Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation (2024)

Abstract

[Purpose] The purpose of this study was to identify how spinal decompression therapy andgeneral traction therapy influence the pain, disability, and straight leg raise (SLR)ability of patients with intervertebral disc herniation. [Subjects] The subjects were 30patients with chronic lumbar pain who were divided into a spinal decompression therapygroup (SDTG, n=15), and a general traction therapy group (GTTG, n=15). [Methods] The SDTGused a spinal decompression device, and the GTTG used a lumbar traction device. Bothgroups received conservative physical therapy three times a week for four weeks. A visualanalog scale (VAS) was used to measure the degree of pain the patients with chronic lumbarpain. The Oswestry Disability Index (ODI) was used to measure the degree of functionaldisability. A goniometer was used to measure the patients’ SLR ability. [Results] BothSDTG and GTTG showed statistically significant decreases in VAS and ODI scores and astatistically significant increase in SLR angle. A comparison of the two groups found nostatistically significant differences. [Conclusion] Spinal decompression therapy andgeneral traction therapy are effective at improving the pain, disability, and SLR ofpatients with intervertebral disc herniation. Thus, selective treatment may berequired.

INTRODUCTION

Eighty percent of adults experience lumbar pain at least once in their lifetime, and 80% ofstructures causing lumbar pain are related to intervertebral discs1⁾. Disc herniation is multifactorial, often related todegenerative processes and mechanical effects, and mostly occurs due to light externalinjuries of the spine, such as spinal bending and stretching, spinal rotation exercises, andabrupt posture changes2⁾. Both surgical andconservative treatment methods are considered for intervertebral disc herniation.Conservative treatments include medication, exercise therapy, and physical andrehabilitation methods. Among them, one of the most widely used methods is traction therapy.Traction therapy reduces the pressure caused by gravity and soft tissues, and sufficienttension extends spinal separation and the intervertebral disc. Negative pressure within theintervertebral disc increases its hydration and reduces pressure on the nerve root byremoving the force applied to the vertebral pulp3⁾.

Spinal decompression therapy is another method that has recently been used as aconservative treatment for intervertebral disc herniation. Spinal decompression therapyreduces the pressure on the intervertebral disc by suppling nutrients and oxygen to theintervertebral disc. This creates a state of non-gravitation or negative pressure byadjusting the direction and angle of traction to suit the location of the intervertebraldisc, which is the target of the treatment. This in turn reduces the pressure inside theintervertebral disc by gradually and softly increasing a specific part of the intervertebraldisc through the decompression of a precise part of the lesion4⁾.

Although studies of various treatment methods for intervertebral disc herniation have beenconducted, comparisons of spinal decompression therapy and general traction therapy remaininadequate. This study aimed to identify how spinal decompression therapy and generaltraction therapy, which are non-surgical treatment methods, influence the pain, disability,and straight leg raise (SLR) ability of patients with intervertebral disc herniation.

SUBJECTS AND METHODS

The subjects of this study were 30 patients (male: 9, female: 21) who complained ofradiating pain caused by chronic lumbar pain. The subjects had suffered from continuouslumbar pain, as diagnosed by an orthopedic specialist, for over three months, and wereselected from among patients who visited S Hospital, located in Daegu Metropolitan City,Korea. On average, the spinal decompression therapy group (SDTG, n=15) was 41.3±7.3 years ofage, 162.3±8.9 cm in height, and 58.3±12.2 kg in weight, and the general traction therapygroup (GTTG, n=15) was 44.0±4.1 years of age, 162.7±8.4 cm in height, and 59.1±11.3 kg inweight. No statistically significant differences were found in their generalcharacteristics. Ethical approval for the study was granted by the Youngdong UniversityInstitutional Review Board. All subjects read and signed consent forms in accordance withthe ethical principles of the Declaration of Helsinki. Those who had undergone an operationon a lumbar vertebra, had spinal tumors or infections in the intervertebral disc,inflammatory diseases such as rheumatism, fractures, or other contraindications for manualtherapy, were excluded from the study.

All subjects were treated three times each week for four weeks. The SDTG were treated witha spinal decompression therapy device (MID 4 M Series, WIZ Medical, Korea) for 20 minuteseach time. The GTTG were treated with a lumbar traction therapy device (OL 110, Dong BangMedical, Japan) for 20 minutes each time. Hot packs (20 minutes), interferential currenttherapy (15 minutes), and ultrasound (5 minutes) were used to treat both groups during theconservative physical therapy.

