1. Intervertebral Differential Dynamics (IDD)
SPINAL DISTRACTION THERAPY
Doing more to beat back pain, neck pain, sciatica and trapped nerves
Spine Plus Chigwell
2a Oak Lodge Ave, Chigwell, Essex, IG7 5HZ
Tel: (020) 8501 0937
www.spineplus.co.uk/iddtherapy
2. The Back Pain Treatment Gap
1/ Despite a variety of treatment options, the number
of people with chronic back pain shows no sign of
decreasing
2/ A significant population of back pain and neck pain
sufferers exists who do not achieve desired outcomes
from existing manual therapy and exercise techniques.
3/ Patients want non-invasive treatments, they wish to
avoid injections and/or surgery and are seeking new
solutions to help them resume normal active lives
Providing technologically-advanced solutions
for low back pain sufferers gives health
providers to do more for their patients and
attract new patients to their clinics. 2
5. IDD Therapy Spinal Decompression
1. Improve Disc Health
2. Re-educate soft tissues
3. Re-align spinal structures
Three Principal Treatment Goals
IDD Therapy Treatment Protocols
developed to treat targeted segments
of the spine as part of tripartite
treatment programme including
manual therapy and rehabilitation.
6. 1 - Improve Disc Health
• Precisely angled pulling force distracts targeted spinal segments
• Joints distracted in longitudinal plane, not anterior -posterior
• Vertebrae opened to create pressure differentials in the disc space
• Negative pressure to promote retraction of bulging nucleus
• Stimulate fluid exchange by diffusion to help improved disc health
• Improve mobility to free natural nutritional pathways for the disc.
7. The Effects of Compression
A compressed sponge loses water
and is unable to absorb water.
Decompressing (taking pressure off)
the sponge allows it to absorb
water.
8. 2 - Re-educate Supporting Tissues
• Works soft tissues by stretching weak
muscles and working tight ligaments
• Increase flexibility to improve joint
mobility and range of motion
• Creates a platform for strengthening
exercises to support the joint and
relieve pressure on the disc
• Reduced tension and greater freedom
of movement opens nutritional
pathways to the disc
9. 3 - Realign Spinal Structures
• Joint mobilisation in longitudinal
Plane
• Promotes fluid transfer around the
joint
• Gently mobilises the facets to reduce
stiffness and increase range of
motion
• Targeted distraction to help realign
spinal structures and balance load
12. Understand the origins
• 1995 Study by Ramos & Martin –
measured the effects of vertebral
axial decompression (Journal of Neurosurgery )
• Recorded a reduction in intradiscal
pressure from +60mm Hg to -100mm
to -160mm Hg
Pressure differentials promote
fluid exchange within the disc
space to aid improved disc
health and to help retract a
bulging nucleus pulposus.
Ramos G and Martin 1. Effects of vertebral axial decompression on intradiscal pressure. J Neurosurg. June 1995. 82 (6): 1095
13. • Leads to the creation of the IDD Therapy spinal
decompression protocols.
• Distraction observed at different spinal levels
by altering the angle of application and the
amount of distraction force.
1997, Shealy & Bourgmeyer test established scientific principles to
to develop new thinking for treating targeted spinal segments.
They perform a single blind RCT comparing traditional traction
with new distraction decompression techniques, (American Journal of Pain
Management).
Origins cont/
With fluoroscopy, measure
a 7mm distraction at L5
Shealy CN and Borgmeyer V. Decompression, Reduction and Stabilization of the Lumbar Spine: A Cost- Effective Treatment for
Lumbosacral Pain. American Journal of Pain Management 1997. 7:63-65
14. Fy
Fx
Vector Illustration of Altered Pulling Force Angles
As the angle which a pulling force makes with the horizontal increases,
the component of force in the horizontal direction (Fx) decreases and the
vertical component of force (Fy) increases.
This causes the relative direction of the pulling force to change and therefore
the focus point of application of the pulling force to move progressively along
the X-Axis.
AB
15. Pulling forces angled to
treat targeted segments
Note: Angles shown for illustrative purposes, not to scale.
