Background Traction is commonly used for the treatment of low back pain (LBP), predominately with nerve underlying involvement; however its benefits remain to be founded. root’ problems is definitely feasible. Further study based upon a fully powered trial is required to ascertain if the addition of traction has any benefit in the management of these individuals. Trial Registration Sign up quantity: ISRCTN78417198 Background There is ongoing confusion encircling the use of traction in the management of low back pain (LBP), with variations between recommendations in the UK, New Zealand, Denmark and the USA clinical recommendations [1]. This is further confounded by a recent Cochrane systematic review which concluded that CID-2858522 IC50 ‘traction probably is not effective,’ however, the authors also mentioned that ‘we lack strong, consistent evidence regarding the use of traction due to the lack of high quality studies, the heterogeneity of study populations, and lack of power. Any long term study should distinguish between sign pattern and period and should become carried out according to the highest methodological standard to avoid bias [2].’ Despite such recommendations, traction continues to be generally used by physiotherapists in the management of LBP; a recent UK-wide survey indicated that 41% of therapists used traction with 5% of LBP individuals, who almost specifically presented with ‘nerve underlying’ problems [3]. Between 3 C 10% of LBP sufferers will experience ‘sciatica’ or ‘nerve root’ pain, with or without neurological indications [4-6] with 90% recovering, but a further 10% requiring surgical treatment [6]. Guidelines highlight this small group of individuals in their triage system with the implication that this group of individuals may be more severe, slower to recover, and may require specialist referral when compared to ‘simple’ LBP [5,7-10]. Effective management of this group of individuals is therefore essential to limit expensive onward referral and surgery that may result. This study was designed to assess the feasibility of a pragmatic randomized controlled trial (RCT) designed to examine the effectiveness of traction with this subgroup of LBP, utilizing CID-2858522 IC50 treatment parameters indicated by medical practice and expert opinion [3]. As manual therapy is definitely often used in conjunction with CID-2858522 IC50 traction in the management of ‘nerve root’ problems, this study compared the addition of traction to a manual therapy treatment protocol (manual therapy, exercise and advice, with or without traction). The specific objectives of Prom1 this study were to ascertain the feasibility of the study protocol, in particular the testing and adequate recruitment of ‘nerve root’ individuals. Methods Ethical authorization was granted by the CID-2858522 IC50 Research Ethical Committee of the University of Ulster. This multicentred, pragmatic randomized controlled trial was set in three physiotherapy departments in the Down Lisburn Health and Social Care Trust, Northern Ireland. General Practitioners with this catchment area were contacted to ensure early referral to physiotherapy of LBP individuals with nerve underlying involvement. Subjects were included if they fulfilled the following criteria (i) Aged 18C65 years of age (male and woman), showing with acute/sub-acute LBP with accompanying radiculopathy; (ii) Radiculopathy or ‘nerve underlying’ was recognized by the presence of: Dermatomal pain distribution CID-2858522 IC50 radiating below the knee (one or both limbs), of a sharp/severe quality, often worse in the leg than back (leg pain threshold of 3/10 VAS). With at least one of the following signs and symptoms: (a) Pins and needles in the distal dermatome (where this was present individuals with leg pain were accepted even though not extending below the knee); (b) Increased pain in the leg on coughing, sneezing or straining; (c) Neurological deficit i.e. decreased muscle strength/sensory loss/reflex loss; (d) Positive straight leg raise test i.e. limb symptoms reproduced on SLR test below 90 degrees [5,8,10-12]; (iii) Acute/sub acute LBP, defined as LBP of less than 12 weeks period [5,7], or perhaps a recurrent.