Cervical Disc Herniation

Resolving Cervical Disc Disorders with Cox Flexion-Distraction Technique

By Dr. Jason Gray BHK DC MSc

Cervical disc injuries can be amongst the most painful and debilitating sources of neck and arm pain.  While most cervical disc injuries do respond well to conservative, non-surgical care it is imperative that  these injuries are managed properly to resolve pain as quickly as possible and to prevent potential serious or long term problems.

Cox Flexion-Distraction Technique has emerged as one of the most effective, safest, and well researched therapies for neuro-musculo-skeletal problems of the neck, including cervical disc conditions such as a disc bulge, disc herniation, or slipped disc.   In fact, Cox Technique can often provide dramatic relief where there are few other effective treatment options available.  But before we talk about how Cox Technique works so effectively,  it is helpful to first talk about how cervical disc injuries occur in the first place.

Cox Technique has emerged as one of the most effective, safest, and well researched therapies for treating Cervical Disc Injuries, and can often provide dramatic relief when there are few other effective treatment options available.

Basic Anatomy of the Cervical Spine and Intervertebral Disc

The cervical spine consists of a series of small, block-shaped bones stacked together to form a moveable column.  Each of these bones – anatomically referred to as vertebrae – are  separated by a soft, circular pad known as an intervertebral disc.  Each intervertebral disc consists of two components.  The central, inner aspect of the disc known as the Nucleus Pulposis,  consists of a free-flowing, jelly-like substance. The outer layer of the disc is known as the Annulus Fibrosis.  It consists of several layers of thin, circular, ligamentous bands which wrap concentrically around the free-flowing nucleus.  Under normal circumstances the nucleus is contained at the centre of the disc by the strong, outer annular fibres. (Think of squeezing a water balloon between your hands.  As your squeeze your hands together the water is pushed outward, but is contained within the balloon between your hands, as long as the balloon is strong enough to withstand the pressure from your hands).

This unique anatomical design of the intervertebral disc is what allows the cervical spine to be so mobile, allowing our necks to bend, flex and twist. The inner nucleus essentially acts as a hydrostatic ball bearing for each vertebra.  For example, to flex forward one vertebra can pivot forward over the nucleus.  As this happens the nucleus will shift towards the back of the disc (Again, think of the water balloon between your hands.  As your hands move and tilt the water acts like a pivot point and is displaced away from the direction of movement).

Cervical Disc Injury

Under normal circumstances, the outer aspect of the disc, the Annulus Fibrosis, acts to hold the Nucleus within the center of the disc as the spine moves.  However, if the Annulus becomes weak or damaged it cannot properly contain the Nucleus. Instead, as the pressure within the disc increases as your neck bends and twists the disc will bulge or herniate.  This results in the outer border of the disc extending beyond the edge of the vertebral body and into the spinal canal – the canal that runs down the centre of the spine which contains the spinal cord and spinal nerves.    Not only can the disc bulge or herniation cause neck pain (due to the stain and damage to the disc itself), but can also cause arm/hand symptoms such as pain, numbness, weakness, or pins-and-needles as the disc herniation can put pressure on the spinal nerves as they pass through the spinal canal.  In severe cases, the disc herniation can compress the spinal cord.  This is a more serious conditon known as a Myelopathy.

Treatment – Resolving Cervical Disc Injuries with Cox Flexion-Distraction

Fortunately, most cervical disc injuries respond well to conservative care and do not require surgery.  In fact, in most cases 4-6 weeks of conservative care is recommended before any advanced imaging or a surgical referral should even be considered.  However, it is important that cervical disc problems are treated and monitored properly to both control pain and prevent any serious or long-term problems.

One of the most effective, safest, and well researched therapies for disc problems is a treatment technique known as Cox Flexion-Distraction Technique.

Research studies reported that 80% of disc herniations in the cervical and lumbar spine were helped by flexion-distraction adjustment, with 63% of cases demonstrating a significant reduction in the size of the herniation on follow-up MRI imaging.
(Journal of Manipulative and Physiological Therapeutics: 1996; 19(9))

Here’s how Cox Technique works…

Cox Flexion-Distraction therapy is performed using a specially engineered treatment table that gently pulls and stretches the spine. With the patient lying face down on the table, the headpiece of the table can be slowly pulled down and away. This motion lengthens the cervical portion of the spine, which pulls the vertebrae away from each other and acts to “decompress” the damaged disc. As the spine stretches the doctor is able to focus the decompression at the specific level of the damaged disc by applying a focal pressure to the damaged area with a specialized hand contact. The ability to direct the distraction effect to the exact level of the irritated nerve root makes Cox Flexion-Distraction treatment more effective than traditional distraction therapies or cervical traction devices which apply only a general traction, and do not provide feedback to doctor with respect to the health of the disc and cervical joints. Each decompression stretch is applied in a rhythmical push-pull action five or six times for a total of about 20 seconds. This process is usually repeated three to four times.

The decompression of the damaged disc achieved with Cox Flexion-Distraction has a number of important effects which help to reduce pain and promote healing of the damaged disc and spinal nerve. For example, this procedure has been shown to dramatically reduce pressure with the intervertebral disc which reduces pain and stimulates healing of the damaged disc.  This reduction in intra-discal pressure also creates a vacuum effect within the disc which acts to pull the herniated Nucleus back towards the centre of the disc.  This reduces the size of the disc herniation and reduces pressure on the adjacent cervical nerve roots (remember it is the bulging/herniated disc that is compressing the nerve root and creating the symptoms into the neck and arm).

An example of Cox Treatment. The doctor applies a specialized hand contact on the neck while the headpiece moves down and away to decompress the disc.

Get Relief with Cox Technique

To book an appointment to see if Cox Flexion-Distraction will be able to help with your cervical disc problem simply call our office at (902) 407-7207. For more information send us an email at info@KinetesisSpineandJoint.ca.