The Musculoskeletal Biomechanics Research Laboratory at the Loyola University Medical Center, endearingly known as the Windy City Lab, is a site of federally funded research into the biomechanical and clinical studies of flexion-distraction, the technique also known as Cox Technic developed by Dr. James M. Cox. The most current project involves the cervical spine.

At the Windy City Lab, Dr. Avinash G. Patwardhan directs a team of orthopaedic surgeons, engineers, medical researchers and statisticians whose publishing credits include over 100 papers in peer-reviewed journals like Spine, J of Bone and Joint Surgery and the J of Biomechanics. It's quite impressive what this small but mighty team has accomplished.

Dr. Ram Gudavalli, chiropractic researcher from Palmer Research Center and director of the chiropractic clinicians and researchers in this particular project under the direction of Christine Goertz, DC, PhD, works closely with Dr. Patwardhan and his team. Consulting chiropractic clinicians who volunteer their time and travel to this project include

• James M. Cox, DC, DACBR
• George Joachim, DC, DACRB
• Ralph Kruse, DC, DABCO
• Robert Rowell, DC 
• Michael Seidman, DC
• Robert Vining, DC

Each time these researchers and clinicians assemble, excitement abounds at the ability to document what happens during this flexion distraction procedure and at the collaborative efforts of all involved.

Please check out the new website for Loyola's Musculoskeletal Biomechanics Research Laboratory, www.WindyCityLab.com. (Watch the image rotator on the homepage to see if you recognize the research team for this flexion distraction research project!)

Healthcare costs and healthcare demands are all the talk today. Families struggle with healthcare decisions. Politicians and insurance companies are changing the system. Doctors are changing their office protocols to meet the new guidelines. It's hard to keep up for everyone. But for your health, you know that evidence-based protocols are those that you want for your loved ones when they hurt.

Evidence-based protocols come from documentation by clinicians and researchers seeking an answer to help sufferers. When it comes to back pain and lower back pain and neck pain sufferers, Cox Technic strives to provide the evidence-based protocols to make a difference in your lives. Researchers from prestigious universities and research centers (click here to see some of the federally funded projects and who is involved) work together to document the biomechanical (answering the question: what happens during Cox Technic?) and clinical (answering the question: how long does it take to get relief?) of Cox Technic.

Systematically, researchers and clinicians work to define the evidence-based protocols that will relieve back pain and neck pain without surgery or drugs when possible. When a doctor implements evidence-based protocols in his or her clinical practice, patients can feel a bit more assured that there is a level of science and understanding behind those protocols and find reasonable relief of pain. All persons involved know what to expect and what to do when those expectations are not met.

Evidence-based medicine and clinical protocols are the present and the future of healthcare. If something works, it will likely be used and paid for. If it doesn't, it likely won't.

If you suffer with back pain or related extremity pain or neck pain, contact a Cox Technic certified physician to discuss your condition and expectation of relief. Cox Technic treatment protocols are safe and gentle.

If you are physician seeking to implement an evidence-based protocol in your spine pain practice, contact us for information on educational opportunities and training seminars, research, and publications about the evidence-based protocols of Cox Technic.

Have you heard about back pain lately? Friends? Family? Football players? Even politicians are having back pain.

Do you hear about surgery and drugs for back pain relief? Sure. Do you want drugs and surgery for back pain relief? No? Many people are with you there. If surgery can be avoided, many want to do that.

Cox Technic Flexion Distraction and Decompression Spinal Manipulation is a non-surgical back pain relief protocol. Its protocols seek a logical amount of relief in a logical amount of time - 50% relief in 30 days - or further tests or imaging studies or surgical consultations will be arranged. Many people experience  50% even 100% relief of pain in that time of 30 days or less (often less!). When you hurt, any % of pain is a relief.

Cox Technic protocols call for this time to heal as it takes time to drop intradiscal pressures to be below the 20mm that cause symptoms like back pain, leg pain, neck pain, arm pain. Hirschberg wrote that it takes 3 months for a disc to heal. Now he doesn't say that back pain continues through that whole time, but he does write that time of low intradiscal pressures and irritation are needed for back pain relief. Cox Technic respects that. You get pain relief and tips on how to control your back pain condition so your visits are limited.

To see a back pain specialist in your area who offers Cox Technic, please click here for the certified Cox Technic physician referral directory.

Just posted to the website and on YouTube, a new video about Cox Technic Flexion Distraction and Decompression with its developer, Dr. James Cox, is ready. Highlighting a demonstration of the proper protocols of Cox Technic, the video also emphasizes the research, the educational opportunities to learn more about it for doctors and patients, the tools availables to enhance the use of flexion distraction as well as the referral directory to certified Cox Technic physicians.

