Question 1

What is the chiropractic physician's education?

Accepted Answer

Chiropractic physicians go to school for at least 7 years. They must attain a 4-year basic science bachelor's degree before entering a doctorate degree program in chiropractic. During chiropractic school, chiropractic students focus on anatomy, physiology, biochemistry, clinical diagnosis, radiological diagnosis as well as training in chiropractic theory, practice, techniques, diagnosis and application which all lead to clinical and practical interaction with patients before graduation. chiropractic physicians are particularly well-trained in the diagnosis and treatment of musculoskeletal conditions.

After graduation, the chiropractic physician tests for a particular state's license board in order to practice in that state. Once licensed, the chiropractic physician must meet annual continuing education requirements to keep his or her clinical, diagnostic and practical skills sharp.

Question 2

What is chiropractic?

Accepted Answer

The word "chiropractic" is from the Greek words "kheir" meaning "hand" and "praktikos" meaning "one who practices." chiropractic is practiced with the hands. chiropractic is a hands-on healthcare profession dedicated to the diagnosis, treatment and prevention of musculoskeletal system disorders.

Question 3

What is Cox® Technic Flexion-Distraction?

Accepted Answer

Cox Technic is a marriage of osteopathic and chiropractic principles as established by Dr. James M. Cox nearly 45 years ago to stop pain by realigning the spine. The osteopathic principles Dr. Cox scrutinized were 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. Since the early 1970's, Dr. Cox has refined the technique; developed a manipulation instrument for effective use of the technique; conducted clinical, as well as participated in experimental, research; lectured around the world; and written well-received articles, chapters for textbooks, and textbooks.

Cox Technic is a gentle, non-force adjusting technique performed on a special table that moves in spinal ranges of motion. These motions allow the physician to open compressed spinal disc spaces, traction the spine and reduce pressure on facet joints and other spinal structures.

Cox Technic can often help a patient avoid spinal surgery.

Cox Technic is a gentle, safe, non-surgical, effective spinal manipulation for low back, neck, arm and leg pain, particularly stenosis and disc herniation related pain.

Cox® Technic is spinal manipulation, a non-surgical, established, evidence-based, non-surgical treatment for spine pain performed by a trained physician and supported by years of clinical experience, many publications of clinical and laboratory outcomes, and clearly defined protocols for application to attain the highest positive clinical outcomes for acute and chronic back pain as well as failed back surgical syndromes. All this is to help restore a patient's quality of life.

Question 4

Is Cox technic safe?

Accepted Answer

Yes, Cox Technic is safe. All its motions are well within the physiological limits of the spine. Biomechanical studies on Cox Technic flexion-distraction document that flexion-distraction motions as applied to the spinal structures are well within safe limits.

Question 5

Can I be treated with Cox Technic flexion distraction and decompression if I have had back surgery?

Accepted Answer

Yes, you can be treated with Cox Technic after spinal surgery in most cases. The type of surgery you had performed will determine your treatment protocol. For example, if your spine is surgically fused, the segments above and below the surgical site can be treated. Cox Technic is gentle and segment specific care. The doctor's hand is on the spine at all times, monitoring the spine and its response to the treatment.

Question 6

How soon after back surgery can I be treated?

Accepted Answer

Typically, evaluation and treatment with Cox Technic protocols can start 6 to 12 weeks after surgery or when you are released from surgical care. Dr. Paulette Hugulet, DC, LLC will carefully examine you prior to any care.

Question 7

Is Cox Technic better than surgery?

Accepted Answer

Oftentimes, Cox Technic is the non-surgical alternative to back surgery. Surgery may offer faster relief for some, but it is not proven to have superior results in the longer term. Surgery alters the spine by removing spinal material. Surgery often places stress on the spinal segments above and below the surgical site. Cox Technic may be helpful after surgery, but can often help you avoid back surgery. Surgery is required for a limited number of patients and often done for pain relief.

Studies to consider that report on long-term (10 years) post care that show successes:

69% surgical care vs 61% chiropractic care for sciatica (leg pain) due to a lumbar spine disc herniation Link
53% surgical care vs 50% chiropractic care for lumbar spine stenosis Link

A trial of non-surgical care may well be warranted at Dr. Paulette Hugulet, DC, LLC prior to a surgical intervention.

