title: Traction for low-back pain with or without sciatica.
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.
  
  
  OBJECTIVE
  To assess the effects of traction compared to placebo, sham traction, reference treatments and no treatment in people with LBP.
  
  
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors: Department of Otorhinolaryngology - Head and Neck Surgery; G05.129, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, Netherlands, 3584 CX.
authors: Inge
authors: I
authors: Wegner
authors: Indah S
authors: IS
authors: Widyahening
authors: Maurits W
authors: MW
authors: van Tulder
authors: Stefan E I
authors: SE
authors: Blomberg
authors: Henrica Cw
authors: HC
authors: de Vet
authors: Gert
authors: G
authors: Brønfort
authors: Lex M
authors: LM
authors: Bouter
authors: Geert J
authors: GJ
authors: van der Heijden
mesh_terms: D059787:Acute Pain / Q000628:therapy; D059350:Chronic Pain / Q000628:therapy; D006801:Humans; D017116:Low Back Pain / Q000150:complications / Q000628:therapy*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D012585:Sciatica / Q000150:complications / Q000628:therapy*; D014143:Traction / Q000009:adverse effects
references: Spine J. 2008 Jan-Feb;8(1):234-42
references: 18164471
references: J Oslo City Hosp. 1973 Oct;23(10):167-76
references: 4775527
references: Rheumatol Rehabil. 1975 Nov;14(4):222-5
references: 1105752
references: Spine (Phila Pa 1976). 1997 Dec 1;22(23):2756-62
references: 9431610
references: Spine (Phila Pa 1976). 2011 Jun;36(13):1050-8
references: 21150697
references: J Neurosurg. 1994 Sep;81(3):350-3
references: 8057141
references: Neurol Res. 2001 Oct;23(7):780-4
references: 11680522
references: J Manipulative Physiol Ther. 2008 Mar;31(3):191-8
references: 18394495
references: Rheumatol Int. 2008 Jun;28(8):749-56
references: 18193231
references: Spine (Phila Pa 1976). 1993 Jan;18(1):98-108
references: 8434332
references: Arch Phys Med Rehabil. 2005 Jun;86(6):1164-9
references: 15954055
references: Arch Phys Med Rehabil. 1993 Aug;74(8):871-6
references: 8347073
references: Scand J Rehabil Med. 1970;2(1):37-42
references: 4257208
references: Spine (Phila Pa 1976). 2008 Jan 1;33(1):90-4
references: 18165753
references: PM R. 2011 May;3(5):447-57
references: 21570033
references: Spine (Phila Pa 1976). 1999 Aug 1;24(15):1579-84
references: 10457578
references: BMJ. 2012 Nov 01;345:e7031
references: 23118303
references: Spine (Phila Pa 1976). 2009 Jul 15;34(16):1685-92
references: 19770609
references: Rheumatol Int. 2006 May;26(7):622-6
references: 16249899
references: Lancet. 2012 Dec 15;380(9859):2163-96
references: 23245607
references: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003010
references: 16235311
references: Arch Phys Med Rehabil. 2003 Oct;84(10):1542-53
references: 14586924
references: Br J Rheumatol. 1987 Dec;26(6):416-23
references: 2961394
references: Scand J Rehabil Med. 1984;16(3):117-24
references: 6494835
references: Spine (Phila Pa 1976). 2006 Jun 15;31(14):1591-9
references: 16778694
references: Arch Phys Med Rehabil. 1964 Sep;45:469-72
references: 14199033
references: Acta Orthop Scand. 1980 Oct;51(5):791-8
references: 6451138
references: Rheumatol Int. 2003 Mar;23(2):82-6
references: 12634941
references: Spine (Phila Pa 1976). 1993 Aug;18(10):1361-5
references: 8211369
references: Spine (Phila Pa 1976). 2009 Aug 15;34(18):1929-41
references: 19680101
references: Eur Spine J. 2011 Jan;20(1):19-39
references: 20640863
references: J Manipulative Physiol Ther. 1995 Mar-Apr;18(3):141-7
references: 7790793
references: Chiropr Osteopat. 2006 Aug 24;14:19
references: 16930489
references: Eur Spine J. 2009 Dec;18(12):1843-50
references: 19484433
references: Phys Ther. 1995 Feb;75(2):93-104
references: 7846138
references: Spine J. 2008 Jan-Feb;8(1):8-20
references: 18164449
references: J Clin Epidemiol. 2005 Dec;58(12):1233-40
references: 16291467
references: BMC Musculoskelet Disord. 2007 Nov 29;8:118
references: 18047650
references: Neurol Res. 1998 Apr;20(3):186-90
references: 9583577
references: Lancet. 1981 May 16;1(8229):1065-8
references: 6112444
references: Man Ther. 2000 May;5(2):72-81
references: 10903582
references: Br J Rheumatol. 1986 May;25(2):181-3
references: 3011174
references: Ann Intern Med. 2007 Oct 2;147(7):492-504
references: 17909210
references: Lancet. 1995 Dec 16;346(8990):1596-600
references: 7500752
references: Eur Spine J. 2006 Jul;15(7):1070-82
references: 16341712
references: J Oslo City Hosp. 1984 Jul-Aug;34(7-8):61-70
references: 6481516
references: Spine (Phila Pa 1976). 2003 Jun 15;28(12):1290-9
references: 12811274
references: Spine (Phila Pa 1976). 2007 Dec 15;32(26):E793-800
references: 18091473
references: Phys Ther. 2001 Apr;81(4):1018-28
references: 11276184
references: Schweiz Med Wochenschr. 1988 Feb 27;118(8):271-4
references: 2965827
references: Ann Rheum Dis. 1992 Jun;51(6):820-2
references: 1535495