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The Cox Technic 50% rule sets the bar for our expectation of outcomes:

  • If you don't have 50% relief of pain within 30 days of care, you will be referred for further testing or consultation. Imaging and other tests are not generally ordered unless progressive neurological deficit or cauda equina syndrome is present or appears during the course of care.

Know that you are in competent hands of care. If any signs of deterioration along the way, you will be referred to the appropriate healthcare provider. As you improve, your treatment plan will be modified accordingly. Don't worry about being seen too many times - or too few. Our office knows pain and is here to help you regain your quality of life.


In the 1000 low back pain cases study by Cox et al, a mean of 91% of patients reported relief within 90 days. However, when the results are considered by condition, the outcomes vary naturally due to the nature of the condition. (1) Here are a two examples:


In the 39 cervical spine pain cases study by Schliesser/Kruse/Fallon [JMPT 26(9)], significant pain relief was reflected in patient-reported Visual Analog Scale scores ("On a scale of 1 to 100, what is your pain today?") which dropped from a mean of 50.1 to 8.7. (2)

In a case report of a 51 year old woman with 2 years of left arm pain due to a C5-6 disc herniation, the patient reports relief after the first visit. She was seen 24 times over 6 months and is symptom-free at 1 year. (3)

In a case of a 33 year old man with foraminal stenosis and radiculopathy due to a cervical C6-7 disc herniation, Cox Technic protocols allowed for good patient reported and examination found outcomes in a total of 15 visits over 10 weeks. At two years post-care, the patient's findings remained stable. (4)

In a case of a 34 year old woman with months of unremitting neck, shoulder and arm pain with a Klippel-Feil syndrome, Cox Technic protocols offered relief at the first visit and complete resolution of pain over 8 treatments in 2 months. (5)

Neck and arm pain relief can be quite dramatic sometimes or take a bit longer, but it too can be controlled so you can enjoy painfree living.

Contact Arctic Chiropractic, Sitka in Sitka to start your pain-relieving treatment plan with high expectations!

  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. Schliesser JS, Kruse RA, Fleming Fallon L: Cervical radiculopathy treated with chiropractic flexion distraction manipulation: a retrospective study in a private practice setting. J of Manipulative Physiological Therapeutics 2003; 26(9):592-596
  3. Kruse RA, Imbarlina F, DeBono VF: Treatment of cervical radiculopathy with flexion distraction. J Manipulative Physiological Therapeutics 2001;24(3):206-209
  4. Gudavalli, S, Kruse, RA. Foraminal stenosis with radiculopathy from a cervical disc herniation in a 33 year old man treated with flexion distraction decompression manipulation.  J Manipulative Physiological Therapeutics 2008;31(5):376-80
  5. Kruse RA, Schliesser J, DeBono VF: Klippel-Feil syndrome with radiculopathy. Chiropractic management utilizing flexion-distraction technique: a case report. J of Neuromusculoskeletal System 8(4):124
"This information and website content is not intended to diagnose, guarantee results, or recommend specific treatment or activity. It is designed to educate and inform only. Please consult your physician for a thorough examination leading to a diagnosis and well-planned treatment strategy. See more details on the DISCLAIMER page. Content is reviewed by Dr. James M. Cox I."