Ivan Fedyaev
HYS
Help
Your
Spine
Auto-decompressionmethod to relieve low back pain,
andfor people
who want to help their s...
2
Nobody can cure herniated disc back pain
but
you can live normal (or almost normal)
life
without that pain dominating you
3
Table of Contents
Punishment for erect walking.............................................................................
4
Punishment for erect walking
Low Back Pain (LBP) is a contradictory symptom. It can be quite strong and yet no definite
...
5
Review ofTraction as a Method of Spine Decompression
Background of SpineTraction
The aim of any spine traction is spine ...
6
The point number 1 is the most instructive in sense that we should not forget the term
„‟traction‟‟ is a general word fo...
7
The extracts from the articles and reviews presented above do not prove that adverse effects
of traction appear more oft...
8
To make a device simpler to use and effective at the same time, the Inversion method was
proposed [34] – [38]. At first ...
9
HYS
Help
Your
Spine
A simple head support frame 1 is used (see Fig XIXattached). After the frame is suspended
from an ov...
10
There might be some other advantagesthat require further investigation:
1. using this Method by patients with simple ba...
11
References
[1] Stephen Hochschuler, Bob Reznik. Treat your back without surgery. Texas Back
Institute.2002.
[2] G.Wadde...
12
[26] US 5 135 537 Home traction device. Lamb. August 4, 1992.
[27] US 6 190345 Vertebral traction device and method. He...
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Hys xix

  1. 1. Ivan Fedyaev HYS Help Your Spine Auto-decompressionmethod to relieve low back pain, andfor people who want to help their spine
  2. 2. 2 Nobody can cure herniated disc back pain but you can live normal (or almost normal) life without that pain dominating you
  3. 3. 3 Table of Contents Punishment for erect walking........................................................................................4 Review of Traction as a Method of Spine Decompression ...................................5 Background of Traction............................................................................................................5 Adverse Effects of Traction.....................................................................................................5 Effectiveness of Traction……………………………………………………………………………..7 Review of Patented Traction Methods................................................................................7 HYS...........................................................................................................................................9 Advantages of the Method.......................................................................................................9 References..........................................................................................................................11
  4. 4. 4 Punishment for erect walking Low Back Pain (LBP) is a contradictory symptom. It can be quite strong and yet no definite damage of intervertebral disc or soft tissues are found (this condition is often called as simple non-specific low back pain or simple backache). On the contrary, some people obviously have herniated (prolapsed, slipped) disc without any pain [1]. Patients suffering from LBP noticed long time ago that this pain is usually eased by lying down. One might expect the pain to ease more with more time spent in bed. Not at all! After a long time in bed or after a night in bed an LBP patient usually is not able to move or bend properly because of back pain that can becomesignificantly worse than before. There are numerous questions relating to back pain to which medical science does not have definite answers, especially in relation to simple non-specific low back pain. “It is a problem to doctors and therapists because we cannot diagnose any definite disease or offer any real cure. So we are unsure and uncomfortable dealing with back pain”[2]. Also, there is no and unlikely to be in near future any real cure for back pain caused by herniated disc. Cartilage of discs has very little capability to scar over. Having only minimum blood supply intervertebral disc, once injured, cannot heal itself. Patients suffering from herniated disc have to accept the fact that there is no real cure. The only thing doctors can do in case of back pain of discogenic origin seems to keep a young patient capable to work and to prevent an old one from becoming a cripple. The National Institute for Health and Clinical Excellence (NICE) in their Guidelines [3]encourage LBP patients to be active and that is very much reasonable. It is true indeed that when an LBP patient is lying in bed the body continues to build up osteophytes. That is why one feels pain and cannot bend properly when getting up in the morning. Much of bed rest can surely lead to disability. The morning low back pain might be said to be caused to a large degree by destruction of osteophytes. When the patient gets up and walks, with every painful movement the inflammatory liquid is being dispersed and the salts depositions demolished, the joints' surfaces smoothed and eventually the back pain becomes relieved. This is deceptive, however. As one continues to walk the upper body weight continues to compress and wear out the discs. The time comes when strong back pain is felt again. To a large degree, it might be said that the morning (osteophytes destroying) back pain is replaced by pain caused by compression of discs, tissues and nerves.Patients with disk generated back pain are stuck in a vicious circle: both lying in bed and being active may result in more back pain. The main causes of disc generated low back pain (except injury and a few others) are gravity and vertical walking. We cannot exclude these causes from our life and it is due to these factors our vertebral discs are pressed every day till they are squashed, damaged and tissues and nerves are compressed. Back pain is said to be „punishment for our erect walking‟.
