Cox Flexion Distraction Feature Image

Cox Flexion Distraction

Cox Technique is researched and documented spinal manipulation treatment used to relieve lower back pain, neck pain, arm pain, leg pain and a host of other spinal related conditions like disc herniation, and spinal stenosis. This technique was developed by Dr James M. Cox, a Doctor of Chiropractic in America. Dr Cox has been practicing for over 50 years and insists on researching and documenting the science of this non-surgical alternative to back surgery treatment for the relief of back pain.

Dr Cox teaches evidence-based protocols, which are tested in laboratory and clinical trials supported by privately funded, clinician-volunteer, and federally funded research grants in the United States. His objectives are to document the actual effect Cox Technic flexion distraction and decompression has on the spine and its nerves to relieve pain, as well as the amount of time in days and visits it takes to relieve pain.

These protocols are well-defined in medically-published textbooks and peer-reviewed journal articles for other chiropractors and back pain specialists to study. Cox Flexion Distraction is taught by qualified and trained lectures in Universities to students in recognized postgraduate and graduate courses.

Patients seeking relief of their lower back pain and neck pain can be assured Cox Technic flexion distraction protocols are safe, gentle, and well researched.

How it helps

Cox Flexion Distraction is non-surgical, practitioner-controlled, hands-on spinal manipulation. Flexion Distraction is performed with the patient lying on The Cox Table. This specially designed chiropractic treatment table permits the effective administration of flexion-distraction (stretching and relaxing) of the spine.

Flexion distraction and decompression helps relieve spinal pain and return patients to their desired quality of life by increasing the intervertebral disc height. This removes tension on the outer portion of the disc (also known as the annular fibres) and adjacent spinal nerves. It allows the centre of the disc (also known as the nucleus pulposus) to assume its central position within the annular fibres. Flexion Distraction can restore the correct physiological motion to the vertebral joints and assists in correcting spinal alignment which improves your posture. Lastly, it increases space locally around the interverbral foramen (the area where the nerves come out of the spine) and increases circulation, speeding up the healing process and reducing inflammation and pain.

The goal of Cox Technic is to help you go from “pain” to “no pain” as quickly as possible by following the “rule of 50%” which governs the Cox Technic System of Spinal Pain Management. Cox Flexion Distraction Evidence-based Cox Technic is appropriate for conditions causing low back and leg pain, as well as neck and arm pain. It also reduces pain attributable to:

•   Disc herniation

•   A slipped disc

•   A ruptured disc

•   Facet syndrome

•   Stenosis

•   Spondylolisthesis

How fast

There are many different variables to consider when talking about back pain and how quickly it can be relieved, for example: intensity of pain, type of condition, length of time of suffering, etc. Cox Technic protocols outline the answer to “how fast will the pain go away” according to the Rule of 50%:

50% relief is sought within 30 days.

At 50% relief of pain, office visit frequency is reduced by 50%.

example: If a patient is seen 4 times a week, they would then be seen two days per week.

Note: Sometimes 50% relief is reported in a day or two, other times (in more painful conditions) it isn’t reported until weeks two to three of care. The Ashgrove Spinal Centre’s Chiropractor, Dr Bailey, is trained to discuss your specific condition with you and set your initial treatment plan. He will then carefully monitor your progress and continue to adjust your plan to suit your specific requirements.


In a clinical study, published by Dr Cox, the following statistics where discovered. The study had over 1000 participants with varying cases of low back pain. The results are listed below:

Days & Visits to Maximum Improvement
To reach maximum improvement (100% relief of pain, 3 months of care, or return to pre-injury state), the mean outcomes regardless of condition were 29 days and 12 visits.

Some Conditions Require More Care
When specific back pain conditions were taken into account, the outcomes vary. Examples:

L5 disc herniation

86% were maximally improved in less than 3 months

36% needed more than 20 visits

30% needed more than 30 visits

Lumbar Sprain/Strain

91% were maximally improved in less than 3 months

29% needed more than 20 visits
9% needed more than 30 visits

91% of patients found relief of their low back pain and leg pain on average in less than 90 days (meaning the patient is then not considered “chronic”) and 12 visits. This is quite a good non-surgical outcome

* The full article was published in Topics in Clinical Chiropractic 1996; 3(3) and is reprinted in Dr. Cox’s Low Back Pain textbook.

Expected outcome

The Rule of 50% guides the expected outcomes of care under Cox Technic protocols:

  1. 50% relief of pain symptoms subjectively reported (by you) and objectively (by certain tests your chiropractor does) is expected within 30 days.
    • If 50% is not attained, further testing and/or a surgical consultation will be considered.
  2. At 50% relief of pain, which may come in just a visit or two, your office visits will be reduced by 50%.
    • Example: If your treatment plan called for your coming to the office 4 times a week, your visits would be reduced to 2 times per week.

Dr Robert Bailey is a fully qualified and registered health professional who is highly trained to diagnose and/or treat conditions of the neuromuscular skeletal system. Dr Bailey works with many other medical professionals and will always refer to your GP or other Medical Specialist if your condition is not one that is suitable to be treated with chiropractic care or if your condition requires further investigation.

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