There is no doubt that decompression therapy is a rage throughout our profession today. Although decompression therapy has been performed for years by chiropractors, some companies are allocating tremendous marketing dollars and techniques to bring decompression tables into the forefront of the minds of chiropractors throughout the profession. Decompression tables have been marketed as a means to help patients with disc problems and as a potential source of increased income.
The intention of this article is not to compare tables or enter into a slanted debate about which table is better, FDA approved, or able to achieve true spinal decompression, or how one table can produce a result above and beyond another table. Statements such as these are used by companies to attempt to increase the sales of their tables to justify their exceedingly high costs. Instead, I would like to present you with some questions that may determine the future of your practice, your patients' lives and the chiropractic profession as a whole.
How does a decompression table strengthen the spine to prevent a disc problem from coming back? It is true that spinal decompression using a table that causes axial distraction of the spine will give patients amazing, temporary pain relief. Many of these sales-based companies will tell you that you will see pain reduction in a relatively quick time frame in some back pain patients, and they are absolutely correct. If muscles support the strength of the spinal curves and disc problems are the result of structural weakness of those spinal curves, the reality is that decompression without proper muscle strengthening and rehabilitation is actually just a very expensive Band-Aid.
As a doctor who teaches rehabilitation for accelerated spinal and curve correction, I am continually fielding calls from doctors who have received patients or have patients returning to them who have spent thousands of dollars for decompression therapy and have had their symptoms return within three to six months. Again, decompression therapy is a very powerful tool, highly recommended and, when appropriately used, can help some disc patients who have experienced failure in all other systems, including traditional chiropractic. However, it is the rehab that creates the stability and correction to enhance and stabilize the benefits of spinal decompression.
What type of rehab has been proven to be the most effective for spinal strengthening and curve correction? When it comes to rehabilitating the spine, certain specific factors must be considered and kept in the forefront of your mind. First of all, traditional, conventional rehab, which involves performing resistance exercises through a range of motion
(i.e., weights, machines, therabands) along with electrotherapeutic machines (i.e., electric muscle stimulation) do not address this problem. The reason is that they are working the fast-twitch muscle fibers. Fast twitch muscles will make you strong, but will not change the structure of the spine or remove the underlying cause of the disc injury. They will help you to carry your groceries, while the spinal structure continues to degenerate and your body becomes sick.
The muscles that support spinal structure and determine the stability, shape of spinal curves and the future of your health are postural, slow-twitch muscles. Slow-twitch muscles that support spinal structure require isometric exercises and are very different from conventional therapy. In addition, this therapy includes a rehabilitative protocol that can predictably rehydrate a degenerative disc. What would it be like to teach a patient how to rehydrate a degenerative disc?
Doesn't the whole spine function as one unit? In other words, when there is an injury or weakness in one area of the spine, isn't the whole spine affected? The answer is yes. In fact, medical studies show that patients with low back pain also have neuromusculoskeletal problems in the cervical and thoracic spine, as well as in the extremities. The Pettibon Institute, developed for the continued research and development of effective spinal corrective therapy, has determined that to more permanently correct the lumbar spine, at least 60 percent correction of the lordotic curve in the cervical spine must be achieved. What does that mean? If you want to fix a patient's back, you have to fix their neck or it won't hold. This is another reason decompression therapy without spinal corrective rehab will not produce more permanent correction.
Another perspective of decompression therapy in your practice is a billing perspective that can create a potentially dangerous situation with medical and insurance reimbursement. Many table companies are recommending that you use exercise codes such 97110 or 97530 for the time a patient is on the decompression table. Every compliance officer I have spoken to regarding that recommendation flatly rejected this billing practice as legal. However, you can bill for spinal strengthening when it's performed separately from the decompression time, but not as part of it.
Decompression may, in fact, be the wave of the future, but how we position ourselves on this wave is of primary importance. If we are effective in our ability to achieve muscular strengthening to aid in structural correction, we can achieve predictable disc rehydration and disc height restoration; and if while doing so, we are ethical in our billing practices and compliant in our insurance vs. cash plans, we can establish ourselves as the leading experts in spinal disc specialists. Now you can tell the world the true chiropractic story of spinal health. How will that affect your practice, your patients' lives and the chiropractic profession? Food for thought.
