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Research Studies on Traction

55+ individually Published Research Studies to support the use of traction (+/- one possible duplication) which we utilized for the design and usage of our products.

These studies range from positive effects on anxiety, depression, muscle relaxation, neck pain, low back pain, osteoarthritis, disc herniations, restoration of normal spinal curves, nerve compression, scoliosis, headaches, dizziness, traction pull angles, chronic pain, intradiscal pressure, restoration of disc heights, traction weights, and aquatic traction to name a few.

Feel free to review this literature to decide for yourself if the evidence supports the efficacy of traction and if it's right for you!

 1. Carrasco-Uribarren, A., Rodriguez-Sanz, J., López-de-Celis, C., Pérez-Guillen, S., Tricás-Moreno, J. M., & Cabanillas-Barea, S. (2022). Short-term effects of the traction-manipulation protocol in dizziness intensity and disability in cervicogenic dizziness: a randomized controlled trial. Disability and Rehabilitation, 44(14), 3601-3609.

2. Colombo, C., Salvioli, S., Gianola, S., Castellini, G., & Testa, M. (2020). Traction therapy for cervical radicular syndrome is statistically significant but not clinically relevant for pain relief. A systematic literature review with meta-analysis and trial sequential analysis. Journal of clinical medicine, 9(11), 3389.

3. Dhuriya, A., Katiyar, N., & Sethi, A. D. K. (2021). Effect of Combined Neural Mobilization and Intermittent Traction in Patients with Cervical Radiculopathy. Journal of Physical Medicine Rehabilitation Studies & Reports. SRC/JPMRS/137. DOI: doi. org/10.47363/JPMRS/2021 (3), 129, 2-4.

4. Elgendy, M. H., Ali, T. T. M., Mohamed, G. I., & Mostafa, M. S. E. M. INTERMITTENT VERSUS CONTINUOUS TRACTION IN MANAGEMENT OF MECHANICAL NECK DYSFUNCTION. Turkish Journal of Physiotherapy and Rehabilitation, 32, 3.

5. Gu, Y., Wu, Q., Luo, S., Lin, T., Zhou, L., Zheng, S., ... & Wang, Z. (2020). Is cervical traction effective in chronic nonspecific neck pain patients with unsatisfactory NSAID control? A nomogram to predict effectiveness. World neurosurgery, 139, e245-e254.

6. Luyao, H., Xiaoxiao, Y., Tianxiao, F., Yuandong, L., & Wang, P. (2022). Management of cervical spondylotic radiculopathy: a systematic review. Global Spine Journal, 12(8), 1912-1924.

7. Kuligowski, T., Skrzek, A., & Cieślik, B. (2021). Manual therapy in cervical and lumbar radiculopathy: a systematic review of the literature. International Journal of Environmental Research and Public Health, 18(11), 6176.

8. Oakley, P. A., Ehsani, N. N., Moustafa, I. M., & Harrison, D. E. (2021). Restoring cervical lordosis by cervical extension traction methods in the treatment of cervical spine disorders: a systematic review of controlled trials. Journal of Physical Therapy Science, 33(10), 784-794.

9. Savva, C., Korakakis, V., Efstathiou, M., & Karagiannis, C. (2021). Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial. Journal of Bodywork and Movement Therapies, 26, 279-289.

 Possible duplicate found here:

Effectiveness of neural mobilization with intermittent cervical traction in the management of cervical radiculopathy: a randomized controlled trial


Savva C, Giakas G, Efstathiou M, Karagiannis C, Mamais I

Contact Information:


Review Group(s):

Cochrane Back Group Trials in the Group's Specialized Register


International journal of osteopathic medicine 2016 21, 19 (19-28) Published by: Elsevier Ltd United Kingdom