Question 8

How many Cox Technic treatments do I have to do?

Accepted Answer

The number of treatments depends on your condition, its severity and your response to care. Some patients report relief in one visit; others in more. Research has shown that 91% of patients report relief within 3 months of care with an average of 29 days and 12 visits to attain maximum improvement. (Cox et al, Topics in Clinical Chiropractic, 1996; 3(3):45-58, 79-81)

Question 9

How long does it take for relief when Cox Technic Flexion Distraction is applied?

Accepted Answer

Each patient is unique. Some patients have suffered for years and others are experiencing their first bouts of pain. Factors such as the underlying cause of pain, the severity of the pain, your cooperation with the at-home instructions - exercise, hot/cold, modification of activities, appointments, etc. - all play a role. Some patients may be seen for just a week or two while others will be seen for 3 months. This doesn't mean you are seen daily for that time period; it just means that each treatment plan is individualized to the patient.

The Rule of 50% guides Cox Technic protocols. The physician monitors your care by seeking 50% relief of pain. This relief is measured subjectively (meaning you are asked to measure your relief) and objectively (meaning the physician performs certain key clinical tests like the straight leg raise to measure your relief). 50% relief may come in as little as one treatment or in 2 to 3 weeks of care. When 50% relief of pain is documented, the treatment visits are reduced by 50%. For example, if you are seen daily, you would then be seen every other day.

One fact to keep in mind though is that it takes 3 months to heal a disc. Consider a broken arm that is cast and is painfree in a few days. A physician doesn't take the cast off when there is no more pain reported. The cast stays on to allow healing. The spine may be painfree in a short amount of time, but true healing takes longer. The spine needs time to heal.

Cox Technic's goal is to get a patient out of pain and back to the painfree quality of life he or she wants. Research has shown that 91% of patients report relief within 3 months of care with an average of 29 days and 12 visits to attain maximum improvement. (Cox JM et al, Topics in Clinical Chiropractic 1996; 3(3):45-57, 79-81)

Question 10

Will I have to have x-rays to receive care?

Accepted Answer

Xrays offer a look at the structure of the spine. They are valuable in the evaluation of your spine. After the clinical examination, xrays may be requested to rule out any abnormalities that may need special attention.

Question 11

Must I be examined prior to treatment? I already know what is wrong with me.

Accepted Answer

Yes, anytime a new patient comes to the office, we must personally examine the spine to rule out any new conditions and confirm the existence of the present condition. A good clinical examination is in both our best interests. A thorough chiropractic examination will reveal a solid diagnosis around which an effective treatment plan can be made for your healing and prevention of future pain.

Question 12

How often do I have to be treated with Cox® Technic?

Accepted Answer

The findings of your examination and diagnosis will determine your visit frequency. Your visits to the chiropractor are determined by your condition and its severity. Dr. Paulette Hugulet, DC, LLC follows published guidelines regarding the visit frequency. The guidelines are dictated by the rule of 50%. 50% relief is sought in the first 30 days of care. If that percent is not attained, further testing or other consultation for your condition will be made.

Once you are asymptomatic, however, it is in the best interest of your spine to be seen periodically. However, if you choose, you can enjoy your asymptomatic lifestyle and return to your physician as needed.

Question 13

Will I have to keep being adjusted with Cox® Technic to stay out of pain?

Accepted Answer

In Cox Technic, it is explained that there is no cure for back pain, but there is control. You will get out of pain and can stay that way if you learn to control your activities as your physician advises during your care. Control comes in the way of basic exercises, nutrition, lifting technique modification, posture, etc. Beware though: patients commonly stop their exercises and proper lifting techniques once their pain is relieved. This may result in a recurrence of the problem. Keep exercising and keep minding proper bending, lifting and twisting motions.

Question 14

What keeps the disc from moving back where it was when I was hurting?

Accepted Answer

The tear in the disc wall heals with scar tissue, and the chemical inflammatory agents created by the disc tear are absorbed.

Question 15

I don't like to be "cracked." Does Cox® Technic crack my bones?

