Cervical Spine - Clinical Outcomes

Cox® Technic Flexion Distraction and Decompression for the cervical spine to relieve neck pain and related arm pain is the younger protocol having its formal introduction in 1991. Yet its application is much in demand as we have grown into an era of computers, car crashes, stress, etc. As with the lumbar spine, publications by private practitioners documenting the effectiveness of Cox® Technic for specific cervical spine conditions like neck pain, arm pain, radiculopathy, Klippel Feil, stenosis, etc., started the documentation of the technique's effectiveness. The Health Resources and Services Administration chiropractic research grant program had already funded a couple of lumbar spine flexion distraction studies in the biomechanics and clinical outcomes and appreciated the interdisciplinary work on those studies before it then funded the larger scale randomized clinical trial comparing FD to medical conservative care. Documentation of the effectiveness of Cox® Technic continues today with both clinician and researcher publications.
Schliesser JS, Kruse RA, Fleming Fallon L: Cervical radiculopathy treated with chiropractic flexion distraction manipulation: a retrospective study in a private practice setting. Journal of Manipulative and Physiological Therapeutics 2003;26(9):592-596
  • 39 patients with cervical radiculopathy were treated by a single practitioner with F/D and some form of adjunctive physical medicine modality.
  • statistically significant reduction in pain
    • VAS scores dropped from mean of 50.1 to 8.7 for a 41.4 drop in pain score
  • mean number of treatments
    • 13.2 ± 8.2, with a range of 6 to 37


Kruse RA, Imbarlina F, DeBono VF: Treatment of cervical radiculopathy with flexion distraction. J Manipulative Physiological Therapeutics 2001;24(3):206-209

  • 51 y/o woman with 2 years of left arm pain
  • MRI = C5-C6 herniated disc
  • P.T., home traction, exercise, medication no help
  • F/D technic given with relief after first treatment
  • 3 visits a week for 2 weeks, then every 2 weeks for total of 24 visits over 6 months
  • 1 year follow up – symptom free and normal neurological status


Kruse RA, Gregerson D: Cervical Spinal stenosis resulting in radiculopathy treated with flexion distraction manipulation: A case study. J of the Neuromusculoskeletal System 2002;10(4):141-7

  • 60 year old male with cervical stenosis and radiculopathy
  • Weakness and pain in left shoulder and arm
  • Previous medication, PT, MRI
  • C4-C5, C5-C6, C6-C7 central and lateral recess stenosis
  • Hyper-reflexia, hypesthesia C6 dermatome, Positive Hoffman reflex
  • Cox® decompression distraction manipulation – Protocol I
  • Five weeks, 3 treatments a week, total of 19 visits over 5 months
  • At 8 weeks – Normal reflexes and sensation, negative Hoffman reflex, VAS improved from 7 to 2, no arm or neck pain


Gudavalli, S, Kruse, RA. Foraminal stenosis with radiculopathy from a cervical disc herniation in a 33 year old man treated with flexion distraction decompression manipulation. J Manipulative Physiological Therapeutics 2008;31(5):376-80

  • Cox® flexion distraction decompression manipulation and physiotherapy modalities showed good subjective and objective clinical outcomes for a C6-C7 disc herniation causing severe neck and upper back pain and radiating left arm pain to the fingers in a 33 year old man.
  • The C6-C7 herniated disc was MRI confirmed. It caused severe foraminal stenosis.
  • The patient was treated 15 times over a 10 week period.
  • At 2 year follow-up he was stable.


Kruse RA, Schliesser J, DeBono VF: Klippel-Feil syndrome with radiculopathy. Chiropractic management utilizing flexion-distraction technique: a case report. J of Neuromusculoskeletal System 8(4):124

  • 34 year old female with severe neck, shoulder, arm pain of months’ duration
  • C2-C3 block vertebrae with occipitalization of atlas and degenerated discs
  • Flexion-Distraction manipulation gave complete resolution of symptoms after 8 treatments over 2 months

  • C6/7 disc herniation with foraminal narrowing
  • C3/4 disc degeneration
  • 10 treatments in 4 weeks
  • painfree and fully functional at 8 months 
Patient case outcomes from podcasts...


For a complete list of publications on Cox® Technic, click here.

For information on federally funded studies - description, status, funding - click here.