STRUCTURAL REHABILITATION OF THE LUMBAR LORDOSIS: A SELECTIVE REVIEW OF CBP® CASE REPORTS
Main Article Content
Keywords
Lumbar Spine, Lordosis, Rehabilitation
Abstract
Objective: To characterize case report evidence of Chiropractic BioPhysics® (CBP®) technique methods applied to increase lumbar lordosis in patients with defined radiographic hypolordosis.
Methods: The CBP NonProfit website and Pubmed and Index to Chiropractic literature databases were searched for case reports/series documenting lumbar lordosis changes in the treatment of low back disorders after CBP technique methods were applied.
Results: Our search located 17 patients reported in 11 publications treated by CBP methods to increase lumbar hypolordosis. On average, CBP lumbar extension traction (LET) methods as a part of a multimodal treatment program increased the lumbar lordosis by 15° after 52 treatments applied over 4.2 months, corresponding to a 75% reduction in pain intensity. Methodological quality of reports varied.
Conclusions: There is an evolving evidence base involving case reports describing the management of CBP LET procedures in rehabilitation of the lumbar lordosis. The available case reports are in general agreement with clinical trial results and approximate treatment durations can be estimated from the existing data.
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References
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5. Sadler SG, Spink MJ, Ho A, et al. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskelet Disord 2017;18:179
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10. Oakley PA, Ehsani NN, Moustafa IM, et al. Restoring lumbar lordosis: a systematic review of controlled trials utilizing Chiropractic Bio Physics® (CBP®) non-surgical approach to increasing lumbar lordosis in the treatment of low back disorders. J Phys Ther Sci 2020;32:601-610
11. Azzam A, Moustafa IM, Ahmed AMA, et al. Efficacy of denneroll traction on restoring normal sagittal configuration of lumber spine in chronic mechanical low back pain. Bulletin of Faculty of Physical Therapy 2013(June) 15(1):5-14
12. Rome P, Waterhouse JD. An evidence-based narrative of the evidence-base concept. Asia-Pacific Chiropr J 2020;1:004 (https://doi.org/10.46323/2021004)
13. Ebrall P, Doyle M. The value of case reports as clinical evidence. Chiropr J Australia, 2020;47:29-43 (www.cjaonline.com.au/index.php/cja/issue/view/15)
14. Chiropractic BioPhysics NonProfit Inc. www.cbpnonprofit.com/publications/. Accessed July 6, 2022
15. Fedorchuk C, Himel B, Lightstone DF. Improved Pain and Quality of Life with Corrected Thoracic and Lumbosacral Spondylolisthesis Subluxations Using CBP®: A Case Study and 1-Year Follow-Up. J Radiol Case Rep 2022;16:21-38
16. Gubbels CM, Werner JT, Oakley PA, et al. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination by Chiropractic BioPhysics® methods in an adolescent with back pain: a case report. J Phys Ther Sci 2019;31:839-843
17. Fedorchuk C, Lightstone D, Baca J. Improvement in sagittal lumbar alignment and posture in an asymptomatic 9-year-old child following reduction in vertebral subluxation using Chiropractic BioPhysics protocol: A case study and review of literature. J Pediatr Matern Fam Health - Chiropr 2019;Oct:109-116
18. Harrison DE, Oakley PA. Non-operative correction of flat back syndrome using lumbar extension traction: a CBP® case series of two. J Phys Ther Sci 2018;30:1131-1137
19. Betz JW, Oakley PA, Harrison DE. Relief of exertional dyspnea and spinal pains by increasing the thoracic kyphosis in straight back syndrome (thoracic hypo-kyphosis) using CBP® methods: a case report with long-term follow-up. J Phys Ther Sci 2018;30:185-189
