Journal of Pharmacy and Pharmacology 2 (2014) 87-94 The Historical Development and Proof of Lumbar Traction Used in Physical Therapy Hidayet Sari 1 , Tugce Ozekli Misirlioglu 1 , Ulku Akarirmak 1 , Sarmad Hussain 1 and Hanifi Deniz Kecebas 2 1. Department of Physical Medicine and Rehabilitation, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul 34098, Turkey 2. School of Medicine, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul 34098, Turkey Received: November 21, 2013 / Accepted: January 06, 2014 / Published: February 28, 2014. Abstract: Lumbar traction is a physical modality that has been used in the treatment of mechanical spinal diseases. The present article focuses on the history of lumbar traction starting from early antiquity until today. The oldest existing reference available about axial traction belongs to an ancient Indian religious literature written between 3500 BC and 1800 BC. Hippocrates was the first physician to use an axial traction device to correct spinal deformities. Since Hippocrates’ time, traction continued to be developed by the contribution of many famous physicians. After the clarification of “nuclear disc herniation” by Mixter and Barr, lumbar traction regained its popularity and in 1950s and 1960s based on James Cyriax’s findings, lumbar traction became a preferred method for the treatment of LDH (lumbar disc herniation). Although mechanical efficiency of lumbar traction on LDH was clearly shown in 1980s; its clinical effectiveness remains to be controversial. Today, more standardized studies with standard traction techniques are needed to be done in order to reach a definitive conclusion about its clinical effectiveness. Key words: Lumbar traction, lumbar disc herniation, history of medicine. 1. Introduction Traction is the process of applying force through body weight, weights, and/or pulleys in order to stretch a given part or to separate two parts. Although it has been used as a medical intervention to correct spinal deformities since early antiquity, it was in only 1950s and 1960s that lumbar traction became a popular treatment method for LDH (lumbar disc herniation) with contribution of James Cyriax [1]. The aim of this article is to discuss the history of lumbar traction including antiquity and modern time as well as the proofs of its clinical effectiveness for LDH. 2. Ancient History of Traction The oldest existing reference available about axial traction was described in “Srimad Bhagwat Mahapuranam”, an ancient Indian religious literature Corresponding author: Tugce Ozekli Misirlioglu, M.D., research fields: physical medicine and rehabilitation. E-mail: tozeklim@gmail.com. written between 3500 BC and 1800 BC [2, 3]. It was a mythological epic about Lord Krishna who corrected the hunchback of one of his devotees, Kubja, by applying axial traction. Much later, Hippocrates (469-377 BC), who is known as the founder of scientific medicine, was the first physician to use an axial traction device to correct spinal deformities [2, 4]. One of the methods he used was “Succussion” method, in which the patient was tied to a ladder (the Hippocratic ladder) and inverted (Fig. 1). The second method he used was a table (the Hippocratic board) with various straps, wheels, and axles to enable the traction (Fig. 2) [5]. In the third method, a board (the Hippocratic scamnum) which was placed into a hole in the wall at one end and pressed down at the other end by applying direct force to it in order to correct the spinal deformity [6]. Claudius Galen (131-201 BC), a noted Greek surgeon, adopted “Hippocrates” work, Hippocratic board and scamnum, and advanced them one step DAVID PUBLISHING D