Changes in sagittal lumbar configuration with a new method of extension traction: Nonrandomized clinical controlled trial  Deed E. Harrison, DC, Rene Cailliet, MD, Donald D. Harrison, PhD, DC, MSE, Tadeusz J. Janik, PhD, Burt Holland, PhD  Archives of Physical Medicine and Rehabilitation  Volume 83, Issue 11, Pages 1585-1591 (November 2002) DOI: 10.1053/apmr.2002.35485 Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 1 New 3-point bending lumbar extension traction.a A posterior padded strap is placed under the subject's low back at the level of most deviation from the normal lumbar ellipse. The tension in the strap is the transverse force and is adjusted to patient tolerance. The upper body weight provides part 2 of the forces in 3-point bending, whereas the second strap at the level of the femur heads is the third component and allows rotation of the pelvis at the femur heads. Archives of Physical Medicine and Rehabilitation 2002 83, 1585-1591DOI: (10.1053/apmr.2002.35485) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 2 Three-point bending traction with anterior translation of the thoracic cage.a If T12 was translated posteriorly compared with S1 on the standing lateral lumbar radiograph, then the patient was positioned with a firm cushion under the thoracic cage to cause anterior translation while in lumbar traction. Archives of Physical Medicine and Rehabilitation 2002 83, 1585-1591DOI: (10.1053/apmr.2002.35485) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 3 Lateral lumbar radiographic analysis. Vertebral body corners were digitized. (A) By using a computer iteration process, a best fit ellipse was determined for the posterior body corners of inferior T12 through superior S1 and a ratio of minor axis to major axis was determined (b/a). (B) By using pairs of posterior body corners, posterior tangents were constructed on each segment, T12 to S1. The intersection of these tangents created segmental and global angles. (C) Cobb angle at T12–S1, Ferguson's sacral base angle to horizontal, an angle of pelvic tilt at posterior-inferior S1 and superior acetabulum to horizontal, and horizontal displacement of T12 compared with S1 (Tz) were created. Archives of Physical Medicine and Rehabilitation 2002 83, 1585-1591DOI: (10.1053/apmr.2002.35485) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 4 (A) Pretreatment, (B) posttreatment, and (C) long-term follow-up radiographs of a 16-year-old boy (height, 167.6cm; weight, 65.9kg) with kyphotic area in the lumbar spine. Lines are drawn on the posterior body margins as visual aids. In actual practice, computer-generated lines are derived from digitized points at the posterior body corners. The normal ellipse,10 drawn from posterior-superior S1 to the height of T12, is used as a guideline to compare with the posterior vertebral body margins. Note that 3-point bending traction has reduced the kyphotic angle and increased Ferguson's sacral base angle. This subject had chronic LBP with an initial VAS of 5/10, first posttreatment VAS of 0/10, and long-term follow-up VAS of 0/10. Archives of Physical Medicine and Rehabilitation 2002 83, 1585-1591DOI: (10.1053/apmr.2002.35485) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 5 (A) Pretreatment, (B) posttreatment, and (C) long-term follow-up radiographs of a 42-year-old man (height, 180.3cm; weight, 86.4kg) with a hypolordotic lumbar spine. The normal ellipse,10 drawn from posterior-superior S1 to the height of T12, is used as a visual aid to compare with the posterior vertebral body margins. Note the deeper lordosis on the postradiograph at L4–S1 as judged by the distances from these posterior vertebral body margins to the normal elliptical arc and the increase in Ferguson's sacral base angle. This subject had had chronic LBP for 10 years; his initial VAS was 5/10; at first posttreatment, it was 0/10; and at long-term follow-up, it was 0/10. Abbreviations: FA, Ferguson's angle; PT, pelvic tilt. Archives of Physical Medicine and Rehabilitation 2002 83, 1585-1591DOI: (10.1053/apmr.2002.35485) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions