Cox Technic Flexion Distraction Decompression Spinal Manipulation is evidence-based spinal care, a form of spinal manipulation in which the human spine is placed in distraction (a type of measured controlled traction of the spine) delivered on a specialized spinal manipulation instrument. The Cox Table is the well-designed instrument of choice.

Five specific changes in spine mechanics occur in the intervertebral disc and nerve openings with this procedure (1):

1. The height of the intervertebral disc is increased.
2. The size of the nerve opening which is called the intervertebral foramen is increased up to 28% in area.
3. The pressure within the intervertebral disc which is created by the fluid within the disc is reduced from a positive pressure to a negative pressure gradient. This aids in dropping the pressure on the pain sensitive nerves within the disc and the pressure on the nerve which lies behind the disc which causes sciatic or leg pain when compressed over 20 mm of mercury pressure.
4. The movements of the spine are restored. A specific spinal vertebral level (consisting of the intervertebral disc and the moveable joints lying behind the disc) is placing into its normal physiological ranges of motion. Remember that loss of spinal mobility is a part of back pain whether it be acute or chronic. Restoring normal spinal mobility offers improved activities of daily living and diminishing spinal stress that causes back pain.
5. Nervous system tracts of nerves from the spine to the human brain are stimulated when spinal manipulation is administered. These nerve tracts respond to touch, motion, temperature, and pressure to initiate nerve reflexes that relieve pain and allow for normal spinal motion. Such nerve tracts can also affect balance and equilibrium that are so often affected with spinal pain.

The goal of Cox® distraction spinal manipulation is summarized as follows: Attain and maintain physiological range of spine motion with the greatest relief of pain. It is also vital to note that some spinal conditions are not cured, that is to say all the pain is relieved and the person can do any activity without pain recurrence. NO, some spinal conditions that are congenital (born with) or acquired from injury or degenerative spine changes are controlled not cured. In such cases it is important that the patient follow the training given by the chiropractor concerning proper ergonomics (how to move, bend, lift, twist the spine) to avoid pain, perform the specific exercise program developed for your spine condition, and in many cases have dedicated times for undergoing Cox® distraction spinal manipulation so as to maintain relief. Cox Flexion Distraction may well be a beneficial alternative to back surgery for back pain patients.

Respectively submitted,

James M. Cox, DC, DACBR

A new video with snippets from Cox Seminars shares the content and intent of Cox Seminars for back pain specialists. Chiropractic physicians will appreciate the cutting edge information and research and applicability of the course content. Lead by experienced chiropractic physicians whose clinical practices involve the use of Cox Technic for neck pain and back pain and leg pain and arm pain relief, Cox Seminars are practical and filled with information applicable on Monday morning. Attendees experience flexion distraction protocols as the "doctor" and the "patient" in practical, hands-on sessions.  Check out the video. Check out the calendar of courses. Choose a course, and join us for a weekend to enhance your clinical practice enthusiasm as well as your enthusiasm for chiropractic!

"This program includes excellent use of evidence to not justify but to determine procedures to achieve the most effective, safest clinical outcomes possible." – Chelsea Drda DC

Click here for the video. 

"If you truly want to know why we treat patients, why this treatment can help patients and how to progress the profession in the future, come to a Cox Seminar." – Vincent Pankonin DC

Contact Cox Technic for more information. 

This inaugural blog on the mechanism, diagnosis and treatment of spine and radicular pain appropriately opens with discussion of the most important element of spine care in the United States and the world for that matter – THE PATIENT.

Do you ever empathize with a person in spine pain who is seeking care – the stressful decisions to be made with sometimes with little knowledge of the problem? Can you blame him or her? Fact-filled alternatives are missing for such hard decisions. Just consider the following truths about spine care today.

SURGERY CONSIDERATION

Surgery yields varying feelings and opinions by patients and for good reason. Consider the following scientific papers on surgeons’ disagreement on spine surgery. The better trained the surgeon the less spine surgery is performed. More surgery is done by private clinics and 4 times less in academic and teaching institutions. (1) Degenerative lumbar scoliosis has variability in both non-operative and operative management. The appropriateness of surgery and specific surgical procedures have not been defined for this important pathology of the aging spine. (2) Such statistics support the patient’s plight in treatment decision making.

PATIENT CHARACTERISTICS IN CHOOSING CHIROPRACTIC CARE

Patients seeking chiropractic care are known to be intelligent seekers of their best care. In a study of non-Hispanic black patients who went to chiropractors, they tended to be female, be older, be college educated, be employed, and have a positive viewpoint on their interactions with their chiropractor. (3) Other studies have documented this as well. So successful is spinal manipulation that physical therapists now practice all forms of chiropractic manipulation from high velocity to Cox® Technic flexion distraction and publish peer reviewed papers on it. In Germany, study of manual therapy by general medical doctors for nonspecific low back pain benefits is to be conducted. (4)

COX® TECHNIC FLEXION DISTRACTION AND DECOMPRESSION SPINAL MANIPULATION

Cox® Technic flexion distraction and decompression spinal manipulation is a popular and growing form of spine care for people suffering from disc degeneration, disc herniation and spinal stenosis that cause leg pain called sciatica and arm pain and other spinal conditions such as spondylolisthesis, transitional segments, scoliosis, facet disease, pregnancy, spondylolysis, osteoporosis, arthritis, and so many more diagnoses.

Spinal mobilizations - low velocity passive oscillatory movements such as Cox® flexion distraction decompression spinal manipulation - are reported to reduce spinal pain in some patient subgroups by an endogenous pain inhibition system mediated by the central nervous system. Cox® flexion distraction low velocity low amplitude spinal manipulation shows short-term, remote antinociceptive effect similar to clinical findings in a rat study. (5,6) This author financed the building of a Cox® spinal manipulation instrument that is 1/12 the size of a regular Cox® manipulation instrument. It was built at the University of Iowa with input from Ram Gudavalli, PhD, and is used for rat experimentation as described here. Quite exciting to see how many years of study and research can lead to new approaches.

LITERATURE STATISTICS ON BENEFITS OF SPINAL MANIPULATION COMPARED TO SURGERY

Favorable outcomes of back pain and radiculopathy are attained in the vast majority of patients under non-operative care. Surgical intervention is reserved for patients who have significant pain that is refractory, non-responsive to at least 6 weeks of conservative care. This author finds this window of time adequate to reverse back and extremity pain in the majority of cases with Cox® Technic Flexion Distraction and Decompression spinal manipulation. Patients who have a severe or progressive motor deficit, or patients who have any symptoms of bowel or bladder dysfunction are surgical candidates but this occurs in a small minority of cases, less than 1% with the condition called cauda equina syndrome. (7)

The Bone And Joint Decade 2000-2010 Task Force On Neck Pain and its associated disorders searched 5 databases from 2000 to 2014 finding 8551 citations for study. New evidence suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counterstrain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, ultrasound) are not effective and should not be used to manage neck pain. (8)

DEPRESSION IN CHRONIC LOW BACK PAIN PATIENTS

Chronic low back pain is known to cause anxiety and depression for the patient. Can you blame them? Suffering without relief will make anyone anxious. The complex, bidirectional correlation between chronic low back pain and generalized anxiety disorder, common in primary care, can increase the risk of inadequate treatment. (9) Chronic low back pain participants have lower working memory performance and higher pain catastrophizing  compared to pain-free controls.  (10) This author finds patient confidence and understanding of their condition reduces depression; some patients state their relief to now just understand their condition as it had not been explained to them by any prior healthcare consultant, doctor or surgeon in an understandable language.

CONSIDERATION OF HIGH VELOCITY LOW AMPLITUDE VERSUS LOW VELOCITY VARIABLE AMPLITUDE SPINE MANIPULATION BY SPINE CONDITIONS

Classic side posture high velocity low amplitude spinal manipulation was compared to Cox® flexion distraction non thrust spinal manipulation in a study of 192 participants, mean age 40 years, 54% male with subacute and chronic low back pain. Similar effects in short-term low back pain improvement for both were superior to a wait list control. (11) This author notes the mean age of the 192 patients was 40, and Cox states that the older the patient the more reliable is flexion distraction decompression spinal manipulation due to degenerative spine disease and inability of the patient to tolerate high velocity thrust adjustment. Also no radicular patients were part of this study and radicular patients, show Cox® flexion distraction decompression non thrust adjusting has great superiority because side posture thrust adjusting is not well tolerated and is shown to aggravate disc herniation and spinal stenosis. Here is seen the erudite decision making of the chiropractor in determining spinal manipulation use and application. (11)

CONCLUDING PATIENT INTERESTS IN CHIROPRACTIC MANIPULATION

Lastly, evidence based clinical practice is three entities:

1. research
2. clinical expertise
3. patient satisfaction and preference.

Chiropractic must persist in the research for documentation of its contribution to the epidemic problem of spine pain. Dissemination of this research to the chiropractic field doctor is an absolute necessity so he or she can implement the principles taught. Patient satisfaction with chiropractic research and clinical superiority will maintain the leadership role for chiropractic in spine care management.

