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.

Only 3 controlled trials were included, so the review is based on a small evidence base. The sample was 120 intervention patients and 102 controls, all mid-aged adults, so results may not apply to younger or older patients. The review authors have financial ties to the method: one is a paid consultant and another teaches and sells products for it. The randomized trials were not blinded: participants, therapists and assessors were not blinded, which can affect pain and function outcomes. Lumbar lordosis was measured differently across trials, using different vertebral levels and methods. In the non-randomized trial, extension traction was given with spinal manipulation, so the effect of traction alone cannot be separated. No study has identified the optimum subgroup of patients with hypolordosis who will respond to extension traction. The authors state the conclusions are preliminary.

Paul Oakley is a paid consultant for CBP NonProfit. Deed Harrison teaches chiropractic rehabilitation methods and sells products for patient care as described. Niousha Navid Ehsani and Ibrahim Moustafa declared nothing.

Do not conclude that extension traction is proven for all low back pain. The review included only 3 controlled trials, the authors have financial ties to the method, and the best candidate subgroup has not been identified.