***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Abstract . The literature on the efficacy of traction in the treatment of low back pain ( LBP ) is conflicting . The aim of this study was to examine its efficacy in this disorder . Forty-two patients with at least 6 weeks of nonspecific LBP were selected . Demographic data were obtained . All patients completed the Oswestry disability index ( ODI ) to assess disability and the 10-cm visual analog scale ( VAS ) for evaluation of pain . Subjects were r and omly assigned into group 1 , receiving only st and ard physical therapy , or group 2 , receiving st and ard physical therapy with conventional lumbar traction . St and ard physical therapy consisted of local heat , ultrasound for the lumbar region , and an active exercise program , given for ten sessions in all . The subjects received instruction on correct posture and recommended therapeutic exercises . They were reevaluated at the end of treatment and at 3-month follow-up . The mean outcome measures were global improvement and satisfaction with the therapy , as well as disability by ODI and pain by VAS . There were no group differences in terms of demographic and baseline clinical characteristics . There was a significant reduction in pain intensity and disability at the end of treatment in both groups . There was complete or mild improvement in 47.6 % of group 1 and 40 % of group 2 . The satisfaction rate with both treatments was more than 70 % immediately after the therapies . During the 3-month period , the outcome measures except disability remained statistically stable , with no difference amongst groups . Disability was significantly reduced at follow-up in both groups . Of the patients , 51 % continued with the recommended exercises and had significantly lower disability scores than those who did not continue with the exercises . Pain and global improvement were also better in this group , but the difference was not statistically significant . In conclusion , no specific effect of traction on st and ard physical therapy was observed in our study group . We suggest focusing on back education and exercise therapy in the management of patients suffering from this chronic condition OBJECTIVE This study compared the effects of high-force versus low-force lumbar traction in the treatment of acute lumbar sciatica secondary to disc herniation . METHODS A r and omized double blind trial was performed , and 17 subjects with acute lumbar sciatica secondary to disc herniation were assigned to high-force traction at 50 % body weight ( BW ; LT50 , n = 8) or low force traction at 10 % BW ( LT10 , n = 9 ) for 10 sessions in 2 weeks . Radicular pain ( visual analogue scale [ VAS ] ) , lumbo-pelvic-hip complex motion ( finger-to-toe test ) , lumbar-spine mobility ( Schöber-Macrae test ) , nerve root compression ( straight-leg-raising test ) , disability ( EIFEL score ) , drug consumption , and overall evaluation of each patient were measured at days 0 , 7 , 1 , 4 , and 28 . RESULTS Significant ( P < .05 ) improvements were observed in the LT50 and LT10 groups , respectively , between day 0 and day 14 ( end of treatment ) for VAS ( -44 % and -36 % ) , EIFEL score ( -43 % and -28 % ) and overall patient evaluation ( + 3.1 and + 2.0 points ) . At that time , LT50 specifically improved in the finger-to-toe test ( -42 % ) , the straight-leg-raising test ( + 58 ) , and drug consumption ( -50 % ) . No significant interaction effect ( group-by-time ) was revealed , and the effect of traction treatment was independent of the level of medication . During the 2-week follow-up at day 28 , only the LT10 group improved ( P < .05 ) in VAS ( -52 % ) and EIFEL scores ( -46 % ) . During this period , no interaction effect ( group-by-time ) was identified , and the observed responses were independent of the level of medication . CONCLUSIONS For this preliminary study , patients with acute lumbar sciatica secondary to disc herniation who received 2 weeks of lumbar traction reported reduced radicular pain and functional impairment and improved well-being regardless of the traction force group to which they were assigned . The effects of the traction treatment were independent of the initial level of medication and appeared to be maintained at the 2-week follow-up Background Traction is commonly used for the treatment of low back pain ( LBP ) , predominately with nerve root involvement ; however its benefits remain to be established . The aim of this study was to test the feasibility of a pragmatic r and omized controlled trial to compare the difference between two treatment protocol s ( manual therapy , exercise and advice , with or without traction ) in the management of acute/sub acute LBP with ' nerve root ' involvement . Methods 30 LBP patients with nerve root pain were recruited and r and omly assigned to one of two treatment groups . Primary outcome measures were the : McGill pain question naire , Rol and Morris disability question naire , and the SF36 Question naire ; recorded at baseline , discharge , 3 and 6 months post-discharge . Results 27 patients completed treatment with a loss of another four patients at follow up . Intention to treat analysis demonstrated an improvement in all outcomes at follow up points but there appeared to be little difference between the groups . Conclusion This study has shown that a trial recruiting patients with ' nerve root ' problems is feasible . Further research based upon a fully powered trial is required to ascertain if the addition of traction has any benefit in the management of these patients .Trial Registration Registration number : IS RCT Three treatments for non-specific lumbar pain -- balneotherapy , underwater traction bath , and underwater massage -- were assessed in a r and omised prospect i ve controlled trial in 158 out patients . Each group was treated for four weeks and patients were review ed at the end of this period and at 12 months after entry to the trial . The prescription of analgesics and the pain score were significantly reduced in all three treated groups , but there was no difference between the three groups . No significant change occurred in spinal motion and the straight leg raising test . After one year only the analgesic consumption was significantly lower than in the control group Traction therapy for  low back pain with sciatica has been evaluated in a double blind study . 