Accepted Answer

No, Cox Technic gently restores range of motion in the joints and muscles and thusly increases flexibility and improves posture. Cox Technic is guided by the physician's contact hand on the involved spinal segment while the flexion-distraction table's movement is controlled by the doctor's other hand. No cracking is involved.

Question 16

What is the sound when I am adjusted?

Accepted Answer

Often patients will hear a "pop" during a traditional chiropractic adjustment, and sometimes during a Cox Technic flexion-distraction adjustment. This "pop" is called a cavitation. This cavitation is simply a release of gases (oxygen, nitrogen, CO2) from the facet joints of the vertebral segments which contain synovial fluid. Synovial fluid lubricates the spinal segments for movement. Consider opening a soda bottle that is dropped. When opened, there is a loud snap and rush of bubbles. The cavitation is similar, but contained.

Question 17

Does Cox Technic hurt?

Accepted Answer

No. Cox Technic Flexion Distraction and Decompression is gentle, controlled stretching of the spine. Patients sometimes comment that they feel like they just need to be "pulled apart". Cox Technic does this gently and in a controlled fashion.

Question 18

I am pregnant and have back pain / leg pain. Can Cox® Technic help me?

Accepted Answer

Yes. Back pain affects 50% to 70% of pregnant women. Since imaging and drugs are not preferred while a woman is pregnant, Cox Technic flexion-distraction is the non-drug, non-invasive, conservative solution. The patient, if early in the pregnancy, may lie on the stomach, but later in the pregnancy, she will lie on her side for comfort while spinal manipulation is given. For more information, read http://www.americanpregnancy.org/pregnancyhealth/backpain.html or watch this video on Cox® Technic and pregnancy-related back pain.

Question 19

How much does a Cox Technic adjustment cost?

Accepted Answer

Cox Technic is chiropractic spinal manipulation. If you have medical insurance that covers chiropractic, Cox Technic is a covered service as spinal manipulation. If you do not, talk with us.

When considering costs, one low back surgery can cost between $83 and $169 thousand. (Menke, Principles of Integrative Medicine) It is interesting to point out that lumbar fusion surgery costs increased 500% in 11 years (1992-2003) going from $75 million to $482 million. (Weinstein, Spine 31(23)) The introduction of devices for spinal fusion in 1996 increased fusion use from 3.6% to 58% in 2001. (Jurati, Spine 31(23))

A trial of conservative, non-operative care is advised before surgery. Of typical pre-operative procedures, chiropractic manipulation only accounts for 2% of charges while injections account for 32%, diagnostic imaging 31%, out-patient visits 13%, physical therapy 11%, pre-operative studies .8%, medications .5%, and miscellaneous charges 2%. (Daffner, Spine Journal 10(6)). As a non-surgical, conservative treatment approach, Cox Technic is quite economical and less complicated.

Question 20

What happens during the first chiropractic appointment?

Accepted Answer

The first appointment is our opportunity to get to know each other. Your first visit to the chiropractor is most important. You will interact with us during the clinical examination which includes a discussion of your history of the current pain episode - when did it start, where does it hurt, how often have you experienced this type of pain -- your family history, dietary habits, work requirements, previous injuries, prior care for your current condition (medical, osteopathic, chiropractic), etc. Physical, orthopedic, neurological and radiological examination are commonly performed on the first visit. We will review any imaging (MRI, x-rays, CT, etc.) that you may already have, take any x-rays that may be needed, define a diagnosis, and explain to you the condition that is causing your pain. We will discuss the treatment plan for your spinal pain condition that will include how often you will be seen and what your expectations of pain relief can be. Your first Cox Technic flexion-distraction and decompression treatment may follow.

Question 21

How long is each treatment?

Accepted Answer

We know your time is as valuable as ours. We are all busy! Granted, the first visit is oftentimes a longer session. Each follow-up chiropractic visit may only be 5 to 15 minutes. Be assured, we will spend the appropriate amount of time as is necessary to address the spinal condition, working for that 50% relief of pain according to the treatment plan for Cox Technic protocols. Keep in mind, each visit builds on the one before. We know your spine well after the first and each subsequent visit and can recognize what it needs today. Time is valuable to all of us. We pledge to be on time as best as possible to get you back to your life.

