Why would I tell a patient to "Own your spine. Own your spine pain."? It's the only one he's/she's got! Where is this bluntness coming from? Well, it’s one of those days. A talk with a patient who wants the fix for back pain NOW got my head spinning. I want to share all I know with the patient, assure him that all will be well beyond this pain episode, that if he just embraces his spine for what it can do, all will be well. But pain gets in the way. I get it. Pain turns our rose colored glasses to gray ones in moments like this. Yet reality intervenes with truth, truth that we all must own our own spine as well as its pain on occasion.

This is what I’d like to share with my patient...

So why must we face this reality? Let’s look at it.

For many with spine pain (neck, mid back or low back with or without arm and leg pain or headache), there is no cure for the spinal condition, only control of pain with proper daily living habits. Let’s consider some facts…

Let’s start with genetics. You may be born with a spinal condition that will never by “normal”. Such conditions have big names like spondylolisthesis, transitional vertebra in which one has 4 or 6 lumbar vertebrae instead of 5, scoliosis, fused or incompletely formed vertebrae. These conditions will always be yours to contend with. No one can remake your spine. Like a bruise on an apple that remains on the apple, the spine is still whole even after attempts to remake it, but it remembers what was done.

Same with life experiences the spine goes through. Let’s take aging. Amazingly, the human spine normally begins to degenerate in the second decade of life, in the teen years. Some people have greater disc degeneration than others. However, if one is deconditioned, that is, out of good physical shape, and then does lifting, bending and twisting with such a compromised spine, the scene is set for back pain. Most of us develop some spine pain early in life, and the pain recedes often with no treatment. Then we continue the same lifestyle of eating too much, lifting heavy weight in the wrong posture to lift, etc.,  our spines then continue to degenerate while we do nothing or very little to maintain good health. Then, later in life, we develop more severe spine and extremity pain and think something can be done to allow us to continue this lifestyle without change. Some even think surgery will reverse all their problems only to find it can make them worse.

Let’s next consider injury from falls, lifting heavy weight, car wrecks, etc.

Now if you have a spine that may have developed in a weakened state - the body of a patient deconditioned - and then add injury to it, pain results. Now, if you are such a person and you develop pain in the back or extremities or headaches and go to a doctor expecting some form of care to relieve this pain, hopefully a pill, surgery, exercise, nutritional supplement or spinal manipulation, you want it quickly so you can return to what you were doing and have the pain not return. So many factors play into the equation for injury (even for work injuries - is it alway entirely the job's fault for a work injury?): genetics, lifestyle, physical condition, life choices in deciding how to use the body to avoid injury or pain may come into play.

DO YOU SEE THE FOLLY OF THIS ATTITUDE?  There is no cure for many spine problems, only control through maintaining a healthy body, learning what you can and cannot do, exercise, visiting the chiropractor for spinal alignment, spinal decompression, spinal manipulation, and conditioning, and supplementing with nutrition to develop and maintain healthy discs in the spine.  A person with a weak spine cannot expect to nevertheless do anything with that spine that he or she wants without a pain consequence forever.  That is like asking a diabetic person to eat a box of chocolates and not be adversely harmed.

OWN IT.  There is no way for you to make a race horse out of a pony. Be content with what you have, and make it work. Appreciate your spine as it is. You may not like these facts, but can you change them? No. Own your spine, and allow it to perform at its peak performance for you and your lifestyle. That requires honest realization of your limitations and living with them while being in the best physical health you can attain. YOU ARE THE ONE WITH THE MOST TO GAIN. The chiropractor is your back pain specialist, your treating doctor, coach, cheerleader, and guide. Work with the trained and even certified in Cox Technic chiropractic physician who uses flexion distraction to maximize your spine’s usefulness and ability!

Respectfully submitted, James M. Cox, DC, DACBR, FICC, HonDLitt, FACO(H)

Cox Technic Flexion Distraction Decompression Spinal Manipulation is evidence-based spinal care, a form of spinal manipulation in which the human spine is placed in distraction (a type of measured controlled traction of the spine) delivered on a specialized spinal manipulation instrument. The Cox Table is the well-designed instrument of choice.

