Flexion-Distraction vs Physiotherapy for Low Back Pain
A Review of the Scientific Literature

There are many treatment options available to those experiencing lower back pain, and deciding on the best avenue of care can often be a difficult decision for the back pain sufferer.  I recently came across an interesting and informative series of articles comparing chiropractic care to physiotherapy exercise in treating chronic low back pain.  A synopsis of the results is a must read for anyone seeking care for back pain.

The first study, published in the European Spine Journal, compared the effectiveness of Flexion-Distraction Technique performed by a group of chiropractors with an exercise program administered by physiotherapists.  In the study people who were suffering from chronic low back pain were randomly assigned to a Flexion-Distraction group and an Exercise Group.  The first group received Flexion-Distraction, a treatment technique which utilizes a specially engineered treatment table that allows the practitioner to gently pull and stretch the spine. This distraction motion, along with specific hand contacts applied by the doctor along the spine works to free-up restrictions in tight joints and ligaments, and opens up compressed joint spaces to relieve pressure from painful discs and irritated nerve roots.  The second group were treated though exercises administered by physiotherapists.  The aim of the exercise program was to strengthen the muscles around the spine as well as increase flexibility, and consisted of a combination of weight training, flexibility, and cardiovascular exercise.   The length of each Flexion-Distraction treatment was approximately 3 to 6 minutes, while each physiotherapy-exercise session was 30 to 45 minutes.  Each group was treated for 1 month, after which time the response to each treatment intervention was analyzed.

The Results…..

The results of the study showed that patients suffering from chronic, continual low back pain benefitted more from Flexion-Distraction technique administered by chiropractors compared to the Exercise group.  In fact, while both groups showed improvement over the month of care, the reduction in lower back pain was almost double what was reported for the Exercise treatment group (1).  Furthermore, additional follow-up studies were conducted on each group over the subsequent year to help determine the response to care after the month of treatment was completed.  In addition to a better response to care immediately following the 1 month of care, those patients receiving Flexion-Distraction technique had significantly less pain at the 3, 6, and 12 month follow-up compared to the exercise group (2).  In addition, patients receiving Flexion-Distraction treatment reported were less likely to visits a healthcare office for low back during the 1 year follow-up, as well as less overall number of visits.

The Take Home Message…

A number of important things can be learned from this research. First and foremost, it establishes that Flexion-Distraction is an important and powerful tool in treating low back pain.  With chronic, continuous low back pain and sciatica this method of care is more effective, and has longer-lasting benefits compared with an exercise only treatment approach.  It is also interesting to note that the flexion-distraction group and considerably less time receiving treatment (treatment sessions for this group last approximately 3 to 6 minutes, whereas the exercise group had to commit 30 to 45 minutes for each treatment session).  In a society with ever increasing time restraints, busy work and home commitments can often be a barrier to treatment compliance, or even seeking care to begin with.  The effectiveness of Flexion-Distraction treatment combined with the relatively short time needed for treament, as well as being a safe and gentle treatment technique makes this a obvious choice for low back pain patients.

It is also important to note that this study does not so much downplay the importance of exercise as it does highlight the effectiveness of Flexion-Distraction. It is the nature of clinical research that patients are delegated into specific treatment groups to determine the effectiveness of one treatment method versus another. However, in the real world two or more treatment techniques are often needed to target various aspects of dysfunction, particularly with complex problems such as chronic lower back pain.  Certainly strength and flexibility of the spine and surrounding joint is an important factor in restoring health and functional capacity, and strength and stretching exercises can and should be part of most treatment approaches. In our clinic in addition to providing flexion-distraction treatment for most types of low back pain at least some home based stretching or exercise component is also part of the treatment plan.


(1) Gudavalli et al. (2006). A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain.  European Spine Journal, 15: 1070-1082

(2) Cambron et al. (2006). One-year follow-up of a randomized clinical trial comparing flexion distraction with an exercise program for chronic low-back pain.  Journal of Alternative and Complimentary Medicine, 12(7): 659-668.

(3) Cambron et al. (2006). Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain.  Chiropractic & Osteopathy, 14:19.