The definitive lumbar spine textbook on this technique and its low back procedures is published by Lippincott Williams and Wilkins titled Low Back Pain: Mechanism, Diagnosis and Treatment (6th edition) by James M. Cox, DC, DACBR, with guest authors. The cervical spine textbook on the cervical spine, Neck, Shoulder & Arm Pain: Mechanism, Diagnosis, Treatment (3rd edition, 2005), is the companion text. (These and other reference materials are available through the website www.coxtrc.com/textbooks.html .)
The Studies' Funding
Funding for chiropractic research comes from various sources: private funding from individual doctors' and occasional patients' donations, chiropractic profession funding sources, federal funding sources like NIH and HRSA, etc. In the early 1990's, the US federal government developed a program to fund chiropractic research that was conducted with a medical or osteopathic school. Each year of its granting, flexion-distraction has received funds.
Cox® Technic flexion-distraction research started in the clinical practice of one physician, Dr. James M. Cox. In the early years of flexion-distraction, Dr. Cox documented his patient case outcomes and published them in chiropractic journals. He described his protocols in articles for chiropractic peer-reviewed journals. Then, he worked with colleagues who followed some of his protocols to gather larger scale outcomes (526 cases then 424 cases which lead to the 1000 cases). Then he met Dr. Ram Gudavalli, a PhD trained researcher, who started documenting biomechanical changes and clinical comparison studies that federal research granting agencies were seeking. Today, Cox® Technic flexion-distraction research is well-funded and exciting.
National University of Health Sciences enjoyed the initial HRSA grants regarding flexion-distraction. Under the guidance of Dr. Gudavalli, the first biomechanical study was done with Loyola Stritch School of Medicine, University of Illinois, Hines VA Hospital staff, and AuburnUniversity graduate student program.
The second study was a clinical comparison study of low back pain patients cared for with chiropractic flexion-distraction versus medical physical therapy treatment conducted at National University of Health Sciences withLoyolaStritchSchool of Medicine. The third study was a clinical comparison study of cervical spine pain patients cared for with chiropractic flexion-distraction versus medical physical therapy treatment conducted at National University of Health Sciences withLoyolaStritchSchool of Medicine and PalmerCenter for Research. In 2004, the fourth federal grant (funded by HRSA) was awarded to do a comparison study of flexion distraction, chiropractic side posture, and medical care of elderly patients’ low back pain. Under its principal investigator, Dr. William Meeker, it is underway currently at Palmer Center for Research in cooperation with the University of Iowa. In 2004, the fifth federal grant (funded by NIH, the National Institutes of Health) was awardedfor predicting low back pain patients response to spinal manipulation (chiropractic side posture & flexion distraction). Under its principal investigator, Dr. William Meeker, it is also underway at the Palmer Center for Research in cooperation with the University of Iowa. In 2006, a grant (funded by FCER) was awarded for the study flexion-distraction for stenosis. Under its principal investigator, Jerrilyn Cambron DC MPh, it is underway at National University of Health Sciences, University of Illinois Medical Center (Chief of Geriatric Medicine).
In 2006, a grant (funded by Health Resources and Services Administration’s Chiropractic Demonstration Project Grant Program) was awarded. The research will help doctors predict patient responsiveness to treatment and help determine who should be referred for spinal manipulation or for active exercise therapy.” Under its principal investigator, Paul Dougherty, DC, of the New YorkCollege of Chiropractic, it is underway in RochesterNY and CanadaiguaNY.
In 2006, a grant “Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain” was awarded to National University of Health Sciences, Dr. Jerrilyn Cambron, which is now published in Osteopathy & Chiropractic and Journal of Complementary and Alternative Medicine.
Gudavalli MR, Cox JM: Measurement of Treatment Parameters: Forces and Table Motions Cox Decompression Procedures in Field Doctors' Clinics. Palmer Center for Chiropractic Research.
Choate CG, DeVocht JW, Ghanayen A, Gudavalli MR, Havey R, Henderson C, Hondras MA, Lamas G, Lawrence D, Long CR, McLean I, Pickar JG: Developmental Center for Clinical and Translational Science in Chiropractic. National Center for Complementary and Alternative Medicine, National Institutes of Health.
Project (3): Gudavalli MR, Patwardhan AG, Voronov L, Havey R, Ghanayen A, Henderson CNR, Pickar JG, Vining R, Rowell R,Hondras MA, Long CR: Cervical Distraction Sham Development - Translating from Basic to Clinical Studies.
Principal Investigator: Ram Gudavalli, Ph.D. (Palmer and NUHS), Co-Investigator/NUHS Project Manager: Jerrilyn Cambron, D.C., M.P.H., Ph.D.
While our first HRSA-funded study demonstrated the biomechanics of flexion distraction therapy, the second project is concerned with the effectiveness of flexion distraction for the relief of chronic low back pain. The study compared the effectiveness of chiropractic flexion distraction therapy with non-operative conservative therapy, physical therapy. Study participants were randomly assigned to either the flexion distraction group or the physical therapy group. Patients completed a therapeutic regimen which lasted four weeks and were then followed for twelve months. Primary outcomes included patients’ perceived level of pain, health status, utilization of other health services, isometric trunk strength, ranges of motion, and patterns of motion. This study is a collaborative effort of Palmer Center for Chiropractic Research, National University of Health Sciences, Loyola University Stritch School of Medicine, Edward Hines VA Hospital, Orthosport Physical Therapy Clinics, and Auburn University. Manuscripts have been submitted for this project.
Funding: Dept. of Health and Human Services Chiropractic Demonstration Project under the under the Health Resources and Services Administration
Principal Investigators: Ram Gudavalli Ph.D. (Palmer and NUHS), Co-Investigator/NUHS Project Manager: Jerrilyn Cambron, D.C., M.P.H., Ph.D.
While HRSA II compared flexion distraction therapy to physical therapy for the relief of chronic low back pain, this project is concerned with the effectiveness of flexion distraction for the relief of chronic neck pain. Study participants were randomly assigned to either (i.) the flexion distraction group, (ii.) the physical therapy group, or (iii.) a combination group of flexion distraction and physical therapy. Patients completed a therapeutic regimen that lasted six weeks and were then followed for twelve months. This study is a collaborative effort of Palmer Center for Chiropractic Research, National University of Health Sciences, Loyola University Stritch School of Medicine, Edward Hines VA Hospital, Orthosport Physical Therapy Clinics, and Auburn University. A manuscript has been submitted for this project.
Funding: Dept. of Health and Human Services Chiropractic Demonstration Project under the Health Resources and Services Administration (HRSA) GRANT NO. 1 R18 HP 10011-01
Principal Investigator: Jerrilyn Cambron, DC, M.P.H., Ph.D.
This randomized clinical trial pilot study will investigate the efficacy of different amounts of total treatment dosage over six weeks in 60 volunteer subjects with lumbar spinal stenosis. Subjects will be evenly randomized into four groups: Group 1 with 8 total chiropractic visits, Group 2 with 12 total chiropractic visits, Group 3 with 18 total chiropractic visits, and Group 4 with 8 total education visits. The study is designed: (1) To determine the feasibility of a larger scale study in terms of logistics, recruitment efforts, and sample size estimations and (2) To determine among the three treatment and one education groups the change in perceived pain levels and general functional health status at the end of six weeks of care and at three and six months post care as follow-up.
Funding: Foundation for Chiropractic Education and Research