Optimizing Lumbar Traction for Effective Back Pain Relief

Lumbar Traction: A Gentle Solution for Back Relief

Lumbar traction optimization represents a promising approach to effectively relieve back pain, particularly in the lumbar region. This technique, often used in physiotherapy and osteopathy, aims to gently stretch the spine to relieve compression on intervertebral discs, joints, and nerves, providing welcome relief for those suffering from persistent lower back pain.

Lumbar traction can be performed in a variety of ways, including manually by a healthcare professional or using specialized devices designed to apply controlled traction. The main goal is to create space between the vertebrae, thereby reducing pressure on nerve structures and allowing better blood circulation around the spine.

When properly optimized, lumbar traction can provide several significant benefits. First, it can help reduce compression of the intervertebral discs, promoting better shock absorption and balanced body weight distribution. This can be particularly beneficial for people with herniated or protruding discs.

Additionally, lumbar traction can help improve lumbar joint mobility by promoting the release of muscle tension and increasing the space between the vertebrae. This, in turn, can help reduce stiffness and improve flexibility in the spine, providing relief from pain associated with limited movement.

To optimize lumbar traction, it is crucial to personalize the approach based on each individual’s specific needs. Healthcare professionals, such as physiotherapists and osteopaths, carefully assess the patient’s physical and medical condition before recommending and adjusting the appropriate traction method. Incorrect application could exacerbate existing problems, hence the importance of professional supervision.

Back pain, a pervasive problem affecting millions of people, has attracted constant interest in various therapeutic approaches. Lumbar traction, in particular, has emerged as a popular method for relieving lower back pain. In this article, we will delve into the history of lumbar traction, examine its purported benefits, and explore two specific methods for effective home use.

⚠️Warning:
Using an inversion table may offer temporary relief from back pain or a sense of relaxation, but it is not suitable for everyone. This technique is contraindicated for individuals with high blood pressure, glaucoma, cardiovascular disorders, hiatal hernia, or a history of balance problems. Prolonged or improper inversion can lead to adverse effects such as dizziness, nausea, or increased intraocular pressure. Do not use this equipment without consulting a qualified healthcare professional. Before trying this method, speak with an osteopath, physician, or physical therapist to ensure it is appropriate for your condition. Incorrect use can worsen your symptoms or cause complications..

Epidemiology and Societal Impact

Low back pain is one of the most widespread health conditions worldwide, affecting up to 80% of adults at some point in their lives. Due to its frequency and high recurrence, it remains a leading cause of medical consultation, work absenteeism, and reduced quality of life. Far from being a minor or transient discomfort, low back pain represents a major public health concern, both because of its prevalence and its socioeconomic consequences.

In Japan, a landmark study by Yamazaki et al. (2015) highlighted the scope of the issue within the general population. Based on patient-reported outcomes, the study revealed that disability levels related to back pain—rather than the pain’s intensity—were more strongly associated with the decision to seek medical care. In other words, it is not merely pain that drives people to consult healthcare providers, but the functional limitations that affect daily activities like walking, dressing, working, or even standing upright.

This finding emphasizes the functional and subjective dimensions of low back pain, which healthcare practitioners must take into account during clinical assessments. It also suggests that measurement tools focused solely on pain intensity (e.g., visual analog scales) may not be sufficient to capture the full burden of the condition.

Data from the Comprehensive Survey of Living Conditions (2013), published by Japan’s Ministry of Health, Labour and Welfare, provide further insights. The report shows that low back pain ranks among the top three reasons for routine medical consultations across all age groups and is a leading cause of activity limitation in older adults. The study also points to a growing trend: as the population ages, the prevalence of musculoskeletal conditions, especially those involving the lumbar spine, continues to rise.

Globally, both the World Health Organization (WHO) and the Institute for Health Metrics and Evaluation (IHME) recognize low back pain as the leading cause of years lived with disability (YLDs). It surpasses other chronic conditions such as depression, joint disorders, and migraines. The economic impact is staggering—encompassing both direct costs (treatments, diagnostics, medications) and indirect costs (loss of productivity, absenteeism, and long-term disability).

Given this reality, low back pain can no longer be viewed simply as a mechanical issue. It is a multifactorial disorder, deeply rooted in complex interactions among physical, psychological, social, and behavioral factors. Any therapeutic approach, including lumbar traction, must be evaluated within the context of this complexity.

