What is Flexion Distraction?
Flexion distraction (FD) is a conservative chiropractic treatment method, often used to manage low-back pain (LBP). It can especially be used when other methods like high-velocity manipulation are not suitable due to low bone density (Bulbulian, Burke & Dishman, 2002). It involves gentle, rhythmic stretching of the lower spine using a specially designed table. This process helps reduce pressure on spinal joints and discs, making it a popular choice for relieving pain and improving mobility (Carrasco-Martínez, Ibáñez-Vera, Martínez-Amat, Hita-Contreras & Lomas-Vega, 2019).
Anatomy and Biomechanics – Dr Willem Boshoff D.C. (USA) Dip NBCE MSc Med (Wits) F. CASA (Hon)
The facet joints are the primary structures treated through the flexion distraction modality. When focussing on these joints, the intervertebral discs, supraspinous, and interspinous ligaments are also positively affected as this method focuses on re-educating facet joints to restore proper function and movement.
Movement in the spine originates from facet joints while intervertebral discs primarily receive movement rather than creating it. This distinction highlights the role of flexion distraction in facilitating mobility in the appropriate structures.
Addressing Age-Related Changes
Flexion distraction is particularly beneficial for the population of 45+ years, where the spine undergoes structural and functional changes.
Conditions such as kissing spine (characterized by limited standing tolerance) can persist despite surgical interventions like foraminectomy. Flexion distraction is very effective to treat the lower back during the different stages of degeneration.
Targeting Facet Joint Pathology
The technique addresses common facet joint pathologies, including:
Pannus Formation: McMannis flexion distraction can gap the joint, reposition pannus formations, and restore normal joint alignment.
Eburnation: In cases of advanced degeneration, where inflammation and hardening lead to loss of joint capsule mobility, immobilisation is prioritised over mobilisation. Flexion distraction is unsuitable for these cases.
Adhesions: The McMannis technique effectively tears adhesions in the facet joints, improving mobility and reducing dysfunction.
The goal of flexion distraction is to re-educate the facet joints and restore natural movement patterns. The McMannis table enhances the effectiveness of flexion distraction through controlled and precise applications.
What Aches and Pains Can Flexion Distraction Tackle?
- Lumbar Spinal Stenosis: Relieves neurogenic claudication by increasing spinal canal space and reducing nerve compression (Choi et al., 2015; Kovacs et al., 2011).
- Disc Herniations: Reduces intradiscal pressure to retract discs and ease nerve root compression (Carrasco-Martínez et al., 2019).
- Facet Syndrome: Alleviates joint pain and improves mobility by tearing adhesions formed in the facet joints (Carrasco-Martínez et al., 2019).
- Chronic Low-Back Pain: Provides short-term relief by decompressing the spine and relaxing muscles (Carrasco-Martínez et al., 2019).
- Sciatica: Eases nerve root pressure to reduce radiating leg pain and weakness (Choi et al., 2015).
- Spondylolisthesis: Manages pain from minor vertebral slippage and improves stability (Kovacs et al., 2011).
- Spinal Reflex Issues: Decreases reflex excitability to relax muscles and reduce spasms (Bulbulian et al., 2002).
Neurophysiological effects: (Bulbulian, Burke & Dishman, 2002)
- Reduced Spinal Reflex Excitability
FD significantly decreases excitability in spinal reflexes, particularly in the lumbar region. This reduction in reflex activity can relax overactive paraspinal muscles, which are often associated with pain and stiffness.
- Improved Neurophysiological Response
During FD, specific nerve receptors, including muscle spindles and Golgi tendon organs, are activated. These receptors help inhibit motor neurons, reducing muscle spasms and promoting relaxation in the lower back.
- Decreased Intradiscal Pressure
FD reduces pressure within the intervertebral discs, which may help alleviate pain caused by herniated or bulging discs. Studies using imaging techniques have shown significant reductions in disc bulging after FD treatments.
What you’ll experience with flexion distraction.
- Reduced Pain and Muscle Spasms: By relaxing tight muscles and decompressing spinal joints, FD can alleviate both acute and chronic LBP.
- Improved Mobility: The rhythmic movements during FD enhance the flexibility and range of motion of the lower back.
- Potential for Disc Healing: Lower intradiscal pressure may promote healing of herniated or damaged discs, reducing the need for invasive interventions.
Co-author: Dr Michelle-Cheri Beech Cloete
References:
Bulbulian, R., Burke, J. & Dishman, J.D. (2002). Spinal reflex excitability changes after lumbar spine passive flexion mobilization. Journal of manipulative and physiological therapeutics, 25(8):526.
Choi, J., Lee, S. & Jeon, C. (2015). Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. J Phys Ther Sci. 27(6).
Carrasco-Martínez, F., Ibáñez-Vera, A.J., Martínez-Amat, A., Hita-Contreras, F. & Lomas-Vega, R. (2019). Short-term effectiveness of the flexion-distraction technique in comparison with high-velocity vertebral manipulation in patients suffering from low-back pain. Complementary therapies in medicine, 4461.
Kovacs, F.M., Urrútia, G. & Alarcón, J.D. (2011). Surgery versus conservative treatment for symptomatic lumbar spinal stenosis. Spine, 36(20):E1335.
