MANAGEMENT OF CHRONIC LOW BACK PAIN IN AN 80-YEAR-OLD FEMALE UTILIZING MODIFIED SIDE-LYING COX TECHNIC FLEXION DISTRACTION DECOMPRESSION: A CASE REPORT

Main Article Content

Ted Siciliano
Casey Rogers
Ralph Kruse

Keywords

Intervertebral Disc Herniation, Spinal Stenosis, Facet Arthropathy, Low Back Pain

Abstract

Objective: To discuss the use of side-lying Cox Technic flexion-distraction decompression for a patient with symptomatic lumbar spinal stenosis unable to lie prone for treatment due to pain.


Clinical Features: An 80-year-old female sought chiropractic care for her chronic low back pain. The patient had a history of lumbar spinal stenosis, multiple lumbar disc herniations, and lumbar spondylosis. The patient’s pain was initially rated as an 8/10 on the numeric rating scale.


Intervention and Outcome: Pain prevented the patient from lying in a prone position, so she was treated in a side-lying position using Cox Technic flexion-distraction decompression approach to lumbar mobilization. Additional treatments also included electronic muscle stimulation, infrared light therapy, and instructions for at-home exercise program and activity modifications. An episode of care was initiated at a frequency of 3 visits per week over a period of 4 weeks, totaling 12 treatments. After a total of 16 visits, the patients pain decreased to 3/10 and she also reported improved sleep, and increased mobility.


Conclusion: The results of this episode of chiropractic care, utilizing side-lying Cox® Technic flexion-distraction decompression, resulted in favorable outcomes. This particular patient experienced reduced pain, increased sleep, and increased mobility after a trial of 16 treatments. This case demonstrates that a modified Cox® Technic flexion-distraction protocol may benefit patients with low back pain, who are unable to receive treatment in the traditional prone position.

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References

. Hoy D, March L, Brooks P, et al The global burden of low back pain: estimates from the Global Burden of Disease 2010 study Annals of the Rheumatic Diseases Published Online First: 24 March 2014. doi: 10.1136/annrheumdis-2013-204428

2. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research, Rockville, MD

3. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [review]. J Bone Joint Surg Am 2006;88(suppl 2):21-24

4. Rubin Dl. Epidemiology and risk factors for spine pain. Neurol Clin 2007;25(2):353-371

5. Chou R, Deyo R, Friedly J, et al. Systemic Pharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. Epub ahead of print 14 February 2017]166:480–492.doi: 10.7326/M16-2458

6. Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low?back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008112. DOI: 10.1002/14651858.CD008112.pub2

7. Cox JM, Hazen LJ, Mungovan M: Distraction manipulation reduction of an L5?S1 disc herniation. J Manipulative Physiol Ther 1993;16(5):342?346

8. Snow GJ. Chiropractic management of a patient with lumbar spinal stenosis. J Manipulative Physiol Ther 2001;24(4):300-304. doi:10.1067/mmt.2001.114359

9. Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine 2000;25(12):1509-1514. doi: 10.1097/00007632-200006150-00009. PMID: 10851099.

10. Kobayashi S. Pathophysiology, diagnosis and treatment of intermittent claudication in patients with lumbar canal stenosis. World J Orthop 2014:18;5(2):134-415. doi: 10.5312/wjo.v5.i2.134

11. Ammendolia C, Schneider M, Williams K et al. The physical and psychological impact of neurogenic claudication: the patients' perspectives. J Can Chiropr Assoc 2017;61(1):18-31
12. Fritz JM, Delitto A, Welch WC, Erhard RE. Lumbar spinal stenosis: a review of current concepts in evaluation, management, and outcome measurements. Arch Phys Med Rehabil 1998;79(6):700-8. doi: 10.1016/s0003-9993(98)90048-x. PMID: 9630153.
13. Sinikallio S, Aalto T, Airaksinen O, et al. Depression and associated factors in patients with lumbar spinal stenosis. Disabil Rehabil 2006;28(7):415-422. doi: 10.1080/09638280500192462. PMID: 16507504
14. Wu L, Cruz R. Lumbar spinal stenosis. [Updated 2020 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531493/
15. Stuber K, Sajko S, Kristmanson K. Chiropractic treatment of lumbar spinal stenosis: a review of the literature. J Chiropr Med 2009;8(2):77-85 doi:10.1016/j.jcm.2009.02.001.
16. Prateepavanich P, Thanapipatsiri S, Santisatisakul P, Somshevita P, Charoensak T. The effectiveness of lumbosacral corset in symptomatic degenerative lumbar spinal stenosis. J Med Assoc Thai 2001;84(4):572-576
17. Ammendolia C, Côté P, Southerst D, Schneider M, Budgell B, Bombardier C, Hawker G, Rampersaud YR. Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial. Arch Phys Med Rehabil. 2018 Dec;99(12):2408-2419.e2. doi: 10.1016/j.apmr.2018.05.014. Epub 2018 Jun 20. PMID: 29935152.
18. Cox JM, Bakkum BW. Possible generators of retrotrochanteric gluteal and thigh pain: the gemelli-obturator internus complex. J Manipulative Physiol Ther. 2005 Sep;28(7):534-8.
19. Cox JM: Low Back Pain: Mechanism, Diagnosis, Treatment, 7th ed. Baltimore: Wolter Kluwers Lippincott Williams & Wilkins, 2011, Chapter , pages
20. Gudavalli MR, Cox JM, Baker JA, Cramer GD, Patwardhan AG: Intervertebral disc
pressure changes during the flexion?distraction procedures for low back pain. Presented
at and in the proceedings of the International Society for the Study of the Lumbar Spine
Meeting, June 1997, Singapore.

21. Bennett CG, Angel N, Hackney ME. Mismatch between subjective and objective motor improvements with adapted tango intervention in older adults. Physiother Res Int. 2020 Jul;25(3):e1835. doi: 10.1002/pri.1835. Epub 2020 Feb 15. PMID: 32061185.

22. 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

23. Kruse R, Gudavalli S, Cambron J: Chiropractic treatment of a pregnant patient with
lumbar radiculopathy. Journal of Chiropractic Medicine 2007; 6(4):153?158
24. Gudavalli MR, 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. Eur Spine J. 2006;15(7):1070-1082. doi:10.1007/s00586-005-0021-8

25. Gudavalli MR, Olding K, Joachim G, Cox JM. Chiropractic Distraction Spinal Manipulation on Postsurgical Continued Low Back and Radicular Pain Patients: A Retrospective Case Series. J Chiropr Med. 2016;15(2):121-128. doi:10.1016/j.jcm.2016.04.004