Background/Mission of the Cox® Certification Courses

63.7% of chiropractic physicians reported that they practice Cox® Technic according to the National Board of Chiropractic Examiners in 2010. This statistic makes it one of the most popular techniques in chiropractic, one of only four in chiropractic that a majority of chiropractic physicians practice. However, only a few are certified, about 3.4% of 49,100 (by Bureau of Labor Statistics 2008) to 2.3% of 70,000 (by National Board of Chiropractic Examiners 2010 report).

To help physicians be more competent in their practices and patients be more confident in their choices of physicians to visit, the Cox® Certification Program was established in 1991 at the National University of Health Sciences in Lombard (Chicago), Illinois, with Dr. James M. Cox. Chiropractic physicians (and students) may choose to take the certification examination. If passed, they are "Certified".

Certification in Cox® Technic Flexion Distraction and Decompression protocols:
  • Establishes that Cox® certified physicians practice similarly. 
  • Patients may expect similar treatment from Cox® certified doctors, should they be away from home and need care. 
  • Cox® certified physicians are committed to providing the best care using the most current research data and information.
  • They keep in touch with the latest findings by keeping their education and experience current via post-graduate courses or via private study of the latest research and demonstrate their understanding of such via a patient case report publishing.

Cox Seminar group

Benefits of Certification

  • Confidence in caring for the severe and routine low back patients. Don’t fear the antalgic sciatic patient.
  • Inclusion in the Cox® Technic on-line Referral Directory
  • Opportunity to have a personalized page for you and your practice on this website - example / Premium Referral Directory Listing 
  • Prestige of public and professional positioning as the low back doctor or spine physician of choice
  • Refer with confidence to fellow physicians who treat similarly to you.

Research is what will save our profession. ... I feel more equipped to take on patients now than when I graduated Chiropractic school.”  - Dr. Luigi Albano (attendee, Parts I/II Combined Certification Coures, 4/13)

The Process:
The Cox® Certification Course consists of taking (Part I -12hrs and Part II - 18hrs) culminating with the passing of a case report-based written and practical examination.  See below for New Options!
The written and practical exam is offered at Part II only:  
  • Review cases
  • Determine the diagnoses
  • Demonstrate your acuity in treating the cases' patients as a Protocol 1 or a Protocol 2 patient as appropriate.
*You may Take your Part I (12 hours) in 2 ways:
  • Online courses (8hrs) with a hands-on workshop (4hrs)
  • 4 day, all in ONE Certification course (Part I & II 30hrs)...please see below and click links for more information! 
  1. Take 8hrs of Part I Online
  2. Take a 4hr Hands-On Workshop (to complete your Part I)
  3. Then attend the Part II portion of our Certification Course and take the exam
  4. Take 30hrs, Part I and Part II Combined - All in ONE, 4 day Certification Course with exam
You may request a Certificate of Cox® Technic Certification from the NUHS Post Graduate Division, upon passing the Certification Exam.

(Students from schools where a Cox® Technic course is taught by an Active Cox® Certified physician may be exempt from taking Part I -- if they take the Part II course within 2 years from graduation - although taking Part I is highly encouraged.)
Part II must be taken within 2 years of taking Part I (or from graduation if a student per the above description).

Doctors remain listed as ACTIVE for two years. If the doctor does not Re-Certify by the end of the second year, the doctor's name is REMOVED FROM THE REFERRAL DIRECTORY.

  • The physician has taken and passed a practical examination in Cox® Technic Flexion Distraction and Decompression procedures at some point reaching as far back as 1973. But, he/she has not been Re-Certified within the past 2 years.


  • The physician has been Certified for the first time within the past 2 years. 
  • The physician, after being Certified, has either taken a 12 hour Cox Seminar, written a case report, or taken 12 hours of on-line courses with or without a 4 hour Hands-On Workshop, to become Re-Certified within the past 2 years. 

The Referral Directory

Certification in Cox® Technic Flexion Distraction & Decompression Adjustment & Manipulation (aka flexion-distraction) and listing in the Referral Directory is a responsibility as is maintenance of the listings as reliable. A patient seeking a practitioner who does this technique does so in hopes of finding a physician to care for his/her spinal condition with this technique on a flexion-distraction table in a similarly effective application as he or she has previously experienced.

The Re-Certification process enhances Certified Practitioners’ awareness and knowledge of the latest research, clinical outcomes and procedures related to Cox® Technic as well as keeps the Referral Directory reliable.