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Expansion of IDD Therapy in the UK – a Physiotherapy Perspective

by John Wood(more info)

listed in back pain, originally published in issue 267 - January 2021

 

Co-Author

Lewis Payne MCSP Sheffield Physiotherapy

 

For nearly ten years Sheffield Physiotherapy has been using the non-invasive spine treatment called IDD Therapy spinal decompression.  We use IDD Therapy to help patients with unresolved back and neck pain, especially those with disc-related problems.

Sheffielld Physiotherapy IDD Therapy Spinal Decompression

When we started, there were only a handful of clinics in the UK using IDD Therapy.  However, the network has grown over the years as more clinics have come to understand how this treatment can help their patients who are suffering with more challenging spinal conditions recover. Like many physios, when I first saw IDD Therapy I thought it was like traction. Traction as we knew it faded out of clinical practice because at that time there were few trials that showed it to be effective. Though ask any older practitioner who used traction and they will tell you that for some patients it really helped them.

IDD Therapy got our attention initially because unlike traction of old, it was specific and able to target particular levels of the spine.

It was developed in the late 1990s in North America, to address the failings of traction and the limitations of what we can achieve with standard hands-on treatments. The team that developed IDD Therapy initially spent a lot of time making sure that there was a tangible effect on the disc at the level of the spine being targeted. 

Whilst most back pain either resolves itself or very quickly improves after a short course of physiotherapy, when it doesn’t it becomes a significant problem for both the patient and health service. Patients presenting again and again with unresolved back pain place an extra burden on GPs, pain clinics and primary care in general.  

We use IDD Therapy to help patients with disc problems, especially bulging or herniated discs with referred pain. It can also help patients with disc degeneration and spinal stenosis.

IDD Therapy at Sheffield Physiotherapy

IDD Therapy works using computer-controlled distraction or pulling forces. The patient lies on a table and is connected to the machine using ergonomic pelvic and chest harnesses.  Measuring specific angles from 10 to 30 degrees, we are able to direct the distraction forces to the targeted spinal segment of the patients, most commonly the lower back segments L4/L5 or L5/S1.

The manner in which the forces are applied is important. Firstly, a sinusoidal waveform means that the initial distraction force is brought on slowly. The force then gently progresses before slowing down to a high tension. The slow stretch applied to the Golgi Tendon Organ ensures the soft tissues remain relaxed, reducing the risk of muscle spasm and allowing us to apply distraction forces of up to and over half a patient’s body weight.

This higher tension is needed to stretch the disc reducing its internal pressure and decompress the spinal segments joints and nerves. Of course, it is physically impossible to apply such forces to a patient with manual techniques with any control or consistency.

At the same time as we decompress the disc, IDD Therapy imparts an oscillation force to gently mobilise the spinal segment longitudinally, when the joint is open. Such stretching movements of connective tissues has been shown to affect both the tissues pH as well as its plasticity and elasticity.

There are thirteen cycles each lasting one minute during which the segment is distracted and mobilised.  After each high tension there is relaxation to a lower tension which is typically half the high tension.  Whilst the soft tissues relax, a tension remains on the tissues throughout.  Each session of IDD Therapy on the Accu SPINA machine is 25 minutes, meaning that as well as thirteen full minutes of distraction and mobilisation, the soft tissues are gently stretched for the duration of the session. 

Sheffield Physiotherapy IDD Therapy Accu SPINA

Many spinal segments become stiff and immobile for a variety of reasons. IDD Therapy not only decompresses the disc, but also mobilises all the tissues of the spinal joint segment. By improving mobility, the aim is to allow the body’s natural healing mechanisms to operate more efficiently.

What has been controversial for some practitioners looking at IDD Therapy has been the number of sessions. The standard protocol of treatment is based on twenty sessions over a six to eight week period, with patients lying on the IDD Therapy machine for 25 minutes. The typical model of manual therapy is four to six sessions. However, what we, and all the IDD clinics, see is that for a certain category of patient, such short programmes simply do not work. This is likely because the mechanical and physiological changes that are required to occur within the connective tissues for a good outcome only happen progressively over time during and in the hours after each treatment. When the degenerative changes are severe enough to show up significantly on an MRI it is often unreasonable to expect symptom resolution to occur without a significant amount of mechanical energy being imparted into the tissues which has the effect of progressively restoring mobility and improving tissue physiology.

