Tuesday, January 29, 2008

DRX 9000 treatment


www.drshoshany.com
I was recently contacted and asked about the safety of the DRX 9000 spinal decompression machine. In my NYC spinal decompression practice I carefully screen patients for contra-indications and if they are not a candidate for the procedure I do not put them on the machine. In addition to spinal decompression using the DRX 9000 I also combine use of the Cox technic. This technic has been proven to open the IVF or intervertebral foreamen by 28%.
Call (212)645-8151 for spinal decompression in NYC or visit www.drshoshany.com
This past weekend I attended a post graduate seminar on the Cox technic.
I recently added the seventh generation Cox table to my practice.
I wanted to add some information on my blog about what I learned and a description of why I think this techic will improve patient outcomes.
Cox® Technic (aka flexion-distraction or F/D) relieves back and leg pain and neck and arm pain. Disc herniation and/or stenosis may be the cause of pain. Or simple arthritis or a back sprain may be the culprit.

Cox® Technic is a gentle, non-surgical, chiropractic spinal manipulation adjustment procedure.

95% of back pain and neck pain patients DO NOT require surgery.

Cox® Technic is a safe alternative to back surgery. It is also appropriate for failed back surgery patients who still suffer after surgery.

Cox® Technic is a well-researched (with research studies completed and underway), well-referenced (with over 90+ articles in medical and chiropractic journals) chiropractic spinal adjusting manipulation

Cox® Technic drops intradiscal pressures to -192 mmHg and increases the foraminal area by 28%.

Cox® Technic stops pain, realigns the spine and restores ranges of motion inherent to the spine while reducing low back pain, especially in radiculopathy (extremity pain--leg pain or arm pain) patients, better than active exercise therapy.

Innovated by James M. Cox, DC, DACBR, in the 1960's, Cox® Technic is a marriage of osteopathic and chiropractic manipulation principles. It is an accepted and widely used form of spinal manipulation.

THE RESEARCH SAYS...

The Biomechanics Study

Federally Funded Research has thus far proven the following about Cox® Flexion Distraction:


Reduces intradiscal pressures (on nerve roots to relieve pain)

Increases intradiscal height

Increases foraminal size up to 28% (more room for nerve roots and spinal cord)



CLINICAL APPLICATION IS...

The following is presented as a general overview of the treatment.

Cox® Technic is DOCTOR-APPLIED, DOCTOR-CONTROLLED, HANDS-ON, SPECIFIC CONTACT, PATIENT-FOCUSED care. During a treatment on this instrument, the patient lies prone while the treating physician concentrates on one vertebral motion segment at a time. The goal is to reduce stenotic effects by dropping intradiscal pressure to allow disc reduction, increasing the size of the intervertebral foramen, and lowering pressure on the dorsal root ganglion and the exiting nerve roots. While concentrating on the low back, the doctor may use the instrument's caudal (the part the legs lie on) section to allow lateral and circular motion which returns normal motion to the spine with reduced pain. The cervical spine can be treated similarly using a specially designed table.

The Lumbar Spine Adjustment

After undergoing a thorough examination which leads the doctor to a diagnosis of the back condition to be treated, the patient lies on a table that is built to traction the spine and also to produce motions that are normal for the spine. To attain these motions, the table goes "up and down" (flexion and extension), goes "side to side" (lateral flexion), or moves in a circular motion (circumduction). All movements are slow.

The doctor will hold a spinous process (the back part of the vertebra that feels like a "bump" on your spine) to isolate a single segment for treatment. The distraction manipulation is applied manually by the doctor to the patient's low back at the levels of the spine to be treated or that are painful. Tolerance testing is performed prior to the application of distraction manipulation to be sure it causes no pain to the patient. This technic is designed to help patients with low back pain and leg pain.

The Cervical Spine Adjustment

The patient will lie prone (face down) on the table whose headpiece moves in motions that are normal for the cervical spine (Flexion, Extension, Rotation, Lateral flexion, and Circumduction). This headpiece also allows traction to be applied to the cervical or thoracic spines alone or while these motions are being administered. The doctor will hold the appropriate spinous process (back of the vertebra) of the cervical spine to isolate the level of pain or the level of vertebra to be adjusted.



This recent study was posted on the DRX 9000 site.

