Cox Technic: Chiropractic Care After Spine Surgery

Traction vs Flexion Distraction for the spine

The Cox Flexion-Distraction technique is one of my favorite chiropractic techniques.  I have found Cox flexion-distraction technique to be invaluable in treating my patients suffering from herniated or bulged discs and neuropathies.  Using this conservative technique along with physiotherapies, I have found that my patients recover much faster than those who receive traditional chiropractic adjustments or spinal decompression alone.  It’s gentle, safe, and effective and patients love how it makes them feel.  And now, we have research that supports Cox technique even for those who have already had back surgery.

The History of Cox Technic and Post-Surgical Chiropractic Care

Researchers estimate that up to 80% of the population will experience back pain at some point in their lives (1).  The American College of Physicians reports low back pain is one of the most common reasons for physician visits in the United States (2).

Additionally, the American College of Physicians supports the classification and treatment of low back based on many factors discussed here in our Chiropractic Clinical Practice Guidelines blog; most important for the article we’re talking about today is the presence or absence of radicular symptoms.  True radicular low back pain results from a nerve root impingement and can cause lower extremity pain, paresthesia (numbness or burning), or weakness.

More recently, when discussing treatment, conservative treatment options have been recommended as the first line of therapy for radicular low back pain by many trusted sources.  A 2007 clinical practice guideline jointly released by the American Pain Society and American College of Physicians compared surgery with nonsurgical treatment for low back and radicular pain and found that intensive rehabilitation was more effective than lumbar fusion surgery at reducing pain levels. (3)

But what if you’ve already had surgery?

The Star of the Show—Cox Technic

Click here for a demonstration of Cox Flexion-Distraction Technique

As mentioned before, the technique heavily concentrates efforts on using the specialized table.

According to one study, changes within the spine during Cox Technic Flexion Distraction include “decreased intradiscal pressure, increase in intervertebral disc foraminal area, increase in intervertebral disc space height, and increase in physiologic range of motion in the facet joints” (9).  All of these are VERY good things…like anti-aging for the spine.

So, for me, it’s a no-brainer for me to use Cox Flexion-Distraction technique on patients who have already had surgery and are still in pain.  Additionally, Dr. James Cox is not shy about the amount of research completed on the technique as a treatment for many conditions, including pelvic painslipped or ruptured discsspondylolisthesis, and pregnancy-related back pain, to name a few.

The Research Supporting Cox Technic for Post-Surgical Care

Fifteen chiropractors across North America were included in this retrospective case series, which included 69 patients.

There were some exciting findings!  On average, patient data revealed eleven treatments in the case series.  81% of these patients noted large improvements in pain levels by the end of the last chiropractic treatment, with data showing more significant than 50% improvements in pain scores.

Two years of follow-up data, 78%  noted continued improvement in pain levels, which persisted at the same level as post-treatment pain levels.  This enduring improvement is consistent with many previous case studies that previously reported favorable spinal manipulation outcomes to treat post-surgical pain (12-15).

Additionally, none of the patients in any of the reviewed case studies experienced any adverse events from this chiropractic technique.


I don’t know that any post-surgical patient, especially those patients above a certain age, can report complete recovery.  After all, tissues were cut and in most cases, cement or hardware was inserted into the spine.  That said, with more than 78% reporting a 50% level of improvement, it certainly is worth the time and effort to treat these patients to get them the highest level of non-pharmaceutical relief possible.  Additionally, this study limited care to 11 treatments.  Just imagine what additional treatments spread out over time might render?


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