Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: a systematic review of controlled trials.
Paul A Oakley, Niousha Navid Ehsani, Ibrahim M Moustafa and 1 others
PMID 34658525WHAT IT FOUND
Cervical extension traction increased cervical lordosis by 12 to 18 degrees across nine controlled trials, with 2 to 4 point pain reductions and 10 to 27% disability improvements.
Control groups showed no lordosis change. Gains held at follow-up up to 15.5 months.
Key findings
01CET patients achieved a 12 to 18 degree increase in cervical lordosis after 15 to 60 treatment sessions over 5 to 15 weeks, corresponding to a 6 to 25 mm reduction in anterior head translation.
02CET patients showed a 2 to 4 point reduction on 11-point pain intensity scales and a 10 to 27% reduction on various disability scales, while all comparison groups receiving other treatments and all no-treatment controls showed no improvement in cervical lordosis.
03In the seven trials with follow-up (3 to 15.5 months), lordosis correction was relatively stable, with no or slight loss of initial improvement, up to 3.5 degrees (19% of original correction) at 15.5 months.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Five of the nine trials were conducted in Egypt, limiting generalizability to other populations. All participants were mid-aged adults (average cohort ages 32 to 54 years), so the findings cannot be assumed to apply to younger or older patients. Five different traction approaches and devices were used across the trials, making it impossible to identify which method is most effective or best suited to which cervical spine pattern. The Lee 2019 trial took its post-treatment X-ray immediately after the last treatment session, which the authors flag as a critical methodological flaw that likely overestimates the lordosis correction (2.4 degrees per treatment versus 0.4 to 0.45 in the other trials). Post-treatment lordosis values (19 to 28 degrees) were below the 31 to 40 degree range the authors cite as clinically normal, suggesting the treatment courses were too short. Only English-language publications were included. None of the trials incorporated sub-cervical spine biomechanics (thoracic curve, T1 slope), which modern cervical analysis considers important. Measurement methods differed: one trial used the C2-C7 Cobb angle while the others used the C2-C7 posterior tangent method.
Declared interests
One author (PAO) is a paid consultant to CBP NonProfit Inc., the organization that teaches the cervical extension traction technique through its seminars. Another author (DEH) teaches and sells products to doctors for spinal rehabilitation. The authors state there are no other conflicts of interest. This matters because the technique under review is the one these authors are professionally invested in promoting.
The easy way to misread this
Do not read this as a settled, universally applicable treatment you can add to your practice on Monday. Five of the nine trials were conducted in Egypt, all participants were aged 32 to 54, the Lee 2019 trial took its post-treatment X-ray immediately after the last session (a flaw the authors themselves flag), and the achieved lordosis of 19 to 28 degrees was below the 31 to 40 degree range the authors cite as clinically normal. One author is a paid consultant to the organization that teaches the technique, and another sells spinal rehabilitation products.
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