ORIGINAL ARTICLE
Treatment of 94 Outpatients With Chronic Discogenic Low Back Pain with the DRX9000:

A Retrospective Chart Review

Alex Macario, MD, MBA**Departments of Anesthesia and Health Research & Policy, Stanford University School of Medicine, Stanford, California; Alex Macario MD, MBA, Professor of Anesthesia and Health Research & Policy, Department of Anesthesia H3580, Stanford University School of Medicine, Stanford, CA 94305-5640, U.S.A. Tel: +1 650 498 6810; E-mail: amaca@stanford.edu. ; Charlotte Richmond, PhD††Biomedical Research & Education Foundation, LLC, Miami Beach, Florida; ; Martin Auster, MD, MBA‡‡Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, ; Joseph V. Pergolizzi, MD§§Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.*Departments of Anesthesia and Health Research & Policy, Stanford University School of Medicine, Stanford, California; †Biomedical Research & Education Foundation, LLC, Miami Beach, Florida; ‡Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, §Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Alex Macario MD, MBA, Professor of Anesthesia and Health Research & Policy, Department of Anesthesia H3580, Stanford University School of Medicine, Stanford, CA 94305-5640, U.S.A. Tel: +1 650 498 6810; E-mail: amaca@stanford.edu.
Reprints will not be available from authors.

■ Abstract

Background: This study's goal was a retrospective chart audit of 100 outpatients with discogenic low back pain (LBP) lasting more than 12 weeks treated with a 2-month course of motorized spinal decompression via the DRX9000 (Axiom Worldwide, Tampa, FL, U.S.A.).

Methods: Patients at a convenience sample of four clinics received 30-minute DRX9000 sessions daily for the first 2 weeks tapering to 1 session/week. Treatment protocol included lumbar stretching, myofascial release, or heat prior to treatment, with ice and/or muscle stimulation afterwards. Primary outcome was verbal numerical pain intensity rating (NRS) 0 to 10 before and after the 8-week treatment.

Results: Of the 100 initial subjects, three withdrew their protected health information, and three were excluded because their LBP duration was less than 12 weeks. The remaining 94 subjects (63% female, 95% white, age = 55 (SD 16) year, 52% employed, 41% retired, LBP median duration of 260 weeks) had diagnoses of herniated disc (73% of patients), degenerative disc disease (68%), or both (27%). Mean NRS equaled 6.05 (SD 2.3) at presentation and decreased significantly to 0.89 (SD 1.15) at end of 8-week treatment (P < 0.0001). Analgesic use also appeared to decrease (charts with data = 20) and Activities of Daily Living improved (charts with data = 38). Follow-up (mean 31 weeks) on 29/94 patients reported mean 83% LBP improvement, NRS of 1.7 (SD 1.15), and satisfaction of 8.55/10 (median 9).

Conclusions: This retrospective chart audit provides preliminary data that chronic LBP may improve with DRX9000 spinal decompression. Randomized double-blind trials are needed to measure the efficacy of such systems. ■

Users who read this article also read:
Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment
P. Prithvi Raj, MD, FIPP, ABIPP
Pain Practice, Volume 8, Issue 1, Page 18-44, Mar 2008, doi: 10.1111/j.1533-2500.2007.00171.x
Abstract| References| Full Text HTML| Full Text PDF (1300 KB)
Intra-articular Application of Pulsed Radiofrequency for Arthrogenic Pain—Report of Six Cases
Menno E. Sluijter, MD, PhD, FIPP; Alexandre Teixeira, MD, FIPP; Vicente Serra, MD; Susan Balogh, MD; Pietro Schianchi, MD, FIPP
Pain Practice, Volume 8, Issue 1, Page 57-61, Mar 2008, doi: 10.1111/j.1533-2500.2007.00172.x
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The Prevalence of Facet Joint-Related Chronic Neck Pain in Postsurgical and Nonpostsurgical Patients: A Comparative Evaluation
Laxmaiah Manchikanti, MD; Kavita N. Manchikanti, BA; Vidyasagar Pampati, MSc; Doris E. Brandon, CST; James Giordano, PhD
Pain Practice, Volume 8, Issue 1, Page 5-10, Mar 2008, doi: 10.1111/j.1533-2500.2007.00169.x
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Late Whiplash Syndrome: A Clinical Science Approach to Evidence-Based Diagnosis and Management
Keith Poorbaugh, PT, ScD, CSCS, FAAOMPT; Jean-Michel Brismée, PT, ScD, OCS, FAAOMPT; Valerie Phelps, PT, OCS, FAAOMPT; Phillip S. Sizer Jr, PT, PhD, OCS, FAAOMPT
Pain Practice, Volume 8, Issue 1, Page 65-89, Mar 2008, doi: 10.1111/j.1533-2500.2007.00168.x
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A Review of the Epidemiology of Painful Diabetic Peripheral Neuropathy, Postherpetic Neuralgia, and Less Commonly Studied Neuropathic Pain Conditions
Alesia Sadosky, PhD; Anne M. McDermott, ScD; Nancy A. Brandenburg, PhD; Marcie Strauss, MPH
Pain Practice, Volume 8, Issue 1, Page 45-56, Mar 2008, doi: 10.1111/j.1533-2500.2007.00164.x
Abstract| References| Full Text HTML| Full Text PDF (114 KB)
www.drshoshany.com
So in conclusion I am confident in my ability to provide patients that have herniated discs, failed back surgery and chronic low back pain a effective means to end their pain and return them to a pain free lifestyle.