Cox® Technic flexion distraction and decompression spinal manipulation has published scientific papers on the biomechanics and clinical outcomes of the technic for spine and radicular pain. Standards of care for cervical, thoracic and lumbar spine spinal manipulation are published as well as tutorials in the application of the flexion distraction and decompression technic. For full study of the work, go to the website www.coxtechnic.com. There you will find copies of the research papers, descriptions of Protocol I and II applications of the technic, clinical outcome studies, and case presentations of spinal conditions such as spinal stenosis, intervertebral disc herniation, spondylolisthesis, Bertolotti’s syndrome, facet syndrome, synovial cyst, Tarlov cyst, scoliosis, and subluxation. Cox Technic Complete® program websites like this one more fully go into the examination, physical, orthopedic, neurological and diagnostic imaging of spine pain patients which are shown in video for patients to study and then arrange care with the physician. These studies are designed to lead to the most prudent diagnosis of the patient’s condition. Study opportunities with Dr. Cox and other certified chiropractors for those interested in the procedures are given. Certification following 32 hours of hands on and didactic study is available for international referral directory opportunities.

Clinical validity of Cox® Technic is shown in the just published Clinical Practice Guideline: Chiropractic Care for Low Back Pain in the Journal of Manipulative and Physiological Therapeutics published online January 19, 2016. (12)  It shares that “currently, the most robust literature regarding manual therapy for low back pain is based primarily on high-velocity, low-amplitude (HVLA) techniques, and mobilization (such as flexion-distraction) therefore, in the absence of contraindications, these methods are generally recommended.” (12) This validation of Cox® flexion distraction decompression spinal manipulation is necessary for developing chiropractic’s role in spine treatment.

It is the leadership of superior spinal manipulation that will ultimately draw the public’s acceptance. It is my opinion that our path of research, clinical application and patient preference is large in the future of expanded chiropractic medicine.

Thank you for studying with me.

Respectfully submitted,

James M. Cox, DC, DACBR, FICC, Hon.D.Litt., FACO(H)

1/26/16 

Join Dr. James Cox for this special hands-on demonstration webinar of live treatment protocol demonstration as the protocols relate to the ICD-10 code classifications. You may also ask questions throughout!

October 28, 2015

12:30pm EST

Wednesday

Register now! 

DC 1: "Flexion distraction. Yeah, I do that. It works great for low back pain and disc herniations."

DC 2: "Have you used flexion distraction for neck pain and arm pain? Cervical spine conditions?"

DC 1: "No. I didn't know it was for that."

DC 2: "The research is amazing, and the technique is so gentle!

Yes, Cox Technic flexion distraction for cervical spine conditions was introduced in 1991 (thanks to Dr. Cox's wife whose C5-6 disc herniation made him venture beyond his beloved L5-S1!). Since then, clinical cases have been published, federally funded studies (both clinical comparison and biomechanical) have been completed, and colleagues have shared their treatment skills with each other formally in workshops and informally in clinics. The Cox Table has also evolved from unwieldy and awkward occipital cups/ropes to simpler long-y axis and straps.

Check out just what Cox Technic flexion distraction offers cervical spine pain patients and their neck pain and arm pain! Then register for a seminar or workshop to learn more.

Certified Cox Technic physician and instructor, Dr. George Joachim, publishes a case report with the Journal of Chiropractic Medicine on his care of a patient with a post surgical C6-C7 spondylotic myelopathy and lumbar radiculopathy occurring together in one patient. Also, his being a chiropractic rehabilitation diplomate, he shares how rehabilitation worked hand-in-hand in this case to help relieve this patient. 

Read the full case study. Share! 

Dr. James Cox well developed Cox® Technic's reputation for managing low back pain and sciatica. Most everyone who uses it says they'd turn to flexion distraction to manage low back pain and leg pain and disc herniation. But the evolution of Cox Technic to caring for the other regions of the spine has grown! Flexion Distraction Cox® Technic for cervical spine disc herniations and disc degeneration and headache and arm pain is well researched biomechanically and clinically. Its research progresses with federal funding via NIH and HRSA chiropractic research grants at NUHS and Palmer Research with Loyola Stritch School of Medicine/Hines VA Hospital and others like University of Iowa and University of Illinois. It's so exciting!

Check out this video that just shows snippets of lumbar spine flexion distraction application (It will look so familiar!) as well as cervical spine treatment (on The Cox8 Table) and side-lying treatment for pregnant patients (so comfortable and effective!) as well as patients who are in too much pain to  lie on their stomaches. 

