Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction: Non-randomized Clinical Control Trial

Authors

• Deed E. Harrison, DC
• Rene Cailliet, MD
  
• Donald D. Harrison, PhD, DC, MSE
• Tadeusz J. Janik, PhD
• Burt Holland, PhD

Publication

Arch Phys Med Rehab. 2002;83(11):1585-1591

Article Link

Changes in Sagittal Lumbar Configuration with a New Method of Extension Traction: Non-randomized Clinical Control Trial. 

Abstract

Objective: To determine if a new method of lumbar extension traction can increase lordosis in chronic low back pain (LBP) subjects with decreased lordosis.
Design: Nonrandomized controlled trial with follow-up at 3
months and 11⁄2 years.
Setting: Primary care spine clinic in Nevada.
Patients: Beginning in mid-1998, the first 48 consecutive patients, who met the inclusion criteria of chronic LBP with decreased lordosis and who completed the treatment program were matched for sex, age, height, weight, and pain scores to 30 control subjects with chronic LBP, who received no treatment.
Interventions: A new form of 3-point bending lumbar extension traction was provided in-office 3 to 4 times a week for 1264 weeks. Per session, traction duration was started at 3 minutes and was increased to a maximum of 20 minutes. For short-term pain relief, torsion lumbar spinal manipulation was provided in the initial 3 weeks.
Main Outcome Measures: Pain as measured on a visual analog scale (VAS) and standing lateral lumbar radiographic measurements.
Results: Pain scales and radiographic measurements did not change in the control subjects. In the traction group, VAS ratings decreased from mean 6 standard deviation of 4.461.9 pretreatment to 0.660.9 posttreatment (P,.001), and radiographic angles (except at T12–L1) showed statistically significant changes. Mean changes were 5.7° at L4 –5 (P,.001), 11.3° between posterior tangents on L1 and L5 (P,.001), 9.1° in Cobb angle at T12–S1 (P,.001), 4.6° in pelvic tilt (P,.001), and 4.7° in Ferguson’s sacral base angle (P,.001). At long-term follow-up (171⁄2mo), 34 of the 48 (71%) subjects returned. Improvements in lordosis were maintained in all 34.
Conclusions: This new method of lumbar extension traction
is the first nonsurgical rehabilitative procedure to show increases in lumbar lordosis in chronic LBP subjects with hypolordosis. The fact that there was no change in control subjects’ lumbar lordosis indicates the stability of the lumbar lordosis and the repeatability of x-ray procedures. Because, on average, chronic LBP patients have hypolordosis, additional randomized trials should be performed to evaluate the clinical significance of restoration of the lumbar lordosis in chronic LBP subjects.