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All About Spinal Decompression Therapy

Spinal Decompression Therapy involves stretching the spine, using a traction table or similar motorized device, with the goal of relieving back pain and/or leg pain.

This procedure is called nonsurgical decompression therapy (as opposed to surgical spinal decompression, such as laminectomy and microdiscectomy).

This article provides an overview of nonsurgical spinal decompression therapy and its role in treatment of lower back pain and neck pain.

Theory of Spinal Decompression

Spinal decompression devices use the same basic principle of spinal traction that has been offered by chiropractors, osteopaths, and other appropriately trained health professionals for many years.

Both traction and decompression therapy are applied with the goals of relieving pain and promoting an optimal healing environment for bulging, degenerating, or herniated discs.

Spinal decompression is a type of traction therapy applied to the spine in an attempt to bring about several theoretical benefits including:

  • Create a negative intradiscal pressure to promote retraction or repositioning of the herniated or bulging disc material.
  • Create a lower pressure in the disc that will cause an influx of healing nutrients and other substances into the disc.

Clinical Evidence

While the fundamental theory of spinal decompression is widely accepted as valid, there is a lack of evidence supporting decompression therapy as being efficacious. Additionally there are some potential risks.

Although some studies that do not include control groups conclude that decompression therapy is efficacious, the few that do generally conclude that mechanized spinal decompression is no better than sham decompression. [Schimmel JJ, et al. European Spine Journal 18(12):1843-50, 2009] Thus, there is insufficient evidence that spinal decompression therapy is as effective, or more effective, than less expensive manual methods in treating back pain or injured herniated discs.

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60-Second Fix For A Stiff Neck

A knot in any muscle is a nuisance, but it’s especially frustrating when the offender is lodged in your neck or upper back. (Turning your head should not induce searing pain…) And while getting a massage can work out the kink, chances are you don’t have time on your way to work to swing by the spa.

Relax (well, figuratively speaking): You can actually knead away the cramp yourself with this quick routine, courtesy of Allyn Kakuk, DPT, a wellness physical therapist at the Mayo Clinic. Here’s how:

Step 1: Find the sore spot. If it’s on the right side of your neck or upper back, place your right hand on the area. If it’s on the left side, use your left hand.

Step 2: Push into the knot with your fingers, using firm pressure. Beware: This may smart. “But it should be a good hurt that you can tolerate, not a sharp pain,” says Kakuk. If you can’t quite reach it, a tennis ball or other prop can do the work for you—just lean against a wall for leverage.

Step 3: Turn your head slightly in the direction opposite the cramp, and bend it diagonally, as if you were trying to touch your armpit with your chin. Activating the cramped muscle, when partnered with pressure, can help relax the kink.

Step 4: Repeat steps 1 through 3 about 20 times in a row. Afterward, give your neck and upper back a nice, long, just-got-out-of-bed style stretch. Complete the series throughout the day to keep your muscle relaxed.

Once your neck is feeling better, prevent future neck pain with this easy exercise:

 

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6 Stretches for Sciatica Pain Relief

What is the sciatic nerve?

Sciatic nerve pain can be so excruciating and debilitating that you don’t even want to get off the couch. Common causes of sciatica can include a ruptured disk, a narrowing of the spine canal (called spinal stenosis), and injury.

Certified physical therapist Mindy Marantz says that sciatica pain can occur for a variety of reasons. She says, “Identifying what doesn’t move is the first step toward solving the problem.” Often, the most problematic body parts are the lower back and hips.

Dr. Mark Kovacs, a certified strength and conditioning specialist, adds that the best way to alleviate most sciatica pain is to do “any stretch that can externally rotate the hip to provide some relief.”

Here are six exercises that do just that:

  • reclining pigeon pose
  • sitting pigeon pose
  • forward pigeon pose
  • knee to opposite shoulder
  • sitting spinal stretch
  • standing hamstring stretch

1. Reclining pigeon pose

Pigeon pose is a common yoga pose. It works to open the hips. There are multiple versions of this stretch. The first is a starting version known as the reclining pigeon pose. If you are just starting your treatment, you should try the reclining pose first.

