THU0539 Mechanical traction for lumbar radicular pain: supine or prone? a randomised controlled trial

Abstract

BackgroundMechanical lumbar traction has been used to treat spinal disorders and low back pain for centuries, since Hippocrates(.2,3Although the supine position is generally preferred, the patient may also be positioned prone during traction treatment(.4,5 However, to the best of our knowledge, no studies have compared the effects of lumbar traction in these two different positions for patients with chronic LBP.ObjectivesTo compare the effects of mechanical lumbar traction either in the supine or prone position with conventional physical therapy(PT) in patients with chronic low back pain(LBP) and lumbosacral nerve root involvement in terms of disability, pain, and mobility.MethodsParticipants(n=125) were randomly assingned to receive 15 sessions of PT with additional mechanical lumbar traction either in the supine position (supine traction group), or in the prone position (prone traction group), or only PT without traction(PT only group). Patients were assessed at baseline and at the end of the PT sessions in terms of disability, pain, and mobility. Disability was assessed using the modified Oswesty Disability Index (ODI); pain was assessed using a visual analogue scale (VAS); and lumbar mobility was assessed using the modified lumbar Schober test (mLST).Results118 patients completed the trial. All groups improved significantly in the ODI, VAS, and mLST (p<0.05) (table 1). In the between-group analysis, improvements of ODI and VAS were found significantly better in the prone traction group compared with the PT only group (adjusted p=0.031 and.006, respectively).ConclusionsAddition of traction in prone position to other modalities resulted in larger immediate improvements in terms of pain and disability, and the results suggest that when using traction, prone traction might be first-choice. Further research is needed to confirm the benefits of lumbar traction in the prone position.References[1] Marketos SG, Skiadas P. Hippocrates. The father of spine surgery. Spine1999;24:1381–7.[2] Krause M, Refshauge KM, Dessen M, et al. Lumbar spine traction: evaluation of effects and recommended application for treatment. Manual therapy2000;5:72–81.[3] Harte AA, Gracey JH, Baxter GD. Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the UK. Archives of physical medicine and rehabilitation2005;86:1164–9.[4] Fritz JM, Lindsay W, Matheson JW, et al. Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine2007;32:E793–800.Disclosure of InterestNone declaredAbstract THU0539 – Table 1 Supine traction group(n=39) Prone traction group(n=39) Only PT group(n=40) preinterventionpostinterventionPpreinterventionpostinterventionP preinterventionpostinterventionP ODI 50.4±22.5 33.2±15.5 .001 53.8±15.1 35.9±15.9 .001 49.5±15.1 40.9±17.6 .002VAS8.0±1.64.3±2.2.0018.0±1.73.7±2.7.0017.7±1.55.2±2.3.001mLST19.4±1.920.7±1.8.00118.8±1.820.5±1.3.00119.7±1.920.8±1.7.001

Impact Of Combined Lumbar Traction with Cervical Traction in Chronic Lumbar Disc Herniation

“…On the other hand, Results are in agreement with prior studies of CM in the treatment of chronic neck pain [27], where CM reduce pain and disability. The current results are also in agreement with prior studies of Spinal Decompression Therapy (SDT) in the treatment of chronic lumbar disc herniation (CLDH) [14,7,19,24,4], where reduction of pain intensity and improvement in activities of daily living were found, in addition to studies of chronic LBP treated by CSE as the pain and functional disability were reduced [2,28,23,12]. Core Stabilization Exercise (CSE) also might be beneficial for patients with chronic LBP, CSE alone might not be sufficient for best improvement in patients with serious physical limitations to functional recovery [29].…”

Učinkovitost Trakcije U Liječenju Spinalnih Radikulopatija

“…U ukupnom uzorku u sva tri istraživanja je 262 ispitanika, s tim da je 142 ispitanika patilo od akutnih oblika spinalnih hernija, a 120 od subakutnih i kroničnih oblika. Prosječna dob ispitanika iznosila je 44,01±9,64 (22), 41±11,3 (23) i 33±8,9 (24). Ženski spol je zastupljeniji u dva istraživanja (61 %, 58,8 %), a u trećem je zastupljeniji muški spol (56,7 %).…”

“…Značajnije razlike u demografskim parametrima između skupina nisu zabilježene ni u jednom istraživanju. Podatci o razini hernije diska su dostupni u dva istraživanja (22,24), a u trećem nisu pronađeni, a prema izračunu dostupnih podataka najveći broj ispitanika je imao herniju u razini L5/S1 (60 %), zatim u razini L4/L5 (34,1 %), a najmanje u razini L4/S1 (5,9 %).…”

“…U svim odabranim istraživanjima naveden je postupak randomizacije, zasljepljenje sudionika te izbjegavanje iskrivljenja istraživanja. U dva istraživanja u promatranim intervencijama, pored trakcije ispitanici su primali druge metode fizioterapije, koje podupire medicina utemeljena na dokazima kako bi se zadovoljila etička načela (22,23).…”

“…Intermitentna trakcija u obje skupine (G1 i G2) sastojala se od 30 sekundi istezanja, 10 sekundi odmora, ukupno 15 min u 1 tretmanu (13 minuta ciljanog intenziteta, 1 minuta ubrzanja, 1 minuta usporenja), u početku s snagom trakcije od 25 % tjelesne težine ispitanika, postepeno povećavajući do 50 %. Položaj u G1 je Fowlerov supinirani (fleksija 90˚ u zdjelici i koljenima, noge podržane) (22). Thackeray sa suradnicima u svom istraživanju su primijenili proniranu statičku trakciju (3D Active Trac table) sa silom od 40 % do 60 % težine ispitanika u trajanju od 12 minuta (23).…”