Lumbar Spine - Biomechanical Outcomes

Cox Technic Flexion Distraction and Decompression for the lumbar spine has a long history since its developer, Dr. James Cox, started in the 1960's. Case reports and a large clinical trial collection documented clinical effects of Cox Technic for the relief of low back pain and leg pain.. The biomechanical effects required a larger, more trained team of biomechanists and researchers. In the early 1990's, Dr. Cox met Dr. Ram Gudavalli at the then National College of Chiropractic. The Health Resources and Services Administration introduced the first-ever federally grant program for chiropractic research. Under Dr. Gudavalli's leadership, the first grant from HRSA was to find out what happens biomechanically when Cox Technic Flexion Distraction is applied to the spine. It was an exciting time which lead to several more studies involving flexion distraction.
Studies...
 
Gudavalli MR, Cox JM, Baker JA, Cramer GD, Patwardhan AG: Intervertebral disc pressure changes during the flexion-distraction procedures for low back pain. Presented at and in the proceedings of the International Society for the Study of the Lumbar Spine Meeting, June 1997, Singapore.

 

Gudavalli MR: Estimation of dimensional changes in the lumbar intervertebral foramen of lumbar spine during flexion distraction procedure. Proceedings of the 1994 International Conference on Spinal Manipulation. June 10-11, 1994, Palm Springs, CA, p81
and
Gudavalli MR, Cox JM, Baker JA, Cramer GD, Patwardhan AG: Intervertebral disc pressure changes during a chiropractic procedure. Presentation and publication at the ASME IMECE 97 Bioengineering Convention, November 16-21, 1997, Dallas, Texas. - Advances in Bioenginneering 1999; BED, vol. 39, pgs 187-188
  • 28% increase in foraminal area
  • 17% increase in height
  • 7% increase in width

 

Gudavalli MR, Cox JM, Baker JA, Cramer GD, Patwardhan AG: Intervertebral Disc Pressure Changes During a Chiropractic Procedure. Abstract from the Proceedings of the Bioengineering Conference, Phoenix, 1999

  • A significant decrease in intradiscal pressure occurs during the flexion-distraction procedure for low back pain.
  • The drop was -39 to -192 mm Hg pressure in unpressurized discs and -117 to -720 mm Hg in pressurized discs.

 

Bulbulian R, Dishman JD, Burke J: Neuroreflex modulation of the lumbar spine in flexion distraction. New York Chiropractic College, Seneca Falls, New York 13148. Presented at 5th World Federation of Chiropractic in Auckland, New Zealand. May 15-23, 1999

  • Flexion distraction showed considerable variation in some movement ranges notwithstanding identical table positioning for all subjects (i.e. Flexion 3-12°).
  • Mean Hmax/Mmax ratios were 65.5+-15, 65.5+-17, 62.8+-12, 59.6+-17 and 65.9+-19 for neutral, flexion, R. Lateral, L. Lateral flexion and R and L axial rotation respectively.
  • The salient findings in the data were the non-existent H-reflex changes in lateral flexion and the significant suppression of neuromuscular activation in flexion (65+-16 vs 60+-15%; p<0.05) and ipsilateral rotation (65+-16 vs 59+-17%; p<0.05).
  • Slight perturbations in numerous afferent receptors are known to significantly alter the H-reflex.
  • The absence of measurable changes in lateral flexion may indicate that both slow and fast adapting receptors could be involved in lumbar motion.
  • These preliminary findings suggest the need for further dynamic motion studies of the flexion distraction neurophysiology.

 

Bulbulian R, Burke J, Dishman JD : Spinal reflex excitability changes after lumbar spine passive flexion mobilization. Journal of Manipulative and Physiological Therapeutics 2002; 25(8):526-532

  • The data showed variation in some movement ranges, notwithstanding identical table positioning for all subjects. Mean H-reflex amplitude was decreased (15.2 ± 5.8 mV to 13.8 ± 5.8 mV), and the H/M ratio was also decreased in flexion compared with neutral (55.0% ± 19.1% to 50.3% ± 19.4%; P < .05).
  • Conclusions: Trunk flexion is accompanied by inhibition of the motor neuron pool. Slight perturbations in numerous afferent receptors are known to significantly alter the H-reflex. The absence of measurable changes in lateral flexion and trunk rotation may indicate that both slow- and fast-adapting receptors could be involved in lumbar motion. These preliminary findings suggest the need for further dynamic motion studies of the flexion distraction neurophysiologic condition.

 

For a complete list of publications on Cox Technic, click here.

For information on federally funded studies - description, status, funding - click here