  1. While on your back, bring your right leg up to a right angle. Clasp both hands behind the thigh, locking your fingers.
  2. Lift your left leg and place your right ankle on top of the left knee.
  3. Hold the position for a moment. This helps stretch the tiny piriformis muscle, which sometimes becomes inflamed and presses against the sciatic nerve, causing pain.
  4. Do the same exercise with the other leg.

Once you can do the reclining version without pain, work with your physical therapist on the sitting and forward versions of pigeon pose.

2. Sitting pigeon pose

  1. Sit on the floor with your legs stretched out straight in front of you.
  2. Bend your right leg, putting your right ankle on top of the left knee.
  3. Lean forward and allow your upper body to reach toward your thigh.
  4. Hold for 15 to 30 seconds. This stretches the glutes and lower back.
  5. Repeat on the other side.

3. Forward pigeon pose

  1. Kneel on the floor on all fours.
  2. Pick up your right leg and move it forward on the ground in front of your body. Your lower leg should be on the ground, horizontal to the body. Your right foot should be in front of your right knee while your right knee stays to the right.
  3. Stretch the left leg out all the way behind you on the floor, with the top of the foot on the ground and toes pointing back.
  4. Shift your body weight gradually from your arms to your legs so that your legs are supporting your weight. Sit up straight with your hands on either side of your legs.
  5. Take a deep breath. While exhaling, lean your upper body forward over your front leg. Support your weight with your arms as much as possible.
  6. Repeat on the other side.

4. Knee to opposite shoulder

This simple stretch helps relieve sciatica pain by loosening your gluteal and piriformis muscles, which can become inflamed and press against the sciatic nerve.

  1. Lie on your back with your legs extended and your feet flexed upward.
  2. Bend your right leg and clasp your hands around the knee.
  3. Gently pull your right leg across your body toward your left shoulder. Hold it there for 30 seconds. Remember to pull your knee only as far as it will comfortably go. You should feel a relieving stretch in your muscle, not pain.
  4. Push your knee so your leg returns to its starting position.
  5. Repeat for a total of 3 reps, and then switch legs.

5. Sitting spinal stretch

Sciatica pain is triggered when vertebrae in the spine compress. This stretch helps create space in the spine to relieve pressure on the sciatic nerve.

  1. Sit on the ground with your legs extended straight out with your feet flexed upward.
  2. Bend your right knee and place your foot flat on the floor on the outside of your opposite knee.
  3. Place your left elbow on the outside of your right knee to help you gently turn your body toward the right.
  4. Hold for 30 seconds and repeat three times, then switch sides.

6. Standing hamstring stretch

This stretch can help ease pain and tightness in the hamstring caused by sciatica.

  1. Place your right foot on an elevated surface at or below your hip level. This could be a chair, ottoman, or step on a staircase. Flex your foot so your toes and leg are straight. If your knee tends to hyperextend, keep a slight bend in it.
  2. Bend your body forward slightly toward your foot. The further you go, the deeper the stretch. Do not push so far that you feel pain.
  3. Release the hip of your raised leg downward as opposed to lifting it up. If you need help easing your hip down, loop a yoga strap or long exercise band over your right thigh and under your left foot.
  4. Hold for at least 30 seconds, and then repeat on the other side.

Exercise with care

Kovacs emphasizes that you should not assume that you’ll be as flexible as the exercises ideally call for. “Don’t think that because of what you see on YouTube or TV that you can get into these positions,” he says. “Most people who demonstrate the exercises have great flexibility and have been doing it for years. If you have any kind of pain, you should stop.”

Corina Martinez, a physical therapist at Duke Sports Medicine Center and member of the American Medical Society for Sports Medicine, says that there is no one-size-fits-all exercise for people who have sciatic nerve pain. She suggests adjusting the positions slightly, such as pulling your knees in more or less, and noticing how they feel. “If one feels better, that is the treatment you want to pursue,” she advises.

Martinez says that anyone experiencing even mild sciatic nerve pain for more than a month should see a doctor or physical therapist. They may find relief with an in-home exercise program tailored specifically to their pain.

