A man lying down for a treatmentShould you do maintenance decompression?

No, is the short answer…for most people. Here’s why.

Medicine is always a risk/benefit proposition. Some patients have asked me over the years, if they should do maintenance or preventive treatment after they are doing better. My usual response has been no, because I can’t prove any benefit if they have no symptoms. But I do treat myself sometimes preventively, so I’m a bit hypocritical in this regard. But I do this partly to test the hypothesis, and after doing this treatment sometimes daily for months, I remain on the fence about preventive treatment.

I do know, for sure, that it costs money and as I can’t prove a benefit, I don’t recommend it. When I do preventive treatment myself, I don’t use maximum pull because spinal decompression is a force imposed upon your soft tissues and any force can have positive and negative effects. Nonetheless, spinal decompression treatment remains the best treatment I have ever used clinically to help patients with neck and back pain, including herniated discs and pinched nerves.

Here’s a definite exception where I do recommend the treatment even when you’re doing reasonably well. I have several patients who are older and have significant degeneration of their joints and discs. Once they get better, they often have recurrence of their pain because their anatomy is compromised by their degeneration, so they can more easily provoke their pain by “overdoing it”. Overdoing it means different things to different people because your limitations are inversely related to your degeneration. More degeneration means less functional capacity, and easier provocation of pain with physical activities. With time, and by experimenting, these patients can figure out how often they need to do such maintenance treatment.

I do recommend staying as strong as possible and that means lifting weights, but you have to experimentally find out what you can do, without provoking painful episodes. As I age, I’m learning what my limitations are. It is important to make the distinction between age and degeneration. They generally correlate but they’re not the same thing. Some older people have a little degeneration, so should be better able to stay strong and lean by lifting weights. Other older people have more degeneration so have a more narrow margin for error in weight training. Notice I don’t say exercise. I say weight training. Weight training is essential for decent body composition. Without it, your body composition worsens every year, with more fat and less muscle.

Back to the topic of maintenance. If I have treated you before and you’re reasonably young, just come back when you have a problem, i.e. when it starts to bother you again. Most of the time when I help people, they won’t need to come back for many months or several years, unless they have a different problem. In the interim, stay or get fit, and practice good body mechanics, e.g. take breaks from prolonged postures like sitting, driving, gardening, and bending. Get good nutrition and sleep. Do the Asian squat for exercise to maintain flexibility and strength. I’ve mentioned these themes before in blog posts.

Here’s an example of how some older people do maintenance treatment. I have an older lady who was a surgical nurse. On surgical days, i.e once weekly, she stood for many hours and that, combined with her degeneration, meant that she needed treatment after those days. After she retired, the reduced work demands meant she didn’t need such frequent treatment and I see her infrequently now.

Another older lady has quite a bit of degeneration, and although she doesn’t work now, her normal activities of daily living bother her so much that she comes every 2-3 weeks for treatment. To each her own.

Keep in mind, that in some cases I will recommend surgery as an alternative to frequent treatment, but often times surgery is not indicated, and non-surgical maintenance is the best approach.

If I can help you, 404-558-4015. Best, Craig.


Craig Castanet, D.C.
Backstrong Non-Surgical Rehab Clinic

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