By framing traction therapy within the broader societal burden of low back pain, it becomes crucial to identify which patient profiles may benefit most—especially those for whom traction could reduce functional disability and support greater autonomy in daily life.

Current Clinical Practices Worldwide

Lumbar traction, although a long-standing therapeutic modality, remains a topic of debate within clinical communities. Its application varies significantly across countries, shaped by local professional cultures, training backgrounds, and dominant therapeutic paradigms. This international disparity highlights an essential question: What is the true role of traction in today’s management of low back pain?

A study conducted in the United Kingdom by Harte et al. (2005) surveyed over 1,000 physiotherapists about their use of lumbar traction. Approximately 41% reported using traction in their practice, though the contexts and frequency varied. Some applied it as part of multimodal treatments, while others reserved it for specific cases, particularly where radiculopathy was present. The study also revealed a cautious attitude among practitioners, largely due to the lack of strong evidence for long-term effectiveness, and noted that usage often reflected personal experience and professional preference rather than formal guidelines.

In the United States, Madson and Hollman (2015) conducted a similar survey among orthopedic physical therapists. Their findings showed even more limited use of traction—fewer than 25% of clinicians used it regularly. Many expressed skepticism about its clinical utility in the absence of clearly defined patient selection criteria. This hesitation is consistent with the shift in treatment recommendations toward active interventions such as exercise, patient education, and functional reconditioning, rather than passive modalities.

This geographic variation reflects deeper differences in medical culture and training philosophies. In some regions, traction is still considered a valuable tool within an integrated therapeutic strategy. In others, it has been relegated to a secondary or even outdated role. Such disparity is not merely anecdotal—it calls into question the evidence-based rigor that should guide clinical decision-making and raises concerns about inconsistencies in care delivery across systems.

As evidence-based practice becomes increasingly central to modern healthcare, it is vital to objectively assess the role of traction in treatment protocols. This involves identifying the subgroups of patients who may benefit most, gaining a better understanding of the underlying mechanisms, and critically evaluating clinical beliefs against findings from randomized controlled trials.

Furthermore, the international inconsistency points to the importance of individualized care. While traction may be effective in carefully selected cases, it should not be used indiscriminately without a thorough clinical assessment. Achieving this requires ongoing professional education, regular updates to clinical knowledge, and interdisciplinary dialogue that respects diverse therapeutic approaches.

A Journey Through Time: The Evolution of Lumbar Traction

Antiquity – The Origin of the Principle of Traction The concept of traction dates back to Antiquity. Hippocrates (circa 460-370 BC), the father of Western medicine, was already using rudimentary devices to stretch the spine. He designed a bench with straps to pull limbs, believing that controlled extension could relieve back pain and deformities.

Middle Ages – Disappearance and Traditional Transmission During the Middle Ages, traction techniques were partially forgotten in the West, but persisted in certain traditional practices in Asia. In India, China, and even among Arab healers, manual forms of body stretching were preserved as a means of relieving joint pain.

19th Century – Re-emergence with Manual Medicine In the 19th century, with the revival of medical practices based on anatomy and body mechanics, traction resurfaced. The first modern attempts were integrated into the beginnings of orthopedic rehabilitation . Mechanical devices, often imposing and rudimentary, were developed to “straighten” the spine.

1950s – The Era of James Cyriax One of the major turning points came in the 1950s with Dr. James Cyriax , a British physician specializing in orthopedics. He formalized the use of lumbar traction as a therapeutic method. His approach was based on three mechanisms:

• Distraction : Create intervertebral space to decompress the nerves.
• Ligament tension : mobilize the posterior longitudinal ligament.
• Disc suction : promotes the re-centering of herniated discs.

Cyriax introduced traction into physical medicine and functional rehabilitation as a flagship technique, particularly for disc protrusions and sciatica.

1970s-1980s – Expansion in Physical Therapy Centers During these decades, lumbar traction became popular in physical therapy clinics, particularly in the United States, Canada, and Europe. Increasingly sophisticated mechanical traction tables were developed, with precise control of angle, force, and duration.

1990s – Evidence-based approach takes over From the 1990s onwards, medicine began to systematically evaluate its interventions through randomized clinical trials . Lumbar traction was then subjected to clinical trials, with mixed results. Some patients reported relief, but the effects were not always superior to those of a simple active treatment or a placebo.