Increasing the angle causes
the point of application of
the pulling force to move
along the spine
Further increase enable us to
target different spinal
segments
The Effects of Increasing Pulling Angles on the Spine
16. Linear vs Sinosoidal Waveform
• Mechanical linear force is
unnatural to the body
• May prompt muscle spasm
• Cause actual increase in intradiscal
pressure
• Natural to body, non linear pull
• Applying slow stretch to Golgi
Tendon Organ causes it to fire,
inhibits tension in the muscle
• Allows parallel elastic component
(sarcomere) of the muscle to
remain relaxed and lengthened
17. Intermittent Distraction
• With conventional intermittent traction, the force is typically ON or OFF
• Spinal decompression has a maximum high tension and a low tension
• The low force does not go to zero, so tension is maintained throughout
treatment
High Force
Low Force Distraction maintained
18. • Cycles of tension force with a maximum distraction applied for one
minute with thirty seconds rest
• One minute is enough to effect an autogenic inhibition on the multifidi
and erector spinae muscles
• Using a continuous cycle of inhibition for fifteen minutes will result in a
relaxed muscular state and better trunk range of motion
• Tight ligaments, especially the posterior longitudinal ligament, will also
benefit.
• Collagen fibres exposed to continuous stretch can increase in length by up
to 10% of the original length
• Ligaments including the anterior longitudinal ligament, interspinous
ligament and supraspinous ligament may also loosen to de-restrict the
joint and increase mobility.
Intermittent Distraction cont/
19. Oscillation & Joint Mobilisation
• Patented oscillation feature which is achievable by having the sinusoidal
waveform
• Top of the high hold when the joint is under distraction, oscillation
mobilise targeted joints
• Mobilisation in a longitudinal plane rather than an anterior-posterior
plane
20. Benefits of Mobilisation in Longitudinal Plane
• Eliminates problems associated with
repeated frictioning of the facet joint
surfaces
• Facet joints glide over one another
• Relieve pressure on the discs and neural
structures of the spine
• Pressure differentials create pumping
action to promote fluid exchange in the
joint
• Works tight muscles and stiff ligaments to
promote increased joint mobility.
• This is not possible with traction devices
and impossible to achieve manually at such
forces and for such duration.
21. Longer Treatment Duration
• Typically traction is applied for ten to fifteen minutes only
• Insufficient time to bring about physiological changes
• IDD Therapy spinal decompression lasts for twenty-five minutes
• The application of the force is comfortable so that higher pulling forces
can be maintained
FULL TWENTY FIVE MINUTE TREATMENT
22. Improved Harnessing Techniques
• Old harnesses did not lock the pelvis and thus were prone to slippage
• Uncomfortable nature of old harnesses could constrict the patient
uncomfortably as higher application forces are applied.
• Improve the harness design using modern materials and design
techniques, including an inbuilt air bladder at the rear.
• Harness is secured comfortably on the pelvis and patient is secured at the
top of the bed, with the harness following the lines of the rib cage.
23. • Measured angle of distraction targeted to specific levels
• Sinusoidal waveform pulling force to avoid spasm
• Stronger pulling forces to achieve distraction
• Twenty five minute treatment duration for soft tissue change
• 13 minutes of maximum disc decompression to promote
fluid exchange
• 13 full minutes of Oscillation / joint mobilisation for improved mobility
• Treatment components occur concurrently, not successively
IDD Therapy – Treatment Summary
High
Force
Low Force Constant Distraction
Joint mobilisation
Twenty-five minute treatment
Sinusoidal
Waveform
24. IDD Therapy Protocols
The IDD Therapy Guidelines exists of a constantly expanding set of protocols
for keeping today’s medical standards en best pratices:
• Herniated Discs Protocol, L5-S1, L4-L5, L3-L4, L2-L3, L1-L2
• Degenerative Disc Disease Protocol, L5-S1, L4-L5, L3-L4, L2-L3, L1-L2
• Posterior Facet Syndrome Protocol, L5-S1, L4-L5, L3-L4, L2-L3, L1-L2
• Sciatica Protocol
• General Low Back Pain Protocol
North Amdericam Medical and its distributros accept no medical liability for the applications of these protocols, in whole or in psrt.