  5. 5. 5 Review ofTraction as a Method of Spine Decompression Background of SpineTraction The aim of any spine traction is spine decompression. There are numerous spine traction methods that differ in effectiveness, safety and simplicity of use but they are all intended to decompress the spine. The abridged biomechanical theory behind spine traction is as follows. Discs do not have blood vessels of their own and their nutrition depends on diffusion. The more the discs are squashed, the more difficult it is for them to get nutrition and the worse their condition becomes. Traction increases the space between vertebrae, the discs expand, get more nutrition and water through diffusion and their condition improves. Traction also decompresses tissues and nerves as inflammatory liquid gets a way out, inflammatory swelling pressure lessens, the nerves get partially freed and back pain is relieved. Due to this decompression blood circulation around discs increases which improves the transport of nutrients and disc metabolism further. Contracted muscles are stretched and relaxed by traction. Increase of intervertebral space and relaxation of spinal muscles is assumed to be the most important mechanical mechanism of back pain improvement by traction (Heijden 1955) [4]. Adverse Effects of Traction The NICE recent Guidelines state “Do not offer traction because of the increased risk of aggravating symptoms”. It is implied in this statement that traction should be avoided not because of its ineffectiveness, but because of “increased risk of aggravating symptoms”. Is it really more dangerous than other treatments? I performed myresearch and found the following statements in some of the systematic reviews and articles: 1. No systematic research has been performed into the adverse effects of traction (Heijden 1995) [4]; 2. Safety of traction has not been specifically studied (Nielens H 2007) [5]; 3. There are few data to suggest that any major adverse events occur from the use of the various forms of traction available on the market (Tong J Gan 2007) [6]; 4. Little is known about the adverse effects of traction, only a few case reports are available (Aetna, Clinical Policy Bulletin 2009) [7]. In a more recent comprehensive systematic review, the Cochrane Collaboration Group (Clarke JA and others) 2009 [8] noted under “Adverse Effects”: 1. increased pain in 11/14 inversion traction patients versus 2/13 conventional traction patients, and anxiety during treatment with “almost all of the inversion traction patients” (Guvenol 2000) [10]; 2. increased pain in 31% of static traction group and 15% of intermittent traction group (Letchuman 1993) [11]; 3. temporary deterioration in 4/24 of traction and 4/26 of exercise group (Ljunggren 1992) [12]; 4. subsequent surgery in 7/83 in lumbar traction group versus none in control group (Mathews 1988) [13]; 5. aggravation of neurological signs in 5/18 of traction group, 4/20 of light traction group and 4/20 of placebo group (Reust 1988) [49]; 6. aggravation of symptoms in 5/43 of traction and 1/43 of sham (Weber 1973) [48]; 7. “probably or definitely worse” at the three-month follow-up in 25 % of traction group and in 37% of the physical therapy group (Borman 2003) [14]. From all these we can at once exclude the point number 7 as it shows positive influence of traction and should not be included under “Adverse Effects” section in my view.
