The Value of Traction in Treatment of Lumbar Radiculopathy

Despite the opinions of clinical experts that patients who might benefit from traction may
represent distinct sub-groups of patients, most studies have not attempted to narrow their
inclusion criteria beyond loose definitions of 'acute' or 'chronic' symptoms. While these
studies seem to indicate that traction interventions will be of little benefit when
administered to large groups of patients without a prior attempt to select which patients
are most likely to benefit, they are not sufficient to preclude the possibility that a
subgroup of patients may benefit substantially from the intervention. Recent preliminary
studies suggest a there exists a subgroup of patients with LBP that is likely to benefit
from traction.

The two primary aims of this study are:

1. Determine the validity of the previously-identified prediction criteria to identify
patients highly likely to benefit from the addition of traction to a standard physical
therapy intervention.

2. Compare the overall effectiveness of addition of a traction component to a standard
physical therapy intervention.

Inclusion Criteria:

- Chief complaint of pain and/or paresthesia in the lumbar spine with a distribution of
symptoms that has extended distal to the gluteal fold on at least one lower extremity
within the past 24 hours based on the patient's self-report.

- Oswestry disability score of at least 20%

- Age at least 18 years and less than 60 years

- At least one of the following signs of nerve root compression:

1. Positive ipsilateral or contralateral straight leg raise test (reproduction of
leg symptoms with straight leg raise < 70 degrees)

2. Sensory deficit to pinprick on the ipsilateral lower extremity

3. Diminished strength of a myotome (hip flexion, knee extension, ankle
dorsiflexion, great toe extension, or ankle eversion) of the ipsilateral lower
extremity

4. Diminished lower extremity reflex (Quadriceps or Achilles) of the symptomatic
lower extremity

Exclusion Criteria:

- Red flags noted in the patient's general medical screening questionnaire (i.e.,
tumor, metabolic diseases, RA, osteoporosis, spinal compression fracture, prolonged
history of steroid use, etc.)

- Evidence of central nervous system involvement, to include symptoms of cauda equina
syndrome (i.e., loss of bowel/bladder control or saddle region paresthesia) or the
presence of pathological reflexes (i.e., positive Babinski)

- Patient reports the complete absence of low back and leg symptoms when seated

- Recent surgery (< 6 months) to the lumbar spine or buttocks, or any fusion surgery of
the lumbar spine or pelvis

- Recent (< 2 weeks) epidural steroid injection for low back and/or leg pain

- Current pregnancy

- Inability to comply with the treatment schedule