A 2006 randomized trial found flexion distraction, a low-force chiropractic traction technique, reduced pain more than active exercise for chronic low back pain. The effect was strongest in patients with moderate-to-severe symptoms and radiating pain. Flexion distraction works by reducing pressure inside the disc.
Questions this episode answers
February 22, 2016.
2006; European Spine Journal.
A Randomized Clinical Trial and Subgroup Analysis to Compare Flexion Distraction with Active Exercise for Chronic Low Back Pain.
Pain longer than three months.
Approximately 50–60% (host's estimate).
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Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. Today we're going to look at a study from 2006 that was in European Spine Journal. It's titled A Randomized Clinical Trial and Subgroup Analysis to Compare Flexion Distraction with Active Exercise for Chronic Low Back Pain. Before we get started, let me say a few words about Rocktape. Rocktape is proud to be a sponsor of the Evidence Based Chiropractor. Rocktape offers the world's best kinesiology tape, pain relief topicals, mobility tools and functional fitness accessories. New from ROC Tape is Rocksauce Chill, a powerfully cool pain relief topical in a convenient roll on with 6% menthol, it's stronger than the freeze competition. They're more than just a tape company, they are a movement company. Learn more and get access to your medical discount by visiting rocktape.com Just last week we had an awesome interview with Dr. Steve, the medical director over at Rock Tape and it really revolved around and functional movement. So check that out if you didn't get the chance. It was just on last week's Evidence Based Chiropractor podcast. But today we are going to look, I will repeat again at a journal article from European spine journal in 2006. It's titled A Randomized Clinical Trial and Subgroup Analysis to Compare Flexion Distraction with Active Exercise for Chronic Low Back Pain. This is a great study because it is an rct. So it's a randomized clinical trial. That's the highest tier of research. Second to that, it's in European Spine Journal, so a very prestigious journal overseas and doesn't typically focus on chiropractic care. But in this instance they are literally looking at a specific chiropractic technique, flexion distraction technique. I believe that statistically within chiropractic, somewhere between 50 to 60% of chiropractors perform flexion distraction in their office. So this is a very relevant study for a lot of people out there. So second to that, it's looking at chronic low back pain. So these are patients that have been in pain longer than three months and it's looking at flexion distraction versus active exercise. Active exercise is what a patient will on the whole go through when they start with physical therapy. So I'm taking it a little bit out of context by saying this, but it's really looking at patients who have chronic low back pain and just chiropractic care or low amplitude adjustment, flexion distraction, going to beat PT or active exercise. So that's kind of what they're looking at. So again, this study compares flexion distraction, a low force manual traction immobilization technique, with active exercise, specifically trunk stabilization as performed by a physical therapist for chronic low back pain. Patients receiving the chiropractic technique experience, they found significantly greater reduced perceived pain according to VAs. So that's great. And that is compared to those in the active exercise group. So from my perspective, these findings support previous research which shows flexion distraction to be effective at reducing pain and disability relating to disc and nerve root pathologies. So previous research has shown that flexion distraction technique actually decreases intradiscal pressure. Again, previous chiropractic research or previous research relevant to chiropractic has shown flexion distraction technique, low force flexion distraction to actually reduce intradiscal pressure. That was a showstopper for me because it also showed that not only was it decreasing the intradiscal pressure, but it actually reduced radicular symptomatology. So when I put all that together, what does that mean? Well, it means that patients that have a disc herniation, disc pathology, occluding a foraminal canal causing radiculopathy, disc on nerve pinch, nerve sciatica. However we want to describe it, whether cervical or lumbar. Excuse me. When they underwent flexion distraction technique, it reduced the intradiscal pressure. Often it did result in some at least temporary subsidence of that protrusion herniation and thus reduced the compression on that nerve and ultimately reduced the symptomatology associated with that compression. So that was research that really struck me previous to this paper. But this paper found. Let's talk about three key items that they found with this paper. One was that again, they found subjects randomly allocated to the flexion distraction group had significantly greater relief from pain than those allocated to the exercise group. Great start. Second to that, they found subjects categorized as chronic with moderate moderate to severe symptoms improved most with flexion distraction protocol. Let me repeat that. Subjects categorized as chronic with moderate to severe symptoms improved most with flexion distraction protocol. This line is exquisitely important when building referral relationships. When we look at that, let's break it down. Chronic pain patients, people that have been in pain longer than three months. Not only that, but patients that had moderate to severe symptomatology where are these patients going to be going? They're going to be going to pain management. Typically they're going to be on the medications. These patients actually improved most with flexion distraction protocol. That is very, very important and very big knowledge and value that you can bring to other providers in your community and your patients by knowing that the third item that they found was a greater decrease in VAS among patients with radiculopathy should be expected for the flexion distraction group where changes in disc pressure may be important. So there we're touching right on exactly what we discussed earlier in this episode. That decrease in VAS with patients that have radiculopathy, radicular symptoms should be expected for the flexion distraction group where changes in disc pressure may be most important. In other words, you are able to do a low velocity technique, you're able to reduce the pressure in the disc and it's going to not only open up mechanically through literally the flexion distraction process, literally open up the ivf, but it also has the potential to then reduce the symptomatology and inflammation around that area. So I just absolutely, I absolutely love this study and I love it because it brings a ton of value. If you can share this information not only with your patients, but also any other providers in your community. I'll take a quick moment here kind of regarding that. Again, to thank everybody who's picked up Marketing Chiropractic to Medical Doctors on Amazon. There's been hundreds of copies that have gone out to chiropractors around the world. The response that I've gotten through email has been absolutely awesome. So thank you to everybody who's picked up Marketing Chiropractic to Medical Doctors. Really, it's about being a step by step guide to help get you up and running. It's probably less than you're going to pay at lunch today for takeout, so I think it's well worth it. If you have any interest in interdisciplinary referrals, I highly recommend checking it out. If you want to go the extra mile, Certainly our monthly membership program at the Evidence Based Chiropractor focuses exclusively on bringing value, building referral relationships and building your practice. So you can check that out@the evidencebasedchiropractor.com but in the bare minimum, I recommend you pick up the book Marketing Chiropractic to Medical Doctors. I spent a lot of time on it. I'm proud of it and certainly don't hesitate to let me know what you think. But getting back to the research today, again, we're looking at flexion distraction, specifically in regards to the chronic pain patience. Decreasing pain I think is extremely important, but also outcomes as far as function are practically just as important from my perspective. And in regards to function, I almost look at this study that you could flip it on its head. Meaning that if you can take flexion distraction technique in your practice, decreased pain significantly of statistically significant increments, decreasing that pain for your patients, they're going to be happy. Then you can take the second step and preferably in your office, go through some active exercise, build that stability. First you got to decrease the pain, no doubt about that. Second to that, you got to get mobility in that area. You absolutely have to get mobility. And the third component then is really going through with that active exercise. That's where you're going to see those gains long term and probably reduce the recurrence of that pain. So looking at all aspects of the patient are important, of course, in a clinical sense. And one other item I'd like to touch on before we end this week's episode is actually this coming Saturday, I'm going to be teaching an online CE course, Essentials of MRI for the practicing chiropractor. A lot of states there's eligible for CE credit. Be on the lookout on my Facebook page. It's going to have all the details and all the direct links necessary to sign up and register for the course. It's basically two hours of ce. It's high impact, it's high energy. It's going to dive into MRI essentials again for the practicing chiropractor. So keep your eyes out on Facebook for that. And until next week, doc, have an awesome week in practice and I will talk to you soon.
