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Original Article 



The Effects of Stretching with Lumbar Traction on 
VAS and Oswestry Scales of Patients with Lumbar 
4-5 Herniated Intervertebral Disc 



J. Phys. Ther. Sci. 
26: 1049-1050, 2014 



Hae-sun Yang^\ Won-gyu Yoo^'* 
Department of Physical Therapy, Hanseo University, Republic of Korea 

Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University: 
607 Obang-dong, Gimhae, Gyeongsangnam-do 621-749, Republic of Korea 



Abstract. [Purpose] This study investigated the effect of stretching with lumbar traction on VAS and Oswestry 
scale scores of lumbar 4-5 herniated intervertebral disc (HIVD) patients. [Subjects] We recruited 20 lumbar 4-5 
HIVD patients. [Methods] We performed stretching with lumbar traction for lumbar 4-5 HIVD patients during 
4 weeks. The VAS and Oswestry scales were measured before and 4 weeks after the intervention. [Results] The 
results showed a significant decrease in VAS scale scores for stretching with lumbar traction in lumbar 4-5 HIVD 
patients, from 18±1.29 to 2.1±1.35. The Oswestry scale scores also decreased significantly, from 20.35±2.01 to 
3.5±2.84, after stretching with lumbar traction. [Conclusion] Thus, we suggest stretching with lumbar traction for 
lumbar 4-5 HIVD patients. 
Key words: HIVD, Lumbar traction. Stretching 

(This article was submitted Dec. 12, 2013, and was accepted Jan. 13, 2014) 



INTRODUCTION 

Pain experienced over long periods, such as with herni- 
ated intervertebral disc (HIVD), shows abnormal aspects 
in terms of its neurological mechanism^'. Changes in the 
neurological mechanism in HIVD patients lead them to per- 
form abnormal patterns of movement^l HIVD patients have 
shown both asymmetry and atrophy of the spinal muscles 
on the side of the pain. Muscle spasms result in nonalign- 
ment of the vertebrae'' Consequently, muscle spasm leads 
to pain and adhesion'- Subjects have a decreased ability 
to recruit spinal muscles in chronic HIVD. Lumbar trac- 
tion reduces pressure on the vertebral foramen by releasing 
tension in the spinal muscles^' ^\ It is used to improve align- 
ment and reduce muscle spasms''^ Lumbar traction reduces 
tension in soft tissue and pressure on the vertebrae^' Also, 
the nucleus pulposus can be moved inward by lumbar trac- 
tion. A previous study showed significant improvements 
in VAS and the Oswestry scale scores between traditional 
physical therapy and traction^l However, traction requires 
more time and effort. Some studies have reported no effect 
of traction, continuous lumbar traction, vertical traction for 
patients with radiating pain, self-traction for location and 
size of disc herniation, and traction for acute disc hernia- 
tion"*'. Stretching alone can help to release muscle spasms 



*Corresponding author. Won-gyu Yoo (E-mail: won7y@inje. 
ac.kr) 

©2014 The Society of Physical Therapy Science. Published by IPEC Inc. 
This is an open-access article distributed under the terms of the Cre- 
ative Commons Attribution Non-Commercial No Derivatives (by-nc- 
nd) License <http://creativecommons.Org/licenses/by-nc-nd/3.0/>. 



and is more rapid. Hamstring stretching affects lumbar lor- 
dosis. The connective tissue of the body is one unit in terms 
of structure and function; the hamstring is attached to the 
hipbone and the knee. Hamstring flexibility reduces back 
pain, increasing flexibility and coordination of the muscles 
without pain; hamstring stretching resulted in significant 
improvements in a previous study''. Thus, we investigated 
the effect of stretching with lumbar traction on VAS and 
Oswestry scale scores of lumbar 4-5 HIVD patients. 

SUBJECTS AND METHODS 

The subjects were 20 patients, aged 20-55, who con- 
sented to participate. They had no acute inflammation, in- 
stability of the cervical spine or joints, cervical flexion or 
extension, outflow of disc fragments, or lumbar, cardiac, or 
respiratory dysfunction, and none of them were pregnant. 
Their average age, height, and weight were 41 . 1±1 1 .03 years, 
I68.4±8.8 cm, and 69.5±11.03 kg, respectively. Each subject 
provided informed consent before participating in the study. 
This study was approved by the Inje University Faculty of 
Health Sciences Human Ethics Committee. 

