Tom Bergmann, DC, editor of Chiropractic Technique, wrote that of adjustive techniques utilizing manual forces on short and/or long levers "only Cox® flexion-distraction technique...has been described in a reviewed text and a number of well-respected, peer-reviewed journals." The Mercy Center Consensus Conference on Chiropractic Practice determined that "flexion-distraction is a standard, widely taught procedure. There is a great deal of supportable and reasonable mechanical and physiologic rationalein the literature for the appropriate use of these procedures for the care of patients with neuro-musculoskeletal problems." This is rated as an "Established" technique, one of only two techniques in chiropractic with this rating.
The 1999 National Board of Chiropractic Examiners found that Cox® Distraction Manipulation is the third most popular technique in chiropractic, 58% of chiropractors reporting that they use this technique.
The 2001 article by Robert Cooperstein et al in the Journal of Manipulative and Physiological Therapeutics reports that flexion-distraction is the second most studied chiropractic adjustive procedure.