Traction
Panel findings and recommendations:
- Spinal traction is not recommended in the treatment of patients with acute low back problems. (
Strength of Evidence =
B.)
Traction, when used for low back problems, involves the application of intermittent or continuous force along the axis of the spine in an attempt to elongate the spine by either mechanical or manual means. The most common type used for low back pain is pelvic traction, in which a snug girdle around the pelvis is attached to weights hung at the foot of the bed. The therapeutic objective of traction for patients with low back problems is to reduce pain.
Traction
Traction
Literature Reviewed. Of 31 articles screened for this topic, 7 articles reporting on 6 RCTs met criteria for review.
131,
138,
139,
172,
173,
174,
175 Another article contained information used by the panel, but did not meet selection criteria.
176
Evidence on Efficacy. A meta-analysis of the studies on traction was done by the panel methodologists. Quality rating was done for the six RCTs reviewed without knowledge of study results. There were no excellent studies, one good study,
173 three fair studies,
131,
139,
172 a fair study reported on by Mathews, Mills, Jenkins, et al.,
138 and one poor study.
175
All the studies involved patients with low back pain of less than 3 months' duration, but studies varied on whether patients with a history of previous low back problems were excluded. Groups receiving traction were compared with groups receiving sham traction.
173,
174 Traction combined with bed rest and corset use was compared with bed rest and corset use alone.
172 Traction was compared with heat
138 and with isometric exercise.
175 In additjion, Coxhead, Meade, Inskip, et al.
131 studied groups receiving various combinations of traction, manipulation, exercise, and corset use in a multifactorial design with 16 cells. The six studies varied with respect to types of traction, control groups, outcome measures, and assessment periods. For this reason, no attempt was made to quantitatively combine these data.
Five of the six studies showed no difference between traction and the comparison group. In one study, the group treated with bed rest and corset use combined with traction had less pain at 1 week than those receiving bed rest and corset use without traction, but this difference was gone by 3 weeks.
172 Moreover, some criticize this study because of attention bias against those in the control group. In general, the studies did not indicate that traction in any form is beneficial in terms of pain relief, physiological status, length of hospital stay, functional outcome, or perception of overall improvement for patients with low back problems. The studies were too small to determine if traction actually harms patients with low back problems.
Potential Harms and Costs. The potential harms from traction relate to debilitation due to prolonged bed rest, including loss of muscle tone, bone demineralization, and the risk of thrombophlebitis. There is added risk of increased intra-ocular pressure and blood pressure with inverted hanging traction.
176 The cost of traction is considered low to moderate if it is done on an outpatient basis, or high if the patient is hospitalized for traction.
Summary of Findings. Evidence does not demonstrate traction to be effective in the treatment of patients with low back problems.
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