Thank you to Chiropractic Economics for publishing an article on flexion distraction, "Flexion distraction may alleviate lower back pain". Tina Beychok did a nice job of summarizing the generic flexion distraction, and the staff and editor of Chiropractic Economics are most kind in prompting this discussion.
General Response by Julie Cox-Cid, co-ordinator for Cox Technic:
Thank you for posting this
article and opening the discussion of the protocols for flexion distraction
as well as the research-documented clinical outcomes of its proper application.
Ms. Beychok pointed out correctly that tolerance testing is of utmost importance
in the application of Cox® Technic flexion distraction protocols. It is well
documented in the textbook (Low
Back Pain by Dr. James Cox for Lippincott Williams and Wilkins) as well as
the notes from Cox® training workshops,
webinars, and seminars, all based on the protocols defined in the various
biomechanical and clinical trials as well as private practitioner data
collection studies.
As a brief summary, the lumbar spine biomechanical
outcomes (HRSA grant) found a reduction in intradiscal pressures to as low as
-192 mm Hg and intervertebral space widening by 28%. The lumbar spine
comparison study (HRSA) between flexion distraction and medical conservative
(active exercise) care showed that flexion distraction provided statistically
significantly more relief for chronic/mild, chronic/severe and radiculopathy
patients. The flexion distraction patients reported fewer healthcare visits
needed in the year following the study and flexion distraction was found to be
more effective in reducing pain for 1 year as well. In the recently completed
cervical spine biomechanical study (NIH), disc pressures in the cervical spine
also dropped. The 1000 cases study revealed the number of days and visits those
patients required to attain maximum improvement. These are documented by
condition (ex: L5 disc herniation, spondylolisthesis, etc.). Proudly, many of these
studies have gathered together chiropractic and medical researchers, chiropractic
and medical physicians, chiropractic and medical facilities. All benefit from
exposure to one another’s functions. NUHS, Palmer, NYCC, Loyola
Stritch School of Medicine, Hines VA Hospital, University of Illinois,
University of Iowa, Auburn University and more have contributed talent to these
studies.
Now, many clinical case reports have been published about
the efficacy of Cox® Technic flexion distraction on a case by case basis for lumbar spine conditions
and cervical
spine conditions as well as an overview basis of several cases, combined
with therapies and applied alone, combined with other chiropractic protocols
and alone.
Cox® Technic flexion distraction has been available to
chiropractic physicians for
over 40 years as Dr. James Cox, the developer of the protocols and enthusiastic
force behind their scientific study and documentation, started teaching them in
the late 1960s and early 1970s. Today, there is a team of workshop and
seminar instructors ready to share the spine research as well as treatment
protocols. Automated flexion distraction protocols have not been researched or documented
for application. Cox® Technic flexion distraction is manually applied as Protocol I or Protocol II
depending on the extent of patient pain. Long-y-axis assisted application is
available as well for patients who have attained at least 50% relief of
their pain. Disc and non-disc conditions have the similar goals of care.
The invitation by Ms. Beychok for more research support
and documentation of flexion distraction is one that is called for across all
of chiropractic and its techniques, and Cox® Technic practitioners,
researchers, and supporters welcome the opportunities to participate in such
research and further document its effectiveness for disc herniation treatment
(lumbar and cervical spines) as well as for relief of pain due to other
non-discogenic conditions like spondylolisthesis
and tropism and Bertolotti’s Syndrome and degenerative scoliosis and spinal
stenosis as well as spinal cysts like the synovial cyst and
pregnancy-related
back pain. Current studies and papers underway include a cervical spine
clinical outcome study at Palmer, a clinician data collection study of
post-surgical continued patients (FBSS) paper is nearly ready for journal
submission, and a report on spinal stenosis treatment is nearing writing
completion. Sometimes an article is published that we don’t know about ahead a
time which is a pleasant surprise.
Cox Technic flexion distraction supports the physicians
who strive to be the back
pain specialists in their area and gladly shares its protocols and research
to support their efforts.
For more information, please click
here for a (nearly complete) list of articles about Cox® Technic flexion distraction
that have thus far been published, or please visit www.coxtechnic.com.
Response by Dr. James Cox:
Flexion distraction spinal manipulation is discussed by
Tina Beychok. As developer of the procedure, it is interesting to see the
reactions, such as this, to it.
Tina says flexion distraction is beneficial in acute low
back pain. What about chronic low back pain? If F/D can aid in acute conditions
such as disc herniation and spinal stenosis, it makes long term care far more
effective. F/D is used in all phases of back pain care – acute to chronic.
Positive and negative responses to F/D are mentioned.
Please reference these for discussion. Also the suggestion is raised that more
research is needed in F/D. That is true in all of spinal manipulation. It is
mentioned that there is little negative or opposing literature to F/D. A good
thing. Could it be beneficial and not hurt the patient? Ndetan published that
Cox F/D showed the lowest adverse reactions to spinal manipulation for both
patient and doctor of all technics studies, including diversified, Thompson,
and Gonstead.
Research is vital. Both the Health Services and Research
Administration of HHS and the National Institutes of Health have funded
research on the biomechanics, treatment, and clinical outcomes of flexion
distraction including randomized clinical trials. Reading them may be positive
for our profession.
Respectfully,
James M. Cox, DC, DACBR
Developer of Flexion Distraction Spinal Manipulation
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