Traction, Low Back Pain, Research Suggests it Doesn’t Work

Traction for low-back pain with or without sciatica. Wegner I, Widyahening IS, van Tulder MW, Blomberg SE, de Vet HC, Brønfort G, Bouter LM, van der Heijden GJ. Cochrane Database Syst Rev. 2013 Aug 19;8

Quotes from abstract (but I read the whole thing)

We included 32 RCTs involving 2762 participants in this review. We considered 16 trials, representing 57% of all participants, to have a low risk of bias based on the Cochrane Back Review Group’s Risk of bias’ tool.

For people with mixed symptom patterns (acute, subacute and chronic LBP with and without sciatica), there was low- to moderate quality evidence that traction may make little or no difference in pain intensity, functional status, global improvement or return to work when compared to placebo, sham traction or no treatment. Similarly, when comparing the combination of physiotherapy plus traction with physiotherapy alone or when comparing traction with other treatments, there was very-low- to moderate-quality evidence that traction may make little or no difference in pain intensity, functional status or global improvement.

For people with LBP with sciatica and acute, subacute or chronic pain, there was low- to moderate-quality evidence that traction probably has no impact on pain intensity, functional status or global improvement.

For chronic LBP without sciatica, there was moderate-quality evidence that traction probably makes little or no difference in pain intensity when compared with sham treatment.

Adverse effects were reported in seven of the 32 studies.

These findings indicate that traction, either alone or in combination with other treatments, has little or no impact on pain intensity, functional status, global improvement and return to work among people with LBP. There is only limited-quality evidence from studies with small sample sizes and moderate to high risk of bias. The effects shown by these studies are small and are not clinically relevant.

To date, the use of traction as treatment for non-specific LBP cannot be motivated by the best available evidence. These conclusions are applicable to both manual and mechanical traction.

Only new, large, high-quality studies may change the point estimate and its accuracy, but it should be noted that such change may not necessarily favour traction. Therefore, little priority should be given to new studies on the effect of traction treatment alone or as part of a package.

My comments:

The authors comments pretty much say it all. Lots of studies done, little to no effect was found and that’s even including studies that are of high risk for bias. I have been following the traction (aka spinal decompression therapy) research for years and this is the strongest wording, as to ineffectiveness, to date coming from Cochrane. Cochrane reviews are usually pretty conservative and lenient with medical claims. Usually they will suggest that more research needs to be done, while these authors seem content to basically say, “save it.”

I had an inversion table in my office for a couple years that was given to me by a patient who no longer used it. I honestly can’t say it did anyone any real good, so my experience is in line with the findings of this review. Plus I thought someone was going to break a leg climbing on and off of it. So I guess you could say I was open to the idea that traction might work, and gave it a shot because it did make a certain amount of intuitive sense. I even have a pair of gravity boots from the 80s, that you can still buy on Amazon collecting dust somewhere.

Reports like this really makes me feel bad for all the physical therapists and chiropractors who went out and purchased Vax D machines, which were not at all cheap. Still I feel more sorry for their patients, so I figured this blog was worth writing. The word was pretty much out on the ineffectiveness of lumbar  traction/Vax-D, (on Chirobase, and Wikipedia) but this most recent Cochrane review added some additional studies strengthening the case against. Given I still see traction promoted around town by some physical therapists and chiropractors for the treatment of low back pain I figured it was worth a blog.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

4 thoughts on “Traction, Low Back Pain, Research Suggests it Doesn’t Work”

  1. Very interesting read, again. It seems the more we think we know about disc injuries and LBP, the less true these ideas seem to be. Question now remains, if traction is indeed ineffective, what is the alternative to regain mobility and get rid of nagging pain? Would it just be strengthening of the core (core as in all of the muscles that connect your lower body to upper body).

    • The history of treatment for low back pain, is a history of treatments that are often placebo at best. I think it’s best not to attempt to regain mobility at all, at least not in the spine, but rather work to increase low back stiffness. In doing so, you give the discs the best chance to heal, such that mobility later returns without trying. It might help to try and increase shoulder and hamstring mobility so that you can bend over with more of the range coming from your hips, but unless you are real tight, that’s usually not a big factor. I would encourage you to read Stuart McGill’s paper on “super stiffness” of the spine, and for that matter his books are great.

      Increasing core strength is good, but you also want to increase total body strength. People with strong cores but weaker legs/hips will often do a lot of their lifting through their core rather, thus stressing their discs, which do seem to be the first structure that fails.

      And you really need good motor control/spine awareness. It doesn’t do your discs a lot of good to be surrounded by strong muscles if it doesn’t occur to you to stop flexing and twisting those discs during your exercise and daily activities.

      The basic formula I use is teaching people to use correct size lumbar supports when they sit, so they aren’t over flexing or extending their spine when they sit. Teaching good motor control/spine awareness during dynamic movements, so as to avoid a lot of spine flexion/extension and twisting. While at the same time working on increasing core and total body strength and endurance. Also, I can’t overstate how much EMS helps. I think it has increased the effectiveness of my program at least 100%. EMS knocks out the pain faster than any modality I have tried, helps strengthen the core, and it’s inexpensive enough for people to have at home.

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