2000s – Debates and Critiques Cochrane reviews and recommendations from health agencies such as NICE (UK) and HAS (France) are beginning to nuance their position on traction. The lack of clinically significant benefits in certain populations limits recommendations for its systematic use. Traction is gradually being re-evaluated as a possible adjunct , but not as a first-line treatment.

2010s – Rise of Home Devices With the emergence of self-care and connected health, lumbar traction is experiencing a new wave through inversion tables , Saunders-type wearables, and pressure relief cushions. These methods are sometimes used unsupervised, raising questions about safety and effectiveness.

2020s – A reasoned integration into care plans Today, lumbar traction remains present in the practices of certain osteopaths, physiotherapists or chiropractors, but it is generally integrated into a multimodal approach : education, exercise, mobilization, manual therapy. Its use is more individualized and justified according to the patient’s profile (moderate disc herniation, absence of instability, personal preference, etc.).

When Is Lumbar Traction Truly Indicated?

While lumbar traction has long been used in clinical practice, it is not a one-size-fits-all solution. Its effectiveness depends heavily on accurate therapeutic targeting. Identifying the right clinical indications is essential to ensure safety, optimize outcomes, and avoid ineffective applications.

Posterolateral Disc Herniation with Radicular Pain

One of the most common and well-supported indications for lumbar traction is a posterolateral disc herniation with associated radicular symptoms (sciatica or femoral nerve pain), but without significant neurological deficits. In this context, traction helps widen the intervertebral foramina, reduce intradiscal pressure, and relieve nerve root compression. It can assist in re-centering the nucleus pulposus and mitigating nerve irritation.

➡️ Typical profile: radiating pain improved in unloaded positions, no major motor weakness.

Moderate Lumbar Spinal Stenosis

In patients with moderate lumbar spinal stenosis (central or foraminal), gentle flexion-based traction can temporarily relieve mechanical compression on nerve roots. It helps increase available space for neural structures and can reduce symptoms such as heaviness, fatigue, or pain during upright activities.

➡️ Typical profile: lower back pain with buttock or thigh radiation, relieved by forward flexion or sitting, with no major vertebral instability.

Mild to Moderate Degenerative Disc Disease

For patients with degenerative disc disease that has not reached severe collapse, traction can enhance disc hydration, alleviate mechanical pain, and improve segmental mobility. It can also break the cycle of muscle guarding and stiffness, particularly in chronic low back pain.

➡️ Typical profile: fluctuating mechanical low back pain, stiffness on waking or after prolonged postures, no neurological involvement.

Stable, Well-Localized Radiculopathy

Patients with well-defined, non-progressive radiculopathy may also benefit from traction. This includes those experiencing stable nerve-related pain or paresthesia without acute motor deficits or red-flag symptoms like bladder or bowel dysfunction.

➡️ Typical profile: localized tingling or radiating pain, stable symptoms, improvement in decompressive positions.

Functional Hypomobility of the Lumbar Spine

In cases of segmental stiffness or joint restriction, traction can be used as a gentle mobilization tool. It stretches periarticular soft tissues and improves range of motion, especially in patients with sedentary lifestyles or postural imbalances.

➡️ Typical profile: “stuck” feeling in the lower back, stiffness during movement, mechanical discomfort during bending.

Clinical Reminder: Customization Is Key

Even in these indications, lumbar traction should never be applied indiscriminately. A thorough clinical assessment—often supported by imaging (MRI, CT)—is crucial. Parameters such as intensity, duration, angle, and frequency must be individually tailored.

In conclusion, lumbar traction has its place in well-defined scenarios, especially when integrated into a broader treatment plan. Its success relies on accurate diagnosis, appropriate technical execution, and personalized follow-up care.

How to Properly Set Up a Lumbar Traction Session

The effectiveness of lumbar traction is not just about the right indication — it’s about precision in technical setup. Incorrect force, duration, or positioning can render the treatment ineffective or even harmful. This is why understanding how to set the traction force, duration, frequency, angle, and cycle type (continuous or intermittent) is key to a safe and therapeutic outcome.

Traction Force: Finding the Right Intensity

Traction force should always be progressive and tailored to the patient’s body weight, condition, and clinical presentation.

Patient Type	Recommended Force (approx.)
First-time patient, acute pain	10–15% of body weight
Chronic low back pain	25–30% of body weight
Targeted disc/radicular symptoms	20–50% depending on tolerance

➡️ Start low, monitor response. The goal is to achieve therapeutic effects (relaxation, pain relief) with the lowest effective load.

