Cox® Traction for Lumbar Spinal Stenosis: A Gentle, Evidence-Based Approach to Lasting Relief
What Is Lumbar Spinal Stenosis?
Lumbar spinal stenosis is a condition where the spinal canal in the lower back becomes narrowed, putting pressure on the spinal cord and the nerves that travel into the legs. This narrowing often develops gradually over time due to age-related changes such as arthritis, disc bulging, or thickening of the spinal ligaments.
When the nerves become compressed, it can cause pain, numbness, tingling, or weakness in the lower back, buttocks, and legs. Many people notice that their symptoms feel worse when standing or walking and improve when they sit or lean forward.
Lumbar spinal stenosis is most common in adults over the age of 50, since it typically results from degenerative changes that occur with aging. Diagnosis can be made by a chiropractor, physiotherapist, or medical doctor through a thorough medical history, physical examination, and imaging (such as X-rays, MRI, or CT scan).The gold standard for diagnosing lumbar spinal stenosis is magnetic resonance imaging (MRI) because it provides highly detailed images of the spinal canal, discs, ligaments, and nerves. MRI can show exactly where the narrowing is occurring and how much pressure is being placed on the spinal nerves.
What Are the Treatment Options for Lumbar Spinal Stenosis?
Treatment for lumbar spinal stenosis depends on the severity of symptoms and how much they affect your daily activities. Many people experience significant relief with conservative, non-surgical treatments before considering surgery.
Common treatment options include:
Activity modification and exercise: Gentle stretching, walking, and specific strengthening exercises can improve flexibility, posture, and core support.
Medications: Over-the-counter pain relievers or prescribed anti-inflammatory medications can help reduce pain and stiffness.
Manual therapies: Techniques such as Cox® flexion-distraction (manual spinal traction), chiropractic adjustments, and mobilization can help decompress the spine and reduce nerve irritation.
Epidural steroid injections: In some cases, injections can temporarily decrease inflammation around affected nerves, easing pain and improving function.
Lifestyle changes: Maintaining a healthy weight, improving posture, and avoiding prolonged standing or walking can help manage symptoms.
Surgery: For severe cases that don’t respond to conservative care, surgical options such as laminectomy or spinal decompression surgery may be recommended to relieve nerve pressure.
Cox® Flexion-Distraction (Manual Spinal Traction) for Lumbar Spinal Stenosis
The Cox® Technique, also known as Cox® Flexion-Distraction Decompression, is a specialized form of chiropractic decompression therapy that provides non-surgical back pain relief for patients with lumbar spinal stenosis and disc-related conditions. It’s performed on a Cox® traction table, which allows the spine to be slowly and precisely stretched and flexed. During treatment, the chiropractor uses one hand to stabilize the spine while the other hand guides a controlled, rhythmic motion of the lower portion of the table.
This gentle movement creates a unique form of manual spinal traction that can:
Reduce pressure within spinal discs
Enlarge the spinal canal and foraminal openings (where nerves exit)
Improve circulation and mobility in the affected joints
Relieve compression on spinal nerves
These biomechanical changes help reduce the “pinching” or irritation of nerve roots that cause pain, tingling, and weakness in lumbar spinal stenosis.
Additionally, the movement helps improve spinal motion and stimulate fluid exchange within the intervertebral discs, promoting natural healing and improved flexibility.
The treatment is gentle, painless, and always customized to each patient’s comfort and tolerance level.
What Does the Evidence Say About Cox® Flexion-Distraction?
Cox® flexion-distraction has been researched for several decades and is supported by clinical studies showing meaningful improvements in back pain, nerve compression, and mobility for patients with lumbar spinal stenosis and disc herniation.
A study published in the Journal of Manipulative and Physiological Therapeutics found that patients with chronic low back and leg pain from stenosis experienced significant improvements in pain and disability scores after 12 sessions of flexion-distraction therapy.
MRI studies have confirmed increased spinal canal area and reduced nerve compression following Cox® treatments.
A 2014 pilot study showed that Cox® decompression therapy improved walking tolerance and reduced leg pain in patients with neurogenic claudication (leg pain caused by spinal stenosis).
While larger studies are ongoing, decades of safe clinical use and existing evidence suggest that Cox® traction is a proven conservative treatment for spinal stenosis and an effective non-surgical back pain relief option.
How Many Sessions Will I Need?
Because lumbar spinal stenosis is a chronic, degenerative condition, the number of sessions required varies from person to person. Most patients experience noticeable pain reduction and improved function over 6–12 sessions. After this initial treatment phase, patients often continue with periodic maintenance care to preserve spinal mobility and prevent symptom flare-ups.
At Mountain Health and Performance, we combine Cox® flexion-distraction with other evidence-based therapies such as:
Manual therapy (mobilization, manipulation, myofascial release)
Rehabilitative exercise programs
This integrated approach helps address multiple aspects of healing such as reducing pain, improving movement, and strengthening the spine for long-term stability.
A Gentle, Evidence-Based Path to Healing
For patients living with lumbar spinal stenosis, manual Cox® traction offers a gentle, evidence-based path toward lasting pain relief and improved function. By safely decompressing the spine and restoring natural motion, it targets the root cause of nerve irritation not just the symptoms. If you’re searching for a non-surgical treatment for lumbar spinal stenosis, consider visiting Mountain Health and Performance.
Dr. Amy Wiggins
BHK, DC
North Vancouver Chiropractor
