Dr. Gabriel Monterrubio and his patient Dr. Diego Paris share his story of a lumbar disc herniation and the treatment he receives to keep him operating.
Dr. Gabriel Monterrubio Santa María graduated from Palmer College of Chiropractic, U.S.A., in 1989.
In 1997, he also received his certificate as a “Sports Medical Chiropractor”.
In the period from 2000 to 2002 he completed his master’s degree in “Organizational Human Development” at the University of Celaya.
He is an active member of the College of Chiropractic Scientific Professionals of Mexico.
He has been Vice President of the Mexican Federation of Sports Chiropractic.
He obtained the Certificate of the National University of Health Sciences on April 21, 2013, in “Techniques of Adjustment and Manipulation” from Dr. James M. Cox.
He won a recognition for his participation in September 2013 at the 15TH International interdisciplinary Chiropractic Congress.
He achieved a record of attendance at the Annual Sports Chiropractic Congress held in October 2012 by the Mexican Federation of Sports Chiropractic.
Dr. Gabriel Monterrubio is also a Chiropractic Certified Sports Physician.
In Santo Domingo, Rep. Dominican Republic in October 2009, he achieved the certificate in “Sports Medicine”, by the International Olympic Committee.
In San Juan de Puerto Rico in the year 2000, he obtained a certificate in “Technique of Dr. Cox Part 1”.
In October 2002 he received his record for participation in the “International Congress of Physical Therapy”, awarded by the National Polytechnic Institute, Academic Secretariat, Mexican Association of Physical Therapy.
Chiropractor Dr. Gabriel Monterrubio Santa María currently has 30 years of experience.
Resources:
garbrielmonterrubiosm@gmail.com
(442) 213 4159
The Cox 8 Table by Haven Medical
Umar Ellahie, D.C.
Activator Methods Advanced Proficiency Rated
Cox-Technic Cervical, Thoracic, & Lumbar Certified
National Academy of Sports Medicine Corrective Exercise Specialist
Dr. Umar Ellahie is a graduate of Palmer West College of Chiropractic. He is a certified Cox Technic and Activator Methods practitioner.
He has been mentored by and practices with Dr. Michael McMurray at Chiropractic Solutions in Campbell, California.
He provides a safe and evidence-based approach as a Cox-Technic and Activator Methods practitioner. He also utilizes fifteen years of experience as a corrective exercise specialist to improve patient functionality.
On this episode, Dr. Ellahie shares a story of a woman who had been suffering from a cervical disc herniation with severe radiculopathy misdiagnosed and mismanaged for three months before finding great relief with chiropractic care.
Resources:
Spine specialist, Dr. Sunni Lomnicki discusses back and leg pain during pregnancy and how it is effectively treated with Cox Technic.
Sunni Lomnicki, D.C. , F.I.A.M.A.
Doctor of Chiropractic, Fellow of the International Academy of Medical Acupuncture
With her experience as an All-American runner at the University of Notre Dame, Dr. Sunni developed an interest in treating the numerous injuries runners acquire through training and competition. Dr. Sunni Graduated Summa Cum Laude and was named Valedictorian of her graduating class at the National University of Health Sciences in 2013, then returned home to Minster to join her father's practice. Dr. Sunni has received additional training in women’s health and pediatrics, along with continuing education courses in Motion Palpation, KinesioTaping, and Active Release Technique®. She is full-spine certified in Cox® Technic. in 2017, Dr. Sunni earned her board certification in medical acupuncture, and currently practices acupuncture in conjunction with her chiropractic treatments. She lives in Minster, Ohio with her husband Tyler and daughter Drea.
Resources:
Spine specialist, Dr. Katrina Weiland shares a story of a 53 y.o. Air Force veteran with debilitating low back pain.
About Dr. Weiland
Atlanta native, Dr. Katrina Weiland, moved to the Shenandoah Valley in 2016 and has called the Valley “home” ever since. Dr. Weiland obtained her Bachelor of Science degree from Kennesaw State University in 2012 and then attended chiropractic school at Life University in Marietta, Georgia. She graduated Magna Cum Laude with her Doctorate in Chiropractic in 2016.
It is no surprise that Dr. Weiland fell in love with chiropractic and became a chiropractor. After being involved in a severe car accident and several different traumas during her career in The United States Army, she was suffering from debilitating migraines and pain. After some sound advice from a friend, Dr. Weiland saw a chiropractor, and it saved her life! After her experience with chiropractic, she knew that she wanted to become a chiropractor and spread the gift of chiropractic to as many people as possible.
When Dr. Weiland is not seeing patients, she is enthusiastically cheering for The University of Georgia Bulldogs and The University of Virginia Cavaliers. During football season, you can find her at every home game sporting her navy and orange yelling “Go Hoos”. You may also find Dr. Weiland walking around town with her nineteen-year-old dachshund, Frank.
Resources:
Spine specialist, Dr. Paulette Hugulet, along with her patient shares an inspiring story of a 77 y.o. former dancer.
Dr. Paulette Hugulet, D.C. Prior to becoming a Chiropractor from University of Western States in 2012, Dr. Hugulet served in the United States military from 1992-2002 in the New Hampshire Army National Guard. Dr. Hugulet sought to expand her medical knowledge by working as a Certified Nursing Assistant in various nursing homes and assisted living facilities. Her compassion and respect for elders served her patients well during her continued exploration into different systems of optimal health care.
After the birth of her son, she pursued a career as a Certified Medical Assistant (CMA) in a variety of medical offices ranging from pediatrics, family practice and specialty clinics. The highlight of her CMA career was working with Dr. John Epley, MD and his research with imbalance disorders (dizziness). This experience has made her knowledgeable about the Epley Maneuvers and the treatment of Benign Paroxysmal Positional Vertigo (BPPV).
So what led Dr. Hugulet to Chiropractic? Through her personal and professional experiences, she has developed a passion for the drug free and integrative approach to healthcare and wellness that Chiropractic provides. She hopes to continue using Chiropractic to provide patients with the proper support to assist the body’s natural abilities to heal itself.
In her free time Dr. Hugulet finds true joy in fishing with her husband. She also enjoys, camping, quilting, dancing, good food and cheering on the Oregon State football team.
Resources:
Spine specialist, Dr. Byron Folwell shares a story of a veteran with low back pain who had two prior back surgeries.
Dr. Byron R. Folwell, a Parkersburg native, has remained very active in post-graduate training with additional schooling for neurology, orthopedic, internal disorders. Certifications in acupuncture, electrodiagnostic testing, and Cox Technic.
Resources:
Discat Plus - Nutrition for your discs.
Spine specialist, Dr. Kurt Olding shares an interesting thoracic disc herniation in an active veteran who was in unremitting pain.
Dr. Kurt Olding has been in practice for over 30 years, opening Minster Chiropractic Center in 1986 after graduating from National College of Chiropractic in Lombard, IL in 1984. Through the years Dr. Kurt has enjoyed treating all age groups, from infants to athletes and parents to grandparents. He took special interest in sports medicine during his early years in practice, completing 300 hours of continuing education through the Certified Chiropractic Sports Physician program.
Dr. Kurt earned Cox® Technic certification in 2009. In 2012 he began co-instructing the technique, and since 2015 has been a full-time instructor alongside Dr. James Cox, Dr. Ralph Kruse, and Dr. George Joachim.