Session Duration: Short but Consistent

Traction time depends on the method used:

• Manual or osteopathic traction: 30 seconds to 2 minutes per cycle, repeated multiple times.
• Intermittent mechanical traction: Around 15–20 minutes.
• Gentle continuous traction (e.g., inversion table): 5 to 10 minutes.

➡️ Long or intense sessions early on can provoke soreness. Start short, increase gradually based on patient feedback.

Cycle Type: Intermittent vs. Continuous

• Intermittent traction: Alternates between pulling and release phases (e.g., 60 seconds traction / 20 seconds rest). Ideal for reducing muscle spasm and improving tolerance.
• Continuous traction: Steady pull for the entire session. More suited for discogenic pain without significant muscular involvement.

➡️ Intermittent = neuromuscular relaxation / Continuous = disc decompression.

Angle and Direction: Precision Matters

Traction angle should reflect the underlying pathology:

Condition	Recommended Position
Foraminal or central stenosis	Spine flexion (15–30°)
Posterior disc herniation	Neutral to slight extension
Degenerative disc disease	Neutral with lumbar support
Segmental hypomobility	Tailored to the blocked region

➡️ Devices like Saunders systems allow precise angle adjustments using knee supports or lumbar bolsters.

Session Frequency: Consistency Over Intensity

• Acute phase: 3 times per week for 2–3 weeks, with frequent reassessment.
• Chronic or maintenance: 1–2 times per week, as part of a broader rehab plan.

➡️ Consistency and clinical monitoring matter more than high frequency. Traction is not a standalone treatment.

The 3 Key Effects of Cyriax: Why Traction Can Work

Lumbar traction, a therapeutic technique developed by Dr. James Cyriax, a pioneer in the field of physical medicine and rehabilitation, relies on three key benefits aimed at relieving lower back pain and improving spinal function. These benefits are distraction to increase intervertebral space, tension on the posterior longitudinal ligament to reduce disc protrusion, and suction to draw the protrusion toward the center of the joint.

First, distraction in the context of lumbar traction refers to the application of a traction force that aims to increase the space between the lumbar vertebrae. This distraction action contributes to the decompression of the spine, thus creating an increased intervertebral space. By widening this space, lumbar traction seeks to reduce the pressure on adjacent nerve structures, which can be particularly beneficial for individuals suffering from nerve compression, herniated discs, or other similar conditions.

Second, tension on the posterior longitudinal ligament is another key mechanism of lumbar traction. This ligament runs along the posterior aspect of the vertebrae and is often involved in disc protrusion problems. Applying traction creates tension on this ligament, which can help strengthen its support function and reduce disc protrusion. By restoring balance and improving spinal stability, this tension helps alleviate lower back pain associated with disc protrusion.

Third, suction is a unique mechanism of lumbar traction, which involves drawing the disc protrusion toward the center of the joint. This action literally sucks the herniated disc or protrusion inward, relieving pressure on the surrounding nerve structures. The suction aims to recenter the protrusion, helping to restore normal vertebral alignment and reduce nerve compression, which can result in a significant reduction in pain and discomfort.

By combining these mechanisms, lumbar traction offers a comprehensive approach to treating lumbar spinal problems. It aims to target the underlying causes of lower back pain, particularly those related to nerve compression due to problems such as herniated discs. Lumbar traction is often used as part of a broader treatment plan, also including physiotherapy, therapeutic exercise, and pain management. It is crucial that lumbar traction be administered under the supervision of a qualified healthcare professional to ensure its effectiveness and safety, and to tailor the technique to the specific needs of each individual.

Controversial effectiveness: what do studies say about lumbar traction?

Although lumbar traction has historically been considered a beneficial approach to back pain relief, significant divergence has recently emerged in the medical field. Recent clinical studies and guidelines from health authorities question the effectiveness of lumbar traction, raising questions about its relevance in the contemporary management of back pain.

Several clinical studies have been conducted to evaluate the effectiveness of lumbar traction, and the results have been mixed. Some clinical trials have reported modest benefits, while others have concluded that the technique has limited or no effectiveness. For example, a systematic review published in the Journal of Orthopaedic & Sports Physical Therapy in 2016 concluded that the evidence supporting the effectiveness of lumbar traction was insufficient and that further research was needed to clarify its role in the management of low back pain.

Guidelines from some health authorities have also reflected this uncertainty about the effectiveness of lumbar traction. Some organizations, such as the National Institute for Health and Care Excellence (NICE) in the United Kingdom, have issued limited recommendations regarding the use of lumbar traction, highlighting the lack of robust evidence to support its clinical effectiveness.

