Middy Flashcards
Cox’s first patient
1963
He did side posture and pt had to be carried out of his office, blew her disc, L4 disc surgery the next day
Who invented the original flexion distraction table?
John MCMannis
He was an osteopath. Dr. Cox says in Chiro school a Dr. Blackmore would take him to use this osteopathic table for acute LB pts.
Dr. Cox worked with _____ to make the first Chiro lumbar flexion distraction table.
Year?
Tables since then?
Mr Jim Barnes
1972, Barnes Chiro-Manis Table 1973 - 1984, Zenith-Cox table 2001, Distraction enterprise 2004, Track corporation 2007, Haven Innovation - Cox 8
What is Dr. Cox’s personal experience with disc herniations?
1981, removed post from ground, sudden LBP, next AM bent over and felt tearing in LB. Leg pain became unbearable. 3 wks later, Cauda Equina. L5/SS1 fragment, had micro-lumbar discectomy
1984, Cox’s wife developed C6 herniated disc making him expand into cervical spine
What is the difference between Cox and Intervertebral Disc Distraction (IDD)?
No specific level in IDD.
Cox is 1 specific vertebral level with applied force, IDD is a general traction throughout the entire spine
T/F
Research showed Cox to have side effects in clinical application of manipulation compared to other forms.
FALSE
JMPT, Parker College found almost NO side effects compared to Diversified, Thompson and Gonstead - to the doctor OR patient
What are the 4 effects of Cox flexion distraction?
- Increase disc space
- Increase IVF (up to 28%)
- decrease intradiscal pressure
- Restore facet joint physiologic ROM
…as found in federally funded research by Gudavalli
T/F
A significant increase in fiscal pressure is observed during flexion-distraction.
FALSE
a decrease in pressure (by almost 192mm/Hg)
T/F
Flexion-straction widens space available in the anterior vertebral region for neural elements.
FLASE
widens posterior regions - dorsal column
T/F
EMG activity increases with flexion-distraction and should be monitored by clinician during procedure
TRUE
Name some general effects of flexion-distraction in the lumbar spine
(There are 8)
- increase posterior disc height
- increase IVF
- decrease intradiscal pressure
- decrease disc protrusion and stenosis
- stretched Lig. Flavum
- Opens vertebral canal
- increases metabolic transport into the canal
- opens apophyseal joints
…and extension-distraction will do the complete opposite
Frequency of visits?
Daily!
until have improved by 50%, then every other day, 2x/wk, 1x/wk
No subjective/objective improvement in 30 days = consider additional testing (MRI, CT, EMG) refer to neuro/ortho
What is the quintessential clinical finding for referral?
Progressive deterioration of motor function
The disc is a 3 joint complex. What are the joints?
2 facet joints - synovial (diarthrosis)
1 disc - cartilaginous (amphiarthrosis)
- PLL is dividing line between posterior column (Dorsal rami pain) and anterior column (Discogenic pain)
What are the four parts of the disc?
- Annulus
- Nucleus
- Cartilaginous endplate
- Water
T/F
The nucleus has a low concentration of proteogylcans
FLASE
high concentration
What are proteoglycans made of?
proteins and carbohydrates
T/F
Proteoglycans within the nucleus are negative which attract Na+/K+, which then attracts water and nutrients through osmosis.
TRUE
Type ____ collagen is found in the annulus fibrosis. What does it do?
Type I - withstand tensile forces, pull strength, are rigid, inflexible and inelastic