report #033

#033 – Mechanical traction for patients with lumbar radiculopathy

ByAl-Jallad

Estimated reading time: 2 minutes, 44 seconds.

Supine mechanical traction can decrease pain and disability in the short-term for patients with lumbar radiculopathy

A Systematic Review and Meta-analysis. (Open Access)

🎯Aim

  • Investigate the effectiveness of mechanical traction compared or added to other conservative treatments on pain and disability, in adults with lumbar radiculopathy.

📊Results

  • 8 Studies with 567 participant.

Mechanical Traction in prone position added to physiotherapy versus physiotherapy alone:

  • No significant difference on pain or disability with high quality evidence, from 3 studies, follow-up between 3 to 6 weeks

Mechanical Traction in prone position versus TENS:

  • Significant difference of mechanical traction in prone over TENS, low quality evidence from 1 study including 44 participant, 4 weeks follow-up.

Mechanical Traction in supine position added to PT versus PT alone:

  • Medium effect size and significant difference on pain (3 studies), and disability (2 studies), low quality evidence, follow-up time, between 3 to 4 weeks follow-up.

Mechanical Traction in supine position versus laser or ultrasound:

  • Small effect and non-significant for ultrasound on pain and disability, medium effect and non-significant for laser on pain and small on disability, low quality evidence from 1 study, 3 weeks follow-up.

Mechanical Traction in supine position versus drugs:

  • Large and significant effect size on pain and disability for mechanical traction, low quality evidence from 1 study, 4 weeks follow-up.

Adverse events

As reported by 1 study of 61 participants

  • The most frequent side effects included aggravation of leg/back pain, reported by 44.3% of participants; stiffness, reported by 23.0%; and arm/leg pain, reported by 26.2%.
  • Less frequent side effects were headache, dizziness, and fatigue. Nevertheless, only 25% of these adverse effects were rated as severe, and there were no significant differences between treatment groups in number, type, duration, or severity of side effects.

⏩Conclusion

  • Mechanical traction applied from supine position has short-term effectiveness on pain and disability when combined with physiotherapy interventions for patients with lumbar radiculopathy.

⏮️Previous reviews on mechanical traction

  • In 2019 a systematic review and meta-analysis concluded that compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction. (Restricted Access)
  • Another systematic review in 2018, on low back pain, found that due to wide variability in the type of traction, traction parameters, and patient characteristics, lumbar traction has little or no value on clinical outcomes. (Open Access)
  • A Cochrane review in 2013, on traction for low‐back pain with or without sciatica, concluded 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. Also, they recommended against prioritizing further research on the topic. (Open Access) (Other researchers)
  • In 2010, a systematic review on conservative management of lumbar disc herniation with associated radiculopathy, regarding traction, the authors stated that the addition of mechanical traction to electrotherapy and medication might reduce the likelihood of sciatica being present at short-term follow-up. (Restricted Access)

🆕Also, in orthopedics this week:

  • Relaxation training, aerobic, and active/stretching exercises had a significant effect on pain intensity and disability for patients with migraine, tension-type, or chronic headaches. (Restricted Access)
  • When managing lateral epicondylitis conservatively, electro-physiotherapy and physical therapy should be prioritized before other interventions. (Restricted Access)

Thank you for reading, I’ll see you in the next one.

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