칵스 신연교정이 L4-5 추간판 탈출증 환자의 기능적 평가측정과 추간판탈출지수에 미치는 효과

The effects of Cox distraction manipulation on functional assessment measures and disc herniation index in patients with L4-5 herniated disc

  • 권원안 (원광보건대학교 물리치료학과) ;
  • 류영상 (요녕 중의약대학교 추나학과) ;
  • 마상렬 (마산대학교 물리치료학과)
  • Kwon, Won-An (Department of Physical Therapy, Wonkwang Health Science University) ;
  • Ryu, Young-Sang (Department of tuina, Liaoning Traditional Chinese Medicine University) ;
  • Ma, Sang-Yeol (Department of Physical Therapy, Masan University)
  • 투고 : 2012.06.15
  • 심사 : 2012.07.08
  • 발행 : 2012.07.31


본 연구의 목적은 요추 추간판 탈출증 환자에게 치료적 모달리티와 칵스 신연교정치료 효과에 대하여 알아보고자 한다. 요추 추간판 탈출증 환자 15명 (나이 36.62, 범위 20-50, 남자 7명과 여자 8명)을 대상으로 4주간 적용하였다. 치료적 모달리티와 칵스 신연교정치료를 첫 2주 동안 주 6일, 12회 적용하였으며, 마지막 2주간은 주 3일 6회 적용하였다. 모든 실험대상자에게 4주 동안 18회를 적용하였다. 측정은 오스웨스트리 요통장애지수, 근력, 하지 직거상 검사는 실험 전, 치료 2주 후, 치료 4주 후 변화의 차이를 일요인 반복측정을 이용하였으며, 추간판 탈출지수는 실험 전, 치료 4주 후 변화 차이를 대응표본 t-검정을 이용하여 측정하였다. 치료적 중재 기간에 따라 치료 전, 2주 후, 4주 후 측정결과 오스웨스트리 요통장애 지수, 하지 직거상 검사, 그리고 근력은 치료 2주 후, 치료 4주 후가 치료 전에 비하여 통계학적 유의한 변화가 있었다. 그러나 추간판 탈출지수는 치료 전에 비하여 감소함을 나타냈으나 통계학적으로 유의한 변화는 없었다. 결론적으로 요추 추간판 탈출증 환자에게 치료적 모달리티와 칵스 신연교정치료가 요통장애지수, 하지 직거상 검사, 근력개선에 효과적이란 결론을 얻었다. 이것은 칵스 신연교정치료의 안전성과 효과의 확인, 그리고 요추 추간판 탈출증 환자에게 비수술적 치료법으로서의 근거를 제시하였다.


