Conservative Care The Sister Kenny Institute Gravity Lumbar Reduction Program

The Sister Kenney Institute
Gravity Lumbar Reduction Program (GLR)

In 1976, at the Sister Kenny Rehabilitation Institute in Minneapolis, a unique program of non-invasive spine care was first introduced. It was christened the "Sister Kenny Institute Gravity Lumbar Reduction Program (GLRP) and it appears to have been the prototype for the first comprehensive conservative care system ever created for long-term self-administered spine care utilizing controlled self-applied axial spine traction combined with other elements. GLRTP was intended for therapy as well as prevention and consisted of the following elements:

1. Primary Education in Spine Anatomy and Physiology
2. Primary Education in Body Mechanics and Dynamics
3. Physical and Aquatic Activation
4. Muscle Strength, Tone, and Flexibility Training
5. Smoking Cessation
6. Training in the use of "Fail-safe" Spinal Axial Distraction

At it's inception the means of achieving controlled spinal distraction (self-governed traction) was a chest harness designed to grasp and support the rib cage so that the only distractive force exerted on the spine was the weight of the lower extremities. In this manner this force would not exceed the compliance of normal tissue. In addition to axial spine distraction important adjuncts of this program were spine education but also the patient training intended to provide each individual with the means of daily self-employment of the program at home and thus become independent of the health care system.

Initially, the program required a 10 day hospital stay. Although a few particularly stoic individuals could immediately begin to use the chest harness at a 90^o angle the average patient required the hospitalization period so that they could gradually acclimate their rib cages to this usual demand being placed on them. Shown, on the left, is a electrically controlled tilt-bed being used to provide intermittent periods (10-15 minutes) of spine traction throughout the day at progressively increasing angles of tilt. Intermittent short-term use was advised to avoid over distention of discs and the production of back pain related to this phenomenon.

The success of the GLRP in the non-invasive treatment of a number of spine disorders including disc herniations, painful scoliosis and early lateral spinal stenosis was such that it was subsequently implemented in a number of other facilities throughout the world.

Shown above is a clinic in Cali, Columbia. As an "orphan" technology with a low M2H factor this program, despite its success, did not receive much attention.

In GLRP once patients had completed the in-hospital training phase they were provided with adjustable support stands developed for home-use. Although cumbersome and rather user-unfriendly the program was quite cost-effective in treating a number of conditions which otherwise would have gone on to surgery (i.e. disc herniation).

In 1975 Oudenhoven published clinical data on 121 patients treated with the SKI gravitational traction and concluded that it warranted "careful consideration in the management of chronic back and extremity pain" (Oudenhoven RC: Gravitational Lumbar Traction, Arch Phys Med Rehabil., Vol. 59:pp. 510-512, 1975).

Clinical Examples of Long-Term GLRTP Success

Despite its cumbersome nature many patients who experienced good results with the GLRP continued with the program on a daily basis for many years. Shown to the right is J. H. in 1999. He completed the 10 day in-hospital GLR program in 1982, continued daily use for 17 years and avoided further low back problems. His reason for being seen for follow-up was related to the onset of neck pain.

In 1980 J.O., shown above, became disabled with left leg pain due to a large herniated disc, with associated free fragment at L5-S1. Because he was neurologically intact he treated non-surgically with the GLRTP. He did well and became asymptomatic. In 1984 a follow-up CT scan documented reabsorbtion of his herniated disc. J.O. was next seen in 2003 because of non-specific back pain. His up-dated MRI study (above) documented an underlying genomic spine condition and further documented the resolution of the disc herniation at L5-S1 (see red dot). The presence of multi-level disc degeneration associated with endplate scalloping and a benign vertebral hemangioma at the L2 level are findings consistent with the diagnosis of a "Genomic Spine Disorder".