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Review
. 2013 Aug 19;2013(8):CD003010.
doi: 10.1002/14651858.CD003010.pub5.

Traction for Low-Back Pain With or Without Sciatica

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Free PMC article
Review

Traction for Low-Back Pain With or Without Sciatica

Inge Wegner et al. Cochrane Database Syst Rev. .
Free PMC article

Abstract

Background: Traction has been used to treat low-back pain (LBP), often in combination with other treatments. We included both manual and machine-delivered traction in this review. This is an update of a Cochrane review first published in 1995, and previously updated in 2006.

Objectives: To assess the effects of traction compared to placebo, sham traction, reference treatments and no treatment in people with LBP.

Search methods: We searched the Cochrane Back Review Group Specialized Register, the Cochrane Central Register of Controlled Trials (2012, Issue 8), MEDLINE (January 2006 to August 2012), EMBASE (January 2006 to August 2012), CINAHL (January 2006 to August 2012), and reference lists of articles and personal files. The review authors are not aware of any important new randomized controlled trial (RCTs) on this topic since the date of the last search.

Selection criteria: RCTs involving traction to treat acute (less than four weeks' duration), subacute (four to 12 weeks' duration) or chronic (more than 12 weeks' duration) non-specific LBP with or without sciatica.

Data collection and analysis: Two review authors independently performed study selection, risk of bias assessment and data extraction. As there were insufficient data for statistical pooling, we performed a descriptive analysis. We did not find any case series that identified adverse effects, therefore we evaluated adverse effects that were reported in the included studies.

Main results: 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. This was true when traction was compared with controls and other treatments, as well as when the combination of traction plus physiotherapy was compared with physiotherapy alone. No studies reported the effect of traction on return to work.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. No studies reported on the effect of traction on functional status, global improvement or return to work.Adverse effects were reported in seven of the 32 studies. These included increased pain, aggravation of neurological signs and subsequent surgery. Four studies reported that there were no adverse effects. The remaining studies did not mention adverse effects.

Authors' conclusions: 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. Implications for practice 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. Implications for research 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.

Conflict of interest statement

Two review authors (GJMG van der Heijden, HCW de Vet) were also authors of two included studies. They did not participate in the quality assessment or data extraction processes in these studies.

Figures

1
1
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Low‐back pain with/without radiation, traction versus placebo, sham or no treatment, Outcome 1 Pain intensity.
1.2
1.2. Analysis
Comparison 1 Low‐back pain with/without radiation, traction versus placebo, sham or no treatment, Outcome 2 Functional status.
1.3
1.3. Analysis
Comparison 1 Low‐back pain with/without radiation, traction versus placebo, sham or no treatment, Outcome 3 Global improvement.
1.4
1.4. Analysis
Comparison 1 Low‐back pain with/without radiation, traction versus placebo, sham or no treatment, Outcome 4 Return to work (days).
2.1
2.1. Analysis
Comparison 2 Low‐back pain with/without radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 1 Pain intensity.
2.2
2.2. Analysis
Comparison 2 Low‐back pain with/without radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 2 Functional status.
2.3
2.3. Analysis
Comparison 2 Low‐back pain with/without radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 3 Global improvement.
3.1
3.1. Analysis
Comparison 3 Low‐back pain with/without radiation, two types of traction, Outcome 1 Global improvement.
4.1
4.1. Analysis
Comparison 4 Low‐back pain with/without radiation, traction versus other treatment, Outcome 1 Pain intensity.
4.2
4.2. Analysis
Comparison 4 Low‐back pain with/without radiation, traction versus other treatment, Outcome 2 Functional status.
4.3
4.3. Analysis
Comparison 4 Low‐back pain with/without radiation, traction versus other treatment, Outcome 3 Global improvement.
5.1
5.1. Analysis
Comparison 5 Low‐back pain with radiation, traction versus placebo, sham or no treatment, Outcome 1 Pain intensity.
5.2
5.2. Analysis
Comparison 5 Low‐back pain with radiation, traction versus placebo, sham or no treatment, Outcome 2 Global improvement.
5.3
5.3. Analysis
Comparison 5 Low‐back pain with radiation, traction versus placebo, sham or no treatment, Outcome 3 Return to work.
6.1
6.1. Analysis
Comparison 6 Low‐back with radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 1 Pain intensity.
6.2
6.2. Analysis
Comparison 6 Low‐back with radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 2 Functional status.
6.3
6.3. Analysis
Comparison 6 Low‐back with radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 3 Global improvement.
6.4
6.4. Analysis
Comparison 6 Low‐back with radiation, physiotherapy with traction versus physiotherapy without traction, Outcome 4 Return to work.
7.1
7.1. Analysis
Comparison 7 Low‐back pain with radiation, traction versus other treatment, Outcome 1 Pain intensity.
7.2
7.2. Analysis
Comparison 7 Low‐back pain with radiation, traction versus other treatment, Outcome 2 Functional status.
7.3
7.3. Analysis
Comparison 7 Low‐back pain with radiation, traction versus other treatment, Outcome 3 Global improvement.
8.1
8.1. Analysis
Comparison 8 Low‐back pain with radiation, two types of traction, Outcome 1 Pain intensity.
8.2
8.2. Analysis
Comparison 8 Low‐back pain with radiation, two types of traction, Outcome 2 Global improvement.
9.1
9.1. Analysis
Comparison 9 Low‐back pain without radiation, traction versus sham, Outcome 1 Pain intensity.

Update of

  • Traction for low-back pain with or without sciatica.
    Clarke JA, van Tulder MW, Blomberg SE, de Vet HC, van der Heijden GJ, Bronfort G, Bouter LM. Clarke JA, et al. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD003010. doi: 10.1002/14651858.CD003010.pub4. Cochrane Database Syst Rev. 2007. PMID: 17443521 Updated. Review.

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