The cost of health care is rising every year in the United States. And part of that economic burden is the management of chronic low back pain (CLBP). Efforts are being made to find out what kind of nonoperative treatment might work best for CLBP. In this report, doctors and therapists from Mayo Clinic bring us up to date on traction therapy. Does it work? How? What's the evidence to support this treatment approach?

Traction to treat spinal disorders has been around for a long time (since at least 1800 BC). It became very popular in the late 20th century for the treatment of lumbar disc lesions with back and leg pain (sciatica). High-dose traction with manipulation has become the most commonly prescribed type of traction used today. High-dose refers to using a pull of 30 to 50 per cent of the body weight.

Mechanical traction should not be used for anyone with severe osteoporosis (brittle bones), ligamentous instability, local infection, or bone cancer. Patients with fractures, hernias, or high blood pressure are also excluded from the use of traction. Traction for the lumbrosacral spine is not advised during pregnancy. It is used most often for patients with subacute or CLBP.

Overall, the evidence points against the use of traction as a treatment for CLBP. Research has not been done to show who (if anyone) might benefit the most from this treatment. Studies comparing traction to other treatment (hot packs, manipulation, exercise) have not had consistent results. Since traction can be applied in different ways with different positions and force, it's not surprising outcomes vary from study to study.

The authors conclude there is a need for further study of traction before discontinuing its use. Patients should be studied based on age, weight (or body mass index), and type of back pain or spinal disorder. The treatment variables should also be tested for number of treatments needed, length of treatment, and type of traction provided.

Ralph E. Gay, MD, DC, and Jeffrey S. Brault, DO, PT. Evidence-informed Management of Chronic Low Back Pain with Traction Therapy. In The Spine Journal. February 2008. Vol. 8. No. 1. Pp. 234-242.