The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis

Abstract

Objective: This study aimed to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) on the comparative effects of different types or parameters of lumbar traction in low back pain (LBP). Methods: CENTRAL, CINAHL, ISI Web of Science, PEDro, PubMed, and Scopus databases were searched from their inception to March 31, 2021. We considered all RCTs comparing different types or parameters of lumbar traction on adults who complained of LBP with or without lumbar radiculopathy (LR). Any restriction regarding publication time or language was applied. Two reviewers independently selected the studies, performed the quality assessment, and extracted the results. Meta-analysis employed a random-effects model. Results: Sixteen studies met the inclusion criteria for qualitative analysis, and five were pooled. Meta-analyses of results from five studies on LBP with LR showed no significant difference between diverse tractions modalities at short-term follow-up. Very low to low-quality evidence supports these results. High-force and low-force traction demonstrated clinically significant improvements in pain. Conclusion: The literature suggests the short-term effectiveness of traction on pain in LBP with LR, regardless of the type or the dosage employed. Different effects of traction other the mechanical ones can be hypothesized. This systematic review may be relevant for clinical practice due to the similar effects of different traction types or dosages. Level of Evidence: Level I, Therapeutic Study

Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review

“…According to the consensus guidelines reviewed, regarding mechanical traction, the available data are insufficient to either endorse or discourage its usage in chronic LDHR treatment, considering its limited effectiveness when combined with other therapies [47,77,78]. However, our review questions the sparse recommendation of traction due to the fact that four systematic reviews with meta-analysis have indicated its short-term effectiveness for the management of patients suffering from LDHR [48][49][50][51]. Furthermore, these guidelines [46,47,77,78] ignore the evolving literature on using LET for the restoration of lumbar lordosis in LDHR [59][60][61][62][63][64][65][66].…”

“…It is interesting that recent international guidelines [46] and consensus initiatives [47] continue to dismiss the evidence that promotes the use of lumbar spine traction for the management of low-back pain with or without radiculopathy due to disc herniation; in fact, spinal traction is rather emphatically listed as a procedure without supporting evidence and not to be employed [46,47]. Interestingly, these consensus documents/opinions [46,47] are in opposition to four recent systematic reviews with meta-analyses [48][49][50][51], and are supported by more recent randomized trials [52], which establish the clinical utility and early effectiveness of traction for LDHR [48][49][50][51]. For example, these meta-analyses have all concluded that NSD traction is effective for relieving back and leg pain intensity [48][49][50][51] and disability [50] due to lumbar disc herniation.…”

“…Interestingly, these consensus documents/opinions [46,47] are in opposition to four recent systematic reviews with meta-analyses [48][49][50][51], and are supported by more recent randomized trials [52], which establish the clinical utility and early effectiveness of traction for LDHR [48][49][50][51]. For example, these meta-analyses have all concluded that NSD traction is effective for relieving back and leg pain intensity [48][49][50][51] and disability [50] due to lumbar disc herniation. However, Cheng et al [48] concluded that the effects of NSD were only significant in terms of short-term outcomes.…”

K-line tilt: A novel potential predictive indicator for the effectiveness of conservative cervical spondylotic radiculopathy management

“…The choice and e cacy of surgical and conservative treatments for radiculopathic cervical spondylosis have been controversial, and surgical and conservative treatment indications, timing, and duration remain unclear. Conservative treatment is usually the rst choice for neurogenic cervical spondylosis because it avoids the trauma and risks of surgical treatment [20][21][22]. Literature indicates that surgical treatment is only considered when the pain is severe, conservative treatment has failed, or muscle weakness and atrophy are evident [23].…”

Lumbar Spine Coronal Balance Parameters as a Predictor of the Rehabilitation Management Outcomes in Patients With Radiculopathy Due to Lumbar Disc Herniation: A Multicenter Prospective Cohort Study

“…Despite the high prevalence of this condition, its conservative treatment remains challenging for spine specialists [2] [3]. Recent systematic reviews reported a lack of clearly effective conservative treatments for lumbar radicular pain, particularly for long-term management [4] [5]. 2 Most important, the literature provides scant information about the relevant biopsychosocial patient variables that may be the explanatory reasons for those patients who will have suboptimal outcomes at long-term assessment after rehabilitation programs [6].…”