Why Every Decompression Doctor Needs to Know the Research

Hey there and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now.

Well, all right, docs, welcome to today's episode of the Practice Builders Podcast. I'm your host for today, Dr. Kyle Pankinen, and I'm gonna bring a topic to you today that probably might not strike you as an obvious topic at first to build your practice, but I think it's an important one. So we're gonna call this Why Every Decompression Doctor Needs to Know the Research. So I'm going to talk about the big picture of why, if you're a decompression doctor, you really need to just understand, have a basic understanding of what the research shows so that you can communicate that to people that need to know. But also, this is going to increase your confidence and it's going to distinguish you As an expert. If you're in the world of niches, it's not enough just to know, okay, this is our protocol for X, Y, or Z condition, but you should become a master of that niche. You should know it inside and out. You shouldn't— if you're a decompression doc, you should know chronic neck or back pain like the back of your hand, in a sense. And One way you do that is to keep on top of all the latest research. So if you offer spinal decompression in your practice, here's a question I want you to think about. When was the last time you read a research paper on it, on the topic of spinal decompression? Not just some manufacturer's brochure, Not something maybe, you know, you saw on a Facebook thing or, you know, in Dynamic Chiropractic or whatever. Not something another doctor said at a seminar. And I'm going to be sharing some of the latest and greatest research at upcoming Decompression Summit certification here at the end of September 2026. But I'm actually just talking about when was the last time you really sat down and looked at a study? You know, you looked at who were the patients, what type of condition did they have, what treatments were performed, what did they measure in the study, how much did patients improve in the study, and probably sometimes more important, what the study proved and maybe what it did not improve. Because I believe if you're going to position yourself as a decompression specialist, You gotta understand the science behind what you're doing. You, you're becoming a master of this decompression science. So that's what we're going to talk about today. We're going to share a couple studies maybe at the end, just some of the latest ones. Like I said, at the summit coming up, I'm gonna share probably— I think there's, oh, 8 or 10 studies that I'm gonna just highlight that have come out over the last year. I might have missed one or two in there, but I got the majority of them. We're gonna cover them at the summit. It's clinically important to know this. It's important for building your practice. It really is. So let's dig in a little bit more. See, one of the problems we've had in Our profession for years is that sometimes the marketing has gotten a little bit ahead of the research. See, we have all heard statements like what decompression puts the disc back in. Decompression creates negative pressure that sucks the herniation back into place. Decompression works what fill in a blank eighty six ninety one. percent of the time. But where did those numbers come from? Where do those statements come from? What was actually measured, for instance? What patient population was studied? Those are questions we need to be able to answer if we are going to ask patients to invest sometimes a pretty sizable chunk of change in their health. To us, I think we owe it to them to just know the evidence. Okay, so research makes you a better clinician. Okay, it makes you better at selecting patients because if you know the research on decompression and disc conditions, you know which ones. Are more likely to respond than not. We're gonna be teaching that in great detail at the upcoming summit, which discs get better statistically compared to other types of disc conditions. So the question should never be, does decompression work? I mean, as decompression doctors, we see it, We know it works. Well, that's, that's too broad of a question. The better question is, for which patient, with which pathology, at which stage of the condition, using which protocol, is decompression most likely to help? That's where knowing the research can help us, docs. Okay. See, that's a completely different question as does decompression work? Because a 42-year-old patient with, say, an L5-S1 contained disc protrusion and radiculopathy, well, that's not the same patient as an 82-year-old with severe multilevel degenerative stenosis. Those are 2 completely different patients, different animals. They both might have back pain. They both have leg symptoms likely, but their pathology is different. Their prognosis is different. And the role that decompression plays may be different. So that's why research matters. Research also, so it can make you a better clinician, It can improve your consultation. More and more people, they're looking up some of this on their own. They're becoming more educated. So they walk into your office and say, doctor, is there actually research on this? Well, there's a couple different ways you can answer that. The first answer is absolutely there's research. I've been doing this for—

30 years.

10 years, whatever, 5 years, 20 years, and I've seen it help thousands of people. Well, that's valuable experience. In my own clinic, I tell patients this. I'll say, I've been doing decompression since 2016. I've kept statistical analysis on every— and this is the truth— every single patient I've done it on over that time. And year in and year out, we hit between an 85% and 93% success rate.

Wow.

