Robotic spinal mobilisation and traction

The system applies traction and mobilisation to the spine along a programmed path with the force, angle, duration and cycle pattern all set numerically. That produces something manual traction cannot: the identical treatment every session, and a record of exactly what was applied.

Force is applied and released in cycles rather than held, which is better tolerated and allows fluid movement within the disc space.

Lumbar and cervical disc herniation with nerve root pain, spinal stenosis, facet joint pain, and mechanical back and neck pain where imaging and examination indicate a compressive or mechanical cause.

It is not appropriate in spinal instability, after spinal fusion, in significant osteoporosis, in the presence of tumour or infection, or where cauda equina signs are present — which is a surgical emergency and not a traction candidate.

For nerve root pain from the lower back, a Cochrane review found that traction probably has no effect on pain, function or overall improvement 2. In the neck, adding traction reduces nerve root pain slightly, but on low-quality evidence and by an amount too small to be clinically meaningful 3. It does not reliably reverse a herniation, and claims that discs are pulled back into place overstate what is known.

It is used to reduce symptoms enough for a spinal stabilisation and movement programme to begin. That programme is what prevents recurrence.

Traction is not recommended for low back pain with or without sciatica in current UK guidance from NICE 1.

It is used selectively, for specific presentations and short courses, alongside exercise. Where a plan consists mainly of traction sessions, the question worth asking is what the active component is.

Where it is used, it is a short defined course alongside an active programme, with a review point. Symptom relief in an individual is a reason to continue for a few sessions, not a reason to sell twenty.

A treatment plan built mainly on traction is the pattern worth questioning anywhere it is offered, including here. The active component is what changes the outcome.

It makes the dose precise and repeatable, which is useful for recording exactly what was applied, but it has not been shown to change the result. A Cochrane review of 32 randomised trials found that traction, alone or added to other treatment, has little or no effect on pain, function or return to work in low back pain, and its authors state that this applies to both manual and mechanical traction 2.

Precision in delivering a treatment cannot add benefit that the treatment itself lacks. That is why, where traction is used at all, it is a short trial with a review point inside an active programme rather than a course in its own right.