Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial.

Diab AA, Moustafa IM. J Manipulative Physiol Ther. 2012 May;35(4):246-53

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.

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?

by:  Mark Rice
by: Stephen Thomas

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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