**6. Contraindications to extension traction**

Generally, contraindications for extension traction protocols are the same as contraindications for SMT. Although traction protocols may be used in these cases, patients with a history of stroke, high blood pressure, bone spurring on the posterior aspect of the spine, spinal stenosis or other space occupying lesions represent potential high-risk, and therefore, extra caution should be taken to screen these patients for tolerance to this type of traction.

Patient screening for the ability to tolerate spinal extension traction should be performed for all patients. This typically includes assessing tolerance while laying supine on an extension traction device (e.g., Denneroll). The patient should be assessed for distress and/or an exacerbation of symptoms including the reporting of nausea, dizziness or increased pain. Those with rigid spine deformities and/or spinal osteoarthritis should have a stress view radiograph taken for flexion-extension as well as lying supine over an extension traction device.

The following represent absolute contraindications to the application of spinal extension traction [36, 37]:


The following represent relative contraindications to spinal extension traction that require diligent screening and clinical evaluation [36, 37]:


*Restoration of Cervical and Lumbar Lordosis: CBP® Methods Overview DOI: http://dx.doi.org/10.5772/intechopen.90713*


When applying extension traction protocols, it is important to realize the obvious notion that this applies only to those presenting with hypolordosis, straightening, or kyphosis of the cervical or Lumbar spinal areas, not to those with hyperlordosis. In such cases, different CBP traction protocols apply which are beyond the scope of this brief review [39, 56]. Also, in the performance of assessing patient tolerance to extension traction, the slow progression of increasing time and transitioning to a more challenging extension stretch is found in the skill and art of the hands of the practitioner. Fortunately, extension traction protocols have been proven safe as no reports of deleterious outcomes have been reported in the multiple RCT's [24–35]. Further, this approach seems so safe that once thought of as contraindications, for example spondylolisthesis, have been shown to be able to be reduced by a special application of these methods [55]. Again, the experience and confidence of the practitioner will dictate whether this approach is selected for different candidate patients with their corresponding varying levels of difficult spinal conditions and case histories.

Concerns over radiation exposures during routine spinal X-ray imaging need discussion. Although this topic has been thoroughly discussed elsewhere [57–60], in brief, patient exposures from spinal X-rays are not harmful. First, the assumption that radiation exposures from low-doses are carcinogenic is false; low-doses of radiation (including X-rays and CT scans) stimulate the adaptive protection systems in the body to "over-repair" any genetic damage done, including DNA double strand breaks by imaging [61]. Second, because of point one, there is no cumulative effect; therefore, the only relative risk can be considered from a single session of X-rays (i.e., 1–3 mGy) [57, 58]. Third, due to point two, the amount of radiation from X-rays of 1–3 mGy is many times lower than the recognized dose threshold for leukemia of 1100 mGy (95% CI: 500–2600 mGy) [57, 62] and therefore cannot be carcinogenic.

### **7. Conclusions**

Today there are reliable and predictable means through application of extension spinal traction as part of comprehensive rehabilitation programs to restore the natural curvatures of the spine. High-quality evidence points to CBP methods as

offering superior long-term outcomes for treating patients with sagittal plane spine and posture deformities who present with various craniocervical and lumbosacral disorders.
