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!)

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

In a randomized, controlled study comparing chiropractic flexion-distraction (Cox® Technic) with medical care (active exercise), flexion-distraction was superior in relieving radiculopathy sciatica (leg pain). Patient were randomized to two groups for care. Those with radiculopathy who were treated with flexion-distraction alone (mind you, no physical modalities or exercise were allowed by the treating chiropractic physicians) had significantly greater relief. The study was published in the European Spine Journal.

Cox® Seminars teach the biomechanics, examination, diagnosis and treatment of spinal pain conditions. Treatment is focused on Cox® flexion-distraction and decompression protocols performed by chiropractic physicians who use their hands and their palpatory skills to adjust the spine. Cox® Seminars emphasize the role of the chiropractic physician and his/her trained hands in caring for spinal pain conditions.

60% of chiropractors reported to the National Board of Chiropractic Examiners that they use Cox® Technic.

Chiropractic research projects funded by various organizations from NIH to HRSA to FCER continue to investigate chiropractic flexion distraction. Projects are underway at Palmer Research Center (Gudavalli et al), National University of Health Sciences (Gudavalli & Cambron), New York College of Chiropractic (Dougherty) among others. These projects' goals and outcomes as available are shared.

Cox® Seminars teach the proper application of flexion-distraction protocols. Attending doctors are often taken aback at the low amount of force and at the depth of flexion that is actually required (only 1 to 2 degrees when the protocol is applied correctly). There is nothing like hands-on experience training to really grasp what a technique is all about.

For more information on Cox® Seminars, please click here.

 

Dr. Cox loves spinal literature research. Anyone who has read his books or attended his lectures knows this. He quotes paragraphs off pages from journals some have never heard of! He loves spine research.

He's not alone. Doctors and researchers around the world publish their clinical and experimental findings. Organizations like ISI and others help research lovers gather the pertinent publishings (out of the 25,000 a week that are published!) for their perusal. Dr. Cox uses ISI's key word service to gather related articles from 36 key words (disc, chiropractic, sciatica, whiplash, etc).

Dr. Cox devotes 15 to 20 hours a week reading all these articles then summarizes and organizes them into categories:

1. Biomechanics
2. Causes
3. Cervical
4. Disc
5. Incidence
6. Scoliosis
7. spondylolisthesis
8. Treatment

 

For each article, Dr. Cox writes a short, succinct, summarizing title. The title often tells the story. But, for those who want to read more, he gives a more detailed summary, too. If you want to read the full article, you can get it from the source as he gives you the full reference.

Dr. Cox can be your researcher by subscription. He shares his past month's collection of spinal literature via the COX® RESEARCH PEARLS. These come via an email link. With the Cox® Research Pearls, the chiropractic physician is kept abreast of the latest in spinal research literature.

Welcome to the blog for Cox® Technic! There have been many requests for this forum, so I trust it will meet your needs. As your host, I plan to share with you pertinent information to enhance your integration of Cox® Technic into your practice.

As an introduction, I'd like to share that Cox® Technic is used by 60% of chiropractic physicians according to the National Board of Chiropractic Examiners (2000). Cox® Technic (aka flexion-distraction) is the creation of James M. Cox, DC, DACBR.  Flexion-Distraction is taught at chiropractic schools either as core curriculum or via a dedicated elective course or technique overview course. Dr. Cox has worked his career with the purpose of documenting the effectiveness of chiropractic, specifically flexion-distraction and decompression. With the advent of the federally funded research projects being offered to chiropractic researchers willing to work with medical or osteopathic researchers, his desire for documentation was met with funding. This opened the door to gathering support for flexion-distraction. The first grants investigated the biomechanics and clinical outcomes of Cox® flexion-distraction for low back pain and cervical spine pain. Each granting year, flexion-distraction was awarded funds. Today, several grants via HRSA, NIH, FCER and others are funded. Here is a summary of the first three studies' outcomes lead by principal investigator, Ram Gudavalli, PhD:

1 - Biomechanics Study - 28% opening of the spinal canal, intradiscal pressure drop to as low as -192mmHg, and widening of the IVD space

2 - Lumbar Spine Clinical Comparison Study (published in European Spine Journal)- F/D vs. Medical Conservative Care for Lumbar Spine Conditions - F/D outshone medical conservative/active exercise, especially for radiculopathy (leg pain) patients.

3 - Cervical Spine Clinical Comparison Study - F/D vs. Medical Conservative vs. Combination for Cervical Spine Conditions - The combination revealed better outcomes.

Today, certified chiropractic physicians are ready to help their patients with research documented protocols via a network of physicians. Dr. Cox's goal 40 years ago was to have a core of 1000 physicians. Today the number is nearly double that and climbing!