Cox Technic is most effective biomechanically and clinically for lumbar spine back pain conditions. Check out what it offers the cervical spine related neck and arm pain conditions, the "newest" application of Cox Technic since 1991. Check out this video.

Dr. James Cox had the privilege to present to the 700+ attendees at the ANJC Fall Summit in East Brunswick NJ this past weekend. As he always does, he passionately shares his love of chiropractic and of the research and science behind its art of healing and pain relief. He loves to share his clinical experience over teh past 51 years. At the ANJC, I heard more doctors come up to me and say "I heard your dad / Dr. Cox speak 30 years ago!" While that is awesome, I am so glad they came to hear him again!!! His passion for chiropractic and its science and its art is amazing, and the stories that come after this conversation starter are always interesting. Those are for another blog post...

I have worked with Dad (Dr. Cox) for 22 years. In 22 years, so much has changed and evolved. I was hired to write a newsletter for him and the technique. Today, I get to talk to doctors from around the globe who share their personal patient success stories (which I wish I could get them all to write for me to share with all of you!) and plan training seminars and support our teaching team and coordinate clinicians who want to do research with researchers and connect patients (who are often at the end of their ropes) who need back pain and neck pain relief with Cox Technic certified physicians who can deliver that relief. 

Further, during these 22 years, I have likely sat in over 400 presentations with Dr. Cox and/or other members of our instruction team (Drs. Greenwood, Hazen, Joachim, Kruse, Olding et al). I learn something new at every single course. I hear a new insight or application of a protocol. I hear a new struggle or a new success. I have been on the scene when Dr. Gudavalli has announced reception of a new grant from NIH or HRSA or FCER (when it was in operation) or that a paper about flexion distraction (teaching tools or biomechanical research outcomes or clinical comparison study) is accepted for publication or that he is invited to present flexion distraction to fellow biomechanical engineers and/or chiropractors at conferences in places like Sydney, Dubai, Portugal, California, etc. I am able to watch new doctors to the technique grow in excitement and passion during the course of a seminar. I am honored to hear their stories throughout the course, their personal struggles with back pain and neck pain or those of a loved one, their professional uncertainty as to whether to keep practicing or retire, their journey for finding a better way to help their patients.

What a privilege it's been to be a part of all this excitement that often goes on behind the scenes yet is only known by a few. So thank you to everyone who gives Dr. Cox a second chance - even if it's 30 years later - to share his passion for chiropractic, its science and its art, its research and its clinical application. And I am so glad that you get that chance as he is my dad, and I am so honored to still have him in my life these 30 years, 40 years, almost (!) 50 years. 

I look forward to seeing you at a seminar or lunchtime LIVE webinar or hands-on workshop and hearing your story of hearing Dad teach you 30 years ago (or 2 years ago or 2 months ago!). I am confident you will hear something new to inspire you and your enthusiasm for your chiropractic practice and profession!

- Julie Cox-Cid 

The referral directory of Cox Technic Flexion Distraction physicians has grown. But time passes too quickly, and certified Cox Technic doctors lose touch with us. Each seminar, though, brings new research and new excitement! The research is directly related to flexion distraction or interrelated to the care of the spine. 

So in this crazy-busy world we live, Cox Technic has arranged for some new options for re-certification:

1. write a case report ("old")
2. attend 12 hours of a Cox Seminar (Part I or II or III - NO TEST!) ("old")
3. take and pass the quizzes for 12 ONLINE COURSES (some for CE; some not; some states take online CE; others don't, but we do for re-certification.)  (new!)
4. take and pass the quizzes for 8 ONLINE COURSES plus attend a 4 HOURS HANDS-ON WORKSHOP  (new!) 

Dr. James Cox presented a webinar that included cases from his clinical practice and demonstration of their treatment on The Cox8 Table by Haven Innovation:

• degenerative scoliosis with osteoporosis
• compression fracture care and options
• disc herniation, spianl stenosis
• disc extrusion

It's always a comfort for both the doctor and the back pain patient to see that other doctors and patients have successfully dealt with the same condition or combination of conditions successfully for relief of pain. Dr. Cox shares the history, examination findings, imaging, diagnosis, treatment and ancillary care (exercise, nutrition, belt, electrical stimulation, hot/cold therapy, etc.)

In a practical way, Dr. Cox shows that these cases come into the chiropractor's office seeking relief and can get it.

The recording is now available of this presentation of 4 cases. Click here to register. You will receive personal log-in instructions and codes to watch the recording on your own time, computer and pace.