Flexion Distraction

Flexion Distraction

Dr. Nicholas Zuccala, a Smithtown Chiropractor at Advanced Alternative HealthCare and Wellness Center utilizes the Cox flexion distraction technique for patients with extreme back pain or leg pain.

Flexion Distraction , also known as Cox Flexion Distraction, is an extremely gentle, non-force chiropractic treatment for low back pain and leg pain. The patient generally lies prone (facedown) on a special segmented, moveable table (Cox table), although the patient may also lie on his or her side. Dr. Zuccala locates the source of the pain, and places his hand on the disc directly above the affected segment of the spine, applying gentle pressure. With his other hand, Dr. Zuccala moves the table, using a series of slow, repetitive movements that gently stretch (or traction) the lower spine. As the spine moves through a normal range of motion, compressed spinal discs are opened and pressure is reduced on the nerves and facet joints of the spine.

Flexion Distraction is most useful for reducing the effects of disc problems such as herniated discs, spinal stenosis (abnormal narrowing of the spinal canal), spondylolisthesis (slipped disc), facet syndrome (deterioration of joints), sciatica (leg pain), and other lumbar, cervical or thoracic disc herniations. It is also effective for post-surgical continued pain and for pregnancy related back pain. Because this treatment is so gentle, working with the body’s natural design, it is very comfortable and well tolerated, even for those experiencing severe pain. Most patients experience some immediate pain relief after just a few treatments, and report significant improvement after about twelve visits. Research indicates that 91% of patients are relieved of pain within 3 months, keeping them from the chronic pain stage.

Dr. Zuccala has been practicing flexion distraction for more than twenty years, with notable results. He received his training directly from Dr. James Cox, the developer of the Cox flexion distraction technique.


1. Cox, JM, Feller JA, Cox JA: Distraction Chiropractic Adjusting: Clinical Application, Treatment Algorithms, and Clinical Outcomes of 1000 Cases Studied. Topics in Clinical Chiropractic 1996; (3)3:45-59, 79-81

2. Cox JM: Chiropractic management of a patient with lumbar spine pain due to a synovial cyst: a case report. J of Chiropractic Medicine 2012;11(1):7-15

3. Kruse R, Gudavalli S, Cambron J: Chiropractic treatment of a pregnant patient with lumbar radiculopathy. Journal of Chiropractic Medicine 2007; 6(4):153-158

Click here for additional research studies on the flexion distraction technique: Lumbar Spine Clinical Outcomes

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