Through his work with Cox® Technic, Dr. Kurt has had several exciting opportunities. In March of 2016, he taught Cox® Technic in Bern, Switzerland as part of the Swiss Chiropractic Academy’s “technique series” program. Later that month, he presented research on Cox® Technic with his mentor Dr. James Cox at the annual Association of Chiropractic Colleges Research Agenda Conference. Dr. Kurt co-authored a paper published in the June 2016 edition of the Journal of Chiropractic Medicine titled Chiropractic Distraction Spinal Manipulation on Post-surgical Continued Low Back and Radicular Pain patients: A Retrospective Case Series.
In 2015, Dr. Kurt became board certified as a Chiropractic Orthopedist, and a Fellow of the Academy of Chiropractic Orthopedists (FACO). He is also a board member of the Academy of Chiropractic Orthopedists, serving since early 2016.
Dr. Kurt and his wife Jackie are Minster natives. They have three children: Sunni, Kregg, and Jack. Sunni and her husband Tyler joined the practice in 2014.
Resources:
Spine specialist, Dr. Sean Delahunt shares a story of a 53 y.o. gentleman with chronic neck pain that developed into numbness and tingling in his arm and hand.
Dr. Sean Delahunt
Dr. Delahunt is a 2013 Graduate of Palmer Chiropractic College. Dr. Delahunt is married and has two sons. He earned his Bachelor’s degree form Western Illinois University, where he also competed as an NCAA Division I athlete in Track & Field. Dr. Delahunt was exposed to Chiropractic at a young age. His experiences with injury prevention and rehabilitation at the collegiate level reinforced his desire to become a Doctor of Chiropractic. This propelled him to excel with advanced certification in Chiropractic Sports Injuries. Dr. Delahunt’s goal is to use his knowledge and skills to provide the best Chiropractic care possible to the Des Moines metro area.
Consumer’s Research Council of America ranks Dr. Delahunt as one of the top chiropractors.
Dr. Delahunt’s Education and Experience
- Attended Western Illinois University – Bachelor of Science
- Attended Palmer College of Chiropractic – Doctorate of Chiropractic
- International Academy of Advanced Orthopedics: Certification in Upper Extremity, Lower Extremity, TMJ, and Carpal Tunnel Syndrome
- Certified Chiropractic Sports Physician – 100 hours minimum of Post- Doctoral study of Sports Medicine
- SFMA certification – Level I
- Cox Certified in Lumbar Spine
Member
- Iowa Chiropractic Society
- Iowa Chiropractic Physicians Clinic
- American Chiropractic Board of Sports Physicians
- Board of Directors for the Iowa Chiropractic Society
Resources:
Spine specialist, Dr. Keith Bartley shares two patient stories about spinal stenosis. You'll get to hear one of the patients share their experience with Cox Technic.
Dr. Bartley graduated from Indiana University with an Athletic Training and Sports Medicine degree and after interning with the New England Patriots entered Logan University. He has been practicing in Jasper, IN since 1990 and is certified in Cox® Technic of the Cervical and Lumbar spines, and has Full Body, Biomechanics and Long Nerve Entrapment certifications in Active Release Technique (ART). He is an avid triathlete and has completed the Boston Marathon.
Resources:
Spine specialist, Dr. Robert Krause shares a story of a retired airline employee with severe disc degeneration. His patient shares his story of recovery with our listeners.
Dr. Robert J Krause
My Chiropractic Story
I initially sought Chiropractic are as a young college athlete. I was experiencing back and hip pain.I was born into a family of medical doctors so naturally this was the area that I first turned to. I quickly realized that a regimen of drugs and surgery were my only options available through that route. When I was finally introduced to Chiropractic, you can only imagine my relief and excitement. Not only did I get relief from my pain, but I had an increased overall feeling of well being.
Chiropractic Education
After completing my undergraduate degree and fulfilling the Chiropractic College prerequisites, I was off to Logan College of Chiropractic.
The main reason I chose Logan College of Chiropractic was the quality of their instructors. Logan’s instructors were shared with Washington University Medical School in St. Louis, Missouri. The education was second to none. We had the unique opportunity of being instructed and taught by the most knowledgeable doctors in the field. Logan College not only had the most knowledgeable instructors in the field but had the most skilled and experienced Chiropractors to teach the art of Chiropractic manipulation.
Resources:
Neurosurgeon, Dr. Arthur Jenkins explains an underdiagnosed cause of low back pain called Bertolotti Syndrome that could be symptomatic in 12% of the population.
In addition to his academic appointment at Mount Sinai Hospital in New York City, Dr. Jenkins serves as a clinical expert and author for clinical research trials and is the official neurosurgeon for the New York Jets, the NFL Retired Players Program, and the New York Police Department.
Dr. Dean Greenwood of the Vancouver Spine Care Centre shares a story along with his patient about her severe back and leg pain. Dr. Greenwood discusses her condition and how she was treated with Cox Technic that got her remarkably better.
Dr. Greenwood has been practicing in Vancouver for the past 40 years and has quite an accomplished professional career.
- Doctor of Chiropractic (Palmer College of Chiropractic)
- Fellow of the Academy of Chiropractic Orthopedists (US)
- Fellow of the College of Chiropractic Orthopaedic Specialists (Canada)
- Master of Science in Advanced Clinical Practice (National University of Health Sciences)
- Cox Technic Instructor
Resources:
The Cox 8 Table by Haven Medical
This is an edited patient version of Episode 198 on Disc Nutrition. The patient will learn about the composition of the disc, how the disc receives its nutritional supply and what nutrients are most beneficial for disc health.
Resources
About Dr. Cox
Find a doctor at
Trauma surgeon, Dr. Turner Olser makes a shift into epidemiology in his career which leads to excessive sitting and low back pain. Dr. Olser's own back pain causes him to take a deep dive into understanding back pain which results in developing an active sitting chair.
Dr. Turner Osler
Turner has the usual academic trauma surgeon back story: BA Neurobiology (Princeton), MD (Medical College of Virginia), surgical residency (Columbia, Harvard), fellowship (University of New Mexico) and then 20 years an academic trauma surgeon (University of Vermont) with over 300 peer reviewed papers and book chapters. But then Turner went off script, got a masters in Biostatistics, an NIH grant and abandoned the operating room to study trauma epidemiology. Somewhere in the last decade he became obsessed with the problems that come from sitting too much. Turner lives in Colchester with his wife, son and QOR360 Co-founder, Lex and their dog Bella.
Resources:
Get the chair! use PROMO code MJOHNSON
Our sponsor The Cox 8 Table by Haven Medical
Dr. Cox is the developer of Cox® Technic Flexion Distraction Manipulation and the proud participant in the on-going federal research projects involving the National University of Health Sciences, Palmer College of Chiropractic Research Center, Loyola Stritch School of Medicine, University of Illinois, University of Iowa, Auburn University, Keiser University, etc. He is a member of the postgraduate faculty of the National University of Health Sciences and has been privileged to speak throughout the world.
On this episode of The Back Doctors Podcast, he discusses nutrition for the disc.
Resources
About Dr. Cox
Find a doctor at
http://www.coxtechnic.com/physicians.aspx
The Cox 8 Table by Haven Medical
Dr. Daniel Kinderleher shares a story of a young man who has a multitude of symptoms including back pain that presents to his office only to discover he has Lyme Disease.
About Dr. Kinderleher
Daniel A. Kinderlehrer, MD, is a nationally recognized physician with expertise in the fields of nutrition, allergy, environmental medicine, Lyme disease, and the healing of mind-body-spirit as a unified whole. He co-founded The New England Center for Holistic Medicine in Newbury, Massachusetts, and has taught extensively, including practitioner training courses at the Omega Institute, The National Institute of Behavioral Medicine, and the International Lyme and Associated Diseases Society. He created and organized the Lyme Fundamentals course which is presented annually at the International Lyme and Associated Diseases conferences. He is the author of several review articles in medical journals and the Lyme Times. His integrated medical practice in Denver, Colorado, focuses on the diagnosis and treatment of tick-borne disease.
Resources:
Dr. Kinderleher's office 303-444-4877
International Lyme and Associated Disease Society
Our sponsor:
The Cox 8 Table by Haven Medical
Dr. William Brady shares a story of a young man with low back pain and sciatica and explains the cause of his pain.
About Dr. Brady:
Dr. William Brady is the founder and president of Brady Back Institute in Danvers, Massachusetts. He graduated from Logan College of Chiropractic as valedictorian in 1998. In 2011, he created Manual Adhesion ReleaseⓇ and Instrument Adhesion ReleaseⓇ. In 2018 he developed a revolutionary treatment table to assist in restoring low back mobility, and in 2019, he completed phase 1 of his diagnostic software for back pain. Dr. Brady is committed to improving the health of his patients by providing revolutionary patient-specific care, allowing them to enjoy their lives without pain.
Resources:
The Cox 8 Table by Haven Medical
Dr. Frances Bigas Morales shares her success treating patients with Cox Technic in her practice in Puerto Rico.
Dr. Frances M. Bigas Morales graduated from New York Chiropractic College earning her doctoral degree in Chiropractic in 2007. In October 2008, the Metropolitan Chiropractic Clinic (CQM) was established in Puerto Rico. Her mission is to be the chiropractic doctor and Latin health consultant who brings hope to humans by expressing health, in harmony and in balance. Transforming healthy lives, and providing hope for positive change is their purpose. Chiropractic is your lifestyle, where it maximizes the optimal health of all individuals.
La Dra. Frances M. Bigas Morales es egresada de New York Chiropractic College obteniendo su grado doctoral en Quiropráctica en el 2007. En octubre 2008 se establece en Puerto Rico y apertura la Clínica Quiropráctica Metropolitana (CQM). Su misión es ser la doctora quiropráctica y consultora de salud Latina que lleve esperanza a los seres humanos expresando salud, en armonía y en balance. Transformar vidas saludables, y brindar esperanza para lograr cambios positivos es su propósito.La quiropráctica es su estilo de vida, donde maximiza el estado óptimo de salud de todos los individuos. Gracias a la quiropráctica, los viajes, las culturas, el baile, y la naturaleza descubrió que todo es un balance, todo es un complemento de vida.
Resources:
On this episode, Dr. Pam Joachim shares a story of a 19 year old female college student with low back pain.
Dr. Pam Joachim
Dr. Pamela Aaron Joachim is a Graduate of Purdue University. She completed her chiropractic training at the National College in Chicago. Dr. Joachim has participated in post-Graduate seminars including fibromyalgia and sports injuries and is certified in impairment rating and whiplash/neck injuries. She has a wide variety of interests ranging from marathon running to competitive body building and crew. Resources: Contact Dr. Joachim Find a Back Doctor The Cox 8 Table by Haven Medical http://thebackdoctorspodcast.com/Dr. Ted Arkfeld shares a story of a high school soccer player who sustains a sports related concussion and then suffers with neck pain with headache.
About Dr. Arkfeld
Dr. Ted A. Arkfeld is a 1988 graduate of Northwestern College of Chiropractic in Bloomington, MN. The decision to become a chiropractor was an easy one after growing up in what Dr. Arkfeld calls, “A chronic pain family”. His father was involved in a motor vehicle crash that ultimately resulted in three unsuccessful spinal fusions that left him on total disability. It was after the last surgery that his father turned to chiropractic treatment for relief of his chronic lower back pain.
As a high school athlete playing both football and baseball, and then collegiate baseball, Dr. Arkfeld experienced the benefits of chiropractic care during his playing days. This love for sports and chiropractic has guided him the past 16-years as the team chiropractor for Gaylord High School football and basketball programs.
Always the student, Dr. Arkfeld has returned to the classroom numerous times for advanced degrees and certifications that allows him to provide the most current research based treatment protocols for his patients.
Resources:
Practicing in Iceland, Dr. Hrefna Sylvia discusses a chronic pain patient with lumbar degenerative disc disease.
About Dr. Hrefna Syliva
Dr Hrefna Sylvia is born and raised in a small town in the Westfjords in Iceland. In 2009 while training for an Ironman she experienced severe low back pain, that is when she first got introduced to chiropractic. Her interest for chiropractic increased with time and in 2014 she moved to Georgia to study chiropractic. Dr Hrefna Sylvia graduated as a Doctor of Chiropractor from Life University in Atlanta, GA in June 2018 and was awarded the Clinic Excellence award at graduation. During her studies she went as a volunteer to Haiti where she treated both children and adults of all ages. She also went as a volunteer to Eugene, Oregon to help out in the medical tent during the track and field tryouts for the Olympics in Rio 2016. Dr Hrefna Sylvia specializes in the Cox technique as well as the Gonstead technique. She is the only fully certified chiropractor in the Cox technique in Iceland.
Resources:
Dr. Clint Dickason shares a story of a nurse he treated during the pandemic who had overworked and injured her back.
About Dr. Dickason
Dr. Dickason, an Indiana native, first became fascinated with Chiropractic Care in 1996. Dr. Dickason was active in High School and College level Wrestling and Football. He found that Chiropractic care kept him on the playing field. His passion for Chiropractic soared when he realized the human body is a self regulating and healing machine and decided he wanted to be a Chiropractor to help others realize their God given potential for health. Dr. Dickason received his bachelors in Exercise Science at Manchester College, in Indiana. After his undergraduate studies, he chose Palmer College of Chiropractic in Davenport, Iowa, coined 'The Fountain Head of Chiropractic'. While at Palmer College of Chiropractic he joined Palmer's Rugby Club as an active player and became president of the club.
Dr. Dickason met his wife Mindy while attending Palmer College, as she was completing her degree in Chiropractic Technology. After graduation Dr. Dickason and Mindy decided to move to Colorado in order to be close to family and search for a community in which to raise their newly developing family. They found and fell in love with Castle Rock.
Dr. Dickason brings more to the table then traditional Chiropractic. He also completed extra studies in Clinical Neurology from the Carrick Institute of Post-Graduate Studies, is knowledgeable in 20 Chiropractic techniques including Cox Technic.
Resources:
Listen as chiropractor and founder of the Cox Technic, Dr. James Cox explains what Cox Technic is and why it is so effective for treating back pain.
James M. Cox, DC, DACBR, FICC, Hon.D.Litt., FACO(H)
Dr. Cox is the developer of Cox® Technic Flexion Distraction Manipulation and the proud participant in the on-going federal research projects involving the Keiser University, National University of Health Sciences, Palmer College of Chiropractic Research Center, Loyola Stritch School of Medicine, University of Illinois, University of Iowa, Auburn University, etc. He is a member of the postgraduate faculty of the National University of Health Sciences and has been privileged to speak throughout the world.
Resources:
About Dr. Cox
The Cox 8 Table by Haven Medical
References:
Chesterton P, Evans W, Wright M, Lolli L, Richardson M, Atkinson G. Influence of Lumbar Mobilizations During the Nordic Hamstring Exercise on Hamstring Measures of Knee Flexor Strength, Failure Point, and Muscle Activity: A Randomized Crossover Trial. J Manipulative Physiol Ther. 2020 Nov 25:S0161-4754(20)30201-3. doi: 10.1016/j.jmpt.2020.09.005. Epub ahead of print. PMID: 33248746.
