Main Article Content

Ted Siciliano
Casey Rogers
Ralph Kruse


Intervertebral Disc Herniation, Spinal Stenosis, Facet Arthropathy, Low Back Pain


Objective: To discuss the use of side-lying Cox Technic flexion-distraction decompression for a patient with symptomatic lumbar spinal stenosis unable to lie prone for treatment due to pain.

Clinical Features: An 80-year-old female sought chiropractic care for her chronic low back pain. The patient had a history of lumbar spinal stenosis, multiple lumbar disc herniations, and lumbar spondylosis. The patient’s pain was initially rated as an 8/10 on the numeric rating scale.

Intervention and Outcome: Pain prevented the patient from lying in a prone position, so she was treated in a side-lying position using Cox Technic flexion-distraction decompression approach to lumbar mobilization. Additional treatments also included electronic muscle stimulation, infrared light therapy, and instructions for at-home exercise program and activity modifications. An episode of care was initiated at a frequency of 3 visits per week over a period of 4 weeks, totaling 12 treatments. After a total of 16 visits, the patients pain decreased to 3/10 and she also reported improved sleep, and increased mobility.

Conclusion: The results of this episode of chiropractic care, utilizing side-lying Cox® Technic flexion-distraction decompression, resulted in favorable outcomes. This particular patient experienced reduced pain, increased sleep, and increased mobility after a trial of 16 treatments. This case demonstrates that a modified Cox® Technic flexion-distraction protocol may benefit patients with low back pain, who are unable to receive treatment in the traditional prone position.


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