Authors: Anne Thackeray, PT, PhD, MPH

Abstract

Study Design
Randomized clinical trial.

Background
The recommended initial management strategy for these patients with low back pain and signs of nerve root compression is conservative treatment but there is little evidence to guide the most appropriate management strategy. Preliminary research suggests a treatment protocol of mechanical traction and extension-oriented exercises may be effective management, particularly in a specific sub-group of patients.

Objective
To examine the effectiveness of mechanical traction in patients with lumbar nerve root compression and within a pre-defined sub-group.

Methods
120 patients with low back pain with nerve root compression were recruited from physical therapy clinics. Using pre-defined sub-grouping criteria, patients were stratified at baseline and randomized to receive an extension-oriented treatment approach (EOTA) with or without the addition of mechanical traction. During a 6-week period, patients received up to 12 treatment visits. Primary outcomes of pain and disability were collected at 6 weeks, 6 months and 1 year by assessors blinded to group allocation. Outcomes were examined using linear mixed model analyses examining change over time by treatment and the interaction between treatment and sub-grouping status.

Results
The mean age of participants was 41.1 (SD 11.3) years, median duration of symptoms was 62 days, and 57% were male. No significant differences in disability or pain outcomes were noted between treatment groups at any time point, nor was any interaction found between subgroup status and treatment.

Conclusion
Patients with lumbar nerve root compression presenting for physical can expect significant changes in disability and pain over a 6-week treatment period. There is no evidence mechanical lumbar traction in combination with an extension-oriented treatment is superior to extension-oriented exercises in management of these patients, nor within a predefined subgroups of patients.

Level of Evidence
Therapy, level 2b. J Orthop Sports Phys Ther, Epub 26 Jan 2016. doi:10.2519/jospt.2016.6238