• Mckee N
• Kruse R
• Rogers C

• Case Reports
• Cox Technique
• Decompression
• Intervertebral Disc Displacement / therapy
• Open Access Document
• Radiculopathy / therapy

Background: Low back pain has various underlying causes, with disc protrusions and annular fissures leading to discomfort and disability. The objective of this paper is to present a case of successful treatment of lumbar disc herniation, annular fissure, and radiculopathy using a multimodal treatment approach including Cox Technic Flexion Distraction Decompression.

Clinical Features: A 26-year-old male presented to the chiropractic clinic with low back pain radiating to the left lower extremity and reported loss of sensation in the lateral aspect of the left lower leg. Despite temporary relief with high velocity low amplitude spinal manipulation, his pain persisted and worsened, leading him to take medical leave 30 days after his injury, which he had been on for 3 weeks at presentation. He described his pain as constant and intense, rating it 8-10/10 on the Numeric Rating Scale (NRS). He reported pain in all ranges of motion, with exacerbation during active range of motion in lumbar flexion
and left rotation. Orthopedic and neurological tests indicated he could tolerate flexion distraction with ankle straps. MRI indicated an L5-S1 disc protrusion causing S1 nerve root displacement, and an L4-L5 disc protrusion and annular fissure. Despite L5-S1 appearing more problematic, the L4-L5 disc protrusion and annular fissure most likely caused more pain, considering the inflammatory response and L5 symptoms.

Intervention/Outcome: Treatment included Cox Technic Flexion Distraction Decompression, end-range loading exercises, other home/rehabilitation exercises, soft tissue therapies, and supplements. The patient was treated three days per week over the course of 2-3 weeks. After the 6th visit, the treatment frequency was reduced to once per week. By the 9th treatment, he reported a reduction in his low back pain rating it as 1-3/10 on the NRS. At the last visit, he continued to experience pain relief, with low back pain occurring if he sat too long with a rounded back or was bent over too long at work. Ergonomic and lifting
techniques were discussed and sit-to-stand/box-squats were introduced. Conclusion: This case highlights the effectiveness of conservative management for lumbar
disc herniation and annular fissure. This patient experienced pain relief with multimodal approaches to pain management including chiropractic flexion-distraction.

Key Words: Chiropractic, Manipulation, Flexion Distraction, Disc Herniation, Decompression, Case Study

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