Lumbar Disc Herniation

Resolving Disc Herniations with Cox Technique

Disc herniations are amongst the most painful and debilitating sources of low back pain and sciatica.  While most disc herniations do respond well to the proper, conservative, non-surgical care it is imperative that  these injuries are managed carefully 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 low back pain, including disc injuries 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. Studies have shown that it is more effective, faster, safer, and provides longer lasting relief for many low back conditions (including disc herniations) than more typical, traditional treatment approaches –  including physical therapy exercises (see references 1-3).  But before we talk about how Cox Technique works so effectively for disc problems,  it is helpful to first talk about how the disc becomes injured in the first place.

Basic Anatomy of the Spine and Intervertebral Disc

The 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.  This intervertebral disc is  a critical component of the spine, which not only helps provide shock absorption, but is also the key structure that allows the spine to bend, twist, and move.  Here is how this works….

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.

With the spine in an upright, standing position gravity pushes the vertebrae together, a motion which acts to squeeze the jelly-like nucleus away from the centre of the disc.  However, 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 spine to be a mobile column, as it 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).

Lumbar Disc Injury

Under normal circumstances, the outer aspect of the disc, the Annulus Fibrosis, acts to hold the Nucleus within the centre 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 trunk 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 back pain (due to the stain and damage to the disc itself), but will also cause leg pain and/or weakness as the disc herniation can put pressure of the spinal nerves as they pass through the spinal canal.  In severe cases, a small tear can develop in the outer aspect of the disc and some of the gel-like nucleus can actually leak out of the disc (this is referred to as a non-contained disc herniation).  This material will create inflammation in the nerves, causing them to be very painful. In these circumstances leg pain is usually worse than the lower back pain.  In many circumstances there is little to no pain in the back at all.

Treatment – Resolving Disc Injuries with Cox Flexion-Distraction

Fortunately, most disc injuries respond well to conservative care and do not require surgery.  In fact, 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 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.

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 lower section of the table (the part of the table supporting the patients’ legs) can be slowly pulled down and away.  This motion lengthens 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 level of the damaged disc by stabilizing the vertebra above the damaged disc using a specific hand contact. This focal pressure applied by the doctor makes Cox Technique more effective than traditional traction therapies or inversion devices which apply only a general traction, and do not provide feedback to doctor with respect to the health of the disc and spinal 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 times.  These procedures are generally supplemented with modalities to help reduce pain and healing such as Laser Therapy.  Home stretches are also part of the treatment process, initially focusing on pain management, with stretching and strengthening exercises being added as pain and tolerance improve.

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 strain and stimulates healing of the damaged Annulus.  It also creates a vacuum effect within the disc.  This acts to pull the herniated Nucleus back towards the centre of the disc, helping to reduce the size of the herniation and reduce pressure on the adjacent nerve root (remember it is the bulging/herniated disc that is compressing the nerve root and creating the symptoms into the leg.

Get Relief with Cox Technique

To book an appointment to see if Cox Flexion-Distraction will be able to help with your disc problem simply call our office at (902) 407-7207. For more information on Cox Technique, Back Pain, or Sciatica, please contact us via phone or email.


(1) Gudavalli et al. (2006). A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain.  European Spine Journal, 15: 1070-1082
(2) Cambron et al. (2006). One-year follow-up of a randomized clinical trial comparing flexion distraction with an exercise program for chronic low-back pain.  Journal of Alternative and Complimentary Medicine, 12(7): 659-668.
(3) Cambron et al. (2006). Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain.  Chiropractic & Osteopathy, 14:19.