Traction

Traction is a traditional CLBP treatment that has fallen out of favor as better efficacy studies have become available.131 Anatomically, spinal traction enlarges the inte-vertebral space (theoretically decreasing forces on the intervertebral disk), stretches muscles and ligaments, separates apophyseal (facet) joints, and enlarges the intervertebral foramen. For CLBP, it appears to be no more effective than placebo, sham, or no treatment.131'132 [III] However, intermittent and continuous traction studies have been combined in systematic reviews. Proponents of traction suggest that intermittent traction may be beneficial. Currently, heavily marketed elaborate systems, such as VAX-D (VAX-D Medical Technologies LLC, Oldsmar, FL, USA) or DRX-9000 (Axiom, Tampa, FL, USA), await studies to support their claims of benefit, but use intermittent traction. Candidates for traction include those with discogenic radiculopathy and an x-ray that reveals no evidence of serious spine disease. Reports of various systems "pulling" a herniated disk back into the disk space are unsubstantiated.

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