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Cox Technic

Cox Technic, also commonly referred to as the Cox technique or flexion distraction, is performed with the patient lying face down on a table specifically designed to distract and flex the spine.

Founder: James M. Cox, DC, DACBR

Year founded: Early 1960s

Certification requirements: The process for becoming certified in Cox Technic involves taking a two-part course, the first section consisting of 12 hours and the second requiring 18. Once those are completed, a written and practical exam must be passed. This exam consists of reviewing cases, determining individuals’ diagnoses, and treating them as appropriate.

Technique description: Cox Technic, also commonly referred to as the Cox technique or flexion distraction, is performed with the patient lying face down on a table specifically designed to distract and flex the spine. At the same time, the chiropractor performs manual adjustments in an effort to treat disc-based issues such as bulging discs and disc herniations.

Research published in the Journal of Chiropractic Medicine adds that this particular chiropractic technique involves the use of two protocols. Protocol I consists of treating cervical disc herniation in which there is pain below the elbow, whereas Protocol II is used when there is cervical disc herniation with no below-the-elbow pain.

Basic technique principles: Logan University describes the Cox flexion distraction technique as a “gentle, non-surgical, no-force procedure that helps the spine heal properly—and keeps it as pain free as possible.” The way it works is by using flexion distraction and decompression that, when combined, increase intervertebral disc height, decrease disc pressure, and realign the spine. This helps to remove tension on the fibers and nerves while also improving circulation and range of motion.

Conditions this technique helps treat: Many studies have been conducted on Cox Technic and have found that it can help treat a number of conditions. These include:

  • Low-back pain. One study published in the European Spine Journal involved 235 subjects who suffered with low-back pain. Each participant was assigned to receive either flexion distraction or active trunk exercise protocol and, upon conclusion of the study, it was noted that the subjects in the flexion-distraction group experienced “significantly greater relief from pain” than the exercise protocol group. Additionally, subjects who started the study with more chronic and severe low-back pain improved the most.
  • ​Neck pain. Cervical radiculopathy is a condition characterized by neck pain (as well as pain that extends to the chest, upper back, shoulders, and arms) and research in the Journal of Manipulative and Physiological Therapeutics reports that chiropractic treatment via flexion distraction helps provide a “statistically significant reduction” in this type of pain. And it generally only takes about 13 visits.
  • Knee pain. Cox Technic can also be beneficial in instances of knee pain, with one study finding that patients’ mean visual analog pain scale scores dropped from 7.7 to 1.8 after approximately five chiropractic visits. Published in The Journal of the Canadian Chiropractic Association, this research further indicated that use of this technique also did not result in any adverse events.
  • Cox Technic | Dr Dan Madock
    Pregnancy-related pain. In March of 2016, the American Chiropractic Association shared a case report in which modified side-lying Cox flexion-distraction spinal decompression therapy (Protocol II) helped reduce low-back and anterior pelvic pain for a 30-year-old woman who was 34 weeks pregnant. Results were reported after just two treatments and the woman indicated that the pain she felt had decreased in both frequency and duration.

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