The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: A randomized trial

Abstract

Background:

There is growing interest in the role of abnormal asymmetrical posture, which is considered one of the most important etiological factors reported to be associated with mechanical low back pain.

Objective:

This study was conducted to investigate the effect of lumbar extension traction on the pain, function and whole spine sagittal balance as represented in lumbar curvature, thoracic curvature, C7 plumb line, and sacral slope.

Methods:

Eighty patients with chronic mechanical low back pain (CMLBP) and definite hypolordosis were randomly assigned to traction or a control group. The control group ( $\mathit{n}=40$ ) received stretching exercises and infrared radiation, whereas the traction group ( $\mathit{n}=40$ ) received lumbar extension traction in addition to stretching exercises and infrared radiation three times a week for 10 weeks. Back pain rating scale, Oswestry Disability Index, and radiological spine sagittal balance parameters in terms of lumbar lordosis, thoracic kyphosis, sacral slope, and positioning of C7 plumb line were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at six months follow-up).

Results:

There was a significant difference between the traction and control groups adjusted to baseline value of outcome at 10 weeks post treatment with respect to lumbar lordotic curve ( $\mathit{P}=0.000$ ), thoracic kyphosis ( $\mathit{P}=0.013$ ), sacral slope ( $\mathit{P}=0.001$ ), C7 plump line distance ( $\mathit{p}=0.001$ ), while there was no significant difference with respect to pain ( $\mathit{p}=0.29$ ) and Oswestry Disability Index (ODI) ( $\mathit{p}=0.1$ ). At 6-months follow-up, there were significant differences between both groups for all the previous variables ( $\mathit{p}\mathrm{<}0.05$ ).

Conclusions:

Lumbar extension traction in addition to stretching exercises and infrared radiation improved the spine sagittal balance parameters and decreased the pain and disability in CMLBP.