What Is Cox Flexion-Distraction?
Cox Flexion-Distraction is a specialized chiropractic technique developed by Dr. James Cox, DC, that uses a segmented treatment table to apply gentle, rhythmic traction to the lumbar and cervical spine. Unlike traditional spinal manipulation, Cox Flexion-Distraction involves no high-velocity thrusting forces — the treatment is slow, controlled, and almost universally tolerated even by patients in significant acute pain.
The technique works by distracting (separating) the vertebral segments while flexing the spine, which creates a decompressive effect on intervertebral discs, nerve roots, and facet joints. This reduction in intradiscal pressure promotes retraction of herniated disc material, reduces nerve root irritation, and restores normal joint mobility.
How It Works: The Mechanics
The Cox table has a movable lower section that the clinician controls with one hand while applying a light contact to the spine with the other. As the table section moves, it creates flexion and lateral flexion through the lumbar segments in a pumping rhythm. Studies using discometry have shown that Cox Flexion-Distraction reduces intradiscal pressure by as much as -192 mmHg — a significant decompressive effect that helps herniated nucleus pulposus material retract away from the nerve root.
Conditions It Treats
- Lumbar disc herniation — one of the most evidence-supported applications
- Sciatica — radiating leg pain from L4-S1 nerve root compression
- Lumbar facet syndrome — painful facet joint arthritis
- Spinal stenosis — narrowing of the spinal canal
- Degenerative disc disease
- Spondylolisthesis — vertebral slippage
- Cervical disc herniation — with appropriate cervical table positioning
- Acute back pain — even severe cases that cannot tolerate manipulation
Good news for surgery-averse patients: Research by Dr. Cox himself shows that approximately 90% of lumbar disc herniation patients treated with Cox Flexion-Distraction achieve satisfactory improvement, avoiding surgery.
What to Expect During Treatment
You lie face-down on the Cox table, fully clothed. The lower portion of the table moves as the doctor applies a light contact to the affected spinal segment. The motion is gentle and rhythmic — most patients find it relaxing rather than uncomfortable. Each session lasts 15–20 minutes. Acute conditions typically respond within 6–12 sessions; chronic conditions may require longer care.
Is It Right for You?
Cox Flexion-Distraction is appropriate for virtually all patients with lumbar disc or nerve root conditions, including those who have not responded to standard manipulation. It is particularly well-suited for:
- Patients with severe acute disc herniation who cannot tolerate traditional manipulation
- Older patients with degenerative changes and spinal stenosis
- Post-surgical patients with residual disc disease
- Patients who have been told they need spinal surgery but want to try conservative care first
At Pittsburgh Physical Medicine, Dr. Foltz and Dr. O'Mara are trained in Cox Flexion-Distraction and incorporate it as part of our comprehensive spine care program.
Suffering from Cox Flexion-Distraction?
Our team at Pittsburgh Physical Medicine treats this condition with chiropractic care, physical therapy, and soft tissue techniques — under one roof in East Liberty, Pittsburgh.
Book an Appointment →