Discrepant clinical trial results and conflicting guidelines highlight the complexity of low back pain management and the need for personalized approaches. The effectiveness of lumbar traction may vary depending on the specific causes of low back pain, the duration of symptoms, and individual patient characteristics.

Contemporary approaches to back pain management increasingly emphasize evidence-based interventions such as physical therapy, therapeutic exercise, pain management, and patient education. These holistic approaches aim to address not only acute symptoms but also promote overall spinal health and prevent recurrence.

Two Simple Techniques for Testing Lumbar Traction at Home

Lying position in front of a sofa (Passive method, without specific equipment)

Objective: Gently decompress the lumbar region through gravitational release.

✅ Instructions :

• Lie on your back on a mat or comfortable surface.
• Place your legs bent at 90°, resting on the seat of a sofa (or a low chair), so that your thighs are vertical and your calves are horizontal.
• Keep your arms relaxed at your sides.
• Breathe deeply, focusing on relaxing the lower back area.
• Hold the position for 10 to 15 minutes , without tension.

🎯 Benefits:

• Relief of lumbar pressure.
• Overall muscle relaxation.
• Easy to implement on a daily basis.

Using an inversion table (Active method, with dedicated equipment)

Goal: Use gravity to actively stretch the spine.

✅ Instructions :

• Position yourself on an inversion table according to the manufacturer’s instructions.
• Secure the ankle ties.
• Gradually tilt the table to a semi-reclined position (30° to 60° initially).
• Let gravity work for 1 to 3 minutes , then slowly come back up.
• Repeat the exercise 1 to 2 times a day , if well tolerated.

⚠️ Precautions:

• Consult a healthcare professional before using this device, particularly in cases of hypertension, glaucoma or severe disc herniation.
• Always start with a moderate incline.

🎯 Benefits:

• Controlled stretching of the lumbar spine.
• Improved circulation around the discs.
• Interesting option for recurring pain or compressive postures.

Adapting the patient’s position: key to therapeutic effectiveness

Patient positioning is critical to achieving therapeutic goals. If the goal is extension, position the patient in extension during traction. When in doubt, traction in the normal lordotic position is recommended, but adjustments are necessary for patients with acute disc herniation. Foraminal stenosis is generally treated in a flexed position. Joint hypomobility and degenerative disease can be treated in flexion, neutral, or extension.

Saunders lumbar traction devices allow the angle of flexion to be adjusted by placing pillows under the knees, or extension to be increased by placing rolled towels in the lumbar region while lying on the back[Reference_Saunders].

Beyond Pain: Other Benefits of Spinal Traction

Although lumbar traction is primarily used for pain relief, particularly in cases of herniated discs or nerve compression, its effects go far beyond immediate analgesia . When properly adapted and performed in a supervised manner, spinal traction can offer a range of physiological and functional benefits that contribute to the overall improvement of spinal health.

Improved disc nutrition

Intervertebral discs do not have direct blood vessels: they are nourished by a process called imbibition , where nutrients diffuse from the surrounding tissues.
➡️ By creating space between the vertebrae, traction facilitates this fluid exchange and improves the oxygenation of the disc tissues , thus contributing to cell regeneration and slowing down disc degeneration.

Nerve root decompression

Even in the absence of acute pain, chronic pressure on nerve roots can cause muscle fatigue, loss of sensation, or paresthesia .
➡️ By reducing this pressure, traction promotes better nerve conduction and can help restore subtle neurological functions, often neglected in conventional treatments.

Restoration of spinal mobility

Joint hypomobility (stiff areas of the spine) can affect the entire body’s biomechanics.
➡️ Gentle traction allows for flexibility of the spinal joints , especially in cases of chronic tension or prolonged flexion posture (such as in office workers). This often results in a better range of motion and a feeling of lightness in the back.

Reduction of reflex muscle tension

Chronic pain is often accompanied by muscle spasms that maintain a vicious cycle of tension.
➡️ Traction interrupts this cycle by causing reflex relaxation of the paravertebral muscles. This relaxation helps reduce secondary contractures and improve overall posture.

Indirect analgesic effect via the autonomic nervous system

Some research suggests that traction can activate the parasympathetic system , which is linked to relaxation, recovery, and stress reduction.
➡️ By reducing the hyperactivity of the sympathetic system (linked to pain and stress), traction contributes to an overall feeling of well-being and a reduction in bodily tension.

