{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:07:09Z","timestamp":1753891629781,"version":"3.41.2"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T00:00:00Z","timestamp":1720396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Integr. Neurosci."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Accurately measuring the forces applied during spinal manipulation and its biomechanical effects on the spine are critically important in current research. This single case report discusses the potential benefit of accurately monitoring manipulative forces in treating low back pain with sciatica. The type of force-based spinal manipulation used to manage this case was Cox Technic flexion distraction decompression (CTFDD) spinal manipulation care, along with other ancillary modalities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The treatment plan, in this case, was primarily force-based CTFDD, equal-force bi-directional traction (EqFT), pre-modulated electrical muscle stimulation (EMS), infrared light therapy (ILT), and a home stretching and strengthening program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical findings<\/jats:title><jats:p>Initially, the case study patient presented with complaints of left lumbar spine pain, which radiated into the left buttock, down the left leg, accompanied by an inability to dorsiflex the left foot. The patient was concerned with this condition as the left leg pain and left lower extremity motor deficit were having a profound effect on the patient\u2019s ability to perform activities of daily living and work. The patient was recommended to undergo spinal decompression surgery, which the patient did not want, and elected to exhaust all alternative, non-surgical treatments first.<\/jats:p><\/jats:sec><jats:sec><jats:title>Diagnosis, intervention, and outcomes<\/jats:title><jats:p>A diagnosis of sciatica with a sequestered disk fragment and left lower extremity motor deficit was rendered through objective physical examination results and a review of a lumbar MRI study. Past interventions included prescription medications, physical rehabilitation, chiropractic, pain management, and neurosurgical consultation. All past interventions prior to initiating CTFDD care provided minimal subjective and\/or objective clinical improvement. This patient had a positive clinical outcome from a force-based CTFDD treatment plan along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Force-based CTFDD spinal manipulation, along with other modalities consisting of pre-modulated EMS, ILT, and a home stretching and strengthening program, has been found to be an alternative, non-surgical treatment for discogenic sciatica. Continued research is needed on force-based CTFDD spinal manipulation to further evaluate the neurological and biomechanical effects of the forces and motion applied to the spine and determine health benefits for the treatment of low back pain.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnint.2024.1356564","type":"journal-article","created":{"date-parts":[[2024,7,8]],"date-time":"2024-07-08T04:44:56Z","timestamp":1720413896000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Spinal manipulation and mobilization forces delivered treating sciatica: a case report"],"prefix":"10.3389","volume":"18","author":[{"given":"Theodore B.","family":"Siciliano","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maruti R.","family":"Gudavalli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralph","family":"Kruse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1186\/s12891-022-05196-x","article-title":"Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability, and quality of life versus physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial","volume":"23","author":"Amjad","year":"2022","journal-title":"BMC Musculoskeletal Disord."},{"key":"ref2","first-page":"370","volume-title":"Low back pain: mechanism, diagnosis, treatment","author":"Cox","year":"2011"},{"key":"ref3","article-title":"Distraction chiropractic adjusting: clinical application, treatment algorithms, and clinical outcomes of a 1,000 cases","volume":"3","author":"Cox","year":"1996","journal-title":"Top. 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