Cox Flexion Distraction Technique for Chronic Low Back Pain

The Cox Flexion Distraction Table used in our office

The Cox Flexion Distraction Table used in our office

Typically, when a patient presents with chronic low back pain our integrative therapeutic approach will include: Flexion Distraction Chiropractic Technique, in addition to Medical Acupuncture, rehabilitative exercises, therapeutic injections, physical medicine modalities (ultrasound, electrotherapy etc.),  corrective orthotics, and supportive clinical nutrition.

Flexion Distraction is a well researched Chiropractic Technique, utilizing a specialized table which allows specific mobilization of lumbar or cervical segments in all ranges of motions in conjunction to traction. The following studies demonstrate efficacy of Flexion Distraction chiropractic technique specifically for chronic low back pain. 

One-year follow-up of a randomized clinical trial comparing flexion distraction with an exercise program for chronic low-back pain.


Flexion distraction is a commonly used form of chiropractic care with chiropractor utilization rates of 58%. However, no previous randomized clinical trial has assessed the effectiveness of this form of care. The objective of this investigation was to compare the pain and disability during the year after active care based on treatment group allocation (Flexion Distraction versus Exercise Program).


Randomized clinical trial, follow-up.


Two hundred and thirty-five (235) subjects who were previously randomized to either chiropractic care (flexiondistraction) or physical therapy (exercise program) within a clinical trial.


Subjects were followed for 1 year via mailed questionnaires to assess levels of pain (Visual Analog Scale) and dysfunction (Roland Morris).


Study subjects had a decrease in pain and disability after intervention regardless of which group they attended (p < 0.002), however, during the year after care, subjects who received chiropractic care (flexion distraction therapy) had significantly lower pain scores than subjects who received physical therapy (exercise program) (p = 0.02).


In this first trial on flexion distraction care, flexion distraction was found to be more effective in reducing pain for 1 year when compared to a form of physical therapy.


Improvement in chronic low back pain in an aviation crash survivor with adjacent segment disease following flexion distraction therapy: a case study.

The purpose of this case study is to describe the chiropractic management of chronic low back pain in a patient with adjacent segment disease.


The patient was a 30-year-old man with a 3-year history of chronic nonspecific low back pain following a lumbar disk herniation. Two years before this incident, he had severe lumbar fractures and cauda equina injury due to an aviation accident that required multilevel lumbar fusion surgery, vertebrectomy, and cage reconstruction.


The patient received chiropractic management using Cox Flexion Distraction over a 4-week period. A complete reduction of symptoms to 0/10 on a verbal numerical rating scale was achieved within 4 weeks. At 3 months, the patient was able to work 8 to 9 hours per day in his dental practice with no pain. At 9 months, the patient continued to report a complete reduction of symptoms.


This report describes the successful management of a patient with chronic low back pain associated with adjacent segment disease using Cox Flexion Distraction protocols



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