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J Can Chiropr Assoc. 2017 Aug;61(2):153-161.

Innovative application of Cox Flexion Distraction Decompression to the knee: a retrospective case series.

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Private practice, Windsor, ON.


in English, French


The purpose of this study is to introduce the application of Cox flexion distraction decompression as an innovative approach to treating knee pain and osteoarthritis.


Six months of clinical files from one chiropractic practice were retrospectively screened for patients who had been treated for knee pain. Twenty-five patients met the criteria for inclusion. The treatment provided was Cox flexion distraction decompression. Pre-treatment and post-treatment visual analog pain scales (VAS) were used to measure the results. In total, eight patients presented with acute knee pain (less than three months' duration) and 18 patients presented with chronic knee pain (greater than three months) including two patients with continued knee pain after prosthetic replacement surgery.


For all 25 patients, a change was observed in the mean VAS scores from 7.7 to 1.8. The mean number of treatments was 5.3 over an average of 3.0 weeks. Acute patient mean VAS scores dropped from 8.1 to 1.1 within 4.8 treatments over 2.4 weeks. Chronic patient mean VAS scores dropped from 7.5 to 2.2 within 5.4 treatments over 3.3 weeks. No adverse events were reported.


This study showed clinical improvement in patients with knee pain who were managed with Cox flexion distraction decompression applied to the knee.


Cox Flexion Distraction Decompression; chiropractic; knee osteoarthritis; knee pain; manipulation; manual therapy


Conflict of interest statement

Funding sources and potential conflict of interest No funding sources were offered or provided for this study. Dr Luigi Albano is a chiropractor in private practice and is a certified Cox Technic provider.

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