Invest Clin 67(2): 178 - 188, 2026 https://doi.org/10.54817/IC.v67n2a02

Corresponding author: Jiaojiao Huang, Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiao-

tong University School of Medicine, Changxing Branch, No. 1008, Fengfu Road, Changxing Town, Chongming Dis-

trict, Shanghai 202150, China. Email: huangjiaojiao22@163.com

The effect of vitamin D3 combined with

traction on the treatment of lumbar disc

herniation.

Yina Yin and Jiaojiao Huang

Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong

University School of Medicine, Changxing Branch, Shanghai, China.

Keywords: Cholecalciferol; Intervertebral Disc Herniation; Traction; Inflammation;

Pain; Rehabilitation.

Abstract. This study examined the clinical effectiveness of vitamin D3

combined with traction therapy in patients with lumbar disc herniation. It in-

cluded 112 patients who received conservative rehabilitation at our hospital

from January 2021 to December 2023. Participants were randomly assigned to

two groups: one received supine mechanical traction, and the other received

the same traction plus oral vitamin D₃ for 4 weeks. The study compared clini-

cal outcomes and quality of life between the groups. Results showed that both

groups experienced improvements in pain and lumbar spine function. However,

the combined treatment group showed significantly better outcomes than the

traction-only group. Inflammation and pain markers decreased significantly,

and 25(OH)D3 levels increased notably in both groups, with greater improve-

ments in the combined treatment group. Additionally, negative mood and

quality of life improved more in the combined group. There was no significant

difference in the measured indicators between the one-month follow-up and

the one-month treatment. In conclusion, vitamin D3 combined with traction

therapy can effectively enhance short-term clinical outcomes and quality of life

for patients with lumbar disc herniation.

Vitamin D3 combined with traction on lumbar disc herniation 179

Vol. 67(2): 178 - 188, 2026

Evaluación de la eficacia clínica de la vitamina D3 combinada

con la tracción en pacientes con hernia de disco lumbar.

Invest Clin 2026; 67 (2): 178 – 188

Palabras clave: Vitamina D3; Hernia de disco intervertebral; Tracción; Inflamación;

Dolor; Rehabilitación.

Resumen. Este estudio se centró en evaluar la eficacia clínica de la terapia

combinada con vitamina D₃ y tracción en pacientes con hernia de disco lumbar.

Se incluyeron 112 pacientes que recibieron tratamiento de rehabilitación con-

servador en nuestro hospital entre enero de 2021 y diciembre de 2023. Los pa-

cientes fueron asignados aleatoriamente a dos grupos: uno recibió únicamente

tratamiento de tracción y el otro, tracción más tratamiento oral con vitamina

D₃ durante 4 semanas. Se compararon la eficacia clínica y la calidad de vida

entre ambos grupos. Los resultados mostraron que ambos tratamientos mejo-

raron el nivel de dolor y la función lumbar, aunque la combinación de vitamina

D₃ con tracción produjo una mejora significativamente mayor. Los marcadores

de inflamación y dolor disminuyeron notablemente, y los niveles de 25(OH)D₃

aumentaron en ambos grupos, con una mejoría mayor en el grupo combinado.

Además, el estado de ánimo y la calidad de vida mejoraron de forma más sig-

nificativa en el grupo de tratamiento combinado. No se observaron diferencias

estadísticamente significativas entre los indicadores de prueba al mes de se-

guimiento y al de tratamiento. En conclusión, la combinación de vitamina D₃

y terapia de tracción puede mejorar eficazmente los resultados clínicos a corto

plazo y la calidad de vida de los pacientes con hernia discal lumbar.

Received: 27-08-2025 Accepted: 22-11-2025

INTRODUCTION

Lumbar degenerative disc disease

(LDDD) is a leading cause of musculoskeletal

disorders, with lumbar disc herniation (LDH)

being its primary manifestation 1. LDH oc-

curs when disc material (nucleus pulposus

or annulus fibrosus) displaces beyond the

intervertebral disc space, causing symptoms

such as nerve root pain, numbness, decreased

sensation, and weakness 2,3. In severe cases,

it can result in paralysis or cardiovascular is-

sues. It is more common in individuals aged

30 to 50, with men being twice as likely as

women 4. Over 50% of people with lumbar disc

disease report lower back pain, which signifi-

cantly impairs quality of life 5. Conservative

treatment remains the first choice for most

LDH patients 6. Pain relief is mainly achieved

through medication, physiotherapy, exercise,

traction, epidural steroid injections, and acu-

puncture 7. Surgery is typically reserved for

severe LDH cases that do not respond to con-

servative approaches. While minimally inva-

sive procedures like microdiscectomy offer

good long-term results for select patients,

traditional open surgery carries risks such as

recurrent herniation and post-operative com-

plications 8.