Each subject of the SDTG, which received the spinal decompression therapy, lay on his/herback on the device’s bed and had the pelvic and thoracic regions fixed with an air belt. Theslipping of the fixed parts was prevented by fixing the patient’s head with a strap. Theregion of the cervical vertebrae was stretched by applying the robotic jog system, and asacrum treatment device that supports the sacrum was used to maintain lumbar lordosis.Traction started with a strength level of 5 to 6; the power level was increased by a certainratio during each phase. When pain occurred due to an increase in traction, the existingpower level of traction was lowered or maintained. The ratio of the hold time to the resttime was set at 2:1, and standard and divided compression methods were used simultaneously.Each subject of the GTTG, which received lumbar traction therapy, lay on his/her back on atraction table and had a knee support placed under each knee. Traction was first applied atone third of the subject’s weight. Then, the traction was increased after each treatment, upto 50% of the subject’s weight. When an increase in traction caused pain, the existingtraction was lowered or maintained.

A visual analogue scale (VAS) was used to evaluate the degree of pain. The OswestryDisability Index (ODI) was employed to evaluate the degree of disability. Nine questionswere scored from 0 to 5 according to functional performance with higher scores indicatinghigher degrees of disability. Percentage (%) values were obtained by adding the scoremeasured from each item and dividing the sum of all items by the maximum score of 45 points.A SLR test was performed to determine whether the nerves under pressure due tointervertebral disc herniation had tension5⁾. For the SLR test, each patient lay on his/her back and relaxed bystretching both legs. While slowly raising the subject’s straight leg on the affected side,the tester used a goniometer to measure the angle when lumbar pain or radiating pain in thelegs occurred.

The paired t-test was conducted to compare values before and after the treatment withineach group to identify the pain, disability, and SLR of patients with chronic lumbar pain.The independent t-test was performed to compare differences between the two groups. Thisstudy performed statistical analyses using SPSS 12.0 for Windows, and the level ofstatistical significance was chosen as α=0.05

RESULTS

The SDTG and GTTG showed statistically significant declines in the VAS and the ODI socres(p<0.05), and a statistically significant increase in the angle of SLR (p<0.05). Onthe other hand, the comparison of the two groups found no statistically significantdifferences (p>0.05) (Table 1).

DISCUSSION

Spinal decompression therapy resolves problems with the disc and removes the pressureapplied to the disc by supplying nutrients and oxygen to the disc. This creates a state ofnon-gravitation or negative pressure within the spinal canal and reduces pressure inside theintervertebral disc by softly increasing a specific part of the disc through thedecompression of a precise part of the lesion6⁾.

Borman et al.7⁾ reported that a grouptreated with general physical therapy and intermittent traction therapy showed statisticallysignificant declines in ODI and VAS scores. Meszaros et al.8⁾ reported that traction therapy for 10 patients, who had a SLR angleof 45° and complained of lumbar or nerve root pain, resulted in an increase in SLR angleafter the treatment. Gose et al.9⁾ notedthat spinal decompression therapy decreased pain and increased mobility and showedstatistically significant effects in MRI images. Gionis and Groteke10⁾ reported that after spinal decompression therapy, 86% of219 patients reported pain reduction. Ramos and Martin6⁾ reported that spinal decompression therapy yielded statisticallysignificant effects on MRI images. Moreover, in a study by Yang11⁾, a group that received spinal decompression therapy showedstatistically significant declines in VAS and ODI scores. Kang12⁾ conducted spinal decompression therapy and manual therapyfor patients with lumbar intervertebral disc herniation, and reported that after thetreatment, the SLR angle showed a statistically significant increase. Lee et al.13⁾ reported that a group that received spinaldecompression therapy and manual therapy showed a larger degree of pain reduction and ahigher increase in the range of motion (ROM) of the hip joint than a group that receivedspinal decompression therapy and general physical therapy.

In the present study, SDTG and GTTG showed statistically significant declines in VAS andODI scores, and a statistically significant increase in the angle of SLR. A possibleexplanation for these results is that spinal decompression therapy and traction therapyreduce the pressure generated by gravity and soft tissues, and increase spinal separationand the diameters of the intervertebral disc and intervertebral foramen. In addition, thegeneration of negative pressure within the space of the intervertebral disc may have led thepart of the disc, which had been pushed out to the rear of the intervertebral disc, toreturn inside, thereby reducing neural sensitivity. No statistically significant differenceswere found between the two groups. This is likely due to the fact that spinal decompressiontherapy and traction therapy have similar basic principles: both therapies relax the overalllumbar region by loosening pressed nerves and tense muscles reducing the pressure on theintervertebral disc. Therefore, the two treatment methods may not have notable differencesin terms of therapeutic effects. In addition, since general traction therapy is covered byhealth insurance but decompression therapy is not in Korea, physical therapists are requiredto select treatments considering patients’ expenses. However, increasing the number oftreatments or lengthening the treatment period might produce different findings.

This study examined the clinical effects of conducting spinal decompression therapy andgeneral traction therapy, which are non-surgical treatment methods, for patients withintervertebral disc herniation. In conclusion, physical therapists may be required to selectan appropriate treatment method considering the condition of a patient, cost, and time.Follow-up studies should be conducted on the long-term effects of these therapies,increasing the treatment period and the number of treatments.

REFERENCES