The Effects of Intermittent Traction and Manual Traction on Lumbar Herniated Disc

간헐적 견인과 도수 견인이 요추 추간판 탈출에 미치는 효과

  • Kwon, Won-An (Department of Physical Therapy, Kimjun's Orthopedic & Pain Clinic) ;
  • Ma, Sang-Yeol (Department of Physical Therapy, Gimcheon College) ;
  • Hwang, Yoon-Tae (Department of Physical Therapy, Gangneyng Yeongdong College)
  • 권원안 (김준정형외과 & 제통의원 물리치료실) ;
  • 마상렬 (김천대학 물리치료학과) ;
  • 황윤태 (강릉영동대학 물리치료과)
  • Received : 2009.02.20
  • Accepted : 2009.07.20
  • Published : 2009.09.25

Abstract

Purpose: The purpose of this study was to investigate the effects of intermittent lumbar traction and manual traction on a $L_{4-5}$ herniated disc. Method: The subjects were randomly divided into the intermittent lumbar traction group (n=10) and the manual traction group (n=10). The intermittent traction group had traction-treatment applied for 12 times in the first two weeks, and then 6 times in the next two weeks. The time the traction was applied was for 30 minutes. The manual traction group had flexion-distraction therapy applied for 12 times in first two weeks, and for 6 times in next two weeks. The time the traction was applied was 3 to 6 minutes per treatment. Results: The change of the muscle test (MT), the disc herniation index (DHI) and the sagittal $T_2$ weighted MRI was measured at pretreatment and 4weeks and 12weeks after treatment. Conclusion: We found that intermittent lumbar traction and manual traction could improved the MT and DHI and this could improve the rehabilitation of patients with lumbar herniated disc.

