Neuropathic Pain, Sciatic Neuropathy

Neuropathic Pain, Sciatic Neuropathy 
Does Cox® Technic address neuropathy / neuropathic pain / foot pain?

Yes, when its source is spinal. Yes, when neuropathic pain is part of sciatica.

Can it help diabetic neuropathy?

It may be helpful, but not documented.

First, a definition of Neuropathic Pain from Cleveland Clinic is quite enlightening in its description of symptoms: motor (muscle weakness, atrophy, uncontrolled movement), sensory (tingling, numbness, imbalance, clumsiness, pain), and autonomic (blood pressure changes, sweating too much/little, bowel/bladder issues, sexual dysfunction, skin color or vision change, etc.). (Cleveland) Specific to this discussion of sciatic neuropathy, increased neuropathic pain in sciatic patients is often linked with elevated levels of depression, anxiety, alexithymia, and C reactive protein levels. (Uher 2013)

Do chiropractors see neuropathy?

Yes, chiropractors do see neuropathic pain as it is seen in 37% of chronic low back pain patients and in 41% of soft tissue syndromes. (Fishbain 2014) Lumbar radicular pain (sciatica) is a type of neuropathic pain. (Miyakawat 2014) Also researchers, in discussing neuropathic pain, note that the substantia gelatinosa and dorsal horn receive afferent inputs which Dr. Cox (in his afferentation lectures) has been discussing for years how spinal manipulation may address such inputs to treat neuropathic pain. With these facts in mind, Cox Technic spinal manipulation successfully addresses neuropathic pain as it relates to sciatica (See list of articles below.) though we are not stating that this address diabetic neuropathy. With recent research discussing how chemical inflammation of the nerve root complex and compression of the dorsal root ganglion being involved in neuropathic pain, the discussion naturally pivots to what chiropractic, and more specifically Cox Technic, can do for such lumbar radiculopathy type neuropathic pain.

Neural Mobilization Helps Neuropathic Pain

Neural mobilization is reported to lower inflammation in an article titled "Effects of simulated neural mobilization on fluid movement in cadaveric peripheral nerve sections: implications for the treatment of neuropathic pain and dysfunction” which describes how neural mobilization may alter nerve tissue environment and promote improved function and nerve health via dispersion of tissue fluid and lower intraneural swelling/pressure. (Gilbert 2015)

Increased Disc Height May Ease Neuropathic Pain

A paper regarding the anatomy of the nucleus and annulus fibrosus of the lumbar spinal disc discusses how increased disc height may contribute to alleviating neuropathic pain. (Zhong 2014)

How Long to Heal

An article titled "Sciatic Neuropathy” reported that good but incomplete recovery happens over 2-3 years in most patients with sciatic neuropathy, especially in those who don’t have severe motor loss. Moderate improvement occurs in 30% of patients by the end of year 1, 50% by end of 2 years, and 75% by the end of 3 years. Slow recovery is expected due to significant axonal loss that is frequently present and re-innervation of the muscles below the knee is delayed due to the long distance from the injury site to them. (Yuen 1999) Lumbosacral neuropathy in lumbar spine disease can be assessed by the deep tendon reflex particularly after gait loading test and standing extension which induce it. (Morimoto 2024) In a staging system of degenerative disc disease, neuropathy is included in Stage 3, accompanying degenerative disc disease and stenosis regardless of the cause. (what are the stages… 2022)

Chemical Irritation

Macrophages infiltrate the dorsal root ganglion once a herniated disc’s nucleus pulposus and tumor necrosis factor A (TNF-A), the chemical inflammatory agent said to be a cause of radiculopathy and neuropathy, contacts it. (You) Symptomatic Tarlov cysts present with pain and neuropathy related to the lumbar spine, pelvis, and urogenital system. (Baker 2018) Suppressing MAPK, ERK and P38 inflammatory signaling pathways via tumor growth factor-beta (TGF-B1) is shown to reduce the sensitivity of a chronically constricted nerve. (Chen 2016) Macrophages contribute to both the triggering and prolonging of neuropathic pain in the dorsal horn microglia after peripheral nerve injury around injured sensory neurons in the DRG. (Yu 2020) Sciatic nerve constriction increases the neuropeptide galanin in the DRG and spinal cord. It modulates neuropathic pain. The degree of galanin production varies directly with the amount of constriction. The highest number of galanin neurons were documented at 14 days post-injury. Neuropathy follows nerve constriction. (Coronel 2008) Typical treatment has been drug therapy while recent papers report on the positive effect of neuromobilization, hands-on therapy, on reducing pain and improvement normal joint and joint mobility to help with neuropathic pain and sciatica. (Du 2023) Cox Technic is just such hands-on treatment producing neuromobilization effects. 

