Evidence Based Research
Proven and Documented Studies
The Extentrac® Elite affords the treating physician the ability to implement evidence-based manual therapy in addition to multi-directional decompression (M3D®). The clinician may quickly modify or change the treatment protocol based on clinical re-assessment at any point in the course of treatment.
The physiological effects on intra-discal pressure change, utilizing spinal flexion-distraction, is well documented. Extentrac® Elite uniquely combines power assisted, manually applied flexion-distraction and extension-distraction at selected angles, simultaneous with axial long-axis decompression. This synergy of positions and protocols offers improved treatment outcomes as compared to when individual procedures are applied separately.
Flexion Studies
Support for the use of flexion to reduce disc pressure, increase vertebral canal diameter, reduces disc protrusion, and improves disc metabolism.
- Flexion Distraction Motion, performed with five 4-second distraction motions of the intervertebral segment resulted in intervertebral discal pressure from 39mm Hg. To-192mm Hg. pressure. Gudavalli MR, Cox JM, Baker JD, Cramer GD, Patwardhan AG. Intervertebral disc pressure changes during the flexion-distraction procedure for low back pain. International Society for the study of the Lumbar Spine; 1997
- Flexion opens the vertebral canal by 2mm (16%) or 3.5 to 6mm. (Schonstrom N, Lindahl S, Wilen J, Hansson T.), Dynamic Changes in dimensions of the lumbar spinal canal; an experimental study invitro. J Orthop Res 1989;7.115-21
- Flexion improves transport of metabolites into the inner posterior annulus. Nachemson AL. The lumbar spine: an orthopedic challenge. Spine 1976; 1;1: 59-71
- Flexion decreases disc protrusion and reduces stenosis. Liyang Dai, Yinkan X, Wenming Z, Zhihua Z. The effects of flexion-extension motion of the lumbar spine on the capacity of the spinal cord. Spine 1989;14:523-5
- Intervertebral foraminal openings enlarge, giving patency to the nerve or dorsal root ganglion. Penning L, Wilmink JT. Posture dependent bilateral compression of L4 on L5 nerve roots in facet hypertrophy: a dynamic CT-myelographic study [abstract]. Spine 1987;12:488
- The Posterior Disc Space increases in height in flexion. Finneson BF. Low back pain. Philadelphia: JB Lippincott: 1973. p.258-9
Extension Studies
Support for the use of extension of the lumbar spine facilitates forward migration of viscoelastic nuclear material and reduces sciatica by reducing nerve root pressure.
- Extension unloads the intervertebral disc and will cause an increase in disc height because of increased fluid flow. Magnusson ML, Pope MH, Hansson T. Does hyperextension have an unloading effect of the intervvertebral disc? Scand J. Rehab Med 1995; 27:5-9
- A decrease in nerve root tension and compression at L5 with extension of the lumbar spine. Schnebel BE, Watkins RG, Dillin W. The role of spinal flexion and extension in changing nerve root compression and disc herniations. Spine 1989; 14:835-837
- Extension movements have been shown to centralize pain in the McKenzie methods protocols. McKenzie RA. The lumbar spine: mechanical diagnosis and therapy. Waikanae, New Zealand: Spinal Publications, Ltd; 1981
Gravitational Traction Studies
- Gravitational traction had a very apparent effect on intervertebral space and was found to be an effective method to distract lumbar vertebrae. Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey. TekeogluI, AdakB, Bozkurt M, Gurbuzoglu N.
Decompression Studies
- Epidurography demonstrated traction produces a negative pressure inside the disc with suction allowing the protruding parts to migrate back into place. Gupta RC, Ramaro SV. Epidurography in Reduction of Lumbar Disc Prolapsed by Traction. Archives Phys. Med Rehab 59:322-327, 1978
- Reducing intradiscal pressure creates a diffusion gradient into the disc, allowing improved bourishment of the nucleus pulposus and reduced lactate levels. Intradiscal pressure higher than capillary pressure impedes diffusion and healing. Tilaro F. An overview of vertebral axial decompression. Can J Clin Med 1998
- The effect of vertebral axial decompression in the lumbar spine's nucleolus pulpous was measured via cannula insertion at the L4-5 discs and was found to have a decreased intradiscal pressure below-100 Hg. Gustavo Ramos and William Martin MDs have published the "Effects of Vertebral Axial Decompression on Intradiscal Pressure" Jrl. Neurosurgery 1994
Non-surgical Disc Decompression refers to the physiological effect on intervertebral disc pressure, through spine positioning coupled with effective distraction, to produce a lowering of internal disc pressure. The use of higher amounts of traction force has been demonstrated by Ramous and Martin to decompress or significantly lower internal disc pressures from 30 to 50 mm Hg above the normal to the negative range of -100 to -150 mm Hg.
High distractive force and precise disc positioning is necessary to generate a sufficiently strong suction force, thus enabling the repositioning of extruded parts, interrupt contact with pain-producing tissues and effect dimensional changes in the lumbar disc. This traction induced negative disc pressure is theorized to be important to "feed the disc" or create a tremendous potential diffusion gradient across the disc space, which is otherwise avascular. Glucose and oxygen and other metabolites may penetrate the disc at the end plate region and facilitate disc healing and increase disc re-hydration.