Meaning that percentage of my cases, 85 to 93%, saw at least a minimum of 50% or greater improvement. Okay, that's valuable. But another step above that is you could say, yes, there are randomized trials, there are MRI studies, there's Clinical studies evaluating non-surgical decompression. And, you know, I always provide prospective patients in a folder with a highlighted research study. On the table that I use in clinical practice, I'll highlight a couple lines of the study, maybe, you know, percent improvement, number of patients in the study, Satisfaction rate, maybe MRI change, things like that. That's the type of stuff where research can become very valuable in the consultation and/or things that you send home with them day one that might help move the needle in the direction. So it can help. The consultation and the case acceptance. So which doctor sounds more credible? Well, I think a combination of both. In my case, I use my own stats and I use research evidence outside of my clinic. Okay, that can increase— it not only increases your confidence. But it increases the patient confidence. Hey, in their mind, this doctor's been doing this for a decade. He keeps track of every patient he does it on. He also knows the literature. Here, oh, he gave me this research study, and they show it to their husband or their wife or whoever they make decisions with. That can be a big-time help, docs, just that little thing alone. So those are the 2 biggest things that I see. Research just helps you build your authority. It helps you become the, the go-to decompression doc in your area. So if we want to become the— if you want to become the decompression authority in your community, you should know more about decompression research than anyone else in your community. You should be able to talk intelligently to patients, bringing it down to their level, but you should also be able to talk to colleagues, other chiropractors, medical doctors, neurosurgeons, orthopedic surgeons, physical therapists, attorneys. When somebody asks what's new in the world of spine research or your specialty or decompression, boom, Oh yeah, new study came out last month. Here's some highlights of it. You should be able to have a working knowledge of the research, and this is going to set you apart from the average doc down the road that just owns a decompression table, but they're not a master of decompression. There's a difference. There's a big difference in patients' eyes, in your colleagues' eyes, and so, and in building your own confidence. That's something I really like to— I talk about a lot is it just builds your own confidence, and that's huge. Patients can sense a doctor that is giving them a line but not super confident in that. Those doctors that speak with— Confidence. Authority, certainty, and clinical confidence. So let's just talk about a couple, 3 recent studies. One is a relatively large real-world clinical study. There's one that's a randomized trial. If we have time, we'll talk about an MRI-documented case study. So the The biggest study that came out over the last year was a 2025 study out of the University of Southern Florida. It was called A Retrospective Chart Review of Nonsurgical Spinal Decompression as a Therapeutic Modality for Low Back Pain, published in Military Medicine, September '25. There is a few— this is an interesting study for several reasons. First, it has got a little bigger size. Always like that in research. 267 patients, records from 7 different clinics. Okay. Most of the decompression studies that have been done over the years, there's a couple exceptions, but most have been done on a smaller patient sample size. So I like the bigger. That's big time in terms of There's more credibility to the study. They did 20 sessions of decompression. That adds to the evidence. Most of the studies where they had a little more what I call robust protocol that were done on bigger groups of patients, that are some of the better studies, that 20 to 24 That seems to be the range. So this study kind of confirms what we teach our doctors at Specialized Practice. That's the dosage for a true decompression case where they maybe have had some chronic pain. There's some MRI documentation of a disc or exam and X-ray confirms that this is likely a disc case.

Yeah.

And they maybe have tried one or two other interventions that have failed. You know, that, you know, it's working towards, yep, this is likely a decompression case that needs the full meal deal, 20 to 24. We always recommend 24. So in this study, and they did it over 8 weeks, so that's about 2 months. Usually we recommend 3 months because— Studies seem to indicate 3 months is a little more optimal healing time for most discs, but this was 6 to 8 weeks. In this study, they didn't just measure pain. They looked at pain, but they also looked at reflexes, myotomes, dermatomes, and activities of daily living. So they looked at something beyond just pain. They looked at some objective findings and some outcome assessments. So what'd they find? Well, the pain improved from an average of 6.9 out of 10 to 2.5 after the 20 sessions. So that's an average of 4.4 points on a 10-point scale. Approximately 90.5% of patients reported some reduction of pain.

Wow.

