Cox flexion distraction, or the Cox® Technic, is a chiropractic technique that uses a special table.
What is Cox Flexion Distraction?
The Cox® Technic is a non-surgical spinal manipulation that chiropractors perform on The Cox® Table. The Cox flexion distraction table allows for both decompression and flexion-distraction, during the manipulation. The purpose of the Cox technique is to alleviate pain by “dropping intradiscal pressure, widening the spinal canal foraminal area, reducing pressure on the spinal nerves, (and) returning motion to the spinal joints”. This method of hands-on manipulation is meant for neck, arm, low back, leg, and pelvic pain. It can be used to treat the pain related to many conditions, including whiplash-related injuries, pain after back surgery, degenerative disc disease, scoliosis, osteoporosis, disc herniation, slipped or ruptured discs, spinal stenosis, facet syndrome, spondylolisthesis, pregnancy-related back pain, and headache, to name a few. The treatment process starts with the doctor examining the patient and coming up with a diagnosis that needs to be addressed. The patient then lies down on The Cox® Table, face down. The first thing the chiropractor will do at that point is “tolerance testing…to ensure that the treatment will not…aggravate the condition”. The doctor then focuses on one vertebral segment at a time. The goal of the treatment is to drop the “intradiscal pressure”, allowing the disc to reduce, while the intervertebral foramen is increased in size. As a result, there should be “a reduction of pressure on the dorsal root ganglion and the exiting nerve root”.1
Cox Technic Background and Research
Dr. James M. Cox developed the Cox® Technic, spending “nearly 50 years on research and documenting the science of this non-surgical approach”. The technique could provide an alternative to having back surgery. It uses “evidence-based protocols” that are tested in laboratory and clinical trials, and this research is supported by “privately funded, clinician-volunteer, and Federally Funded Research grants” through the Health Resources and Services Administration (HRSA) and the United States National Institutes for Health (NIH). The Cox® Technic Flexion Distraction and Decompression effects are documented. It takes about 29 average days and about 12 average visits to relieve pain via the drop in pressure provided by the technique. The protocols of the method have been published in textbooks and journals, and the proper way to do the technique is taught in seminars and workshops.2 According to Dr. Cox, the treatment is “smooth, rhythmical, slow, and specifically applied”. With the table, the chiropractor can treat the lower back and even the cervical (neck) region. Originally the technique was called “flexion distraction”. “Research, education, and documentation” are important to Dr. Cox, the training offers instruction in the proper application of the technique, and “nearly 2000 chiropractors have taken advantage of this certification opportunity”. Dr. Cox noted that “nearly 64% of chiropractic physicians report using flexion distraction”. Although the technique looks easy, it is the “balance of the hand pressure and the table motion that requires skill and experience”. Dr. Cox stresses that the certification teaches chiropractors the proper way of using the technique.3
Does it Work?
Flexion distraction can drop the intradiscal pressure “as low as -192mmHg” while widening the spinal canal area by as much as 28%”, and flexion distraction is said to return “motion to the spinal joints”.4 The Cox flexion distraction method could be used as an alternative to back surgery, or even in patients who have persistent pain after surgery. The key to the method is the “gentle application of pressure in key areas”. With the repeated movements and gentle stretches, pressure is reduced. The movable sections of The Cox® Table provide “effective division of the different areas of the spine”. The patient has support to the legs and head, while the spine can then be flexed in different directions. The pressure applied is mild, and it is meant to decompress areas where there is inflammation, leading to a re-establishment of nerve functioning. The amount of time it takes varies from patient to patient, but “some patients have immediate results”. This treatment is painless, so it is suitable for patients with a low tolerance for pain. It can decrease migraines and headaches, and the technique could also improve posture and vertebral joint functioning. Other benefits of the Cox® Technic are improvements in nerve communication and increasing circulation. It is said to be effective for alleviating the effects of degenerative disc diseases, (and) lumbar, cervical and thoracic disc herniations”.5 The non-force and gentle nature of the technique is beneficial for post-surgery patients and rehabilitation patients, as well. It is said to be “an effective methodology for relieving pain, often without the need for spinal surgery”.6 In a case study of a 64-year-old male patient with “cervical disk herniation with radiating pain and loss of sensation”, Cox flexion distraction protocols, along with Active Release Techniques, Graston Technique, and therapeutic exercises, led to full recovery. “Even 8 months after treatment, the patient was “pain-free and fully functional”.7
Cox Technic Equipment
Haven Innovation makes the Cox flexion distraction table, which is now in its 8th generation. The Cox7 Table was considered “the benchmark chiropractic flexion distraction table for nearly a decade”, but the Cox8 is being touted as an improvement. The Cox Table 8 has “comfort tipped locks to the responsive tiller bar”, a “quiet motor to the gliding sections”, and “cushion covers to the wire covers”, as well as “ergonomic design points”.8 The Cox Table Model 8 can be used on patients over 7’ tall and up to 500 lbs. There are Base, Deluxe, and Platinum versions available.9 The tiller bar provides the ability to move the caudal section of the table up and down, and there is a foot pedal that can raise and lower the entire table. There is also automated tension available on the caudal section, which allows that section of the table to move easily, no matter the size of the patient, leaving the chiropractor in charge of “the contact and proper force applied to the segment of the spine”. The table does the work of setting the tension for up and down movements. The tiller bar is ergonomically designed to alleviate wrist pressure for the chiropractor. The Cox8 also has a flexion-extension lock on the lower end of the caudal section of the table, with “fingertip control”. The table can also move in side-to-side, in back and forth motions, or even in “circumduction”, which is more of a 360 degree movement. The depth of distraction can be set, for how far the caudal section of the table moves, “from ½ to 2 ½ inches”. The center section of the table has “thoracic drops for treating sacroiliac joints”. The head piece of the Cox8 can provide “long y-axis distraction”, moving forward and back. This helps patients with radicular pain as well. This section of the table can move side-to-side, up and down, and it can even provide rotation without resistance. There are also safety features. If someone was to “crawl underneath” the table as it lowers, there is a pressure strip that will stop and raise the table. Additionally, if a patient has discomfort during treatment, such as during “unattended long y-axis distraction”, there is a “kill switch” under the arm rest that the patient can use.10
Find out more about chiropractic treatment with the Cox flexion-distraction technique.