60 patients hospitalized for sciatica with or without signs of sensory or motor deficiency were r and omized to 3 treatment groups : " placebo traction " ( 5 kg ) , " light traction " ( 15 kg ) and " normal traction " ( 50 kg ) . Clinical evaluation after 4 , 8 and 12 traction sessions showed no difference between the three groups Four treatment regimens for patients with specified combinations of low back pain and sciatica were evaluated . The largest group studied had low back pain with limited straight-leg raising ( SLR ) and in them the beneficial effect of manipulation in hastening pain relief was highly significant . In similar patients without limitation of SLR , the effect was of borderline significance . In all the other groups , treated patients also recovered more quickly than their controls . Traction , for patients with low back pain and sciatica , and epidural injections when a root palsy was present also produced some significant pain relief . The effect of sclerosants for back pain was less clear 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 r and omly 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 A controlled trial of continuous lumbar traction in the treatment of  back pain and sciatica  showed similar improvements in both the treated group ( weighted traction ) and the control group ( simulated traction ) . The findings of this study question the justification of admitting patients with back pain into hospitals for purpose s of traction alone STUDY DESIGN A r and omized trial design ed to compare interferential therapy with motorized lumbar traction and massage management for low back pain in a primary care setting . OBJECTIVE To measure and compare the outcome of interferential therapy and management by motorized lumbar traction and massage . SUMMARY OF BACKGROUND DATA Management of low back pain by interferential therapy and motorized lumbar traction and massage is common in Germany . No reports of previous r and omized trials for the outcome from interferential therapy were found . METHODS Consenting patients were r and omly assigned into one of two groups . A pretreatment interview was performed by the patient using a computer-based question naire . It also incorporated the Oswestry Disability Index and a pain visual analog scale . Management consisted of six sessions over a 2- to 3-week period . Oswestry Disability Indexes and pain visual analog scale scores also were obtained immediately after and at 3 months after treatment . RESULTS A total of 152 patients were recruited . The two treatment groups had similar demographic and clinical baseline characteristics . The mean Oswestry Disability Index before treatment was 30 for both groups ( n = 147 ) . After treatment , this had dropped to 25 , and , at 3 months , were 21 ( interferential therapy ) and 22 ( motorized lumbar traction and massage ) . The mean pain visual analog scale score before treatment was 50 ( interferential therapy ) and 51 ( motorized lumbar traction and massage ) . This had dropped , respectively , to 46 and 44 after treatment and to 42 and 39 at 3 months . CONCLUSIONS This study shows a progressive fall in Oswestry Disability Index and pain visual analog scale scores in patients with low back pain treated with either-interferential therapy or motorized lumbar traction and massage . There was no difference in the improvement between the two groups at the end of treatment . Although there is evidence from several trials that traction alone is ineffective in the management of low back pain , this study could not exclude some effect from the concomitant massage Many clinical trials on chiropractic management of low back pain have neglected to include specific forms of care . This study compared two well-defined treatment protocol s. The objective was to compare the outcome of flexion – distraction ( FD ) procedures performed by chiropractors with an active trunk exercise protocol ( ATEP ) performed by physical therapists . A r and omized clinical trial study design was used . Subjects , 18 years of age and older , with a primary complaint of low back pain ( > 3 months ) were recruited . A 100 mm visual analogue scale ( VAS ) for perceived pain , the Rol and Morris ( RM ) Question naire for low back function , and the SF-36 for overall health status served as primary outcome measures . Subjects were r and omly allocated to receive either FD or ATEP . The FD intervention consisted of the application of flexion and traction applied to specific regions in the low back , with the aid of a specially design ed manipulation table . The ATEP intervention included stabilizing and flexibility exercises , the use of modalities , and cardiovascular training .  A total of 235 subjects met the inclusion /exclusion criteria and signed the informed consent . Of these , 123 were r and omly allocated to FD and 112 to the ATEP . Study patients perceived significantly less pain and better function after intervention , regardless of which group they were allocated to ( P<0.01 ) . Subjects r and omly allocated to the flexion – distraction group had significantly greater relief from pain than those allocated to the exercise program ( P=0.01 ) . Subgroup analysis indicated that subjects categorized as chronic , with moderate to severe symptoms , improved most with the flexion – distraction protocol . Subjects categorized with recurrent pain and moderate to severe symptoms improved most with the exercise program . Patients with radiculopathy did significantly better with FD . There were no significant differences between groups on the Rol and Morris and SF-36 outcome measures . Overall , flexion – distraction provided more pain relief than active exercise ; however , these results varied based on stratification of patients with and without radiculopathy and with and without recurrent symptoms . The subgroup analysis provides a possible explanation for contrasting results among r and omized clinical trials of chronic low back pain treatments and these results also provide guidance for future work in the treatment of chronic low back pain OBJECTIVE To investigate the effect of aquatic vertical traction on spinal height , pain intensity , and central ization response compared with a l and -based supine flexion position for patients with low back pain and signs of nerve root compression . DESIGN Single-blind , repeated- measures crossover design . SETTING Outpatient physical therapy clinic . SUBJECTS Ninety-eight subjects were recruited using consecutive sampling , with 28 men and 3 
    Output:
    
Conclusion There is wide variability in the type of traction , traction parameters and patient characteristics found among the RCTs of lumbar traction .
The variability may call into question the conclusion that lumbar traction has little no or value on clinical outcomes .