Physical agents
Spinal decompression
A programme of controlled decompression cycles used for disc-related leg or arm pain when surgery is not indicated. Its evidence is considerably weaker than its marketing: it has not been shown to outperform conventional traction or a good exercise programme, which is tried first.
Negative pressure within the disc space
A computer-controlled table applies graded axial distraction to the spine in a cycled pattern, with feedback that adjusts force if the paraspinal muscles guard. The aim is to reduce pressure within the targeted disc space, which is proposed to reduce nerve root compression and improve fluid exchange in the disc.
A course typically runs to fifteen to twenty sessions over several weeks. That is a significant commitment of time and money, and it should be entered into with a clear view of the evidence.
Who it is used for
Lumbar disc herniation with radicular pain, degenerative disc disease, facet syndrome and spinal stenosis, in patients who have not responded to conservative treatment and are not currently surgical candidates.
The same contraindications apply as for traction: instability, fusion, significant osteoporosis, tumour, infection, pregnancy, and any red flag suggesting cauda equina.
Where the evidence stands
Non-surgical spinal decompression has considerably weaker evidence than its marketing suggests 1 2. Some patients with radicular pain improve; the trials are small, and it has not been shown to outperform conventional traction or a good exercise programme 3 4.
We offer it as one option, we say plainly that the evidence is limited, and we do not recommend a long course before an exercise-based approach has been tried properly. If a provider tells you it repairs discs, they are ahead of the evidence.
The same caution, applied here
Motorised decompression is marketed extensively with claims about disc regeneration and non-surgical cure. Those claims are not supported by the evidence, and the honest description is symptomatic relief in selected patients.
It is offered as part of a programme with exercise, for a defined number of sessions, with a review point. Long expensive courses sold on the promise of avoiding surgery are the pattern to be wary of anywhere.
What do the trials actually show?
Decompression is a motorised form of traction, and the research on it is thin 1 2. A systematic review of motorised decompression for chronic disc-related back pain found that six of seven randomised trials showed no difference from the comparison treatment and concluded that its efficacy remained unproven 1. Since then, a sham-controlled trial found that adding a decompression device to a graded activity programme made no difference to pain or function, although both groups improved 3. A small trial comparing decompression with conventional traction also found no difference between them 4.
One small trial did report better pain and disability after four weeks when decompression was added to routine physiotherapy 5. None of these trials supports claims of disc repair, and UK guidance from NICE advises against traction for low back pain with or without sciatica 6.
Sources
- Macario A, Pergolizzi JV. Systematic literature review of spinal decompression via motorized traction for chronic discogenic low back pain — Pain Practice (2006)
- Daniel DM. Non-surgical spinal decompression therapy: does the scientific literature support efficacy claims made in the advertising media? — Chiropractic & Osteopathy (2007)
- Schimmel JJP, de Kleuver M, Horsting PP, Spruit M, et al. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy — European Spine Journal (2009)
- Choi J, Lee S, Hwangbo G. Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation — Journal of Physical Therapy Science (2015)
- Amjad F, Mohseni-Bandpei MA, Gilani SA, Ahmad A, et al. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial — BMC Musculoskeletal Disorders (2022)
- Low back pain and sciatica in over 16s: assessment and management (NG59) — National Institute for Health and Care Excellence (2020)
Conditions this device is used for
The 2 conditions where this device is part of a routine programme, grouped by area. It is one tool inside the plan, never the plan itself.
Devices are used inside a programme and chosen after examination — they are not booked separately.
Your path to this treatment
Nothing here is booked from a page. You send the records you have, a rehabilitation physician reads them, and you get a written answer — including when the answer is that an intensive programme will not help.
4 steps, start to finish
1.Send your records
A discharge summary from the hospital that treated the original event, and any imaging of the affected area — CT, MRI or X-ray.2.A written plan in 48 hours
A rehabilitation physician reviews the case and returns the expected duration, the recommended programme and the centre. Free, no obligation.3.Travel and admission
Where a visa is needed we issue an invitation letter and treatment confirmation naming the dates and the facility. You are met at the airport and driven to the centre by private vehicle or ambulance; a bed for one companion and interpreting during therapy are arranged.4.Treatment, then home
The programme runs, then you leave with a discharge report and a written home exercise plan. Your return journey is organised before you go, with scheduled video reviews so progress does not stop.
In their words
What patients say after a programme
Short videos filmed during therapy: a child’s rehabilitation after a brain tumour, suspended gait training after spinal cord injury, and learning to walk again after a fall. Individual results vary.
Dave Evans on his physical therapy here
Musculoskeletal physiotherapy
Paediatric rehabilitation after a brain tumour
Inside a physiotherapy session
Spinal cord injury — the rehabilitation process
Suspension-assisted gait training
Walking difficulty and restricted movement after a fall
Regaining gait and range of motion
Locations
Centres that have this device — pick one.
Questions people actually ask
About this device
Can it avoid surgery?
For people who were never going to need surgery, most conservative treatment appears to avoid it. Where there are genuine surgical indications, delaying with a long course of decompression risks the outcome.
Does it regenerate discs?
No. Claims of disc regeneration or rehydration are not supported by credible evidence.
How many sessions are typical?
A short defined course with a review. Programmes of twenty or more sessions sold in advance are a commercial pattern rather than a clinical one.
Who should not have it?
The same exclusions as traction: osteoporosis, instability, fracture, malignancy, pregnancy, and recent spinal surgery.
Should I try exercise before decompression?
Yes. UK guidance from NICE recommends considering a group exercise programme for low back pain with or without sciatica and advises against traction, of which decompression is a motorised form 1 6. Decompression, if considered at all, comes after a genuine exercise programme, as a short course with a review point.
