A common question when patients begin care at Corrective Chiropractic is “What is the difference between the traction and decompression?”
The concept of decompression is similar to that of inversion tables but much more advanced. An inversion table keeps the legs in place while inverted to allow for the weight of your body from the knees to your head to be pulled down by gravity when inverted. This will distract the spine and opens the joints in the spine, which can relieve discomfort originating from a disc bulge, disc herniation or disc degeneration. It does this because as the intervertebral joints in the spine are pulled apart which pulls the disc inward like a vacuum. When the disc is drawn inwards towards the middle of the joint it can take pressure off of any nerves that the bulge is pressing on.
The main similarity to an inversion table and decompression is that they can both distract the spine. This is not to say that patients should get an inversion table and use “to tolerance”. As far as I’m concerned, inversion tables should be available only with a prescription, but that’s another story.
Decompression utilizes motorized axial (head to toe) distraction of the lumbar or cervical spine. This machine is often capable of taking constant measurements of the forces being exerted between the machine and the patient. This is done to determine any muscle guarding that is happening during the decompression treatment. These measurements allow the machine to adjust the distraction forces in real time to avoid pulling “too hard”. If there is too much force distracting the patient they may start to have pain or discomfort and, as a result, muscle guarding. When the muscles are guarding and firing the decompression is then having to fight against the patient making the treatment potentially less effective.
Decompression is a great tool to use for patients with acute pain due to disc bulge or disc herniation because of its ability to reduce forces in real time and avoid pulling against the patient’s natural response to pain.
Decompression is technically different than traction. Depending on the type of traction it can be substantially different (more on that later).
Decompression is FDA approved but is rarely reimbursed by insurance companies, citing a lack of research. This is one area where I actually agree with the insurance companies… partly. There is certainly research that supports the benefits of decompression for certain situations. The insurance companies, in an unending quest for profit, claim that while there is research to support the benefits of decompression, more research should be conducted. This assessment leads insurance companies to the assumption that decompression is not a viable treatment for general symptoms like back pain, radiating pain.
However, I don’t agree with the insurance companies. It is tragic that they are more than happy to cover the costs to mutilate a person’s spine with surgery or pay for the chronic poisoning and potential addiction of a patient with pain pills. Yet, refuse to pay for a treatment that is far safer and more effective according to the research than the medical alternatives.
That being said, there is no reason to pay several thousands of dollars for decompression treatment. The AMA, the FDA and the Centers for Medicare and Medicaid Services (CMS) all consider decompression therapy to be a form of traction as opposed to a separately billable service called decompression. The main difference is that a decompression treatment vs traction is the cost of decompression is a LOT higher, which is likely why the insurance companies refuse to pay for it.
I have seen many chiropractors get excited about the potential of a new decompression machine which cost them $30,000-$60,000 (sometimes much more) because the company’s representative told them they could charge $3,000-$6,000 cash for a series of treatments. Yes, that is a MUCH better option than allowing yourself to be cut on and screwed together, permanently deforming your spine with surgery. Decompression is much safer and is very effective at reducing stress on the spinal nerves due to a disc bulge, disc herniation or disc degeneration. BUT… decompression like drugs, like surgery and like some non-specific forms of traction will not fix the cause of that disc bulge, disc herniation or disc degeneration.
Traction is described as any mechanical traction using force to create tension and/or separation between joints. There are a couple different types of traction most of which are VERY different from each other.
Traction is often confused with decompression because decompression is coded and billed as traction, which is, in fact, accurate according to the American Chiropractic Association. Insurance companies do not want to pay for it, though. Remember I said that insurance doesn’t pay for decompression. Well, the “loophole” around that is to bill it as traction. It’s technically not wrong.
The doctor is only going to get reimbursed a fraction of the cost allowed for a decompression code but since insurance refuses to pay for a decompression code, reimbursement for traction is better than nothing because it still allows the patient to use their insurance. Not all chiropractors will do this because of course, insurance companies threaten to recover money they reimbursed for traction if it is in fact decompression being administered despite the fact that both codes are correct.
Some traction is almost identical to decompression save for the machine being able to measure and adjust force to compensate for muscle guarding. Many decompression manufacturers claim this is a distinguishing difference but really decompression can be accurately coded as decompression or traction. Decompression is traction being administered in one direction (head to toe tension).
There are numerous different forms of traction, some with completely different treatment goals in mind. As we’ve seen above both decompression and axial (head to toe) traction can help with pain from a disc bulge, disc herniation or disc degeneration. However, there are numerous other directions and applications that traction can be exerted on the spine.
The most common and most nonspecific form of traction is done with a patient lying on a “roller table”. This table has three large cylinders rotate around each other in a circle while they are being moved up and down the spine. This type of “traction” is extremely generic and likely why insurance companies are able to easily justify ridiculously low reimbursement for traction services, aside from their dedication to profit above the patients’ wellbeing. In my opinion, a roller table is not much different than sitting in an automatic massage chair. The only real goals of traction on a roller table is to help mobilize the joints to “warm up” the spine. Not a bad type of traction but far inferior to the advanced type of spinal remodeling traction done at a structurally focused chiropractic office.
At Corrective Chiropractic most of our traction devices and treatment are designed to remodel and reshape the spine for long term correction, not merely short-term pain relief. This is one of the key points that sets structurally focused chiropractic apart from traditional and pain based chiropractic or physical therapy. Without specific remodeling traction, the spine will not be able to actually change shape with statistically significant reproducibility.
Spinal remodeling traction is a fundamental part of structurally focused chiropractic care. It can be done with numerous different types of traction equipment and spinal traction orthotics which are prescribed based on the patient’s unique spinal abnormality (often called a subluxation). Here are just a few of the different types of spinal remodeling traction devices that are performed in the office.
As you can see there are a number of different ways to reshape a patient’s spine toward its normal or ideal structure. The one thing that all these forms of traction have in common is that they are not all right for everyone. Each patient will necessitate a different form of traction.
The spine is a three-dimensional structure and cannot rely solely on decompression. While decompression can be helpful in those acute situations as describe above it will NOT correct the abnormal loads that are being placed on the spine or discs as a result of an improper spinal structure. Decompression is only capable of tractioning the spine in ONE direction. If your spine was designed to be straight up and down with no curves then decompression might be all that is necessary, but it’s not.
The curves in your neck, mid-back, and low back are all very unique and specific shapes that require more advanced and specific forms of traction to correct. Traction depends on a great deal on the skills of the chiropractor. As a structurally focused chiropractor, Dr. Wickstrom is highly skilled in Three-Dimensional Traction treatment.
Corrective chiropractic care is much more complicated than that. Specific forces are necessary to remold the spine. It is important that both the intensity and especially the direction of and location of force be correct. This means that you must first know what a normal spinal position is and how the patient’s spine has deviated from said normal.
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