INFLUENCE OF LUMBAR MOBILIZATIONS DURING THE NORDIC HAMSTRING EXERCISE ON HAMSTRING MEASURES OF KNEE FLEXOR STRENGTH, FAILURE POINT, AND MUSCLE ACTIVITY: A RANDOMIZED CROSSOVER TRIAL. AFTER SPINAL MOBILIZATION, IMMEDIATE CHANGES IN BILATERAL HAMSTRING FORCE PRODUCTION AND PEAK TORQUE OCCURRED DURING THE NHE. THE EFFECT ON THE NHE FAILURE POINT WAS UNCLEAR. ELECTROMYOGRAPHIC ACTIVITY INCREASED ON THE IPSILATERAL SIDE.
Meet the Nordic hamstring exercise, also known as the Nordic hamstring curl—your potential new favorite go-to that can help keep you healthy while boosting your performance. me 19
Lead researcher Nicol van Dyk, Ph.D., of Aspetar Orthopaedic and Sports Medicine Hospital in Qatar, told Runner’s World the move is simple: Begin in a kneeling position with both ankles secured—tucking your feet under a bar, for example, or having a running buddy hold them down—and then progressively lean forward as slowly as possible while keeping your back straight. When you can’t resist anymore, just fall forward, catching yourself with your hands against the floor. Check out the video below for how to do it properly.
Ekşi MŞ, Özcan-Ekşi EE, Özmen BB, Turgut VU, Huet SE, Dinç T, Kara M, Özgen S, Özek MM, Pamir MN. Lumbar intervertebral disc degeneration, end-plates and paraspinal muscle changes in children and adolescents with low-back pain. J Pediatr Orthop B. 2020 Nov 27. doi: 10.1097/BPB.0000000000000833. Epub ahead of print. PMID: 33252539.
FATTY INFILTRATION IN THE PARASPINAL MUSCLES AND IVDD WERE CLOSELY ASSOCIATED WITH MODIC CHANGES IN CHILDREN AND ADOLESCENTS WITH LBP. LUMBAR IVDD IN CHILDREN AND ADOLESCENTS COULD BE THE RESULT OF A MECHANICAL PATHOLOGY
Karartı C, Özüdoğru A, Basat HÇ, Özsoy İ, Özsoy G, Kodak Mİ, Sezgin H, Uçar İ. Determination of Biodex Balance System Cutoff Scores in Older People With Nonspecific Back Pain: A Cross-sectional Study. J Manipulative Physiol Ther. 2020 Nov 25:S0161-4754(20)30153-6. doi: 10.1016/j.jmpt.2020.07.006. Epub ahead of print. PMID: 33248744.
DETERMINATION OF BIODEX BALANCE SYSTEM CUTOFF SCORES IN OLDER PEOPLE WITH NONSPECIFIC BACK PAIN: A CROSS-SECTIONAL STUDY
BBS CUTOFF SCORES ARE SENSITIVE AND SPECIFIC IN DISTINGUISHING BETWEEN POOR AND GOOD POSTURAL PERFORMANCE IN OLDER PEOPLE WITH NSLBP.
TRACTION EFFECTS:
TRACTION AND DISTRACTION STUDIES ON WHICH OUR WORK IS BASED.
Luigi Albano, DC introduced the first paper on which I built the remaining studies.
This gives us foundational understanding as to the benefits of placing a spine into distraction prior to producing ranges of motion – IT FIRST REDUCES STENOTIC EFFECTS THAT COULD CAUSE GREATER NERVE AND DRG COMPRESSION AND CHEMICAL INFLAMMATORY IRRITATION. - JMC
Gaowgzeh RAM, Chevidikunnan MF, BinMulayh EA, Khan F. Effect of spinal decompression therapy and core stabilization exercises in management of lumbar disc prolapse: A single blind randomized controlled trial. J Back Musculoskelet Rehabil. 2020;33(2):225-231. doi: 10.3233/BMR-171099. PMID: 31282394.
A COMBINATION OF SPINAL DECOMPRESSION THERAPY WITH CORE STABILIZATION EXERCISE HAS PROVEN TO BE MORE SIGNIFICANT WHEN COMPARED WITH CSE ALONE TO REDUCE PAIN AND DISABILITY IN SUBJECTS WITH CHRONIC LDP.
Demirel A, Yorubulut M, Ergun N. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial. J Back Musculoskelet Rehabil. 2017 Sep 22;30(5):1015-1022. doi: 10.3233/BMR-169581. PMID: 28505956.
THIS STUDY SHOWED THAT PATIENTS WITH LHNP RECEIVED PHYSIOTHERAPY HAD IMPROVEMENT BASED ON CLINICAL AND RADIOLOGIC EVIDENCE. NON-INVASIVE SPINAL DECOMPRESSION THERAPY (NSDT) CAN BE USED AS ASSISTIVE AGENT FOR OTHER PHYSIOTHERAPY METHODS IN TREATMENT OF LUMBAR DISC HERNIATION.
Karimi N, Akbarov P, Rahnama L. Effects of segmental traction therapy on lumbar disc herniation in patients with acute low back pain measured by magnetic resonance imaging: A single arm clinical trial. J Back Musculoskelet Rehabil. 2017;30(2):247-253. doi: 10.3233/BMR-160741. PMID: 27636836.
SEGMENTAL TRACTION THERAPY MIGHT PLAY AN IMPORTANT ROLE IN THE TREATMENT OF ACUTE LBP STIMULATED BY LDH.
Kamanli A1, Karaca-Acet G, Kaya A, Koc M, Yildirim H Conventional physical therapy with lumbar traction; clinical evaluation and magnetic resonance imaging for lumbar disc herniation. Journal of Back and Musculoskeletal Rehabilitation, vol. 30, no. 2, pp. 247-253, 2017
CONVENTIONAL PHYSICAL THERAPIES WITH LUMBAR TRACTION WERE EFFECTIVE IN THE TREATMENT OF PATIENT WITH SUBACUTE LDH. THESE RESULTS SUGGEST THAT CLINICAL IMPROVEMENT IS NOT CORRELATED WITH THE FINDING OF MRI. PATIENTS WITH LDH SHOULD BE MONITORED CLINICALLY
Choi J, Lee S, Hwangbo G. Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation. J Phys Ther Sci. 2015 Feb;27(2):481-3. doi: 10.1589/jpts.27.481. Epub 2015 Feb 17. PMID: 25729196; PMCID: PMC4339166.
SPINAL DECOMPRESSION THERAPY AND GENERAL TRACTION THERAPY ARE EFFECTIVE AT IMPROVING THE PAIN, DISABILITY, AND SLR OF PATIENTS WITH INTERVERTEBRAL DISC HERNIATION. THUS, SELECTIVE TREATMENT MAY BE REQUIRED
JUDOVICH BD. Herniated cervical disc; a new form of traction therapy. Am J Surg. 1952 Dec;84(6):646-56. doi: 10.1016/0002-9610(52)90127-x. PMID: 12986095.
CLINICAL STUDIES INDICATE THAT IN THE AVERAGE INTRACTABLE CASE THE CERVICAL SPINE SHOULD BE STRETCHED BY FORCE RANGING FROM 25 TO 45 POUNDS. ALMOST HALF THE PATIENTS IN A SERIES OF SIXTY CASES EXPERIENCED PARTIAL OR COMPLETE MOMENTARY RELIEF WHEN THIS FORCE WAS APPLIED.
