Objective This study is aimed at exploring the clinical effect of mechanical traction on lumbar disc herniation (LDH). Methods Related literatures were retrieved from PubMed, Medline, Embase, CENTRAL, and CNKI databases. Inclusion of literature topic was comparison of mechanical traction and conventional physical therapy for lumbar disc herniation. Jadad scale was used to evaluate the quality of the included RCT studies. The Chi-square test was used for the heterogeneity test, and a random effect model was used with heterogeneity. Subgroup analysis and sensitivity analysis were used to explore the causes of heterogeneity. If there was no heterogeneity, the fixed effect model was used, and funnel plots were used to test publication bias. Results Visual analog scale (VAS) in the mechanical traction group was lower than that in the conventional physical therapy group (MD = −1.39 (95% CI (-1.81, -0.98)), Z = 6.56, and P < 0.00001). There was no heterogeneity among studies (Chi2 = 6.62, P = 0.25, and I2 = 24%) and no publication bias. Oswestry disability index (ODI) in the mechanical traction group was lower than that in the conventional physical therapy group (MD = −6.34 (95% CI (-10.28, -2.39)), Z = 3.15, and P = 0.002). There was no heterogeneity between studies (Chi2 = 6.27, P = 0.18, and I2 = 36%) and no publication bias. There was no significant difference in Schober test scores between the mechanical traction group and the conventional physical therapy group (MD = −0.40 (95% CI (-1.07, 0.28)), Z = 1.16, and P = 0.25). There was no heterogeneity among studies (Chi2 = 1.61, P = 0.66, and I2 = 0%) and no publication bias. Conclusion Mechanical traction can effectively relieve lumbar and leg pain and improve ODI in patients with lumbar disc herniation but has no significant effect on spinal motion. The therapeutic effect of mechanical traction was significantly better than that of conventional physical therapy. Lumbar traction can be used in conjunction with other traditional physical therapy.

/pdf/clinical-efficacy-of-mechanical-traction-as-physical-therapy-17buvxxg.pdf

Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis

The prolapsed intervertebral disc (PIVD) at the lumbar spine is one of the most common causes of low back pain (LBP) affecting humans worldwide. Lumbar traction is widely used as a part of physiotherapeutic modalities for its treatment; however, reports on its effectiveness and dosage are conflicting. This study is aimed at comparing the acute effects of three traction forces on the straight leg raise (SLR) test and LBP intensity. A total of 45 (age 35.53 yrs., ±3.09) participants with 15 participants in each group were recruited for the study. Participants were divided into groups A, B, and C wherein traction forces equal to one-fifth, one-third, and one-half of their bodyweight were applied, respectively. SLR range of motion (ROM) and pain were examined before and immediately after the application of traction. Significant improvement was observed in SLR ROM in all three groups ( ). However, for pain, significant improvement ( ) was observed only in the group with one-half of bodyweight force. There was no significant difference ( ) between the three groups for both variables. All three forces were equally effective in immediately improving SLR ROM in patients suffering from lumbar PIVD; however, pain improvement was observed with one-half of bodyweight only.

/pdf/effects-of-one-fifth-one-third-and-one-half-of-the-1gb4soqumw.pdf

Effects of One-Fifth, One-Third, and One-Half of the Bodyweight Lumbar Traction on the Straight Leg Raise Test and Pain in Prolapsed Intervertebral Disc Patients: A Randomized Controlled Trial.

Aiming at evaluating the effects of pompage as a complementary therapy to aerobic exercises and stretching on pain, fatigue, and sleep quality in women with fibromyalgia, 23 women with this diagnosis were allocated randomly in the groups: Experimental (EG, n = 13) and Control (CG, n = 10). Subsequently, they were assessed using McGill Pain Questionnaire, Chalder Fatigue Questionnaire, and Sleep Inventory. For 12 weeks, twice a week, the EG made pompage, aerobic exercises, and stretching, while the CG only aerobic exercises and stretching. Evaluation was repeated after 6 and 12 weeks. We had sample losses totaling 15 individuals (EG, n=7/CG, n=8). We used ANOVA for repeated measurements in the statistical analysis, followed by the T test for independent samples with significant differences (p≤0.05). There was a significant reduction of McGill Pain Questionnaire joint score after 12 weeks in the EG compared with CG. There were not significant changes in other aspects evaluated for pain, fatigue and sleep quality. Therefore, we suggest that pompage as a complementary therapy to aerobic exercises and stretching did not have beneficial effects on women with fibromyalgia, since there was improvement in only one aspect of the pain evaluated. Studies with larger samples are necessary for a more consistent analysis of the results investigated.

/pdf/effects-of-pompage-associated-with-aerobic-exercises-on-pain-4o94b9eafk.pdf

Effects of pompage associated with aerobic exercises on pain, fatigue, and sleep quality in female patients with fibromyalgia: a pilot study

PURPOSE
Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR.


MATERIALS AND METHODS
Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round.


RESULTS
Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice.


CONCLUSIONS
Experts agree effectiveness of interventions differs through the evolution of LR.IMPLICATIONS FOR REHABILITATIONTo date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition.Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication.Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered.Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity.

Conservative management for lumbar radiculopathy based on the stage of the disorder: a Delphi study.

Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags. The methodology employed in this review involves an extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR. By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections. Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling. Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy.

Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review

Objective Lumbar radiculopathy (LR) is a pain syndrome caused by compression/irritation of the lumbar nerve root(s). Traction is a well-known and commonly used conservative treatment for LR, although its effectiveness is disputed. The purpose of this systematic review and meta-analysis of randomized controlled trials was to evaluate the effects of different types of traction added to or compared with conservative treatments on pain and disability. Methods Data were obtained from CENTRAL, PUBMED, CINAHL, Scopus, ISI Web of Science, and PEDro from their inception to April 2020. All randomized controlled trials on adults with LR, using mechanical traction, and without any restriction regarding publication time or language were considered. Two reviewers selected the studies, evaluated the quality assessment, and extracted the results. Meta-analysis used a random-effects model. Eight studies met the inclusion criteria, and 5 were meta-analyzed. Results Meta-analyses of results from low-quality studies indicated that supine mechanical traction added to physical therapist treatments had significant effects on pain (g = -0.58 [95% confidence interval = -0.87 to -0.29]) and disability (g = -0.78 [95% confidence interval = -1.45 to -0.11]). Analyses of results from high-quality studies of prone mechanical traction added to physical therapist intervention for pain and disability were not significant. These results were also evident at short-term follow-up (up to 3 months after intervention). Conclusion The literature suggests that, for pain and disability in LR, there is short-term effectiveness of supine mechanical traction when added to physical therapist intervention. Impact This systematic review may be relevant for clinical practice due to its external validity because the treatments and the outcome measures are very similar to those commonly used in a clinical context.

Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis.

Only low-quality evidence is currently available to support the effectiveness of different traction modalities in the treatment of lumbar radiculopathy (LR). Yet, traction is still very commonly used in clinical practice. Some authors have suggested that the subgroup of patients presenting signs and symptoms of nerve root compression and unresponsive to movements centralizing symptoms may benefit from lumbar traction. The aim of this study is to conduct a systematic review of randomized controlled trials (RCTs) on the effects of vertical traction (VT) on pain and activity limitation in patients affected by LR. We searched the Cochrane Controlled Trials Register, PubMed, CINAHL, Scopus, ISI Web of Science and PEDro from their inception to March 31, 2019 to retrieve RCTs on adults with LR using VT to reduce pain and activity limitation. We considered only trials reporting complete data on outcomes. Two reviewers selected the studies, extracted the results, and performed the quality assessment using the Risk of Bias and GRADE tools. Three studies met the inclusion criteria. Meta-analysis was not possible due to the heterogeneity of the included studies. We found very low quality evidence for a large effect of VT added to bed rest when compared to bed rest alone (g = − 1.01; 95% CI = -2.00 to − 0.02). Similarly, VT added to medication may have a large effect on pain relief when compared to medication alone (g = − 1.13; 95% CI = -1.72 to − 0.54, low quality evidence). Effects of VT added to physical therapy on pain relief were very small when compared to physical therapy without VT (g = − 0.14; 95% CI = -1.03 to 0.76, low quality evidence). All reported effects concerned short-term effect up to 3 months post-intervention. With respect to short-term effects, VT may have a positive effect on pain relief if added to medication or bed rest. Long-term effects of VT are currently unknown. Future higher quality research is very likely to have an important impact on our confidence in the estimate of effect and may change these conclusions.

/pdf/vertical-traction-for-lumbar-radiculopathy-a-systematic-3thjhu96b8.pdf

Vertical traction for lumbar radiculopathy: a systematic review.

Background: Osteopathic manual procedures called pump techniques include thoracic, abdominal, and pedal pumps. Similar techniques, called pompages, are also addressed to joints and muscles. Despite their widespread use, no systematic review has been published on their effectiveness. (2) Methods: CINAHL, Cochrane Controlled Trials Register, ISI Web of Science, PEDro, PubMed, and Scopus databases were searched until July 2020. Randomized Controlled Trials (RCTs) on adults were included. Subjective (e.g., pain, physical function) and objective (e.g., pulmonary function, blood collection) outcomes were considered. The Risk of Bias tool (RoB 2) and the GRADE instrument were used to evaluate the quality of evidence. (3) Results: 25 RCTs were included: 20 concerning the pump techniques and five concerning pompages. Due to the extensive heterogeneity of such studies, it was not possible to perform a meta-analysis. The risk of bias resulted from moderate to high and the quality of the evidence was from very low to high. Singular studies suggested some effectiveness of pump techniques on pain and length of hospitalization. Pompage seems also to help improve walking distance and balance. (4) Conclusions: Although several studies have been published on manual pump techniques, the differences for population, modalities, dosage, and outcome measures do not allow definite conclusions of their effectiveness.

The Effectiveness of Pump Techniques and Pompages: A Systematic Review

The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis

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Papers

Effectiveness of Mechanical Traction for Lumbar Radiculopathy: A Systematic Review and Meta-Analysis.

Vertical traction for lumbar radiculopathy: a systematic review.

The Effectiveness of Pump Techniques and Pompages: A Systematic Review

The effects of the addition of mechanical traction to physical therapy on low back pain? A systematic review with meta-analysis