The first line of intervention for sciatica should definitely be physical therapy because it is active, it is educational, and the primary goal is to restore function and make each patient independent.

The clue is to find experienced, manual trained physical therapists who combine an understanding of alignment, movement, and therapeutic exercise, and who set up a clear plan of care to reach measurable goals. After that, what’s left is to actively participate in the program!
– Mindy Marantz, PT, MS, GCFP

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Decompression For Pinched Nerve

If low back pain, leg pain or a herniated disc is impinging on your life, spinal decompression treatment may offer a solution for you.

Pinched Nerve

Put a straw in your fist. Now squeeze. You’ll notice not much is able to pass through the straw. This is, essentially, what is happening in your spine when you have a pinched nerve. Your spinal cord or nerves (the straw) are being squeezed because of the impinging by bone/and or disc material.

Decompression is a surgical procedure to relieve pressure and alleviate pain caused by this impingement. A small portion of the bone over the nerve root, called lamina, and/or disc material from under the nerve root is removed to give the nerve more space.

There are 3 common types of spinal decompression procedures, all of which can be done using minimally invasive techniques:

  • Laminotomy/foraminotomy – Shaving off part of the lamina to create a larger opening to relieve the pinched nerve
  • Laminectomy – Complete removal of the lamina
  • Discectomy – Removal of part of a disc that is compressing a nerve

Each of these procedures can be performed as an independent surgery or can be combined together. For example, a laminotomy may be done together with a discectomy. Your doctor will determine which procedure or procedures will give you the most relief.

What Are a Laminotomy and Laminectomy?

Laminotomy and laminectomy are spinal decompression surgeries on the lower spine that involve removing bone, called the lamina, to relieve pressure on the spinal nerve(s).

  • Laminotomy is the partial removal of the lamina to create an larger opening
  • Laminectomy is the complete removal of the lamina

Why Are These Procedures Done?

Laminotomy and laminectomy are commonly done to relieve symptoms of spinal stenosis, including pain, and weakness or numbness that can radiate down the arms or legs.

Your doctor may recommend one of these procedures if non-surgical treatments do not improve symptoms, or if muscle weakness or numbness makes standing or walking difficult.

There are many other spinal conditions that may be treated with a laminotomy and/or laminectomy:

  • Spinal stenosis
  • Herniated disc
  • Sciatica

In some cases, these procedures may be necessary as part of surgery to treat a herniated spinal disk. Your surgeon may need to remove part of, or the complete lamina to gain access to the damaged disk.

What to Expect During a Laminotomy or Laminectomy

Laminotomy/laminectomy can be performed as open surgery, where your doctor uses a single, larger incision to access your spine, or using a minimally invasive method, where a smaller incision is made and muscles are gently separated instead of cutting them.

The operation is performed with the patient on his or her stomach.

Accessing the Spine
First, the surgeon makes a small incision. Through this incision, the muscle will be gently and gradually dilated, or separated, and a tubular retractor will be inserted to create a “tunnel” through which the surgeon may perform minimally invasive surgery.

Laminotomy/Laminectomy
Part of the lamina is cut away to uncover the ligamentum flavum—a ligament that supports the spinal column. Next, an opening is cut in the ligamentum flavum, through which the spinal canal is accessed. The compressed nerve is now visible, as is the cauda equina (the bundle of nerve fibers at the end of the spinal cord) to which it is attached. The cause of compression may now also be identified: a bulging, ruptured or herniated disc, or perhaps a bone spur.

At this point the surgeon will assess and perform a discectomy (removal of a disc or bone spur) or a spinal fusion, if necessary.

Your surgeon will then close the incision, which typically leaves behind only a small scar, if a minimally invasive procedure is performed.

What to Expect After Surgery

The minimally invasive procedure allows many patients to be discharged the same day of surgery; however, some patients may require a longer hospital stay. Many patients will notice immediate improvement of some or all of their symptoms; other symptoms may improve more gradually.

What is a Discectomy?

