most decompression technology today, particularly in the area of weight perception.) Variable angulation of decompression forces combined with the pattern of forces makes non-surgical SDT more focused and more effective than simple traditional traction. METHODOLOGY Patient Positioning. Two critical factors impact the effectiveness of non-surgical SDT machines: 1. correct patient positioning on the device, and 2. appropriate selection and positioning of the angulation of the decompression forces. Spinal decompression technology relies on the assumption that the patient’s spine is in a specific predictable position during care, so that changes in the angulation of the decompression pulling mechanism can be carefully and precisely adjusted to target the disc(s) requiring care. To reduce possibility of error in positioning, specific landmarks on the different pieces of technology must align with specific patient anatomical landmarks used, in turn, for locat- ing specific spinal segments. Regarding lumbar spinal decompression, the practitioner relies on the location and position of the anterior superior iliac spine (ASIS), corresponding to the L5 vertebra, for the purposes of pre- paring the patient for a lumbar disc decompression session. The practitioner directs the angle of applied decompression forces ei- ther manually or automatically, depending on the machine. The procedure for positioning a patient for cervical SDT is simi- lar in concept, but utilizes a unique harnessing system with adjust- able pulling angulations. Angulation Adjustment. The angle at which the pulling force meets the patient is adjusted to target the precise disc area requiring care. Treatment Time and Frequency Protocol. Most SDT treatment follows a similar protocol. It typically involves three to five ses- sions in the first week, and three to four sessions in the follow- ing weeks. A program is typically four to six weeks long. Practi- tioners must employ sound judgment based on ongoing objective evaluation to determine if the number or frequency of visits must be adjusted down or up, or discontinued altogether. The protocol used must be that which will maximize each individual’s healing potential. Pre- and Post-Session Care. Many practitioners offer heat treat- ments to patients prior to each session. This helps relax the peri- spinal musculature of the affected region. It is common practice for patients to receive ice treatments after each session. Active Rehabilitation. Some practitioners introduce active re- habilitation of the lumbar/cervical spine early in a patient’s care program. Others offer active rehab in stages, towards the middle and then the end. The goal is to help patients restore and improve flexibility and strength, including core strength. Some practitio- ners also use modalities including various supports ranging from lumbo-sacral belts and orthotics. Some also add nutritional sup- plementation to their patients program of care. MACHINES Today a variety of non-surgical SDT machines are used. They have several features in common: • The motor responsible for the pulling forces is always under the control of the practitioner. • There are a number of pre-set programs that control the 24 • CANADIAN CHIROPRACTOR | JUNE 2010 decompression forces in frequency, cycles, load magni- tude and duration of individual treatment; non-surgical SDT table manufacturers boast unique pulling patterns. • Lumbar spinal decompression therapy requires the pa- tient’s chest region to be harnessed to a part of the bed, often with shoulder posts restraining the arms. This im- mobilizes the patient’s upper body, enhancing the de- compression forces; a cable from the motor connected to a pelvic harness (also worn by the patient) delivers de- compression forces, pulling caudally towards the motor. • Cervical decompression utilizes a harnessing system, as well, with decompression forces that are adjustable in angulation, magnitude, duration as well as frequency. There are also variations among the machines, including: • Harnessing methods vary for lumbar and cervical treatments. • In simpler machines, the angulation of pulling is altered manually by the doctor, usually by raising or lowering the vertical position of the motor. More sophisticated machines have automatic adjustment by way of pre- set buttons that correspond to specific disc levels. The angle can be further adjusted manually, by degrees, if needed. (Note: This changes the height of the cable as it exits the tower containing the motor – not the position of the motor itself.) • The more advanced machines offer computer auto- mated controls as well as monitors that display, in real time, the patient loading or pulling forces as well as the patient’s muscular response to care. • Some tables transfer the pulling forces via a direct drive- shaft system. Others utilize a belt system. • Most tables have some kind of biofeedback/tensiom- eter system responsible for monitoring and adjusting the magnitude of the pull in response to changes in the patient’s muscle tone. • More sophisticated beds use a hi-lo system to easily board patients onto the bed, from a standing posture. Other sys- tems require the patient to climb onto a horizontal bed. • Most systems have the patient positioned supine while under care. Some machines position patients prone. One system requires the patient to be in a seated position. • Specific technologies exist whereby the practitioner may change the patient’s pelvic position, either manu- ally or by controls, to assist in the procedure. • Some tables have a bed that separates a few inches in the early stages of a session to enhance the decompression. Patients today are more informed than ever before. When they arrive for a consultation, they have often done extensive research on their particular condition, and have consulted with peers and professionals. They ask intelligent questions and expect exemplary care. They are wise to the fact that there is technology available that was created specifically to assist in the healing of disc problems. At the same time, they know that technology is only as good as the doctor running it. Chiropractors can assure each patient that they will receive the most robust and effective care because we are meticulous and appropriate in our work. With non-sur- gical SDT technology, we must remember that success begins with correct selection of patients, and builds when the patient is positioned and harnessed correctly and the appropriate an- gulation and decompression force pattern is utilized. Only then can the technology deliver best results. • www.canadianchiropractor.ca
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