Cox Flexion Distraction Therapy

As a Chiropractor I have always strived to provide the best care possible to my patients. However, even with my best efforts there has been a small percentage of back pain patients who traditional chiropractic methods have not helped. Research findings show that 95% of spinal care costs are incurred by less than 25% of back pain patients. This group haD been my biggest challenge in practice.  Not one to enjoy failer, I have searched for solutions and it is this search that has led to me to employ Cox-Flexion Distraction Therapy into practice (along with a few other methods).

Many spinal symptoms result from functional problems (such as poor movement patterns, restricted joint motion, weak or poorly conditioned muscles, tight fascia, contracted muscles) associated with lifestyle patterns. These conditions respond well to correcting faulty movement patterns, freeing up stiff joints, conditioning muscles and stretching fascia. At Spine Central we address all these treatment options. However, these options do not address spinal issues where there is direct compression on the nerve such as in cases of disc protrusion or spinal stenosis.

Cox Flexion Distraction Therapy is a technique developed by an American Chiropractor by the name of Dr James Cox. Dr Cox has combined Chiropractic and Osteopathic principles and aligned these principles with scientific study. Dr Cox has been developing and researching spine treatments for over fifty years. His research has not only involved 100’s of case studies but significantly university government funded studies using cadavers to assess the effect of flexion distraction therapy on the spine. In these studies they have found the application of flexion with spinal distraction resulted in:

  • Dropping intradiscal pressure to as low as -192 mmHg (the pressure inside the disc)
  • In cases of disc herniation, this negative pressure within the disc acts to draw the jelly like material known as the nucleus pulposus back into the disc.
  • Intradiscal pressure reduction also aids in the nutrition of the disc by drawing in nutrients required for healing.
  • Reducing intradiscal pressure also increases the disc space height by up to 17% reducing loading on the posterior spinal facet joints
  • Increasing disc height also increases the spinal foramina through which spinal nerves pass from the spinal cord to the body by up to 28%
  • By increasing this area acts to reduce nerve pressure on exiting nerves from the spine that cause arm and leg pain
  • Distraction in combination with flexion/extension/rotation/lateral flexion helps restore normal motion to the spinal joints
  • Improves nerve conduction from the extremities, spinal joints and intervertebral discs to the spinal cord and brain has a sedating and pain relieving capability (afferentation).

Cox Technic is non-surgical, doctor-controlled, hands-on spinal manipulation performed with the patient lying on a specially designed chiropractic instrument. This table permits the effective administration of flexion-distraction and decompression adjustment and manipulation.


The goal of Cox Technic is to help the spinal pain patient go from “pain” to “no pain” as quickly as possible following the “rule of 50%” which governs the Cox Technic System of Spinal Pain Management.

Evidence-based Cox Technic is appropriate for conditions causing low back and leg pain as well as neck and arm pain. It also reduces pain attributable to …

Flexion Distraction is the gentle, safe, controlled treatment for spinal pain relief.

Extensive studies of patients treated with Cox Flexion Therapy have shown the following findings:

  • Flexion distraction for low back pain conditions takes just 12 visits in 29 days average. (1)
  • Flexion distraction for neck pain conditions takes just 13 visits average. (2)
  • These are just averages and will depending on the severity of the injury, age and type of injury.
  • Some back pain and neck pain sufferers find relief in just a visit or two.
  • 91% of patients are satisfied with flexion distraction in 90 days.

Here at Spine Central the use of Flexion- Distraction is a foundation treatment for many spinal conditions and requires the use of the specially designed Flexion-Distraction table. The table allows multiple movement directions of the spine in an unloaded state manner with varying degrees of decompression.


  1. Gudavalli, M.R., Cambron, J.A., McGregor, M., Jedlicka, J., Keenum, M., Ghanayem, A.J. and Patwardhan, A.G., 2006. A randomized clinical trial and subgroup analysis to compare flexion–distraction with active exercise for chronic low back pain. European Spine Journal15(7), pp.1070-1082.
  2. Choi, J., Lee, S. and Jeon, C., 2015. Effects of flexion-distraction manipulation therapy on pain and disability in patients with lumbar spinal stenosis. Journal of physical therapy science27(6), pp.1937-1939.