Keywords

References

  1. Wheeler AH, Murrey DB. Chronic lumbar spine and radicular pain: pathophysiology and treatment. Curr Pain Headache Rep. 2002;6(2):97-105. https://doi.org/10.1007/s11916-002-0005-x
  2. Frymoyer JW, Gordon SL. American academy of orthopaedic surgeons symposium: New perspective on low back pain. Chicago, American academy of orthopaedic surgeons, 1989:168-98.
  3. Milette PC. Classification, diagnostic imaging, and imaging characterization of a lumbar herniated disk. Radiol Clin North Am. 2000;38(6):1267-92. https://doi.org/10.1016/S0033-8389(08)70006-X
  4. Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15(2):167-74. https://doi.org/10.1016/j.mric.2006.12.001
  5. Bailey WM. A practical guide to the application of AJNR guidelines for nomenclature and classification of lumbar disc pathology in Magnetic Resonance Imaging (MRI). Radiography. 2006;12(2):175-82. https://doi.org/10.1016/j.radi.2005.05.004
  6. Fardon DF. Nomenclature and classification of lumbar disc pathology. Spine. 2001;26(5):461-2. https://doi.org/10.1097/00007632-200103010-00007
  7. Tertti M, Paajanen H, Laato M et al. Disc degeneration in magnetic resonance imaging. A comparative biochemical, histologic, and radiologic study in cadaver spines. Spine. 1991;16(6): 629-34. https://doi.org/10.1097/00007632-199106000-00006
  8. Fagerlund MK, Thelander U, Friberg S. Size of lumbar disc hernias measured using computed tomography and related to sciatic symptoms. Acta Radiol. 1990;31(6):555-8.
  9. Onel D, Tuzlaci M, Sari H et al. Computed tomographic investigation of the effect of traction on lumbar disc hermiations. Spine. 1989;14(1):82-90. https://doi.org/10.1097/00007632-198901000-00017
  10. Sari H, Akarirmak U, Karacan I et al. Computed tomographic evaluation of lumbar spinal structures during traction. Physiother Theory Pract. 2005;21(1):3-11. https://doi.org/10.1080/09593980590911507
  11. Meszaro FF, Olson R, Kulig K et al. Effect of 10%, 30%, and 60% body weight traction on the straight leg raise test of symptomatic patients with low back pain. J Orthop Sports Phys Ther. 2000;30(10):595-601.
  12. Rattanatharn R, Sanjaroensuttikul N, Anadirekkul P et al. Effectiveness of lumbar traction with routine conservative treatment in acute herniated disc syndrome. J Med Assoc Thai. 2004;87(2):272-7.
  13. Moret NC, van der Stap M, Hagmeijer R et al. Design and feasibility of a randomized clinical trial to evaluate the effect of vertical traction in patients with a lumbar radicular syndrome. Manual Therapy. 1998;3(4):203-11. https://doi.org/10.1016/S1356-689X(98)80049-0
  14. Gay RE, Bronfort G, Evans RL. Distraction manipulation of the lumbar spine : A review of the literature. J Manipulative Physiol Ther. 2005;28(4):266-73. https://doi.org/10.1016/j.jmpt.2005.03.012
  15. Cox J, Hazen LJ, Mungovan M. Distraction manipulation reduction of an $L_{5}-S_{1}$ disk herniation. J Manipulative Physiol Ther. 1993;16(5):342-6.
  16. Cox J. Low back pain : mechanism, diagnosis, and treatment. 5th ed. Baltimore (MD), Williams & Wilkins, 1990:320-45.
  17. Gudavalli MR, Cambron JA, McGregor M et al. A randomized clinical trial and subgroup analysis to compare flexion-distraction with active exercise for chronic low back pain. Eur Spine J. 2006;15(7):1070-82. https://doi.org/10.1007/s00586-005-0021-8
  18. Hession EF, Donald GD. Treatment of multiple lumbar disk herniations in a adolescent athlete utilizing flexion distraction and rotational manipulation. J Manipulative Physiol Ther. 1993;16(3):185-92.
  19. Griffith JF, Wang YX, Antonio GE et al. Modified pfirrmann grading system for lumbar intervertebral disc degeneration. Spine. 2007;32(24):708-12.
  20. Pfirrman CW, Metzdorf A, Zanetti M et al. Magnetic resonance classificaltion of lumbar intervertebral disc degeneration. Spine. 2001;26(17):1873-8. https://doi.org/10.1097/00007632-200109010-00011
  21. Kwon WA, Ma SY, Hwang YT et al. Therapeutic modalities: cervical and lumbar traction. 3ed. Seoul, Yeong mun publishing company, 2007:349-70.
  22. Ramos G. Efficacy of vertebral axial decompression on chronic low back pain. Neurol Res. 2004;26(3):320-4. https://doi.org/10.1179/016164104225014030
  23. Ma SY, Lee HH, Kim SH et al. The effects of distraction manipulation on the pain and intervertebral disc angle in patients with herniated intervertebral lumbar disc. J Kor Soci of Phys Ther. 2007;19(3):31-9.
  24. Ma SY, Gong WT, Cho GY. The effects of motorized flexiondistraction treatment on the lumbosacral region angle in patients with chronic low back pain. J Kor Data & Infor Scien Soci. 2009;20(2):339-48.
  25. Kwon WA, Kim HS. The spontaneous regression of lumbar disc herniation: 3 cases report. J Kor Soci Phys Ther. 2008;20(3):69-74.
  26. Ombregt L, Bisschop P, ter Veer HJ. A system of orthopaedic medicine. 2nd. London, Churchill Livingstone, 2005:357-97.
  27. Cox J. Chiropractic and distraction adjustments today. In: Cox JM, eds, Low back pain: mechanisms, diagnosis and treatment, 6th ed, Philadelphia, (Pa)7 Lippincott Williams & Wilkins, 1998:1-16.
  28. Bulbulian R, Burke J, Dishman JD. Spinal reflex excitability changes after lumbar spine passive flexion mobilization. J Manipulative Physiol Ther. 2002;25(8):526-32. https://doi.org/10.1067/mmt.2002.127073
  29. Cyriax J. Textbook of othopaedic medicine, vol I, Diagnosis of soft tissue lesions. 8th ed. London, Bailliere Tindall, 1984:189-235.
  30. Gunzburg R, Parkinson R, Moore R et al. A cadaveric study comparing discography, magnetic resonance imaging, histology and mechanical behavior of the human lumbar disc. Spine. 1992;17(4):417-26. https://doi.org/10.1097/00007632-199204000-00007
  31. Boden SD, Davis DO, Dina TS et al. Abnormal magneticresonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990;72(3):403-8.
  32. Boos N, Rieder R, Schade V et al. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine. 1995;20(24):2613-25. https://doi.org/10.1097/00007632-199512150-00002
  33. Wilberger JE Jr, Pang D. Syndrome of the incidental herniated lumbar disc. J Neurosurg. 1983;59(1):137-41. https://doi.org/10.3171/jns.1983.59.1.0137
  34. Garfin SR, Ryderik BL, Lind B et al. Spinal nerve root compression. Spine. 1995;20(16):1810-20. https://doi.org/10.1097/00007632-199508150-00012