All subjects began treatment sessions with a 5-min hot 
pack. They then performed 10 min of hamstring stretching. 
The subject were asked to lie on their back with their legs 
straight. An assistant stood next to the side of the subject to 
be exercised and held the leg under the ankle and on top of 
the knee. The assistant lifted the leg as far as possible while 
keeping the knee straight. This stretching was progressed 
by the physical therapist according to symptom response. 
Lumbar traction was applied to produce a lordosis angle of 
15° at the lumbar 4-5 disc with an Electric Ortho Traction 



1050 J. Phys. Then Sci. Vol. 26, No. 7, 2014 



Apparatus (STC-200N, Shin Jin Medical Co., Seoul, Re- 
public of Korea). Subjects were positioned supine with the 
knee flexed on a wedge. The chest and pelvic were belted 
to provide support. For the first time, the traction was 25% 
of the body weight and was increased gradually by 2.25 kg/ 
day. The maximum lumbar traction was 25% of the body 
weight plusl3.5 kg. Stretching with lumbar traction was 
provided 6 days/week for 4 weeks. The VAS and Oswestry 
scales were measured on the day before and 4 weeks af- 
ter the intervention. The participant's perceived disability 
was assessed using the modified Oswestry disability ques- 
tionnaire (ODI). The contents of the ODI include 10 items 
concerning pain intensity, personal care, lifting, walking, 
sitting, standing, sleep, sex life, social life, and traveling. 
The 10 items are scored from 0 to 5. The sum total score 
is then doubled and reported as a percentage, from 0-100, 
with a higher score indicating greater disability^'. The data 
were analyzed using the paired t-test. The significance level 
was set at p < 0.05. The SPSS software (ver. 12.0) was used 
for the analyses. 

RESULTS 

The results showed a significant decrease in VAS scale 
scores for stretching with lumbar traction in lumbar 4-5 
HlVD patients, from 18±1.29 to 2.1±1.35 (p < 0.05). The 
Oswestry scale scores also decreased significantly, from 
20.35±2.01 to 3.5±2.84, after stretching with lumbar trac- 
tion (p < 0.05). 

DISCUSSION 

In this study, we investigated VAS and Oswestry scale 
scores of lumbar 4-5 HlVD patients with stretching and 
lumbar traction. The VAS scores decreased significantly 
after stretching with lumbar traction, as did the Oswestry 
scale scores. Gose'' suggested that lumbar traction influ- 
enced disc herniation, degenerative discs, and facet joint 
syndrome and thus affected pain, mobility, and daily liv- 
ing function. Kisner and Colby^' suggested that there was 
a limit to correction of the symmetric stability in scoliosis 
using lumbar traction alone. Subsequently, it was shown 
that traction with exercise affected thoracic expansion in 
scoliosis. Therapeutic application of a stretching motion in 
scoliosis to increase flexibility may affect abdominal and 
pelvic muscles'- Previous in vivo studies assessing the 
effect of stretching on the hamstring muscle -tendon com- 
plex have demonstrated significant load-relaxation behav- 
jQj.ii-13) xjjggg results indicate that stretching to reduce 



muscle spasm influences VAS and Oswestry scale scores, 
as does stretching with lumbar traction. A study of children 
with scoliosis also showed that traction significantly influ- 
enced related exercises"'. The present results indicate that 
stretching with lumbar traction reduced VAS and Oswestry 
scale scores in lumbar 4-5 HlVD patients. We believe that 
lumbar stretching with lumbar traction was shown to be 
more beneficial for reducing the tension on back muscles. 

ACKNOWLEDGEMENT 

This research was supported by Basic Science Research 
Program through the National Research Foundation of Ko- 
rea (NRF) funded by the Ministry of Education, Science 
and Technology (No. 2012R1A1B4001058). 

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