Flexion Distraction

The Flexion-distraction technique has become a widely used approach to treating symptomatic disc injuries involving back pain and the often-accompanying leg pain.

Flexion-distraction involves the use of a specialized table that gently distracts or stretches the spine and which allows the chiropractor to isolate the area of disc involvement while slightly flexing the spine in a pumping rhythm. There is little to no pain involved in the treatment. (Scroll down to see a video of the technique.)

Theoretically, the tractioning or distraction of the disc combined with isolation and gentle pumping of the involved area allows the central area of the disc, the nucleus pulposus, to assume its central position in the disc. Flexion-distraction is thought to improve disc height. These actions may also move the disc away from the nerve, reducing inflammation of the nerve root, and eventually the associated pain and inflammation into the leg.

Flexion-distraction is applied in a series of treatments and may be combined with adjunctive physiotherapy, soft tissue work and home instructions. Eventually, specific exercises for low back disc conditions are introduced. Patients are evaluated and monitored throughout the treatment program.

With the flexion-distraction technique  or any treatment technique, if a patient has not improved objectively and subjectively over time then imaging studies are assigned and spine specialist referral is considered (if that has not already been obtained).  If there is substantial worsening at any time during treatment, imaging and neurosurgical referral are the standard of care. The low back disc is always seen in the context of the spine as a whole. In addition to addressing low back, the chiropractor addresses possible spinal joint restrictions in the neck, midback, and extremities that may need correction. Manual adjusting techniques can be used successfully in the neck and mid-back, while the low back may only be addressed with low force techniques.

As published in the Journal of Manipulative and Physiological Therapies, in June 2008, a clinical study showed that flexion-distraction allows a reduction of intradiscal pressure, an increase in intervertebral disc height, and an increase in intervertebral foramen size.