When it comes to a condition like low back pain, the care a patient receives can depend on case history and examination findings, as well as the doctor’s training and treatment preferences. For the patient with a lumbar disk pathology, a doctor of chiropractic may employ lumbar traction in combination with manipulation and joint mobilization techniques.
Lumbar traction (LT) is often performed on patients with radicular pain, or pain that radiates into the leg due to intervertebral disk conditions such as a herniated disk, degenerative conditions such as osteoarthritis, and/or spinal stenosis (a combination of aging factors that result in narrowing of the foramen, or holes that nerves travel through). The specific benefits of LT include increasing the disk space, which produces a negative pressure within the disk to draw in a disk protrusion, stretching ligaments, widening the foramen, and encouraging movement of the facet joints. Unfortunately, there is no hard and fast rule that exists for when and/or how to apply traction, leaving this decision up to each clinician to judge what, when, and how—that is until recently!
A group of researchers tackled the job of developing a clinical guideline to identify patients with lumbar disk herniation (LDH) that would most likely benefit from mechanical lumbar traction (MLT). Doctors applied MLT on over 100 LDH patients over the course of two weeks and measured the benefits using history and physical examination as well as various questionnaires that measure pain intensity, function, and psychological parameters. The research team defined “responders” as those who improved at least 50% over the initial, baseline evaluation.
Of the 103 participants, 24 were responders (23.3%), and from this group, the researchers used the following five features to establish clinical prediction rules: 1) limited lumbar extension (backward bending) movement; 2) low-level fear-avoidance beliefs regarding work; 3) no segmental hypomobility in the lumbar spine; 4) short duration of symptoms; and 5) sudden onset of symptoms. For those who had at least three of five of these predictors, the probability of pain and function improvement rose from 23.3% to 48.7% compared to those with fewer predictors. The authors concluded that healthcare providers can use these five predictors to help select patients with LDH who might benefit from applying lumbar traction.
A 2020 study reported that combining spinal manipulation and mobilization with traction produced better outcomes than traction alone. Doctors of chiropractic offer a multi-modal treatment approach to patient with LDH, of which traction may be included in the management plan. These non-surgical options frequently work very well, and guidelines recommend utilizing non-surgical care options before considering surgery.
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