Traction Therapy
Spinal Traction for Disc Pain and Sciatica: What It Actually Does
Spinal traction gets recommended for disc pain and sciatica all the time, but the research on it is more mixed than most clinics admit. Here's what traction actually does, what the studies say about standard traction versus the curve-focused CBP approach, and who it's a reasonable fit for.
By Dr. Edward Johns, DC · October 1, 2026 · 8 min read
What Spinal Traction Is, in Plain Terms
Traction is a pulling force applied along the spine. The Cochrane Collaboration describes it as a force that draws two neighboring bones apart to increase the space between them. The idea is that a little more room takes pressure off a disc and off the nerve beside it.
It can be done by hand, with a provider gently holding and pulling, or mechanically, with you lying on a table or in a device that applies a steady, controlled pull. Cleveland Clinic describes neck traction as lightly pulling on the head to create space between the bones of the neck.
What traction is not: hanging upside down, or someone yanking on your spine. Done properly it's slow, sustained, and adjusted to how you respond.
What the Research Says About Standard Traction
We'd rather you hear this from us than find it on your own later. For standard traction, the kind that simply pulls the spine lengthwise, the research is not encouraging.
A 2013 Cochrane review of 32 randomized trials with 2,762 people found that traction, alone or combined with other treatments, has little or no impact on pain, function, overall improvement, or return to work for low back pain, with or without sciatica. The reviewers also noted that many of the trials were small and of limited quality.
The neck looks similar. A 2020 review of 7 randomized trials on traction for pinched nerves in the neck found a statistically significant effect on pain, but one too small to make a meaningful difference for patients, and the overall quality of evidence was low.
So if someone tells you traction alone will fix a disc problem, that isn't what the evidence shows.
Why CBP Extension Traction Is a Different Question
The traction we use at North River is based on Chiropractic BioPhysics (CBP), and it works from a different premise. Instead of just pulling the spine longer, CBP traction places the spine in a specific position meant to restore a curve that's been lost, like the forward curve of the low back or neck flattening out over time.
In the research, this is usually called extension traction, and it's aimed at a narrower group of people: those whose X-rays show a reduced curve. That's also why our setup is based on your own digital X-rays and postural analysis rather than one setting used on everyone.
Because it targets a different problem in a different group of patients, the standard traction studies above don't really answer whether it works. That takes its own research.
What the CBP Studies Found, and Where They Fall Short
A 2020 systematic review looked at 3 controlled trials (2 of them randomized), reported across 4 papers, on CBP extension traction for low back problems in people with a reduced lumbar curve. Patients gained about 7 to 11 degrees of curve over 10 to 12 weeks, across 30 to 36 sessions. In the randomized trials, the traction groups mostly kept their improvements in curve, pain, and disability at 6 months, while comparison groups getting standard physical therapy care started slipping back toward where they began as early as 3 months.
One of those trials followed 64 people with sciatica from a low back disc herniation and a reduced low back curve. Adding extension traction to standard care led to better pain, disability, and nerve function results at 10 weeks, and the difference held at 6 months.
For the neck, a 2022 randomized trial of 30 people with pinched nerves and a reduced neck curve found that the group getting extension traction kept improving at 2 years. The comparison group's pain crept back up after treatment ended, and their neck curve never improved, measuring slightly lower at 2 years than at the start.
Those results are encouraging. They also come with real limits, and you deserve to know them:
- The number of trials is small, and the review's own authors call their conclusions preliminary.
- The studies are small, ranging from 30 to 64 people in the trials described above.
- Nearly all of it comes from the same small group of researchers, including some of the review's own authors, and some disclose that they teach CBP methods or sell related products.
- The comparison groups mostly received passive care like hot packs or infrared heat, not fake traction, so the studies can't fully rule out a placebo effect.
- The review notes that no study has yet identified exactly which back pain patients with a reduced curve are the best candidates.
