Spinal Decompression Hype: Yet another over-marketed low back pain cure (because that’s just what the world needed

Interested in spending vast sums of money on a dubious therapy for your back pain? Well, boy, are you in luck! Nonsurgical spinal decompression therapy (SDT) — also known as “pulling on your back” or “traction” — is ready to drain your bank account. (This section concerns SDT performed with expensive machinery. Self-administered traction is a different story.) Various forms of spinal traction machinery have always been available to desperate low back pain patients, and four facts are clear about this therapy to date:

1. It might work occasionally, a little bit, for some patients.
2. But no one really has a clue.

Serious criticism from serious people

This topic has been well-covered by several effective and credible critics. Good summaries include Dr. Harriet Hall’s article for LiveScience.com, a detailed critique by the formidable Dr. Stephen Barrett, and a scholarly but readable article (ideal for professional readers) by a chiropractor, Dwain Daniel, in Chiropractic & Osteopathy.

3. It is routinely prescribed and promoted with unjustified confidence.
4. There is a risk of injury.

Chiropractors have found ways to make traction sound better and cost more than ever before, by doing it with extremely expensive machinery (doubtless it goes “ping”) with names like (I am not making this up) the DRX9000 True Non-Surgical Spinal Decompression System™. (You have to love the “true” in there. From now, everything I market is going to have “true” in it. No longer will I sell mere e-books on this website: I am going to start selling true e-books!) Once a chiropractor has purchased such a machine, he or she is more less obliged to hard-sell it in order to pay for it.

A machine that goes “ping” — the DRX9000 True Non-Surgical Spinal Decompression System™.

The most recent incarnation of traction therapy is non-surgical spinal decompression therapy which can cost over $100,000 [the equipment, not the therapy]. This form of therapy has been heavily marketed to manual therapy professions and subsequently to the consumer.

Daniel, Chiropractic & Osteopathy, 2007

The SDT hype covers up a nearly perfect lack of evidence to support the use of any kind of traction, let alone extremely expensive traction, so much so that the Florida Attorney General’s office launched a lawsuit against the largest manufacturer for “false and misleading claims.” It’s the combination of cost and a therapy that’s experimental at best that’s the problem here. Daniel again:

There is very limited evidence in the scientific literature to support the effectiveness of non-surgical spinal decompression therapy. Considering the cost-benefit relationship, many better researched and less expensive treatment options are available to the clinician.

A 2007 review of traction therapy for low back pain reports that experimental results “consistently showed that traction … as a single treatment for LBP was not more effective than placebo, sham treatment or other treatments.” Regardless of a few modestly positive studies, traction continues to be hammered in other studies, like this fresh new one from the European Spine Journal with a good, rigorous design that showed absolutely no difference between traction and placebo.

Incidentally, traction for neck pain is similarly devoid of any clear support from science (see Graham).

And what about risks? Obviously, if you are pulling on painful lower backs with powerful machinery, there are risks. SDT has been promoted as a safe therapy. However, Daniel reports:

This was a case report of a 46 year old male with a three month history of radicular pain consistent with a S1 radiculopathy. During his 5th session he suffered a severe exacerbation of his pain with marked enlargement of the disc protrusion requiring urgent microdiscectomy.

Personally, I recall three cases of severe negative reactions to SDT in my decade of clinical work. In the most memorable example, my patient described going for therapy with a minor low back pain, and experiencing rapidly escalating discomfort in the machine, leading in just seconds to a pop, excruciating pain, and “screaming.” This extraordinarily poor outcome was followed by a long period of much more severe, chronic low back pain. I remember his case clearly because he attributed it almost entirely to the SDT. He considered himself injured by the technique, and was seeking therapy for its long term consequence many months after the injury.

Incidents of minor harm are likely to be much more common than serious ones, of course.

None of this means that traction never has any merit — it almost certainly does help the occasional patient. But it does mean that it doesn’t pass the impress me test (not by a long shot). The SaveYourself.ca salamander says: spinal decompression therapy should never be sold aggressively for a high price to vulnerable, desperate patients. On principle, you should not give your hard-earned money to chiropractors who unethically push this “technology” without clearly informing you of its limitations and risks.