Prevention of recurrences and support in rehabilitation

Used progressively and integrated into a rehabilitation program (with exercises, postural corrections and manual therapy), traction can stabilize the spine , prevent relapses and strengthen the patient’s autonomy in managing their pain.

In conclusion, while lumbar traction has been a popular approach to back pain relief, its effectiveness remains a matter of debate. Guidelines issued by health authorities vary, but it is important to note that some home lumbar traction methods may offer temporary relief. However, before undertaking any home treatment, it is strongly recommended to consult a healthcare professional. They can thoroughly assess the individual situation, identify the underlying causes of lower back pain, and recommend individualized management.

The variability in lumbar traction results observed in the medical literature highlights the complexity of this approach and the importance of considering the specific characteristics of each patient. Consulting a healthcare professional, such as a physiotherapist, physician, or spine specialist, allows for personalized advice based on a comprehensive assessment of the individual’s condition.

It is crucial to recognize that lower back pain can have a variety of causes, ranging from mechanical issues to underlying medical conditions. Therefore, a holistic approach that integrates evidence-based interventions, such as physical therapy, therapeutic exercise, and pain management, may be preferable to an approach focused solely on lumbar traction.

In summary, although lumbar traction can be considered one option among others in the management of low back pain, caution and professional consultation are essential to ensure appropriate and safe management. A thorough understanding of the individual condition, combined with evidence-based interventions, will help guide more effective and sustainable solutions for individuals suffering from low back pain.

