Non-Surgical Decompression Options For Spinal Stenosis and Pinched Nerves

What is spinal decompression therapy and how can it help you?

Perhaps before we discuss spinal decompression therapy we should take a brief moment to talk about who might benefit from this treatment and why. As the name implies spinal decompression therapy is a treatment for spinal problems that are associated with pressure or compression. There are a number of different spinal ailments that are the result of compression of the nerves exiting the spine. The most common are slipped discs, spinal stenosis, sciatica and pinched nerves.

While the exact mechanisms of these various conditions are different they all ultimately involve pressure on or compression of the spinal nerve roots. There are surgical techniques of spinal decompression, but this article will focus on non-surgical methods available to decompress the spine. Many times these non-surgical techniques can reduce or eliminate the need for surgery. Several studies suggest that the techniques that we are about to be discuss may reduce the need for back surgery from 47 to 60 percent. So in theory more widespread use of non-surgical spinal decompression strategies could effectively eliminate the need for about one in every two spine surgery procedures. That is really great news for folks suffering from pinched spinal nerves regardless of the cause of the compression.

So how does it all work? The basic concept is really quite simple. A nerve exiting the spine gets compressed by a bad disc, spinal stenosis of spondylosis, a fancy name for spinal arthritis. Pressure on the nerve causes it to become inflamed and chemical changes occur in the nerve which makes it hyper-excitable. The result is pain, lots of it and also numbness and even weakness in the muscle of the lower back, hip and leg. Depending on the nature of the nerve compression and the amount of chemical changes that occur in each patient's compressed nerve, the signs and symptoms will vary from patient-to-patient. The important thing to remember is that the first job is to decompress the nerve. Then the inflammation and chemical changes need to be addressed for the body to heal properly.

Step one: Take the pressure off the spinal nerve to stop ongoing nerve damage. There are a number of ways to take the pressure off a pinched nerve. The general term for this is called spinal decompression; in truth we should really call it spinal nerve decompression therapy. Because it is more accurate to say we decompress the spinal nerve than to state we decompress the spine. So how do we decompress the spinal nerves? The answer is straight forward. Apply traction. Spinal traction has been used to treat back pain from nerve compression for thousands of years.

The most important question is how to most efficiently apply traction to the spine to effectively decompress the spinal nerves? There are a number of ways.

You probably can remember seeing pictures of patients strung up in harnesses with pulleys and weights. This old style of traction has been dismissed as ineffective, probably because it was inefficient in truly separating the vertebrae and causing decompression of the spinal nerve roots.

Then there are some home-based methods of spinal decompression. The two most popular ones are inversion machines that turn you upside down and cause gravity to distract the spine rather than compress it and the large exercise balls that can be used to elongate the spine through exercise. Both have pros and cons and for our discussion these should be relegated to follow-up home use after a course of true medical spinal decompression therapy.

That leaves two competing professional technologies to provide spinal decompression therapy in a medical setting. One therapy is called Spinal Decompression Therapy. It consists of a traction-like table and uses computerized sensors to monitor muscle contraction. This is important because when you start to administer traction to the spine a reflex occurs in the back muscles that resists the decompressive force. This is called the muscle stretch reflex. So this monitoring of the muscle stretch reflex is important to provide effective force to decompress the spine and pinched nerves. The Spinal Decompression Equipment times the traction with the relaxation of the muscles. Without considering this reflex muscle contraction the force used to decompress the spine will only be placing traction on the spinal muscles and not truly decompressing the pinched nerve.

In fact some scientists believe that old school traction failed to produce excellent results because they could not overcome the reflex muscle contraction hat occurs when you stretch the spinal muscles. If this was the case then traditional traction devices were limited to stretching back muscles and did very little to decompress the spine nerves. Modern Spinal Decompression equipment seems to have overcome this obstacle to true spinal nerve decompression.

An alternative to Spinal Decompression Treatment Tables is a technique called Flexion-Distraction Therapy. Flexion Distraction Therapy is unique because it is one of the only forms of decompression that treats the patient while he/she is face down. This is important for a couple of reasons.

We just talked about the muscle stretch reflex in the spinal muscles that makes them contract and resist decompression of the spine. There are many more reflexes associated with muscles. Another important reflex is called the agonist-antagonist reflex. Simply put, this is a reflex that causes the back muscle to relax when the stomach muscles are shortened. This reflex may be one of the reasons why Flexion Distraction Therapy can have profound effects on pinched spinal nerves.

