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Exclusion criteria were: (1) low back pain due to neoplastic, inflammatory, infectious, or metabolic causes; (2) indication of urgent surgery (Cauda equina syndrome or progressive motor deficit); (3) spinal stenosis; (4) pregnancy, postpartum period, and postoperative 3 months; (5) previous vertebral surgery; (6) gross structural abnormalities (e.g. spondylolisthesis); (7) being unable to tolerate physical therapy due cardiovascular reasons; (8) presence of significant degenerative changes in lumbosacral vertebrae on X-rays; (9) duration of low back pain of more than 6 months.
     The patients were randomly divided into two groups. The treatment group (Traction group) included 24 patients (14 men and ten women; mean age 40.2 ± 11.4 (16-65 years), and they were given a physical therapy program including hotpack (for 15 min), continuous ultrasound (to lumbar paravertebral muscles, 1.5 W/cm² for 5 min), and diadynamic currents (with intermittently changed diadynamic current forms and polarities, the current intensity adjusted below the pain threshold, total duration of treatment 10 min) and traction (as continuous lumbar traction for 15 min). The control group included 22 patients (eight men and 14 women; mean age 52.7 ± 8.8 (35-70) years) and the same physical therapy program was given without traction. Each patient was given a total of 15 session of physical therapy, a session each weekday by the same physical therapist during the treatment period. Lumbar traction was applied only to the first group. Enraf Nonius Traction Eltrac 439 was used. Traction was started with 25% of patients' body weight, and increased with the same increment everyday to 50% of patients' body weight at the tenth session, and continued at this level to the end of the treatment. Ibuprofen 400 mg tid and a muscle relaxant preparation (mephenoxalone 200 mg + paracetamol 450 mg) tid were given to all subjects during the treatment period. Ibuprofen was discontinued in two patients due to gastrointestinal side effects.
     A 10-cm visual analog scale (VAS) was used to evaluate the pain intensity. Unbearable pain intensity was accepted as 10, and 0 indicated no pain at all. All patients were let to decide their pain levels. For lumbar motion assessment, modified Schober test was done. Straight leg raising (SLR) test was done, and the angle at which the test was positive was measured with a goniometer ("SLR angle"). Motor deficits were determined by clinical examination bilaterally. Motor deficits were recorded as % loss. L4, L5, and S1 dermatomes were examined for evaluation of sensory deficits. Patella and Achilles reflexes were also examined and recorded as normal decreased, and absent. The VAS, modified Schober test, SLR measurements, and clinical examinations were performed before and after the treatment.
     After the initial clinical examination, CT scans of L3-S1 intervertebral disc levels were obtained. The CT scans were made on a General Electric Sytec SR1 spiral tomography, using 3-mm thick slice sections at 3 mm intervals. Images were viewed with a window width of 300 and a window level of 800 Hounsfield units. A blind and expert radiologist		 assessed all the CTs. The disc and canal measurements were done in the axial slice, in which there was greatest encroachment of the disc. Sagittal distance of herniated material (maximum anteroposterior disc length, AB) and the sagittal length of the spinal canal (maximum anteroposterior canal length, EF) were measures (Fig. 1). A line was drawn which divided the herniated material into anterior and posterior halves. The width of the herniated material (CD) and the width of the spinal canal (GH) were measured at the level of this line. The following formula was used for the calculation of the "herniation index" [6]: (AB x CD)/(EF x GH)x 1,000. Repeat lumbar CTs were obtained and the same measurements were done after the treatment.
     Statistical evaluations were made by student's t-test and Mc Pearson correlation analysis, and p<0.05 was considered significant.
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Results

Disc herniations were found in 50 levels in these 46 patients. There were 12 L3-L4, 23 L4-L5, and 15 L5-S1





Fig. 1 Schematic diagram of the CT measurements. AB = maxiumum anteropesterior disc length, CD = width of the herniated material at the level of the mid AB distance, EF = maxiumum anteropsterior canal length, GH = width of the spinal canal at the level of the mid AB distance. The "herniation index" is calculated as: (AB x CD)/EF x GH) x 1,000
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