Why One80 PT Doesn’t Use Decompression, Traction, or Inversion Tables

The Idea Behind Decompression — and Why It Doesn’t Hold Up

Spinal decompression, mechanical traction, and inversion tables operate on a simple and appealing premise: if a disc and nerve in your spine are under pressure, pull the spine apart to create space and relieve that pressure. It makes intuitive sense. It also misunderstands what’s causing the compression in the first place.

Disc compression and nerve irritation in the spine are not primarily mechanical problems caused by gravity and load. They are the result of the deep spinal stabilizing musculature failing to maintain spine stability. When these muscles are weak, the spine is left to rely on passive structures (ligaments, joint capsules) for support they weren’t designed to provide. The result is excessive compressive load, disc breakdown, and eventual nerve involvement.

Pulling the spine apart may temporarily reduces that pressure (the amount of pull is typically too much for patients to tolerate). But it does nothing to restore the muscle activation that is failing to provide stability. The moment treatment ends and the patient stands up, gravity reapplies load to a spine that still lacks muscular support. In most cases, the repeated passive distraction actually weakens the stabilizing muscles even more because the mechanical unloading “unplugs” the nerve stimulation needed for them to activate.

What the Research Shows

A systematic literature review of spinal decompression via motorized traction found that six of seven randomized controlled trials reported no significant difference between decompression and control conditions for chronic sciatica and low back pain. The overall quality of evidence was rated low.

📚 NCBI Bookshelf Systematic Review: 6 of 7 RCTs — no significant difference between spinal decompression and control for chronic discogenic LBP.

A 2023 systematic review and meta-analysis by Vanti et al., evaluating different types of lumbar traction in patients with low back pain and sciatica, found very low to low-quality evidence across all traction modalities, with no significant difference between diverse traction types at short-term follow-up.

📚 Vanti et al. 2023 Systematic Review & Meta-Analysis: Very low to low-quality evidence; no significant difference between traction modalities at short-term follow-up.

The most commercially marketed decompression systems — DRX9000, VAX-D, and similar devices — have been studied with consistently poor results, and several major insurers have classified them as experimental or investigational, and will not cover treatment with those machines on the basis of lack of evidence.

The Inversion Table Problem

Inversion tables are the consumer version of the same idea, hang upside down, let gravity decompress the spine. The research on inversion therapy is similarly unimpressive. Short-term pain relief is reported by some users, driven by the same temporary pressure reduction and stretching of the tight back muscles. But, as stated above, the amount of pull needed to get passed muscle spasm and unload a disc it impossible with a home unit. Thus, the spine returns to its unresolved state the moment the patient is upright again.

There is also a safety concern: inversion increases blood pressure and intraocular pressure and is contraindicated for patients with hypertension, glaucoma, retinal detachment, or cardiovascular disease, populations that significantly overlap with chronic back pain patients.

What One80 Does for Disc and Nerve Pain

When a patient comes to us with a herniated disc, sciatica, degenerative changes or spinal stenosis symptoms, our first question is not ‘how do we reduce the pressure?’ Our first question is ‘why is the spine being compressed?’ Almost universally, the answer involves deep stabilizers muscle dysfunction causing movement patterns that are putting too much load on the spine and discs.

The One80 System identifies the specific muscles that have been shut down, restores their activation, and rebuilds a movement pattern that distributes spinal load the way the body is designed to distribute it. Patients with disc herniations routinely resolve their symptoms within a handful of visits — not because we “decompressed” them, but because we gave the spine back its own muscular support system, which returns load on the discs to normal levels.

FAQs

My MRI shows a herniated disc. Doesn’t that need decompression?

MRI findings often don’t correlate with pain or function. Studies consistently show that a significant percentage of asymptomatic adults have disc herniations visible on MRI. The herniation may be present, but whether it’s causing symptoms depends on the neuromuscular environment around it. Restore the stability, and the disc can often heal without any intervention to the disc itself. Remember, an MRI shows what things look like now, NOT what caused things to get that way.

What about traction for neck issues?

Cervical traction requires much less “pull” from the machine. So, it is easier to tolerate. But, the neck functions just like the low back, and if muscle function is not normal, neither is spine and disc pressure. As a long-term treatment strategy, it produces the same dependency pattern as lumbar decompression without lasting functional results.