Five specific changes in spine mechanics occur in the intervertebral disc and nerve openings with this procedure (1):

1. The height of the intervertebral disc is increased.
2. The size of the nerve opening which is called the intervertebral foramen is increased up to 28% in area.
3. The pressure within the intervertebral disc which is created by the fluid within the disc is reduced from a positive pressure to a negative pressure gradient. This aids in dropping the pressure on the pain sensitive nerves within the disc and the pressure on the nerve which lies behind the disc which causes sciatic or leg pain when compressed over 20 mm of mercury pressure.
4. The movements of the spine are restored. A specific spinal vertebral level (consisting of the intervertebral disc and the moveable joints lying behind the disc) is placing into its normal physiological ranges of motion. Remember that loss of spinal mobility is a part of back pain whether it be acute or chronic. Restoring normal spinal mobility offers improved activities of daily living and diminishing spinal stress that causes back pain.
5. Nervous system tracts of nerves from the spine to the human brain are stimulated when spinal manipulation is administered. These nerve tracts respond to touch, motion, temperature, and pressure to initiate nerve reflexes that relieve pain and allow for normal spinal motion. Such nerve tracts can also affect balance and equilibrium that are so often affected with spinal pain.

The goal of Cox® distraction spinal manipulation is summarized as follows: Attain and maintain physiological range of spine motion with the greatest relief of pain. It is also vital to note that some spinal conditions are not cured, that is to say all the pain is relieved and the person can do any activity without pain recurrence. NO, some spinal conditions that are congenital (born with) or acquired from injury or degenerative spine changes are controlled not cured. In such cases it is important that the patient follow the training given by the chiropractor concerning proper ergonomics (how to move, bend, lift, twist the spine) to avoid pain, perform the specific exercise program developed for your spine condition, and in many cases have dedicated times for undergoing Cox® distraction spinal manipulation so as to maintain relief. Cox Flexion Distraction may well be a beneficial alternative to back surgery for back pain patients.

Respectively submitted,

James M. Cox, DC, DACBR

Tremendous growth in the use of spinal manipulation to treat human spine pain conditions is reported in the literature today. Chiropractic, osteopathy, physical therapy, and allopathy all research and document these benefits; let’s look at some of these benefits.

Physical therapists find tension type headache patients were relieved by suboccipital inhibitory pressure and suboccipital spinal manipulation (upper neck and base of the skull area) in a combined use. It is effective at changing different dimensions of quality of life, and the results support the effectiveness of treatments applied to the suboccipital region for patients with tension type headache. (1)

Treatment of 455 low back pain patients with osteopathic manipulation treatment showed substantial improvement which was defined as 50% or greater reduction of pain at week 12 compared with baseline. Patients with higher pain levels actually showed the greatest relief. In another study, 6 osteopathic spinal manipulation treatments over an 8 week period gave significant and clinically relevant recovery of chronic low back pain. Interestingly, patients without depression were more likely to recover from chronic low back pain with osteopathic manipulation therapy.  A trial of osteopathic manipulation may be useful before progressing to other more costly or invasive interventions in the medical management of patients with chronic low back pain. (2)

Patient age can determine the best form of spinal manipulation to be administered. The American Academy of Osteopathy studied the use of osteopathic spinal manipulative treatment (OMT) in 3 age groups of patients: <65 years, 65-79 years, and ≥80 years.  Osteopathic spinal manipulative treatment can be used to address serious conditions affecting older persons (≥65 years). Spinal manipulation was  used equally in all 3 age groups but varied in the type of spinal manipulation given. Over age 65, more gentle spinal manipulation procedures are used while more vigorous types of spinal manipulation can be delivered in patients under age 65. Respiratory and neurologic conditions were often treated with spinal manipulation. (3)

Chiropractic spinal manipulation showed 86% of low back pain patients showed relief following 12 spinal manipulation treatments given over an average of 29 days. The type of spinal manipulation used was Cox® flexion distraction decompression. (4)

Spinal manipulation is first line treatment for low back pain. (5) When considering treatment for low back pain and sciatic pain, note that epidural steroid injections are reported no better than a placebo for sciatica and spinal stenosis.  These facts can aid a patient in choosing their treatment for headache or low back pain with or without leg pain.

Respectfully,

James M. Cox, DC, DACBR

Kuo reported that impaired nutrition leads to disc degeneration; therefore, there is a definite need to improve disc nutrition. (1) Zhu stated impairment of different nutrition pathways results in different degenerative patterns in human discs. (2) Shirazi-adl reported disc nutrient concentrations could fall to levels inadequate to maintain cellular activity or viability, resulting in cell death and disc degeneration. Gu states that poor nutritional supply has a long-term effect on disc degeneration. The nutritional level, proteoglycan content, water content, and volume during human disc degeneration in a realistic 3-dimensional finite element model of the human intervertebral disc was developed for the study of nutrition of the disc. (3)