20. Weiner MT, Oakley PA, Dennis AK, et al. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year-old surgical candidate: a CBP® case report. J Phys Ther Sci 2018;30:1364-1369
21. Oakley PA, Harrison DE. Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks, following failed treatment from three previous chiropractors: a CBP® case report with an 8 year follow-up. J Phys Ther Sci 2017;29:2051-2057
22. Fedorchuk C, Mohammed H. Improvement in GERD Following Reduction of Vertebral Subluxations & Improved Sagittal Alignment Utilizing Chiropractic Biophysics Protocol. Ann of Vert Sublux Res June 26, 2014:99-109
23. Paulk GP, Harrison DE. Management of a chronic lumbar disk herniation with chiropractic biophysics methods after failed chiropractic manipulative intervention. J Manipulative Physiol Ther 2004;27:579
24. Troyanovich SJ, Buettner M. A structural chiropractic approach to the management of diffuse idiopathic skeletal hyperostosis. J Manipulative Physiol Ther 2003;26:202-206
25. Brown J, Jaeger J, Polatis T, et al. Increasing the lumbar lordosis by seated 3-point bending traction: A case series utilizing Chiropractic BioPhysics technique. Chiropr J Australia 2017;45:144-154
26. Harrison DE, Oakley PA. An Introduction to Chiropractic BioPhysics® (CBP®) Technique: A Full Spine Rehabilitation Approach to Reducing Spine Deformities. In: Bernardo-Filho, M, Taiar, R, de Sá-Caputo, DC, Seixas A., editors. Complementary Therapies [Internet]. London: IntechOpen; 2022 [cited 2022 Jul 09]. Available from: https://www.intechopen.com/chapters/81876. doi: 10.5772/intechopen.102686
27. Mendoza-Lattes S, Ries Z, Gao Y, et al. Natural history of spinopelvic alignment differs from symptomatic deformity of the spine. Spine 2010;35:E792-798
28. Harrison DE, Harrison DD, Janik TJ, et al. Elliptical modeling and sagittal lumbar radiographic alignment variables in normal vs. chronic low back pain subjects: does pelvic morphology explain group lordotic differences? Proceedings of the 34th annual meeting of the International Society for the Study of the Lumbar Spine (ISSLS) 2007; June 10–14, Hong Kong, p 149
29. Harrison DE, Keller TS, Harrison DD, et al. Pelvic morphology affects the sagittal plane alignment of the lumbo-pelvic spine normal subjects and low back pain patients. Proceedings of the 34th annual meeting of the International Society for the Study of the Lumbar Spine (ISSLS) 2007; June 10–14, Hong Kong, p 148
30. Harrison DE, Betz JW, Harrison DD, et al. CBP structural rehabilitation of the lumbar spine. Harrison Chiropractic Biophysics Seminars, Inc. 2007
31. Noshchenko A, Hoffecker L, Cain CMJ, et al. Spinopelvic Parameters in Asymptomatic Subjects Without Spine Disease and Deformity: A Systematic Review With Meta-Analysis. Clin Spine Surg 2017;30:392-403
32. Fujishiro T, Boissiere L, Cawley DT, et al. European Spine Study Group, ESSG. Decision-making factors in the treatment of adult spinal deformity. Eur Spine J. 2018 Sep;27(9):2312-2321
33. Banno T, Togawa D, Arima H, et al. The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 2016;25:3687-3693
34. Corso M, Cancelliere C, Mior S, et al. The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature. Chiropr Man Therap 2020;28:33
35. Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap 2018;26:48
36. Kawchuk G, Goertz C, Axén I, et al. Letter to the Editor Re: Oakley PA, Cuttler JM, Harrison DE. X-Ray Imaging Is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose Response, 2018 Jun 19;16(2). Dose Response 2018 Dec 27;16(4):1559325818811521
2. Buchbinder R, van Tulder M, Öberg B, et al. Lancet Low Back Pain Series Working Group. Low back pain: a call for action. Lancet 2018;391:2384-2388
