RE: disc pump (long reply)

[Guest guest]

Here goes my take on this. I ordered the disc pump a couple of years ago,

and at first couldn't figure out how to put it into my protocol.

but my office manager, who has a chronic back problem, had a bad flare up,

and the only thing I did that helped her was the VDP (my acronym for

Vertebral Disc Pump).

This made me look at the instrument with new eyes.

I think the key to disc and disc like problems is long axis decompression.

This can be done with McMannis, and with the VDP. I have both of these, and

I use the VDP more often, although for some patients, they love the McMannis

9 (flexion disctraction, cox table work, etc)

Here is my criteria, I find a tender place in the midline, can be L5-S1, can

be L4-5, etc, I find this best with the patient prone, if they are highly

hyperlordotic I may place a small pillow under them. I press in a superior

anterior direction, with my thumb, with significant pressure, probably 4 lbs

of so, to find the spot, it will not be just a little sore when significant,

but exquisitely tender. This is the inflamded disc. You can think of this as

the poor man's discogram, meaning its a cheap way to access information

about the deep structures of the back. There is literature on using

vibration to test this, but I talked with Karasec about this, and he feels,

and I find that digital pressure is just as useful. I did try out an oral B

toothbrush with modified head on this for a while, my fingers work just as

well.

After finding the tender spot, I mark it with a pen.

I then assess for short leg, and block the patient SOT category 3. This

means on the short leg side, the block is low, under the trochanter, and

points obliquely downward. The upper block is under the iliac crest on the

long leg side, and also points obliquely downward. So the blocks do not

point toward each other, but both are pointing about 45 degrees downward.

If this is the correct blocking positiion, when I go back to the inflamed

tender level, the tenderness will be somewhat diminished. If not, I play

with the angle on the lower block, or even try reversing the blocking. On

rare cases, it works better to just bilaterally block under the ilium, with

the blocks directly across from each other. Again, diminishment of

tenderness is my final arbiter.

Next, use the VDP, with about 6 reps of separating the vertebrae at the

involved level, holding for 10 seconds each time. You can attempt this

manually. I call my VDP my " hands of Shaquille O'Neal " , because it gives me

stronger hands. When I do it manually, I put one hand on the sacrum, and

the other hand on the lower border of the spinous at the involved level. The

VDP is better for giving more leverage, and by putting the pressure

paraspinally, its less tender or less painful to the patient.

When you are done, the interspinous space should now be minimally tender.

It works like a charm, don't forget all the other good stuff we do for

patients, I'm appending and attaching my general criteria of what I do for

discs. Like any chiropractic procedure, you will probably need to do the

procedure several times, discs are tough to change.

I am current trying out the Vertetrac, an ambulatory traction unit, traction

while the patient walks, for my discs, but I just got it yesterday, so the

jury is still out.

PS- I never could figure out how to use or make effective the cervical disc

pump, so I sent it back and they sent me another lumbar unit, I've got one

in both of my treatment rooms.

Vertebral Distraction Pump is from

Bray Corporation

Dr Bruce Broughton

18245 Hwy 18 suite 6

Apple Valley, Ca. 92307

phone 760-946-4619

he sells a set of 2, one for cervical and one for lumbar for $350 US or so,

I didn't find much use for the cervical one, and they were willing to

exchange it for a second lumbar unit

Disc Protocol- by Marc Heller, DC

Manual Methods to reduce biomechanical stress

1- use low force methods, or at least non-rotary methods, to decrease spinal

dysfunction of lumbars

2- balance pelvis

3- consider McMannis/ table distraction

4- McMannis as static traction, special set up

5- Vertebral distraction pump with category 3 blocking

6- Assess and release sciatic nerve and femoral nerve

7- Assess and release dural tension, from cranium thru spine

By end of each session, the interspinous spaces should be non-tender at the

involved segments, this is a good way to keep score.