10. Abi-Aad, K. R., & Derian, A. (2022). Cervical Traction. In StatPearls. StatPearls Publishing.
11. Cheng, Y. H., Hsu, C. Y., & Lin, Y. N. (2020). The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis. Clinical rehabilitation, 34(1), 13-22.
12. Filiz, M. B., Kiliç, Z., Uçkun, A., Çakir, T., Dogan, S. K., & Toraman, N. F. (2018). Mechanical traction for lumbar radicular pain: supine or prone? A randomized controlled trial. American journal of physical medicine & rehabilitation, 97(6), 433-439.
13. Liu, Z. Z., Wen, H. Q., Zhu, Y. Q., Zhao, B. L., Kong, Q. C., Chen, J. Y., & Guo, R. M. (2021). Short-term effect of lumbar traction on intervertebral discs in patients with low back pain: correlation between the T2 value and ODI/VAS score. Cartilage, 13(1_suppl), 414S-423S.
14. Tanabe, H., Akai, M., Doi, T., Arai, S., Fujino, K., & Hayashi, K. (2021). Immediate effect of mechanical lumbar traction in patients with chronic low back pain: A crossover, repeated measures, randomized controlled trial. Journal of Orthopaedic Science, 26(6), 953-961
15. Tadano, S., Tanabe, H., Arai, S., Fujino, K., & Akai, M. (2019). Lumbar mechanical traction: A biomechanical assessment of change at the lumbar spine. BMC Musculoskeletal Disorders, 20(1), 1-12.
16. Vanti, C., Panizzolo, A., Turone, L., Guccione, A. A., Violante, F. S., Pillastrini, P., & Bertozzi, L. (2021). Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis. Physical Therapy, 101(3).
17. Afzal, R., Ghous, M., Shakil Ur Rehman, S., & Masood, T. (2019). Comparison between manual traction, manual opening technique and combination in patients with cervical radiculopathy: randomized control trial. J. Pak. Med. Assoc, 69, 1237-1241.
18. Shahar, D., & Sayers, M. G. (2019). Changes in the sagittal cranio-cervical posture following a 12-week intervention using a simple spinal traction device. Spine, 44(7), 447-453.
19. Influences of spinal decompression therapy and general traction therapy on the pain, disability, and straight leg raising of patients with intervertebral disc herniation
Jioun Choi, MS, PT,1 Sangyong Lee, PhD, PT,2 and Gak Hwangbo, PhD, PT3,*
Author information Article notes Copyright and License information Disclaimer
This article has been cited by other articles in PMC.
20. Effects of vertebral axial decompression on intradiscal pressure.
Ramos G1, Martin W.
Author information Department of Neurosurgery, Rio Grande Regional Hospital, McAllen, Texas.
Rheumatol Int. 2003 Mar;23(2):82-6. Epub 2002 Sep 26.
21. The efficacy of lumbar traction in the management of patients with low back pain.
Borman P1, Keskin D, Bodur H.
Author information Clinic of Physical Medicine and Rehabilitation, Numune Training and Research Hospital, Ankara, Turkey.
Neurol Res. 1998 Apr;20(3):186-90.
22. Vertebral axial decompression therapy for pain associated with herniated or degenerated discs or facet syndrome: an outcome study.
Gose EE1, Naguszewski WK, Naguszewski RK.
Author information Department of Bioengineering, University of Illinois at Chicago, USA.
J Back Musculoskelet Rehabil. 2017 Sep 22;30(5):1015-1022. doi: 10.3233/BMR-169581.
23. Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial.
Demirel A1, Yorubulut M2, Ergun N1.
Author information 1. Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Samanpazarı, Ankara, Turkey. 2. Radiology Department, Private Acıbadem Hospital, Cankaya, Ankara, Turkey.
24. Effects of segmental traction therapy on lumbar disc herniation in patients with acute low back pain measured by magnetic resonance imaging: A single arm clinical trial.
Noureddin Karimi, Parvin Akbarov, Leila Rahnama
Published in Journal of back and musculoskeletal…2017
Int J Environ Res Public Health. 2019 Jun; 16(12): 2162.
Published online 2019 Jun 19. doi: 10.3390/ijerph16122162
PMCID: PMC6617374
PMID: 31248064
25. The Functional and Morphological Changes of the Cervical Intervertebral Disc after Applying Lordotic Curve Controlled Traction: A Double-Blind Randomized Controlled Study
Chang-Hyung Lee,1 Sung Jin Heo,2 So Hyun Park,3 Hee Seok Jeong,4 and Soo-Yeon Kim1,*
Author information Article notes Copyright and License information Disclaimer
26. Effects of Vertebral Axial Decompression (VAX-D) On Intradiscal Pressure Gustavo Ramos, M.D., William Marin, M.D. Journal of Neursurgery 81:350-353 1994
 Departments of Neurosurgery and Radiology, Rio Grande Regional Hospital, McAllen, and Division of Neurosurgery, Health Sciences Center, University of Texas, San Antonio, Texas  
