The flexion/distraction treatment is a gentle technique but has great power when
adjusting the vertebrae of the lower back
Lower-back problems are the most costly of all musculoskeletal disorders. Nearly half
of all workers’ compensation insurance claims are due to back injuries. Soft-tissue
injuries and mechanical injuries of the lower back account for most cases of disability.
Because of these statistics, evaluation and treatment methods for lower-back disorders are
continually being researched.
Attempts to manage the problem have led to research resulting in new knowledge in
anatomy, biomechanics, exercise physiology, and neurology of the lower back. This
expanding knowledge base has in turn resulted in the modification of some practice habits,
the discarding of others, and the addition of new and innovative forms of treatment.
Clinical practice has also been continually reshaped as a result of this. It is well
recognized that treating the mechanical lower-back-pain patient with activity decreases
the disability, whereas treating the patient with prolonged rest, analgesics, and minimal
activity increases the disability.
Address Function—or Mechanics—of the Spine
At our center, the management of the problem has shifted from passive therapeutic
interventions to more active approaches that encourage an early return to activities. We
attempt to identify and recognize the mechanics and status of the injury, and to maximize
the potential for repair of the musculoskeletal tissues. Our objective and goal is to
allow the vertebral segments to restore function as rapidly as possible without reinjury.
The key word here is “functional.” If only the soft tissue is healed, without
the function or the mechanics of that spine addressed, the problem is going to become a
chronic one.
When a patient comes to the office in a chronic state, we have to address soft-tissue
lumbar mechanics and pain levels. Early care leads to success in most patients, with
active patient participation necessary for effective results. The treatment plan should
emphasize functional improvement as well as pain reduction.
At our office, the treatment program examines each patient’s total recovery
potential, from vocational activities to pain tolerance. The appropriate regimen is
constructed for each individual’s needs. The reduction of pain is considered a
crucial factor of any rehabilitation program. I stress to patients that pain is definitely
an issue, but I explain that the mechanical problems in their lower back are more
important than just the alleviation of their pain. After ruling out any bone pathology,
and after finding areas of segmental dysfunction, we prescribe a series of modalities that
are standard modalities of treatment, including heat packs, cryotherapy, ultrasound,
hydrotherapy, whirlpool, interferential therapy, and most importantly, specific
chiropractic adjustments of the spine.
Once the patient is more comfortable, he will be able to begin an exercise program.
With any mechanical injuries, there is evidence of soft-tissue injuries. The soft-tissue
injuries heal more quickly with an early guided exercise program. Our patients are
instructed how to improve their posture and use proper body mechanics in their everyday
lives. This is crucial for preventing further aggravation of their injuries.
Rehabilitation is dependent on patient cooperation. Without adherence to a proper
treatment program, chronic pain often develops.
Case Study
A 45-year-old male, 6’2” and 210 pounds presented to the office with
moderate-to-severe lower-back pain radiating into his left lower extremity. The patient
had been taking muscle relaxants and anti-inflammatory medication given to him by his
primary medical doctor. He was told that if that did not work, a series of epidural
injections would be given to him. If that particular feature failed, he was told a lumbar
diskectomy or laminectomy should be performed. The patient came to my office for a second
opinion on this problem. The patient
presented with central disk herniations at L4-L5, and L5-S1 intervertebral disk spaces
with annular tear. Lumbar straightening is evident, as well.
X-rays of the patient’s lower back were relatively
normal. There was an extension subluxation of the L4 vertebral level with a slight degree
of left body rotation. The patient was limping, and his left knee jerk deep tendon reflex
and his Achilles reflex were sluggish in comparison to the right lower extremity, and the
Achilles reflex was basically non-existent.
We ordered an MRI of this patient. The MRI came back with the
impression of a large herniated disk with a left lateral recess creating stenosis on the
left IVF canal. Due to the fact that there was no ruptured disk, we proceeded to do the
flexion/distraction adjustment. The first two treatments alleviated some degree of the
pain but the patient was still under distress by the third visit. I proceeded to do the
flexion/distraction on the table and added the lateral flexion component. I laterally
flexed the table to the right and the table was locked in that position while the
ultrasound and the rest of the adjustments were given to the patient.
