1. Murphy D et al: Nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics 2009; 32(9):723-33
- 49 consecutive patients with disc herniation confirmed on MRI with pain and disability for an average of 60.5 weeks were treated 2-3 times a week initially for 3 weeks with flexion distraction manipulation.
- Flexion Distraction manipulation, neurodynamic techniques, joint manipulation, myofascial technic and exercise were utilized.
- Clinical outcome at end of treatment and 14.5 months later showed
- Clinically meaningful improvement of pain and disability in
- 79% and 70% of patients respectfully at end of treatment
- 79% and 73% respectfully at 14.5 months follow-up 2. 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
- 29 days to maximum improvement (mean) regardless of condition treated
- 21 visits to maximum improvement (mean) regardless of condition treated
- Disc herniations take longer than sprain/strains
- 91% of patients relieved within 90 days, keeping them from the chronic pain stage
- Results
3. Gudavalli R, Cambron JA, McGregor M et al: A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain. European Spine Journal 2006; 15: 1070-1082 [results of HRSA funded federal grant project between National University of Health Sciences, Loyola Stritch School of Medicine,
- Comparison of flexion distraction (FD) to physical therapy/active exercise (ATEP) for low back pain
- Both groups improved significantly (measured by VAS and RM) after treatment
- Patients assigned to FD did better than ATEP (VAS)
- Patients with radiculopathy improved significantly better with FD therapy (VAS)
- Results 4. Cambron GA, Gudavalli MR, Hedecker D et al: One-Year Follow-Up of a Randomized Clinical Trial Comparing Flexion Distraction with an Exercise Program for Chronic Low-Back Pain. J of Alternative and Complementary Medicine 2006; 12(7): 659-668
- Flexion distraction was found to be more effective in reducing pain for 1 year when compared to a form of physical therapy. 5. Morris CE: Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation. Journal of Manipulative and Physiological Therapeutics 1999; 22(1):38-44
- 31 y/o man with severe lbp, plantar flexion weakness of left leg, absent Achilles reflex, hypesthesia S1 dermatome, MRI large L5-S1 HNP
- Cox decompression distraction adjustment was part of the treatment resulting in RTW in 27 days.
- Repeat MRI showed no change
- 20 visits over 50 days with total remission. Absent Achilles maintained.
6.Spine J. 2010 (Jun); 10 (6): 463–468
Daffner SD, Hymanson HJ, Wang JC.
Department of Orthopaedics, West Virginia University, Morgantown, WV 26506-9196, USA. [email protected]
In this Spine Journal study, the cost of chiropractic and other conservative treatments were evaluated for patients prior to possible surgical discectomy. The question was: is conservative care for patients who are believed to need surgery warranted? Are enough individuals able to avoid the dangers and cost of surgery to warrant the cost of conservative management prior to scheduling surgery? This study concluded that: “Although a large number of patients will ultimately require surgical intervention, given that many patients will improve with nonoperative therapy, a trial of conservative management is appropriate.”
- Clinically meaningful improvement of pain and disability in