Traction for low-back painClarke JA, van Tulder MW, Blomberg SEI, de Vet HCW, van der Heijden GJ, Brnfort G, Bouter LMPublished Online: May 12, 2010This systematic review involves the effect of traction for patients with acute, sub-acute or chronic low-back pain, with or without sciatica. Outcomes of interest include pain, functional status, global measures (such as overall improvement), and return to work.Low-back pain (LBP) is a major health problem among populations in western industrialized countries and a major cause of medical expenses, absenteeism and disablement. Various types of traction are used to treat low-back pain patients, often in combination with other treatments. The most commonly used traction techniques are mechanical or motorized traction (where the traction is exerted by a motorized pulley) and manual traction (in which the traction is exerted by the therapist, using his or her body weight to alter the force and direction of the pull).The review includes 25 studies, and 2206 patients with LBP. In studies involving patients with a mix of symptoms (i.e., where some but not all had sciatica), results consistently showed that traction (continuous or intermittent) as a single treatment for LBP was not more effective than placebo, sham treatment or other treatments. For patients with sciatica, there is conflicting evidence on many of the comparisons, but moderate evidence that continuous or intermittent traction is not more effective than other treatments.Seven of the 25 studies report that patients receiving traction experienced some adverse effects (such as increased pain, subsequent surgery); two studies reported that there were no adverse effects; in the remaining studies adverse effects were not mentioned.A limitation of this review stems from the scarcity of high quality studies, especially those which distinguish between patients with different symptom patterns (with and without sciatica, with pain of different duration).HideAbstract (click to read)Background: Traction is used to treat low-back pain (LBP), often with other treatments.Objectives: To determine traction's effectiveness, compared to reference treatments, placebo, sham traction or no treatment for LBP.Search strategy: We searched CENTRAL (The Cochrane Library 2006, issue 4), MEDLINE, EMBASE, and CINAHL to October 2006, references in relevant reviews and personal files.Selection criteria: Randomized controlled trials (RCTs) involving traction to treat acute (less than four weeks duration), sub-acute (four to 12 weeks) or chronic (more than 12 weeks) non-specific LBP with or without sciatica.Data collection and analysis: Study selection, methodological quality assessment and data extraction were done independently by two authors. As there were insufficient data for statistical pooling, we performed a qualitative analysis.Main results: We included 25 RCTs (2206 patients; 1045 receiving traction). Five trials were considered high quality.For patients with mixed symptom patterns (acute, sub-acute and chronic LBP with and without sciatica) there is:- strong evidence of no statistically significant difference in outcomes between traction as a single treatment and placebo, sham or no treatment;- moderate evidence that traction as a single treatment is no more effective than other treatments;- limited evidence of no significant difference in outcomes between a standard physical therapy program with or without continuous traction.For LBP patients with sciatica (with acute, sub-acute or chronic pain), there is