Clinical Trial Outcomes

Cox® Technic clinical trial outcomes are documented. Randomized control trials compared flexion distraction with medical conservative treatment. Low back pain and leg pain patients as well as neck pain and arm pain patients were followed.
The Low Back and Leg Pain Study
European Spine Journal reports on a comparison study of flexion-distraction to medical conservative active-exercise therapy in treating chronic pain patients. Participating, eligible patients were randomized to one of two treatment groups: flexion distraction only or medical conservative (active exercise program) only.
Statistics were gathered on each participant as to their pain's source, duration, symptomatology, etc.
The study revealed chronic low back pain patients, including the more difficult and painful radiculopathy (pain that extends down the leg and/or foot) patients did statistically better with flexion distraction.  
Follow Up Report #1 — “Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain” in Chiropractic and Osteopathy - Click here for the Chiropractic and Osteopathy article 
Physical therapy subjects attended significantly more health care visits in the year following care than those receiving chiropractic care:
  • 38% of flexion distraction patients
  • 54% of physical therapy patients

Follow Up Report #2 — “One-Year Follow-Up of a Randomized Clinical Trial Comparing Flexion-distraction with an Exercise Program for Chronic Low-Back Pain” in Journal of Alternative and Complementary Medicine (full article from  - Click here for the J of Alternative and Complementary Medicine article

  • Flexion distraction chiropractic manipulation was found more effective in reducing pain for 1 year when compared to a form of physical therapy
The Neck Pain and Arm Pain Study
Participating, eligible patients were randomized to one of three treatment groups: flexion distraction only, medical conservative (active exercise program) only, or a combination group of both therapies.
There was a clinically significant difference in the outcomes, but not a statistical difference in the outcomes. As expected, patients receiving the combination of treatments had significant improvement in pain and disability.
This study was presented at the World Federation of Chiropractic, 8th Biennial Conference, Sydney Australia, June 16-18, 2005, by Dr. Ram Gudavalli.
These findings and others are really expanding the teaching of how Cox® Technic for cervical spine is taught and applied clinically! 
MORE publications of study outcomes leading to more clinical outcomes research studies: 
Gudavalli R, Potluri T, Caranandang G, Havey R, Vornov L, Cox J, Rowell R , Kruse R, Joachim G, Patwardhan A, Henderson, Goertz: Intradiscal Pressure Changes during Manual Cervical Distraction: A Cadaveric Study. Evidence‐Based Complementary and Alternative Medicine Volume 2013 (2013), Article ID 954134, 10 pages
In this cadaveric study we observed decreases in IDP in the lower cervical spine during a chiropractic MCD procedure in prone position. Based on the maximum number of specimens DC1 has done, moving flexion and traction seem to reduce more IDP, followed by neutral traction, fixed flexion and tractions, and generalized traction. Although the doctors of chiropractic in this study demonstrated good intraclinician reliability, the magnitude of traction forces varied. Larger powered studies should be undertaken to determine if these decreases in IDP are significant depending on the doctor, contact location, and the different traction procedures. Also, the clinical significance of these differences is unknown.
Maruti Ram Gudavalli, PhD, James M. Cox, DC, DACBR: Real‐time force feedback during flexion distraction procedure for low back pain: A pilot study. J Can Chiropr Assoc 2014; 58(2):193‐197
This paper reports on the development of real‐time feedback on the applied forces during the application of the flexion‐distraction procedure. In this pilot study we measured the forces applied by experienced DCs as well as novice DCs in using this procedure. After a brief training with real‐time feedback novice DCs have improved on the magnitude of the applied forces. This real‐time feedback technology is promising to do systematic studies in training DCs during the application of this procedure.
Gudavalli Maruti Ram et al. Clinician proficiency in delivering manual treatment for neck pain within specified force ranges. The Spine Journal , Volume 15 , Issue 4 , 570 ‐ 576 
Clinician proficiency in delivering cervical traction forces within three specified ranges (low force, less than 20 N; medium force, 21–50 N; and high force 51–100 N). Clinicians delivered manual cervical distraction treatments within the prescribed traction force ranges 75% of the time without visual feedback and 97% of the time with visual feedback. This study
demonstrates that doctors of chiropractic can successfully deliver prescribed traction forces while treating neck pain patients, enabling the capability to conduct force‐based dose response clinical studies.
Gudavalli MR, Salsbury SA, Vining RD, Long CR, Corber L, Patwardhan AG, Goertz CM. Development of an attention‐touch control for manual cervical distraction: a pilot randomized clinical trial for patients with neck pain. Trials. 2015 Jun 5;16(1):259. doi: 10.1186/s13063‐015‐0770‐6.
This pilot study demonstrated the feasibility of a clinical trial protocol and the utility of a traction‐based, minimal intervention as an attention‐touch control for future efficacy trials of MCD for patients with neck pain.