This systematic review involves the effect of traction for patients with acute, sub-acute or chronic low-back pain, with or without sciatica. Outcomes of interest include pain, functional status, global measures (such as overall improvement), and return to work.
Low-back pain (LBP) is a major health problem among populations in western industrialized countries and a major cause of medical expenses, absenteeism and disablement. Various types of traction are used to treat low-back pain patients, 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 review includes 25 studies, and 2206 patients with LBP. In studies involving patients with a mix of symptoms (i.e., where some but not all had sciatica), results consistently showed that traction (continuous or intermittent) as a single treatment for LBP was not more effective than placebo, sham treatment or other treatments. For patients with sciatica, there is conflicting evidence on many of the comparisons, but moderate evidence that continuous or intermittent traction is not more effective than other treatments.
Seven of the 25 studies report that patients receiving traction experienced some adverse effects (such as increased pain, subsequent surgery); two studies reported that there were no adverse effects; in the remaining studies adverse effects were not mentioned.
A limitation of this review stems from the scarcity of high quality studies, especially those which distinguish between patients with different symptom patterns (with and without sciatica, with pain of different duration).