• The IDD Therapy treatment protocols were developed to help guide
clinicians treating targeted spinal segments.
• The standard protocol is based on a series of 20 treatments spread over a
6 week period.
Five treatments per week for two weeks - No Exercises.
Three treatments per week for two weeks - Passive Exercises Only
Two treatments per week for two weeks - Active Exercises
• Herniated Discs Protocol, L5-S1, L4-L5, L3-L4, L2-L3, L1-L2
• Degenerative Disc Disease Protocol, L5-S1, L4-L5, L3-L4, L2-L3, L1-L2
• Posterior Facet Syndrome Protocol, L5-S1, L4-L5, L3-L4, L2-L3, L1-L2
• Sciatica Protocol
• General Low Back Pain Protocol
See IDD Therapy Protocol Book for full details
26. Optional Treatment adjuncts
FAR infrared before IDD Therapy for deep tissue
heat:- increase blood flow, relax muscles, warm
ligaments and aid healing
Cold Therapy after treatment. Stretching creates “micro
trauma” as soft tissues adapt. Helps reduce soreness
Anti-inflammatories may be taken in the initial stages
of treatment at the guidance of the clinician
Some patients with joint problems may also choose to
take dietary supplements to support the joints.
27. EXERCISE
• Treatment forms part of a rehabilitation programme which
includes exercise training
• As well as education
28. •Sciatica or radiculopathy
•Herniated or bulging discs
•Degenerative discs and joint diseases
•Spinal stenosis
•Facet syndrome
•Chronic low back and neck pain
•General low back pain
IDD THERAPY - Indications
A typical patient has back or neck pain > 3 months. Has had one or more types of
conservative treatment and yet is still in pain. Is likely to be taking pain killers and
may or may not be considering invasive procedures.
29. • Pregnancy
• Patient younger than 15
• Patient weight greater than 425lbs
• Severe osteoporosis (T-score -2.5 to -2.8
or greater)
• Congenital abnormalties of the spine
• Pacemakers
• Unstable post-surgical conditions
• Any kind of surgical hardware (if in the
area being treated)
• Spine instability (Doctor’s precaution)
• Recent vertebral fracture(s)
• Open growth plates
• Severe canal stenosis
• Rotatory or severe scoliosis
• Abdominal aortic aneurysm
• Some annular tears (Doctor’s precaution)
• Spondylolysis
• Spondylolithesis (Grade II or higher)
• Vertebral fusions, less than 6 months old
• Inflammatory, infectious or neoplastic
conditions
• Meningitis
• HNP (sequestered/ free floating fragment)
• Multiple myeloma
• Osteosaracoma
• Osteomyelitis
• Hemiplegia
• Cauda equine syndrome
• Severe peripheral neuropathy
• Paraplegia
• Pelvic or abdominal cancer
• Pars defect
IDD THERAPY - Contraindications
30. • A suitable scan is recommended to assist
the clinician in ruling out
contraindications.
• The scan may also help the supervising
clinician to confirm diagnosis of the
pathology and to the targeted level.
• It is recommended that IDD Therapy
patients undergo a suitable scan, although
treatment may be given without a scan at
the direction of the supervising clinician.
PATIENT SCAN
32. McClure & Farris examine 415 patients treated with IDD Therapy
programmes. Treatment success measured as 50%+ decrease in
average pain scores taken at 2 months and 2 years.
(European Musculoskeletal Review, 2006
IDD Therapy Spinal Decompression cont/
92% Success rate in 129 patients
categorised as surgery candidates
McClure D and Farris B, Intervertebral Differential Dynamics Therapy – A New Direction for the Initial Treatment
of Low Back Pain. European Musculoskeletal Review 2006. 45-48.
33. MRI Evidence
“Not only provided symptom-
atic improvements, but also
showed reduced disc herniation
and improved disc hydration
after only 11 sessions.”