27. THE JOURNAL OF ORTHOPAEDIC AND SPORTS PHYSICAL THERAPY Copyright O 1980 by The Orthopaedic and Sports Medicine Sections of the American Physical Therapy Association Effect of Angle of Traction Pull on Upper Trapezius Muscle Activity* FRED G. DELACERDA,~ PhD, PT
Niger Postgrad Med J. 2006 Sep;13(3):230-5.
28. Effects of different cervical traction weights on neck pain and mobility.
Akinbo SR1, Noronha CC, Okanlawon AO, Danesi MA.
Author information 1. Department of Physiotherapy, College of Medicine, University of Lagos.
The Journal of Bone and Joint Surgery. British volumeVol. 40-B, No. 1 Pathology and Basic SciencesFree Access
Neil G. C. Hendry
Published Online:1 Feb 1958 Published: 08 July 2010.
30. Restoration of disk height through non-surgical spinal decompression is associated with decreased discogenic low back pain: a retrospective cohort study
Christian C Apfel1,5,
Ozlem S Cakmakkaya1,5,
William Martin2,5,
Charlotte Richmond3,5,
Alex Macario4,5,
Elizabeth George1,5,
Maximilian Schaefer1,5 &
Joseph V Pergolizzi4,5
- Show fewer authors
BMC Musculoskeletal Disorders volume 11, Article number: 155 (2010) Cite this article
Pre-publication history
The pre-publication history for this paper can be accessed here:
31. Eyerman EL. MRI evidence of nonsurgical, mechanical reduction, rehydration and repair of the herniated lumbar disc. Journal of Neuroimaging 1998;8(2).
32. Nonsurgical Spinal Decompression Of Lumbar Disc Herniation: A Case Report And Proposed Multimodal Chiropractic Treatment Approach
L Henry
L Henry. Nonsurgical Spinal Decompression Of Lumbar Disc Herniation: A Case Report And Proposed Multimodal Chiropractic Treatment Approach. The Internet Journal of Chiropractic. 2015 Volume 4 Number 1.
DOI: 10.5580/IJCH.31697
33. Treatment of 94 Outpatients With Chronic Discogenic Low Back Pain with the DRX9000:
A Retrospective Chart Review
Alex Macario, MD, MBA*; Charlotte Richmond, PhD†; Martin Auster, MD, MBA‡; Joseph V. Pergolizzi, MD§
*Departments of Anesthesia and Health Research & Policy, Stanford University School of
Medicine, Stanford, California; †Biomedical Research & Education Foundation, LLC, Miami
Beach, Florida; ‡Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, §Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A.
Pain Practice 2008;8(1):11-7
34. Use of a Spinal Traction Device during Work Shift in Assembly Line Workers.
Academic Journal
(English) By: Rabal-Pelay J; Cimarras-Otal C; Macia-Calvo M; Laguna-Miranda C; Bataller-Cervero AV, International journal of environmental research and public health [Int J Environ Res Public Health], ISSN: 1660-4601, 2021 Jul 20; Vol. 18 (14); Publisher: MDPI; PMID: 34300157;
Increasing back discomfort and spinal shrinkage during the workday is a problem that affects assembly line workers. The aim of this research was to analyze the effect of a spinal traction system on discomfort, spinal shrinkage, and spinal sagittal alignment in assembly line workers, who are in prolonged standing conditions during a workday. A total of 16 asymptomatic males were recruited to assess spinal shrinkage, spinal sagittal alignment, and back discomfort during the workday. The measurement was carried out in two days of work, a normal day, and the other using a spinal traction device utilized in two breaks during the workday. Assembly line workers lost height significantly on both control and intervention days. No differences were found between days. No changes were found in spinal sagittal alignment on the control day. Lumbar lordosis angle increased significantly at the end of the intervention day. The use of a spinal traction device during the workday in two breaks time did not significantly reduce the spinal shrinkage of healthy workers. Lumbar lordosis angle increased significantly at the end of the spinal traction intervention day. Prospective studies would be necessary to clarify the possible benefits of the traction device., Database: MEDLINE with Full Text PubMed
Subjects: Lordosis; Traction; Humans; Lumbar Vertebrae; Male; Prospective Studies; Spine; Standing Position
35. The use of underwater horizontal traction and mechanotherapy in the complex treatment of degenerative spondylolisthesis of the lumbosacral spine: a pilot clinical study.
Academic Journal
(Russian) By: Borodulina IV; Badalov NG; Mukhina AA; Chesnikova EI; Yakovlev MY, Voprosy kurortologii, fizioterapii, i lechebnoi fizicheskoi kultury [Vopr Kurortol Fizioter Lech Fiz Kult], ISSN: 0042-8787, 2022; Vol. 99 (2), pp. 45-52; Publisher: Media Sfera; PMID: 35485660;