ROENTGEN STUDIES REVEAL THAT IN THE AVERAGE PATIENT THE INTERVERTEBRAL SPACES OF THE CERVICAL SPINE BEGIN TO SHOW MEASURABLE WIDENING WITH TRACTION FORCE RANGING FROM 25 TO 50 POUNDS.
THE NECESSARY FORCE TO RELIEVE PAIN CANNOT BE TOLERATED BY THE AVERAGE PATIENT WHEN IT IS ADMINISTERED AS A CONSTANT PULL. IF ADMINISTERED INTERMITTENTLY, ADEQUATE AND MUCH GREATER TRACTION LOAD CAN BE TOLERATED WITHOUT THE DISCOMFORT WHICH WOULD NORMALLY ACCOMPANY SUCH FORCE.
A NEW METHOD OF MOTORIZED INTERMITTENT TRACTION IS PRESENTED. THE CLINICAL RESULTS OF INTERMITTENT TRACTION, BECAUSE OF ADEQUATE FORCE, HAVE BEEN EXCELLENT AS COMPARED TO CONVENTIONAL TRACTION METHODS.
Burton AK, Tillotson KM, Cleary J. Single-blind randomised controlled trial of chemonucleolysis and manipulation in the treatment of symptomatic lumbar disc herniation. Eur Spine J. 2000 Jun;9(3):202-7. doi: 10.1007/s005869900113. PMID: 10905437; PMCID: PMC3611397.
BECAUSE OSTEOPATHIC MANIPULATION PRODUCED A 12-MONTH OUTCOME THAT WAS EQUIVALENT TO CHEMONUCLEOLYSIS, IT CAN BE CONSIDERED AS AN OPTION FOR THE TREATMENT OF SYMPTOMATIC LUMBAR DISC HERNIATION, AT LEAST IN THE ABSENCE OF CLEAR INDICATIONS FOR SURGERY. Further study into the value of manipulation at a more acute stage is warranted.
Kirkaldy-Willis WH, Cassidy JD. Spinal manipulation in the treatment of low-back pain. Can Fam Physician. 1985 Mar;31:535-40. PMID: 21274223; PMCID: PMC2327983.
RESULTS OF SPINAL MANIPULATION IN 283 PATIENTS WITH LOW BACK PAIN ARE PRESENTED. THE PHYSICIAN WHO MAKES USE OF THIS RESOURCE WILL PROVIDE RELIEF FOR MANY PATIENTS.
Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210. doi: 10.1016/j.jmpt.2003.12.023. PMID: 15129202.
THE APPARENT SAFETY OF SPINAL MANIPULATION, ESPECIALLY WHEN COMPARED WITH OTHER “MEDICALLY ACCEPTED” TREATMENTS FOR LDH, SHOULD STIMULATE ITS USE IN THE CONSERVATIVE TREATMENT PLAN OF LDH.
Kane MD, Karl RD, Swain JH. Effects of Gravity-Facilitated Traction on lntervertebral Dimensions of the Lumbar Spine*. J Orthop Sports Phys Ther. 1985;6(5):281-8. doi: 10.2519/jospt.1985.6.5.281. PMID: 18802302.
MEAN POSTERIOR SEPARATION WAS SIGNIFICANT AT ALL LEVELS EXCEPT L1-L2 AND L5-S1. MEAN INTERVERTEBRAL FORAMINAL SEPARATION WAS SIGNIFICANT AT ALL LEVELS BUT L5-S1. IF INCREASES IN INTERVERTEBRAL DIMENSIONS PLAY A ROLE IN THE RELIEF OF LOW BACK SYNDROME, THEN GRAVITY-FACILITATED TRACTION MAY BE AN EFFECTIVE MODALITY IN THE TREATMENT OF THIS CONDITION.
Unlu Z, Tasci S, Tarhan S, Pabuscu Y, Islak S. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. J Manipulative Physiol Ther. 2008 Mar;31(3):191-8. doi: 10.1016/j.jmpt.2008.02.001. PMID: 18394495.
TRACTION, ULTRASOUND, AND LOW POWER LASER THERAPIES WERE ALL EFFECTIVE IN THE TREATMENT OF THIS GROUP OF PATIENTS WITH ACUTE LDH. THESE RESULTS SUGGEST THAT CONSERVATIVE MEASURES SUCH AS TRACTION, LASER, AND ULTRASOUND TREATMENTS MIGHT HAVE AN IMPORTANT ROLE IN THE TREATMENT OF ACUTE LDH
Chung TS, Yang HE, Ahn SJ, Park JH. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction. Radiology. 2015 Jun;275(3):755-62. doi: 10.1148/radiol.14141400. Epub 2015 Jan 22. Erratum in: Radiology. 2015 Jun;275(3):934-5. PMID: 25611735.
HERNIATED LUMBAR DISKS: REAL-TIME MR IMAGING EVALUATION DURING CONTINUOUS TRACTION
CONTINUOUS TRACTION ON HERNIATED LUMBAR DISKS AND SURROUNDING STRUCTURES RESULTED IN CHANGE IN DISK SHAPE, DISK REDUCTION WITH OPENING IN THE INTERVERTEBRAL DISK, REDUCTION OF HERNIATED DISK VOLUME, SEPARATION OF THE DISK AND ADJOINING NERVE ROOT, AND WIDENING OF THE FACET JOINT.
Isner-Horobeti ME, Dufour SP, Schaeffer M, Sauleau E, Vautravers P, Lecocq J, Dupeyron A. High-Force Versus Low-Force Lumbar Traction in Acute Lumbar Sciatica Due to Disc Herniation: A Preliminary Randomized Trial. J Manipulative Physiol Ther. 2016 Nov-Dec;39(9):645-654. doi: 10.1016/j.jmpt.2016.09.006. Epub 2016 Nov 9. PMID: 27838140.
HIGH-FORCE VERSUS LOW-FORCE LUMBAR TRACTION IN ACUTE LUMBAR SCIATICA DUE TO DISC HERNIATION: A PRELIMINARY RANDOMIZED TRIAL
PATIENTS WITH ACUTE LUMBAR SCIATICA SECONDARY TO DISC HERNIATION WHO RECEIVED 2 WEEKS OF LUMBAR TRACTION REPORTED REDUCED RADICULAR PAIN AND FUNCTIONAL IMPAIRMENT AND IMPROVED WELL-BEING REGARDLESS OF THE TRACTION FORCE GROUP TO WHICH THEY WERE ASSIGNED. THE EFFECTS OF THE TRACTION TREATMENT WERE INDEPENDENT OF THE INITIAL LEVEL OF MEDICATION AND APPEARED TO BE MAINTAINED AT THE 2-WEEK FOLLOW-UP.
DURING THE 2-WEEK FOLLOW-UP AT DAY 28, ONLY THE LT10 GROUP IMPROVED (P < .05) IN VAS (–52%) AND EIFEL SCORES (–46%).
Onel D, Tuzlaci M, Sari H, Demir K. Computed tomographic investigation of the effect of traction on lumbar disc herniations. Spine (Phila Pa 1976). 1989 Jan;14(1):82-90. doi: 10.1097/00007632-198901000-00017. PMID: 2913674.
COMPUTED TOMOGRAPHIC INVESTIGATION OF THE EFFECT OF TRACTION ON LUMBAR DISC HERNIATIONS. CHANGES OCCURRING UNDER THE EFFECT OF A TRACTION LOAD OF 45 KG HAVE BEEN EVALUATED IN 30 PATIENTS WITH LUMBAR DISC HERNIATION WITH CT INVESTIGATION. THE HERNIATED NUCLEAR MATERIAL (HNM) HAS RETRACTED IN 11 (78.5%) OF MEDIAN, SIX (66.6%) OF POSTEROLATERAL, AND FOUR (57.1%) OF LATERAL HERNIATIONS.