Friday, January 18, 2008

NYC Chiropractor



Above are images of a cervical MRI a pre and post of a patient with a herniated cervical disc.
NYC Chiropractor
I recently added the brand new Cox table to my arsenal and this table has been improving patient outcomes.

Published Outcomes of the Cox technic.

The European Spine Journal published (in July 2006) the outcomes of the US Government's Health Resources & Services Administration (HRSA)-funded comparison study of chiropractic flexion-distraction care and medical conservative care for low back pain. Its findings are that


"Overall, flexion-distraction provided more pain relief than active exercise [the medical conservative approach]; however, these results varied base on stratification of patients [1] with and without radiculopathy [extremity/leg pain/sciatica] and [2] with and without recurrent symptoms."

"Patients with radiculopathy did significantly better with FD."
a herniated disc relief pain
Goals of Treatment



DISC RELATED PAIN CONDITIONS

For patients with a "slipped/bulging/ruptured/herniated" disc (without cauda equina syndrome or progressive neurological deficit), Cox® Technic provides the following benefits:


increases the intervertebral disc height (C) to remove anular tension on the anular fibers (E) and nerve (B) by making more room and improving circulation;

allows the nucleus pulposus (A) -- the center of the disc -- to assume its central position within the anular fibers (E) and relieves irritation of the spinal nerve (B);

restores vertebral joints (D) to their physiological relationships of motion;

improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.


NON-DISC RELATED

For patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac subluxation, stenosis), Cox® Technic provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain.
The combination of Cox Flexion distraction combined with DRX 9000 spinal decompression has been providing excellent results for my patients in my NYC practice.







1. The posterior disc space increases in height.
2. Flexion decreases disc protrusion and reduces stenosis. Note: Discs protrude and degenerate into the concavity of a curve, into the side of extension.
3. Flexion stretches the ligamentum flavum to reduce stenosis.
4. Flexion opens the vertebral canal by 2 mm (16%) or 3.5 to 6 mm more than extension.
5. Flexion increases metabolite transport into the disc.
6. Flexion opens the apophyseal joints and reduces posterior disc stress.
7. The nucleus pulposus does not move on flexion. Intradiscal pressure drops under distraction to below 100 mm Hg. On extension the nucleus or anulus is seen to protrude posterior into the vertebral canal.
8. Intervertebral foraminal openings enlarge giving patency to the nerve.


[for references for the above, see Cox JM, Feller JA, Cox-Cid JA:
Topics in Clinical Chiropractic 1996; 3(3):45-59]

Friday, January 11, 2008

NYC Chiropractor introduces the Cox technique


Cox Technique in New York City
Call (212) 645-8151

I am proud to introduce the Cox technique and the brand new cox table into my Practice. This addition completes the total Disc care that I offer.
The combination of the DRX 9000 spinal decompression table the Brand new Cox table and core stabilization with the Power Plate is the most powerful method in dealing with chronic back pain and hard to treat disc problems.


The Technic




Cox® Technic is performed on a specially designed chiropractic instrument (The Cox® Table for flexion-distraction) which has a movable headpiece and a movable caudal piece (that part on which a patient's legs lie). Each section flexes, extends, laterally bends and circumducts (combination of flexion and lateral flexion), and long-y-axis plane distracts.