Underwater traction of the spine is a physiotherapeutic method that combines the effects of mechanical traction and fresh water of indifferent temperature and seems promising for the treatment of pain in the lower back, which is due to the physiological basis of the mechanism of action on the spinal motion segment by eliminating muscle spasm and restoring the biomechanics of the spine.
Objective: To study the effectiveness of underwater horizontal traction in combination with mechanotherapy in patients with non-stenosing unstable degenerative spondylolisthesis of the lumbosacral spine of the 1st degree, accompanied by pain.

Material and Methods: The clinical study included 14 patients (mean age 50.21 years). Patients underwent underwater horizontal traction of the spine according to the modified Pushkareva-Vozdvizhenskaya method in a variable mode, the procedures were performed every other day, for a course of 6 procedures. After completion of the traction procedure, patients were recommended to put on a fixing lumbosacral corset, in which they rested for 30 minutes in the supine position. At the end of the rest period, the patients performed training of the back muscles with biofeedback on the mechanotherapeutic complex of simulators for 30 minutes daily, except for weekends, for a course of 10 procedures.
Results: All patients completed the course of treatment, during the procedures no side effects or deterioration were noted. During the treatment, motor and daily activity significantly improved according to the Oswestry scale ( p =0.002), the severity of the pain syndrome and its effect on the patient's activity decreased, according to the Roland-Morris questionnaire ( p =0.003). According to an objective assessment of the muscle strength of the lumbosacral spine at the initial level, no deviations from the normative parameters were revealed, however, during the treatment, a significant increase in strength was noted in all muscle groups.

Conclusion: Underwater horizontal traction of the spine in variable mode according to Pushkareva-Vozdvizhenskaya is an effective and safe method of conservative treatment of unstable non-stenosing degenerative spondylolisthesis of the 1st degree, accompanied by back pain, which helps to reduce the intensity of the pain syndrome and improve the daily motor and social activity of patients. The traction method should be supplemented with therapeutic exercises using mechanotherapeutic simulators to achieve a clinical result., Database: MEDLINE with Full Text PubMed
Subjects: Spondylolisthesis therapy; Traction methods; Humans; Lumbar Vertebrae; Middle Aged; Pain; Pilot Projects
36. Reduction of Adolescent Idiopathic Scoliosis and Improved Z-Axis Alignment of the Entire Spine When Treating a Symptomatic Patient Using a Multidisciplinary Approach: A Case Report
Academic Journal
By: Juan Jesus Villa; Zhiyang Zhao; Weicheng Pan; Yongfei Guo. In: Frontiers in Rehabilitation Sciences, Vol 3 (2022); Frontiers Media S.A., 2022. Language: English. Abstract: BackgroundThis study presents findings on improvements of both the X-axis and Z-axis posture in a young female with adolescent idiopathic, scoliosis suffering from pain complaints who was treated with a multidisciplinary approach.Case PresentationThe 15-year-old patient reported low back pain for several months. Full spine radiographic assessment revealed a cervical kyphosis, forward head translation, a right ribcage translation, a left higher shoulder, and a dextroconvex lumbar scoliosis with a Cobb angle of 23°. The patient was treated with novel ASPINE Systems treatment protocols incorporating posture exercises, muscle balancing exercises, spinal 3D traction, and spinal manipulation.ResultsAssessment after 50 treatment sessions over 32 weeks revealed a dramatic improvement in postural distortions. The cervical kyphosis was reduced by 9° and was accompanied by a reduction in forward head posture, centering of the thoracic spine, leveling off her shoulders, and a reduction in the dextroconvex scoliosis by 10°. The lower back pain was relieved.ConclusionA reduction of postural distortions including idiopathic adolescent scoliosis resulted from a multidisciplinary approach utilizing ASPINE Systems. (AN: edsdoj.23c69d28e4c41068bbf24383075dff4), Database: Directory of Open Access Journals
Subjects: idiopathic juvenile scoliosis; cervical kyphosis; low back pain; ASPINE Systems; spinal XYZ traction; Other systems of medicine; RZ201-999; Medical technology; R855-855.5
37. Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature.
Academic Journal
(English) By: Fedorchuk C; Lightstone DF; McRae C; Kaczor D, Journal of radiology case reports [J Radiol Case Rep], ISSN: 1943-0922, 2017 May 31; Vol. 11 (5), pp. 13-26; Publisher: EduRad Publishing; PMID: 29299090;
Objective: Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided.
Clinical Features: A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm.
Interventions and Outcomes: The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits.

