Flexion Distraction Discussion

Thank you for posting this article and opening the discussion of the protocols for flexion distraction as well as the research-documented clinical outcomes of its proper application. Ms. Beychok pointed out correctly that tolerance testing is of utmost importance in the application of Cox® Technic flexion distraction protocols. It is well documented in the textbook (Low Back Pain by Dr. James Cox for Lippincott Williams and Wilkins) as well as the notes from Cox®  training workshops, webinars, and seminars, all based on the protocols defined in the various biomechanical and clinical trials as well as private practitioner data collection studies.

As a brief summary, the lumbar spine biomechanical outcomes (HRSA grant) found a reduction in intradiscal pressures to as low as -192 mm Hg and intervertebral space widening by 28%. The lumbar spine comparison study (HRSA) between flexion distraction and medical conservative (active exercise) care showed that flexion distraction provided statistically significantly more relief for chronic/mild, chronic/severe and radiculopathy patients. The flexion distraction patients reported fewer healthcare visits needed in the year following the study and flexion distraction was found to be more effective in reducing pain for 1 year as well. In the recently completed cervical spine biomechanical study (NIH), disc pressures in the cervical spine also dropped. The 1000 cases study revealed the number of days and visits those patients required to attain maximum improvement. These are documented by condition (ex: L5 disc herniation, spondylolisthesis, etc.). Proudly, many of these studies have gathered together chiropractic and medical researchers, chiropractic and medical physicians, chiropractic and medical facilities. All benefit from exposure to one another’s functions. NUHS, Palmer, NYCC, Loyola Stritch School of Medicine, Hines VA Hospital, University of Illinois, University of Iowa, Auburn University and more have contributed talent to these studies.

Now, many clinical case reports have been published about the efficacy of Cox® Technic flexion distraction on a case by case basis for lumbar spine conditions and cervical spine conditions as well as an overview basis of several cases, combined with therapies and applied alone, combined with other chiropractic protocols and alone.

Cox® Technic flexion distraction has been available to chiropractic physicians for over 40 years as Dr. James Cox, the developer of the protocols and enthusiastic force behind their scientific study and documentation, started teaching them in the late 1960s and early 1970s. Today, there is a team of workshop and seminar instructors ready to share the spine research as well as treatment protocols. Automated flexion distraction protocols have not been researched or documented for application. Cox® Technic flexion distraction is manually applied as Protocol I or Protocol II depending on the extent of patient pain. Long-y-axis assisted application is available as well for patients who have attained at least 50% relief of their pain. Disc and non-disc conditions have the similar goals of care.

The invitation by Ms. Beychok for more research support and documentation of flexion distraction is one that is called for across all of chiropractic and its techniques, and Cox® Technic practitioners, researchers, and supporters welcome the opportunities to participate in such research and further document its effectiveness for disc herniation treatment (lumbar and cervical spines) as well as for relief of pain due to other non-discogenic conditions like spondylolisthesis and tropism and Bertolotti’s Syndrome and degenerative scoliosis and spinal stenosis as well as spinal cysts like the synovial cyst and pregnancy-related back pain. Current studies and papers underway include a cervical spine clinical outcome study at Palmer, a clinician data collection study of post-surgical continued patients (FBSS) paper is nearly ready for journal submission, and a report on spinal stenosis treatment is nearing writing completion. Sometimes an article is published that we don’t know about ahead a time which is a pleasant surprise.

Cox Technic flexion distraction supports the physicians who strive to be the back pain specialists in their area and gladly shares its protocols and research to support their efforts.

For more information, please click here for a (nearly complete) list of articles about Cox® Technic flexion distraction that have thus far been published, or please visit www.coxtechnic.com.

Response by Dr. James Cox:

Flexion distraction spinal manipulation is discussed by Tina Beychok. As developer of the procedure, it is interesting to see the reactions, such as this, to it. 

Tina says flexion distraction is beneficial in acute low back pain. What about chronic low back pain? If F/D can aid in acute conditions such as disc herniation and spinal stenosis, it makes long term care far more effective. F/D is used in all phases of back pain care – acute to chronic.

Positive and negative responses to F/D are mentioned. Please reference these for discussion. Also the suggestion is raised that more research is needed in F/D. That is true in all of spinal manipulation. It is mentioned that there is little negative or opposing literature to F/D. A good thing. Could it be beneficial and not hurt the patient? Ndetan published that Cox F/D showed the lowest adverse reactions to spinal manipulation for both patient and doctor of all technics studies, including diversified, Thompson, and Gonstead.

Research is vital. Both the Health Services and Research Administration of HHS and the National Institutes of Health have funded research on the biomechanics, treatment, and clinical outcomes of flexion distraction including randomized clinical trials. Reading them may be positive for our profession.