  1. Avramov, A. I., Cavanugh, J. M., Ozaktay, C. A., Gretchell, T. V. and King, A. I. (1992). The effect of controlled mechanical loading on group II, , and IV afferent units from the lumbar facet joint and III surrounding tissue. Journal of Bone and Joint Surgery American, 74, 1464-1471.
  2. Bailey, W. M. (2006). A paractical guide to the application of AJNR guidelines for nomenclature and classification of lumbar disc pathology in magnetic resonance imaging(MRI). Radiography, 12, 175- 182.
  3. Beira, R. and Peers, A. (1998). A study of the effects of chiropractic therapy on the diameter of the spinal canal in patients with low back pain and radiculopathy. Journal of Neuromusculoskel System, 6, 114- 126.
  4. Bulbulian, R., Burke, J. and Dishman, J. D. (2002). Spinal reflex excitability changes after lumbar spine passive flexion mobilization. Journal of Manipulative and Physiological Therapeutics, 25, 526-532.
  5. Cox, J. M. (1998). Chiropractic and distraction adjustments today. In Low Back Pain: Mechanisms, Diagnosis and Treatment, 5th Ed., edited by J. M. Cox, Lippincot Williams & Wilkins, Philadelphia, 1-16.
  6. Cox, J. M. (2000). A review of biomechanics of the central nervous system. Part I: Spinal canal deformations caused by changes in posture. Journal of Manipulative and Physiological Therapeutics, 23, 211-217.
  7. Cox, J. M. (2012). Chiropractic management of a patient with lumbar spine pain due to synovial cyst: A case report. Journal of Chiropractic Medicine, 10, 255-210.
  8. Cox, J. M. and Cox II, J. M. (2005). Chiropractic treatment of lumbar spine synovial cysts: A report of two cases. Journal of Manipulative and Physiological Therapeutics, 28, 143- 147.
  9. Fagerlund, M. K., Thelander, U. and Friberg, S. (1990). Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms. Acta Radiologica, 31, 555-8.
  10. Gay, R. E., Bronfort, G. and Evans, R. L. (2005). Distraction manipulation of the lumbar spine : A review of the literature. Journal of Manipulative and Physiological Therapeutics, 28, 266-73.
  11. Gay, R. E., Ilharreborde, B., Zhao, K. D., Berglund, L. J., Bronfort, G. and An, K. N. (2008). Stress in lumbar intervertebral discs during distraction: A cadaveric study. The Spine Journal, 8, 982-990.
  12. Goh, K. J., Khalifa, W., Anslow, P., Cadoux, H. T. and Donaghy, M. (2004). The clinical syndrome associated with lumbar spinal stenosis. European Neurology, 52, 242-249.
  13. Gong, W. T., Cheun, H. J. and Lee, K. M. (2010). The effect of cervical stabiliazed exercise and joint mobilization on maximum muscle strength and static muscle endurance of cervical region. Journal of the Korean Data & Information Science Society, 21, 33-42.
  14. Gudavalli, M. R. (1999). Biomechanics research on flexion-distraction procedure. In Low Back Pain: Mechanisms, Diagnosis and Treatment, 6th Ed., edited by J. M. Cox, Lippincot Williams & Wilkins, Philadelphia, 263-268.
  15. Hasegawa, T., Mikawa, Y., Watanabe, R. and An, H. S. (1996). Morphometirc analysis of the lumbosacral nerve roots and dorsal toot ganglia by magnetic resonance imaging. Spine, 21, 1005-1009.
  16. Hides, J. A., Richardson, C. A. and Jull, G. A. (1996). Multifidus muscle recovery is not automatic after resolution of acute, first episodes low back pain. Spine, 21, 2763-2769.
  17. Joung, K. H. and Chung, S. S. (2011). Health-related quality of life among home-dwelling people with arthritis in Korea: Comparative study of osteoarthritis and rheumatoid arthritis. Journal of the Korean Data & Information Science Society, 22, 555-563.
  18. Kim, D. Y., Lee, S. H., Lee, H. Y., Lee, H. J., Chang, S. B., Chung, S. K. and Kim, H. J. (2005). Validation of the Korean version of the Oswestry disability index. Spine, 30, 123-127.
  19. Kruse, R. A. and Cambron, J. A. (2011a). Cox decompression chiropractic manipulation of a patient with postsurgical lumbar fusion: A case report. Journal of Chiropractic Medicine, 10, 255-260.
  20. Kruse, R. A. and Cambron, J. A. (2011b). Chriopractic management of postsurgical lumbar spine pain: A retrospective study of 32 case. Journal of Manipulative and Physiological Therapeutics, 34, 408-412.
  21. Kruse, R. A., Gudavalli, S. and Cambron, J. A. (2007). Chiropractic treatment of a pregnant patient with lumbar radiculopathy. Journal of Chiropractic Medicine, 6, 153-158.
  22. Ma, S. Y. (2010a). The effects of mulligan manual therapy on pain and muscle assessment questionnaire in female elders with osteoarthritis of the knee. Journal of the Korean Data & Information Science Society, 21, 641-650.
  23. Ma, S. Y. (2010b). Effect of whole body cryotherapy with spinal decompression on lumbar disc herniation by functional assessment measures. Journal of the Korean Data & Information Science Society, 21, 1101-1108.
  24. Macario, A., Richmond, C., Auster, M. and Perglizzi, J. V. (2008). Treatment of 94 outpatients with chronic discogenic low back pain with the DRX9000: A retrospective chart review. Pain Practice, 8, 11-17.
  25. Manison, A. M. (2011). Chiropractic management using Cox cervical flexion-distraction technique for a disk herniation with left foraminal narrowing in a 64-year-old man. Journal of Chiropractic Medicine, 10, 316-321.
  26. McLain, R. F. (1994). Mechanoreceptor endings in human cervical facet joints. Spine, 19, 495-501.
  27. Milette, P. C. (2000). Classification, diagnostic imaging, and imaging characterization of a lumbar herniated disk. Radiologic Clinic of North America, 38, 1267-92.
  28. Nakagawa, H., Kamimura, M., Takahara, K., Hashidate, H., Kawaguchi, A., Uchiyama, S. and Miyasaka, T. (2007). Optimal duration of conservative treatment for lumbar disc herniation depending on the type of herniation. Journal of Clinical Neuroscience, 14, 104-109.
  29. Patterson, M. M. and Steinmetz, J. E. (1986). Long lasting alterations of spinal reflexes: A potential basis for somatic dysfunction. Manual Medicine, 2, 38-42.
  30. Schaible, H. G. and Grubb, B. D. (1993). Afferent and spinal mechanism of joint pain. Pain, 55, 5-54.
  31. Troup, J. D. G. and Videman, T. (1989). Inactivity and the aetiopathogenesis of musculoskeletal disorders. Clinical Biomechanics, 4, 173-178.
  32. Waddell, G., Somerville, D., Henderson, I. and Newton, M. (1992). Objective clinical evaluation of physical impairment in chronic low back pain. Spine, 17, 617-628.
  33. Wheeler, A. H. and Hanley, E. N. (1995). Nonoperative treatment for low back pain rest to restoration. Spine, 20, 375-378.
  34. Zusman, M. (1988). Prolonged relief from articular soft tissue pain with passive joint movement. Manual Medicine, 3, 100-102.

피인용 문헌

  1. Effects of Manual Therapy on Pain and Function of Patients with Chronic Low Back Pain vol.29, pp.2, 2017,