Conclusions: This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods., Database: MEDLINE with Full Text PubMed
Subjects: Lumbar Vertebrae diagnostic imaging; Manipulation, Chiropractic methods; Spondylolisthesis therapy; Traction methods; Aged; Clinical Protocols; Female; Humans; Low Back Pain etiology; Muscle Cramp etiology; Rehabilitation; Spondylolisthesis complications; Spondylolisthesis diagnostic imaging; Spondylolisthesis rehabilitation
38. Systematic Review and Meta-Analysis of the Evaluation of the Efficacy of Manipulation and Cervical Traction in the Treatment of Radical Cervical Spondylosis
Academic Journal
By: Chen, Jianquan; Chen, Rongbin; Li, Yong; Chen, Maoshui; Lv, Zhouming; Zeng, Haobin; Lian, Qiang. In: Emergency Medicine International. October 6, 2022, Vol. 2022; Hindawi Limited, 2022. Language: English. Abstract: Background. With the accelerated pace of life in modern society, changes in work style, and the popularity of computers, the prevalence of cervical spondylosis (CSR) is increasing, and the age of onset is advancing. Once suffering from this disease, it is often difficult to cure and recurring, with complex clinical symptoms, causing a serious impact on human health. Objective. To evaluate the efficacy of manipulation and cervical traction in the treatment of radical cervical spondylosis. Methods. The PubMed, CNKI, and Wanfang databases were searched for literature. The literature related to this study was included according to selective criteria and inhibitory elimination criteria, and valuable information was selected for statistical analysis, resulting in a total of 11 randomized controlled trials with 994 subjects. Results. The short-term efficacy of manual treatment for CSR was superior to that of cervical traction alone (P / Author(s): Jianquan Chen [1,2]; Rongbin Chen [1,2]; Yong Li [2]; Maoshui Chen [2]; Zhouming Lv [2]; Haobin Zeng [2]; Qiang Lian (corresponding author) [2] 1. Introduction The cervical spine is [...] (AN: edsgcl.722695154), Database: Gale Health and Wellness
Subjects: China; Orthopedic traction -- Analysis; Kyphosis -- Drug therapy; Spinal osteophytosis -- Drug therapy; Evidence-based medicine – Analysis
39. Changes in sagittal lumbar configuration with a new method of extension traction: nonrandomized clinical controlled trial
By: Harrison DE Cailliet R Harrison DD Janik TJ Holland B. Review Group(s): Cochrane Complementary Medicine Field. Source: Archives of physical medicine and rehabilitation 2002 Nov 8311 (11),, p1585 (1585-91). MEDLINE Publication Type: Clinical Trial; Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't. Abstract available.
Subjects: Adult; Female; Humans; Male; Middle Aged; Adult; Female; Humans; Male; Middle Aged; Biomechanical Phenomena; Chronic Disease; Equipment Design; Follow-Up Studies; Lordosis complications; Lordosis physiopathology; Low Back Pain complications; Low Back Pain physiopathology; Manipulation, Spinal; Pain Measurement; Range of Motion, Articular; Rotation; Time Factors; Traction instrumentation; Traction standards; Treatment Outcome; Lordosis; Lordosis; Low Back Pain; Low Back Pain; Lumbar Vertebrae; Traction; radiography; rehabilitation; radiography; rehabilitation; radiography; methods
40. Comparison of the Effect of Lumbar Traction, Spinal Manipulation, and Surgery in the Treatment of Lumbar Disc Herniation
Report In: Comparison of the Effect of Lumbar Traction, Spinal Manipulation, and Surgery in the Treatment of Lumbar Disc Herniation; Shin Kong Wu Ho-Su Memorial Hospital Language: English. Abstract: To compare the effect of lumbar traction, lumbar spinal manipulation and lumbar surgery in the treatment of LDH. / Back pain is the second leading cause of work absenteeism (after upper respiratory tract complaints) and results in more lost productivity than any other medical condition. The lifetime prevalence of back pain exceeds 70% in most industrialized countries, and the 1-year prevalence for an episode of acute low back pain (LBP) has been estimated to be 65%. Sciatica is present in about 25% of those with LBP, and one of the major cause of sciatica is herniation of intervertebral disc (HIVD) of the lumbosacral spine or lumbar disc herniation (LDH). In the United Kindom, the estimated prevalence of LDH is from 1% to 3%. Although 95% of LBP patients recovered in 12 weeks, recurrent pain and disability were common and occurred in 12% over the 18-month observation period. Disc herniation may be purely annular, purely nuclear, or consist of a combination of annular and nuclear tissues. Nuclear disc herniation track posteriorly between the anterior surface of the posterior longitudinal ligament and the posterior surfaces of the annulus and vertebral body and then into the spinal canal. Disc herniation may be described as protrusion or extrusion (or sequestration, if the displaced disc material has lost completely any continuity with the parent disc); contained or uncontained. The usual presenting complaint is acute or chronic intermittent LBP with or without sciatica, which is radiating pain in a dermatomal distribution and classically described as a burning, stabbing, or electric sensation, sometimes accompanied with paresthesia. Central disc herniations or herniation that have migrated can each result in a mixed clinical picture or, alternately, signs of stenosis may predominate. The mechanism of pain is mutifactorial, involving mechanical stimulation of the nerve endings in the outer annulus, direct compression on the posterior longitudinal ligament, dura, or nerve root, and/or the chemical inflammatory cascade induced by the exposed nucleus pulposus or annulus fibrosis.The classic straight leg raising (SLR) test or Lasegue test is thought to be a useful clinical test to demonstrate an inflammatory compressive process across single or multiple spinal nerve roots. Magnetic resonance imaging (MRI) has become the examination of choice for diagnosing LDHs.It has the advantage of having no known side effects or morbidity, no radiation exposure, and is noninvasive. The sensitivity and specificity of MRI in detecting annular tears, disc herniation, and nerve root swelling has been confirmed in several studies. MRI findings have been correlated to clinical findings and are strong predictors of surgical