title: The Effectiveness of Mechanical Traction Among Subgroups of Patients With Low Back Pain and Leg Pain: A Randomized Trial.
abstract: METHODS
  Randomized clinical trial. Background The recommended initial management strategy for patients with low back pain and signs of nerve root compression is conservative treatment, but there is little evidence to guide the most appropriate management strategy. Preliminary research suggests that a treatment protocol of mechanical traction and extension-oriented exercises may be effective, particularly in a specific subgroup of patients.
  
  
  OBJECTIVE
  To examine the effectiveness of mechanical traction in patients with lumbar nerve root compression and within a predefined subgroup.
  
  
  METHODS
  One hundred twenty patients with low back pain with nerve root compression were recruited from physical therapy clinics. Using predefined subgrouping criteria, patients were stratified at baseline and randomized to receive an extension-oriented treatment approach with or without the addition of mechanical traction. During a 6-week period, patients received up to 12 treatment visits. Primary outcomes of pain and disability were collected at 6 weeks, 6 months, and 1 year by assessors blinded to group allocation. Outcomes were examined using linear mixed-model analyses examining change over time by treatment and the interaction between treatment and subgrouping status.
  
  
  RESULTS
  The mean ± SD age of participants was 41.1 ± 11.3 years, median duration of symptoms was 62 days, and 57% were male. No significant differences in disability or pain outcomes were noted between treatment groups at any time point, nor was any interaction found between subgroup status and treatment.
  
  
  CONCLUSIONS
  Patients with lumbar nerve root compression presenting for physical therapy can expect significant changes in disability and pain over a 6-week treatment period. There is no evidence that mechanical lumbar traction in combination with an extension-oriented treatment is superior to extension-oriented exercises alone in the management of these patients or within a predefined subgroup of patients. The study protocol was registered with ClinicalTrials.gov (NCT00942227). Level of Evidence Therapy, level 2b.
authors.forename: Anne
authors.initials: A
authors.lastname: Thackeray
authors.forename: Julie M
authors.initials: JM
authors.lastname: Fritz
authors.forename: John D
authors.initials: JD
authors.lastname: Childs
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Brennan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities; D011843:Radiculopathy / Q000628:therapy*; D014143:Traction; D016896:Treatment Outcome
keywords: exercise therapy; herniated disc; lumbar radiculopathy; mechanical traction; randomized trial; sciatica