Traction Failure No 1 - Non-specific, not targeted to the injured spinal level.

IDD Therapy Education – The importance of angles when targeting spinal segments.?

Imagine you have a bow and arrow and I want you to hit a target 100 yards away.? Now I put a blindfold on you.? How accurate will you be??

If I then spin you around a few times, the chances of you hitting the target are next to … nil.?

Old traction went out of use, though it is still practiced in some clinics. There are many problems with traditional traction, yet for some time, people didn't consider, what are you trying to achieve, what is wrong with the equipment and method, and what would you need to differently to achieve a desired outcome.?

I am going to share a few short briefings to help you understand aspects of IDD Therapy, the gold standard in spinal decompression.? The starting point is focus.?

FOCUS?

Back pain is multi-factorial, but consider an L4L5 disc bulge.? How is traction going to decompress and mobilise that specific spinal segment, take pressure off the injured disc, create pressure differentials and work stiff and tight soft tissues to improve function.

Traditional traction was unfocussed.? A linear force applied to the length of the spine.

So if we have a problem at a specific level, it makes sense that we should try to focus our treatment to that specific level. ?

In their study of 1997 (1), Shealy and Bourgmeyer showed that it was possible to distract different lumbar spinal levels by between 5-7mm.?

They did this using a new form of spinal decompression by altering and measuring an angle at which a force is applied, and using distraction tensions of half body weight to open the disc space.?

This is the precursor to the development of the IDD Therapy protocols which allow clinicians to treat targeted spinal segments with the Accu-SPINA.

So how do you get the angle??

Without going too deeply into physics, it is based on vector forces.?

As the angle at which a force is applied increases, the point of application of the force, moves along the x-axis from A to B.? (A physicist will explain this in greater detail).?

So how does that translate with the spine???

The Accu-SPINA has a motor and a patient is connected to the motor via a belt and a series of harnesses.?

A computer controls the height of the motor so that as the decompression belt makes an angle to the patient, ?it is possible to get an accurately measured angle at which to apply the force.

By changing the angle, the bulk of the distraction force is focussed to the targeted spinal level, enabling clinicians to distract (and mobilise) the desired spinal level.

?L5S1 – 10 degrees

L4L5 – 15 degrees

L3L4 – 20 degrees

L2L3 – 25 degrees

L1L2 – 30 degrees

Clinical experience – practice-based evidence has taught us that a 5 degree change in angle can make a difference in the outcome.??

To get the angle, the patient lies on the Accu-SPINA table, knees are bent (over the ‘toblerone cushion’) to flatten the lordotic curve.?

Each patient is different, tall short, slim, bigger …? the angles are the same, but the patient’s build may alter the angle from the tower.?

Thus the supervising clinician uses an “inclinometer” like a spirit level with an angle scale to adjust the height of the motor on the tower in increments, literally a degree at a time as needed to get the exact angle for the targeted spinal level.

This was never done and wasn’t possible with the old traction machines found in a physical therapy departments.?

This is one part of the challenge.??

Further articles will look at the force, the manner the force is applied (sinusoidal waveform) to enable higher distraction forces to be applied comfortably, the oscillation mobilisation component unique (patented) to IDD, the duration of treatment and the number of treatments required.?

During IDD Therapy training in clinic, these elements are covered and they are very straightforward.? Albeit they are new.?

Do you use manual traction?? Do you mobilise joints??

Consider what you are doing physiologically.?

Then consider that most manual therapy is adequate because whatever healing mechanism you are stimulating, in combination with stretches and exercise, is working.?

If those mechanisms work with manual therapy, why do some back pain sufferers not respond.? It is multifactorial, but part of the problem is the lack of function in the affected spinal segment and the challenge of distraction, mobilising etc in anything but an anterior-posterior plane.??

That would lead to consider, how would you distract and mobilise targeted spinal segments in a longitudinal plane.?

That is the heart of IDD Therapy.?

1/ Shealy CN and Borgmeyer V. Decompression, Reduction and Stabilization of the Lumbar Spine:? A Cost- Effective Treatment for Lumbosacral Pain.? American Journal of Pain Management 1997. 7:63-65

Useful Links:

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