The forces used to decompress the spine are built up over the sessions, rather like a strengthening programme gradually conditions the body.  Some patients can experience symptomatic relief very quickly whilst for others it takes longer. 

It should be stressed that the 25 minutes of the machine-based IDD Therapy is one part of the equation.

Firstly, we use heat to warm soft tissues for ten minutes prior to patients going on the Accu SPINA. It is actually a new carbon-fabric infrared which replaces lamps of old and avoids burns.  It also means we get an increase in blood flow through the injured area.

After the IDD Therapy, we give patients ten minutes of cryotherapy. This is a simple cold pack applied to the treated area, either with the patient lying down or on a chair.  The work done to the spine and the stretching of soft tissues can create some soreness, rather like after an exercise programme. The cold therapy helps to reduce such soreness.

IDD Therapy is a lot more than a session on the machine itself.  When patients come to us with a herniated disc, we know that their condition has built up over time and the pain is the last stage in the breakdown. 

At different stages in the programme, we will use manual therapy. There is often stiffness in the thoracic spine and there may also be problems with hip flexors or hamstrings.

IDD Therapy helps us get the patient moving, we use manual therapy to address the underlying causes which led to the problem in the first place. We look at lifestyle factors and work on those also and of course we look at strength and posture. 

We aim to get patients into a virtuous circle of improvement rather than a boom bust cycle of pain episodes. All clinics have their own approach to corrective exercise and we work closely with the patients so that they can manage some simple exercises. Usually we see that as patients’ pain subsides and mobility improves, it becomes far easier for people to be more active, returning to some of the things they had given up doing... because it doesn’t hurt so much when they attempt them. Such success builds confidence and belief that they are on the road to recovery. At a basic level, walking, carrying and returning to normal activities helps people onto a better path of long-term improvement, with help and encouragement from us along the way.

The IDD Therapy programme has brought about a real shift in thinking about non-surgical spinal rehabilitation. The method and number of treatments is now much more widely accepted because of the growing experience of the outcomes. Indeed, some insurance companies, including AVIVA, are now paying for programmes of IDD Therapy because it can be more cost-effective and better for the patient when they avoid surgery. 

At a time when there is pressure to reduce the burden on primary care in the NHS, IDD Therapy is enabling patients to have a credible opportunity to resolve their problem, without resorting to surgery.  We believe that unless a patient has an urgent need for surgery, e.g. for cauda equina syndrome, IDD Therapy programmes can be given before any invasive treatment is considered, including injections and surgery. 

Spinal injections have their place and can create a window where conservative treatments can be applied. However, they do not address the underlying compression and immobility in the spine which is so often the root cause of the problem.  There are significant cost/benefits of providing a conservative course of IDD Therapy before invasive options are considered. 

When an injection is given for inflammation or as an anaesthetic, it seems logical to us that IDD Therapy form part of their rehabilitation. Most people try one or more forms of manual therapy before they end up having an injection. If those treatments failed initially one wonders why we would expect them to become more successful as time passes.

There are over 1,000 clinics using IDD Therapy globally.  Here in the UK there are physiotherapists, osteopaths and chiropractors providing IDD Therapy within their clinics.  We get together for a conference and at the time of writing have agreed an expanded set of measures which clinics will use to track outcomes. 

In healthcare, change happens slowly, especially within physical therapy.  Having used IDD Therapy for many years, both on its own and in combination with other modalities, we believe it provides the greatest opportunity for scalable improvement for patients suffering with unresolved back and neck pain.

About IDD Therapy

IDD Therapy is the fastest growing non-surgical spinal treatment for intervertebral discs with over 1,000 clinics worldwide and a network of clinics across the UK. http://iddtherapy.co.uk/

Facebook: IDD Therapy Europe Twitter: https://twitter.com/IDDTherapyDisc

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About John Wood

John Wood MCSP is from Sheffield Physiotherapy, a long-established physiotherapy clinic specialising in unresolved back and neck pain. http://iddtherapy.co.uk/

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