The problem with traction is that it can aggravate a swollen nerve root. It is hard for the therapist to know “how much is too much” as the root may “not complain” initially but will become painful with a delayed response. However, small traction maneuvers can be helpful post-operatively to prevent root adhesions and gently “squeeze” a root to reduce root swelling.
In addition, small and simple maneuvers can sometimes cause a recurrent herniation with “just the right angular movement”. If the symptoms are the same but somewhat more intense without new neurological examination findings, the chances of recurrent herniation are not too high. If however, there is a change in pain pattern down the leg, significant increased paresthesias or new finding on the neurological examination, a new MRI should be considered.
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