outcomes. However, morphological abnormalities demonstrated by MRI do not always reflect LBP or sciatica. MRI should be interpreted with consideration of full clinical signs, symptoms, and other relevant background. Treatment of LDH consists of operative and non-operative treatments. Non-operative care of LDH includes a wide range of different methods: lumbar supports, bed rest, oral analgesics and muscle relaxants, lumbar traction, therapeutic exercise, spinal manipulation, epidural steroid injections, and behavioral therapy. Lumbar traction is a very popular therapy for treatment of LDH in our country. Patients would be placed in traction with the expectation that stretching of the lumbar area would result in distraction and elongation of the structural elements and resolution of pain. Other physiological effects of lumbar traction including decrease in the intra-disc pressure, relief of muscle spasm , reduction of prolapsed disc and forcing patients to bed rest. Despite favorable outcomes have been reported previously, there are few scientifically rigorous studies in the literature that allow the effect of traction to be distinguished from the natural history of the pathology being treated. Spinal manipulation for treatment of LBP or LDH has been practiced for hundreds of years. Theories for the effect of manipulation include restoring normal motion to restricted segments and impacts proprioceptive primary afferent neurons from paraspinal tissues. It also affects pain processing by altering the central facilitated state of the spinal cord. Multiple randomized controlled trials and systematic review have been done to assess the efficacy of manual therapy. In a meta-analysis by Assendelft et al, spinal manipulation was found to be more effective than placebo for acute and chronic LBP.Santilli et al also found that active manipulation had more effect than simulated manipulation on pain relief of acute back pain and sciatica with disc protrusion. However, in a recent review article, the authors concluded that definitive values on safety and effectiveness of spinal manipulation cannot be made, but they admit that many patients with LDH did undergo manipulative treatment, and spinal manipulation may be effective in the treatment of symptomatic LDH. The goal of surgery for a LDH is to remove the portion of disc that is impinging on the nerve root. There are many options for surgery for LDH, including open discectomy, laminotomy, laminectomy, or the combinations. There are also new techniques such as endoscopic discectomy, laser discectomy, and electrothermal disc decompression. Choice of surgery depends on surgeons' experience and condition of the patients. Favorable short-term results have been reported before. Although lumbar traction, spinal manipulation, and surgery have been used extensively in the management of LDH, comparison of the three treatments has never been studied before. The purpose of this study is to compare the effect of lumbar traction, spinal manipulation, and surgery in the treatment of LDH. (AN: edsclt.NCT03118271), Database:
Subjects: Intervertebral Disc Displacement; Hernia; Lumbar Disc Herniation; Lumbar Traction; Spinal Manipulation; Lumbar Surgery
41. Anxiety, depression, and quality of life in backache patients before and after spinal traction
Academic Journal By: Shalaby, Amr Said; el-sharaki, Dina Rifaat; Salem, Gelan Mahmoud. In: The Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 54(1); Springer Berlin Heidelberg Language: English. Abstract: Background: Chronic pain has a negative impact on quality of life and psychological well-being. The objectives of this study are to investigate the psychological status and quality of life in backache patients before and after spinal traction and reflect how this maneuver is effective in treating backache.
Methods: Forty-seven backache patients completed the hospital anxiety and depression scale (HADS) and Short-Form 36 Health Survey (SF-36) before and after treatment with spinal traction. Forty-eight healthy controls, matched with patients for age and sex, completed the same questionnaires. Pain was assessed before and after the maneuver using a visual analog scale (VAS). Traction was added to patients’ medications which were not enough to control patients’ symptoms and did not change during the course of traction.
Results: Before spinal traction, the mean VAS score was 7 ± 1.36, abnormal levels of anxiety and depression were found in 36.17% and 40.43%, respectively, of patients, and all SF-36 domains of the study population, except for physical functioning, showed mean scores < 50%. After spinal traction, the mean VAS score dropped significantly to 5.44 ± 1.51, abnormal levels of anxiety and depression became 14.9% and 21.3%, and all SF-36 domains improved significantly, with six of the eight domains showing mean scores > 50%. There were significant differences regarding all SF-36 domains, and anxiety and depression scores between patients and controls, in favor of controls, before traction. These differences disappeared after spinal traction.
Conclusion: Pain, psychological status, and quality of life improved when spinal traction was added to medications reflecting its efficacy for patients with backache.
(AN: edssjs.E534CDAD), Database: Springer Nature Journals
Subjects: Backache; Spinal traction; Psychological status; Quality of life
42. Effects of patient-specific three-dimensional lumbar traction on pain and functional disability in patients with lumbar intervertebral disc prolapse.
Academic Journal
(English) By: Asiri F; Tedla JS; D Alshahrani MS; Ahmed I; Reddy RS; Gular K, Nigerian journal of clinical practice [Niger J Clin Pract], ISSN: 1119-3077, 2020 Apr; Vol. 23 (4), pp. 498-502; Publisher: Medknow Publications; PMID: 32246656;
Background: Prolapsed lumbar intervertebral disc is one of the most prevalent causes of low back pain and traction is one of the most common physical therapy treatments offered to affected patients. Advancements in traction equipment are needed to ensure their effectiveness in clinical situations.
Aims: The objective of the study was to find out the effect of patient-specific three-dimensional lumbar traction on pain and functional disability in individuals with lumbar intervertebral disc prolapse.