Eyerman EL, Journal of Neuroimaging 1998
Eyerman EL. Simple Pelvic Traction Gives Inconsistent Relief to Herniated Lumbar Disc Sufferers.
Presented to the American Society of Neuorimaging and printed in the Journal of Neuroimaging. June 1998.
34.
35.
36. • Clinic opened in 2000
• Clinic director (Robert Shanks) felt that we were not doing enough for patients
with disc problems and that their only other treatment options were injection
and surgery.
• Looked into experiences of Alan Stoddard (famous osteopath and orthopaedic
physician in the 60’s. Alan Stoddard’s booked had section on treating
disc problems using regime of “intermittent sustained spinal distraction”.
• Robert had a replica of Alan Stoddard’s cervical distraction harness made and
started treating appropriate patients using Alan Stoddards protocols.
• The results more or less replicated those described in Stoddard’ book.
• Subsequently bought lumbar traction machine from America capable of
exerting intermittent sustained traction on the lower back.
• Soon started seeing positive outcomes for lower back disc problems in addition to disc problems in the neck.
• Was introduced to IDD therapy by the European distributor in 2009, at which time there were only two clinics in the UK
offering IDD therapy.
• Within 18 months this had grown to 5 clinic.
• Robert Shanks visited the Brighton to try personally try their machine in late 2010. Very impressed by the result “feel” of
the machine and ability to target segments of the spine.
• Machine installed at Chigwell in April 2011.
Chigwell Osteopathy & Physiotherapy Practice
Our history with traction based treatment for
discogenic disorders
37. Patient 1 (RT): Had been attending the practice intermittently for the last 3 years due to persistant pain and back spasms around the
thoroco-lumbar area. MRI revealed small herniation and spondylosis with secondary mild facet inflammation at L1/2. She had had
two opinions from spinal surgeons, both of whom deemed her inappropriate for surgery. Two rounds of facet injections / denervation
failed to produce any improvement lasting more than a few weeks. The only thing keeping her going was the acupuncture and (old
style) traction at the practice. After just 3 sessions of IDD targetted to the L1/2 disc she has been virtually pain free (no muscles
spasms) for over 6 weeks, back doing housework, cleaning windows etc.
Patient 2 (DC): MRI showed general wear and tear in her lower lumbar segments. Her symptoms wear general back ache with some
vague referral to her leg on exertion (in keeping with the stenosis picture). She booked in for 3 IDD sessions in one week but
cancelled after the second session as she felt so good. Darren checked up with her last week and she has remained virtually
symptom free, she is extremely please with the result (and Darren is amazed!).
Patient 3 (SM). Completed the full 20 session programme. He came to us with a 4+ year history of sciatica. He had previously been
seen several other therapists including a chiropractor who had been performed numerous sessions of tradional traction and
acupuncture – without any improvement in symptoms. Two year old scans showed a massive L5/S1 disc extrusion with a sequested
portion, this was mainly in the canal (not formamina - hence his SLRT was better than expected). Initially I gave him quite a bad
prognosis and encouraged him to look into having a microdiscectomy, however he had heard about IDD and wanted to pursue it. On
completion of the 20 session programme (incorporating IDD, medical acupuncture and a home Pilates exercise programme) he
noticed some functional improvement and reduced pain levels and number of “bad days”. He had a fresh MRI which has revealed
total resolution of the sequestration and definite reduction in the size of the extrusion. Theses scans were two years apart - and one
could suspect that the improvements in disc structure could had have happened anyway (i.e. in absence of IDD). HOWEVER, I had
Dr Sajid Butt (consultant MSK radiologist from the Royal National Orthopaedic Hospital in Stanmore) go through the two scans with
me and he was amazed to see that the most recent scan showed definite regeneration of the nucleus pulposus i.e. rehydration of the
disc (original scan show a very diffuse, broken down nucleus whereas the new scan had clearly deliniated edges and more intense
T2 (white) signal. Dr Butt encouraged me to keep going with this chap and to avoid sending him for microdiscectomy, at least for
now!
Case Studies
From patients treated with IDD at Chigwell
Osteopathy & Physiotherapy Practice since April 2011
