Winning the War on Spinal Pain
Are you frustrated with the lack of positive results with your spinal patients? Are you dissatisfied with the numbers of invasive spinal procedures currently being performed? Are you saddened to hear another failed back surgery story, with yet another person addicted to opiates? And do you feel that you have personally lost the war on spinal pain to other practitioners, some of whom are less qualified to treat spinal pain than you are?
These are some of the questions I contemplated during my early career as a clinical physical therapist. As a result, I have sought a better answer for treating this patient population. I began seeking positive, long-term outcomes to spinal problems, rather than merely treating symptoms. Throughout my 35-year career, I’ve constantly questioned prevailing treatment protocols and found most of them lacking in results.
Doomed to Fail
Over the past 30 years, non-invasive treatment techniques employed by most physical therapists have changed only minimally. The large majority of techniques and protocols has been, and continues to be, symptom-based. Consequently, they are doomed to have very little if any long-term value.
Instead, I have sought to find the better long-term answer by addressing the source of the problem. For a great majority of my clinical career, I have found that the intervertebral disc (IVD) is the direct or indirect source of most patients’ spinal problems.
Current estimates state that 80 to 90 percent of the adult population will experience significant, activity-limiting low back pain at some point in their lives.
Many will end up seeking relief through physical therapy, with mixed results. In fact, most ambulatory outpatient physical therapy clinics can expect to have more than 50 percent of their caseload be spine related.
Unfortunately, a large number of these patients are doomed to fail by receiving a “symptom-based” treatment regimen, which leads to recurring, episodic spinal pain. Modalities, most manual techniques, and core strengthening are standard treatments that fail to adequately address the source of most patients’ spinal pain-the IVD.
In fact, most treatment techniques currently being used by therapists to address spinal problems have not changed significantly since World War II. Many have been re-named and re-packaged as new, but the symptom-based theme persists.
Today’s society encourages an “instant gratification” attitude, and patients experiencing spinal pain are certainly no different in expecting an immediate fix. This causes them to pursue a variety of treatments ranging from massage, chiropractic, and drug therapy, to more invasive epidural injections and spinal surgery. In fact, the number of spinal surgeries currently being performed has grown exponentially over the past decade to a staggering figure.
At our rehab clinics in northwest Ohio, we have developed a new, non-invasive, source-based model that has consistently achieved positive long-term outcomes. Our mechanical, source-based protocols have allowed us to bring positive outcomes to a complex patient population that has tried and failed other treatment options.
These protocols have been successfully used to treat a variety of spinal diagnoses, from stenosis and sciatica to herniated nucleus pulposus (HNP), facet arthropathy and extruded disc, among others. They are the result of a marriage of several mechanical technologies designed to address the source of the patient’s current symptoms.
A key to our approach is to identify the IVD as the primary or secondary source of a large majority of spinal pain. The IVD is the most fluid and dynamic structure in the spine, and therefore the most susceptible to injury. Bulging or herniated discs can produce pressure on spinal nerves and cause the radicular symptoms we see in our clinics. HNP can also produce foraminal and/or central canal stenosis.
Traditional physical therapy and most other treatment options focus on relieving the symptoms produced by these disc pathologies with modalities or chemical treatments in the form of an epidural injection. We have found that a non-invasive, source-based model is quite effective in addressing most spinal problems. In short, to treat a mechanical problem, a mechanical intervention is necessary.
Spinal decompression is focused on reducing abnormal pressure on the tissues that create symptoms, by altering the pressure on gel contents of discs. While we feel that computerized traction tables are effective to begin the decompression process, much more is required to effectively treat complex spinal issues and achieve positive long-term outcomes. To that end, our treatment protocols consist of several mechanical interventions designed to initiate and maintain decompression of a damaged IVD.
The initial mechanical technology we use is treatment on a spinal decompression (or computerized traction) table, which has been shown to achieve negative pressure on the nuclear contents of the IVD. This negative pressure is effective in initiating the decompression process by helping to pull the nuclear contents of the IVD inward (a centripetal force). This negative pressure helps significantly reduce a disc herniation and the associated symptoms produced by pressure on the exiting spinal nerve, or other affected tissue.
While traditional pelvic traction can reduce disc pressure somewhat and stretch soft tissues, it does not create a negative-pressure environment. This negative stress is essential in the spinal decompression process, but cannot be relied upon as the sole treatment for a spinal problem.
To prolong the decompressed state of the disc, we employ a proprietary aquatic component with our treatment protocols. The unique properties of water provide the perfect environment for maintaining the decompressed state of the IVD, and allow soft-tissue remodeling and healing to occur.
Temperature, buoyancy, and hydrostatic pressure are all prioritized to maximize disc decompression. This specialized aquatic component encourages healing of the remodeled disc wall in a low-stress environment. Aquatic therapy is also an important source-based method to restore spinal range of motion safely, and to initiate core training.
Another mechanical component to these protocols is based upon the principles developed by Robin McKenzie and Dr. James Cyriax. The exercise and postural program we use is designed to reduce physical stress on all spinal tissues to encourage the soft tissue remodeling process necessary to eliminate symptoms.
Our patients are instructed in simple exercises to be performed on a 1-2 hour basis, and to avoid high-stress positions and postures due to the great amount of physical stress they place on lumbar tissues. Our program requires strict patient compliance when the patient is not in our clinic. This compliance is usually achieved without extensive reminding, as most of our patients will begin to notice positive changes quickly.
Our source-based protocols have been consistently successful in achieving positive, long-term outcomes in a very complex patient population. These results are demonstrated in a random sampling of the 3,000 such patients we’ve treated in our clinics.
All patients in the sampling had tried other interventions (massage, chiropractic, epidural injections, surgery, etc.), including previous traditional physical therapy. A very large majority had radicular symptoms into their foot, with many having experienced this pattern of symptoms for over a year.
After an average of 15 visits, 50 percent of patients were asymptomatic and less than 10 percent had a significant radicular component remaining after completing our source-based program. Overall pain scores were reduced by more than 50 percent.
These results are not limited to an older or complex patient population. We have consistently demonstrated positive outcomes with athletes as well, and have successfully treated patients between the ages of 12 and 95 with documented disc herniations.
Our clinical results have allowed us to be recognized as a Center for Spinal Excellence in northwest Ohio. This has helped us reclaim a large patient population previously lost to other practitioners. We’ve been able to take advantage of this niche market to create a lucrative, source-based business model. More importantly, we’re producing a positive and encouraging change in both physician and public attitudes toward the treatment of spinal diagnoses.