A discectomy is a surgical procedure to remove a herniated disc that is causing back pain and/or leg pain, numbness or muscle weakness.

Why is This Procedure Done?

When an intervertebral disc ruptures in the spine, it puts pressure on one or more nerve roots (often called nerve root compression). This causes pain and other symptoms in the neck, arms, and even legs.

Your doctor may recommend one these procedures if non-surgical treatments do not improve symptoms, and if you are experiencing leg pain that limits your normal daily activities or weakness or numbness in your leg(s) or feet.

What to Expect During a Discectomy

Like the laminotomy/laminectomy, this procedure may also be performed using an open or minimally invasive approach. Your doctor will determine what is the best method for your spinal condition.

The operation is performed with the patient positioned on his or her stomach.

Exposure of the Nerve Root
In a minimally invasive discectomy, after a small incision is made, the muscles of the spine are dilated, or gently separated, and a tubular retractor is inserted to create a “tunnel” through which the surgeon may perform surgery. A microscope or an endoscope is used to look down the tube and visualize the spine. Through the tubular retractor, a portion of the lamina is removed to expose the compressed area of the spinal cord or nerve root(s).

Decompression
The disc is visualized underneath the nerve root and pressure is relieved by removing the source of compression—herniated disc, a bone spur, or in some instances a tumor. Implants may or may not be needed to stabilize the spine.

The small incision is closed, which typically only leaves behind a minimal scar.

This surgery may also be performed as a microdiscectomy, using a surgical microscope and microsurgical techniques. A microdiscectomy requires only a very small incision and will remove only that portion of your ruptured disc, which is “pinching” one or more spinal nerve roots.

What to Expect After Surgery

This minimally invasive procedure allows many patients to be discharged the same day of surgery; however, some patients will require a longer hospital stay. Many patients notice immediate improvement in some or all of their symptoms; other symptoms may improve more gradually.

At home you will have medication to help with any discomfort. Any severe increase in pain not controlled with the medication should also be reported to your physician or the physician’s nurse. You should report any elevation in your temperature, drainage from your incision, or increase in numbness or weakness.

What Are the Risks of These Procedures?

Potential risks to any surgical procedure include unforeseeable complications caused by anesthesia, blood clots, undiagnosed medical problems such as silent heart disease, and rare allergic reactions. Complications of spinal surgery can include neurological damage, paralysis, damage to the surrounding soft tissue and, where used, instrument malfunction. Most of these complications can be treated once they are detected, but sometimes they require a longer period of hospitalization or recovery, additional medications, and sometimes even additional surgery. Depending upon the type of surgery you are having, these risks will be explained by the primary surgeon. As a patient, it is important to understand and follow your doctor’s advice so that the best possible outcome can be achieved. This surgery is not for everyone. Please consult your physician.

 

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Physical Therapy Benefits For Back Pain

After an episode of low back pain has lasted between two and six weeks, or if there are frequent recurrences of low back pain, physical therapy is often recommended. Some spine specialists consider physical therapy sooner, particularly if the pain is severe.

In general, the goals of physical therapy are to decrease pain, increase function, and provide education on a maintenance program to prevent further recurrences.

A physical therapy program for back pain usually has two components:

  1. Passive physical therapy to help reduce the patient’s pain to a more manageable level
  2. Active exercises

Passive Physical Therapy – Modalities

Acutely, the physical therapist may focus on decreasing pain with passive physical therapy (modalities). These therapies are considered passive because they are done to the patient. Examples of modalities include:

  • Heat/ice packs
  • TENS units
  • Iontophoresis
  • Ultrasound

 

Active Physical Therapy – Back Pain Exercises

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Generally, a patient’s back exercise program should encompass a combination of the following:

Stretching for back pain exercises
Almost every individual who has suffered from low back pain should stretch their hamstring muscles once or twice daily. Simple hamstring stretching does not take much time, although it can be difficult to remember, especially if there is little or no pain. Therefore, hamstring stretching exercises are best done at the same time every day so it becomes part of a person’s daily routine. There are many more stretches that can be done to alleviate lower back pain.

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