Comparison of Passive Translatoric Intervertebral Glides and Manual Segmental Traction
Condition: Mechanical Low Back Pain
MeSH terms: Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The aim of this study is to find and compare the effects of passive translatoric
      intervertebral glides and manual segmental traction in patients with mechanical low back pain
      on pain ,range of motion and disability. Randomized controlled trial done at Aziz Bhatti
      Shaheed teaching hospital Gujrat. Total 34 participants will be enrolled (17 in each group A
      and group B. Group A received PA glides while group B received manual traction 25-65 years
      participants were included in study. Study duration was of 3 months .Sampling technique
      applied was purposive non probability sampling technique. Tools used in the study are
      (NPRS),Modified Oswestry disability index. Data was analyzed through SPSS 22.
    

Detailed description: 
      Low back pain is a global health issue and one of the leading causes of disability and
      morbidity worldwide. The overall lifetime prevalence of low back pain is estimated to be as
      high as 60%-84% .According to some studies low back pain is more common in women (60.9%)than
      in men (39.1%). In which 97% of the cases were reported to be of mechanical in origin.
      Mechanical back ache is the low back pain without any recognizable pathology. It can
      originate from spinal structures such as bone, joints, disc, and nervous or soft tissue.
      Mechanical back pain can be acute or chronic. Persistent pain for less than 4 to 6 weeks can
      be termed as acute mechanical low back pain or lumbago while pain lasting for more than 6
      weeks is called chronic back pain. The episodes of disabling chronic low back pain has a
      tendency to reoccur and it affects up to 23% of the population globally with 24% to 84% of
      recurrence rate annually .

      In a recent narrative article published by in 2020, current rehabilitation strategies
      available for low back pain were reviewed. Various approaches are patient advice, regular
      physical exercises, McKenzie method, lumbar stabilization exercises, directional preference
      exercises, Yoga, strength building and aerobic exercises, traditional Chinese practices
      including Tai-chi and Qigong exercises, spinal mobilization and manipulation, Traction, Hot
      and cold therapy, bracing and rest.

      Joint mobilizations have been used for the treatment of musculoskeletal pain and to increase
      functionality for many years. The exact physiological mechanism by which intervertebral joint
      mobilizations reduce nociceptive activity in spinal lesion is still unknown but due to recent
      advancement in technology most of the researches believe it can be due to the stimulation of
      mechanoreceptors as well as free fluid movement within the joint space and disc structures .

      In 1960s Maitland proposed a classification system for these joint mobilizations which is not
      only a treatment method but also a diagnostic tool that can be used to diagnose a joint
      dysfunction based on clinical findings.

      A study in 2015 by Karina Yuko analyzed that use of Maitland's PA glides for 30 seconds in
      each painful lumbar vertebra twice a week for 4 weeks significantly increased strength and
      mobility and reduced pain after the 2nd week of intervention.

      A study conducted in Pakistan by Komal et al in 2018 showed that Maitland's grade I and II
      spinal glides are effective in reducing pain in patients with chronic low backache and can be
      used as an effective treatment in low back pain management .

      In 2018, a study published spinal mobilization and gliding techniques were found to be more
      effective in reducing pain than other active therapies including exercises (p<0.05) while
      these were not comparatively effective in reducing disability (p>0.05). When compared with
      manipulation technique, spinal manipulation was considered more effective than spinal
      mobilization and intervertebral glides in treating low back pain .

      In 2017, conducted a systematic review with meta-analysis on lumbar stabilization exercises
      and conventional physical therapy along with manual therapeutic approaches for low back pain
      and concluded that no one form of exercise is more effective than the other in treating the
      pain or disability and encouraged using both forms of techniques in rehabilitation of
      musculoskeletal disorders .

      While there are numerous treatment options available, one of the common practices used for
      treatment of low back pain is spinal traction. Spinal traction is a technique in which,
      depending on the mode of delivery, varying amount of force is used to separate the vertebrae.
      It provides pain relief by removing the pressure off the spinal structures as well as by
      neurophysiological effects such as pain modulation of nociceptive input. This is generally
      believed that traction benefits the patients with acute back pain with neurological deficits
      as well as spinal stiffness. Available evidences suggest that even a small dose of traction
      (5-10kg)or 10-20% of total body weight proves to be effective. While another study supports
      that the optimal force of traction should be 40% of the total body weight .Traction can be
      applied in various ways that include mechanical or motorized traction via pulley system,
      auto-traction without external help of the therapist, gravitational traction with a
      suspension device or a manual traction with force applied by therapist.

      A cross sectional survey was conducted in 2015 to estimate the number of physical therapists
      who use traction in their clinical practices. 4000 physical therapists were randomly included
      in the study. The response rate was 25.5% from which 76.6% reported using traction. Most of
      those who used spinal traction in their practice preferred manual delivery methods (68.3%)
      while the others used mechanical traction tables along with other conventional physiotherapy
      interventions like posture correction or stabilizing exercises.

      In 2020 a trial to report the immediate effects of lumbar traction in patients with chronic
      low back pain. A total 40% to 50% of the body weight for mechanical traction was used and the
      mode of delivery was intermittent traction with or without vibrations. The results showed
      that lumbar traction with the force of 40% of total body weight especially along with
      vibration can be an effective intervention in chronic low back pain.

      As discussed earlier the causes of mechanical low back pain are vertebral joint degeneration,
      disc pathologies, spinal muscular imbalances or strains and nerve tissue irritation,
      therefore intervertebral translatoric glides and lumbar manual segmental traction can be
      effective for pain management and restricted joint mobility. While currently to our knowledge
      there exists very weak evidence to which one technique can proved to be more effective than
      the other. Therefore this study will evaluate the efficacy of both the interventions in pain,
      restricted range of motion and disability in patients with mechanical low back pain,
    

Intervention name(s): Conventional treatment with Passive translatoric intervertebral glides; Conventional treatment with manual segmental lumbar traction
Intervention type(s): Other; Other
Intervention description(s): Patient education (Postural correction, lifting, sitting and sleeping positions) • Hot Pack 10 mins
• PA Glides (Central and Transverse mobilizations) (10 sec each) x5 sets • Core stabilization exercise (Knee to chest, bridges, prone press ups, cat and camel stretches) • Home plan (bridges, knee to chest, cat and camel stretch and prone press ups; Patient education (Postural correction, lifting, sitting and sleeping positions) • Hot Pack 10 mins
• Manual lumbar Traction (L1-L5) for 15-20 sec x5 sets • Lumbar facet gapping (LFG) in side lying (10 sec 3 sets) and Lumbar rotational facet gapping (LRFG) in side lying (10 sec 3 sets) • .Core stability exercises (Knee to chest, bridges, prone press ups, cat and camel stretches) • Home plan
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Mechanical Low Back Pain,Mobilizations.Traction