Comparative effects of cox flexion-distraction therapy and conventional physical therapy on pain, lumbar range of motion, disability, and quality of life in patients with lumbar disc herniation: a prospective controlled study

Background Lumbar disc herniation commonly causes low back pain and functional limitation, affecting mobility, daily activities, and health-related quality of life. Evidence comparing Cox flexion-distraction therapy (CFT) with conventional physical therapy (CPT) is limited. This study compared their short-term effects on disability, pain, lumbar range of motion (ROM), and quality of life. Methods This prospective, two-centre, non-randomized controlled study included adults aged 30–60 years with L4–L5 lumbar disc herniation. Allocation was determined by treatment centre (CPT: Bursa VM Medical Park Hospital; CFT: Nilüfer Spine Health Center) according to participant preference, not individual randomization. Both interventions were delivered three times weekly for four weeks. Outcomes at baseline and week four were the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), SF-36 (eight domains and health-transition item), and lumbar ROM in six planes. The final sample comprised 66 participants (CFT, n = 32; CPT, n = 34). Between-group effects were estimated using baseline-adjusted analysis of covariance, reported as adjusted mean differences with 95% confidence intervals, with Benjamini–Hochberg false-discovery-rate control. Results Both groups improved on most outcomes. CFT produced a greater adjusted reduction in ODI than CPT (−12.6 points, 95% CI: −16.8 to −8.3; p < 0.001). CFT was also superior for SF-36 Pain (+12.3, 95% CI: 7.1 to 17.5) and health transition (+12.8, 95% CI: 7.1 to 18.5), whereas CPT was superior for Emotional Well-being (−6.5, 95% CI: −10.3 to −2.7). Unadjusted ROM change favoured CPT in all six planes, but these differences did not persist after baseline adjustment, and limited baseline overlap rendered the comparisons inconclusive. No between-group difference in VAS change was observed. Conclusion Over four weeks, CFT was associated with greater improvement in disability and pain-related quality of life, whereas CPT was associated with greater improvement in emotional well-being. No clear differences emerged for pain intensity or adjusted ROM. Given centre-based allocation, findings should be interpreted cautiously in light of the non-randomized design and potential centre-related confounding. Adverse events were not systematically monitored, so no safety conclusions can be drawn. Clinical Trial Registration ClinicalTrials.gov , identifier NCT06886334.