Report #39 featured image

#039 – Physiotherapy for Neck Pain and Vertical traction for lumbar radiculopathy

Vertical traction is effective in the short-term for lumbar radiculopathy

Vertical traction for lumbar radiculopathy: a systematic review.


Investigate the effectiveness of each different type of vertical traction (VT) compared with or added to other conservative treatments on pain and activity limitations, in patients with lumbar radiculopathy (LR)

Inclusion criteria

18 years or older, with at least two of the following criteria for LR:

  1. Radicular symptoms: LBP with pain and/or numbness radiating below the knee.
  2. ≥1 radicular signs: a. Sensory loss/paresthesia in any of the L4-S1 dermatomes b. Diminished Patellar/Achilles reflex c. Muscle strength deficit in any of the L4-S1 myotomes
  3. Positive imaging (MRI/CT).


  • 3 studies including 85 particiapnt.
  • Large statistically significant results on pain in favor of VT only when traction was combined with a passive treatment (bed rest or medications) and compared with the same treatment alone.
    • These results are based on very low and low quality evidence respectively.
  • Inversion traction, combined with PT and compared with PT alone, has no statistically significant results either on pain or on activity limitation.
    • These results are based on low quality evidence.
  • No statistically significant results on activity limitation, based on low quality evidence, were found even when VT was combined with bed rest and compared with bed rest alone.
  • Better results for VT appear to emerge only when it was compared with treatments whose effectiveness is uncertain.
  • In one study, 76.9% of the patients in the traction group avoided surgery, while only 22.2% of the patient in the control group.


  • VT may be an effective treatment only for reducing pain in LR at short-term, and may be preferred to passive treatments as bed rest and medications.
  • VT does not demonstrate significant effects on activity limitation due to LR.
  • We have insufficient data to conclude that VT gives additional benefits when combined to or compared with PT treatments.


  • Another systematic review, publish in march 2021, found that mechanical traction can improve pain in the short-term on patients with lumbar radiculopathy. Physiokeys Report here.

Physiotherapy management of neck pain

Liteature review (Open Access)


  • Education is defined as a process of enabling individuals to make informed decisions about their personal health-related behavior.
  • A recent systematic review found that structured patient education alone is equally beneficial compared with other conservative interventions for patients with neck pain with or without traumatic origin. (Restricted Access)
    • An earlier Cochrane review did not find evidence to support education. (Restricted Access)
  • Recommended education:
    • Reassuring patients that the pain is not a serious condition;providing information on pain and prognosis, including information that imaging is not recommended; advising to stay active; and educating about self-care, exercises and (stress) coping skills


from 1 cocharnce review

  • Cochrane review on exercises for mechanical neck disorders found that a wide variety of exercises had been evaluated, varying from breathing exercises to strength and endurance exercises, the quality of the evidence was categorized as very low, low, moderate or good. (Restricted Access)
  • Strength, endurance and stabilizing exercises were beneficial in chronic neck pain (moderate-quality evidence);
    • Only strength and endurance exercises were beneficial in chronic cervicogenic headaches (moderate-quality evidence);
    • Small benefit of stretching, strengthening and stabilization exercises in acute cervical radiculopathy (low-quality evidence) (Open Access).

👨‍🔧Mobilisation and manipulation

  • 2 reviews found that cervical mobilizations and manipulations were equally beneficial (moderate-quality evidence) in patients with non-specific neck pain.
  • Cervical manipulations show a small beneficial effect (low-quality evidence), but thoracic manipulations show a larger beneficial effect when compared to an inactive treatment (moderate-quality evidence), indicating that thoracic manipulations were more beneficial than cervical manipulations. (Review one, two)
    • This was not supported by more recent study, the same review also found that thoracic manipulations were more beneficial than mobilizations and standard care (very low-quality evidence). (Open Access)

🤸‍♀️Mobilisation, manipulation, advice and exercise

  • The combined treatment of exercise and manipulations seem to be more effective than exercises alone for immediate pain, but not on all other outcomes for people with neck pain, and there is probably not a clinically relevant benefit of adding mobilizations or manipulations to exercises. (small effect size, moderate-quality evidence) (Restricted Access).


Massage techniques commonly used by physiotherapist are known as conventional western massage and were found to be beneficial (in one small study) in the treatment of patients with neck pain compared with no treatment or placebo. (Restricted Access)


  • Manual therapy, exercise and education – usually in combination – seem to be the preferred evidence-based physiotherapy treatments for most patients with neck pain. Nevertheless, most interventions and management strategies are not based on firm evidence and effect sizes are small.

Check out earlier Physiokeys reports on neck pain here

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