Question 22

Should I use ice or heat on my back?

Accepted Answer

In the first 72 hours (or longer if severe pain or swelling persist), ice should be applied. Ice reduces inflammation. After that, apply 10 minutes of heat, 10 minutes of cold, and 10 minutes of heat again. Heat draws blood into the area, and ice drives out swelling, thus creating circulatory stimulation.

Question 23

What are epidural steroid injections?

Accepted Answer

Epidural steroid injections are common medical conservative treatments. If you choose to have one in conjunction with your flexion-distraction care, you may do so. We can discuss the clinical relief you might expect from this form of care to aid in your decision-making.

Question 24

How does Cox Technic compare to decompression?

Accepted Answer

Cox Technic is a hands-on, doctor-controlled spinal adjusting procedure that is segment specific in its application. If there is an L5S1 disc herniation, the L5S1 segment is addressed until the disc herniation pain is reduced, and the segment is able to move through its normal ranges of motion painfree. Its sessions are a few minutes in length, under doctor control at all times, and shown to reduce intervertebral disc pressures to as low as -192mm HG pressure, open the spinal canal space by 28%, and increase the disc height. The Cox Technic treatment plan is individualized by patient response, not by number of treatments or number of minutes. The Rule of 50% standardizes the care.

Question 25

How does Cox compare to a "regular" chiropractic adjustments?

Accepted Answer

Cox Technic Flexion Distraction and Decompression is a gentle, non-force, chiropractic adjusting technique that allows us to place spinal joints in a more normal motion and position without pain or irritation of the present condition. It is low-force adjusting (even described by researchers as low velocity-low amplitude) that produces painfree results. There is no quick thrusting motion.

Question 26

How can I prevent a herniated disc?

Accepted Answer

Prevention of a disc herniation may be a goal that a healthy lifestyle may influence. Proper ergonomics are also quite important in prevention and control of a disc herniation or back pain issue. You may want to consider the following tips

Eat a healthy diet.
Maintain a healthy weight because excess weight puts pressure on the lower back.
Don't smoke or quit if you do. Smoking impairs blood flow which deprives spinal tissues or nutrition and oxygen.
Stay active. Consult with your doctor for the best ideas for you.
Warm up before physical activity be it gardening or exercising or walking.
Avoid long periods of bed rest and inactivity.
Do not sit! Sitting increases the pressure up to 11 times higher than when you lie flat.
- If you do have to sit, try to not sit longer than 15-30 minutes without getting up and stretching the spine and walking.
Consider your work. Be sure its demands do not stress your spine. Make sure the work area design is ergonomically appropriate to avoid irritation.
Exercise regularly to keep the muscles of your back, legs, and stomach strong. Try to balance aerobic, flexibility and strength exercises throughout the week.
Focus on your posture. For example,
- when walking, stand up straight with your shoulders back, abdomen in, and the small of your back flat.
- when sitting, sit with your feet flat on the floor or elevated.
Consider your mattress for sleeping. It doesn't have to be a certain firmness. It needs to be supportive.
- Sleep on a firm enough mattress that minimizes any curve in your spine.
- Sleep on your side or back, not your stomach.
Wear comfortable, supportive, low-heeled shoes.
Be careful when lifting.
- Do not bend at the waist.
- Bend your knees.
- Keep your legs strong, and use them to support the load.
- Always keep the weight being lifted close to you body, not lifting with the arms outstretched as this stresses the discs in the low back.
Consider supplementing your diet with cartilage, bone, and immunity building nutritional supplements.

Contact Dr. Paulette Hugulet, DC, LLC to discuss your back condition and its pain prevention and control.

Question 27

Are there contraindications to receiving Cox Technic?

Accepted Answer

Contraindications to Cox Technic are necessarily not absolute. Cox Technic Flexion Distraction and Decompression protocols always begin with a careful tolerance test prior to treatment. Any intolerance to the distraction manipulation is addressed with modified treatment technique. The following conditions require special consideration in evaluating their being treated: acute fracture and stroke, intolerance to contact, claustrophobia (as the treatment is performed with the face down on a headpiece - this situation can be accommodated), cancer and advanced osteoporosis (which have caused loss of structural integrity), spinal fusion (unhealed, unstable), rheumatoid arthritis with ligament laxity. This is not to say that patients with these conditions can't be treated, but that their treatment may be modified to avoid aggravation.

