Short time effects in pain of mechanical flexion-distraction technique compared to lumbar manipulation techniques in patients with low back pain

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Lower back pain is one of the most important cause of laboral absenteeism. Among 70% and 80% of population have ever feel lower back pain. Depending on its etiology, could be classificated as: -Mechanic lower back pain: 90% of all cases, it differs from the others because patient only feel pain in lumbar spine without irradiation to lower limb. -Lumbo-ciatalgya: when pain at lower limb is worse than in lumbar spine. -Reflex lower back pain: irradiated pain to lower limb from the lumbar spine. Flexion-distraction technique: the first time this technique was developed was in 1909 by the osteopath McManis. He prepared a table to carry it out. The technique consisted basically of placing the patient in the prone position, with the feet off the table tied at the ankles. The arms are stretched towards the cranial margin of the table until they can be held with the hands in an accessory. In this position, flexion-extension, lateral bending and circumduction movements are applied, taking as a reference the horizontal midline and always by the lower lever. At the end of the 70s, A. Stoddart developed the technique of manual vertebral traction and a few years later, James Cox made a series of modifications to the Mc Manis technique. The patient's position is the same as before, the difference was in the treatment protocol applied by Cox. He despises the extension of the lumbar spine above the horizontal line. Small flexion-extension movements were made from a flexion position that was applied to the lower lever. The effects of the flexion-distraction technique are the following: - It increases the interdiscal somatic space, decreasing the intradiscal pathogenic pressure, facilitating the reduction of the herniated disc. - Produces a suction effect that tends to suck the disc and reintegrates it in its space. - Create a disc edema that fights against the edema and rehydrates the disc. - It decreases the tensions on the posterior common vertebral ligament and moves the disc away from the sensitive structures. - Decompress and stretch the joint capsules. The traction stretches the capsule rhythmically and stimulates the mechanoreceptors during each phase of traction, thus producing an analgesic and lowering of muscle tone. - The traction inhibits the spasm of the transverse thorns responsible for a part of the pain. Golgi receptors and neuromuscular spindles cause reflex inhibition that boxes muscle tone. - The capsule stretching activate the control-gate system. The large fibers that transmit the proprioceptive information about the movement, saturate the marrow in such a way that it closes the door to the painful information of the small fibers. This explains the analgesic action of this technique. The aim of this study is to compare the effects of flexion distraction technique with high velocity and low amplitud lumbar manipulation, treatment which has shown good results in immediate reduction of lower back pain.

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