Subjects and Methods: Original article and Experimental design. Twenty-five participants (age range: 34-67 years) diagnosed with lumbar intervertebral disc prolapse were included in this study. Patient-specific three-dimensional lumbar traction was given as three sessions per week for the duration of one month. All participants completed a 10-cm visual analog pain scale and pain pressure threshold to assess pain and the Oswestry disability index to assess the functional disability.

Results: On pre to post interventions, a significant change in mean values were found for visual analog scale pain score, pain pressure threshold, and Oswestry disability index (P < 0.001). The pain intensity was reduced from 8.5 to 3.2, pain pressure threshold increased from 0.7 to 1.6 kg/cm 2 , and functional disability was reduced from 53.5% to 31.3%.

Conclusion: Twelve sessions of patient-specific three-dimensional lumbar traction promoted a reduction in pain and improvement in functional disability among subjects with lumbar intervertebral disc prolapse.
Competing Interests: None, Database: MEDLINE with Full Text PubMed
Subjects: Intervertebral Disc Degeneration therapy; Intervertebral Disc Displacement therapy; Low Back Pain therapy; Traction methods; Adult; Aged; Female; Humans; Male; Middle Aged; Physical Therapy Modalities; Prolapse; Treatment Outcome; Visual Analog Scale
By: Sahasrabudhe A Eapen C Zulfeequer CP. Review Group(s): Cochrane Back Group. Source: Journal of musculoskeletal research 2017. Published by: World Scientific Publishing Co. Pte Ltd in Singapore MEDLINE Publication Type: Journal: Article in Press. Abstract: Purpose: The aim of this paper is to see the effectiveness of cervical traction manual or mechanical as an adjunct to physical therapy in the treatment of radiating neck pain. Method: 50 subjects with radiating neck pain, 25 in each group were taken. Both groups received moist heat and cervical retraction exercises for five sessions. The KTr group received Kaltenborn manual traction and the Tr group received mechanical cervical traction. Outcome measures: Numeric Pain Rating Scale and cervical ROM were taken at baseline, after first treatment and at the end of 5th day. Neck disability index and Patient-Specific Functional Scale were taken at baseline and at the end of fifth session. Results: After 5 days of treatment, statistical improvements ((Formula presented.).05) were observed in all outcome measures in both groups. The immediate reduction in pain intensity and increased range of motion was observed in the KTr group. Conclusion: The study showed that both traction methods are equally effective when used as adjunct to physical therapy in radiating neck pain treatment. Immediate effects in reduction of pain and increase in the ROM are more in the manual traction group. Hence, manual cervical traction along with physical therapy can be considered as choice of treatment for immediate improvements in pain and ROM of the cervical spine. (AN: CN-01441452), Database: Cochrane Central Register of Controlled Trials
Subjects: adult; cervical spine; clinical article; controlled study; exercise; female; heat; human; *Neck Disability Index; numeric rating scale; outcome assessment; pain intensity; physiotherapy; randomized controlled trial; range of motion; *traction therapy
44. No effect of traction in patients with low back pain: a single centre, single blind, randomized controlled trial of Intervertebral Differential Dynamics Therapy.
Academic Journal (English) By: Schimmel JJ; de Kleuver M; Horsting PP; Spruit M; Jacobs WC; van Limbeek J, European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J], ISSN: 1432-0932, 2009 Dec; Vol. 18 (12), pp. 1843-50; Publisher: Springer-Verlag; PMID: 19484433; Low back pain (LBP) poses a significant problem to society. Although initial conservative therapy may be beneficial, persisting chronic LBP still frequently leads to expensive invasive intervention. A novel non-invasive therapy that focuses on discogenic LBP is Intervertebral Differential Dynamics Therapy (IDD Therapy, North American Medical Corp. Reg U.S.). IDD Therapy consists of intermittent traction sessions in the Accu-SPINA device (Steadfast Corporation Ltd, Essex, UK), an FDA approved, class II medical device. The intervertebral disc and facet joints are unloaded through axial distraction, positioning and relaxation cycles. The purpose of this study is to investigate the effect of IDD Therapy when added to a standard graded activity program for chronic LBP patients. In a single blind, single centre, randomized controlled trial; 60 consecutive patients were assigned to either the SHAM or the IDD Therapy. All subjects received the standard conservative therapeutic care (graded activity) and 20 sessions in the Accu-SPINA device. The traction weight in the IDD Therapy was systematically increased until 50% of a person's body weight plus 4.45 kg (10 lb) was reached. The SHAM group received a non-therapeutic traction weight of 4.45 kg in all sessions. The main outcome was assessed using a 100-mm visual analogue scale (VAS) for LBP. Secondary outcomes were VAS scores for leg pain, Oswestry Disability Index (ODI), Short-Form 36 (SF-36). All parameters were measured before and 2, 6 and 14 weeks after start of the treatment. Fear of (re)injury due to movement or activities (Tampa Scale for Kinesiophobia), coping strategies (Utrecht Coping List) and use of pain medication were recorded before and at 14 weeks. A repeated measures analysis was performed. The two groups were comparable at baseline in terms of demographic, clinical and psychological characteristics, indicating that the random allocation had succeeded. VAS low back pain improved significantly from 61 (+/-25) to 32 (+/-27) with the IDD protocol and 53 (+/-26) to 36 (+/-27) in the SHAM protocol. Moreover, leg pain, ODI and SF-36 scores improved significantly but in both groups. The use of pain medication decreased significantly, whereas scores for kinesiophobia and coping remained at the same non-pathological level. None of the parameters showed a difference between both protocols. Both treatment regimes had a significant beneficial effect on LBP, leg pain, functional status and quality of life after 14 weeks. The added axial, intermittent, mechanical traction of IDD Therapy to a standard graded activity program has been shown not to be effective., Database: MEDLINE with Full Text PubMed
Subjects: Intervertebral Disc Displacement therapy; Low Back Pain therapy; Physical Therapy Modalities statistics & numerical data; Traction methods; Traction statistics & numerical data; Activities of Daily Living; Adult; Biomechanical Phenomena physiology; Disability Evaluation; Female; Humans; Intervertebral Disc physiopathology; Intervertebral Disc Displacement complications; Intervertebral Disc Displacement physiopathology; Low Back Pain etiology; Low Back Pain physiopathology; Male; Middle Aged; Mobility Limitation; Outcome Assessment, Health Care; Pain Measurement; Patient Satisfaction; Physical Therapy Modalities instrumentation; Range of Motion, Articular physiology; Single-Blind Method; Spine physiopathology; Stress, Mechanical; Surveys and Questionnaires; Traction instrumentation; Treatment Failure; Weight-Bearing physiology
45. Systematic Literature Review of Spinal Decompression Via Motorized Traction for Chronic Discogenic Low Back Pain.
Academic Journal By: Macario, Alex; Pergolizzi, Joseph V.. Pain Practice, Sep2006, Vol. 6 Issue 3, p171-178, 8p, 2 Charts. Publisher: Wiley-Blackwell.; Abstract Objective: The objective of this study was to systematically review the literature to assess the efficacy of nonsurgical spinal decompression achieved with motorized traction for chronic discogenic lumbosacral back pain. Design: Computer-aided systematic literature search of MEDLINE and the Cochrane collaboration for prospective clinical trials on adults with low back pain in the English literature from 1975 to October 2005. Methodologic quality for each study was assessed. Studies were included if the intervention group received motorized spinal decompression and the comparison group received sham or another type of nonsurgical treatment. Results: Data from 10 studies were fully analyzed. Seven studies were randomized controlled trials using various apparatus types. Because of this low number, we also analyzed three nonrandomized case series studies of spinal decompression systems. As the overall quality of studies was low and the patient groups heterogeneous, a meta-analysis was not appropriate and a qualitative review was undertaken. Sample sizes averaged 121 patients (range 27–292), with six of the seven randomized studies reporting no difference with motorized spinal decompression and one study reporting reduced pain but not disability. The three unrandomized studies (no control group) of motorized spinal decompression found a 77% to 86% reduction in pain.

