Michael Epstein


Objective: To describe as a case report a novel method of compression traction to the lumbar spine and its suggested ability to reduce axial pain and bilateral radicular leg pain as a result of its application.

Clinical Features: SMAT (Supine Mid Abdominal Traction) is an intervention which allows a static load to be applied to the anterior abdomen while in a supine position with the knees flexed. Its main clinical feature appears to be its influence during SMAT on increasing intervertebral disc space.

Intervention and Outcome: A series of increasing static loads (~50N, 100N, 150N) were applied to the participant while performing SMAT. Digital radiographs, CT and CTA scans with 3D reconstructions was analyzed using PostureRay digitization, hand-drawn measurement and visual analysis. CT angiography was performed to test if any abdominal vascular compromise had occurred during the application of SMAT. The earliest data was collected over a period of 3 years, which lead to the tested method. When Supine Mid Abdominal Traction was performed, the lumbar lordosis reduced by up to 32.5% (~150N, knees flexed) compared to no SMAT (knees flexed only). A series of comparative standing sagittal lumbar radiographs were taken over a 3-year period, with SMAT being the only therapeutic intervention. This resulted in a reduction of L2-L3 intersegmental translation from an abnormal value of -6.3mm to 3.4mm, a 46.03% change.

To test the safety of SMAT, CT angiography was performed with a SMAT load of ~100N with no change was evident to the caliber of the abdominal aorta during abdominal compression.

Conclusion: This case report suggests that SMAT was safe to perform, observed during its application a reduction to relative and absolute lumbar vertebral rotation angles and an increase of lumbar disc height at multiple levels. There was immediate and long term relief of lumbar axial and radicular leg pain associated with the application of SMAT.