Question 28

What is cauda equina syndrome?

Accepted Answer

The cauda equina is at the end of the spinal cord. Cauda equina syndrome occurs when this bundle of nerves is compressed. Fortunately, cauda equina syndrome usually only affects LESS THAN 1% of low back pain sufferers. Cauda equina syndrome is associated with bowel and bladder problems like loss of control of bowel and bladder functions or loss of feeling to the lower pelvic area and legs. These symptoms need more immediate medical attention and possible surgery. Cauda equina syndrome is sometimes caused by a herniated disc that ruptures into the spinal canal and compresses the cauda equina.

Question 29

When might surgery be appropriate for back pain?

Accepted Answer

Back surgery might be appropriate in some cases of spine pain. Only 2%-5% of patients with low back pain require surgery:

Progressive neurological deficit - If you are getting worse and say you are losing muscle strength, it would be time to see a surgeon. Pain alone is not reason for surgery. There must be other signs such as reflex loss and muscle weakness.
Cauda equina syndrome (CES)- If you lose control of your bowel/bladder function, it would be time to see a surgeon. (statistics on CES)

Keep in mind that though surgery is shown to sometimes provide faster relief, but at follow-up 10 years after surgery, little difference is noted in the daily functioning of patients who had back surgery vs those who chose a non-surgical route. (Atlas, Spine 30(8))

Your condition is individual. Your doctor at Dr. Paulette Hugulet, DC, LLC will carefully examine you for any and all symptoms and recommend a treatment plan for you. If at any time in your care, your condition changes, tell us. We will monitor your condition and adjust the plan as required.

Question 30

Is it normal to have bulging discs or herniated discs?

Accepted Answer

No, a normal disc does not bulge; however, with aging and/or injury, the outer anulus fibrosus can tear to allow the nucleus pulposus material to bulge through it resulting in a bulge of the disc. These bulges are commonly found on MRIs of asymptomatic (no pain) patients in about 76% of people. In patients with pain, 96% of their MRIs show disc herniations. (Boos, Spine 20(24)) Disc bulges and disc herniation occur with age due to degeneration and dehydration of the disc. Varying factors like the size of the spinal canal into which the disc is bulging plays a large role in whether a disc bulge causes pain or not.

Question 31

What is whiplash? Does it cause disc herniations?

Accepted Answer

Whiplash describes the sprain of neck muscles or strain of the muscles in the neck. It is typically associated with accidents, but it can happen in many situations when there is a sudden flexion and extension of the neck. If a disc is bulging or otherwise predisposed to disc herniation but not painful prior to the whiplash event, it may herniate at the time of the whiplash event.

Contact Dr. Paulette Hugulet, DC, LLC for an examination and treatment plan to deal with your whiplash.

Question 32

Is a herniated disc the same as a bulging disc or ruptured disc or slipped disc?

Accepted Answer

The terms slipped disc, herniated disc, bulging disc, ruptured disc are all commonly used terms to refer to a condition in which the inner part of the intervertebral disc called the nucleus pulposus pushes through the outer containing fibers of the disc called the anulus fibrosus. This bulging of the inner nucleus into the anulus fibrosus can take two forms. If the nucleus is held within the anulus fibrosus, the process is termed a contained disc, and sometimes referred to as a disc protrusion or herniation. If the anulus fibrosus tears and allows the inner nucleus pulposus to escape through the anlus fibrosus it is called a non-contained disc herniation and often called a ruptured or fragmented disc.

Whether the disc is contained or non-contained, it is possible that the disc can press on a nerve with sufficient pressure to mechanically irritate a nerve to cause back, neck, arm or arm pain, or in the case of the non-contained disc to chemically irritate the nerve by chemical reaction of the free nucleus pulposus material contacting the nerve.

Contact Dr. Paulette Hugulet, DC, LLC for a thorough examination of your pain due to a bulging disc and a treatment plan to relieve it.