  6. 6. 6 The point number 1 is the most instructive in sense that we should not forget the term „‟traction‟‟ is a general word for variety of methods. The inversion method is only one of them. It is effective in decompression of the spine, but it is very dangerous and has many important contra-indications. No wonder that many patients have negative adverse effects. We should, however, keep in mind that increased pain during any spine traction procedure might be the result of destruction of osteophytes and stretching of joint capsules, ligaments and muscles which might be partially infiltrated with the salt crystals. So this pain is the pain that we feel while getting up in the mornings. I feel increasing back pain every time I am using my Method, especially when I am doing hula-hoop movements during the procedure, and for me it is a sign that traction is working. Increased pain reported by Letchuman (see point 2) and Weber (see point 6) is I believe of the same origin. The difference in adverse effects of traction and of other treatments in points 3 and 5 is not material. Subsequent surgery reported by Mathews (point 4) seems to be the only and the most important published adverse effect of traction. The traction studied in this case was of mechanical nature. 83 patients suffering from LBP plus nerve root compression had to come to the hospital to be treated using mechanical traction. 60 patients with the same syndrome in the control group were given only ultra-red heat. Seven patients from traction group (8.4%) had to have discectomy but none in the control group. This report shows that mechanical traction may be dangerous for patients with severe spine pathology. The authors did not suggest any explanation for this result. In my view, when the procedure is performed in a horizontal position, material of nucleus pulp may further protrude from the disc simply due to the force of gravity, especially in cases where annulus fibrosis is heavily damaged, the mechanical stretching force is strong and intervertebral separation is large enough. The subsequent strangulation of the protruded part of nucleus pulp may lead to severe aggravation of symptoms especially if the patient has to go home (i.e. move actively) immediately after the procedure. However, proposed Method is completely different from mechanical traction in this aspect as it is done in vertical position which prevents nucleus pulposus from further protruding. On the contrary, there is a chance (though small) for the protruded part of nucleus pulposus to come back inside the disk. Furthermore, this Method uses the force of gravity to achieve decompression; the force of decompression is regulated by the users themselves to avoid potential aggravation of symptoms. In addition to Cochrane Collaboration Group, in publications by Oslo City Hospitals the following was noted with regards to adverse effects of traction. From 1950 to 1961 350 patients with ruptured lumbar discs were operated in Oslo City Hospital. 37 patients used traction before an operation and in 12 of them Eie N., Kristiansen K 1962 claimed the operation to be directly connected with traction [15]. As in the study by Mathews, these 37 patients suffered from associated nerve root involvement. When disease is at this stage even a common cough (as the authors themselves say) can contribute to an aggravation of symptoms. It was not specified what traction methods were used and it was not stated in the article whether an operation would not be necessary if traction had not been used (no control group was reported). It is interesting to note that 313 patients (from 350 operated) did not use traction, they used other treatments but were operated all the same. From this fact it can be implied that other treatments also had the adverse effect of the subsequent surgery. It is likely, however, that a certain stage of the disease can lead to an operation more often than not, notwithstanding the treatments applied. As far as acupuncture is concerned, Dr CM Witt et al (2009) reported that 19,726 patients (8.6% from 229,230 treated by acupuncture) experienced at least one adverse effect and 4,963 (2.2%) reported one which required treatment. Common adverse effects were bleeding or haematoma, pain and vegetative symptoms. Two patients experienced pneumothorax and one patient experienced nerve lesion of the lower limb that lasted for six months [16]. In addition, Diane Joswick (2009), before having confirmed that ''...acupuncturists have an extremely good safety record..'', wrote that ''Others have spread serious infections by using needles that were not sterile'' [17]. She did not say what ''serious infections'' they had spread.
