we can ask it is any wonder that outcomes in clinics were so poor?!

The other benefit of the scan is to be able to see the size of a disc herniation or the degree of degeneration.  It is extremely difficult to structure a randomised controlled trial with a one-size fits all approach for back pain. 

IDD Therapy has a growing body of evidence to support it and more will be needed to help develop and refine treatment programmes.

Anecdotally, clinicians will confirm that larger disc herniations require more time for treatment than small bulges, whilst degenerative discs tend to require more treatments before improvements can be felt.

The use of the MRI scan is thus a key tool to enable clinicians to target and treat chronic low back pain more effectively.

For a summary of the differences between IDD Therapy Spinal Decompression and traditional traction, please use the form below.

(1) Shealy CN and Borgmeyer V. Decompression, Reduction, and Stabilization of the Lumbar Spine: A Cost-Effective Treatment for Lumbosacral Pain. American Journal of Pain Management. 1997. 7:63-65.

Author: Stephen Small
www.SteadfastClinics.co.uk

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IDD Therapy Spinal Decompression of Targeted Intervertebral Discs


This article examines the physics and mechanics of how IDD Therapy Spinal Decompression is able to distract and mobilise specfic segments of the spine and thus decompress a targeted intervertebral disc.

Traditional traction has been outmoded for a number of years and one of the shortcomings of traction was the inability to focus and control forces at specifc spinal levels.

The four goals of IDD Therapy spinal decompression are to:

  1. Release pressure on nerves
  2. Improve Disc Health
  3. Re-educate soft tissues
  4. Re-align spinal structures

IDD Therapy treatment is applied by distracting and mobilising targeted spinal segments at precisely measured angles, using high distraction forces which incorporate joint mobilisation in a longitudinal plane.

Controlled forces are high enough to comfortably stretch the paraspinal tissues, open and create pressure differentials in the disc space and are applied for sufficient time to have a therapeutic effect.

Ergonomic pelvic and thoracic harnesses secure the patient to the bed and a computer controlled cyclic distraction force is applied.  Treatment is delivered by CE & FDA cleared Class II SPINA devices.  All aspects of treatment and outcomes are recorded as part of a commitment to evidence-based medicine.

Decompression of a Targeted Spinal Segment.Vector Diagram Showing Application of Forces at Varying Angles

In order to decompress a targeted level, engineers applied the principles of vector forces from physics to the spine.  They observed that by focussing a controlled distraction force at a specific angle, they could open targeted spinal segments by between 5mm -7mm1.

As the angle which a pulling force makes with the horizontal increases, the component of force in the horizontal direction (Fx) decreases and the vertical component of force (Fy) increases.

This causes the relative direction of the pulling force to change and therefore the focus point of application of the pulling force to move progressively along the x-axis.

Measured changes in the angle of applied pulling force enable clinicians to focus and direct distraction forces accurately to injured spinal segments.

Sinusoidal distraction force:  This patented waveform replaces linear pulling forces allowing greater comfort and application of higher distraction forces of up to half body weight plus 5-10kgs.

 

Longer treatment duration:  Twenty-five minute treatment during which time joints are distracted for 13 times to a high tension, whilst soft tissues are worked and remain under constant tension.

Joint Mobilisation:  The sinusoidal waveform allows for the application of oscillatory forces to mobilise the joint in a longitudinal, rather than anterior-posterior plane at the point when the joint is distracted.


Low frequency    Mid Frequency  High Frequency     Low Amplitude     High Amplitude

The sum of the parts:  Improved harnessing secures the pelvis, measured angle of distraction, computer controlled sinusoidal waveform, cyclical distraction and patient remains completely relaxed for 25 minutes.

Low Back Pain Treatment Programme

SUMMARY

In order to decompress (take pressure off) a joint, it is necessary to distract it in the opposite direction to the compressive force.  Where a joint has become stiff and immobile, gentle mobilisation at the point of distraction helps to improve mobility in the joint and allow the natural mechanisms which keep joints healthy to operate freely.

IDD Therapy Spinal Decompression applies new technology to physical laws to enable clinicians to distract and mobilise targeted spinal segments as part of a complete programme of care, including manual therapy and exercise rehabilitation.

Author: Stephen Small www.steadfastclinics.co.uk

1 Shealy N, Leroy P: New Concepts in Back Pain Management. AJPM (1) 20:239241 1998 

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