The Canadian healthcare system may demand waittimes for spinal surgery for months or years if emergency intervention is not required. This is a frustration for many patients and the spine surgeons. In the intervening time of pain that takes a patient to his or her physician who then refers him or her to a spine surgeon, many expensive tests like MRI are ordered which may reveal abnormalities that are not of that much consequence but distract the primary care doctor who sends the patient to a surgeon.

“As a screening tool for back pain,” Dr. [Hamilton] Hall said, “MRIs are worse than useless.” Amazingly, "$24-million [is spent] annually on unnecessary MRI and CT scans in Ontario alone."

He explains his frustration as a spine surgeon is seeing patients who don't need his care - which is like 90 out of every 100 patients with back pain. He wants patients who need surgery.

Chiropractic can benefit this problem. Chiropractic physicians can diagnose and treat the 90% of patients who don't need surgery and send the surgical patients to the spine surgeons. Plus chiropractic offers this care at a lower price without always needing the expensive imaging tests for care.

For more details on the Canadian situation, please see the article Canada's Costly Spine Surgeon Backlog. Consider these chiropractic documents that show chiropractic to be

• less expensive than medical care (cost of treatment, hospitalization, compensation payments, lost workdays)  - Phelan
• effective in 29 days and 12 visits for low back pain - Cox
• effective in 13.2 visits for cervical spine - Schliesser/Kruse
• 40% less expensive when care for back pain is started with a chiropractor than a medical doctor - Liliedahl

Chiropractic has a place in healthcare to help patients and the cost of helping patients.

Consider The Cox Technic System of Spinal Pain Management for back pain relief. As a doctor, come to a Cox seminar to learn more. As a patient, consult with a local certified chiropractor for your back pain relief.

Chiropractic and Back Pain. Chiropractic and Neck Pain. Chiropractic and Spine Pain. The public thinks of chiropractic for back pain by and large.

• 33% of 27,810 people chose chiropractors as their treating physician for low back pain in the National Health and Nutrition Examination Survey. (NHANE) [in Deyo R: Spine 12(3)]
• Spine care delivery is 60% by the medical model and 40% by the chiropractic model. [Saal, Spine 22(14)]
• The total number of US adults who went to a chiropractor increased 57% from 2000-2003. [Davis, Health Svcs Research 45(3)]
• Paid costs for back pain care started with a chiropractor were 40% less than care started with a MD. [Liliedahl, JMPT 33(9)]

Chiropractic is reknown for its back pain care. Chiropractic has evidence-based technique to relieve and control back pain like Cox Technic.

The federally funded studies document Cox Technic Flexion-Distraction and Decompression's biomechanical effects on the spine as well as its clinical outcomes:

• intradiscal pressure drops to as low as -192mm Hg in the lumbar spine
• 28% widening of the area of the intervertebral canal
• flexion distraction is superior in relieving pain due to radiculopathy (leg pain) compared to medical care. (Gudavalli, Euro Sp J 2006) 
• 29 days and  12 visits are the averages for relief of low back pain when not taking into account specific conditions of back pain. [Cox, Topics in Clinical Chiropractic 1996, 3(3)]
• 13.2 treatments is the average for relief of neck pain radiculopathy. [Schliesser, Kruse, JMPT 26(9)]

Back pain and chiropractic fit together. The chiropractic physician is skilled in the diagnosis, examination and treatment of back pain as well as its prevention with nutrition, exercise and lifestyle choices. The chiropractic back pain research continues to evolve in support. Chiropractic physicians train specially to keep abreast of the latest research and Cox Technic treatment application in seminars. Back pain patients find Cox Technic physicians for their back pain relief when they search the referral directory of certified Cox Technic physicians.

Research leads the way in evidence-based care and in Cox Technic.

Contact Cox Technic if you have any questions.

MSNBC reports on the statistics of back surgery which aren't all that favorable: http://www.msnbc.msn.com/id/39658423/ns/health-pain_center

1. 600,000 Americans choose back surgery
2. 1450 Ohio Work Comp back pain patients with similar diagnoses:
   • 1/2 had surgery with fusion - At 2 years, 26% returned to work...plus a 41% increase in pain killer use.
   • 1/2 did not have surgery - At 2 years, 67% returned to work.
3. 2007 Agency for Health Care Policy and Reform reports
   • 27 million Americans with back problems
   • $30.3 million spent on back pain.
   • PT, pain management, chiropractic, spine surgeries (which makes up the most)
4. complicated spine surgeries with fusion - 8 times increase in 15 years
5. "Even when the surgery is a success, it rarely dispels 100 percent of back pain."

Conservative options like chiropractic, particularly Cox Technic flexion distraction decompression, is ready to help patients after surgery who still suffer, but is most viable for those patients before surgery who need pain relief.

The American Academy of Orthopaedic Surgeons states that "acupuncture or chiropractic manipulation can also be attempted" prior to surgery for stenosis.  [from    http://orthoinfo.aaos.org/topic.cfm?topic=A00329 accessed on 6/8/09, American Academy of Orthopaedic Surgeons website, "Lumbar Spinal Stensosis"]

The 2009 National Board of Chiropractic Examiners Survey results have been published. Survey participants reported that 63.7% use flexion-distraction.

Past years' surveys revealed

1991    53.7%   (It is termed "Cox flexion-distraction" in the list of techniques.)

1998    58.0%   (It is termed "Cox flexion-distraction" in the list of techniques.)

2003    56.5%   (It is termed "Cox flexion-distraction" in the list of techniques.)

2009    63.7%   (It is termed "flexion-distraction" in the list of passive adjunctive procedures.)

* from Practice Analysis of Chiropractic 2010, page 134.

Welcome to the blog for Cox® Technic! There have been many requests for this forum, so I trust it will meet your needs. As your host, I plan to share with you pertinent information to enhance your integration of Cox® Technic into your practice.

As an introduction, I'd like to share that Cox® Technic is used by 60% of chiropractic physicians according to the National Board of Chiropractic Examiners (2000). Cox® Technic (aka flexion-distraction) is the creation of James M. Cox, DC, DACBR.  Flexion-Distraction is taught at chiropractic schools either as core curriculum or via a dedicated elective course or technique overview course. Dr. Cox has worked his career with the purpose of documenting the effectiveness of chiropractic, specifically flexion-distraction and decompression. With the advent of the federally funded research projects being offered to chiropractic researchers willing to work with medical or osteopathic researchers, his desire for documentation was met with funding. This opened the door to gathering support for flexion-distraction. The first grants investigated the biomechanics and clinical outcomes of Cox® flexion-distraction for low back pain and cervical spine pain. Each granting year, flexion-distraction was awarded funds. Today, several grants via HRSA, NIH, FCER and others are funded. Here is a summary of the first three studies' outcomes lead by principal investigator, Ram Gudavalli, PhD:

1 - Biomechanics Study - 28% opening of the spinal canal, intradiscal pressure drop to as low as -192mmHg, and widening of the IVD space

2 - Lumbar Spine Clinical Comparison Study (published in European Spine Journal)- F/D vs. Medical Conservative Care for Lumbar Spine Conditions - F/D outshone medical conservative/active exercise, especially for radiculopathy (leg pain) patients.

3 - Cervical Spine Clinical Comparison Study - F/D vs. Medical Conservative vs. Combination for Cervical Spine Conditions - The combination revealed better outcomes.

Today, certified chiropractic physicians are ready to help their patients with research documented protocols via a network of physicians. Dr. Cox's goal 40 years ago was to have a core of 1000 physicians. Today the number is nearly double that and climbing!