  7. 7. 7 The extracts from the articles and reviews presented above do not prove that adverse effects of traction appear more often and are heavier than adverse effects of other treatments (we cannot apply this conclusion to Inversion and horizontal Mechanical traction). Adverse effects clearly vary with different traction methods and depend a lot on the stage of the illness. Effectiveness of Traction The conclusions on traction effectiveness are contradictory in the available literature. Among the reviewed trials there are many with positive results, such as Lind 1974, Tesio 1993, Krause 2000, Sherry 2001, Newcastle General Hospital Study 2003-2006, Dimberg 2009 and others. These positive results are lost in the majority of “no significant difference” traction results. The Cochrane Group 2005 even said that “traction is probably not effective”[9]. They repeated this conclusion in their Review of 2009, though in the same Review they wrote: “The literature allows no firmly negative conclusion, i.e. that traction, in a generalized sense, is not an effective treatment for LBP patients” [8]. The same we read in van der Heijden (1995): “There is no conclusive evidence, however, that traction is an ineffective therapy for back and neck pain”. Comparing different traction methods, Clarke JA mentioned Lind 1974 and said that he had reported “extraordinary positive results” in favour of auto-traction compared to mechanical traction [18]. It is difficult to understand how one “probably not effective” method may be more effective than another “probably not effective” method. Why is all this so contradictory? One reason might be that back pain is contradictory in itself; the other one is that the word “traction” is used to describe many completely different methods. The third reason, perhaps the most important one, is that most authors talk about LBP patients in general. They do not subdivide patients by degrees of disc injury. But the matter is that any traction method is focused on disc. One would expect getting immediate visible positive results from traction in those LBP patients only who are already suffering from herniated (injured) disc. We should not expect immediate visible positive results from traction in patients whose disc is still more or less healthy. In general, it might be said that the more disc is injured, the more visible positive influence of traction will be observed. The researchers who paid attention to this fact noticed that ''patients with greater herniations tended to respond better to traction'' Ozturk B et al 2006 [23], “the more acute the case, the more effective is the method” W H Kirkaldy-Wills 2010 [50]. Does it mean traction is useless for LBP patients without disc‟s injury? I believe it is useful because traction naturally betters discs‟ condition though a patient may not yet feel it and medical science cannot yet measure it. Furthermore, traction is necessary for them to prevent a disc injury which might demonstrate itself later on. It is said that about half of the people who got simple backache will get it again within a couple of years. G. Waddell asked: “Why some people become chronic back cripples due to ordinary backache? Why their number has increased?”. We can certainly agree that there are many of those with ''illness behaviour''. We can as well certainly assume that among ordinary nonspecific LBP there are those with certain pathological disc changes which medical science of our days cannot discover. The aim of using my Method for preventative purpose is to decrease the number of such people becoming back pain cripples. Review of Patented Traction Methods Various traction methods have been patented. Inventors are trying to solve three main problems: effectiveness of decompression method, safety of the device and simplicity of its use. In the early methods various weights were attached to patient‟s legs with his/her head or shoulders fastened to bed [24] - [28]. Later special beds (often called tables) were invented to allow stretching of patient‟s body with various mechanisms (mechanical traction) [29] – [33]. All these methods using beds and tables may, in certain cases, provide effective decompression but they do not solve the simplicity problem and can only be used in hospitals but not at home. Furthermore, as already mentioned above, it was shown by Mathews 1988 and Eie N., Kristiansen K 1962 that mechanical traction may be dangerous for patients with severe back pathology.
  8. 8. 8 To make a device simpler to use and effective at the same time, the Inversion method was proposed [34] – [38]. At first it was called “Full Body Weight Traction” to highlight that the whole body weight is utilized in the process of decompression and no external weights or mechanisms are attached. Although the claim of the “Full Body Weight” is not correct as the weight of the legs is not utilized in the process of decompression, the method of inversion is very effective because it decompresses all the parts of entire spinal column simultaneously with quite a strong force that can be regulated.Unfortunately, this method has a major safety problem. Inversion position causes a rush of blood to the head which can result in haemorrhage. Accordingly, inversion must not be used by people taking anti-coagulants or suffering from glaucoma, retinal detachment, high blood pressure, a heart illness, an ear disease and from some other ailments and disorders. Some of these diseases can also be in a latent period and to use inversion in this period can strongly accelerate pathological process. Many other methods of decompression solve this safety problem using traction in upright vertical position. Some of them substituted gravitational weight of the body for the force of patient‟s muscles [39] [40] or for various weights [41] – [43], some use different hydraulic, pneumatic or electrical motors [44] [45].All these methods are either not effective as they deliver only partial decompression in separate parts of vertebral column and/or not simple to use (see details in our GB Patent or US Application).