Clarke J, van Tulder M, Blomberg S, de Vet H, van der Heijden G, Bronfort G. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane collaboration. Spine (Phila Pa 1976). 2006 Jun 15;31(14):1591-9. doi: 10.1097/01.brs.0000222043.09835.72. PMID: 16778694.
INTERMITTENT OR CONTINUOUS TRACTION AS A SINGLE TREATMENT FOR LBP CANNOT BE RECOMMENDED FOR MIXED GROUPS OF PATIENTS WITH LBP WITH AND WITHOUT SCIATICA. NEITHER CAN TRACTION BE RECOMMENDED FOR PATIENTS WITH SCIATICA BECAUSE OF INCONSISTENT RESULTS AND METHODOLOGICAL PROBLEMS IN MOST OF THE STUDIES INVOLVED. HOWEVER, BECAUSE HIGH-QUALITY STUDIES WITHIN THE FIELD ARE SCARCE, BECAUSE MANY ARE UNDERPOWERED, AND BECAUSE TRACTION OFTEN IS SUPPLIED IN COMBINATION WITH OTHER TREATMENT MODALITIES, THE LITERATURE ALLOWS NO FIRM NEGATIVE CONCLUSION THAT TRACTION, IN A GENERALIZED SENSE, IS NOT AN EFFECTIVE TREATMENT FOR PATIENTS WITH LBP
Beattie PF, Nelson RM, Michener LA, Cammarata J, Donley J. Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study. Arch Phys Med Rehabil. 2008 Feb;89(2):269-74. doi: 10.1016/j.apmr.2007.06.778. PMID: 18226650.
TRACTION APPLIED IN THE PRONE POSITION USING THE VAX-D FOR 8 WEEKS WAS ASSOCIATED WITH IMPROVEMENTS IN PAIN INTENSITY AND RMDQ SCORES AT DISCHARGE, AND AT 30 AND 180 DAYS AFTER DISCHARGE IN A SAMPLE OF PATIENTS WITH ACTIVITY-LIMITING LBP. CAUSAL RELATIONSHIPS BETWEEN THESE OUTCOMES AND THE INTERVENTION SHOULD NOT BE MADE UNTIL FURTHER STUDY IS PERFORMED USING RANDOMIZED COMPARISON GROUPS.
REAL-TIME MR IMAGING WHILE PERFORMING TRACTION IS POSSIBLE.
Mitchell UH, Beattie PF, Bowden J, Larson R, Wang H. Age-related differences in the response of the L5-S1 intervertebral disc to spinal traction. Musculoskelet Sci Pract. 2017 Oct;31:1-8. doi: 10.1016/j.msksp.2017.06.004. Epub 2017 Jun 9. PMID: 28624722.
TO DETERMINE DIFFERENCES IN THE APPARENT DIFFUSION COEFFICIENT (ADC) OBTAINED WITH LUMBAR DIFFUSION-WEIGHTED IMAGING (DWI) OF THE L5-S1 IVD BEFORE, AND DURING, THE APPLICATION OF LUMBAR TRACTION
STATIC TRACTION WAS ASSOCIATED WITH AN INCREASE IN DIFFUSION OF WATER WITHIN THE L5-S1 IVDS OF MIDDLE-AGE INDIVIDUALS, BUT NOT IN YOUNG ADULTS, SUGGESTING AGE-RELATED DIFFERENCES IN THE DIFFUSION RESPONSE. FURTHER STUDY IS NEEDED TO ASSESS THE RELATIONSHIP BETWEEN THESE FINDINGS AND THE SYMPTOMS OF BACK PAIN.
HIGHLIGHTS:
STATIC TRACTION IS ASSOCIATED WITH AN INCREASE IN ADC IN OLDER DISCS, NOT YOUNGER.
INVERSE RELATIONSHIP BETWEEN BASELINE ADC AND PERCENT INCREASE WITH TRACTION.
FINDINGS SUGGEST PRESENCE OF AGE-RELATED CHANGES IN THE RATE OF DIFFUSION RESPONSE.
SAAL, JEFFREY A., MD; SAAL, JOEL S., MD Nonoperative Treatment of Herniated Lumbar Intervertebral Disc with Radiculopathy: An Outcome Study, Spine: April 1989 - Volume 14 - Issue 4 - p 431-437
64 PATIENTS WITH LUMBAR HERNIATED NUCLEUS PULPOSUS WITHOUT SIGNIFICANT STENOSIS WERE TREATED NON SURGICALLY.
90% GOOD OR EXCELLENT OUTCOME WITH A 92% RETURN TO WORK RATE.
FOR THE SUBGROUPS WITH EXTRUDED DISCS AND SECOND OPINIONS, 87% AND 83% HAD GOOD OR EXCELLENT OUTCOMES, RESPECTIVELY, ALL (100%) OF WHOM RETURNED TO WORK.
SICK LEAVE TIME FOR THESE SUBGROUPS WAS 2.9 MONTHS (+/- 1.4 MONTHS) AND 3.4 MONTHS (+/- 1.7 MONTHS), RESPECTIVELY. THESE RESULTS COMPARED FAVORABLY WITH PREVIOUSLY PUBLISHED SURGICAL STUDIES. FOUR OF SIX PATIENTS WHO REQUIRED SURGERY WERE FOUND TO HAVE STENOSIS AT OPERATION.
Sari H, Akarirmak U, Karacan I, Akman H. Computed tomographic evaluation of lumbar spinal structures during traction. Physiother Theory Pract. 2005 Jan-Mar;21(1):3-11. PMID: 16385939.
DURING TRACTION OF INDIVIDUALS WITH ACUTE LDH THERE WAS A REDUCTION OF THE SIZE OF THE HERNIATION, INCREASED SPACE WITHIN THE SPINAL CANAL, WIDENING OF THE NEURAL FORAMINA, AND DECREASED THICKNESS OF THE PSOAS MUSCLE.
Park WM, Kim K, Kim YH. Biomechanical analysis of two-step traction therapy in the lumbar spine. Man Ther. 2014 Dec;19(6):527-33. doi: 10.1016/j.math.2014.05.004. Epub 2014 May 22. PMID: 24913413. A
COMBINATION OF GLOBAL AXIAL TRACTION AND LOCAL DECOMPRESSION WOULD BE HELPFUL FOR REDUCING TENSILE STRESS ON THE FIBERS OF THE ANNULUS FIBROSUS AND LIGAMENTS, AND INTRADISCAL PRESSURE IN TRACTION THERAPY. THIS STUDY COULD BE USED TO DEVELOP A SAFER AND MORE EFFECTIVE TYPE OF TRACTION THERAPY
Chow DHK, Yuen EMK, Xiao L, Leung MCP. Mechanical effects of traction on lumbar intervertebral discs: A magnetic resonance imaging study. Musculoskelet Sci Pract. 2017 Jun;29:78-83. doi: 10.1016/j.msksp.2017.03.007. Epub 2017 Mar 20. PMID: 28347933.
HORIZONTAL TRACTION WAS EVIDENTLY EFFECTIVE IN INCREASING THE DISC HEIGHT OF LOWER LUMBAR LEVELS, PARTICULARLY IN THE POSTERIOR REGIONS OF THE DISCS. FURTHER EVIDENCE OF THE EFFECTS OF TRACTION OF DIFFERENT MODES, MAGNITUDES, AND DURATIONS ON THE CHANGE IN DISC HEIGHT IS REQUIRED FOR PROPER CONTROL OF TRACTION APPLIED TO SPECIFIC DISC LEVELS.
