Estudo europeu mostra ineficácia  da tração lombar para tratamento de dor inespecífica.
Autor: Fisioterapia &amp; Ciência | Publicado: 2012-12-02T05:08:00-08:00


  
 
 
  
   
    
     Traction

     Definition of the procedure


     Lumbar traction is applied by putting a harness around the
lower rib cage and a second one around the iliac crest, and
applying a force aiming at separating both harnesses. The
applied force must be at least 25% of the body weight
(weaker forces are considered as placebo). The duration
and level of exerted traction can be varied in a continuous
or intermittent mode (van der Heijden et al 1995).


     Different types of traction exist: manual traction (i.e.
traction exerted by the therapist, using the patient’s head,
arms or legs), motorised traction (i.e. traction exerted by a
motorised pulley), suspension (i.e. traction exerted by
gravitational forces, through the body weight of the pa-
tient), and bed-rest traction (i.e. traction by a pulley and
weights) (van der Heijden et al 1995).


     Systematic reviews


     One systematic review (SR) was found (van der Heijden et
al 1995) .


     Among the 17 RCTs included in the review, 16 were
excluded for the following reasons:


     

       3 focused on cervical traction (British 1966, Goldie and
Landquist 1970, Zylbergold and Piper 1985)


      

       5 included only acute low back pain patients (Coxhead
et al 1981, Larsson et al 1980, Mathews et al 1987, Pal
et al 1986, Walker et al 1982)


      

       2 did not provide information on the duration of
pain (Mathews and Hickling 1975, Reust et al 1988)


      

       4 focused specifically on prolapsed lumbar disk, and not
on common low back pain (Ljunggren et al 1984, Weber
1972, 1973, Weber et al 1984)


      

       1 used only “global treatment effect” as the outcome
measure (Bihaug 1978)


      



     • 1 examined combination treatments (intermittent motor-
ized traction and isometric abdominal exercises vs hot
packs and rest vs hot packs, massage and mobilisation)
and also used only “global treatment effect” as the out-
come measure (Lidstrom and Zachrisson 1970)


     The remaining RCT were used as the basis for formulating
these recommendations (van der Heijden et al 1970).


     Additional trials


     No additional trials were found.


     Quality assessment of the evidence


     The systematic review was of high quality. The one rele-
vant RCT on CLBP that it included was of high quali-
ty (van der Heijden et al 1970).


     Effectiveness


     The RCT compared motorized traction with sham traction
and did not find any significant differences between the
treatments for any of the outcome measures exam-
ined (van der Heijden et al 1970).


     There is limited evidence that lumbar traction is not
more effective than sham traction (level C).


     Unknown (no studies were found on this issue)


     There is no evidence for the effectiveness of lumbar
traction compared with other treatments in the treatment of
chronic low back pain (level D).


     Cost/effectiveness


     Unknown (no studies were found on this issue)


     Safety


     The SR did not review studies on safety of lumbar trac-
tion, but cited case reports suggesting that there is danger
of adverse effects in heavy traction (lumbar traction with
forces exceeding 50% of the total body weight) (van den
Hoogen et al 1995). Those risks include increased blood
pressure and respiratory constraints due to the traction har-
ness, and a theoretical potential increase of nerve impinge-
ment in cases of medial or distal disk protrusion.


     Subjects (indications)


     Not having shown evidence of effectiveness, it is not pos-
sible to define indications for lumbar traction.


     Comments


     None


     Summary of evidence
There is limited evidence that lumbar traction is not more
effective than sham traction (level C).


     There is no evidence for the effectiveness of lumbar
traction compared with other treatments in the treatment of
chronic low back pain (level D).&nbsp;

  
 
 
  
   
    
     Recommendation


     We cannot recommend lumbar traction as a treatment for
chronic low back pain.&nbsp;



  
 
 
  
   
    
     References


     

       Bihaug O (1978) Autotraksjon for ischialgpasienter; en kon-


       trollert sammenlikning mellom effekten av Auto-trakjson-B or
isometriske ovelser ad modum Hume endall eg enkins. Fys-
ioterapeuten, 45: 377-9.


      

       British (1966) Pain in the neck and arm: a multicentre trial of
the effects of physiotherapy, arranged by the British Associa-
tion of Physical Medicine. Br Med J, 5482: 253-8.


      

       Coxhead CE, Inskip H, Meade TW, North WR, Troup JD
(1981) Multicentre trial of physiotherapy in the management
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       Goldie I, Landquist A (1970) Evaluation of the effects of dif-
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       Larsson U, Choler U, Lidstrom A, Lind G, Nachemson A,
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       Lidstrom A, Zachrisson M (1970) Physical therapy on low
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       Ljunggren AE, Weber H, Larsen S (1984) Autotraction versus
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       Mathews JA, Hickling J (1975) Lumbar traction: a double-blind
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       Reust P, Chantraine A, Vischer TL (1988) [Treatment of lum-
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ized clinical trial methods. Phys Ther, 75(2): 93-104.


      

       van der Heijden GJ, Bouter LM, Terpstra-Lindeman E (1970)
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van een pilotstudy. Ned T Fysiotherapie, 2: 117-21.


      

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       Weber H (1972) Har traksjonbehandling noen effect ved is-
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       Weber H (1973) Traction therapy in sciatica due to disc pro-
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City Hosp, 23(10): 167-76.


      

       Weber H, Ljunggren AE, Walker L (1984) Traction therapy in
patients with herniated lumbar intervertebral discs. J Oslo City
Hosp, 34(7-8): 61-70.&nbsp;