That's so, you know, there's a you can glean something. A little larger study, little over 90% of people saw some reduction of pain. Okay, they also reported reflex improvement in about 61%, myotome improvements in 75%. In other words, they found a deficit. And in those percentage of people that had a deficit, it improved. Dermatomal findings improved in approximately 78%, and activities of daily living improved significantly as well. So these are— they're impressive real-world findings. You know, this is just— here's a group of patients, we reviewed the charts, we collected the stats, and this is what we found. So I like this study for many reasons. Most decompression doctors immediately focus on the pain, and I do too, but they evaluated neurological function and ADLs. Okay? So that's important. We're not simply asking, does your back hurt less? We're asking, are you functioning better? And so is that not what we ask our patients to? Is that not what we track as well? So I always have docs that we teach us. We always have— I've had my patients fill out an Oswestry Back Index beginning of treatment, usually midway through, and usually at the end, because I want to track how their pain is affecting their activities of daily living, their walk, their They're sleeping, or how long they can stand, things of that nature. It's important to track that, not just what is your pain today and pain at the end, because pain sometimes doesn't always reflect how much functional improvement they may be gaining. Okay, so those are meaningful clinical outcomes. There's some limitations in the study. There's no randomized group. A control group. In other words, there was no sham decompression. In other words, it wasn't compared to some other form of treatment or no treatment. Okay. So, and treatment wasn't standardized across every clinic. So we can take this study and say, this proves that decompression caused all these improvements. No, you can't go that far. But that's not a retrospective study that can't prove that. You need to randomize, okay? But what we can say, that is a fairly large group of real-world patients receiving decompression, they saw significant improvements that were documented across pain, neurological function, and ADLs. And that's encouraging. But it needs to be followed up with with a randomized prospective research. Okay, so that's very good though. So what can you tell a patient? Hey, study just came out this last year and 296 patients, over 90% of them saw some improvement, and not only in pain but in their aid, their their function, what their pain was taking from their life. And I've covered that on. podcasts lately, we always want to know, go after that 50% or more improvement of pain, but we also want to know how is your pain affecting— what, what is the thing that's most taking from your life? Well, that's kind of what they're tracking here.

