1

Extentrac Elite

Presentation Paper

David F. Cuccia, D.C.

Robert McKee M.P.A., P.T.

Presented at Stony Brook University Outpatient Physical Therapy Department,

June 2005

2
Advanced Back Technologies, Inc. has developed a new, technologically
advanced treatment apparatus and methodology for the treatment of lower back pain.
Extentrac Elite represents the next generation in non surgical spinal
decompression tables.
I. Facts and Statistics
The study: Diagnosis and Management of Acute Low Back Pain (LBP), Atul, Patel
published in the American Academy of Family Physicians.

In the United States, LBP is the 2nd most common reason for a physician visit. It
is responsible for more then 20 billion dollars of cost annually.

In the United States, 60 to 90% of adults will experience some type of LBP during
their life.

In the United States, 50% of the adult working population experience LBP every
year.

In the United States, LBP is the #1 Workers Compensation claim for ages 20-39
years of age. Workers in this age group have the highest exposure to heavy work
demands.

77% of male workers compensation claims are for LBP.

The study: LBP published in the New England Jrl. of Med., 1995,333:913-7 Reported in
Am. Family Physician April 1996 V53 p181.

It is reported that 25 billion dollar direct costs are associated with LBP and LBP is
the 2nd most common reason for lost time from work.

LBP is the leading cause of disability of people younger than 45 yrs of age.

II. The opportunity

Extentrac Elite enables the clinician to provide new, additional, and improved
techniques, utilizing their technical skill and knowledge. Its revolutionary design allows
the course of treatment intervention to match the patients examination findings. A
general description of Physical Therapy is the constant assessment and reassessment of
changes in strength and mobility of joints and soft tissue and the patients functional
ability. This is performed through multiple methods of treatment techniques including:
Therapeutic Exercise and Activities, Manual Therapy, Neuromuscular Re-education,
Physical Modalities and Patient Education. Each patients treatment plan is individually

3
designed and modified based on the clinical assessments made at the initial examination
and subsequent follow-up evaluations.

III. Evidence Based

Extentrac Elite affords the therapist the ability to implement evidenced based research
study findings as described below and incorporate accepted physical therapy practice
modalities and spinal positions during axial decompression. The clinician may quickly
modify or change the treatment protocol based on clinical re-assessment at any point in
the course of treatment.
The study and effectiveness of treatment of non-surgical spinal axial decompression
therapy is documented in existing published studies.

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 2 mm (16%) or 3.5 to 6 mm.

(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 disk 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 chord. 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 CTmyelographic 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.

Axial Decompression Studies

Support for the use of axial decompression to reduce internal disc pressure, increase
vertebral canal diameter, reduces disc protrusion, and improves disc metabolism.

The effect of vertebral axial decompression in the lumbar spines

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.

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 nourishment 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.

Extension Studies
Support for the use of extension of the lumbar spine to 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
intervertebral 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.

Only relaxes the chord and nerve roots and that slight extension is the
preferred position in the cervical and lumbar spine. Inufusa A, An HS,
Lim TH, Hasagawa T, Haughton VM, Nowicki BH. Anatomic changes of the
spinal canal and intervertebral foramine associated with flexion-extension
movement. Spine 1966; 21: 2412-20.

IV. Key Features

Extentrac Elites versatile design permits the clinician the ability to apply evidenced
based therapeutic procedures and unique proprietary procedures. Patients may be
positioned in pain-alleviating, anatomically correct positions during decompression
which include lumbar extension, flexion, lateral flexion, and axial positioning.
Pre-existing axial decompression tables limit the direction of distraction to the axial
position. Additional key features which differentiate the Extentrac Elite from all other
decompression units include:

Other decompression devices cannot achieve similar positions required for the
duplication of the integrated dynamic lumbar motion, which is found to provide
positive therapeutic intervention with the unloading and decompression of the
spine, with which the Extentrac Elite produces synergistically for the patient.

Various combinations of therapeutic treatment capabilities are the integral

components in reproducing the Extentrac Treatment Protocol and attaining the
outstanding positive clinical changes the Extentrac Elite achieves.

The Extentrac Elites M3D system is a patient positioning system enabling

decompression from varying angles not limited to the axial position unlike other
decompression units.

Administration of treatment can be Vertical or Horzitional, in the Prone or

Supine position, while incorporating Flexion, Lateral Flexion, or Extension
positions of the lumbar spine.

A choice to incorporate axial decompression with any of the aforementioned

treatment positions through 2 separate powered decompression systems. The
clinician may utilize either the Lumbo-Pelvic assembly or the Leg assembly for
power decompression.
The orientation of the patient treatment platform is vertical, permitting
gravitational traction features in cases requiring non-powered horizontal
decompression treatment. The clinician may control the percent of the body
weight by altering the patient platform.

The Extentrac Elite also has a unique feature: the Lumbo - Pelvic Support, that
allows for increase or decrease in lumbo-pelvic tilt. This can be controlled via the
PC computer for individual incremental treatment changes as well as the
pre-programmed treatment angles corresponding to approximate lumbar levels.

At any time during the treatment, the clinician can disengage the power systems
and incorporate direct manual therapy with joint mobilization.

The Extentrac Elites treatment versatility allows for decision making by the
clinician based on what method is deemed the best form of treatment for the
individual patient. The clinician can devise a plan of treatment specific to the
examination findings and the patients needs. The clinician can match the clinical
exam to the type of intervention (flx/ext, ex, decomp, etc) and change the
treatment plan based on new clinical findings.

The Extentrac Elite adds valuable assistance to support McKenzies

Centralization Theory via the Extentrac Elite Disc Decompression treatment in
an extension position. (The Centralization Theory: a rapid change in the location
of pain from a distal or peripheral location to a more proximal or central position.
The theory attempts to centralize the pain with the goal of quicker recovery and
return to normal function).

Spinal Decompression, Manual Therapy, Joint Mobilization, Therapeutic

Exercise, Neuro Muscular Re-education, Soft Tissue Mobilization, and PROM
can all be administered while on the Extentrac Elite table. Additionally, based on
the patients treatment findings, modalities such as Moist Heat, Ice and
Neuromuscular electrical stimulation can be administered.

The Extentrac is PC Computer driven with multiple safety features, many of

which are manually controlled by the patient and/or clinician, as well as
automatically controlled by the computer.

The Extentracs PC software has pre-programmed treatment protocols, and the

ability for the clinician to customize the treatment protocol and parameters for
each individual patient. The treatments can be administered via the computerized
software automated though the computer, or manually controlled by the clinician.

Patient set up time is quick and efficient, requiring only a few minutes. Treatment
time is patient dependent with a graduated increment of treatment time as
indicated, generally, starting with 15 minutes and progressing up to 30 minutes as
patient tolerance allows.

The frequency for treatment, based on ABTs protocols, for the best outcome is 5
days per week for 2-4 weeks, followed by a decrease of treatment frequency over
the next few weeks.

Treatment is dependent upon the clinical findings determined after initial patient
assessment, including a complete neuro and musculo skeletal exam including
strength, endurance, coordination, and mobility of the joints and soft tissue.

With a post Extentrac treatment re-evaluation and comparison of pre and post
treatment findings.

The frequency and duration of treatment will vary dependent upon the individual
patient and the clinicians exam findings.