Check out the video today!

Chiropractic and Back Pain. Chiropractic and Neck Pain. Chiropractic and Spine Pain. The public thinks of chiropractic for back pain by and large.

• 33% of 27,810 people chose chiropractors as their treating physician for low back pain in the National Health and Nutrition Examination Survey. (NHANE) [in Deyo R: Spine 12(3)]
• Spine care delivery is 60% by the medical model and 40% by the chiropractic model. [Saal, Spine 22(14)]
• The total number of US adults who went to a chiropractor increased 57% from 2000-2003. [Davis, Health Svcs Research 45(3)]
• Paid costs for back pain care started with a chiropractor were 40% less than care started with a MD. [Liliedahl, JMPT 33(9)]

Chiropractic is reknown for its back pain care. Chiropractic has evidence-based technique to relieve and control back pain like Cox Technic.

The federally funded studies document Cox Technic Flexion-Distraction and Decompression's biomechanical effects on the spine as well as its clinical outcomes:

• intradiscal pressure drops to as low as -192mm Hg in the lumbar spine
• 28% widening of the area of the intervertebral canal
• flexion distraction is superior in relieving pain due to radiculopathy (leg pain) compared to medical care. (Gudavalli, Euro Sp J 2006) 
• 29 days and  12 visits are the averages for relief of low back pain when not taking into account specific conditions of back pain. [Cox, Topics in Clinical Chiropractic 1996, 3(3)]
• 13.2 treatments is the average for relief of neck pain radiculopathy. [Schliesser, Kruse, JMPT 26(9)]

Back pain and chiropractic fit together. The chiropractic physician is skilled in the diagnosis, examination and treatment of back pain as well as its prevention with nutrition, exercise and lifestyle choices. The chiropractic back pain research continues to evolve in support. Chiropractic physicians train specially to keep abreast of the latest research and Cox Technic treatment application in seminars. Back pain patients find Cox Technic physicians for their back pain relief when they search the referral directory of certified Cox Technic physicians.

Research leads the way in evidence-based care and in Cox Technic.

Contact Cox Technic if you have any questions.

Once every two years, certified chiropractic physicians in Cox Technic are asked to re-certify to remain listed as active in the referral directory. Attending a course or writing a case report for publication is all that is required.

A recent attendee to the Part I Orlando Cox Seminar for re-certification said this:

I am a Cox® certified doctor who has had the new [Cox7] table for over 4 years. I was amazed at how much I learned on improving my technique. If you have not returned to Cox Seminars in a while, you will be impressed by how much you will learn in areas you thought you had mastered. As you all know Dr Jim doesn't not sit still, and the research is constantly getting better.

Cox Technic strives to keep on top of the most recently published medical research as well as keep in tune with the on-going federally funded and other funded research in chiropractic. In just the past 6 weeks, new information from the laboratory has been shared in the lectures. So exciting!

Consider a Cox Technic course soon. The calendar offers courses Part I, II and III around the country: Boston, St. Louis, San Diego, Nashville, Chicago and more.

• Part I - introductory, non-disc related conditions, biomechanics, examination, diagnosis, step-by-step instructor-guided hands-on application
• Part II - continuation of Part I principles with more emphasis on the disc-related conditions, Dr. Gudavalli presents the latest in Cox Technic (flexion-distraction) resesarch and allows time for each participant to use the pressure transducer to measure his or her application of proper pressures
• Part III - Open to anyone to attend, Part III features Cox Technic in the clinic, in the research realm, in the healthcare community. Dr. Cox and Dr. Gudavalli present the latest information and research. Clinical case reports are presented by Dr. Cox as well as certified doctors. Unique practice situations are discussed (interdisciplinary clinics, military integration, hospital integration, etc): how they came about, if the situtations were initiated by the chiropractor or just came about. Interesting and inspiring. 

Well, Dr. Cox and I are venturing into the world of online eCourses. We are not designing these for CE credit, but rather for information and sharing purposes. We can prepare these mini-courses here and you can watch and interact with them wherever you want - home, office, beach.

Course #1 is ready! The first course is on SCOLIOSIS: DEGENERATIVE & IDIOPATHIC. It features clinical patient cases, demonstration of treatment protocols, powerpoint slides of research papers that recently were published discussing scoliosis, its source, treatment and bracing.

It runs about 75 minutes if you take your time in reading the slides and listening to each video segment. I have included links to all the articles Dr. Cox refers in his talk too. You can gather as much information as you want!

We'll work on another one soon. Topic suggestions? We can take those too. Email Julie at info@coxtechnic.com.

Check out our online university at http://coxtechnic.myicourse.com/menu/menu/24537.

June 23, 2010

For release:    Immediately

Contact:          Lori Leipold, Media Relations; Palmer College of Chiropractic; phone (563) 884-5726; fax (563) 884-5225; e-mail lori.leipold@palmer.edu; College website at www.palmer.edu

Palmer College of Chiropractic, Loyola University, Hines VA researchers and Dr. James Cox work together to understand Cox® distraction procedure for neck pain

In a ground-breaking study, medical and chiropractic researchers are joining efforts to study the effects of a form of non-surgical treatment for neck pain, more specifically Cox distraction manipulation. This study is one of three projects that are part of a four-year, $2.8 million grant awarded in 2008 to the Palmer Center for Chiropractic Research (PCCR), headquartered on the Palmer College of Chiropractic campus in Davenport, Iowa. The grant is from the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine to establish a multidisciplinary Developmental Center for Clinical and Translational Science in Chiropractic, and the principal investigator is Christine Goertz, D.C., Ph.D., who also serves as Palmer’s vice chancellor for Research and Health Policy. Co-leaders of the Cox distraction manipulation project are M. Ram Gudavalli, Ph.D., PCCR, and Avinash G. Patwardhan, Ph.D., Loyola University Stritch School of Medicine and Edward Hines Jr. Veterans Affairs Hospital.

This study is in progress and funded through May 30, 2012. It combines the efforts of medical doctors, chiropractors, biomechanists and clinical researchers, in order to document the effects of the Cox distraction chiropractic procedure on neck pain and develop sham and active treatment parameters for conducting clinical studies.

The project, titled Cervical Distraction Sham Development: Translating from Basic to Clinical Studies, consists of three main parts. After completing the pilot studies, the formal basic research study began in March 2010 on the Cox distraction procedure for neck pain at Edward Hines VA Hospital and Loyola University Stritch School of Medicine. This study is a collaborative effort between researchers at these facilities, researchers from Palmer College of Chiropractic, clinicians who perform this technique in their practices, and Dr. James Cox, the originator of the procedure. 

“As the manipulation procedure is performed, we are measuring the variability between four different clinicians trained in this procedure by measuring the loads and the controlled displacements of the table using a basic science approach as well as a clinical approach,” said Dr. Gudavalli from Palmer. “According to practicing doctors of chiropractic, this chiropractic procedure has provided relief for musculoskeletal conditions such as neck pain. However, there is a need for studies that provide information on the biomechanical characterization of such therapies, the biomechanics of normal and pathological joint and muscle systems, and the development of new technologies that study such biomechanics in real time. In other words, what physiological effect does the procedure have that is responsible for its clinical successes?”

The results of this study will aid in the planning and development of controlled procedures in the clinical setting, and test the validity of delivering the controlled procedures by conducting clinical studies and obtaining patients’ perception on the controlled intervention. This knowledge has the potential to guide the future conduct of clinical research in this area and impact training of students and doctors in the chiropractic profession.

- end -

Lori Leipold

Media Relations Manager

Palmer College of Chiropractic

Office: (563) 884-5726

Cell: (563) 343-0665

Cox® Technic (aka flexion-distraction) clinical outcomes published in European Spine Journal. Flexion-Distraction provided more low back pain relief than did medical conservative active exercise. 

Patients with radiculopathy (leg pain) did significantly better with flexion-distraction than active exercise. 

article link: http://www.springerlink.com/content/f32603l877144k77/?p=1ba95a15a905467b8ed4080941ee22e6&pi=4

Dr. Cox has been a proponent for years of chiropractic research, research that documents what the chiropractic spinal manipulation does to the spine. He has talked many times about the importance of evidence-based technique. Interestingly, this excerpt from an insurance provider in Indiana ( The Indiana Comprehensive Health Insurance Association, P.O. Box 33009, Indianapolis, IN 46203-0009) which defines, under the section 18 on Therapies, the following:

a)      definition of physical therapy...

b)      definition of speech therapy...

c)      definition of occupational therapy...

d)      Spinal manipulation services to correct, by manual or mechanical means, structural imbalance or subluxation to remove nerve interference from or related to distortion, misalignment or subluxation of or in the vertebral column.

       Note from Dr. Cox is that d) does not define the providers of spinal manipulation. My point in presenting this is that, in the future, the provider of this service, in my opinion and defined by my life stress on chiropractic clinical and biomechanical research studies, will be the profession that has shown evidence-based research to prove its clinical outcome benefits. Thus that will be the profession which is reimbursed.

It's important to support chiropractic research and documentation.