Lumbar Traction

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Definition/Description[edit | edit source]

Various forms of lumbar traction has been used for the relief of pain since the time of Hippocrates. During the 1950’s and 1960’s it became a popular, and until today it is used by physiotherapists for threatening patients with low back and leg pain.[1] Although its effectiveness is still being questioned by a few clinical trials (see further), there are three benefits described of lumbar traction: distraction to increase the intervertebral space, tensing of the posterior longitudinal vertebral ligament and suction to draw the disc protrusion towards the center of the joint.[2]
Different types of lumbar traction can be used.[3] First of all there is mechanical traction, using a mechanical device and a specially designed table that is divided into two sections.[2] The device delivers a certain tension to perform the traction. The patient wears a harness, which consists of two rings, to support the patient.[4]
Autotraction also utilized a table divided into two sections, the patient provides the traction force by pulling with the arms and/or pushing with the feet.[2] Finally there is manual traction performed by the therapist, pulling at the patient his ankles. Another way of manual traction is with the patient his legs over the therapist his shoulders, the therapist will place his arms on the patient’s thighs and pull.[4]
Continuous traction is applied for several hours with the use of a small amount of weight. Sustained traction has a shorter duration but a larger tension force.[3] Intermittent traction is similar sustained traction but alternately applies and releases the traction force at certain intervals.[2]

Clinically Relevant Anatomy[edit | edit source]

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Epidemiology /Etiology[edit | edit source]

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Characteristics/Clinical Presentation[edit | edit source]

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Medical Management
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Physical Therapy Management
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Lumbar traction is used in many disorders of the low back.

Lumbar disc herniation:
</uSeveral studies have investigated the effect of lumbar traction on lumbar disc herniation. Tesio et al (1993)[5] demonstrated that autotraction showed continued improvement after three months, pain ratings remained stable but disability scores decreased to 0 to 23% of the pretreatment value. Autotraction does not change the location and size of an herniation but there is an marked clinical improvement in the patients.[6]
According to Ljunggren et al. autotraction and manual traction are equally efficient, in both treatments the pain intensity was significantly reduced.[7]
Mechanical lumbar traction as additional therapy to extension exercises facilitates the patient’s improvement in pain and return to prior level of function. After 5 weeks patients no longer experience low back pain and improved in terms of functional status and pain-related disability.[8] Lumbar traction in combination with a physical therapy program also gives a decrease in the size of herniated disc material.[9]
Unlike the previous studies, Rattanatharn et al. showed no benefit of traction (together with routine conservative treatment) for patients with acute herniated disc syndrome.[10] Both the traction group and the sham traction group had improvement of their symptoms, which means the patients can be treated conservatively at home with proper instructions.

Low back pain:
</uSeveral studies found no positive effect of lumbar traction for low back pain. There is no improvement in functional status, pain, range of motion and work absence due to lumbar traction (compared with sham traction).[11] Also the addition of intermittent mechanical traction to a standard graded activity program gives no extra advantages for people with low back pain. There is no difference in outcome of the graded activity program with or without the lumbar traction.[12] Borman et al. had the same effect in their study: no specific effect of traction in standard physical therapy for low back pain was observed.[13]
Although previous conclusions give no benefit to lumbar traction for low back pain, Cai et al.[14] searched prediction rules for those patients who have an improvement. The presence of non-involvement of manual work, low level fear-avoidance beliefs, no neurological deficit and age above 30 years increase the probability of response to mechanical lumbar traction.

Lumbago - Sciatica:
</uIn the treatment of lumbago – sciatica lumbar autotraction is a better method than the use of a corset and rest. It gave an immediate relief of pain and a normalizing of the SLR test, also after three weeks.[15] Autotraction has also an improvement in long term results for people with chronic lumbago and sciatica.[16]

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References[edit | edit source]

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  1. ↑ Lee RY et al. Loads in the lumbar spine during traction therapy. Australian Journal of Physiotherapy. 2001; 47(2): 102-108. (LEVEL E)
  2. ↑ 2.0 2.1 2.2 2.3 Pellecchia GL et al. Lumbar traction: A review of the literature. J Orthop Sports Phys Ther. 1994 Nov;20(5):262-267. (LEVEL 1A)
  3. ↑ 3.0 3.1 Saunders HD. Lumbar traction*. J Orthop Sports Phys Ther. 1979; 1(1): 36-45. (LEVEL 1A)
  4. ↑ 4.0 4.1 http://www.surgery-lumbar.com/lumbar_traction
  5. ↑ Tesio L et al. Autotraction versus passive traction: an open controlled study in lumbar disc herniation. Arch Phys Med Rehabil. 1993 Aug; 74(8): 871-876. (LEVEL 1B)
  6. ↑ Gillström P et al. Autotraction in lumbar disc herniation. A myelographic study before and after treatment. Arch Orthop Trauma Surg. 1985; 104(4): 207-210. (LEVEL 1B)
  7. ↑ Ljunggren AE et al. Autotraction versus manual traction in patients with prolopsed lumbar intervertebral discs. Scand J Rehabil Med. 1984; 16(3): 177-124. (LEVEL 1B)
  8. ↑ Gagne AR et al. Lumbar extension exercises in conjunction with mechanical traction for the management of a patient with a lumbar herniated disc. Physiother Theory Pract. 2010 May; 26(4): 256-266. (LEVEL 3B)
  9. ↑ Ozturk et al. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation. Rheumatol Int. 2006 May; 26(7): 622-626. (LEVEL 1B)
  10. ↑ Rattanatharn R et al. Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. J Med Assoc Thai. 2004 Sep; 87 (2): 272-277. (LEVEL 1B)
  11. ↑ Beurskens AJ et al. Efficacy of traction for nonspecific low back pain, 12-week and 6-month result of a randomized clinical trial. Spine. 1997 Dec1; 22(23): 2756-2762. (LEVEL 1B)
  12. ↑ Schimmel JP et al. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy. Eur Spine J. 2009 (18): 1843-1850. (LEVEL 1B)
  13. ↑ Borman P et al. The effect of lumbar traction in the management of patients with low back pain. Rheumatol Int. 2003; 23(2): 82-86. (LEVEL 1B)
  14. ↑ Cai et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction. Eur Spine J. 2009; 18(4): 554-561. (LEVEL 1B)
  15. ↑ Larsson U et al. Auto-traction for the treatment of lumbago-sciatica, a multicentre controlled investigation. Acta orthop Scand. 1980; 51; 791-798. (LEVEL 1B)
  16. ↑ Gillström P et al. Long-term results of autotraction in the treatment of lumbago and sciatica. Arch Orthop Trauma Surg. 1985; 104(5): 294-298. (LEVEL 1B)
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