References

1. Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, Castel LD, Kalsbeek WD, Carey TS. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251–258. doi: 10.1001/archinternmed.2008.543. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
2. Ono R, Yamazaki S, Takegami M, Suzukamo Y, Konno S, Kikuchi S, Fukuhara S. Patient-reported disability in the general Japanese population was associated with medical care visits for low back pain, regardless of pain intensity. J Orthop Sci. 2015;20(4):742–749. doi: 10.1007/s00776-015-0719-3. [PubMed] [CrossRef] [Google Scholar]
3. Graphical Review of Japanese Household, from Comprehensive Survey of Living conditions. 2013. Available at: http://www.mhlw.go.jp/toukei/list/dl/20-21-h25.pdf Accessed June 29, 2018.
4. Guzman J, Esmail R, Karjalainen K, Malmivaara A, Irvin E, Bombardier C. Multidisciplinary bio-psycho-social rehabilitation for chronic low back pain. Cochrane Database Syst Rev. 2002;1:CD000963. [PubMed] [Google Scholar]
5. Schimmel JJ, de Kleuver M, Horsting PP, Spruit M, Jacobs WC, van Limbeek J. No effect of traction in patients with low back pain: a single Centre, single blind, randomized controlled trial of intervertebral differential dynamics therapy. Eur Spine J. 2009;18(12):1843–1850. doi: 10.1007/s00586-009-1044-3. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
6. Wegner I, Widyahening IS, van Tulder MW, Blomberg SE, de Vet HC, Brønfort G, Bouter LM, van der Heijden GJ. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2013;8:CD003010. [PMC free article] [PubMed]
7. Harte AA, Gracey JH, Baxter GD. Current use of lumbar traction in the management of low back pain: results of a survey of physiotherapists in the United Kingdom. Arch Phys Med Rehabil. 2005;86(6):1164–1169. doi: 10.1016/j.apmr.2004.11.040. [PubMed] [CrossRef] [Google Scholar]
8. Madson TJ, Hollman JH. Lumbar traction for managing low back pain: a survey of physical therapists in the United States. J Orthop Sports Phys Ther. 2015;45(8):586–595. doi: 10.2519/jospt.2015.6036. [PubMed] [CrossRef] [Google Scholar]
9. Diab AA, Moustafa IM. The efficacy of lumbar extension traction for sagittal alignment in mechanical low back pain: a randomized trial. J Back Musculoskelet Rehabil. 2013;26(2):213–220. doi: 10.3233/BMR-130372. [PubMed] [CrossRef] [Google Scholar]
10. Fritz JM, Thackeray A, Childs JD, Brennan GP. A randomized clinical trial of the effectiveness of mechanical traction for sub-groups of patients with low back pain: study methods and rationale. BMC Musculoskelet Disord. 2010;11:81. doi: 10.1186/1471-2474-11-81. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
11. Thackeray A, Fritz JM, Childs JD, Brennan GP. The effectiveness of mechanical traction among subgroups of patients with low back pain and leg pain: a randomized trial. J Orthop Sports Phys Ther. 2016;46(3):144–154. doi: 10.2519/jospt.2016.6238. [PubMed] [CrossRef] [Google Scholar]
12. Shirado O, Doi T, Akai M, Fujino K, Hoshino Y, Iwaya T. An outcome measure for Japanese people with chronic low back pain: an introduction and validation study of Japan low Back pain evaluation questionnaire. Spine. 2007;32(26):3052–3059. doi: 10.1097/BRS.0b013e31815cda68. [PubMed] [CrossRef] [Google Scholar]
13. Mechanical lumbar traction What is its place in clinical practice? J Orthop Sports Phys Ther. 2016;46(3):155–156. doi: 10.2519/jospt.2016.0501. [PubMed] [CrossRef] [Google Scholar]
14. Frost M, Stuckey S, Smalley LA, Dorman G. Reliability of measuring trunk motions in centimeters. Phys Ther. 1982;62(10):1431–1437. doi: 10.1093/ptj/62.10.1431. [PubMed] [CrossRef] [Google Scholar]
15. Kurutz M. In vivo age- and sex-related creep of human lumbar motion segments and discs in pure centric tension. J Biomech. 2006;39(7):1180–1190. doi: 10.1016/j.jbiomech.2005.03.021. [PubMed] [CrossRef] [Google Scholar]
16. Park WM, Kim K, Kim YH. Biomechanical analysis of two-step traction therapy in the lumbar spine. Man Ther. 2014;19(6):527–533. doi: 10.1016/j.math.2014.05.004. [PubMed] [CrossRef] [Google Scholar]
17. Simmerman SM, Sizer PS, Dedrick GS, Apte GG, Brismée JM. Immediate changes in spinal height and pain after aquatic vertical traction in patients with persistent low back symptoms: a crossover clinical trial. PM R. 2011;3(5):447–457. doi: 10.1016/j.pmrj.2011.01.010. [PubMed] [CrossRef] [Google Scholar]
18. Chow DHK, Yuen EMK, Xiao L, Leung MCP. Mechanical effects of traction on lumbar intervertebral discs: a magnetic resonance imaging study. Musculoskelet Sci Pract. 2017;29:78–83. doi: 10.1016/j.msksp.2017.03.007. [PubMed] [CrossRef] [Google Scholar]
19. Lai A, Chow DH. Effects of traction on structural properties of degenerated disc using an in vivo rat-tail model. Spine. 2010;35(14):1339–1345. doi: 10.1097/BRS.0b013e3181c617f6. [PubMed] [CrossRef] [Google Scholar]
20. Lee RY, Evans JH. Loads in the lumbar spine during traction therapy. Aust J Physiother. 2001;47(2):102–108. doi: 10.1016/S0004-9514(14)60301-9. [PubMed] [CrossRef] [Google Scholar]
21. Cai C, Pua YH, Lim KC. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with mechanical lumbar traction. Eur Spine J. 2009;18(4):554–561. doi: 10.1007/s00586-009-0909-9. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
22. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G. Outcome measures for low back pain research. A proposal for standardized use. Spine. 1998;23(18):2003–2013. doi: 10.1097/00007632-199809150-00018. [PubMed] [CrossRef] [Google Scholar]
23. Suzukamo Y, Fukuhara S, Kikuchi S, Konno S, Roland M, Iwamoto Y, Nakamura T. Committee on science project, Japanese Orthopaedic association. Committee on science project, Japanese Orthopaedic association. Validation of the Japanese version of the Roland-Morris disability questionnaire. J Orthop Sci. 2003;8(4):543–548. doi: 10.1007/s00776-003-0679-x. [PubMed] [CrossRef] [Google Scholar]
24. Stokes IA, Gardner-Morse M. A database of lumbar spinal mechanical behavior for validation of spinal analytical models. J Biomech. 2016;49(5):780–785. doi: 10.1016/j.jbiomech.2016.01.035. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
25. Wang S, Wang L, Wang Y, Du C, Zhang M, Fan Y. Biomechanical analysis of combining head-down tilt traction with vibration for different grades of degeneration of the lumbar spine. Med Eng Phys. 2017;39:83–93. doi: 10.1016/j.medengphy.2016.10.004. [PubMed] [CrossRef] [Google Scholar]