HIGHLIGHTS:
MECHANICAL EFFECTS OF TRACTION ON LUMBAR DISCS WAS EVALUATED USING MRI.
HORIZONTAL TRACTION USING 42% OF BODY WEIGHT WAS ASSOCIATED WITH AN INCREASED DISC HEIGHT OF LOWER LUMBAR DISCS.
HORIZONTAL TRACTION ALSO RESULTED IN REDUCED LORDOSIS AND CHANGE IN TILT ANGLE.
THE EFFECTS WERE MORE PROMINENT AT THE POSTERIOR DISCAL REGIONS.
Qaseem A, Wilt TJ, McLean RM, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530. doi: 10.7326/M16-2367. Epub 2017 Feb 14. PMID: 28192789. a systematic review of randomized, controlled trials and systematic reviews published through April 2015 on noninvasive pharmacologic and nonpharmacologic treatments for low back pain. Updated searches were performed through November 2016.
Recommendation 1: Given that most patients with acute or subacute low back pain improve over time regardless of treat-ment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)
Recommendation 2: For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)
Recommendation 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits out-weigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence)
Low back pain is one of the most common reasons for physician visits in the United States. Most Americans have experienced low back pain, and approximately one quarter of U.S. adults reported having low back pain lasting at least 1 day in the past 3 months (1).Low back pain is associated with high costs, including those related to health care and indirect costs from missed work or reduced productivity (2). The total costs attributable to low back pain in the United States were estimated at $100 billion in 2006, two thirds of which were indirect costs of lost wages and productivity (3).Low back pain is frequently classified and treated on the basis of symptom duration, potential cause, presence or absence of radicular symptoms, and corresponding anatomical or radiographic abnormalities. Acute back pain is defined as lasting less than 4 week
Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, Fu R, Dana T, Kraegel P, Griffin J, Grusing S, Brodt ED. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166(7):493-505. doi: 10.7326/M16-2459. Epub 2017 Feb 14. PMID: 28192793.
Background: A 2007 American College of Physicians guideline addressed nonpharmacologic treatment options for low back pain. The current evidence on non-pharmacologic therapies for acute or chronic nonradicular or ra-dicular low back pain from MEDLINE (January 2008 through February 2016), Cochrane Central Register of Controlled Trials, CochraneDatabase of Systematic Reviews, and reference lists.
Evidence continues to support the effectiveness of exercise, psychological therapies, multidisciplinary rehabilitation, spinal manipulation, massage, and acupuncture for chronic low back pain.
Funding Source:Agency for Healthcare Research and Quality. (PROSPERO: CRD42014014735)Ann Intern Med.2017;166:xxx-xxx. doi:10.7326/M16-2459Annals.org
the American College of Physicians (ACP)and American Pain Society (APS) recommended spinal manipulation as a treatment option for acute low back pain and several nonpharmacologic therapies for sub-acute or chronic low back pain.
Stochkendahl MJ, Kjaer P, Hartvigsen J, Kongsted A, Aaboe J, Andersen M, Andersen MØ, Fournier G, Højgaard B, Jensen MB, Jensen LD, Karbo T, Kirkeskov L, Melbye M, Morsel-Carlsen L, Nordsteen J, Palsson TS, Rasti Z, Silbye PF, Steiness MZ, Tarp S, Vaagholt M. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018 Jan;27(1):60-75. doi: 10.1007/s00586-017-5099-2. Epub 2017 Apr 20. PMID: 28429142.
Purpose: To summarise recommendations about 20 non-surgical interventions for recent onset (
If treatment is needed, the guidelines suggest using patient education, different types of supervised exercise, and manual therapy.
The guidelines recommend against acupuncture, routine use of imaging, targeted treatment, extraforaminal glucocorticoid injection, paracetamol, NSAIDs, and opioids.
Krekoukias G1, Gelalis ID1,2, Xenakis T1, Gioftsos G3, Dimitriadis Z4, Sakellari V3. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23.
MANUAL THERAPY SPINAL MOBILIZATION IS PREFERABLE TO CONVENTIONAL PHYSIOTHERAPY IN ORDER TO REDUCE THE PAIN INTENSITY AND DISABILITY IN SUBJECTS WITH CHRONIC LBP AND ASSOCIATED DISK DEGENERATION. THE FINDINGS OF THIS STUDY MAY LEAD TO THE ESTABLISHMENT OF SPINAL MOBILIZATION AS ONE OF THE MOST PREFERABLE APPROACHES FOR THE MANAGEMENT OF LBP DUE TO DISK DEGENERATION.
REFERENCES FOR 25% RELIEF PAPER BY WIRTH ET AL
Wirth B1, Riner F1, Peterson C1, Humphreys BK1, Farshad M2, Becker S3, Schweinhardt P1. An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment. Chiropr Man Therap. 2019 Feb 5;27:6. doi: 10.1186/s12998-018-0225-8. eCollection 2019.
Refs on minimal clinical improvement determination:
- Farrar JT, Young JP, Jr, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94:149–158. doi: 10.1016/S0304-3959(01)00349-9. [PubMed] [CrossRef]
- Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Cano A, et al. Minimal clinically important change for pain intensity and disability in patients with nonspecific low back pain. Spine (Phila Pa 1976) 2007;32:2915–2920. doi: 10.1097/BRS.0b013e31815b75ae. [PubMed] [CrossRef]
- Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimal clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. Eur J Pain. 2004;8:283–291. doi: 10.1016/j.ejpain.2003.09.004. [PubMed] [CrossRef]
- Robinson-Papp J, George MC, Dorfman D, Simpson DM. Barriers to chronic pain measurement: a qualitative study of patient perspectives.Pain Med. 2015;16:1256–1264. doi: 10.1111/pme.12717. [PMC free article] [PubMed] [CrossRef]
- Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, et al. Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976) 2008;33:90–94. doi: 10.1097/BRS.0b013e31815e3a10. [PubMed] [CrossRef]
Chung TS1, Yang HE, Ahn SJ, Park JH. Herniated Lumbar Disks: Real-time MR Imaging Evaluation during Continuous Traction. Radiology 2015 Jan 22:141400.
CONTINUOUS TRACTION ON HERNIATED LUMBAR DISKS AND SURROUNDING STRUCTURES RESULTED IN CHANGE IN DISK SHAPE, DISK REDUCTION WITH OPENING IN THE INTERVERTEBRAL DISK, REDUCTION OF HERNIATED DISK VOLUME, SEPARATION OF THE DISK AND ADJOINING NERVE ROOT, AND WIDENING OF THE FACET JOINT.
Wong A, Parent E, Dhillon S, Prasad N, Kawchuk G: Do Participants With Low Back Pain Who Respond to Spinal Manipulative Therapy Differ Biomechanically From Nonresponders, Untreated Controls or Asymptomatic Controls? Spine: 01 September 2015 - Volume 40 - Issue 17 - p 1329–1337 doi: 10.1097/BRS.0000000000000981
PARTICIPANTS WITH LBP AND ASYMPTOMATIC CONTROLS ATTENDED 3 SESSIONS FOR 7 DAYS. ON SESSIONS 1 AND 2, PARTICIPANTS WITH LBP RECEIVED SMT (+LBP/+SMT, N = 32) WHEREAS ASYMPTOMATIC CONTROLS DID NOT (−LBP/−SMT, N = 57). IN THESE SESSIONS, SPINAL STIFFNESS AND MULTIFIDUS THICKNESS RATIOS WERE OBTAINED BEFORE AND AFTER SMT AND ON DAY 7. RESULTS.
