On an average day at your clinic, how many patients do you treat that present with low back pain, sciatica, neck pain, or pain or numbness in the arms? I would guess that such common symptoms represent a fair number of patients in your clinic. More importantly, have you ever had difficulty treating patients who present with such symptoms? If so, I highly recommend the Cox® Technic (www.coxtechnic.com) and the instrument used in its application, the Cox Table (www.coxtable.com).

Cox teaches this low-force technique at seminars across the country, and Cox Technic certification is available through the National University of Health Sciences in Lombard, Ill. I first became certified in the technique while attending Palmer College of Chiropractic, and have maintained my certification for more than 10 years.

For my first 10 years in practice, I used the Zenith Cox tables. These models were reliable, but offered only manual lumbar flexion and little else. I investigated many other types of flexion-distraction tables—including those with automated flexion—at state chiropractic conventions. The problem with them is that not every patient needs or can tolerate flexion of the lumbar spine. It really depends on their specific condition. Also, I was unimpressed with the cervical traction units that I had seen. As for the spinal decompression units that are becoming increasingly popular in our profession, most of those were too expensive and didn't allow for the proper application of the Cox Technic.

I needed a table that incorporated spinal distraction or decompression and also allowed me to perform a specific motion or combination of motions. Such a table would present me with numerous options to choose from in treating the entire spine. As a chiropractor, I also required a table that would allow me to use my hands and would serve to assist me in the application of the adjustment, rather than replacing me and relegating me to the role of technician. After attending a recertification seminar at National University of Health Sciences last year, I made the decision to purchase the latest version of the Cox Table.

The Basics

This is the seventh generation of the table used in the Cox Technic since the first was introduced in 1973. It was designed by Cox and a team of chiropractic patient engineers. The table is manufactured by the Track Corp (www.trackcorp.com), located in Spring Lake, Mich. The list price for the table, including all options, is less than $16,000. Leasing options are available, and the table may qualify for certain tax credits.

The lumbar unit includes an easily adjustable tiller bar with an ergonomic round handle. The tiller bar has fingertip controls for easy access to multiple table functions.

Since I practice in Michigan, I decided to make the trip to the factory to pick up the two tables that I had ordered. This gave me the opportunity to tour the facility and meet the men who build the instrument piece by piece. I was impressed by their knowledge of the application of the Cox Technic and by their attention to detail. Two tables were being assembled while I was there, and I noticed each man checking a single table motion repeatedly to make sure it felt just right. Rex Peterson manages the construction of the tables, and he gave me a thorough demonstration and gave me his direct phone line in case I had any problems or questions.

The table is quite sturdy (it will support up to 500 pounds) and weighs in at 385 pounds. Fully retracted, the table is 6 feet in length. The table is powered using a standard three-prong, 110V outlet. The upholstery is durable, yet comfortable. This is no surprise, because the Track Corp also manufactures seating for many popular vehicles and theaters. The doctor has the choice of five different colors: black, hunter green, navy blue, burgundy, and teal green. Further patient comfort is achieved by a contoured face cushion with adjustable width. Occipital and ankle restraints with Velcro fastener strips are included to limit motion in those areas when desired. A thoracic restraint is also available as an option.

The table also comes with a verti-lift feature which, as a taller doctor, I certainly appreciate. The table starts at a 24-inch height, which makes it easy for patients to get onto. I typically move the table up, using either the included foot switch or tiller bar button, another 12 inches to minimize the strain on my back while working on a patient. Several patients have remarked that they can hear the table doing something but cannot feel what is happening when the verti-lift is moving. Similarly, I have found that every motion used on the table is extremely smooth. The verti-lift feature does take 15 to 20 seconds to completely raise or lower. It would be nice if there was a one-touch method for this feature, rather than the required constant pressure on the tiller bar button or foot pedal. The Track Corp does take field doctor comments and suggestions for improvement.

Another wonderful feature is a powered tension control that is located conveniently on the tiller bar. This allows the doctor to increase or decrease the spring tension of the table to accommodate for a heavier or lighter patient. This is similar to the power steering feature of your car. It takes minimal effort for the doctor to move the lumbar section of the table into flexion, and then the table will return to neutral with ease. In fact, it is possible to set the tension to the point that the doctor could push the table into flexion with one finger and have it return to neutral. Of course, this isn't necessary because the tiller bar has an ergonomically designed round head for easy grasping. A 1-year parts and labor warranty is standard for the Cox Table.

