ACA’s annual meeting, the National Chiropractic Leadership Conference (NCLC), is packed with great educational content and world-class presenters. Join us Feb. 28-March 3 in Washington, D.C., to hear from some of the profession’s most compelling thought leaders. Here we pose several questions to one of our featured speakers: James M. Cox, DC, DACBR
Dr. Cox’s Presentation: “Cox Technic: Spinal Stenosis, Post Surgical, Cervical, Upper Thoracic, Lumbar” on Saturday, March 3. (For complete conference information and schedules, click here.)
How did you become interested in the topic you are presenting?
Following graduation from National College of Chiropractic in 1963, I soon found my clinical outcomes from spinal manipulation were wanting. Not enough people were getting help. Within two months of practice, I delivered a lumbar side-posture adjustment to a young woman with low back pain and sciatica, with the result that she was carried from my office and had spine surgery. My stepfather, who was an osteopath and a chiropractor, told me I was in the way of learning. That was true. Being valedictorian of my class did not mean much when it resulted in a poor result. Therefore, I started to study other forms of spinal manipulation, namely osteopathy, and read authors such as Ashmore, Still, Stoddard and McManis. Combining new knowledge about spinal manipulation with my chiropractic education resulted in a spinal manipulation technique known today as Cox® Technic flexion distraction decompression spinal manipulation. It resulted in superior clinical outcomes and patient preference--truly evidence-based clinical practice consisting of research, clinical expertise, and patient satisfaction and preference.
Who should attend your presentation and why?
A doctor would find this presentation appealing if he or she:
- wishes to expand his/her manipulative skills and/or finds some difficulty relieving conditions such as spinal stenosis or post-surgical continued pain
- seeks the biomechanics research and clinical application of flexion distraction spinal manipulation, and the clinical outcomes of it to incorporate into practice
- wishes to potentially expand and improve his or her clinical outcome results or finds that some spine conditions require a different form of spinal manipulative care.
What about your presentation topic (or you) may surprise people?
Spinal stenosis is the specific spine topic in this presentation. It is, in my opinion, the most challenging spine pain condition that I see. Disc herniation and disc and facet degeneration are primary causes and represent major pain and disability in the world. You will be surprised at the relief possible with distraction spinal manipulation. Having had this condition with cauda equina syndrome personally (necessitating decompression laminectomy), my spine’s own care is the technique presented. It is a stimulus to study and apply superior spinal manipulation when it is your own condition. I started out in practice with a challenge of low back pain and sciatica in a patient, lived it myself and then devoted my life to seeking the best evidence-based clinical treatment for spinal stenosis.
Are there any new developments in your specialty/topic area that make your presentation at NCLC 2018 especially relevant or timely?
This is the most relevant part of my presentation. Federally funded National Institutes of Health (NIH) and Health Resources and Services Administration (HRSA) research into the biomechanical spine changes that take place with the specialized form of spinal manipulation presented will be of great interest to my colleagues in attendance. These studies show the comparison of Cox Technic to physical therapy and exercise in the treatment of chronic low back pain and radiculopathy. The biomechanical spine changes that take place during cervical spine manipulation with my procedures will be most interesting to manipulating chiropractors. These research studies were performed at the Hines Veterans Hospital at Loyola University School of Medicine, Palmer College of Chiropractic and National University of Heath Sciences, with collaboration with the University of Illinois. Rounding out the latest developments is the most recent study of 69 cases of post-surgical continued pain patients, which was presented at the World Conference on Low Back Pain in 2016 in Singapore and published in the Journal of Chiropractic Medicine (issue 15(2) in 2016).
References will be presented from European Spine Journal, Trials, Spine, Journal of Manipulative and Physiological Therapeutics, Journal of the Canadian Chiropractic Association, Academy of Chiropractic Orthopedists, International Society for the Study of the Lumbar Spine, ACA News, Journal of Physical Therapy Science, The Spine Journal, and Evidence Based Complementary and Alternative Medicine, etc. The entire presentation will steer the concept of the chiropractic physician as a primary spine practitioner.
Most relevant is the place of distraction spinal manipulation in today’s chiropractic practice. Patients today require a broad skill set from their chiropractor. Some tolerate high-velocity thrust, and some cannot. Some cannot cavitate due to many pathological changes. Yet flexion distraction decompression spinal manipulation produces decreased intradiscal pressure, increased foraminal area, increased disc height, physiological range of facet motion and afferentation of the spinal tracts and chemical inflammation reduction. The published referenced studies and case reports of patient care will be cited.
What’s your best advice to a recent chiropractic college graduate (or, alternatively, what is your best advice to someone who has been in the field for several years and is looking for new challenges or ways to expand their practice)?
Become a spinal specialist. That means expanding your education and abilities and telling the patient community about your skills. Inform medical doctors that spinal manipulation is first-line care for spine and radicular pain. Get the best clinical outcome possible. New graduates can start years ahead of their learning curve by studying with experienced chiropractors, particularly certified Cox® practitioners, or becoming certified in Cox® Technic. Older doctors often tell me that the new knowledge puts romance back into their lives and practices. That is because of improved clinical outcomes. The patient also feels this renewed vigor and interest, as well.
Our profession is challenged with spinal stenosis patients and post-surgical continued pain patients (failed back surgical syndrome), and this will continue with our aging population. These people expect chiropractic to help them, which demands that the chiropractor have the skill set to produce good outcomes.
Here are some stories from my professional journey:
- I never wanted to be an instructor of chiropractic spinal manipulation. It was thrust on me after hurting a young woman with sciatica and sending her to surgery, which has never happened in my practice again incidentally; however, the learning curve has been steep.
- Being called upon for treatment by college presidents, television stars and all the wonderful regular people suffering from spine and radicular pain is most meaningful.
- Writing textbooks on low back and neck pain with and without radiculopathy and having them interpreted into foreign languages means this work has value; and yes, a substantial percent of sales are to physical therapists and other professionals.
- Presenting to interdisciplinary spine programs with surgeons, pain control doctors, physical therapists, etc., in meetings with hundreds of attendees and discovering interest in our profession and what I do has been a privilege.
- Having faculty teaching my work, under the auspices of post-graduate continuing education syllabus approval of the National University of Health Science/Lincoln College of Post-Graduate Education, is the result of doing what is right. These men and women are good people and doctors, interested in seeing chiropractic become the profession they envision.
- Cox® Technic is worldwide now in its teaching and certification program. The ultimate compliment is to see patients gain relief after failure from other forms of spine manipulation.
There is no doubt that spinal manipulation will grow in demand and use. The question is, “Who will deliver and control it: chiropractors or another branch of the healing arts?” I intend the answer to be my chiropractic colleagues first and foremost.
* * *
Learn more from Dr. Cox about this topic by joining us Feb. 28-March 3 in Washington, D.C. Register for the annual meeting today by clicking here. Join the conversation online by using the hashtag #NCLC2018.