A chiropractor in Illinois named Jeff Winternheimer claims to have discovered an effective way to heal herniated discs by rehydrating them. He calls it Functional Disc Rehydration and he offers it through a network of four offices in the Chicago area called the Illinois Back Clinic. He has lots of testimonials and one sorry amateurish attempt at a scientific study that claimed to show 100% improvement; but there is no published evidence, no controlled observations, and no comparison of his methods with other methods.
Degenerative disc disease
Between the spinal vertebrae there are soft, jelly-like compressible discs that act as shock absorbers. They are “corralled” by a fibrous annulus. As we get older, the disc material loses water and becomes less flexible; the disc thins, and the space between the vertebrae narrows, so in old age we are not quite as tall as we once were. Cracks in the annulus develop with age or with trauma, allowing the disc material to bulge out or rupture. Herniated discs don’t necessarily cause pain; disc degeneration can be seen on MRI in 37% of asymptomatic people over the age of 60.
by “debivort,” licensed under CC BY-SA 3.0 via Wikimedia Commons
An unusual approach to providing evidence
In looking for scientific evidence on the Illinois Back Institute website, I encountered something I had never seen before. They offer one study as evidence that Functional Disc Rehydration works, but before they will let you read it you have to supply your name and e-mail address, tell them what kind of back problem you have, and tell them which of their clinics you live closest to. There is an opportunity to make an appointment and supply your insurance data before you have even downloaded the study.
The study
The downloadable “study” itself is a travesty. It is not a published study and is not presented in the format of a scientific paper. It consists of five pages on the Institute’s letterhead. The first page explains the purported mechanism of the treatment and makes the claim that Functional Disc Rehydration provides better results than surgery. Page 3 is a testimonial from a patient. Pages 4 and 5 offer a free consultation and a clickable link to schedule an appointment. Only page 2 is devoted to the study itself. The two researchers who invented Functional Disc Rehydration are “Dr. Jeff Winternheimer, D.C.” and “a PAC 10 university medical researcher” who is not named. There was no control group. The subjects were “more than 50” people (they didn’t bother to get an exact count?) ranging in age from 39 to 83 who had chronic back pain and had already tried other treatments. After one treatment, “all patients experienced disc rehydration of at least 18%.” After 10 weeks, there was 80% rehydration, and at 25 weeks there was 100% rehydration. In addition to the rehydration, “All patients experienced complete elimination of herniated and bulging discs.” They don’t tell us how they measured hydration or confirmed the elimination of degenerated discs. They conclude:
The statistics overwhelmingly prove that re-hydration through Functional Disc Rehydration will help reverse a degenerated discs [sic], neck pain and back pain permanently.
Of course, this abominable, pathetic, laughable, puerile excuse for a “study” proves no such thing. It’s as if they didn’t even try. With only a little effort, they could have put it in proper format and made it at least sort of look like a publishable study. Anyone with any sense would have known that 100% success is suspicious and is seldom if ever reported in a scientific paper, and it would have been so simple to write “52 patients” instead of “more than 50.” What were they thinking?
More evidence
In addition to a few testimonials, they offer three before-and-after MRIs that show a reduction in disc protrusion, one after 50 treatments, one after seven months, and the third simply labeled “before” and “after”. Pretty impressive, unless you happen to know that similar improvement can occur over time with no treatment at all. Without a control group, there is no way to tell whether the treatment had anything to do with the improvement.
I watched a video where Dr. Jeff says that in 2007 an experienced researcher told him he would have to study eight patients with severe back pain with before and after MRIs to show that the treatment gets oxygen, nutrients, and fluid into the disc. He claims his study showed that, but he doesn’t explain how the measurements were made. He seems to be describing eight of the patients who were included in the larger study reported on the website. He seems to be saying they could measure rehydration by MRI and that they were surprised when they found that the disc protrusions also resolved. The MD who did the MRIs supposedly said he had never seen a disc protrusion resolve. I find that hard to believe.
How it works
They claim it “reverses” disc degeneration. They tell us a healthy disc is filled with a gel-like substance; a disc that has been worn down has lost its gel and is therefore dehydrated, and a dehydrated disc can bulge or herniate. Functional Disc Rehydration takes the pressure off the discs through cycles of compression and traction movements, allowing the spine to replenish the missing fluids back into the discs naturally. Then physical therapy is used to strengthen and stabilize the spine.
With the advent of MRIs, many studies have documented the regression of disc protrusions, and spontaneous improvement is thought to be a result of inflammatory processes and reabsorption of disc material, not to “rehydration” or sucking the material back into place. One study found that in 14 out of 15 patients with massive lumbar disc herniation, there was dramatic resolution after 24 months of conservative therapy. Discs naturally lose water content with aging and become brittle and deformed, but this is usually asymptomatic until the annulus tears and allows the disc material to protrude and put pressure on a nerve. If there were a way to rehydrate the disc, that might conceivably be helpful, but it would not reverse the tears in the annulus. And even if the remaining disc material became better hydrated, how would we know that from an MRI? Would it show up as increased space between the vertebrae? Would that say anything about oxygen and nutrients? And if you hydrate the disc material wouldn’t that cause it to swell and possibly increase the pressure on the nerves that is causing the pain?
They don’t really define their approach, but apparently it involves cycles of compression and traction movements along with stretching, exercise, PT treatments, listening to patients, etc. In one testimonial a woman describes two-hour visits three times a week. One patient describes feeling a little better, then doing too much, having increased pain, and having to slow down again.
Does it make sense?
Not to me. I couldn’t find any evidence that increased hydration had been measured in discs after compression/traction cycles and PT, or that oxygen and nutrient levels in the disc increased. We have a generally-accepted explanation of spontaneous improvement on MRI (inflammation and reabsorption) that doesn’t involve rehydration.
Similar claims
Chiropractors have made similar claims for spinal decompression devices, which are all versions of the original VAX-D that Stephen Barrett has written about on Quackwatch. I wrote about one of the newer versions, the DRX-9000 and a couple of years later the Canadian Broadcasting Corporation show Marketplace did a scathing exposé. These glorified traction devices claim to relieve pressure on the disc, improve circulation, supply nutrients to the disc, and even suck the extruded part of the disc back into place by creating a vacuum. No studies have yet shown that that is even possible.
Conclusion
I’ll say what I’ve said many times before about other questionable treatments. I don’t know if this treatment works, and neither do they, because it has not been submitted to controlled scientific testing. My impression is that this is more of a business model than a revolutionary new treatment for back pain. If they publish credible evidence from well-designed studies in peer-reviewed journals, I’ll reconsider.