The end result of that particular treatment is that the
patient got up from the table walking; his Achilles reflex and his knee jerk reflex were
back, and the patient felt a burning sensation leaving his lower back. After that
particular treatment, we saw the patient for five more flexion/distraction treatments and
the patient has been pain-free for the last five and a half months. The patient stopped
taking medication, and he went back to his particular line of work with recommendations of
an aggressive abdominal strengthening exercise program and care on a twice-per-month basis
to prevent any acute flare ups of his condition. |
Focus on Mechanics in Addition to Pain
In my office, from day 1, it is explained to my lower-back pain patients that
pain is a secondary factor of an underlying mechanical problem in their spine. The
mechanical problem is going to affect the nerve root, the nerve root is going to affect
the nerve, and the nerve is going to affect the muscle. All of these factors result in
pain. The patient is given a complete neurological and orthopedic evaluation, including
reflex evaluation and testing. We evaluate the status of the lower extremities, especially
the knees and the ankles.
In my office, using the flexion/distraction treatment, we strap the patient’s
ankles to make sure no underlying problems exist with the knees and the lower leg. I have
found that the flexion/distraction treatment is a gentle technique, but it has great power
regarding adjusting the vertebrae of the lower back. The mechanics involved in
flexion/distraction are simple but effective. Patients that present to our center with
disc inflammation, disc herniation, bulging disc, mechanical abnormalities of the spine,
and muscle spasms respond very quickly to flexion/distraction therapy. What I have found
very important is that during those acute stages when the patient has so much muscle
guarding, we do not have to move the patient side to side or rotate him. Everything can be
done in a prone position. I also like the tables that we use because the patient is prone
and the DC actively participates in the healing of the patient. Placing my hands on the
patient’s spine allows me to see how the flexion/distraction treatment is helping the
particular area that I am adjusting. The tables not only have flexion distraction, but
also have lateral flexion movements and rotational movements while the patient is in a
prone position. We can provide all the adjunctive therapies while we are doing all this
active adjustment of the patient’s lumbar spine.
We have even used the flexion/distraction technique for the treatment of scoliosis. It
is amazing to see the patient in a prone position with the x-rays in the view box and my
hands on the patient’s back, and performing the flexion of the lumbar spine and
actually feeling how that spine is reacting to that particular force.
We can also adjust the table to different positions where you minimize the curve while
you are adjusting and while you are doing a particular therapy. The modifications and
adjustments to the table allow an opening of the disk spaces in the areas of joint
dysfunction. The unique qualities of administering treatment with this table allows the DC
to pinpoint specific areas of concern, helping the patient be more comfortable at the time
of treatment and alleviating their symptoms faster, which increases their compliance with
the treatment. CP
Case Study
A 74-year-old female with a history of lumbar stenosis, moderate disc degeneration, and L5
spondylolisthesis with a transitional segment of S1 presented to the office. The patient
also had right convex rotatory scoliosis. She has had epidural injections and all kinds of
medications and physical therapy. Despite all this treatment, she was just getting worse.
We analyzed the patient’s lower-extremity functional status and reflexes. Her
lower-extremity reflexes were normal, but the lower-back pain was extremely sharp. We
started a regimen of lumbar flexion/distraction. In this case, each visit began with
ultrasound, interferential, heat, and hydrotherapy to soften and relax the musculature of
the lower back. Because this was an elderly patient, we wanted those tissues to be more
elastic before performing the treatment. We then proceeded to do the flexion/distraction,
and it took this patient eight to nine visits to accomplish a 90% improvement. This
patient had been diagnosed with stenosis, and was told that there was no hope for
treatment outside of spinal surgery—and even this had no guarantees. At the time she
came to our office, we offered her hope when there was none in the “standard”
medical field.The plan and purpose in all of
our cases is to assist the patients in increasing the potential for functional healing and
to enhance their body’s ability to decrease stresses in the lumbosacral region. This
goal is accomplished by optimizing the patient’s ability to take care of the forces
of gravity and movement by balancing anatomic structures and improving musculoskeletal
efficiency. |
Kyzor M. Dahdah, DC, practices in Plantation, Fla. Contact him at drdahdah@aol.com.
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