Cox Technic Spinal Manipulation & Mobilization

Nerve compression causes neuropathic pain. Neuropathic pain accompanies sciatica, and chiropractors deal with it. Cox Technic case reports and clinical trials have documented successful clinical outcomes of treatment. The Cox Technic System of Spinal Pain Management incorporates nutrition (like Discat) for the neuropathies associated with nutritional deficits and exercise. Here are a few articles to consider:

Cox JM, Shreiner S:  Chiropractic manipulation in low back pain and sciatica:  statistical data on the diagnosis, treatment, and response of 576 consecutive cases.  Journal of Manipulative and Physiological Therapeutics 7(1): 1-11 (March 1984)
A chiropractic multi-center observational pilot study to compile statistics on the examination procedures, diagnosis, types of treatment rendered, results of treatment, number of day of care, and number of treatment required to arrive at a 50% and a maximum clinical improvement was collected on 576 patients with low back and/or leg pain. The purpose was to determine the congenital and developmental changes in patients with low back and/or leg pain, the combinations of such anomalies, the accuracy of orthodox diagnostic tests in assessing low back pain, ergonomic factors affecting onset, and, ultimately, the specific difficulty factors encountered in treating the various conditions seen in the average chiropractor's office. For all conditions treated, the average number of day to attain maximum improvement was 43 and the number of visits was 19. It was concluded that this study provided useful data for assessment of routine chiropractic office based diagnosis and treatment of related conditions; however, further controlled studies are necessary for validation of specific parameters.

Cox, JM, Feller JA, Cox JA: Distraction Chiropractic Adjusting: Clinical Application, Treatment Algorithms, and Clinical Outcomes of 1000 Cases Studied. Topics in Clinical Chiropractic 1996; (3)3:45-59, 79-81
An overview of Cox® distraction manipulation protocols is presented including diagnosis and treatment decision making in low back pain and sciatica cases and proper utilization of flexion distraction in treating lumbar spine and lower extremity pain. In addition, the outcome of 1,000 cases involving low back and/or leg pain treated with chiropractic adjusting (92% utilizing flexion distraction) is presented.
A qualitative clinical and literature review provides the basis of the overview of diagnostic and treatment protocols. A descriptive case series design was used to collect outcome information on 1,000 patients with low back and/or leg pain; patients were pooled from two separate studies. Patients were treated by 30 different chiropractors, and a minimum of 20 cases was supplied by each physician.
A descriptive review of cases showed that less than 4% of patients with low back or leg pain were candidates for surgery. Less than 9% of patients reached the chronic stage of care. The mean number of days to maximum improvement under care was 29, and the average number of treatments to maximum improvement was 12.
The results of this study provide some evidence for the use of chiropractic management, particularly flexion distraction manipulation, in the treatment of back pain problems due to a variety of mechanical causes.

Bergmann TF, Jongeward BV: Manipulative therapy in lower back pain with leg pain and neurological deficit. J Of Manipulative and Physiological Therapeutics 1998; 21(4):288-294
Chiropractors need a nonsurgical, conservative approach to treat low back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious used of manipulation. Although significant questions remain for the evaluation and treatment of lumbar radiculopathy (sciatica) with disc herniations) there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.
Ice was applied to a patient's lower back for 5 minutes, followed by flexion-distraction mobilization done by placing a hand contact over the L4 spinous process and using the pelvic section of the table to distract the lumbar spine between the L4-L5 segment. This procedure was repeated three times with each distractive process held for 20 seconds. The patient was told to lie on her back at home with her knees bent in a "90/90" position whenever possible. She was instructed to get up only for bathroom use.
One week after this appointment, she reported that her lower back pain was almost gone and that the leg pain no longer bothered her. Treatment again consisted of lumbar flexion distraction and long axis distraction of the lower extremity. At this point, side posture rotary manipulation was added to her treatment plan.