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. 
  • Allows patients to expect similar treatment from Cox® certified doctors, should they be away from home and need care. 
  • Shows that Cox® certified physicians are committed to providing the best care using the most current research data and information.
  • Allows the expectation that certified doctors 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.
  • May also be acquired for Cervical Spine and Thoracic Spine in addition to Lumbar Spine.
  • To be listed in the referral directory, you must have the LUMBAR SPINE certification completed.

Cox Seminar group

Benefits of the Certification

  • Confidence in caring for the severe and routine low back patients. Don’t fear the antalgic sciatic or radicular 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.
  • 15% discount on future seminars with Cox® Technic!

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 Courses, 4/13)

The Process:
The Cox® Certification Course for Lumbar Spine consists of taking (Part I - 15 hrs and Part II - 15 hrs) culminating with the passing of a case report-based written and practical examination.
The written and practical exam for lumbar spine 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. 
30 hours plus passing the written and practical tests 

  • In response to patient requests for referral to doctors who do cervical spine work and from doctors who want a more advanced study of the cervical spine and the application of Cox® Technic, there is a new course. The inaugural cervical spine certification course was offered in September 2016. It was limited to 30 attendees and taught by 4 instructors with 3 of The Cox8® Tables. One of the Cox8® Tables was specially equipped with force measuring tools. The full weekend was devoted to cervical spine and protocol application with force transducer measurements of the forces as they are applied in addition to the cervical spine research studies related to Cox® Technic for the cervical spine. The anatomy, biomechanics, examination, diagnosis, and patient education of cervical spine conditions was shared. A written and practical test was offered. We will continue to offer this certification course annually. Lumbar spine certified doctors have been introduced to cervical spine protocols in other Cox® Technic courses as they evolved with research study while there was not yet a means developed to certify. Lumbar certified physicians are capable of applying cervical spine protocols and are now offered the opportunity for advanced study of the cervical spine specifically with updated research and technique application of Cox® Technic flexion distraction cervical spinal manipulation. Those doctors who are already lumbar spine certified and then pass the cervical certification exams (written/practical) are indicated with a bullet point next to their names in the referral directory as being "cervical spine certified".
  • Currently, the course is developed for a one weekend attendance of 14 hours.
  • Click here for the schedule .
  • The exams are incorporated into the weekend.
  • Click here for the study guide to the Cox® Technic Cervical Spine Certification Course/Exam
  • This program was initially offered in 2021. 
  • 14 hours
  • "certified" - attending 14 hours and passing both written and practical hands-on exam
  • Once certified in thoracic (and already passed and listed as being lumbar spine certified), thoracic certification status will be added to the referral directory listing. 
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).

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. To be listed in the referral directory, a physician must be certified in lumbar spine.

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, is currently Re-Certified within the past 2 years. 
  • Re-certification status (lumbar) may be attained by taking/certifying with Cervical and/or Thoracic courses. 
    • 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.