The patented headpiece unit allows for smooth motion in multiple planes, including Y-axis distraction. This is useful in treating cervical disk lesions as well as cervical and upper thoracic nerve root compression.

Capabilities

Unlike many of the costly spinal decompression tables available, the Cox Table is capable of decompressing any specific level of the spine. Also, since chiropractic is a hands-on profession, the table is designed to allow the doctor to apply pressure and motion to specific vertebral segments. This is critically important when working with an acute disk lesion at a specific spinal level. Further, it allows the DC to work with ranges of motion that aren't possible with other tables. For example, the cervical section allows for 20° of flexion, lateral flexion, or rotation, and 15° of extension. By releasing two locks, the coupled motion of circumduction is possible. The cervical unit also allows for manual long Y-axis distraction of the spine.

I have found the cervical unit to be even more beneficial in treating various problems than I had anticipated. Several of my patients have experienced complete relief of neck and arm pain, upper-extremity numbness, and headaches within the first few treatments. Word of mouth has spread quickly in the communities where I practice, and I have many new patients specifically asking to use the "new table" that helped their friend or loved one.

The thoracic section can be equipped with a drop mechanism, allowing for drop adjusting of the thoracic and lumbar spine as well as the sacroiliac joints upon proper patient positioning. The table is sturdy enough to accommodate other techniques as well, such as high-velocity, low amplitude (HVLA) thrusts and side-posture adjusting. I have found that diversified adjustments of the thoracic spine are much easier to perform when the patient's spine is distracted.

Lumbar ranges of motion available include up to 16° of flexion, 8° of extension, and 25° of lateral flexion. As with the cervical headpiece, circumduction may also be used.

Dan Spencer, DC, practices in Hudson, Mich. Contact him at .

One of the features that I have found to be quite useful is the automated long Y-axis lumbar distraction feature. This method is used only for non-acute, non-sciatica patients only. The table can be set for specific amplitudes of distraction from ½ inch up to 2½ inches. The table will distract or lengthen the patient's spine by the set amount, then return to the original position. This "pumping" motion is repeated every few seconds. The DC also sets the duration of the automated distraction, anywhere from 2½ minutes to 12½ minutes.

The automated distraction has proven to be very useful in my clinic. I can set the duration and amplitude on the table and move to another room to care for another patient when appropriate. I recently used the automated distraction with a new patient who has undergone eight spinal surgeries and still has low back pain. In fact, his neurological integrity was so compromised that he had not been able to stand on his toes and forefeet for the past 3 years. After one 5-minute session of automated distraction, he was able to do so. He continues to improve with each treatment session and is much more satisfied with chiropractic care than his surgical interventions.

The Cox protocols call for manual treatment, including lumbar flexion, for patients with sciatica. For patients who don't have sciatica but have acute back pain, the DC may choose to use attended long Y-axis distraction. The DC is free to use his or her hands to apply distraction to the desired vertebral level by using the distraction button on the tiller bar or a taped foot switch on the table base.

One possible improvement to the automated distraction feature would be the ability to "ramp up" the distance of spinal distraction. For example, if I had a patient with severe lumbar muscle spasms, I may want to start with a half-inch of distraction and slowly increase that up to 1½ inches. The table will not do this automatically, but it can be accomplished by stopping distraction and resetting the amplitude.

The Results

As I have mentioned, the Cox Table has taken my practice to the next level by allowing me the tools to treat various spinal conditions. Patients quickly see that their health is improving and are eager to refer others for similar treatment. I would advise every DC to take the opportunity to attend one or more of Cox's seminars, where you will learn the latest research on the treatment of spinal disorders. Once you attend a seminar, I believe you will want to become certified in the technique. You'll see how the Cox Technic uses research to develop treatment methods that result in the best possible patient outcomes. The next step is to buy the table. It will help you better care for your patients and will surprise you in how quick, effective, and easy it really is.