Mechanical traction for neck pain with or without symptoms that radiate to the neck or arm

Twenty-six to 71% of the adult population can recall experiencing an episode of neck pain or stiffness in their lifetime. Neck pain is more common in females than in males, with rates reported as high as 77.8%. The natural history is unclear. Neck pain has a costly impact on society because of visits to healthcare providers, sick leave, disability and loss of productivity. There are a number of treatments available for neck pain, one of which is mechanical traction.

Mechanical traction 'stretches' the neck. With the patient lying on their back, a head halter is placed under the back of the head and possibly the jaw and attached to a machine. The machine is set for a certain time period and specific weight for the pulling action to occur. The traction can remain on steadily for the specified time (referred to as continuous or static) or intermittently (on/off cycle) during the treatment session. Experts think that traction expands the space between the vertebrae, increases the movement of the joints and stretches the muscles and ligaments around the vertebrae. Side effects are generally few, but can include headache, nausea, fainting and injury to tissue.

We included seven randomized controlled trials (RCT), with a total of 958 participants, that looked at the effects of continuous or intermittent mechanical traction for individuals with chronic neck pain (lasting for more than three months). Some had symptoms that radiated into the arms and head (radicular symptoms), others did not.

Only one RCT (100 participants) had a low risk of bias, which means we can have confidence in the findings. This trial found that on average, there was no statistically significant difference between continuous and placebo traction in reducing pain or improving function for individuals with chronic neck disorder with radicular symptoms.

In summary, our review found no evidence from RCTs with a low potential for bias that clearly supports or refutes the use of either continuous or intermittent traction for individuals with chronic neck disorders.

Authors' conclusions: 

The current literature does not support or refute the efficacy or effectiveness of continuous or intermittent traction for pain reduction, improved function or global perceived effect when compared to placebo traction, tablet or heat or other conservative treatments in patients with chronic neck disorders. Large, well conducted RCTs are needed to first determine the efficacy of traction, then the effectiveness, for individuals with neck disorders with radicular symptoms.

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Background: 

Neck pain is a frequently reported complaint of the musculoskeletal system which can be disabling and costly to society. Mechanical traction is often used as an adjunct therapy in outpatient rehabilitation.

Objectives: 

To assess the effects of mechanical traction for neck disorders.

Search strategy: 

A research librarian searched computerized bibliographic databases without language restrictions up to March 2008 for randomized controlled trials (RCTs) from the medical, chiropractic, and allied health literature.

Selection criteria: 

The RCTs we selected examined adults with neck disorders who received mechanical traction alone or in combination with other treatments compared to a placebo or another treatment. Our outcomes of interest were pain, function, disability, global perceived effect, patient satisfaction, and quality of life measures.

Data collection and analysis: 

Two review authors with different backgrounds in medicine, physiotherapy, massage therapy and chiropractics independently conducted study selection, risk of bias assessment and data abstraction using pre-piloted forms. We resolved disagreement through consensus.

Main results: 

Of the seven selected RCTs (total participants = 958), only one (N = 100) had a low risk of bias. It found no statistically significant difference (SMD -0.16: 95%CI: -0.59 to 0.27) between continuous traction and placebo traction in reducing pain or improving function for chronic neck disorders with radicular symptoms. Our review found no evidence from RCTs with a low potential for bias that clearly supports or refutes the use of either continuous or intermittent traction for neck disorders.

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