  9. 9. 9 HYS Help Your Spine A simple head support frame 1 is used (see Fig XIXattached). After the frame is suspended from an over door bar 3, a patient puts a double mouth guard into the mouth to protect the teeth, settles the head inside the frame on a head back pillow 2 and their chin on a chin support (not visible on this figure), grasps the frame with both hands to protect the neck, and gradually and carefully begins bending in the knees thus applying decompressing force to the spine. To reduce strain of leg muscles the patient can simply move the feet forward from the axis of the spine as shown on Fig XIX. The larger is distance A, the stronger force is applied to the spine. This stage of the decompressing procedure, when the legs are still on the ground, is the main stage; it allows a user to carefully regulate the decompressing force applied to the spine from zero to 20% of the body gravitational weight. Contrary to Judovich B 1957 [46] and some others, even a low dose (sham) traction forces can produce intervertebral separation due to flattering of lumbar lordosis and relaxation of spinal muscles (Harte 2003, Krause 2000) [47] [26]. It is important to mention here that all the adverse effects described in the “Adverse effects of Traction” section have nothing to do with proposed Method - it simply does not have those adverse effects. The patients should know, however, that severe osteoporosis is the absolute contra-indication to this Method because of the neck strain during the decompressing procedure. Before deciding to use this Method patients should consult their GP about a test for osteoporosis risk. In future special devices will be developed for osteoporotic patients to show them the force they apply to their spine. Such devices will exclude severe osteoporosis as contra-indication for using the proposed method. If a patient has dental implants or uses dentures they should consult their GP/dentist about the risk to them although mouth guard is used in any case. Mentioned in the GB Patent and the US Application, the second stage and the third stage of decompression procedure are not recommended for general use because decompressing force in these stages is quite strong and difficult to regulate which might be dangerous for osteoporotic people. These stages (if recommended) should be used only in a hospital under a doctor or nurse supervision. Advantages of the Method 1. it is focused on the disc itself which is in most cases the source of the disease; 2. it is used in upright vertical position which is much more comfortable as compared with the inversion method; 3. it is simple because the head support frame is very simple, small and light allowing a person of any age and condition to use it at home on a regular basis; 4. it is safe because the force of decompression can be easily regulated by the users themselves; the user‟s neck is protected, the user‟s teeth are protected; and no rush of blood to the head is caused (as opposed to inversion); upright vertical position prevents material of nucleus pulposus from further protruding during decompression (as opposed to horizontal mechanical traction) and there is some chance for the protruded part of nucleus pulposus to come back inside the disc; 5. all the parts of the entire vertebral column are decompressed simultaneously which improves the discs‟ condition throughout the whole column; 6. using any other back pain treatment shall be gradually abandoned; 7. it is self-help, self-managed treatment, patients do it at home any time suitable; 8. this Method keeps young LBP patients capable to work; 9. this Method keeps old LBP patients from becoming back pain cripples.
