title: Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled 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.
  
  
  METHODS
  Nonrandomized controlled trial with follow-up at 3 months and 1(1/2) years.
  
  
  METHODS
  Primary care spine clinic in Nevada.
  
  
  METHODS
  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.
  
  
  METHODS
  A new form of 3-point bending lumbar extension traction was provided in-office 3 to 4 times a week for 12+/-4 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.
  
  
  METHODS
  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 +/- standard deviation of 4.4+/-1.9 pretreatment to 0.6+/-0.9 posttreatment (P<.001), and radiographic angles (except at T12-L1) showed statistically significant changes. Mean changes were 5.7 degrees at L4-5 (P<.001), 11.3 degrees between posterior tangents on L1 and L5 (P<.001), 9.1 degrees in Cobb angle at T12-S1 (P<.001), 4.6 degrees in pelvic tilt (P<.001), and 4.7 degrees in Ferguson's sacral base angle (P<.001). At long-term follow-up (17(1/2)mo), 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.
authors.affiliation: Department of Rehabilitative Medicine, University of Southern California School of Medicine, 1339 Luna Vista Drive, Pacific Palisades, CA 90272, USA.
authors.forename: Deed E
authors.initials: DE
authors.lastname: Harrison
authors.forename: Rene
authors.initials: R
authors.lastname: Cailliet
authors.forename: Donald D
authors.initials: DD
authors.lastname: Harrison
authors.forename: Tadeusz J
authors.initials: TJ
authors.lastname: Janik
authors.forename: Burt
authors.initials: B
authors.lastname: Holland
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002908:Chronic Disease; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008141:Lordosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000534:rehabilitation*; D017116:Low Back Pain / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000534:rehabilitation*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008297:Male; D020393:Manipulation, Spinal; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D016059:Range of Motion, Articular; D012399:Rotation; D013997:Time Factors; D014143:Traction / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D016896:Treatment Outcome