Click here to download a PDF version of The Eight Major Aberrations of the Lumbar Spine and Their Ideal Corrective Traction Setting.
April 2005, Vol. 15, Iss. 2
In the April 26, 2004 issue of Newsweek, an article entitled, “Treating Back Pain: The New Debate Over an Affliction Shared by 65 Million Americans,” reported that back pain is now the number two reason for doctor visits in the United States. The author, Claudia Kalb, goes on to state that eighty percent of Americans will battle the condition at some point in their lives and that back pain sufferers cost this country more than $100 billion annually in medical bills, disability and lost productivity.
According to this article, the Orthopedics answer to this growing problem has been a 77 percent increase in spinal-fusion surgeries in the United States, between 1996 and 2001. Fusion surgery was originally designed to treat serious instability or deformity of the spine. Over the past 10 to 15 years, the patient pool has gradually expanded to include more common disc problems. All this in spite of the fact that spinal fusion surgery is very expensive, may lead to nerve injury, infection or other post-operative problems, can place abnormal strain on other vertebra and often does not resolve the problem.
In fact, the February 2004 issue of The New England Journal of Medicine contained a paper by Dr. Richard Deyo, a professor of medicine and health services at the University of Washington. In this paper, Dr. Deyo and two other colleagues charge that there is insufficient data to justify treating common disc degeneration with invasive spinal fusion surgery.
The main jest of the Newsweek article is that medical doctors and the general public are searching for better, more conservative solutions for chronic back pain. Unfortunately, this national article goes on to state that the main downfall of most conservative treatments, such as massage, chiropractic manipulation and acupuncture is the lack of good research to prove their efficacy. In my opinion, it can not be much longer before the general medical community and the general public, in their search for research proven treatments, find out about Chiropractic Biophysics® with its wealth of peer-review research and predicable results.
Recent CBP® research has been documenting the grossly increased loads that are subjected to the intervertbral discs with aberrant thoraco-lumbar-pelvic postures.1 A mere 40 millimeters of anterior or posterior thoracic translation causes an approximate 60% increase in the compressive force acting on the L5-S1 intervertebral joint.2 Reducing these abnormal loads through the correction of the aberrant posture would, according to Wolfe’s Law, obviously slow or diminish the painful degenerative changes in the spinal discs and/or facet joints in direct proportion to the amount of postural correction achieved. Reduction of the aberrant posture would also help to normalize the physical stress and strain on muscles and other soft tissues
It is increasingly becoming obvious that appropriate physical rehabilitation must include postural and structural correction, if it is expected to lead to a lasting improved function without repeated post-inflammatory fibrotic changes, early progressive degenerative changes and eventual chronic pain/disability.
In an effort to make more consistent corrections of thoraco-lumbo-pelvic posture and from insights we have gained from the development of corrective cervical procedures, Chiropractic Biophysics® doctors now look at aberrant lateral lumbo-pelvic structure as geometric displacements of form in comparison to their ideal elliptical arc line and not just as a numerical loss or increase of lordosis. The ideal elliptical arc line can be drawn onto the patient’s lateral lumbo-pelvic x-ray with the use of a special plastic template (available from CBP®). The elliptical arc line represents the ideal position of the posterior bodies of the L1 – L5 vertebral segments. It is based on the work of Doctors Harrison and Janik and has been proven valid in publications such as the Journal of Spinal Disorders and the Journal of Orthopedic Research.3,4
Rather then list the different thoraco-lumbo-pelvic aberrant lateral postures according to the type of traction best suited to corrected it, as is done in the CBP® Lumbar Rehabilitation Seminars, I have, in this article, listed what I propose to be eight major aberrant postural forms of the lumbo-pelvic spine in relation to the ideal elliptical arc line.
These eight lumbo-pelvic geometric forms will be presented with ideas on correcting them, utilizing corrective traction and exercise procedures. In the year 2000, I developed the active, CBP® approved, method of lateral thoraco-lumbo-pelvic corrective traction. It involves having the patient wear a posture corrective brace called the “Spinal Remodeling Brace” or “Antro Brace” to pre-stress their aberrant lateral thoraco-lumbo-pelvic posture into a corrected or Mirror-Image® posture and then having the patient walk at 1.8 to 2.0 mph on a treadmill to stimulate proprioceptive input and structural/postural correction. I will list the best corrective settings for the Spinal Remodeling Brace with each of the eight aberrant forms as well as the best Mirror-Image® or body weighting exercise. The reader should keep in mind that proof for all of this needs to be presented in the form of clinical trials, which are currently in the planning stage for future CBP® research.
The eight Figures to illustrate the eight basic types (referred to as Forms) are shown at the right of this page.
The development of spinal traction dates back to 4000 B.C.5 Hippocrates created a traction bench in 400 B.C.6 More recently, motorized intermittent Lumbar Disc Distraction has been enjoying a resurgence in popularity. Physical rehabilitative traction has been a constantly evolving science since its inception. I feel very fortunate to have, within my studies and thoughts, stumbled upon undiscovered types of posture and structure corrective thoraco-lumbo-pelvic traction. It is my hope that the presentation of these aberrant forms in relation to their ideal elliptical arc line may make the use of my traction and exercises easier for the clinican to correctly apply for optimum correction.
- Harrison DE, Colloca CJ, Keller TS, Harison DD, Janik TJ, Hass JW. Anterior Thoracic Posture Increases Thoracolumbar Disc Loading. Euro Spine J 2004; In press.
- Kiefer A, et al. Synergy of the Human Spine in Neutral Postures. Euro Spine J 1998;7:471-479.
- Janik TJ, Harison DD, Cailliet R, Troyanovich SJ, Harison DE. Can the Sagittal Lumbar Curvature be Closely Approximated by an Ellipse? J Orthop Res 1998;16(6):766-770.
- Harrison DD, et al. Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects. J Spinal Disorders 1998;11;430-439.
- Loeser JD. History of Skeletal Traction in the Treatment of Cervical Spine Injuries. J Neurosurg 1970;33(1):54-59.
- Kumar K. Spinal deformity and axial traction. Spine 1996;21:653-655.