The Cox® Technic, founded by James M. Cox, DC, DACBR in the 1960s, was created with the intent of offering a non-invasive and effective means of treating low back and neck pain. In particular, the technic is aimed at treating disc pathology (to keep people out of surgery!), spinal stenosis, back pain, sciatica and sciatica-like pain syndromes, whiplash, headache, arm pain, neck pain, facet joint imbrications (jamming), sprains/strains, and other neck and low back joint and soft tissue problems.
Exciting NewsColumbia Advanced Chiropractic, LLC offers the NEWEST Hill Laboratories Automated Flexion/Distraction table. This table is of the best on the market and allows for automated flexion/distraction and axial decompression for the reduction of disc pathology. It has both cervical and lumbar applications. Dr. Manison is the ONLY certified Cox flexion/distraction doctor in the Columbia / Ellicott City (Howard County), MD area. His training and experience with the Cox technic helps make Columbia Advanced Chiropractic, LLC the best place to go if you have cervical and/or lumbar disc pathology!


r. Cox and others have been researching the technic for decades and there are many medical articles regarding the efficacy of the treatment protocol, especially regarding the treatment of disc pathology. The technic has its roots in chiropractic and osteopathic medicine and it is, in Dr. Manison’s experience and opinion, the best form of conservative care for neck and low back conditions, yielding the best results.

Cox technic is administered with a specialized table. The patient is placed prone (face down), screened for comfort, and then the technic is applied by moving the table in specific movement patterns based on the patient’s unique condition so as to create the negative disc pressure. It is important to note that table flexion with the patient prone creates the negative pressure in the disc and this is much harder (if possible) to achieve if the patient is supine (face up).

Unlike other forms of ‘axial decompression’ on the market today, Cox flexion/distraction is the real deal as it is the only one with specific medical substantiation regarding its ability to create negative intradiscal pressure. This is necessary to allow for the disc bulge/herniation to regress so as to help restore proper joint function, reduce inflammation and pain, and allow for better movement patterns. This helps pave the way for rehabilitation and stabilization exercises to help the patient remain pain-free and fully functional.

The technic incorporates not only proper application of technic protocols, but also a thorough understanding of its applicability to MRI results (if available). The care is individualized for each type of disc pathology. Other forms of ‘axial decompression’ have the patient supine (facing up) and simply pull the patient straight; this may not be effective for many forms of disc pathology. Any form of traction therapy for disc problems needs to be specific for the type of problem, not just the same for everyone!

Cox technic is truly individualized, with treatments plans that are reduced based upon patient progress. Unlike other ‘axial decompression’ techniques, the patient is not required to sign up for dozens of treatments upfront and pay exorbitant amounts of money…and most importantly, Cox flexion/distraction has medical proof of its success!

Dr. Manison was the first certified and recertified Cox flexion/distraction technic provider in Maryland. Dr. Manison has also written a case study on the topic of Cox flexion/distraction for the cervical spine that was published in a peer-reviewed medical journal (JCM). He is the only certified practitioner in the Columbia, Ellicott City, Howard County region.  If you have a disc problem or are recovering from disc surgery, this technique offers you the best potential for recovery.

Please check out our Techniques page as it discusses all the high level approaches our doctors use to treat your specific musculoskeletal conditions.

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