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Brett Sears

Non-Surgical Spinal Decompression for Low Back Pain: Does it Really Work?

By January 28, 2012

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Every Sunday morning, I see really big advertisements in the newspaper for a revolutionary new product to help treat low back pain. Non-surgical spinal decompression promises to help eliminate low back pain or sciatica and improve your function and quality of life. The trade name for many of these decompression units are the VAX-D, the DRX 9000, or the SpinalAid system. (Fancy, space age sounding names, right?) But does spinal decompression really work?

While researching the answer to the question, I came across many different websites for spinal decompression units. Some of the websites were run by doctors, physical therapists, or chiropractors. My favorite website was for the VAX-D system. I liked it because the site listed many different published studies that prove how effective the VAX-D is. It made my search for scholarly studies a lot easier.

One of the studies listed on the VAX-D site was "published" in the Journal of Orthopedic and Sports Physical Therapy (JOSPT). Great! I have access to that journal, and I can easily find the study to evaluate the power of the study and decide if the VAX-D system is really as great as the VAX-D folks say it is.

One problem: I couldn't find the study in the JOSPT. The study was not listed in the table of contents in the JOSPT edition that was cited in the study. As a member in good standing with the American Physical Therapy Association (APTA) and a member of the Orthopedic Section, I should be able to find this study.

I contacted the JOSPT via email about my inability to locate the study that the VAX-D website listed. I got a response quite quickly from Edith Holmes, Executive Director/Publisher of the JOSPT. She noted that the citation in question was listed as a poster presentation at the 2005 Combined Sections Meeting (CSM) of the APTA. These lists are usually tucked in the back of the JOSPT during the month of the CSM. She went on to write, "The abstracts are presented here as prepared by the authors. (her bolding) The accuracy and content of each abstract remain the responsibility of the authors."

I responded to her with gratitude, and asked if those abstracts presented at the CSM were peer reviewed. She responded, "JOSPT does not peer-review these abstracts." (Peer review is important. It pretty much says, "Hey, this is a well-designed study and the results should be considered highly when making clinical decisions.")

Oh. So the study listed on the VAX-D is not peer reviewed. But the abstract is published. In the very back of the journal. Gotcha.

So back to the original question: Does spinal decompression really work as it says it does? The data available is from poorly designed studies that are very weak. Some of the studies, although "published," are not even peer reviewed.

Spinal decompression is a form of lumbar traction, and lumbar traction received a grade of "C" (no benefit demonstrated) in a (peer reviewed) study published in the October 2001 issue of Physical Therapy Journal. Spinal decompression may work, but we really can't prove it works. Plus, many insurance companies don't provide coverage for spinal decompression, so the out of pocket expense may be great.

Proven treatments for low back pain include advice to remain active, exercise, and maintain good posture. Your physical therapist can help you decide which exercises to perform to help you recover quickly from your episode of low back pain.

Have you used spinal decompression to help treat your low back pain? If so, please share your story and let us know how things turned out.

Comments
February 3, 2012 at 6:17 pm
(1) Spinal Decompression Doctors says:

While I appreciate your article, it seemed quite slanted in trying to bring doubt as to the research papers. I’m sure you understand that it is quite challenging to arrange all studies to fit into certain peer reviewed journal’s requirements. But that in no way invalidates the usefulness of the study. So, in citing one example of one research paper does not invalidate this non surgical technique. By the same logic, if I were to show all the peer reviewed negative outcomes on spine surgery, then one could deduce that all spine surgery is not required.

Unfortunately, when it comes to the spine and difficult spine conditions, treatment can be quite difficult and many times it warrants an integrative approach among different specialists. One thing is certain, and that is non surgical spinal decompression is safe and it is often very successful for many people. It is logical to try the safer, less invasive treatments before jumping into riskier procedures.

The following group of doctors specialize in non surgical spinal decompression therapy. It’s effective more times than it’s not.

February 5, 2012 at 7:38 pm
(2) physicaltherapy says:

Thank you for your insightful comment. I appreciate you taking the time to help shed light on this subject.

I agree with you…if you show me peer reviewed studies (randomized controlled trials (RCT)) on the negative effects of spine surgery, I would deduce that all spine surgery is negative. BUT, there are RCTs that demonstrate positive effects of spine surgery, and I would not ignore those when deciding if spine surgery works.
I would be happy to review a peer reviewed RCT for spinal decompression if I could locate one. Many of the studies published are not randomized trials. If everyone in a study receives spinal decompression for eight weeks, did the spinal decompression make the patient better, did time make the patient better, or did the placebo effect play a role in the positive recovery of the patient? Randomization is important, and control groups are pretty essential too.
In this blog post, I do state that “spinal decompression may work” and it may be a helpful component of any spine care, but I have not seen the research to PROVE it.
I feel that the folks at VAX-D are making claims about the usefulness of their product by citing “published” studies. At least one study listed on their site isn’t really “published.”
I also contacted the author of the study in question to see if he had some more information about it (the outcomes; was he compensated by VAX-D) and to date have not received a response.
Again, thank you for your insightful comment. I must agree with you that treatment of spinal conditions should be an integrated approach of many specialists.
~Brett

February 5, 2012 at 7:54 pm
(3) physicaltherapy says:

For my readers, comment number one was posted by the American Spinal Decompression Association (ASDA). Their website is http://www.americanspinal.com/

~BAS

February 19, 2012 at 7:46 am
(4) Sharon says:

Like the blog

August 23, 2012 at 5:31 am
(5) Pavers Bacchus Marsh says:

What is the remedy of this problem? Iím facing it from long time.