Note that the term proteoglycan content is referred to in the above citation by Gu. What is this proteoglycan so important in maintaining a normal intervertebral disc and preventing disc degeneration? It is glycosaminoglycan which is the proteoglycan in the intervertebral disc that imbibes water to give the intervertebral its normal hydrostatics for weight bearing and normal motion. Glycosaminoglycan is primarily chondroitin sulfate. Schleich states biochemical alterations of spinal discs are present before degeneration of the disc is visible on x-ray or MRI. (4) Glycosaminoglycan (GAG) loss plays a central role in these degenerative processes. GAG content of the nucleus pulposus (np) and annulus fibrosus (af) of the disc showed lower levels of gag content as disc degeneration worsens. Deng found glycosaminoglycan in the nucleus pulposus and annulus fibrosus decreases as disc degeneration increases.  Of great interest is that the depletion of GAG content in degenerative lumbar discs correlated significantly with intervertebral disc herniation.

What can be done to impede disc degeneration and enhance disc regeneration?  Mavroaonatou stated that glycosaminoglycan synthesis stimulated by glucosamine provides a possible promising clinical role for treating disc degenerative disorders. (7) Shostak reported on 30 patients with LBP (mean age 51) who were given chondroitin sulfate (drug structum) 1g/day for 24 weeks. 73% of patients showed pain relief and improved spinal function and structum is included in treatment of low back pain as chondroprotective drug. (5) Seleznova reports that chondroitin sulfate in combination with non-steroidal anti-inflammatory drugs could achieve rapid rehabilitation of patients with locomotor activity and improve quality of life in general for non-specific back pain. (6)

Since 1966 I have researched chondroitin sulfate, the chemical making up glycosaminoglycan within the human intervertebral disc, and have formulated Discat Plus which contains chondroitin sulfate, glucosamine sulfate, and other nutrients found in the disc- calcium, magnesium, zinc, manganese, and potassium.

In clinical practice, I give Discat Plus to patients with disc degeneration, disc herniation, and spine pain. It will, in the future, be a preventive supplement as is the structum formula described above.

Consider the nutritional aspect of treating spine pain, disc degeneration, disc herniation and spinal arthritis. Flexion distraction spinal manipulation which incorporated disc decompression under traction may be a stimulus to enhance imbibition of Discat Plus into the intervertebral disc.

For further information, contact Julie or this link on Discat Plus.

Respectfully submitted,

James M. Cox, DC, DACBR

This inaugural blog on the mechanism, diagnosis and treatment of spine and radicular pain appropriately opens with discussion of the most important element of spine care in the United States and the world for that matter – THE PATIENT.

Do you ever empathize with a person in spine pain who is seeking care – the stressful decisions to be made with sometimes with little knowledge of the problem? Can you blame him or her? Fact-filled alternatives are missing for such hard decisions. Just consider the following truths about spine care today.

SURGERY CONSIDERATION

Surgery yields varying feelings and opinions by patients and for good reason. Consider the following scientific papers on surgeons’ disagreement on spine surgery. The better trained the surgeon the less spine surgery is performed. More surgery is done by private clinics and 4 times less in academic and teaching institutions. (1) Degenerative lumbar scoliosis has variability in both non-operative and operative management. The appropriateness of surgery and specific surgical procedures have not been defined for this important pathology of the aging spine. (2) Such statistics support the patient’s plight in treatment decision making.

PATIENT CHARACTERISTICS IN CHOOSING CHIROPRACTIC CARE

Patients seeking chiropractic care are known to be intelligent seekers of their best care. In a study of non-Hispanic black patients who went to chiropractors, they tended to be female, be older, be college educated, be employed, and have a positive viewpoint on their interactions with their chiropractor. (3) Other studies have documented this as well. So successful is spinal manipulation that physical therapists now practice all forms of chiropractic manipulation from high velocity to Cox® Technic flexion distraction and publish peer reviewed papers on it. In Germany, study of manual therapy by general medical doctors for nonspecific low back pain benefits is to be conducted. (4)

COX® TECHNIC FLEXION DISTRACTION AND DECOMPRESSION SPINAL MANIPULATION

Cox® Technic flexion distraction and decompression spinal manipulation is a popular and growing form of spine care for people suffering from disc degeneration, disc herniation and spinal stenosis that cause leg pain called sciatica and arm pain and other spinal conditions such as spondylolisthesis, transitional segments, scoliosis, facet disease, pregnancy, spondylolysis, osteoporosis, arthritis, and so many more diagnoses.

