Is traction effective in treating low-back pain?

Low-back pain (LBP) is a major cause of medical expenses, work absenteeism and disability. Although back pain often resolves without clinical care, a wide variety of treatments are available. Traction is a technique that is used for low-back and sciatica. Sciatica can result when the nerve roots in the lower spine are irritated or compressed. The goal of this review was to determine if traction is more effective than other treatments or no treatment for low-back pain.

The researchers conducted a comprehensive systematic review of the research literature. They searched several databases and the latest issue of the Cochrane Library. Only randomized controlled trials (RCT) were included in their review. This type of trial randomly assigns patients to a treatment, placebo or no treatment group and compares findings. The trials involved any type of traction for the treatment of non-specific low-back pain with or without sciatica. Back pain was classified as acute (it had started within four weeks of treatment), sub-acute (it lasted four-12 weeks) or chronic (it lasted more than 12 weeks).

A total of 24 trials involving 2,177 patients were included. Five trials were considered high quality. The researchers found that for a mixed group of patients with/without sciatica there was:

• strong evidence that there was no difference in short- or long-term outcomes from traction and placebo, sham or no treatment
• moderate evidence that traction as a single treatment was no more effective than other treatments
• only one RCT that added traction to a standard physiotherapy program, which didn’t lead to significantly different results.

For sciatica patients, the evidence was not consistent.

One strength is that it includes several new trials published since the last systematic review on this topic. A weakness is the inconsistency of the evidence regarding patients with sciatica. Also, some studies were designed poorly or did not report findings sufficiently.