Cox Technic flexion distraction: An evolution of technique

Cox Technic flexion distraction is an established technique among practitioners. It is rooted in the care of disc herniation and spinal stenosis and accompanying radiculopathy. Students learn about it as chiropractic schools emphasize its importance in chiropractic medicine. Its success is only as good as its research documentation. Its maturation is only as good as its practitioners. Its appreciation by the back and neck populous is only as good as its clinical outcomes.

Its evolution continues.

Use

Practitioners note non-discogenic conditions such as facet syndrome, spondylolisthesis and tropism respond beautifully to flexion distraction. Reports indicate it alleviates symptoms of degenerative scoliosis, spinal stenosis, spinal cysts and pregnancy-related back pain, too. Students in chiropractic schools use flexion distraction. One study undertaken at Parker College of Chiropractic reported Cox Technic Flexion distraction was least injurious among the various techniques.The National Board of Chiropractic Examiners also reports 63.7% of chiropractors use flexion distraction. In prior years, it ranged from 53-58%.

Adjusting Technique	# of cases	# of injuries to doctor	# of injuries to patient
Diversified	280	61	74
Thompson	142	3	25
Gonstead	135	31	39
Cox F/D	54	0	1

Bottomline: use is increasing.

Protocols

To limit any injury to doctor or patient, observe application protocol. Start all treatment with tolerance testing. It puts the treatment segments through gentle range of motion and contact testing before the treatment is applied. Cox Technic is also best applied on a proper flexion distraction table. Proper equipment is essential.

Cox Technic flexion distraction is guided by a carefully set and published algorithm of decision making. It is manually applied as Protocol I or Protocol II depending on the extent of patient pain. No protocols are established for automated flexion distraction. Long-y-axis assisted application is applied as well for patients who have attained at least 50% relief of their pain.The Rule of 50% guides the treatment plan frequency and type of protocol for back and neck pain patients in the Cox Technic System of Spinal Pain Management. Disc and non-disc conditions have similar goals of care.

Key points to application of flexion distraction are (1) the treatment is applied by the physician’s hands and (2) the “pumps” are only 1” to 2” from the treatment start point and always to patient tolerance which may keep them shorter in Protocol I. Protocol II restores physiological range of motion the spinal segments: flexion, extension, lateral bending and circumduction. The physician’s hand on the spine throughout the treatment is essential to monitor the spine and its musculature’s response.

Privately funded

Flexion distraction appreciates privately funded research studies as well as larger scale, federally funded studies via HRSA (Health Resources and Services Administration) and NIH (National Institutes for Health). Such grants study it more closely biomechanically or clinically.

• The lumbar spine biomechanical outcomes study (HRSA grant) found a reduction in intradiscal pressures to as low as 192 mm Hg and intervertebral space widening by 28%.

• The lumbar spine comparison study (HRSA) between flexion distraction and medical conservative (active exercise) care showed that flexion distraction provided statistically significant more relief for chronic/mild, chronic/severe and radiculopathy patients.

• The flexion distraction patients reported fewer healthcare visits needed in the year following the study, and flexion distraction was found to be more effective in reducing pain for 1 year as well.

• In the recently completed cervical spine biomechanical study (NIH), disc pressures in the cervical spine also dropped.

• The 1000 cases study of flexion distraction treatment for lower back pain conditions revealed the number of days and visits patients required to attain maximum improvement.These are documented by condition (ex: L5 disc herniation, spondylolisthesis, etc.) with an average of 12 visits in 30 days regardless of condition. 

• A study of 39 patients with cervical spine radiculopathy found that patients’ pain dropped by over 40 points with flexion distraction in 13.2 treatments. 

All this research must translate into the clinical application for patient pain relief and documenting the clinical outcomes is vital. Many clinical case reports have been published about the efficacy of Cox® Technic flexion distraction on a case by case basis for lumbar spine conditions and cervical spine conditions as well as an overview basis of several cases, combined with therapies and applied alone, combined with other chiropractic protocols and alone. Current studies and papers underway include a cervical spine clinical outcome study, a private clinician data collection study of post-surgical continued patients (FBSS) paper which is nearly ready for journal submission, and a report on spinal stenosis treatment is nearing completion.

Julie Cox is a professional content director and advocate of Cox Technic. Reach her at: juliecoxcid@coxtechnic.com.