Spinal mobilizations - low velocity passive oscillatory movements such as Cox® flexion distraction decompression spinal manipulation - are reported to reduce spinal pain in some patient subgroups by an endogenous pain inhibition system mediated by the central nervous system. Cox® flexion distraction low velocity low amplitude spinal manipulation shows short-term, remote antinociceptive effect similar to clinical findings in a rat study. (5,6) This author financed the building of a Cox® spinal manipulation instrument that is 1/12 the size of a regular Cox® manipulation instrument. It was built at the University of Iowa with input from Ram Gudavalli, PhD, and is used for rat experimentation as described here. Quite exciting to see how many years of study and research can lead to new approaches.

LITERATURE STATISTICS ON BENEFITS OF SPINAL MANIPULATION COMPARED TO SURGERY

Favorable outcomes of back pain and radiculopathy are attained in the vast majority of patients under non-operative care. Surgical intervention is reserved for patients who have significant pain that is refractory, non-responsive to at least 6 weeks of conservative care. This author finds this window of time adequate to reverse back and extremity pain in the majority of cases with Cox® Technic Flexion Distraction and Decompression spinal manipulation. Patients who have a severe or progressive motor deficit, or patients who have any symptoms of bowel or bladder dysfunction are surgical candidates but this occurs in a small minority of cases, less than 1% with the condition called cauda equina syndrome. (7)

The Bone And Joint Decade 2000-2010 Task Force On Neck Pain and its associated disorders searched 5 databases from 2000 to 2014 finding 8551 citations for study. New evidence suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, ultrasound) are not effective and should not be used to manage neck pain. (8)

DEPRESSION IN CHRONIC LOW BACK PAIN PATIENTS

Chronic low back pain is known to cause anxiety and depression for the patient. Can you blame them? Suffering without relief will make anyone anxious. The complex, bidirectional correlation between chronic low back pain and generalized anxiety disorder, common in primary care, can increase the risk of inadequate treatment. (9) Chronic low back pain participants have lower working memory performance and higher pain catastrophizing  compared to pain-free controls.  (10) This author finds patient confidence and understanding of their condition reduces depression; some patients state their relief to now just understand their condition as it had not been explained to them by any prior healthcare consultant, doctor or surgeon in an understandable language.

CONSIDERATION OF HIGH VELOCITY LOW AMPLITUDE VERSUS LOW VELOCITY VARIABLE AMPLITUDE SPINE MANIPULATION BY SPINE CONDITIONS

Classic side posture high velocity low amplitude spinal manipulation was compared to Cox® flexion distraction non thrust spinal manipulation in a study of 192 participants, mean age 40 years, 54% male with subacute and chronic low back pain. Similar effects in short-term low back pain improvement for both were superior to a wait list control. (11) This author notes the mean age of the 192 patients was 40, and Cox states that the older the patient the more reliable is flexion distraction decompression spinal manipulation due to degenerative spine disease and inability of the patient to tolerate high velocity thrust adjustment. Also no radicular patients were part of this study and radicular patients, show Cox® flexion distraction decompression non thrust adjusting has great superiority because side posture thrust adjusting is not well tolerated and is shown to aggravate disc herniation and spinal stenosis. Here is seen the erudite decision making of the chiropractor in determining spinal manipulation use and application. (11)

CONCLUDING PATIENT INTERESTS IN CHIROPRACTIC MANIPULATION

Lastly, evidence based clinical practice is three entities:

1. research
2. clinical expertise
3. patient satisfaction and preference.

Chiropractic must persist in the research for documentation of its contribution to the epidemic problem of spine pain. Dissemination of this research to the chiropractic field doctor is an absolute necessity so he or she can implement the principles taught. Patient satisfaction with chiropractic research and clinical superiority will maintain the leadership role for chiropractic in spine care management.

Cox® Technic flexion distraction and decompression spinal manipulation has published scientific papers on the biomechanics and clinical outcomes of the technic for spine and radicular pain. Standards of care for cervical, thoracic and lumbar spine spinal manipulation are published as well as tutorials in the application of the flexion distraction and decompression technic. For full study of the work, go to the website www.coxtechnic.com. There you will find copies of the research papers, descriptions of Protocol I and II applications of the technic, clinical outcome studies, and case presentations of spinal conditions such as spinal stenosis, intervertebral disc herniation, spondylolisthesis, Bertolotti’s syndrome, facet syndrome, synovial cyst, Tarlov cyst, scoliosis, and subluxation. Cox Technic Complete® program websites like this one more fully go into the examination, physical, orthopedic, neurological and diagnostic imaging of spine pain patients which are shown in video for patients to study and then arrange care with the physician. These studies are designed to lead to the most prudent diagnosis of the patient’s condition. Study opportunities with Dr. Cox and other certified chiropractors for those interested in the procedures are given. Certification following 32 hours of hands on and didactic study is available for international referral directory opportunities.