  10. 10. 10 There might be some other advantagesthat require further investigation: 1. using this Method by patients with simple backache might prevent subsequent disk injury that is highly possible in this group; 2. this Method may be useful for patients with neck pain; 3. it may be useful for patients with ankylosing spondylitis; 4. It may be reasonable to use this Method for preventative measures by people in groups of risk: sedentary mode of life, drivers, porters, weight-lifters, oarsmen and some other sportsmen; 5. regular use of this Method might prevent osteoporosis development in the bones of spine, upper limbs and shoulder girdle (it is a positive side effect); 6. it may be used for spine curvature correction; 7. it might prevent periodontal disorders providing the gums' massage (it is another positive side effect of this Method). The most important advantage of this Method is that it is a self-help, self-manage treatment. Patients with disc generated low back pain receive a simple means for management of their back pain, they do not go to a GP or hospital, they do it at home. “Subjects cope better if they feel they have some control over what is happening” (G. Waddell 2004). In my view, the proposed Method has that balance of holistic and mechanistic approaches Gordon Waddell speaks about in his ''Back Pain Revolution''. This approach will cost nothing for NHS because most patients should be able to afford the device themselves. Even if NHS decides to provide some patients with the device, I believe it will not cost more than £200 and, once bought, it will be used for several years. This is significantly less than the cost of other treatments currently used (e.g. acupuncture), cost of work days lost and cost of sickness benefits. Most importantly, the Method significantly improves patient‟s wellbeing.
  11. 11. 11 References [1] Stephen Hochschuler, Bob Reznik. Treat your back without surgery. Texas Back Institute.2002. [2] G.Waddell. Back Pain Revolution 2004. [3] NICE Guidelines. Low back pain:early management of persistent non-specific low back pain 2009. [4] Geert JMG van der Heijden, Anna JHM Beurskens, Bart W Koes, Willem JJ Assendeft, Henrica CW de vet lex M Bouter. The efficacy of traction for Back and Neck Pain. A Systematic, Blinded Review of Randomized Clinical Trial Methods. Physical Therapy, Vol. 75, number 2, Febr 1995. [5] Nielens H, van Zundert J, Mairiaux P. Chronic low back pain. KCE reports, Vol. 48.Brussels 2007. [6] Tong J Gan, John B Leslie, Joseph V Pergolizzi. Nonsurgical Spinal Decompression to treat Chronic Low B ack Pain. Anaesthesiology News.Pain Medicine News.Special Report 2007. [7] Aetna.Clinical Policy Bulletin:Lumbar Traction Devices. 2009. [8] Clarke JA, van Tulder MW, Blumberg SEL, de Vet HCW, van der Heijden G, Bronfort G, Bouter LM, Traction for low back pain with or without sciatica (Review). The Cochrane Collaboration. 2009. [9] Clarke JA, van Tulder MW, Blumberg SEL, de Vet HCW, van der Heijden G, Bronfort G, Bouter LM. Traction for low back pain with or without sciatica.Cohrane Group. October 19, 2005. [10] Guvenol K, Tuzun C, Peker O, Goktay Y. A comparison of inverted spinal traction and conventional traction in the treatment of lumbar disc herniations. Physiotherapy Theory and Practice 2000; 16;151-160. [11] Letchuman R, Deusinger RH. Comparison of sacrospinalis myoelectric activity and pain levels in patients undergoing static and intermittent lumbar traction. Spine 1993; 18(10); 1361-5. [12] Ljunggren AE, Weber H, Larsen S. Autotraction versus manual traction in patients with prolapsed lumbar intervertebral discs. Scand J Rehub Med 1984; 16; 117-24. [13] Mathews W, Morkel M, Mathews J. Manipulation and traction for lumbago and sciatica: Physiotherapeutic techniques used in two controlled trials. Physiotherapy Practice 1988; 4:201-206. [14] Borman P, Keskin D, Bodur H. The efficacy of lumbar traction in the management of patients with low back pain.Reumatol.Int 2003; 23; 82-86. [15] Eie N, Kristiansen K. Complications and hazards of traction in the treatment of ruptured lumbar intervertebral discs. J Oslo City Hosp. 1962; 12: 5-12 [16] CM Witt et al. Safety of acupuncture: Results of Perspective Obsevational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form. J Research in Complementary Medicine.Vol. 16, Number 2, 2009. [17] Diane Joswick. Are there risks or side effects to acupuncture? Printed from Acufinder.com 09/29/2009. [18] Lind GAM. Auto-traction, treatment of low back pain and sciatica.An electromyographic, radiographic and clinical study.University of Lincoping 1974. [19] Tesio L, Merio A. Autotraction versus passive traction.An opened controlled study in lumbar disc herniation.Arch Phys Med Rehabil 1993; 74:871-6. [20] Krause M, Refshauge KM, Dessen M, Boland R. Lumbar spine traction: evaluation of effects and recommended application for treatment. Manual Therapy 2000; 5(2):72. [21] Sherry E, Kitchener P, Smart R. A perspective randomized controlled study of VAX and TENS for the treatment of chronic low back pain. Neurological research 001;23: 780-784. [22] Dimberg L, Ericsson B, Effect of gravity-facilitated traction of the lumbar spine in persons with chronic low back pain at the work place..Mastercare AB 2009. [23] Ozturk B, Gunduz OH, Ozoran K, Bostanoglu S. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation.Reumatol.Int. 26.07.2006. [24] US 4 181 125 Portable traction device. Carlson et al. January 1, 1980. [25] US 4 257 410 Traction device. Flewelling. March 24, 1981.
