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 

Certified Cox Technic physician and instructor, Dr. George Joachim, publishes a case report with the Journal of Chiropractic Medicine on his care of a patient with a post surgical C6-C7 spondylotic myelopathy and lumbar radiculopathy occurring together in one patient. Also, his being a chiropractic rehabilitation diplomate, he shares how rehabilitation worked hand-in-hand in this case to help relieve this patient. 

Read the full case study. Share! 

 

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.

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.

Cox® Technic certified physician, Dr. Mark Ashley, published a case report on "Cox® Distraction Treatment of Extruded L5/S1 with Neural Impingement, Disc Herniations at L2‐L4 and Sciatic Radiculopathy and Paresthesia." Complete with an MRI image, Dr. Ashley's case demonstrates the efficacy of Cox Technic protocols for relieving spine pain in a difficult case involving multiple level herniations. Click here to read the case.

Dr. Robert Rice presents the case of a patient suffering with an L4/5 disc protrusion with scoliosis who was treated for a year with VAX-D with little relief.  Following Cox® protocols, Dr. Rice states reports that "The patient has attained 50% relief of pain in twelve visits, and four weeks of care. She states she has noticed a decreased sensation of heaviness in her low back and has also noticed that she can stand for longer periods of time with decreased low back pain."

Read the whole report which includes pre and post-treatment MRI images at this link.

Thanks for writing, Dr. Rice!

   

Cox® Technic (aka flexion-distraction) clinical outcomes published in European Spine Journal. Flexion-Distraction provided more low back pain relief than did medical conservative active exercise. 

Patients with radiculopathy (leg pain) did significantly better with flexion-distraction than active exercise. 

 

article link: http://www.springerlink.com/content/f32603l877144k77/?p=1ba95a15a905467b8ed4080941ee22e6&pi=4

In a randomized, controlled study comparing chiropractic flexion-distraction (Cox® Technic) with medical care (active exercise), flexion-distraction was superior in relieving radiculopathy sciatica (leg pain). Patient were randomized to two groups for care. Those with radiculopathy who were treated with flexion-distraction alone (mind you, no physical modalities or exercise were allowed by the treating chiropractic physicians) had significantly greater relief. The study was published in the European Spine Journal.

Gudavalli, Kruse and Cambron reported on a case of a 26-year-old pregnant patient in her second trimester of pregnancy with severe pain in her lower back extending to her hips on both sides and to her right leg. She even felt tingling down her right lower leg to her foot. She reported relief of pain after the first treatment with Cox flexion-distraction decompression. Granted the application is a bit modified since she is pregnant, but she was comfortably accommodated by lying on her side on the Cox® Table while the doctor used the manual lateral flexion to allow flexion into the spine and flexion to allow lateral flexion. She reported being painfree and was documented as such using both objective and subjective tests after just 8 visits.

Click here for the abstract of the article.

Cox® Technic is gentle and effective care for the most delicate conditions like pregnancy and stenosis and disc herniation and older spines that want gentler care.

Cox® Technic is gentle and effective treatment for spinal pain conditions.