Clinical validity of Cox® Technic is shown in the just published Clinical Practice Guideline: Chiropractic Care for Low Back Pain in the Journal of Manipulative and Physiological Therapeutics published online January 19, 2016. (12)  It shares that “currently, the most robust literature regarding manual therapy for low back pain is based primarily on high-velocity, low-amplitude (HVLA) techniques, and mobilization (such as flexion-distraction) therefore, in the absence of contraindications, these methods are generally recommended.” (12) This validation of Cox® flexion distraction decompression spinal manipulation is necessary for developing chiropractic’s role in spine treatment.

It is the leadership of superior spinal manipulation that will ultimately draw the public’s acceptance. It is my opinion that our path of research, clinical application and patient preference is large in the future of expanded chiropractic medicine.

Thank you for studying with me.

Respectfully submitted,

James M. Cox, DC, DACBR, FICC, Hon.D.Litt., FACO(H)

1/26/16 

Dr. James Cox well developed Cox® Technic's reputation for managing low back pain and sciatica. Most everyone who uses it says they'd turn to flexion distraction to manage low back pain and leg pain and disc herniation. But the evolution of Cox Technic to caring for the other regions of the spine has grown! Flexion Distraction Cox® Technic for cervical spine disc herniations and disc degeneration and headache and arm pain is well researched biomechanically and clinically. Its research progresses with federal funding via NIH and HRSA chiropractic research grants at NUHS and Palmer Research with Loyola Stritch School of Medicine/Hines VA Hospital and others like University of Iowa and University of Illinois. It's so exciting!

Check out this video that just shows snippets of lumbar spine flexion distraction application (It will look so familiar!) as well as cervical spine treatment (on The Cox8 Table) and side-lying treatment for pregnant patients (so comfortable and effective!) as well as patients who are in too much pain to  lie on their stomaches. 

Cox Technic is most effective biomechanically and clinically for lumbar spine back pain conditions. Check out what it offers the cervical spine related neck and arm pain conditions, the "newest" application of Cox Technic since 1991. Check out this video.

Dr. James Cox presented a webinar that included cases from his clinical practice and demonstration of their treatment on The Cox8 Table by Haven Innovation:

• degenerative scoliosis with osteoporosis
• compression fracture care and options
• disc herniation, spianl stenosis
• disc extrusion

It's always a comfort for both the doctor and the back pain patient to see that other doctors and patients have successfully dealt with the same condition or combination of conditions successfully for relief of pain. Dr. Cox shares the history, examination findings, imaging, diagnosis, treatment and ancillary care (exercise, nutrition, belt, electrical stimulation, hot/cold therapy, etc.)

In a practical way, Dr. Cox shows that these cases come into the chiropractor's office seeking relief and can get it.

The recording is now available of this presentation of 4 cases. Click here to register. You will receive personal log-in instructions and codes to watch the recording on your own time, computer and pace. 

An eye-opening article in the Houston Press reports on the veterans coming home from wars in the Middle East, suffering with back pain and sciatica.

Back packs of 80 and 90 and 100 plus pounds that must be carried by on their backs plus the body armor of 30 to 40 pounds is being discussed as a culprit. Amazing that airport baggage over 50 pounds is considered too heavy and charged a surplus fee. Shipping companies charge extra for heavier loads, too. Military men and women carry these heavy loads daily and jump in and out of vehicles according to this article. No wonder lower back pain and leg pain (sciatica) is an issue.

The Veterans Administration does what it can. It seems that a suggestion was bantered around for a "back pain management clinic" to be added to all VA Hospitals. That didn't happen. Chiropractic is supposed to be available in all the VA Hospitals. It's coming slowly, it seems, but has never been in more demand. Chiropractic's non-surgical and non-drug approach may certainly meet the demand because these veterans don't want to take drugs and have surgery if they don't have to. Cox Technic may be the successful back surgery alternative for them.

Cox Technic is poised ready with certified and otherwise trained physicians to meet the demand for back pain relief for US veterans. A few bases even have Cox Tables and physicians on staff who treat the veterans with back pain, and these docs are busy.

We wish our veterans safety, thank them for their service, and hope more of them get access to chiropractic and even Cox Technic Flexion Distraction Spinal Manipulation care for their back pain.

• article on a veteran who did get flexion distraction care
• article reviewing how chiropractic is integrated into VA
• article on current integration of chiropractic into VA