Diab AA, Moustafa IM. J Manipulative Physiol Ther. 2012 May;35(4):246-53http://www.ncbi.nlm.nih.gov/pubmed/22632584
Low back pain (LBP) can be one of the most debilitating and frustrating conditions to deal with both as an athlete and as a clinician. While there are a multitude of treatment options focusing on lumbar extension, muscle stretching, core strengthening, as well as, therapeutic modalities. However, none of these options focus on restoration or reconstituting normal lumbar spine curvature. Therefore, the purpose of the present study was to determine the effect vertical lumbar traction has on lumbar spine curvature (measured with radiographs) and to determine if the traction was effective at decreasing the participants' LBP. In this study, Diab et al. recruited 80 subjects to go through treatment for LBP. The subjects were randomly placed into 1 of 2 treatment groups and completed a visual analog scale (VAS) for pain. Both groups underwent a 10-week treatment plan that included erector spinae/hamstring stretching and 15 minutes of infrared radiation to the lumbar paraspinal musculature. However, the intervention group also underwent 3 point vertical traction. Traction was applied in supine through a belt around the subjects' hips and low back, while their femurs and upper torso were anchored to the table with straps. Traction was performed 3x/week for 10 weeks with treatment time progressing from 3-20 minutes over the subsequent weeks. After completion of the study there was a significant and stable decrease in pain for the traction group. Not only had their VAS pain scores significantly decreased from pre-test to post-test, but they remained significantly lower at 3-month follow-up. The control group's VAS scores did decrease at completion of the 10-week trial, but at 3-month follow-up their VAS scores approached baseline levels. It was also discovered that after vertical traction, the treatment groups lumbar spine angles, as measured on radiograph, significantly improved at all levels (L1-L2 through L5-S1) towards normal, for both sagittal translation and sagittal rotation, and remained that way at the 3 month follow-up period.
This study is interesting for a handful of reasons. They found a significant pain reduction in the traction group. Low back pain can be a debilitating situation, and the day-to-day struggle to find relief is an effort in itself. Vertical lumbar traction is intriguing because it appears to address a major root problem for LBP, which is the restoration of normal lumbar curvature. While the body of evidence for this technique is limited, the results demonstrating 3 months of pain reduction compared to constant pain, ingestion of oral medication for pain relief, injection, and the transient effect that physical medicine alone seems to provide is powerful. This study suggests that the identification of faulty anatomical alignment will bring about altered kinematics. Regardless of the body part, when the body's kinematics are altered, and pain sets in, it stands to reason that we need to get down to the root cause and begin looking more critically at the patient's/athlete's anatomy. Great strides have been made over the past few years in this area regarding other body parts, and now it appears that the premise has advanced to the low back. What are your thoughts on the use of vertical lumbar traction for LBP? Are you surprised by the results? What other variable would like to see investigated in conjunction with vertical lumbar traction?
Written by: Mark Rice
Reviewed by: Stephen Thomas
How Do You Determine Low Back Pain with Young Athletes?
Getting “Back” on Track – Abdominal Bracing, Rehabilitation and Low Back Pain
Can Patients with Low Back Pain Benefit from Pilates?
Accuracy of Clinical Tests to Identify a Subset of Patients with Low Back Pain
Diab AA, & Moustafa IM (2012). Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial. Journal of Manipulative and Physiological Therapeutics, 35 (4), 246-53 PMID: 22632584