Validity and Reliability of Cox Technic

02/18/2025

Validity and Reliability of Cox® Technic Flexion Distraction Decompression (CTFDD) 

aka low velocity low amplitude (lvla), low velocity variable amplitude (lvva), flexion distraction, FD, Cox Technic
 
Reliability/Validity - Reliability is about the consistency of a technique, the extent to which it can be reproduced similarly by various practitioners (chiropractors in this case), and validity is about the accuracy of a technique, the extent to which it produces its desired effect.
 
Clinical, biomechanical, and biochemical research continues to reveal important findings regarding CTFDD treatment. The validity of Cox Technic Flexion Distraction Decompression (CTFDD) spinal manipulation has support via studies that have shown notable reductions in intradiscal pressure, changes in spinal reflex excitability, and improvements in vertebral motion, which lead to increased disc space height, area, and width, as well as enhanced spinal mobility. Additional findings include advancements in intervertebral disc spectral features observed through magnetic spectroscopy, demonstrating a reduction in biochemical pain markers and an increase in glycoprotein production. Furthermore, recent data highlight the forces applied during CTFDD treatment and report a significant decrease in opioid usage among patients with failed back surgical syndrome undergoing this therapy. (1-8) The reliability of CTFDD has been supported by numerous case reports, case series, and a randomized clinical trial, demonstrating its effectiveness across a range of spinal conditions. These include disc herniation, spondylolisthesis, failed back surgical syndrome, spinal stenosis, chronic low back pain, and radiculopathy. (9-20)
 
 

References (and more at this link):

  1. Maruti R. Gudavalli, Gregory D. Cramer, and Avinash G. Patwardhan. Changes in Intradiscal Pressure During Flexion-Distraction Type of Chiropractic Procedure: A Pilot Cadaveric Study. Integrative Medicine Reports. Nov 2022.209-214.
  2. Bulbulian R, Burke J, Dishman JD : Spinal reflex excitability changes after lumbar spine passive flexion mobilization. Journal of Manipulative and Physiological Therapeutics 2002;  (Vol. 25, Issue 8, Pages 526532 
  3. Maruti R. Gudavalli, Gregory D. Cramer, and Avinash G. Patwardhan. Intervertebral Movements and Changes in Intervertebral Foraminal Morphology in the Lumbar Spine During a Chiropractic Procedure: A Cadaveric Study. Integrative Medicine Reports. Jan 2023.7-13.http://doi.org/10.1089/imr.2022.0022
  4. Pi T, Chung Y: Immediate Effect of Flexion-Distraction Spinal Manipulation on Intervertebral Height, Pain, and Spine Mobility in Patients with Lumbar Degenerative Disc Disease. Phys Ther Rehabil Sci 2021;10:235-43
  5. Choi J, Hwangbo G, Park J, Lee S. The Effects of Manual Therapy Using Joint Mobilization and Flexion distraction Techniques on Chronic Low Back Pain and Disc Heights. J Phys Ther Sci. 2014 Aug;26(8):125962. doi: 10.1589/jpts.26.1259. Epub 2014 Aug 30. 
  6. Siciliano TB, Gudavalli MR, Kruse R. Spinal manipulation and mobilization forces delivered treating sciatica: a case report. Frontiers in Integrative Neuroscience. 07 July 2024; 18. https://doi.org/10.3389/fnint.2024.1356564  
  7. Billham J F, Shi D, Evans Roland E, et al. (October 23, 2024) Intervertebral Disc Magnetic Resonance Spectroscopy Changes After Spinal Manipulative Therapy for Lumbar Discogenic Pain. Cureus 16(10): e72225. doi:10.7759/cureus.72225
  8. Kruse R, Gudavalli MR, Rogers C. Opioid Use Reduction in Failed Back Surgery Syndrome Patients at Three Months Utilizing Manual Spinal Decompression Manipulation. J of the International Academy of Neuromusculoskeletal Medicine. 2023; 20(2): Open Access.  https://ianmmedicine.org/wpcontent/uploads/2023/08/Kruse.pdf 
  9. Rogers C, Elchert C, Hackney M: Chiropractic Management of a 67‐Year-old Veteran With Chronic Low Back Pain Utilizing Low‐Velocity Flexion‐Distraction: A Case Report. J Chiro Med 2023; in press April 27, 2023; https://doi.org/10.1016/j.jcm.2023.03.002
  10. Gudavalli MR, Olding K, Joachim G, Cox JM: Chiropractic Distraction Spinal Manipulation On Postsurgical Continued Low Back And Radicular Pain Patients:  A Retrospective Case Series. Journal Of Chiropractic Medicine 2016; 15(2):121‐128 
  11. Kruse R, Cambron J: Chiropractic Management of Postsurgical Lumbar Spine Pain: A Retrospective Study of 32 Cases. J of Manipulative and Physiological Therapeutics 2011; 34(6):408‐412 
  12. Smith D, Olding K. Malaya C, McCarty M, Haworth J, Pohlman K: The Influence Of Spinal Manipulation On Patients With Lumbar Spinal Stenosis: A Pilot Study. J of Bodywork & Movement Therapies. Accepted for publication May 15, 2022. 
  13. Siciliano T, Rogers C, Kruse R. Management Of Chronic Low Back Pain In An 80‐Year Old Female Utilizing Modified Sidelying Cox Technic Flexion Distraction Decompression: A Case Report. Journal Of Contemporary Chiropractic, Vol. 4, No. 1, Mar. 2021, Pp. 35‐39, 
  14. Stuber K, Sajko S, Kristmanson K: Chiropractic treatment of lumbar spinal stenosis: a review of the literature. J Chiro Med 2009; 8(2):77–85. 
  15. Bergmann TF, Jongeward BV: Manipulative therapy in lower back pain with leg pain and neurological deficit. J Of Manipulative and Physiological Therapeutics 1998; 21(4):288‐294 
  16. Cox, JM, Feller JA, Cox JA: Distraction Chiropractic Adjusting: Clinical Application, Treatment Algorithms, and Clinical Outcomes of 1000 Cases Studied. Topics in Clinical Chiropractic 1996; (3)3:45-59, 79-81
  17. Murphy D et al: Nonsurgical approach to the management of patients with lumbar radiculopathy secondary to herniated disk: a prospective observational cohort study with follow-up. Journal of Manipulative and Physiological Therapeutics 2009; 32(9):723-33
  18. Gudavalli R, Cambron JA, McGregor M et al: A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain. European Spine Journal 2006; 15: 1070-1082
  19. Cambron GA, Gudavalli MR, McGregor M et al: Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain. Osteopathy and Chiropractic 2006; 14:19
  20. Cambron GA, Gudavalli MR, Hedecker D et al: One-Year Follow-Up of a Randomized Clinical Trial Comparing Flexion Distraction with an Exercise Program for Chronic Low-Back Pain. J of Alternative and Complementary Medicine 2006; 12(7): 659-668

 



< view all news