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Another study, a 26-randomized trial on decompression versus stabilization exercise. The title of it was Comparison of the Therapeutic Effects of Robotic Spinal Decompression Therapy and Lumbar Stabilization Exercise In patients with lumbar disc herniation, a randomized controlled trial. This was published in Korea. 34 patients, so small study, with lumbar disc herniation. They were randomly assigned to 2 groups. So about what, 17 in each, right? 17 got decompression, 17 stabilization exercise. 30-minute treatments, 3 times per week for 8 weeks. What does that equal? 24, right? So that last study was 20, this is 24. There's— that's why we, we say 20 to 24 is the range. Here's what makes this study particularly interesting. They didn't only measure symptoms, they also used MRI. So that's, that's pretty cool. They looked at pain, the Oswestry, motion, and disc protrusion on MRI. The MRI measurements were performed by blinded orthopedic specialists. So that's some credibility. It reduces some potential measurement bias. So what happened? Both groups improved. Pain improved, disability improved, range of motion improved. There wasn't a big significant difference between the 2 groups. The lumbar range of motion extension improved more in the rehabilitation, the stabilization exercising group. But both groups were helped. But then the interesting finding is this. The decompression group showed significantly greater reduction in disc protrusion on MRI compared with the stabilization group. That's a pretty interesting finding. So for years we've been saying one of the proposed mechanisms of decompression that it helps to it affects the disc. But we've— in this study, they objectively measure it. They can objectively show some structural changes, but it was only on 34 patients and 17 that were actually in the decompression group. So, you know, you can't just tell a patient decompression is automatically gonna put your disc back in. But a more accurate statement would be to say emerging research shows that measurable changes in disc herniation can occur following decompression in some patients. In other words, Mrs. Jones, this MRI is showing this disc right here. See how that's herniating out right there or bulging out there? Recent research is showing that it is possible to potentially reduce the size of that bulge or that herniation. Now, this does not happen in every patient, but there is research showing that it can happen. And so that is going to be one of the goals of our treatment is to see if we can reduce the size of that to reduce the pressure on this nerve right here. That is something that you can't guarantee to a patient. You can't say decompression is the only reason why disc bulges or herniation reduce, but you can certainly say there is evidence there and there's more and more emerging evidence that we can make some changes in these types of discs. It's accurate. It's impressive. Okay, and that's an important thing to share with patients. Now, the other thing I like from the study, both groups improved. It wasn't that decompression improved pain so much more than the exercise group, but— or vice versa. The exercise helped with motion better, decompression reduced the disc better, but— What do you and I do with our decompression patients? Do we do just decompression alone? Well, no. We usually combine it with laser. And by the way, there is a study out, brand new study out, showing that you can reduce the size of a disc herniation with class 4 laser therapy. So you combine decompression with laser, you give the patient some Exercises that you're gonna prescribe for them to do at home. All these things work together synergistically to provide the best possible outcome, which is patient gets 50% or greater relief and they get whatever their pain is most affecting in their life, they get that back either to some degree or all of it. Okay, that's a victory, docs. Final study, um, this was titled Can Intensive Conservative Treatment Reverse Chronic Cervical Disc Herniation? A Pre-Registered Case Study with Complete MRI-Documented Resolution. So the patient here is a 44-year-old man. He had a 7 millimeter C6-7 disc extrusion, and he'd been experiencing radiculopathy for approximately 12 months, a year. So not a brand new disc. This was chronic. What did they do in the study? 6 months. 6-month conservative program incorporating decompression, Intensive physical therapy, a home-based program, and he added, he added it in a steroid injection. So it wasn't the decompression alone. We cannot attribute the outcome entirely to decompression. And this is one patient, of course, keep that in mind. But what happened here? They obtained follow-up imaging. The original C6-7 extrusion Demonstrated complete resolution. The measure went from 0.405 to 0 on this modified disc herniation index that they do. So basically, it was essentially 100% reduction in the measured herniation. This patient had severe. Left foraminal narrowing. Will that reduce to moderate? So pretty fascinating imaging result here. What does it prove? Well, from a case study, not a lot. But you can't conclude that cervical decompression resolves disc extrusions. You can't do that because the patient received multiple interventions. And we know from studies that disc extrusions can spontaneously regress. There's no control group. But does the case matter? Well, absolutely it matters because it demonstrates something biologically and clinically plausible that deserves research investigation. It adds to a growing group of MRI-based reports suggesting that structural disc changes can occur with conservative management, including spinal decompression therapy. Think of cases as hypothesis-generating research. They tell us this happened. We need to study it further and whether it happens consistently. We need to study how it happens consistently and why. So you put all these together, hey, these are telling us some things. The retrospective study showed pain, neurologic function, daily function. The other study showed stabilization and decompression both can produce Results, little different results than the other, but hey, let's work these things together. And the case study showed, hey, it's possible to resolve a fairly significant disc extrusion. So do we need larger studies? Do we need a lot more studies? Well, absolutely we do. But these are the types of things that the decompression doctor keeps track of. They know what studies have been done in the past. They are familiar with the recent research studies and they know that, hey, here is some of the strengths of the research. This is what we can gather from it, but there is also some limitations in that we do not want to overpromise to our patients. It is always better, docs, to underpromise And overdeliver. It's better to say, see that disc you have on MRI or this report I'm reading? It shows this disc extruding right here. And that's— I want you to know, Mrs. Jones, that's a— it's a big one. But we know from studies that the size of the disc herniation doesn't always determine which ones will get better or not. And we know from studies that there is some evidence pointing that decompression and laser can help in many cases the body to reabsorb or resolve some of these— this disc that is coming out. And so we are going to try to avoid surgery. We are going to try to get you 50% or greater relief. We are going to try to get you back to being able to walk a mile again like you used to enjoy. And we are going to be monitoring this and evaluating this as we go through. That is a well-referenced, reasonable approach and a conversation to have with a patient. And it is one that is credible, it is respectable, and it can be It can be backed up. So I hope this resonates with you docs. I'm not trying to put a guilt trip on anybody. I'm just saying, if you're a decompression doc, own it, be the master of it, keep up to date with the latest research. If you're a knee pain doc, if you're a neuropathy-based doctor treating peripheral neuropathy, Whatever that niche is, own it, master it, and become the best at it. And it will pay off clinically. It'll pay off professionally. It'll pay off business-wise. It's all a part. The better doctor you are, the better outcomes you're going to get. The more patient satisfaction, the more referrals. Uh, it's just a win-win situation. So put in the time and effort. Uh, use AI technology. This is the final tidbit I'll share with like things like ChatGPT. It used to be harder to keep up the research because you had to dig around. You can just set up, and I've done this over the last year, you can just set up Put in ChatGPT, I want you to update me once per week at 8 AM on Friday mornings any new studies that come out on non-surgical spinal decompression therapy, Class 4 laser, and shockwave therapy. Boom. Every Friday morning, 8 o'clock, you get an email. Click on it, you can access all the latest studies and it summarizes them for you. It is a beautiful thing. So every week you can keep up with the latest and greatest. And not every week something comes out, but you're never going to miss a week when it does come out. And that is so important. So give us a like, give us a share, spread the news about the Practice Builders Podcast. And we do, you know, Dr. Leone and I do a lot of these together. We do sometimes do them separately. His are a little more business-oriented. Mine are a little more clinically oriented, but that both works together to build your practice. And we appreciate all our listeners, especially those— I know several docs that listen. They have never missed an episode. And, uh, so we really appreciate that. We're here to deliver to our profession and to help us to grow all together. And, uh, let's just keep growing and learning together. So thanks for joining me for today's episode of the Practice Builders Podcast.

Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support, and it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.