Traction therapy is a conservative treat-

ment commonly used in clinical practice

that can increase the intervertebral space

and reduce intervertebral pressure through

physical pulling, thereby improving lum-

180 Yin and Huang

Investigación Clínica 67(2): 2026

bar disc-related symptoms such as acidity,

numbness, swelling, and pain 9. However,

traction therapy slightly raises the risk of

lumbar spine injury 10. Previous meta-analy-

ses, including Tadano et al. 11, confirm that

mechanical traction in the supine position

offers short-term pain relief in radiculopa-

thy, although long-term effectiveness varies

and depends on the patient.

Vitamin D is a widely used neurosteroid

hormone with multiple skeletal and non-

skeletal functions. Vitamin D receptors have

been identified in bone marrow, and several

reports have demonstrated a regulatory role

for vitamin D in bone metabolism and osteo-

porosis 12,13. Research on the relationship be-

tween vitamin D receptors and lumbar disc

degeneration and herniation has become

a hot topic 14-16. Mechanistic studies have

found that vitamin D has a protective effect

against neurotoxicity and can reduce pain

by modulating neurons 17, in addition to re-

ducing inflammation and pain in patients by

down-regulating the release of pain-produc-

ing inflammatory factors from glial cells18,19.

However, there is less information about the

clinical application of vitamin D in LDH.

This study focuses on the short-term

clinical effects of supine mechanical trac-

tion therapy and oral vitamin D3 supplemen-

tation in patients with LDH.

MATERIALS AND METHODS

Study subjects

One hundred and twelve outpatients

with LDH receiving conservative treatment

at the Rehabilitation Department of Xinhua

Hospital, affiliated with the Shanghai Jiao-

tong University School of Medicine (Changx-

ing Branch, Shanghai, China), between

January 2021 and December 2023, were en-

rolled. Inclusion criteria: (1) LDH confirmed

by magnetic resonance imaging (MRI); (2)

radicular pain (VAS ≥4); (3) no treatment

in the previous six months. Exclusion crite-

ria: (1) severe spinal pathology; (2) cardiac

or hepatic dysfunction; (3) malignancy or

autoimmune disease; (4) recent vitamin D

use; (5) inability to comply. The study was

approved by the Ethics Committee of Xinhua

Hospital (Approval No. 2021-001).

Treatment protocol

The control group (CG) received su-

pine mechanical traction using a Lumbar

Traction Device (Model: TR-200, China).

Pelvis and thorax were fixed, and intermit-

tent traction was applied at 50–80% of body

weight (adjusted for tolerance). Sessions

lasted 20 minutes per day, 5 days a week, for

4 weeks. Patients rested in a supine position

for 30 minutes after traction. The observa-

tion group (OG) received the same traction

protocol plus oral vitamin D₃ (800 IU/day;

Cholecalciferol, 1000 IU capsules, Shanghai

Pharma) for 4 weeks.

Observation indicators

1. Lumbar function/pain: JOA 20, ODI 20,

VAS 20.

2. Efficacy: Classified as significant

(JOA↑>75%, VAS↓>75%), effective

(JOA↑35–75%, VAS↓25–75%), ineffecti-

ve (JOA↑<35%, VAS↓<25%) 21.

3. Inflammation/pain: Serum IL-1β,

TNF-α, IL-6, IL-8, 25(OH)D₃, SP, 5-HT,

PGE₂ (ELISA kits, R&D Systems).

4. Complications: Assessed via clinical

evaluation and MRI at follow-up.

5. Negative emotions: SAS 21, SDS 21.

6. Quality of life: LHFQ 22.

Abbreviations: LDH – Lumbar Disc Her-

niation, VAS – Visual Analogue Scale, JOA

– Japanese Orthopaedic Association Score,

ODI – Oswestry Disability Index, IL-1β – In-

terleukin-1 Beta, TNF-α – Tumor Necrosis

Factor-Alpha, IL-6 – Interleukin-6, IL-8 – In-

terleukin-8, 25(OH)D3 – 25-Hydroxyvitamin

D3, SP – Substance P, 5-HT – 5-Hydroxytryp-

tamine (Serotonin), PGE2 – Prostaglandin

E2, SAS – Self-Rating Anxiety Scale, DS –

Self-Rating Depression Scale, LHFQ – Lum-

bar Health Functional Questionnaire.

