Vertical traction for lumbar radiculopathy: a systematic review.
Carla Vanti, Luca Turone, Alice Panizzolo and 3 others
PMID 33715638WHAT IT FOUND
Vertical traction added to bed rest or medication appeared to reduce short-term pain compared with those treatments alone.
It did not reduce pain or activity limitation when added to physical therapy. Evidence was low or very low.
Key findings
01Vertical traction added to routine medication appeared to reduce short-term pain compared with routine medication alone.
02Vertical traction added to bed rest appeared to reduce short-term pain compared with bed rest alone.
03Inversion traction added to physical therapy did not significantly improve short-term pain or activity limitation compared with physical therapy alone.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only three randomized trials were included, with 90 enrolled and 85 completing assessments, so each comparison rested on one small study. All pain and activity limitation results were short-term only. The trials used different vertical traction methods, positions, forces, schedules, and control treatments, so the review could not pool them. Two studies had moderate risk of bias and one had high risk of bias. GRADE rated the evidence low or very low, and publication bias could not be excluded. Some standard deviations were borrowed from other studies, which could have changed the estimates. Positive pain effects were seen only against bed rest or medication, not against physical therapy. Only one study separately measured lumbar and sciatic pain.
The easy way to misread this
Do not read the significant pain reductions against bed rest or medication as proof vertical traction works. They came from one small trial each, at short-term follow-up, with low or very low-quality evidence, and pain did not improve when traction was added to physical therapy.