CONDITIONS THAT MAY BENEFIT FROM COX® TECHNIC:



Failed Back Surgical Syndromes

Disc Herniation / Ruptured Disc / Bulging Disc / Herniated Disc

Sciatica / Leg Pain

Stenosis

Arm Pain

Neck Pain

Failed course of Steroid Injections

Chemical Radiculitis

Spondylolisthesis

Synovial Cyst

Headache

"Hip Pain" due to sciatic nerve irritation

Transitional segment

many more …




History of Cox® Technic

Cox® Technic is a marriage of chiropractic principles with osteopathic principles set forth by Alan Stoddard, DO, in his book, Manual of Osteopathic Technique, written about the manipulative procedures developed by John McManis, DO, in the early 1900's.

Its procedures were established by Dr. James M. Cox and have evolved over the past 40+ years due to the many efforts of researchers and fellow chiropractic physicians.

Since the early 1970's, Dr. Cox has refined the technique, designed a manipulation instrument for effective use of the technique (The Cox® Table), conducted clinical as well as participated in experimental research, lectured around the world, and written well-received articles, chapters for textbooks, and textbooks (published by Lippincott Williams & Wilkins, Baltimore).

Please visit www.vertebre.com for an in-depth interview of Dr. Cox with the editor of this French chiropractic website regarding the history and evolution of flexion-distraction Cox® Technic.




Goals of Treatment for the Cox Technique




DISC RELATED PAIN CONDITIONS

For patients with a "slipped/bulging/ruptured/herniated" disc (without cauda equina syndrome or progressive neurological deficit), Cox® Technic provides the following benefits:


increases the intervertebral disc height (C) to remove anular tension on the anular fibers (E) and nerve (B) by making more room and improving circulation;

allows the nucleus pulposus (A) -- the center of the disc -- to assume its central position within the anular fibers (E) and relieves irritation of the spinal nerve (B);

restores vertebral joints (D) to their physiological relationships of motion;

improves posture and locomotion while relieving pain, improving body functions, and creating a state of well-being.


NON-DISC RELATED

For patients with other conditions causing back pain (facet syndrome, spondylolisthesis, sprain/strain, scoliosis, transitional vertebra, sacroiliac subluxation, stenosis), Cox® Technic provides all of the above benefits plus the ability to place the spinal joints into normal, painless movements so as to restore spinal motion without pain.

Thursday, January 03, 2008

New York Chiropractor

New York City Chiropractor Offers Solution for Various Recurring Pain and Problems
New York City ,New York Chiropractor New York Chiropractor, Dr. Steven Shoshany has recently completed a certification program offered by the Council on Extremity Adjusting and has become a Certified Chiropractic Extremities Practitioner (CCEP).

New York City, NY (PRWEB) January 7, 2008 -- New York Chiropractor, Dr. Steven Shoshany has recently completed a certification program offered by the Council on Extremity Adjusting and has become a Certified Chiropractic Extremities Practitioner (CCEP). Dr. Shoshany is one of 850 extremity specialists worldwide, and the only chiropractor in NYC.



The course of certification he has completed required 105 hours of study and the passing of a final exam on the following subjects: Upper and Lower Extremity Adjusting, TMJ, Ribs and Shoulder Girdle, Foot, Gait and Orthotics, Extremity Rehabilitation, Soft Tissue Methods for the Extremities, and Global Assessment of the Extremities.

As a CCEP, Dr. Shoshany is trained to pinpoint and treat root causes to recurring pain in the spine or extremities. He is equipped to successfully treat TMJ, Shoulder Girdle Syndromes, Tennis Elbow, Carpal Tunnel, Knee Subluxations, Baker's Cysts, Sprained Ankles, Shin Splints, and Foot and Gait mechanics , herniated discs ,chronic back pain and other ailments.

The Council on Extremity Adjusting (CEA) was founded by Dr. Kevin Hearon, internationally acclaimed expert on extremity adjusting, who has written several books on the subject. Dr. Hearon is also the president of the Council on Extremity Adjusting. The Council is governed by seven board members, and there are twelve instructors dedicated to the advancement of knowledge regarding extremity adjusting in the chiropractic profession worldwide. More information about the Council and the CCEP certification program is available at www.councilonextremityadjusting.com .

New York City Chiropractor
, Dr. Shoshany is the only chiropractor in New York that has also combined Cold Laser therapy and Kineso-taping to compliment his treatment of extra spinal injuries. Dr. Shoshany is founder and director of_New York City disc decompression specialists_ which was established to provide excellence in non surgical spinal decompression using equipment like the DRX 9000 and Dr. Shoshany consults with Doctors worldwide on the proper methods and protocols for non surgical treatment of the herniated disc. Dr. Shoshany's website is www.drshoshany.com