Vitamin D3 combined with traction on lumbar disc herniation 181

Vol. 67(2): 178 - 188, 2026

Statistical analysis

Data were analyzed with IBM SPSS Sta-

tistics for Windows, Version 25.0 (IBM Corp.,

Armonk, NY, USA). Continuous variables

were reported as mean ± standard devia-

tion (SD). The paired sample t-test was used

for within-group (pre- and post-treatment)

comparisons, while the independent sample

t-test was employed for between-group com-

parisons. Categorical data were compared

using the Chi-square (χ2) test or Fisher’s ex-

act test when appropriate. Statistical signifi-

cance was defined as p<0.05.

RESULTS

Improvement in lumbar spine function

and pain level after treatment

As shown in Fig. 1, the JOA scores for

both groups increased, while the ODI and

VAS scores decreased after treatment, and

the OG scores were significantly better than

those of CG (p<0.05). The one-month fol-

low-up results after treatment showed no

statistically significant differences in lumbar

spine function and pain levels compared to

the post-treatment period (p>0.05).

Combination therapy improves clinical

outcomes

As shown in Table 1, OG’s treatment ef-

ficiency was significantly higher than CG’s

(p<0.05).

Combination therapy improves

inflammatory factors and vitamin D levels

As shown in Fig. 2, the levels of IL-1β,

TNF-α, IL-6, and IL-8 were lower in both

groups after treatment, with a greater de-

crease in OG than in CG (p<0.05). The lev-

els of 25(OH)D3 in the patients increased

following vitamin D3 supplementation.

As shown in Fig. 3, SP, 5-HT, and PGE2

decreased in both groups, and OG decreased

more than CG (p<0.05).

Assessment of the incidence

of complications in both groups

As shown in Table 2, the complication

rate of OG had a decreasing trend compared

with that of CG, but there was no statisti-

cally significant difference between the two

(p>0.05).

Fig. 1. Comparison of lumbar spine function and pain level. *p<0.05 compared with CG, #p<0.05 compared

with before treatment. JOA: Japanese Orthopaedic Association Score; ODI: Oswestry Disability In-

dex; VAS: Visual Analogue Scale; CG: Control Group; OG: Observational Group. Data are presented

as mean ± SD. Independent sample t-test and paired sample t-test were used for between- and within-

group comparisons, respectively.

182 Yin and Huang

Investigación Clínica 67(2): 2026

Table 1. Comparison of treatment efficacy (%).

Groups Obviously effective Effective Ineffective Effective rate

CG (n =56) 30(53.57) 12(21.43) 14(25.00) 75.00

OG (n =56) 35(62.50) 15(26.79) 6(10.71) 89.29

χ2 3.896

p 0.048

CG: Control Group; OG: Observational Group. Data, expressed as n (%), were compared using the Chi-square

(χ²) test, p<0.05 indicates statistical significance.

Fig. 2. Comparison of inflammatory factors and vitamin D levels. *p<0.05 compared with CG, #p<0.05

compared with before treatment. IL-1β: Interleukin-1 Beta; TNF-α: Tumor Necrosis Factor-Alpha;

IL-6: Interleukin-6; IL-8: Interleukin-8; 25(OH)D3 – 25-Hydroxyvitamin D3; CG: Control Group; OG:

Observational Group. Data are presented as mean ± SD. Independent and paired sample t-tests

were used.

Fig. 3. Comparison of pain-related indicators. *p<0.05 compared with CG, #p<0.05 compared with befo-

re treatment. SP: Substance P; 5-HT: 5-Hydroxytryptamine; PGE2: Prostaglandin E2; CG: Control

Group; OG: Observational Group. Data expressed as mean ± SD. Statistical comparisons were per-

formed using independent sample t-tests and paired sample t-tests.

Vitamin D3 combined with traction on lumbar disc herniation 183

Vol. 67(2): 178 - 188, 2026

Combination therapy reduces negative

emotions

As displayed in Fig. 4, SDS and SAS

scores decreased in both groups after treat-

ment, with OG scores being lower than CG

(p<0.05). The follow-up results after one

month showed no significant difference

compared to those immediately after treat-

ment (p>0.05).