Question 33

How do you get sciatica?

Accepted Answer

You get sciatica buy a spinal nerve's being irritated, once or over a period of time. You may develop sciatic leg pain due to many different conditions singly or in combination: stenosis, disc herniation, facet syndrome, etc. Sometimes the spinal nerve is mechanically irritated by a disc herniation, pressing into the spinal canal or chemically irritated by disc material that finds its way into the canal where it isn't supposed to be.

Sometimes you can recall a specific incident that caused your leg pain to begin, but more often, you can't point to one event. A lifetime of small events often accumulate to result in sciatica due to poor posture, too much heavy lifting, extra pounds of weight. These stresses build up to one day when a normal thing like bending to pick up the newspaper results in shooting pain to foot.

Contact Dr. Paulette Hugulet, DC, LLC today for an evaluation of your sciatic leg pain, the first step toward its relief.

Question 34

Will Cox Technic cure my back pain?

Accepted Answer

"Control, Not Cure"

Cox Technic does not claim to cure back pain, but rather Cox Technic Flexion Distraction and Decompression chiropractic protocols set a plan to control it. If you have disc degeneration or tropism or a transitional segment, for example, you will live your life with it. If you have had back pain off and on for years, the affected spinal nerve needs less and less irritation to cause pain. Now, this does not mean that you must live your life with pain. Your body heals with guidance from Cox Technic and some lifestyle alterations. Your understanding your spine pain condition gives you power to control it to some extent. Cox Technic drops intradiscal pressures, widens the intervertebral canal space, increases the disc space height and restores healthy movement to spinal joints.

Contact Dr. Paulette Hugulet, DC, LLC to discuss how you can control your back pain so it doesn't control you!

Question 35

How many treatments do I need for sciatica relief?

Accepted Answer

Sciatica or sciatic leg pain heals interestingly. It often comes and goes as it heals, and its going more than it comes is a good sign of healing. Most sciatica sufferers are satisfied with their relief in just a few days, weeks or months of care. chiropractic Cox Technic's research of 1000 patients found that 12 visits in 29 days was average, but your response is unique due to your unique journey of pain to this current episode. (Cox J et al, Topics in Clinical Chiropractic 1996; 3(3)) It sometimes takes a few episodes of sciatica for a patient to realize that control, not cure, is really true. Periodic chiropractic check-ups, exercise, healthy lifestyle changes all can help control sciatica. After considering your options, the number of treatments is up to you.

Contact Dr. Paulette Hugulet, DC, LLC for an evaluation of your sciatica and plan for its relief.

Question 36

How can it be that my arm or wrist pain could be due to my neck problem?

Accepted Answer

Arm pain and/or wrist pain may be due to a neck problem starting in the cervical spine. From the brain, the spinal cord extends through the spinal column with its smaller nerve roots trailing between the vertebrae (bones) to take impulses and instructions to all parts of the body, including your arm or wrist (or foot or toe or leg). If your arm or wrist hurt or throb or tingle, one of the nerves off the spinal cord could well be compressed or otherwise irritated. Thus, your arm pain or wrist pain may well be due to a neck problem whereby the spinal canal through with the nerve passes is somehow not functioning normally. A thorough examination and gentle chiropractic care may be a solution for you.

Consult Dr. Paulette Hugulet, DC, LLC for a thorough examination and treatment plan to relieve neck-related arm and wrist pain.

Question 37

Do I have to wear a gown?

Accepted Answer

Gowns allow two essential elements for the doctor: view and access. During the chiropractic examination, the doctor will study your whole body as clues to your condition are visible that way: gait, skin irritation, curve to your spine, lean, etc. He or she also needs to be able to palpate your spine, to feel spinal elements for tightness, misalignments, and other issues. During the treatment, the doctor needs to firmly hold spinal segments to adjust the spine and to apply therapies to your spine and/or extremities if they are involved. Clothes allow slippage of the hand and prevent access for modalities; gowns allow contact. If you have an issue with the gown process, certainly discuss it with us so that you are at ease. We certainly don't want a gown to come between you and your pain relief.

Contact Dr. Paulette Hugulet, DC, LLC for your chiropractic examination and treatment.

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