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Traction for low-back pain

Wegner I, Widyahening IS, van Tulder MW, Blomberg SEI, de Vet HCW, Brønfort G, Bouter LM, van der Heijden GJ
Published Online: 
19 August 2013

We reviewed the evidence on the effect of traction on pain intensity, ability to perform normal daily activities, overall improvement and return to work among people with low back pain (LBP) in the acute (less than four weeks' duration), subacute (from four to 12 weeks' duration) or chronic (more than 12 weeks' duration) phase. Some patients also had sciatica. We examined the effects of traction immediately after the traction session, in the short-term (up to three months after traction) and in the long-term (around one year after traction).

LBP is a major health problem around the world and is a major cause of medical expenses, absenteeism and disability. One treatment option for LBP that has been used for thousands of years is traction, the application of a force that draws two adjacent bones apart from each other in order to increase their shared joint space. Various types of traction are used, often in combination with other treatments. The most commonly used traction techniques are mechanical or motorized traction (where the traction is exerted by a motorized pulley) and manual traction (in which the traction is exerted by the therapist, using his or her body weight to alter the force and direction of the pull).

The evidence is current to August 2012. The review included 32 studies and 2762 people with LBP. Most studies included a similar population of people with LBP with and without sciatica. The majority of studies included people with acute, subacute and chronic LBP. Most studies reported follow-up of one to 16 weeks, and a limited number of studies reported long-term follow-up of six months to one year.

The included studies show that traction as a single treatment or in combination with physiotherapy is no more effective in treating LBP than sham (pretend) treatment, physiotherapy without traction or other treatment methods including exercise, laser, ultrasound and corsets. These conclusions are valid for people with and without sciatica. There was no difference regarding the type of traction (manual or mechanical).

Side effects were reported in seven of the 32 studies and included increased pain, aggravation of neurological signs and subsequent surgery. Four studies reported that there were no side effects. The remaining studies did not mention side effects.

The quality of the evidence ranged from very low to moderate. There was a scarcity of high-quality studies, especially those that distinguished between people with different symptom patterns (with and without sciatica, with pain of different duration).