Combination therapy improves Quality

of Life (QOL)

As shown in Fig. 5, LHFQ scores improved

after treatment in both groups, with OG scores

lower than those in the CG (p<0.05).

DISCUSSION

This study assessed the short-term ef-

fectiveness of combining oral vitamin D₃ with

supine mechanical traction for LDH. The pri-

mary finding was that combination therapy

significantly enhanced pain relief, functional

ability, inflammation reduction, and quality

of life compared to traction alone. Specifical-

ly, this integrated approach led to a notable

decrease in nerve root pain and better func-

tional outcomes versus traditional conserva-

tive treatments. Nerve root pain is a common

persistent issue that hampers daily activities

for people with LDH. Local inflammatory re-

sponses are caused by malfunctioning mus-

cles and soft tissues, which lead to herniation

that compresses the nerve root. Disc inflam-

mation contributes to disc degeneration or

herniation through ongoing inflammation

and production of inflammatory factors. Ad-

ditionally, the nucleus pulposus releases in-

flammatory agents by activating the autoim-

mune system, worsening pain.

Traction therapy reduces soreness and

pain by increasing the patient’s lumbar in-

tervertebral space and relieving the pressure

caused by herniated nucleus pulposus. How-

ever, its effectiveness on lumbar interverte-

bral discs when used alone is limited, and

prolonged traction can lead to drawbacks

like instability of lumbar spinal muscles and

ligaments. Vitamin D is a neurosteroid hor-

mone that modulates the immune system,

protects the central nervous system, and

helps resist cell damage. Studies have shown

a link between vitamin D and lumbar disc

herniation. Yang et al. 23 found that levels of

vitamin D receptor gene expression could

serve as a marker for lumbar disc degenera-

tion. Sedighi et al. 24 discovered that subcu-

taneous vitamin D3 injections can decrease

neural tension and improve sensory deficits

related to lumbar discs. This study investi-

gated the combined effects of traction ther-

apy and vitamin D3; unlike previous research,

the vitamin therapy was administered orally,

which is a new approach. Feedback on treat-

ment effectiveness was assessed by observing

changes in pain mediators and inflammatory

factors.

Our results demonstrate that lumbar

spine function and overall pain levels im-

proved in both groups, with relief from com-

Table 2. Comparison of complications.

Groups Nerve root

compression

Intervertebral disc

degeneration

Narrowing of the

spinal canal Total incidence rate

CG (n =56) 3 (5.36) 3(5.36) 2(3.57) 8(14.29)

OG (n =56) 1(1.79) 1(1.79) 0(0.00) 2(3.57)

χ2 -

p 0.094

CG: Control Group; OG: Observational Group. Data are expressed as n (%), compared using the Chi-square

(χ2) test, p<0.05 is considered statistically significant.

184 Yin and Huang

Investigación Clínica 67(2): 2026

Fig. 4. Comparison of negative emotions. *p<0.05 compared with CG, #p<0.05 compared with one month

of treatment. CG: Control Group; OG: Observational Group; SAS: Self-Rating Anxiety Scale; SDS:

Self-Rating Depression Scale. Data are presented as mean ± SD. Statistical analysis performed us-

ing independent and paired sample t-tests.

Fig. 5. Comparison of QOL. *p<0.05 compared with CG, #p<0.05 compared with one month of treatment.

LHFQ: Lumbar Health Functional Questionnaire; CG: Control Group; OG: Observational Group.

Data are presented as mean ± SD. Independent sample t-tests and paired sample t-tests were used for

between- and within-group comparisons, respectively.

Vitamin D3 combined with traction on lumbar disc herniation 185

Vol. 67(2): 178 - 188, 2026

bination therapy exceeding that of mono-

therapy. The effectiveness of the treatments

was assessed using the JOA and VAS scores,

which showed superior results in the com-

bined treatment group. To better understand

the role of improved effectiveness, we tested

patients for inflammatory and pain-related

factors. Evidence suggests that vitamin D

receptors, cytokines, apoptotic factors, and

pain mediators contribute to the develop-

ment of intervertebral disc herniation 25-27.

IL and TNF are the primary inflammatory

mediators involved in lumbar disc disease.

