Flexion-Distraction: The Gentle Table Treatment Helping Edgeworth Backs Move Again

In a randomised clinical trial published in 2006, people with low back pain lasting more than three months received either flexion-distraction or an active exercise program. The flexion-distraction group had significantly greater pain relief. People with chronic, moderate-to-severe pain improved the most. Results did vary depending on whether patients had leg pain or recurring episodes, which is why we tailor care to the person in front of us.

Why might a stretching table help a disc? Lab studies offer a clue. Researchers placed pressure sensors inside lumbar discs and measured what happened during the Cox flexion-distraction procedure. Pressure inside the disc dropped, most markedly at L4–L5, one of the most commonly injured levels. A separate cadaver study found that distraction reliably lowered pressure in the disc's centre compared with standing or lying.

Lower pressure inside the disc is thought to help reduce stress on a bulge and allow nutrients to move into the disc. These were lab studies, not patients, but they help explain what we see in clinic.

Sciatica is leg pain from an irritated nerve root, often caused by a lumbar disc herniation. In a 2009 study of 49 people with sciatica from a disc herniation, nearly all patients were treated with distraction manipulation, alongside exercises and other care. On average, patients rated themselves about 77% improved by the end of treatment, and nearly 90% described their outcome as good or excellent. Those gains held at follow-up more than a year later.

That study had no comparison group, so we can't say the table alone did all the work. But it shows what a thoughtful, non-surgical plan built around flexion-distraction can look like.

Spinal stenosis is a narrowing of the spaces around the nerves, common as we age. Leg pain and heaviness when walking that eases when you sit or bend forward is a classic sign. Flexion-distraction makes intuitive sense here, because bending forward opens those spaces.

In a study of 57 people with stenosis managed mainly with distraction manipulation and nerve mobilisation, patients reported an average improvement of around 65%. Smaller trials have also reported less pain and disability, and a pilot trial of older adults found no adverse events across six weeks of treatment.

Your SI joints sit where your spine meets your pelvis, and they're a common source of low back and buttock pain. Flexion-distraction tables can also be used to gently mobilise this region, which is a great option for people who don't want a more forceful adjustment. We'll be honest: there's less dedicated research on flexion-distraction for SI joint pain specifically than for discs and sciatica. It's usually one part of a broader plan that includes movement, strengthening and other hands-on care.