While the patient is face down on the table, the Flexion Distraction Table flexes slightly. This has the effect of shortening the stomach muscles and causing a reflex relaxation of the back muscles. By slightly flexing the spine before applying the traction, the Flexion Distraction Therapy abolishes or greatly reduces the muscle stretch reflex in the back muscles. So once the spine is slightly flexed, resistance to traction of the back muscles is minimized and the spinal nerves can be effectively decompressed. Another advantage of Flexion Distraction Therapy is that the flexion movement of the table mechanically opens up the canal where most spinal nerve compression occurs.

So the properties of Flexion Distraction Therapy that make is ideal for spinal decompression is that by the nature of the procedure, back muscle relaxation and resistance to distraction are eliminated and the area of maximum nerve compression is mechanically enlarged all of which adds to effectiveness of spinal nerve root decompression.

Both Spinal Decompression technology and Flexion Distraction Technology for the non-surgical decompression of spinal nerve roots can be highly effective in reducing the pain and other symptoms associated with spinal nerve root compression. They are usually administered with additional therapies which are designed to reduce nerve inflammation and restore proper nerve chemistry. Either are worth looking into before considering surgery to decompress pinched spinal nerves.

Research supports the effectiveness of both of these competing techniques for the non-surgical decompression of spinal nerve roots.

Sitting Can Reduce Hip Mobility and Cause Back Pain

Over the course of their lives, nearly eighty percent of Americans will experience some sort of back pain. Many of them will experience pain so debilitating that they actually miss work because of it. These are extraordinarily high numbers of people with discomfort in this region of the body. While many causes of back pain can be prevented, it is only by understanding two of the most important reasons leading to soreness and injury that people can take preventative action and reduce their chances of experiencing pain. These two causes are sitting for long periods of time and lack of hip flexibility.

However, people should also realize that these two causes of back pain also work together to increase injury and soreness. Sitting for hours and hours every day in front of a computer or at a workstation leads to a cramming of the spinal discs, as well as a reduction of mobility in the hips. The hips are designed to be extremely mobile with a large range of motion, But sitting down causes the lower back to take over when movements are required. In essence, the hips tend to "turn off" and the low back takes up the slack when sitting. And when the person gets up, this habitual use of muscles continues unless corrected.

Sitting down puts increased pressure on the vertebrae of the back, especially compared to standing up. When standing, the loads placed on the spine are reduced because the abdominal muscles are more activated and the hips and leg muscles are also working to support the body. But when sitting in a chair, all of the weight of the upper body comes to rest on the pelvis directly, with no transfer of the force through the hips to the legs and feet. This results in higher loads being placed on the joints of the lower back where the lumbar (lower) spine meets the pelvis. Over time, the tissues supporting this area of the body tend to weaken and break down.

While many people feel that standing for long periods of time causes soreness and discomfort, this is usually the feeling of sore muscles. The back extensors, hips, and legs may get sore from spending too much time standing up, but usually the pressures on the tissues such as the ligaments and the spinal discs are reduced. But when sitting down for too long, the muscles may be saved from working to support the spine, but the loads are then directed to the ligaments, discs, bones, and other connective tissues. Muscles soreness can be recovered from much more quickly than damage to the discs.

Sitting also places the hips in a position where they are not allowed to expand, move, or activate muscles to support the body. This can lead to reduced flexibility and range of motion in the hips. When this happens, additional stress is placed on the low back, as the body seeks necessary mobility from the tower back that is missing in the hips. The lumbar spine, however, is not meant to have a large range of motion -- it is built to be very stable and supportive of the joints directly above and below it. When the body is lacking in mobility at the hips, back injuries occur.

Thus, sitting down for long periods of time and reduced mobility in the hip joints can lead to back injuries. The longer one sits in a chair and the less flexibility in the hips, the greater the chance of lower back pain and the worse that soreness can be. People who are seriously concerned about the health of their back must learn to reduce or mitigate the compressive forces on their spines and use their bodies as they were designed -- to keep the loads off of the discs and ligaments of the lumbar spine and utilize the natural mobility of the hips for movement and activity.

How the Nerves and Brain Communicate to Create or Ignore Pain Messages

The pain alert system in the body is one of the most useful aspects of the nervous system, at least from a survival and danger-avoidance standpoint. But when the system becomes overly sensitized, either due to tissue damage or long-term inflammation, it can cause all sorts of problems for people, the main one being chronic pain lasting months or years. But much of the pain that is felt years after an injury may be due to the nervous system and brain not communicating effectively with each other anymore.

There are pain sensors spread throughout the body; they are located near the skin, in muscles, and on bones. When these nerves receive enough of an input, they open up and allow a flood of positively-charged ions in, which sends a pain message to the spinal cord and brain. The pain receptors can be activated through a number of different mechanisms, from a hammer hitting someone's thumb, to a dangerous chemical being dropped on a hand or leg, to hot coffee being spilled. All of these can result in pain due to mechanical, chemical, or temperature changes that affect the nerves.

However, the pain messages must reach a critical level in order to send a real pain message to the brain. Lightly touching a hammer to your thumb will not usually send you screaming and sucking it to reduce the pain (unless the nerves are already highly sensitized). The pain receptors may open and allow some positive ions in, but they are not judged to be enough to create pain. The brain, along with the spinal cord, evaluates the messages received from the pain receptors and decides whether or not there is a danger. If danger is perceived, then pain is the result, but if the inputs are not sufficient to cause pain, the brain does not send the message to protect the body part.

This processing by the brain is one of the most important aspects of pain for people to understand. Elite athletes may be able to run the last 6 miles of a marathon with a stress fracture, while other people have to take the day off of work if they have a mild paper cut. Why is this? In essence, it is due to the sensory messages that the brain receives from the tissues and the messages it sends after receiving those inputs from the nerves. The actual condition of the tissues is one of the aspects the brain evaluates, but it is not the only one. It may be more important to keep running and finish the race than to send a danger message full of pain.

But when the brain believes that a person is in danger, it will send the pain message. At that point, the brain is almost completely in control and other various systems can take over. There is nothing like being hit with an object to test the reflexes to see how fast a person can get out of the way. The inflammatory system may turn on as the body then sends blood and nutrients to the site of the injury to cause swelling in order to protect the tissues. And pain from an acute injury can last as long as the brain determines that there is still a danger.

What Causes Degenerative Disc Disease?

Degenerative Disc Disease (DDD) is a process that may involve one intervertebral disc or numerous. It's a fairly common condition, at least 30% of people aged 30-50 years old will have some degree of DDD, although a lot will not have any pain at all from it.

It involves loss of hydration to the disc which is normally 80% water and can be from natural causes, post traumatic, genetics, essentially numerous causes, some of which we know and some we don't.

Here are the ones we know:

1) Acute injury to the back - This may occur from a car accident or some other accident that causes the disc to sustain tears in the outer portion of the disc. The outer portion is called the annulus and is the part that has the nerve endings where pain occurs.

2) Wear and Tear - Repetitive injury to the disc, such as occurs with heavy lifting occupations or truck driving, can over time cause disc degeneration and back pain or neck pain depending on where the problem occurs.

3) Post-surgical - Patients who undergo a discectomy for a herniated disc will have less disc after the discectomy than prior. With less spongy material to support body loads, the remaining disc will have a higher propensity for degeneration.

4) Obesity - Higher body mass will place more stress on your discs and potentially enhance the degeneration.

5) Genetics - You may be predisposed to excessive disc wear and tear, so if someone in your family has or had degenerative disc disease, you may also develop back or neck pain related to DDD.

6) Smoking - This habit adversely affects discs and can cause faster degeneration. Smoking decreases the amount of water in your discs, and that water is what helps your discs absorb stresses from movement successfully. With less water content, your intervertebral discs can wear out sooner.

As you can see, there are some causes of DDD that can be controlled, but genetics is not one of them.

How Does Degenerative Spondylolisthesis Create Back Pain and Leg Pain?

Degenerative Spondylolisthesis is an extremely common spinal condition that causes back pain along with hip, buttock, and leg pain. The term "spondy" means spine and "listhesis" means slip. From degenerative arthritis occurring, one vertebral body ends up shifting on the one below it, and this can cause pain from either:

1. Spinal arthritis


2. Spinal instability


3. Pinching nerves from the slip (spinal stenosis)

The spinal canal has a typical cross sectional area that allows nerve roots to get out just fine normally. But if one vertebra slips and thereby shifts its position on top of another level, that cross sectional area decreases. You have a bony area that is shifting, but the surrounding soft tissues are shifted right with it.

This can pull traction on nerve roots that were previously very happy with the amount of space they had to exit from the spinal canal. With the slippage, those nerve roots may get pinched at one of 3 places:

1. Pinched nerve in the area where they come off of the spinal cord (dura)


2. The area as they enter the exit hole (foramen) from the spinal canal called the lateral recess


3. The exiting hole from the spinal canal, called the foramen

Either place of compression can produce symptoms of hip, buttock, and/or leg pain called spinal stenosis. Stenosis in this case refers to constriction of an anatomic circumference. If there instability when a person moves, such that the vertebra shifts when a person stands up and moves and then goes back upon sitting, this can create intermittent symptoms of back pain and/or spinal stenosis.

Unfortunately when spondylolisthesis occurs, it is a mechanical problem. We do not have a special powder or injection material that will fix it. However, degenerative spondylolisthesis is obviously not a fatal condition, and it doesn't cause paralysis.

So it can be treated conservatively with many options including:

1. Physical Therapy


2. Pain Management injections


3. Pain Medication


4. Chiropractic Treatment


5. Spinal Decompression Treatment

If these options fail, then surgery can work very well but should be considered as a last resort.

Lasting Pain Management Relief With Manipulation Under Anesthesia

Anyone who has long-term pain syndromes may consider manipulation under anesthesia as an alternative treatment to painkillers and surgery. Basic conditions that may lead to this procedure are acute and chronic neck pain, joint pain, back pain, shortened muscles, muscle spasms, and fibrous adhesions (scar tissue).

Pain caused by the lumbar, thoracic, or cervical spine, frozen shoulder, and any discomfort in the pelvic region or sacroiliac may be treated by manipulation under anesthesia (MUA). The treatment is safe and can serve as a replacement for more intrusive and dangerous medical procedures. There are three primary ways that patients undergo this procedure.

1. During mild sedation
2. Under general anesthesia
3. After injection of the anesthetic into a specific area of the spine

Specialists working in a team environment to assure the safety of the patient may perform this procedure in a medical surgery facility. Manipulation under anesthesia is always a team effort, which generally consists of the anesthesiologist, the chiropractor or doctor responsible for the manipulation, and an assistant. Unlike general chiropractic procedures, manipulation under anesthesia is almost always performed in a hospital or other traditional medical facility such as an outpatient surgery center.

The primary aim of manipulation under anesthesia is to break up scar tissue or fibrous adhesions that center around the spine. The process uses specific kinesthetic maneuvers of postural and articular varieties, passive stretches, and short-lever manipulations of the spine specific to the problem areas.

Although the terminology might be new to many people, manipulation under anesthesia is far from a new procedure. It has been a part of medical treatment for more than sixty years and has its own CPT Code designation.

Who Receives Treatment

Back and neck injuries are the leading reasons for spinal manipulation, but not every situation requires the procedure, and some doctors might be hesitant to perform manipulation based on many factors including the physical condition of the patient. One of the main reason the procedure is done is for frozen shoulder, also known as adhesive capsulitis

Other care and treatment is often attempted before spinal manipulation, but if those efforts prove ineffective, manipulation is the next step. Scar tissue builds up along with adhesions during prolonged aggravation of spinal joints. Over time, this produces chronic pain in the spine and surrounding muscles.

While chiropractic treatments, epidural injections, and physical therapy often give temporary relief from pain, they do nothing to treat the underlying problem of fibrous adhesions. Back surgery most often does nothing for this either and may make that problem worse. Manipulation under anesthesia can bring results that are more permanent for chronic back and neck pain.

Afraid of an Epidural for Back Pain?

An epidural for back pain relief cannot only be an unpleasant experience it can also provide the patient with some relief from their back pain. I have personally undergone fifteen of these procedures myself so please keep in mind this article is written from my experiences and what works for me may not work for you.

With this in mind, here we go.

I suffered a devastating injury to my lower spine (L4-5) and have since had 8 back surgeries, a spinal infection, 15 epidural for back pain along with many other treatments in my quest for pain relief.

First of all, let me say that an epidural injection can be uncomfortable at times. However, I never experienced any actual pain during or after one of these procedures. To me there is a big difference between being sore or uncomfortable than being in pain.

I have been sedated before undergoing an epidural and I've also been awake and alert for some. I prefer to be sedated but when I wasn't, it really was not too bad. No worse than having a root canal for me and the discomfort is over shortly after the procedure. Unlike the pain and discomfort some feel after having a root canal.

The actual procedure lasts only fifteen minutes to a half an hour. In fact you will probably spend more time in the waiting room than the procedure itself.

The relief I feel (especially for the pain in back of leg) has been instantaneous at times and at other times I did not feel relief for a day or so. The point is, I did get some relief. Again, this is just my experience.

So the question you have to ask yourself a question. Is a little more pain and discomfort worth the chance to finally get some pain relief that lasts? For me the answer was obvious.

The best advice I can offer you is to not fret over the procedure and go in with a positive attitude. A positive attitude is everything in my book. I also find it helps to calm my nerves as well!

In my experience, having an epidural for back pain relief was well worth the little discomfort I felt and I can only hope that if you decide to undergo an epidural that you experience the same positive results as I.

Now if I could only get rid of my stiff back.