  12. 12. 12 [26] US 5 135 537 Home traction device. Lamb. August 4, 1992. [27] US 6 190345 Vertebral traction device and method. Henderson. February 20, 2001. [28] US 7 033 333 Self-actuated cervical (neck) traction device. Croft etal.April 25, 2006. [29] US 6 971 997 Multi-axis cervical and lumbar traction table. Ryan et al. December 6, 2005. [30] US 2008 176 721 Horizontal lumbar stretching Machine and Method..Boren John P 2008-07-24. [31] CN 101 385 672 (A) Traction gentle stepping table. Qingluo Lu.2009-03-18. [32] EP 2 108 351 (A1) Traction bed with vibrator assembly. Cook Jerry. 2009-10-14. [33] US 7 648 473 (B1) Traction extension table. PeruvingalJedheesh. 20010-01-10. [34] US 4 410 176 Full body weight traction device. Miller.october 18,1983. [35] US 5 885 197 Exercise equipment. Barton . March 23. 1999. [36] US 6 464 296 Therapeutic inversion chair. Sumner. October 15, 2002. [37] US 7 361 128 Exercising apparatus. Chen. April 22, 2008. [38] GB 2 444 708 Power driven inversion exerciser. Teeter Roger Charles. 2008-6-18. [39] US 3 621 839 Apparatus controlling the relaxation and elongation of the spine.. Barthe.Nov.23, 1971. [40] US 1 675 552 A Gymnastic Appliance. Hawxhurst. July 3, 1928. [41] US 2 658 506 A Head traction device. Haskell.Nov.10, 1953. [42] US 4 869 240 Cervical traction unit. Boren. Sept. 26, 1989. [43] FR 2 686 260 Apparatus intended for relaxation and gymnastic exercise of the cervical (neck) and lumbar regions and, more generally, of regions of the spinal column. Jean Plantier.1993-07-23. [44] US 6 468 240 Self-seating occiput wedge system for applying a therapeutic traction force. Saunders. October 22, 2002. [45] US 6 506 174 Portable traction device. Saunders et al. January 14, 2003. [46] Judovich B, Nobel GR. Traction therapy: a study of resistance forces. Am. J Surg.1957; 93: 108 -114. [47] Harte AA, Baxter GD, Gracey JH. The efficacy of traction for back pain. A systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil.2003; 84: 1542 - 53. [48] Weber H. Traction therapy in sciatica due to disc prolapse. J Oslo City Hosp. 1973, Vol 23, pages 167 - 76. [49] Reust P, Chantraine A, Vischer T.L. Mechanical traction for low back pain with and without sciatica.Schweiz. Med. Wschr. 1988; 118(8): 271 - 4. [50] W H Kirkaldy-Willis. Managing Low Back Pain (from Gen 3 Kinematics.The Latest Low Back Pain Treatment Method. The Medical Equipment, June 25, 2010)

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