AFTER THE FIRST SMT, SMT RESPONDERS DISPLAYED STATISTICALLY SIGNIFICANT DECREASES IN SPINAL STIFFNESS AND INCREASES IN MULTIFIDUS THICKNESS RATIO SUSTAINED FOR MORE THAN 7 DAYS;
THESE FINDINGS WERE NOT OBSERVED IN OTHER GROUPS. SIMILARLY, ONLY SMT RESPONDERS DISPLAYED SIGNIFICANT POST-SMT IMPROVEMENT IN APPARENT DIFFUSION COEFFICIENTS.
Wong AYL1,2, Parent EC3, Dhillon SS4, Prasad N5, Samartzis D6, Kawchuk GN3. Differential patient responses to spinal manipulative therapy and their relation to spinal degeneration and post-treatment changes in disc diffusion. Eur Spine J. 2019 Jan 2. doi: 10.1007/s00586-018-5851-2.
NON-SPECIFIC LOW BACK PAIN PATIENTS WHO RESPOND WITH >30% RELIEF SHOW HIGHER APPARENT DIFFUSION COEFFICIENT DISC DIFFUSION OF WATER THAN NON POSITIVE RESPONDERS. MRI WAS PERFORMED BEFORE AND AFTER SMT ON DAY 1 OF CARE. OSWESTRY DISABILITY TEST WAS ALSO USED.
Beattie PF, Butts R, Donley JW, Liuzzo DM. The Within-Session Change in Low Back Pain Intensity Following Spinal Manipulative Therapy is Related to Differences in Diffusion of Water in the Intervertebral Discs of the Upper Lumbar Spine and L5-S1. Orthop Sports Phys Ther. 2013 Nov 21.
Doctoral Program in Physical Therapy, Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
STUDY TO DETERMINE DIFFERENCES IN THE CHANGES IN DIFFUSION OF WATER WITHIN THE LUMBAR INTERVERTEBRAL DISCS BETWEEN THOSE SUBJECTS WITH LOW BACK PAIN (LBP) WHO DID, AND DID NOT, REPORT A WITHIN-SESSION REDUCTION IN PAIN INTENSITY FOLLOWING A SINGLE TREATMENT OF SPINAL MANIPULATIVE THERAPY (SMT) WAS DONE.
CHANGES IN THE DIFFUSION OF WATER WITHIN THE LUMBAR INTERVERTEBRAL DISCS AT THE L1-2, L2-3, AND L5-1 LEVELS APPEAR TO BE RELATED TO DIFFERENCES IN WITHIN-SESSION PAIN REPORTS FOLLOWING A SINGLE TREATMENT OF SPINAL MANIPULATIVE THERAPY. PARTICIPANTS UNDERWENT T2- AND DIFFUSION-WEIGHTED LUMBAR MAGNETIC RESONANCE IMAGING SCANS IMMEDIATELY BEFORE, AND AFTER, RECEIVING A SINGLE TREATMENT OF SMTJ
Kuo, Ya-Wen PhD; Hsu, Yu-Chun MS; Chuang, I-Ting MS; Chao, Pen-Hsiu Grace PhD; Wang, Jaw-Lin PhD Spinal Traction Promotes Molecular Transportation in a Simulated Degenerative Intervertebral Disc Model. Spine: April 20th, 2014 - Volume 39 - Issue 9 - p E550
Traction biomechanics studied in the porcine model biomechanical benefits include disc height recovery, foramen enlargement, and intradiscal pressure reduction.
48 thoracic discs were dissected from 8 porcine spines and then divided into 3 groups: intact, degraded without traction, and degraded with traction.
From Day 4 to Day 6, half of the degraded discs received a 30 min traction treatment per day (traction force: 20 kg, loading: unloading = 30 sec: 10 sec).
Traction treatment is effective in enhancing nutrition supply and promoting disc cell proliferation of the degraded discs.
Dr. Lee Hazen, a Cox Certified practitioner and his wife Cheri, a Functional Nutritional Lifestyle practitioner share how they use a wholistic approach to healing by sharing a recent patient story.
Lee Hazen, D.C.
Dr. Hazen graduated Cum Laude from Cleveland Chiropractic College of Los Angeles in 1989. After a short post-ceptorship in Burbank, Ca, he was invited to become a resident in Dr. James Cox's clinic. From 1989 until 1998 he was co-director and resident in Ft. Wayne Indiana with Dr. Cox. While there, he attended and completed a 400 hour post-graduate Chiropractic Orthopedics training sponsored by National University of Health Sciences. Dr. Hazen has been serving the Murrieta-Temecula area for 15 years.
As a Cox Technique instructor for the past 25 years, he has taught many chiropractors across the country the use of the specialized decompression table, diagnosis and care of spinal disease. Currently, he is on the post-graduate faculty of National University of Health Sciences.
Lee Hazen D.C. and TCIM is committed to helping you regain and then maintain your quality of life, devoid of spine and extremity pain. Dr. Hazen offers specific protocols for spinal pain relief that are well-researched, well-documented, repeatedly-published and clinically-effective: Cox Technic Flexion-Distraction and Decompression Adjusting Manipulation. The protocols were started 48 years ago by Dr. James M. Cox in Fort Wayne, Indiana. The Cox Technic protocols have evolved as clinical application demands and research studies dictate. We are proud to offer the most cutting-edge, 21st century, non-surgical decompressive spinal pain relief.
Cheri Hazen, RN, ICHC, FNLP, LE
RN (Registered Nurse)
ICHC (International Cert. Health Coach)
FNLP (Functional Nutrition Lifestyle Practitioner)
LE (Lifestyle Educator)
Cheri has dedicated her life to serving others and working with people on making true transformational changes in their lives. As a dedicated founder of TCIM, her unique approach to healing and her calming influence are appreciated by everyone that gets the privilege to work with her.
Cheri’s formal training is in Nursing. She graduated from BYU in 1984 and started her career by working on a very busy surgical floor preparing patients for surgery. Throughout her career, she has spent time working at a number of different hospitals in California and Indiana. She has helped countless patients ranging from those faced with cancer to helping mothers deliver babies. Cheri has also graduated from massage therapy school and most recently, she has worked with the love of her life, her husband Dr. Lee Hazen at Chiropractic Works, in Murrieta CA as his medical assistant.
She received her degree as a certified Health Coach from the Institute for Integrative Nutrition. She is excited that her degree and unique life experiences will give her the ability to empower others and help to restore their health and vitality.
Cheri’s unique approach to healing comes from her own first-hand experience with suffering from a life-altering chronic condition. Cheri’s journey through intense pain and chronic fatigue forced her to make permanent lifestyle changes, practice coping skills like deep breathing and meditation, and discover the power that proper nutrition has in reversing the disease process. Now that she is healthy, she has rededicated her life to sharing her story and helping others faced with similar challenges.
Healing is possible…and Cheri is the living proof that her methods work. Cheri makes healing fun, exciting, and breaks everything down into small, obtainable steps. She will never overwhelm a patient with too much information or too much radical change all at once. She understands that this is all a process and she hopes to be viewed as a health partner helping her patients through it all!
Cheri works with patients on the following:
Health Coaching
Stress Management
Diet and Exercise Plans
Lifestyle Changes
Breathing Exercises and Techniques
Encouragement and Reinforcement
Nutritional Consulting
Resources: