A Life's Effort

New research investigates the use of Cox Flexion Distraction and Decompression technique for neck pain.

By Caitlin Lukacs

More than 40 years after James M. Cox, DC, DACBR, developed the Cox Flexion Distraction and Decompression Manipulation technique, approximately 58 percent of chiropractors use it on a daily basis. Over the years, several studies have investigated the efficacy of this technique on low-back pain. Now Dr. Cox is teaming up with Palmer College of Chiropractic, Loyola University and Edward Hines VA Hospital researchers to document the effects of the procedure on neck pain.

How did you come to develop Cox Decompression Manipulation?
I graduated from National College of Chiropractic in 1963 and returned home to Fort Wayne, Ind., to go into practice with my step-father. Within the first two months, I saw a 24-year-old woman who had severe pain stretching from her lower back down her leg. She couldn’t stand up straight, and I did what I was taught to do: a side-posture adjustment. It ended up making her condition worse—she eventually had surgery. I was distraught over the incident and decided that there must be a better way to approach such cases.

My stepfather, an osteopath, used the McManis osteopathic table, and I decided to take the best of osteopathy and of chiropractic and marry them together. At first I called this hybrid the ChiroManis technique, but it became the Cox Flexion Distraction technique in the late 60s and eventually developed into the Cox Flexion Distraction and Decompression technique.

What conditions are treated most effectively by this technique?
First I used the technique predominately for more severe back pain cases, such as sciatic radiculopathy, but eventually Cox Decompression Manipulation has evolved into a technique that is applicable to all patients.

Is the Cox Decompression Table necessary for the proper use of this technique?
In developing this technique, I discovered that I couldn’t do flexion distraction work using a standard chiropractic table, and I couldn’t do general chiropractic work using the McManis osteopathic table. So I went to a local engineer, and we created a blend of the two tables. It’s gone through several improvements, and today it’s in its seventh version.

To perform Cox Decompression Manipulation on the upper back and cervical spine, the Cox table is necessary. You can complete the technique on the lower back and legs using a McManis osteopathic table.

How did you become interested in chiropractic research?
As I developed the Cox technique, I realized that it demanded basic science and clinical outcomes studies to document its validity and value, but at that time, the federal government was not funding chiropractic research. In the ’80s, I funded my own case study on clinical outcomes, but I’m not a trained researcher, so I knew I needed to surround myself with talented people who know how to do proper research.

In 1990, I met Ram Gudavalli, PhD, from the Palmer Center for Chiropractic Research, at the time when the federal government would fund chiropractic research done in collaboration with a medical or osteopathic institution. Thanks to Dr. Gudavalli and his relationship with Avinash G. Patwardhan, PhD, director of the musculoskeletal biomechanics laboratory at the Loyola University Stritch School of Medicine, we began our legacy of research collaboration. In 1994, we began our first federally funded study: Biomechanics of Low Back Flexion-Distraction Therapy, to describe the biomechanical events that occur in the spine during distraction manipulation and to define the limits of safety for the structures of the lumbar spine during this manipulation. We were so successful that we were approached by the Department of Health and Human Services to extend our grant to do additional research studies.

What will the current study focus on?
All of our research is focused on two areas: biomechanics and clinical outcomes. We’ve been looking at what happens inside the upper thoracic and cervical spines when we apply this particular technique, as well as at the strengths and weaknesses of this technique, so that in the end we can establish the best manipulation procedures for specific spinal conditions.

Your life has been dedicated to your work. What do you do for fun outside of chiropractic?
I founded the Fort Wayne Children’s Foundation, an organization that raises funds to fight child abuse. While it’s certainly a lot of work, it’s also fun for me to see the great results we’ve achieved.

I like to golf with my grandsons, and I have a small retreat farm that I escape to. There I mow the grass and think about the future and what I can do to better serve my family and my profession. Also, catching walleye is a passion of mine.