Background <p>Conventional traction therapy for LDH is widely used but has inconsistent efficacy in relieving pain and restoring motor function. Therefore, we designed and evaluated MTD that combines traction and rotation.</p> Methods <p>A prospective randomized controlled trial with a follow-up period from January 2022 to July 2024.Patients with LDH were randomly allocated to receive either treatment with a multifunctional traction device combining traction and twisting (MTD group), or conventional lumbar traction therapy (Control group). A total of 47 patients (MTD, <i>n</i> = 23; Control, <i>n</i> = 24) completed the study and were included in the final analysis. The major outcome was assessing changes from baseline to post-treatment in Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, Japanese Orthopaedic Association (JOA) scores and magnetic resonance imaging (MRI) evaluations.</p> Results <p>A total of 47 patients were included, with 23 in the MTD group and 24 in the control group. There were no specific differences between the two groups in terms of gender, age, height, weight, BMI, ODI, JOA or VAS scores at baseline date. Generalized estimating equation (GEE) analysis showed that ODI and VAS scores in the MTD group were lower compared to baseline (<i>P</i> &lt; 0.05). MRI evaluation showed no notable differences between the groups in terms of Pfirrmann grading and disc protrusion severity (<i>P</i> &gt; 0.05).</p> Conclusions <p>The MTD treatment is more effective in reducing low back pain and enhancing daily function than conventional treatment in patients with LDH.</p> Trial registration <p>This study has been registered in the Chinese Clinical Trial Registry (ChiCTR2100053940, <a href="https://www.chictr.org.cn">https://www.chictr.org.cn</a>).</p>