July 10, 2013 at 8:12 am
(6) Rachael says:

Appreciating the time and effort you put into your site and in depth information you present.

It’s nice to come across a blog every once in a while that isn’t the same out of date rehashed information.
Fantastic read! I’ve bookmarked your site and I’m adding
your RSS feeds to my Google account.

July 23, 2013 at 2:05 pm
(7) david says:

I’m in the process of having these spinal decompression treatments.. I’m on my 6th treatment of 20. It seemed after the 4th treatment, that I had more energy. I’m not saying it works, but so far I can’t complain, except for the cost!!!!!!!!!!

July 27, 2013 at 3:03 pm
(8) physicaltherapy says:

David,
Thanks for your comment. I hope the treatments help. Keep us informed on your progress.

Brett

September 18, 2013 at 11:00 am
(9) Rob says:

I’ve used the DRX 9000 on many occasions throw out the past 10 years and I’ve tried everything except surgery which I refuse to do. I have 3 documented bulging discs. Decompression needless to say I was very sceptical. But I was desperate to find a relief of pain. My first onset I was very scared because nothing worked for any type of relief. After 2 weeks of being on the table I didn’t noticed any improvement but after the 3rd I was amazed. After about 3 months of nothing but decompression I was pain free then went about strengthing it worked for me. ON the other occasions that I had relapses I would right away get back on the table and I could get myself back to activities in only a few weeks time. I now enjoy backpacking and most activities. I’m 53.
The whole key is keeping the core muscles fit after you get the decompression. It made me a believer and I’m a real hard cookie to crack.

January 5, 2014 at 9:43 pm
(10) Todd says:

I went to a chiropracter that wanted $5,000 for 30 sessions, and basically said i would probably have to come back once a month for the rest of my life($150/session after the 5k). I have a really bad herniated disc and 2 bulging….all in my lower back. I went to 2 treatments and felt no difference. I talked to 2 spine MD’s at the school of medicine(in nyc) and 1 physiatrist. They all said stay away from the dxr900 or vax machine. They said it was a waste of money and nothing was scientifically proven. I stopped going but am kind of regretting. I stilll have terrible pain and have not tried shots or surgery yet. CUrrently now trying hot yoga…Why is there no evidence or cure with decompression machines? Can’t you simply survey 10 people with disc issues, give them treatment for months. Take before and after MRI’s and simply ask how they are feeling???

January 7, 2014 at 1:10 pm
(11) physicaltherapy says:

Todd,
First, thanks for your comment, and hope you find the right treatment for your back problems.

The points you make about simply finding people with herniated discs and asking them about their pain is complicated for many, many reasons. There are millions of people with herniated discs who have NO PAIN and do not know they have herniated discs. Plus, there are millions of people with incredible low back pain and have no herniated disc or other pathology found on MRI. So, the presence or absence of a disc problem does not necessarily mean a person will have low back pain or sciatica.
Whenever a scientific study is done, there are multiple confounding variables and bias that must be controlled for. A researcher can never control for all variables.
For example, if you have a disc problem and have 10 treatments of DRX, perhaps you start feeling better. Is it because of the DRX? Is it because you know that SOMETHING, ANYTHING was done for you, and this makes you feel better? Are you feeling better simply because of the passage of time? And what if you feel better, but the MRI still shows you have a herniated disc? Should you still be considered “better?”
Researchers also need to be careful to control their own biases. If I put 10 people on a DRX, I may say something that could change the outcome, simply because I EXPECT or DESIRE you to get better. It would looks something like this: “Here, Todd, get on this DRX machine and we will see if you get better. We expect you will because we think it will take pressure off your herniated disc and nerves.” I just planted the seed in your head that the DRX will get you better, and maybe the improvements we see are due to your expectations.
Low back pain is a complicated thing to evaluate and treat, and not one treatment is for everyone. Some of my patients report improvement with the DRX. I’m still not a huge fan of something that you need to pay a boatload of money for, and what happens if your pain strikes when you are traveling? You need something you can turn to right away. That’s where postural correction and exercise come in. Your physical therapist can help you with both.
Which exercise is best? Physical therapists who practice the McKenzie Method (which I do) will tell you that an exercise that centralizes your symptoms is best. (I am a little biased there, too).
Anyway, hope you find the right things that get your back moving in the right direction.

March 19, 2014 at 4:36 pm
(12) Gary says:

Currently completing my 2nd week of decompression. Results have been positive.
Problem area is a disk (L5/S1) that was herniated 27yrs ago (i’m 45 now) and after several weeks of PT at that time, elected to have discectomy.
A few weeks ago, I re-injured the area. xrays show an estimated 30% of the disk remaining.
Current treatment includes chiropractic adjustment, non-surgical decompression, and physical therapy exercises, all in all, probably about 60-90 minutes of work 4 days/week. All care being done through a local Healthsource chiropractic and progressive rehab office.
Results so far are promising.

March 26, 2014 at 4:05 pm
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