Archive for category: KDT Blog

After a decade in practice I began to think ‘disc’ problems were not responding as I would hope they would. This concern is a major one since a vast majority of our most motivated and disconcerted patients are dealing with a disc hernia or other disc issue. I began to investigate the VAX-D and the concept of decompression and I was sold. Twenty year later I may have altered my level of skepticism toward ‘magic decompression machines’ but not toward the potency of traction-based therapies and the amazing “sell-ability” and relevance to patient retention.

A compression issue simply ‘demands’ a ‘decompression’ treatment solution. Intuitive and logical assessment never guarantees a great outcome but it sure is a lot easier to sell and relate than an ‘irrelevant’ procedure. IF a patient feels better lying down ‘decompression’ is NEVER an inappropriate treatment. That a patient already tends to understand this cannot be over emphasized. The ROF’s must make clear the interconnection and natural benefit decompression will create…BUT that it takes time, commitment and a multi-focal approach. It is in allied treatments where “sell-ability” and strong closing makes its’ mark. Our Kdt table features, “open” belt and pertinent classification are designed to focus patient-problems TO table-solutions.

Table vibration (supine), bolster-less leg/pelvic support & tilt, extension-at-the-waist (prone) and Laser DURING decompression are just such propositions. These attributes and treatment propositions are still very unique in the marketplace and allow excellent compelling clinical selling points.

The simplest and most utilitarian way to categorize disc-issues is with provocative/relieving motion tests and a detailed history. I deduce that there are generally (3) disc types:

1. Herniation g. derangement of the nucleus pressurizing & distorting the outer annulus, either contained or ‘broken-thru’ and either constrained by the PLL or not. This is your “young man/woman’s’ disc” typically with a DP (when contained: pain to-the-knee) or full blown Sciatic issues (pain thru foot with neurologic issues). Back pain for sure but lots of leg/hip/butt/foot issues as well…mitigated with key-motions and traction.
2. Discogenic/degenerative/Internal-disc-disruption: The standard finding in the “recalcitrant” class of cLBP, the “persnickety” back and the long-standing “bad backers’”. Typically no discernible DP and predominate back-pain issues.
3. “Other” disc issues:g. one-off or recurrent low back “sprains”, motion disorders or peripheral structure-involvements. Form-closure/repositioning motions help in the case of “disorders” NOT primarily from a ligament tear or contusion.

The bending & distraction tests remain the gold-standard determining whether the “bulge” is a protrusion, extrusion or circumferential/degenerative/flat-tire bulge.

Number (1) allows us potential “draw-in” and re-arrangement with traction and facilitated motions (typically extension or lateral).

Number (2) is to the greatest degree a palliative, nutrition and ergonomic/education responder.

Sprains are luckily VERY disconcerting but typically fully healed within the 12 week time frame (often with or without treatment) and palliative, “hope-full” treatments, that “first DO NO harm” are most beneficial while innate does her job.    

Cochrane database Jan. 2010

Placebo effects are often claimed to substantially improve patient-reported and observer-reported outcomes across many clinical conditions, but most reports are from biased research without controls.

This Cochrane database systematic review looked at over 200 trials and discussed the effect and the findings. Many CAM practioners and adherents of alternative ‘medicine’ become, by default promoters of the value of placebo effects after such interventions. This is due to the increasing awareness that substantial, curative benefits from most CAM procedures are simply not forthcoming in well-done studies. Over the last several years Placebo effects have been relegated to the status of mundane… as opposed to miraculous. 

The conclusions of this review suggest:

“Placebo interventions do not appear to have important clinical effects in general”. “In certain settings patient-reported outcomes of pain and nausea can be influenced. The effect on pain varies considerably and it’s difficult to distinguish it from biased reporting. Variations in placebo effect can be partly explained by how trials are conducted and how patients are informed”.

If you have ever been tractioned you’ll have recognized that (depending on your size) even small, incremental additions of force can be quickly perceived. Since we have a variable-extension spring-retraction on the Kdt NF we can make subtle adjustments to the ‘retraction-force’ of the sliding lumbar section and allow the perception of the pull (via table motion) to be enhanced. It is highly recommended that novice-decompression clinicians follow: ’40 pound max/females, 50 pound max/males for the first 1 or 2 sessions to avoid untoward effects…not that they are extremely common but the annoyance of such effects can ruin your day. The spring can be fully tightened prior to treatment and then ‘backed-off’ to allow the patient to better sense the pull and their ‘lower body participation’ (caudal motion) with the pull. When adding force typically the spring should be fully ‘off’ and 5 pound increments then dialed in on the motor. Of course excess caution is never a bad clinical attribute and even though many bigger, male patients will be able to well-tolerate 15-20 additional pounds sticking to the 5 pound rule makes the most sense. As was described in a previous blog; degenerative discs typically show marked thinning of the posterior annular fibers and excessive strain could theoretically “sprain” them.

Many of those who attend our certification seminars are surprised to find we reserve a segment of the seminar to discuss and demonstrate the ATM2. Others are surprised we don’t spend much more time given the importance we tend to impute on it as a co-treatment to decompression-traction. The primary reason I discuss it and will demonstrate it on several attendees is simply due to my great faith in it as a viable and demonstrably effective modality. Active-interventions & exercise can NEVER be discounted in a clinical encounter. In acute pain conditions exercise per se is generally avoided….however in many “acute” conditions the ATM2 IS the treatment of choice. This is even more so in chronic cases and confusing diagnostic profiles where movement disorders scuttle clear indications to or benefits with adjusting.

Additionally every clinician needs active–interventions that supplement passive ones…and the ATM is without equal. I recognized the advantages to having an ATM2 and the large number of patients having disordered–movement patterns attendant with compression that thrive with it as part of the program.

The manufacturer of the ATM2 offers the complete education that most new owners will require to really get-with-the-program. Our seminar discussion is rudimentary and meant as an introduction. We recognize many are focused entirely on their decompression education and don’t want to be side–tracked! If however you are interested in more detailed instruction from us while attending a Kdt seminar we’ll be happy to give you additional one-on-one instruction.