IL-1β is primarily secreted by mononuclear

macrophages within the intervertebral disc,

and elevated levels promote disc degenera-

tion and pain. In one study, IL-1β was in-

jected into the intervertebral space of a rat

model, which caused inflammation and disc

damage 28. IL-8 and IL-6 can stimulate the

release of inflammatory mediators, promote

the recruitment of inflammatory cells, and

accelerate the progression of intervertebral

disc disease 29,30. TNF-α is a potent inflamma-

tory mediator that increases the release of

other pro-inflammatory substances, induces

apoptosis of chondrocytes, and affects osteo-

blast growth—key factors in lumbar disc pa-

thology 31.

Furthermore, because pain mediators

are key contributors to patient pain, we

chose representative mediators—SP, 5-HT,

and PGE2—as our study subjects. Serum

levels of SP, 5-HT, and PGE2 were higher in

patients with lumbar disc herniation than in

healthy controls. SP is an injurious stimula-

tory neuropeptide found in nerve fibers with

pain signaling capacity and has been linked

to lumbar disc herniation pain 32. 5-HT is a

common pain mediator that transmits and

modulates pain signals 33. PGE2 can activate

sensory nerve receptors by lowering the pain

threshold and increasing pain perception 34.

Our study showed that levels of inflamma-

tory factors and pain mediators improved af-

ter treatment in both groups, with the com-

bined treatment group experiencing greater

relief.

Evidence suggests that vitamin D defi-

ciency is prevalent among patients with lum-

bar degenerative spine conditions. Our find-

ings showed that 25(OH)D3 levels in patients

were at deficient levels prior to treatment,

and after four weeks of vitamin supplemen-

tation, there was a significant increase, ap-

proaching the normal range. Mechanistic

studies have found that vitamin D interacts

with vitamin D receptors in the paraverte-

bral muscles, supporting injury recovery. In

addition, vitamin D can inhibit neurotoxic

factors through immunomodulation and

modulate inflammatory cell populations,

thereby contributing to inflammation and

pain relief. IL-6, TNF-α, and prostaglandins

released by glial cells are downregulated by

vitamin D 35-37. Therefore, we hypothesize

that the improved efficacy of combination

therapy is due to vitamin D’s ability to inhib-

it the expression of inflammatory and pain

mediators.

Statistics on patients’ mood and qual-

ity of life, as measured by questionnaires,

revealed that combination therapy provided

significantly greater benefits than mono-

therapy. One-month follow-up results sug-

gested that the efficacy of combination ther-

apy was maintained beyond one month.

However, there are still some limita-

tions to this study. Firstly, the sample size

was small, which may introduce bias into

the findings. Secondly, the vitamin D3 sup-

plementation dose was not graded, and the

optimal oral dose was not identified. These

shortcomings represent directions for fu-

ture research.

The present study demonstrates that

combining vitamin D3 supplementation with

mechanical traction yields superior clinical

benefits compared with traction alone in pa-

tients with lumbar disc herniation (LDH). Be-

yond alleviating pain and improving lumbar

function, the combined regimen effectively

modulates inflammatory and neurochemical

pathways, reflected by reductions in IL-1β,

TNF-α, IL-6, IL-8, SP, 5-HT, and PGE2 levels.

These biochemical improvements parallel

186 Yin and Huang

Investigación Clínica 67(2): 2026

the enhancement in patients’ quality of life

and emotional well-being. The elevation of

serum 25(OH)D3 following therapy under-

scores the systemic contribution of vitamin

D3 to neuromuscular recovery and anti-in-

flammatory balance.

At a broader level, these findings sub-

stantiate the biopsychosocial impact of ad-

junctive vitamin D3 therapy in musculoskel-

etal rehabilitation. By addressing both the

physiological and psychological dimensions

of LDH, vitamin D3 with traction represents

a biologically integrative and patient-centric

approach that may redefine conservative

management strategies. Future multicen-

tric studies with larger cohorts and graded-

dosing protocols are warranted to estab-

lish long-term efficacy, optimal dosing, and

mechanistic insights into this synergistic

interaction.

Funding

None.

ORCID ID of the authors

• Yina Yin (YY):

0009-0007-1907-5773

• Jiaojiao Huang (JH):

0009-0004-5828-156X

Author's contributions

Both authors contributed to the devel-

opment and writing of the paper.

Conflict of interest

The authors state that there are no con-

flicts of interest to disclose.

Assurance of the originality of data

The author(s) assure the readers and

the publishers that all the data presented

here is original.

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