Who Traction May Fit, and Who It Doesn't
In our office, traction is one part of a plan, usually alongside adjustments and physiotherapy, not a stand-alone fix. It's most worth considering when imaging and your exam both point to a structural issue it's meant to address, such as:
- A disc herniation or bulging disc with a flattened spinal curve
- Sciatica or arm pain from an irritated nerve, where the curve has been lost
- Chronic neck or back pain tied to a reduced or reversed curve
- Not a fit, per Cleveland Clinic's guidance on neck traction: pregnancy, osteoporosis, spinal tumors or a spinal bone infection, a previous neck fusion, aneurysm, untreated high blood pressure, or spinal cord compression (myelopathy)
- Also not a fit: anyone who finds being positioned or restrained in a device too anxious or claustrophobic to tolerate
What a Traction Session Is Like at North River
You're positioned on specialized equipment and the traction force is applied steadily for a set number of minutes, often as part of a visit that also includes an adjustment or physiotherapy. Most patients describe it as a controlled, sustained stretch rather than anything forceful.
Traction isn't risk-free, though. Cleveland Clinic says to get checked if you notice worsening pain, numbness, tingling, vision changes, or headaches after neck traction, and the Cochrane review found reports of increased pain and worsening nerve symptoms in some studies. If anything feels worse during or after a session, tell us. Dr. Johns will change the setup or stop it.
When to Skip Traction and Get Care Right Away
For most people, disc pain gets better on its own over time. According to the American Academy of Orthopaedic Surgeons, most people with a herniated disc in the low back feel better within a few weeks or months without surgery, and most are symptom-free by 3 to 4 months.
The one exception to waiting is loss of bladder or bowel control along with back or leg pain. That can be a sign of cauda equina syndrome, which the AAOS calls a medical emergency. Go to the emergency room, not a chiropractor's office.
FAQ
Frequently asked questions
Does spinal traction actually work for a herniated disc?+
For standard traction that simply pulls the spine lengthwise, a large Cochrane review found little or no benefit for low back pain with or without sciatica. CBP extension traction, which aims to restore a lost spinal curve, has smaller trials showing better and longer-lasting results, but that research is still limited. We use it as one part of a plan, not a stand-alone fix.
What's the difference between CBP traction and an inversion table?+
An inversion table or a basic traction unit pulls the spine lengthwise the same way for everyone. CBP traction places your spine in a specific position meant to restore a lost curve, set up from your own digital X-rays and postural analysis.
Does traction hurt?+
It shouldn't. Most patients describe it as a controlled, sustained stretch. If you notice new or worse pain, numbness, or tingling, tell us right away so we can change the setup or stop.
How many traction sessions will I need?+
It depends on your exam and imaging. For reference, the CBP studies used about 30 to 36 sessions over 10 to 12 weeks. Dr. Johns will give you a realistic plan after your first visit rather than a generic number.
Who shouldn't have spinal traction?+
Cleveland Clinic lists pregnancy, osteoporosis, spinal tumors or a spinal bone infection, a previous neck fusion, aneurysm, untreated high blood pressure, and spinal cord compression as reasons to avoid neck traction. Loss of bladder or bowel control with back pain needs emergency care, not traction.
Can traction make a disc problem worse?+
It can. Some studies in the Cochrane review reported increased pain or worsening nerve symptoms. That's why the setup is based on your own imaging and adjusted to how you respond, and why we want to hear right away if anything feels worse.
Sources
- 1. Cochrane: Traction for low-back pain with or without sciatica (Wegner et al., 2013)
- 2. Colombo et al., Traction Therapy for Cervical Radicular Syndrome is Statistically Significant but not Clinically Relevant for Pain Relief, Journal of Clinical Medicine (2020)
- 3. Oakley et al., Restoring lumbar lordosis: a systematic review of controlled trials utilizing Chiropractic BioPhysics (CBP), Journal of Physical Therapy Science (2020)
- 4. Moustafa and Diab, Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial, Clinical Rehabilitation (2013)
- 5. Moustafa, Diab, and Harrison, The Efficacy of Cervical Lordosis Rehabilitation for Nerve Root Function and Pain in Cervical Spondylotic Radiculopathy: A Randomized Trial with 2-Year Follow-Up, Journal of Clinical Medicine (2022)
- 6. Cleveland Clinic: Cervical Traction
- 7. OrthoInfo (American Academy of Orthopaedic Surgeons): Herniated Disk in the Lower Back
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