EOTA With Or Without Mechanical Traction For Patients With Lumbar Spondylosis
Condition: Lumbar Spondylosis
MeSH terms: Spondylosis; Osteoarthritis, Spine
Study type: Interventional

Summary: 
      The aim of this research is to find and compare the effect of extension oriented treatment
      approach with or without mechanical traction on pain, range of motion and disability in
      patients with lumbar spondylosis. Randomized controlled trial is being conducted at Women
      Institute of Rehabilitation sciences. The sample size is 70. The subjects are being divided
      in two groups, 35 subjects in extension oriented treatment approach (EOTA) group and 35 in
      EOTA + traction group. Study duration is of 6 months. Sampling technique being applied is
      purposive non probability sampling technique.Tools being used in the study are Numeric pain
      rating scale (NPRS), Goniometer and Oswestry disability index (ODI).
    

Detailed description: 
      Lumbar spondylosis is a degenerative condition of lower lumbar spine that presents with
      chronic low back pain that last from more than three months and is aching in nature and
      radiates to lower limbs. Lumbar region pain, range of motion restriction and limitation in
      functions are features of lumbar spondylosis. Symptoms of lumbar spondylosis include low back
      pain, radicular pain, numbness of leg, weakness of leg and neurogenic claudication. Lumbar
      spine degenerative disorders are normal, age related phenomena. Repetitive loading of the
      spine, abnormal working postures and repeated movements can all lead to the degenerative
      changes in the spine. Low back pain due to degenerative changes disturb the individual
      functional activities. Mechanistically spondylosis is the hypertrophic response of adjoining
      vertebral bone to degenerative disk. The term spondylosis nonspecifically can be applied to
      degenerative changes affecting the discs and vertebral bodies and associated joints of the
      lumbar spine. Decrease in the height of disk lead to increase in loads on the facet joints.

      In LBP rehabilitation the challenge is to arrive at any basic general rehabilitation care
      paradigms that would apply to most sub populations of low back. The goals of physical therapy
      management for patients with low back pain are to control pain, restore function and prevent
      future functional deficits.

      Substantial variation in management by conservative and invasive approaches exists between
      practitioners throughout the country. Treatment options for the management of chronic low
      back pain syndromes include: physical therapy (and associated modalities and behavioral
      techniques), pharmacotherapy, injection therapy, and surgical intervention. Exercise therapy
      (ET) remains one of the conservative mainstays of treatment for chronic lumbar spine pain,
      and may be tailored to include aerobic exercise, muscle strengthening, and stretching
      exercises. TENS, Back School (concepts of posture, ergonomics, and appropriate back
      exercises), Lumbar back supports, traction and spine manipulation are other treatment methods
      commonly used for treating low back pain. Delito and colleagues described the treatment based
      classification system (TBC) is a classification approach for low back pain. The treatment
      based classification system includes subgroup of subjects with lumbar conditions that
      benefits from an Extension oriented treatment approach. EOTA includes active and passive
      activities combination to promote lumbar spine extension. EOTA exercises are used to reduce
      leg symptoms or promote centralization. Several studies provided evidence that subgrouping
      classification methods use for the physical therapist management of LBP patients provide
      better outcomes than physical therapy management that is not based on classification.
      Randomized controlled trials using TBC for patients with LBP of acute and sub-acute have
      reported significant outcomes compared with usual care or random interventions.

      Lumbar traction is a popular modality used for patients with chronic LBP. Many healthcare and
      physical therapist utilized it for treating chronic LBP. Research suggests that certain LBP
      patients benefit from lumbar traction. Traction mechanical effects involve lordosis
      reduction, separating the facets, intervertebral foramen opening and eliminating muscles
      spasms. Pressure caused by gravity and soft tissues reduced by traction therapy, and adequate
      tension allows intervertebral disc, vertebra, and spinal nerves separation. It is suggested
      that elongation of spine inhibits nociceptive impulses by increases intervertebral space and
      reducing lumbar lordosis and also, releases adhesions around the zygapophysial joint and the
      annulus fibrosus and decreases mechanical stress. Evidence of Physiotherapy with traction
      versus physiotherapy without traction showed lower mean pain intensity in the traction group
      (a difference of 7.96 points on the VAS, 95% CI -16.53 to 0.61) at one to two weeks'
      follow-up.

