Ibrahim Moustafa

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: Eeighty patients with chronic mechanical low back pain (CMLBP) and definite hypolordosis were randomly assigned to traction or a control group. The control group (n=40) received stretching exercises and infrared radiation, whereas the traction group (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 (P=0.000), thoracic kyphosis (P=0.013), sacral slope (P=0.001), C7 plump line distance (p=0.001), while there was no significant difference with respect to pain (p=0.29) and Oswestry Disability Index (ODI) (p=0.1). At 6-months follow-up, there were significant differences between both groups for all the previous variables (p< 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.

Keywords
Traction, mechanical low back pain, randomized controlled trial

Objective: To investigate the effects of lumbar extension traction in patients with unilateral lumbosacral radiculopathy due to L5–S1 disc herniation.

Design: A randomized controlled study with six-month follow-up.

Setting: University research laboratory.

Subjects: Sixty-four patients with confirmed unilateral lumbosacral radiculopathy due to L5–S1 disc herniation and a lumbar lordotic angle less than 39°, randomly assigned to traction or control group.

Interventions: The control group (n = 32) received hot packs and interferential therapy, whereas the traction group (n = 32) received lumbar extension traction in addition to hot packs and interferential therapy.

Main outcome measures: Absolute rotatory angle, back and leg pain rating scale, Oswestry Disability Index, Modified Schober test, H-reflex (latency and amplitude) and intervertebral movements were measured for all patients three times (before treatment, after 10 weeks of treatment and at six-month follow-up).

Results: There was a significant difference between the traction group and the control group adjusted to baseline values at 10 weeks post treatment with respect to: absolute rotatory angle (P < 0.001), Oswestry Disability Index (P = 0.002), back and leg pain (P = 0.009, P = 0.005), Modified Schober test (P = 0.002), latency and amplitude of H-reflex (P = 0.01, P < 0.001), intervertebral movements (P < 0.05). At six-month follow-up there were statistically significant differences between the study and control groups for all the previous variables (P < 0.05).

Conclusion: The traction group receiving lumbar extension traction in addition to hot packs and interferential therapy had better effects than the control group with regard to pain, disability, H-reflex parameters and segmental intervertebral movements.

Objective: To investigate the effect of forward head posture correction on pain and nerve root function in cases of cervical spondylotic radiculopathy.
Design: A randomized controlled study with six months follow-up.
Setting: University research laboratory.
Subjects: Ninety-six patients with unilateral lower cervical spondylotic radiculopathy (C5–C6 and C6– C7) and craniovertebral angle measured less than or equal to 50_ were randomly assigned to an exercise or a control group.
Interventions: The control group (n=48) received ultrasound and infrared radiation, whereas the exercise group (n=48) received a posture corrective exercise programme in addition to ultrasound and infrared radiation.
Main outcome measures: The peak-to-peak amplitude of dermatomal somatosensory evoked potentials, craniovertebral angle, visual analogue scale were measured for all patients at three intervals (before treatment, after 10 weeks of treatment, and at follow-up of six months).
Results: There was a significant difference between groups adjusted to baseline value of outcome at 10 weeks post-treatment for craniovertebral angle, pain, C6 and C7 peak-to-peak amplitude of dermatomal somatosensory evoked potentials P=0.000, 0.01, 0.000, 0.001 respectively and at follow-up for all previous variables (P=0.000).
Conclusion: Forward head posture correction using a posture corrective exercise programme in
addition to ultrasound and infrared radiation decreased pain and craniovertebral angle and increased the peak-to-peak amplitude of dermatomal somatosensory evoked potentials for C6 and C7 in cases of lower cervical spondylotic radiculopathy.
Received: 23 April 2011; accepted: 16 July 2011

