The European Spine Journal published (in July 2006) the outcomes of the US Government's Health Resources & Services Administration (HRSA)-funded comparison study of chiropractic flexion-distraction care and medical conservative care for low back pain. Its findings are that

1. "Overall, flexion-distraction provided more pain relief than active exercise [the medical conservative approach]; however, these results varied base on stratification of patients [1] with and without radiculopathy [extremity/leg pain/sciatica] and [2] with and without recurrent symptoms."
   
2. "Patients with radiculopathy did significantly better with FD."
   

Goals of Treatment

DISC RELATED PAIN CONDITIONS

For patients with a "slipped/bulging/ruptured/herniated" disc (without cauda equina syndrome or progressive neurological deficit), Cox^® Technic provides the following benefits:

1. increases the intervertebral disc height (C) to remove anular tension on the anular fibers (E) and nerve (B) by making more room and improving circulation;
   
2. allows the nucleus pulposus (A) -- the center of the disc -- to assume its central position within the anular fibers (E) and relieves irritation of the spinal nerve (B);
   
3. restores vertebral joints (D) to their physiological relationships of motion;
   
4. improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.
   

1. The posterior disc space increases in height.
2. Flexion decreases disc protrusion and reduces stenosis. Note: Discs protrude and degenerate into the concavity of a curve, into the side of extension.
3. Flexion stretches the ligamentum flavum to reduce stenosis.
4. Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6 mm more than extension.
5. Flexion increases metabolite transport into the disc.
6. Flexion opens the apophyseal joints and reduces posterior disc stress.
7. The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100 mm Hg. On extension the nucleus or anulus is seen to protrude posterior into the vertebral canal.
8. Intervertebral foraminal openings enlarge giving patency to the nerve.

[for references for the above, see Cox JM, Feller JA, Cox-Cid JA:
Topics in Clinical Chiropractic 1996; 3(3):45-59]