      Most previous studies have not examined effects of an EOTA with or without traction for
      patients with lumbar spondylosis. The purpose of this study is to examine the effects of an
      EOTA with or without traction for patients with lumbar spondylosis.

      Sharma A, Alahmari K, Ahmed I conducted a research Efficacy of Manual Therapy versus
      Conventional Physical Therapy in Chronic Low Back Pain Due to Lumbar Spondylosis. Total of 30
      samples of subjects were assigned into two groups in this study. Group -I received Maitland
      mobilization and lumbar stabilization exercises and group-II received conventional physical
      therapy (traction, strengthening, stretching exercises). Then outcomes were assessed. The
      results showed that managing low back pain, range of motion and function of the lumbar spine
      manual therapy interventions are more effective than conventional physical therapy.

      Research by David A Browder, John D Childs, Joshua A Cleland, and Julie M Fritz which is the
      Effectiveness of an Extension-Oriented Treatment Approach in a Subgroup of Subjects with Low
      Back showed that the EOTA group demonstrated greater change in pain at the 1-week follow-up
      only. An EOTA was more effective than trunk strengthening exercise in a subgroup of subjects
      hypothesized to benefit from this treatment approach.

      In a study by Anne Thackeray et al which is to examine the effectiveness of mechanical
      traction in patients with lumbar nerve root compression and within a predefined subgroup. In
      this study criteria of predefined subgrouping was used and patients were randomized to
      receive an extension oriented treatment approach with or without the mechanical traction
      addition. The results of this study concluded that there is no evidence that addition of
      lumbar mechanical traction with an extension oriented treatment is more beneficial to
      extension oriented treatment alone for the predefined subgroup of patient's management.

      A case report by Allison R. Gagne & Scott M. Hasson (2010) Lumbar extension exercises in
      conjunction with mechanical traction for the management of a patient with a lumbar herniated
      disc. In this case report mechanical traction in addition with lumbar extension exercises was
      used for a patient with lumbar herniated disc and purpose was to describe and discuss its
      use. The results indicated that goals for the patient were achieved and the patient complaint
      of numbness and tingling was no more present. Patient improvement of pain and prior function
      level was achieved with lumbar extension exercises in addition with mechanical traction this
      case report data suggests.
    

Intervention name(s): Extension Oriented Treatment Approach; EOTA+ Traction
Intervention type(s): Other; Other
Intervention description(s): The EOTA intervention involves three components.
The first component is a series of active extension- oriented exercises:
Prone lying: Able to tolerate for 5 minutes, no pillow Prone lying on elbows: Able to tolerate for 5 minutes Prone press up exercise: 3 sets of 10 repetitions, move to end-range extension Repeated extension in standing: 3 sets of 10 repetitions, move to end-range extension The second component of the EOTA is subject education. Subjects are educated to maintain the natural lordosis of the lumbar spine while sitting, and are instructed to avoid prolonged sitting for greater than 20-30 minutes whenever possible.
The third component of the EOTA is mobilization of the lumbar spine to promote lumbar extension. The mobilization component consist of a series of up to 20 graded oscillatory mobilizations performed with the subject prone by using a grade I - IV mobilization force as described by Maitland.; Subjects in the EOTA + traction group receive the EOTA components described above with Mechanical lumbar traction.
Intermittent traction being applied (30-sec hold, 10-sec rest) for 15 minutes. Traction started with 25% of the patients' body weight and increased until the patient indicated that the tolerance for pulling was reached, with a maximum of 50% of the total body weight.
2 sessions being given per week for 3 weeks.
Other intervention name(s): EOTA
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Lumbar Spondylosis, EOTA, Mechanical traction