Exercise

Establish bias- usually extension bias for fine-tuning exercise

1- piriformis, making sure they are not doing it in flexion. This generally

means sitting piri with large bolster under them, or prone piri. Supine

piri may also work. Sitting piri probably won’t.

2- Nerve root mobilization, see form for this. Add lumbar fulcrum

If this is working, it will immediately improve ROM of SLR

3- Extension exercises, a la McKenzie, I tend to use prone and against wall,

although McKenzie does show a regular standing version. I also like one leg

press ups, although it’s a little tricky to do these on a bed, is better on

a table.

4- Abdominal bracing, and understanding of bending forward from the hips

while using abdominal bracing. Abdominal bracing has impressive literature

support, and helps make the whole trunk work effectively as support,

decreasing the backward pressure from the disc.

5- Repetitive instruction on keeping movement going thru micromovement,

getting up from sitting, etc.

Belts- consider use, either while acute, or while doing physical bent over

labor, or prolonged sitting. Again, goal is to decrease posterior trunk

loading. May also use SI belt, may help decrease sitting pain, stabilize

pelvis.

Modalities- We use frequency specific microcurrent, as taught by Carolyn

McMakin, DC. We often find it helpful.

Anti- Inflammatories- Pharmaceutical and/or natural. I think they are

effective dealing with the chemically mediated aspect of the disc pain.

Consider one of the pharmaceutical, stronger, long acting ones, for a

period of a few weeks. Botanical anti-inflammatories include enzymes, such

as bromelain or mixed enzymes (Intenzyme-biotics), and ginger-tumeric mix,

and fish oil or flax oil, and anti-oxidants.

Steroids- a more allopathic approach, that may be needed for severe

inflammation. Epidural steroids- especially with specific injection, are

often effective, oral steroids also work.

Here's another blurb I wrote on discs

Midline tenderness- Indicator for Disc irritation

I find that even after I’ve corrected various factors as I outlined above

and continue with below, the patient will often still show midline

tenderness. This is an important factor to correct for optimal results. I

strongly suspect that this midline tenderness is an indicator of

inflammation at a deep level, probably from the disc. A recent paper in

Spine spoke to using a modified electric toothbrush to assess the

interdiscal space, via vibration. In private conversation with

Karasec, a neurologist who specializes in back pain, he stated that he

thinks that direct digital pressure gives the same information.

Here’s what I do when I find this indicator still showing up after I’ve

completed my other corrections. I have not yet come up with a clearcut

restriction type indicator for this, so my indicator at this time is

strictly tenderness.

This whole procedure is done with the patient prone. First, I mark the

specific midline segmental level that is most tender. I check for the short

leg, prone. On the short leg side, I block with the SOT block under the hip

joint, facing obliquely downward, lateral to medial. On the other side, I

block under the pelvis, again obliquely down, lateral to medial. This is

category 3 blocking, used in SOT for hot low backs, or disc problems. The

blocking should reduce the tenderness by 50% or more. If it doesn’t change

the tenderness, I’ll change the angle of the lower block, and see if it

makes a difference in the tenderness. If not, I will switch sides with the

blocks. If this doesn’t help, especially in a hyperlordotic patient, I’ll

block with both blocks under the pelvis.

Now, I’ve found a blocking position that eliminates 50% of the tenderness. I

’ll leave the patient there for at least 2 minutes, longer is often better.

While they are lying there, I will further separate the involved vertebrae.

My preferred tool is the Vertebral Distraction Pump, but I can do this

manually as well. If I am doing it manually, I’ll use ELF, and line up my

exact forces. One could also use flexion-distraction to get a similar

effect. I have a McManis table, but since getting the VDP, I rarely use it.

This combined procedure, the blocking plus the distraction, will usually

eliminate 90% of the tenderness. It’s often the last thing I do. If you

have a symptomatic low back that looks like a disc, and this procedure is

having no effect, it may mean that the degree of chemical inflammation is

extreme, and the patient may need an epidural steroid or some other strong

anti-inflammatory therapy.

The Dura and Nerve Root

We need to address the tension of the dura and nerve root. One aspect of

this is the nerve gliding, nerve tension concept. I like Mark Bookhout’s

pioneering integration of nerve tension work and dural tension (cranial

based) concepts. Simply put, we can use hamstring tightness as an

indication of nerve root tension, and use a combination of nerve gliding

with an externally applied fulcrum (the doctors contact or a tennis ball for

self-mobilization), to free dural restrictions while we are gliding the

sciatic nerve by stretching the hamstrings. We will teach a simple version

of how to use a fulcrum with nerve gliding. It’s a simple exercise that the

patients can do themselves. We’ll also teach a similar procedure as an

in-office procedure that decreases the tension on the nerve root

dramatically. Our reality check for nerve root irritation is the SLR. If the

procedure works, it will improve the straight leg raise immediately. This

is a simple procedure. Here it is. You will also receive this as an exercise

handout.

Eval- Supine, Treatment- Supine

Nerve Tension Release- Hamstring and Sciatic Nerve stretch

As pictured, lie on your back, and grasp behind the knee. You may

support your head with a pillow, if this makes you more comfortable.

Start with your knee bent, and slowly straighten the leg, letting your leg

down as soon as you feel a stretch.. Keep your toes pulled back toward

your shin, don’t point your toes upward. You should feel tension in the

back of your thigh or behind your knee. You should not feel sharp shooting

pains in the leg or back. You can increase the tension by bringing the

thigh across toward the opposite thigh, holding it there with your arms

while you straighten your leg.

Repeat slowly 10 to 20 times, 1-3 times per day.

Variation 1: You may be shown how to do this with a tennis ball behind your

low back on one side or the other.

What does this exercise do? You can have an unnecessary pull or tension in

your main nerve trunks and the lining of your whole nervous system (the

dura). This tension can be most easily accessed in the the neck, and the

low back.

When you straighten your bent leg you help release the whole nerve trunk.

We may have you hold, or stabilize, the other end at the back or neck., as

in variations 1 and 2.

DO NOT OVERDO THIS ONE!

BE GENTLE, ESP AT FIRST

For the in office version, place your hand, at the level of the most

restricted spinous junction, pulling into the barrier, while the patient

does the leg lift.

McKenzie- for extension bias

A second aspect of nerve root tension is related to the McKenzie concept. I

’m a simplifier, so I’ll state my basic understanding of this. If the

patient repetitively flexes, does this worsen or improve their leg symptoms

or signs? If the patient repetitively extends, does this improve or worsen

their leg symptoms or signs. For example, repetitive extension decreases

leg or buttock pain, and improves the SLR, so give the patient McKenzie

extension exercises. These are a simple, easy to use, way for the patient to

ease tension on the sciatic nerve. When they work, the patient can tell the

difference, and will be motivated to continue.

Eval- Standing, Treatment- prone or standing

Muscular Imbalance

One factor here is the patterns of muscular imbalance which develop with any

injury, overuse, or inflammation. Again, the operative word is ANY.

Whatever the source of the problem, the muscles will react within a typical

pattern, as outlined by Janda, and taught by Liebenson. This would include

hamstring, piriformis, rectus femoris and psoas hypertonicity, and

weakness/inhibition of the deep fibers of the multifidus, transverse abs,

gluteus max, gluteus medius, and quadriceps. The brilliant work of the

Australian physical therapists has clearly shown the significance of the

transverse abs and the multifidi. This has to addressed with simple

exercises and with manipulative correction of abnormal movement. Research

has shown rapid local atrophy of the multifidi after any spinal injury. The

muscular pattern, even if not primary, will continue to reinforce the

aberrant movement patterns, until rehab is underway.

We’ll review as much of this as we have time for.

Marc Heller,DC

mheller@...

www.DrMarcHeller.com

987 Siskiyou Blvd.

Ashland, OR 97520

541-482-0625

disc pump

Can anyone tell me if the disc pump is effective. How does it

compare with flexion distraction? Thanks, Ed Lanway.

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