Objective: The purpose of this study was to investigate the effects of lumbar extension traction with stretching and
infrared radiation compared with stretching and infrared radiation alone on the lumbar curve, pain, and intervertebral
movements of patients with chronic mechanical low back pain (CMLBP).
Methods: This randomized clinical study with 3-month follow-up was completed at the Cairo University research
laboratory. Eighty patients (age ranged from 40 to 50 years) with CMLBP and a hypolordotic lumbar spine were
randomly assigned to traction or a comparison group. The comparison group (n = 40) received stretching exercises and
infrared radiation, whereas the traction group (n = 40) received lumbar extension traction in addition to stretching
exercises and infrared radiation. The absolute rotatory angle, intervertebral movements, and visual analog scale were
measured for all patients at 3 intervals.
Results: The results revealed a statistically significant difference between the groups at 2 follow-up time points
compared with the baseline values for the translational and sagittal rotational movements of L3-L4, L4-L5, L5-S1, and
L2-L3(posttreatment) and absolute rotatory angle (P b .01). There were no statistically significant changes in pain
(P = .1 and .3) and L1-L2 (P = .072 and .076) or L2-L3 (at follow-up; P = .3), and there was no significant difference
between all the previous variables adjusted to the groups' baseline outcome interaction (P N .01).
Conclusion: Lumbar extension traction with stretching exercises and infrared radiation was superior to stretching
exercises and infrared radiation alone for improving the sagittal lumbar curve, pain, and intervertebral movement in
CMLBP. (J Manipulative Physiol Ther 2012;35:246-253)
Key Indexing Terms: Randomized Trial; Traction; Lordosis; Low Back Pain

Purpose: This study was conducted to test the hypothesis that improvement of cervical lordosis in CSR, using 3-point bending traction, will improve the clinical features in a sample population of patients suffering from Cervical Spondylotic Radiculopathy( CSR )with defined cervical hypo-lordosis.
Relevance: This study assists in the understanding of the association between sagittal curve alignment and lasting improved function providing physiotherapists with a guidelines for proper rehabilitation of CSR.
Participants: Thirty patients with lower CSR and with a cervical hypo-lordosis were included in the study. The patients were assigned randomly into two groups of equal number, study and control groups.
Methods: Both groups received stretching exercises and infrared radiation; additionally the study group received 3 point bending cervical traction. Treatments were applied 3 x per week for 10 weeks after which a 12 week follow up was performed. The peak to peak amplitude of dermatomal somatosensory evoked potentials (DSSEPS), absolute rotation angle (ARA C2-C7), cervical flexion-extension kinematics analysis, and visual analogue scale (VAS) were measured for all patients at three intervals (initial, after 10 weeks of treatment, and at follow up of 3 months).
Analysis: The outcome measure of ARA, pain, peak to peak DSSEPS, and kinematics analysis of cervical spine were measured using repeated measures one-way ANOVA to compare measurements made at three intervals.
Results: In the study group, an increase in cervical lordosis (ARA C2-C7) was found (p< 0.0001, F=49.81) and maintained at follow up. No statistically significant improvement in lordosis was found for the control group. A Significant reduction in VAS for study group after 10 weeks of treatment and at 12 weeks follow up was found. In contrast, there was a less significant decrease in post treatment VAS and the follow up measures revealed a significant increase in the VAS score towards initial baseline values. An inverse linear correlation between increased lordosis and VAS was found (r=-.49; p=0.0059) for both groups initially and maintained in the study group post treatment (r=-.6; p=0.0138). At 10-week follow up, we found statistically significant improvements in DSSEPS for both groups (one way ANNOV, p< 0.0001). However, at 12 week post treatment follow up, only the study group showed statistically significant improvement compared to initial (p < 0.006) whereas the control group values returned to baseline measurement (p<0.153). We identified a linear correlation between initial DSSEPs and ARA for both groups (r=.65; p<0.0001), where as this relationship was only maintained in the study group at final follow-up (r=.55; p=0.033).
Conclusions: Improved lordosis in the study group was associated with significant improvements in nerve root function, VAS rating, and translational and rotational motions of the lower cervical spine. Only in the study group were the results maintained at long-term follow up.
Implications: Appropriate physical rehabilitation for CSR should include cervical sagittal curve correction, as it is may to lead greater and longer lasting improved function.
Key-words: 1. cervical sagittal curve 2. 3-point beding traction 3. DSSEPS
Funding acknowledgements: This study was unfunded.
Ethics approval: institutional review board approval was obtained before the study was initiated from Cairo University´s ethics committee.
Session name:
MUSCULOSKELETAL: Spine 2

Programme track/theme:
Professional Practice - MUSCULOSKELETAL: Spine