Conclusions: These data suggest that the efficacy of spinal decompression achieved with motorized traction for chronic discogenic low back pain remains unproved. This may be, in part, due to heterogeneous patient groups and the difficulties involved in properly blinding patients to the mechanical pulling mechanism. Scientifically more rigorous studies with better randomization, control groups, and standardized outcome measures are needed to overcome the limitations of past studies. [ABSTRACT FROM AUTHOR]; (AN 21857435), Database: Complementary Index
Subjects: LUMBAR pain; BACK diseases; PAIN; SPINE; DECOMPRESSION (Physiology)
46. Immediate Changes in Spinal Height and Pain After Aquatic Vertical Traction in Patients With Persistent Low Back Symptoms: A Crossover Clinical Trial
Academic Journal By: Simmerman, Susanne M.; Sizer, Phillip S.; Dedrick, Gregory S.; Apte, Gail G.; Brismée, Jean-Michel. PM & R: Journal of Injury, Function & Rehabilitation, May2011, Vol. 3 Issue 5, p447-457, 11p. Publisher: Wiley-Blackwell.; Abstract Objective: To investigate the effect of aquatic vertical traction on spinal height, pain intensity, and centralization response compared with a land-based supine flexion position for patients with low back pain and signs of nerve root compression. Design: Single-blind, repeated-measures crossover design. Setting: Outpatient physical therapy clinic. Subjects: Ninety-eight subjects were recruited using consecutive sampling, with 28 men and 32 women of a mean ± standard deviation (SD) age of 59.6 ± 11.6 years completing testing. Intervention: Each subject participated in 2 sessions that consisted of loaded walking for 15 minutes, followed by either 15 minutes of land-based supine position or 15 minutes of aquatic vertical traction. Measurements: Spinal height change, measured using a commercial stadiometer, was determined after completing loaded walking and after each intervention. Results: The mean ± SD height change of 4.99 ± 2.88 mm after aquatic vertical traction was similar to that of 4.21 ± 2.53 mm after the land-based supine flexion (P = .0969). Paired t-test indicated that both interventions resulted in significant increased height (P < .0001). Decreases in pain after aquatic intervention (2.7 ± 2.1 cm) were significantly greater than decreases after land intervention (1.7 ± 1.7 cm; P = .0034), and centralization of symptoms was more pronounced after aquatic vertical suspension compared with the supine land-based flexion condition (P < .0001). A significant correlation between height change and both pain reduction (r = 0.39; P = .001) and centralization (r = 0.29; P = .013) was observed for the aquatic intervention only. Conclusion: Although both the aquatic and land interventions produced significant increases in overall spinal height, the aquatic intervention produced greater pain relief and centralization response in subjects with low back pain and signs of nerve root compression. [ABSTRACT FROM AUTHOR]; (AN 60666612), Database: Complementary Index
Subjects: Research and Development in the Physical, Engineering, and Life Sciences (except Biotechnology); LUMBAR pain; CLINICAL trials; SUPINE position; ENTRAPMENT neuropathies; PHYSICAL therapy; ANALGESIA; SPINE diseases
47. Biomechanical analysis of combining head-down tilt traction with vibration for different grades of degeneration of the lumbar spine.
Academic Journal (English) By: Wang S; Wang L; Wang Y; Du C; Zhang M; Fan Y, Medical engineering & physics [Med Eng Phys], ISSN: 1873-4030, 2017 Jan; Vol. 39, pp. 83-93; Publisher: Butterworth-Heinemann; PMID: 27816390;
In recent years, a combination of traction and vibration therapy is usually used to alleviate low back pain (LBP) in clinical settings. Combining head-down tilt (HDT) traction with vibration was demonstrated to be efficacious for LBP patients in our previous study. However, the biomechanics of the lumbar spine during this combined treatment is not well known and need quantitative analysis. In addition, LBP patients have different grades of degeneration of the lumbar spinal structure, which are often age related. Selecting a suitable rehabilitation therapy for different age groups of patients has been challenging. Therefore, a finite element (FE) model of the L1-L5 lumbar spine and a vibration dynamic model are developed in this study in order to investigate the biomechanical effects of the combination of HDT traction and vibration therapy on the age-related degeneration of the lumbar spine. The decrease of intradiscal pressure is more effective when vibration is combined with traction therapy. Moreover, the stresses on the discs are lower in the "traction+vibration" mode than the "traction-only" mode. The stress concentration at the posterior part of nucleus is mitigated after the vibration is combined. The disc deformations especially posterior disc radial retraction is improved in the "traction+vibration" mode. These beneficial effects of this therapy could help decompress the discs and spinal nerves and therefore relieve LBP. Simultaneously, patients with grade 1 degeneration (approximately 41-50 years old) are able to achieve better results compared with other age groups. This study could be used to provide a more effective LBP rehabilitation therapy.
Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved., Database: MEDLINE with Full Text PubMed
Subjects: Head-Down Tilt; Intervertebral Disc Degeneration therapy; Lumbar Vertebrae; Mechanical Phenomena; Traction instrumentation; Vibration; Adult; Aged; Biomechanical Phenomena; Female; Humans; Intervertebral Disc Degeneration complications; Low Back Pain complications; Low Back Pain therapy; Male; Middle Aged
48. Effect of spinal decompression therapy and core stabilization exercises in management of lumbar disc prolapse: A single blind randomized controlled trial.
Gaowgzeh RAM
Chevidikunnan MF
BinMulayh EA
Khan F
Journal of back and musculoskeletal rehabilitation [J Back Musculoskelet Rehabil] 2020; Vol. 33 (2), pp. 225-231.
Publication Type:
Journal Article; Randomized Controlled Trial
49. Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial
Amjad, FareehaAff1, IDs1289102205196x_cor1
Mohseni-Bandpei, Mohammad A.Aff1, Aff2
Gilani, Syed Amir
Ahmad, Ashfaq
Hanif, Asif
BMC Musculoskeletal Disorders. 23(1)
Publication Status:
Publisher Information:
BioMed Central
Publication Year:
50. H-reflex latency changes after combined application of traction and neural mobilization in cervical radiculopathy
Mohammed M. Hegazy
Ebtessam F. Gomaa
Salwa F. Abd El Mageed
Hala R. El Habashy
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, Vol 55, Iss 1, Pp 1-6 (2019)
Publisher Information:
SpringerOpen, 2019.
Publication Year:
LCC:Neurosciences. Biological psychiatry. Neuropsychiatry
51. Effects of Intermittent Traction in Patients With Cervical Osteoarthritis
Mohammad Akbari
Mohammad Bayat
Medical Journal of The Islamic Republic of Iran, Vol 24, Iss 1, Pp 23-28 (2010)
Publisher Information:
Iran University of Medical Sciences, 2010.
Publication Year:
LCC:Medicine (General)
52. Research on the effectiveness of intermittent cervical traction therapy, using short-latency somatosensory evoked potentials
Hattori, Mikihiko
Shirai, Yasumasa
Aoki, Takafumi
Journal of Orthopaedic Science. March 2002 7(2):208-216
Publication Status:
Publisher Information:
Publication Year:
53. Changes in neck muscle thickness due to differences in intermittent cervical traction force measured by ultrasonography.
Kuniyasu K; Kawasaki University of Medical Welfare, Japan.
Journal of physical therapy science [J Phys Ther Sci] 2014 May; Vol. 26 (5), pp. 785-7. Date of Electronic Publication: 2014 May 29.
Publication Type:
Journal Article
Journal Info:
Publisher: Society of Physical Therapy Science Country of Publication: Japan NLM ID: 9105359 Publication Model: Print-Electronic Cited Medium: Print ISSN: 0915-5287 (Print) Linking ISSN: 09155287 NLM ISO Abbreviation: J Phys Ther Sci Subsets: PubMed not MEDLINE
54. Innovative seated vertical lumbar traction allows simultaneous computer work while inducing spinal height changes similar to supine lying.
Johnson, Marit E.1
Karges-Brown, Joy R.2
Brismée, Jean-Michel3
Brenza, Timothy M.1,4
Piper, Adam K.1,5
Journal of Back & Musculoskeletal Rehabilitation. 2023, Vol. 36 Issue 3, p739-749. 11p.
55. Clinical Efficacy of Mechanical Traction as Physical Therapy for Lumbar Disc Herniation: A Meta-Analysis.
Wang, Wenxian1 (AUTHOR)
Long, Feibing2 (AUTHOR)
Wu, Xinshun2 (AUTHOR)
Li, Shanhuan2 (AUTHOR)
Lin, Ji3 (AUTHOR)
Computational & Mathematical Methods in Medicine. 6/21/2022, p1-7. 7p.

56. Effects of Different Angles of the Traction Table on Lumbar Spine Ligaments: A Finite Element Study


Clin Orthop Surg. 2017 Dec; 9(4): 480–488.

Published online 2017 Nov 10. doi: 10.4055/cios.2017.9.4.480

Hekmat Farajpour, MS and Nima Jamshidi, PhD

57. The effects of cervical traction, cranial rhythmic impulse, and Mckenzie exercise on headache and cervical muscle stiffness in episodic tension-type headache patients.

J Phys Ther Sci. 2016 Mar; 28(3): 837–843. Published online 2016 Mar 31. doi: 10.1589/jpts.28.837

Authors: Sung-Yong Choi, PT, MS1 and Jung-Hyun Choi, PT, PhD1,*