3. Nuckols TK, Lim YW, Wynn BO, et al. Rigorous development does not ensure that guidelines are acceptable to a panel of knowledgeable providers. J Gen Intern Med 2008;23:37-44
4. Chun SW, Lim CY, Kim K, et al. The relationships between low back pain and lumbar lordosis: a systematic review and meta-analysis. Spine J 2017;17:1180–1191
5. Sadler SG, Spink MJ, Ho A, et al. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskelet Disord 2017;18:179
6. Moustafa IM, Diab AA. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial. Clin Rehabil 2013;27:51–62
7. Diab AA, Moustafa IM. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. J Manipulative Physiol Ther 2012;35:246–253
8. Diab AA, Moustafa IM. The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: a randomized trial. J Back Musculoskeletal Rehabil 2013;26:213–220
9. Harrison DE, Cailliet R, Harrison DD, et al. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial. Arch Phys Med Rehabil 2002;83:1585–1591
10. Oakley PA, Ehsani NN, Moustafa IM, et al. Restoring lumbar lordosis: a systematic review of controlled trials utilizing Chiropractic Bio Physics® (CBP®) non-surgical approach to increasing lumbar lordosis in the treatment of low back disorders. J Phys Ther Sci 2020;32:601-610
11. Azzam A, Moustafa IM, Ahmed AMA, et al. Efficacy of denneroll traction on restoring normal sagittal configuration of lumber spine in chronic mechanical low back pain. Bulletin of Faculty of Physical Therapy 2013(June) 15(1):5-14
12. Rome P, Waterhouse JD. An evidence-based narrative of the evidence-base concept. Asia-Pacific Chiropr J 2020;1:004 (https://doi.org/10.46323/2021004)
13. Ebrall P, Doyle M. The value of case reports as clinical evidence. Chiropr J Australia, 2020;47:29-43 (www.cjaonline.com.au/index.php/cja/issue/view/15)
14. Chiropractic BioPhysics NonProfit Inc. www.cbpnonprofit.com/publications/. Accessed July 6, 2022
15. Fedorchuk C, Himel B, Lightstone DF. Improved Pain and Quality of Life with Corrected Thoracic and Lumbosacral Spondylolisthesis Subluxations Using CBP®: A Case Study and 1-Year Follow-Up. J Radiol Case Rep 2022;16:21-38
16. Gubbels CM, Werner JT, Oakley PA, et al. Reduction of thoraco-lumbar junctional kyphosis, posterior sagittal balance, and increase of lumbar lordosis and sacral inclination by Chiropractic BioPhysics® methods in an adolescent with back pain: a case report. J Phys Ther Sci 2019;31:839-843
17. Fedorchuk C, Lightstone D, Baca J. Improvement in sagittal lumbar alignment and posture in an asymptomatic 9-year-old child following reduction in vertebral subluxation using Chiropractic BioPhysics protocol: A case study and review of literature. J Pediatr Matern Fam Health - Chiropr 2019;Oct:109-116
18. Harrison DE, Oakley PA. Non-operative correction of flat back syndrome using lumbar extension traction: a CBP® case series of two. J Phys Ther Sci 2018;30:1131-1137
19. Betz JW, Oakley PA, Harrison DE. Relief of exertional dyspnea and spinal pains by increasing the thoracic kyphosis in straight back syndrome (thoracic hypo-kyphosis) using CBP® methods: a case report with long-term follow-up. J Phys Ther Sci 2018;30:185-189
20. Weiner MT, Oakley PA, Dennis AK, et al. Increasing the cervical and lumbar lordosis is possible despite overt osteoarthritis and spinal stenosis using extension traction to relieve low back and leg pain in a 66-year-old surgical candidate: a CBP® case report. J Phys Ther Sci 2018;30:1364-1369
21. Oakley PA, Harrison DE. Lumbar extension traction alleviates symptoms and facilitates healing of disc herniation/sequestration in 6-weeks, following failed treatment from three previous chiropractors: a CBP® case report with an 8 year follow-up. J Phys Ther Sci 2017;29:2051-2057
