Chiropractic CE

Cox Technique

            Cox Technique is reported to have been used by 63.7% of chiropractic providers according to the National Board of Chiropractic Examiners in 2010. The unique way in which the Cox technique uses a gentle approach to chiropractic adjustments is what many chiropractors and patients alike find very appealing. The Cox Technique was developed by Dr. James M. Cox in the early 1960’s in an effort to combine osteopathic principles with chiropractic principles. Just as any other chiropractic technique, it has evolved, improved, and been researched over the years with much success, which is why it is used by many chiropractic providers today.

What is the Cox Flexion Distraction Technique?

            Cox technique, also known as the Cox Flexion Distraction technique, is a hands-on, non-surgical, gentle modality done with the patient lying on a specialty table which permits performance of decompression, adjustment and manipulation, and flexion-distraction. No quick thrusting motion is used with this technique, but instead a low velocity-low amplitude or low-force thrust producing pain-free results. It is a non-force adjustment to allow the spine to heal naturally for quick relief from various pain conditions.

Conditions treated with the Chiropractic Cox technique:

  • Disc herniation

  • Slipped disc

  • Spinal stenosis/stenosis

  • Facet syndrome

  • Ruptured disc

  • Spondylolisthesis

There are an infinite number of conditions that the Cox technique helps to address. There are many benefits to implementing the Cox technique into your chiropractic practice, especially if you have a patient base that is a little more hesitant to try chiropractic treatment or who need a gentler modality.

Chiropractic Cox technique benefits the patient by:

  • Improves posture

  • Increases circulation

  • Boost nerve communication

  • Decrease neck pain and headaches

  • Relieve stiffness

  • Delay or even eliminate need for surgery in some cases

  • Relieve pain and numbness

  • Widen the spinal canal

  • Decrease the pressure within the disc

  • Reduce the pressure on the spinal nerves

  • Improve range of motion

All of the above benefits are reason enough for a patient to come to your practice, but the most important aspect of the Cox technique is that you, as the chiropractic provider, remain in control of the level of force behind the thrust.  With the help of the Cox table, you can allow gravity to do a lot of the adjusting. Not to mention that it will also be easier on your body as the provider. Doing forceful adjustments for a long time, and bending over a patient can be taxing on your own body,

Cox technique allows for the table to take the brunt of the load in performing adjustments. Giving patients an option that is gentle is helpful to reach a larger populous, and bring them the advantages of chiropractic flexion.

Cox Protocol & Other Techniques

            As chiropractic providers, we know that there are many patients who come through our doors who are hesitant or uneasy with trying chiropractic manipulative therapy (CMT) for the first time. Even though CMT is a safe form of chiropractic treatment, those who come into our office in pain don’t always like the thought of being twisted or cracked, but may rather have a subtle stretching, leading to decompression of the spine which is what Cox technique provides. Many neck and back conditions involve compression of the spinal cord or nerves, and Cox works to reduce this compression.

Cox technique separates conditions into 2 different protocol types, and recommends slightly different treatment options for each.

Chiropractic Cox technique patient and treatment protocols:

  • Protocol 1:

    • Patients – these patients have pain that extends below the elbow or below the knee.

    • Treatment – the treatment for these patients is slow, careful, and manual with a bit of flexion (neck or lower back) or long y-axis (neck) until pain is relieved by at least 50%.

  • Protocol 2:

    • Patients – these patients have pain above the elbow or above the knee.

    • Treatment – the treatment for these patients is slow and careful including the introduction of normal ranges of motion to each segment of the spine.

The type of treatment applied is determined by the category of pain that a patient is in. A certified Cox technique provider will use these guidelines to examine and perform the proper adjustment for the patient for pain relief.

Cox Technique Research

Research in support of the Cox technique is becoming larger as the years go on. There are many research studies showing the benefits of Cox technique, especially in relation to disc herniation.

Chiropractic Cox technique research:

  • Chiropractic Management Using Cox Cervical Flexion-Distraction Technique for Disk Herniation – 2011

    • The goal of this case study was to describe chiropractic management of a 64-year-old disc herniation patient with upper left extremity radiating pain using the Cox technique.

    • Treatment included Cox technique protocols to reduce nerve root compression, and aid in pain reduction and functional improvement. The patient was treated for 4 weeks for a total of 10 times.

    • The patient reported being pain free 8 months after the final treatment. This study concluded that the use of Cox technique for the treatment of a patient with disc herniation was successful and lead to a full recovery.

  • Effects of Flexion-Distraction Manipulation Therapy on Pain and Disability Patients with Lumbar Spinal Stenosis – 2015

    • The goal of this study was to review the effects of the Cox technique on pain and disability patients with lumbar spinal stenosis. Thirty patients were divided into either the conservative treatment group or the flexion-distraction (Cox) manipulation group.

    • The conservative treatment group received physical therapy, and the Cox group received both conservative physical therapy and flexion-distraction manipulation therapy. They received treatment 3 times a week for 6 weeks.

    • Researchers concluded that there was an exceptionally larger decrease in pain and disability in the Cox technique group.

  • Innovative Application of Cox Flexion Distraction Decompression to the Knee – 2017

    • The goal of this study was to use the Cox flexion distraction decompression to treat knee pain and osteoarthritis. 25 patients met the criteria for inclusion being treated for knee pain.

    • 3 of the patients presented with knee pain that was less than 3 months in duration (acute), and 18 patients presented with knee pain that persisted for more than 3 months (chronic). This included 2 patients that continued to have knee pain despite having prosthetic replacement surgery.

    • This study concluded that using the Cox technique may offer benefits on patients with knee pain or osteoarthritis. The Cox table “may allow for more standardized and reproducible treatments.”

Although further study is needed in the area of chiropractic techniques, these results of the use of the Cox techniques are very positive and promising.

Should I Become a Cox Provider?

            It is no secret that back pain is the most common complaint that chiropractors hear about each day, and it makes sense since it is the second most common reason patients see their doctor. According to the American Chiropractic Association, as many as 31 million Americans experience back pain. The Cox technique offers a unique treatment compared to other techniques utilized in the chiropractic profession, and that is a gentle and more individualized treatment. When dealing with complex neck or back issues, amongst other conditions, it may be important to be well versed or even certified in a gentler technique, such as Cox to bring versatility and ease into your practice.