22. Fedorchuk C, Mohammed H. Improvement in GERD Following Reduction of Vertebral Subluxations & Improved Sagittal Alignment Utilizing Chiropractic Biophysics Protocol. Ann of Vert Sublux Res June 26, 2014:99-109
23. Paulk GP, Harrison DE. Management of a chronic lumbar disk herniation with chiropractic biophysics methods after failed chiropractic manipulative intervention. J Manipulative Physiol Ther 2004;27:579
24. Troyanovich SJ, Buettner M. A structural chiropractic approach to the management of diffuse idiopathic skeletal hyperostosis. J Manipulative Physiol Ther 2003;26:202-206
25. Brown J, Jaeger J, Polatis T, et al. Increasing the lumbar lordosis by seated 3-point bending traction: A case series utilizing Chiropractic BioPhysics technique. Chiropr J Australia 2017;45:144-154
26. Harrison DE, Oakley PA. An Introduction to Chiropractic BioPhysics® (CBP®) Technique: A Full Spine Rehabilitation Approach to Reducing Spine Deformities. In: Bernardo-Filho, M, Taiar, R, de Sá-Caputo, DC, Seixas A., editors. Complementary Therapies [Internet]. London: IntechOpen; 2022 [cited 2022 Jul 09]. Available from: https://www.intechopen.com/chapters/81876. doi: 10.5772/intechopen.102686
27. Mendoza-Lattes S, Ries Z, Gao Y, et al. Natural history of spinopelvic alignment differs from symptomatic deformity of the spine. Spine 2010;35:E792-798
28. Harrison DE, Harrison DD, Janik TJ, et al. Elliptical modeling and sagittal lumbar radiographic alignment variables in normal vs. chronic low back pain subjects: does pelvic morphology explain group lordotic differences? Proceedings of the 34th annual meeting of the International Society for the Study of the Lumbar Spine (ISSLS) 2007; June 10–14, Hong Kong, p 149
29. Harrison DE, Keller TS, Harrison DD, et al. Pelvic morphology affects the sagittal plane alignment of the lumbo-pelvic spine normal subjects and low back pain patients. Proceedings of the 34th annual meeting of the International Society for the Study of the Lumbar Spine (ISSLS) 2007; June 10–14, Hong Kong, p 148
30. Harrison DE, Betz JW, Harrison DD, et al. CBP structural rehabilitation of the lumbar spine. Harrison Chiropractic Biophysics Seminars, Inc. 2007
31. Noshchenko A, Hoffecker L, Cain CMJ, et al. Spinopelvic Parameters in Asymptomatic Subjects Without Spine Disease and Deformity: A Systematic Review With Meta-Analysis. Clin Spine Surg 2017;30:392-403
32. Fujishiro T, Boissiere L, Cawley DT, et al. European Spine Study Group, ESSG. Decision-making factors in the treatment of adult spinal deformity. Eur Spine J. 2018 Sep;27(9):2312-2321
33. Banno T, Togawa D, Arima H, et al. The cohort study for the determination of reference values for spinopelvic parameters (T1 pelvic angle and global tilt) in elderly volunteers. Eur Spine J 2016;25:3687-3693
34. Corso M, Cancelliere C, Mior S, et al. The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature. Chiropr Man Therap 2020;28:33
35. Jenkins HJ, Downie AS, Moore CS, French SD. Current evidence for spinal X-ray use in the chiropractic profession: a narrative review. Chiropr Man Therap 2018;26:48
36. Kawchuk G, Goertz C, Axén I, et al. Letter to the Editor Re: Oakley PA, Cuttler JM, Harrison DE. X-Ray Imaging Is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks. Dose Response, 2018 Jun 19;16(2). Dose Response 2018 Dec 27;16(4):1559325818811521
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Sep 14, 2022
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Oakley, P., Kallan, S., & Harrison, D. (2022). STRUCTURAL REHABILITATION OF THE LUMBAR LORDOSIS: A SELECTIVE REVIEW OF CBP® CASE REPORTS . Journal of Contemporary Chiropractic, 5(1), 206–211. Retrieved from https://journal.parker.edu/index.php/jcc/article/view/233
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