Traction

Traction gained popularity in the 1950's and 60's when Cyriax (he's kind of a big deal) recommended it for its efficacy in treating back and leg pain. Research, however, has mixed reviews as to the effectiveness of traction as an individual treatment or even in combination with other treatments. There is good evidence demonstrating the mechaical effects of traction but that clinical effectiveness is controversial. One of the greatest concerns is the "passiveness of the treatment." Traction is frequently used in the treatment of back pain regardless. Traction can help reduce the signs and symptoms of lumbar and cervical spineal compression by increasing space between vertebrae, separating the apophyseal joint, widening the foramen, relaxing muscles, and changing disc pressures.

Proposed Effects of Spinal Traction

Joint distraction
- Separation of two articular surfaces perpendicular to the plane of the articulation, elongating soft tissues. Temporary effect.
Widening of foramen
- Separation of the apophyseal joints, providing more room for the interforamen structures and a reduction of symptoms
Reduction of disc protrusion
- "suction" due to decreased intradiscal pressure by tensing the PLL and pushing any displaced material anteriorly. Treatment of choice for small nuclear protrusions, but patients with greater herniations tended to respond better.
Soft tissue stretching
- May have an effect by increasing ROM and decreasing pressure on facet joint surfaces
Muscle relaxation
- May be due to decreased pain, depression in monosynaptic response (static) or stimulation of GTo's to inhibit alpha motor neurons firing (intermittent)
Joint mobilization
- May be due to the stretching of the soft tissue at high traction forces. Oscillatory motions may also stimulat mechanoreceptors and thereby decrease joint related pain by gating. This is less specific than manual techniques because there is a finite time for the machine to turn off and on for the hold/relax cycle that is providing those oscillations.
Patient Immobilization
- Continuous traction of 10-14 hours/day for complete immobilization.

Indications

Disk bulge or herniation
- Traction can provide a reduction of the protrusion. This will be easier if applied sooner, with sufficient force, and when the disc material is softer rather than when it is large or calcified. Must be combined with postural correction, body mechanics, and lumbar stabilization
Nerve root impingement
- Applied sooner rather than later to treat neuro defiicts from impingement by temporarily increasing the size of the neural foramen. People who are positive in compression and distraction testing will likely benefit from this.
Joint hypomobility
- Non-specific mobilization. Want to be cautious of hypermobility at other segments as these loose segments will be pulled preferentially rather than the area of hypomobility.
subacute joint inflammation
- Distraction reduces pressure on inflamed joint surfaces but should be avoided immediately after injury. Small oscillatory motions may control pain by gating transmission at the spinal cord.
Paraspinal muscle spasm

The spine is involved with some pretty important stuff

so there are some things that need

to be considered before starting traction

Lumbar Traction

Position

Supine - Most common position, promotes flexion, better for facet dysfunction
Prone - Tends to promote extension, better for disc problems. Use when supine position isn't tolerated.

Belt

directly on the skin to prevent friction, sliding, and accidently pants-ing your patient
use a towel roll under the buckles for comfort
Position the belts while the patient is standing or lying
Position pelvic belt just below the iliac crest
Make sure that the thoracic belt is anchored

Angle

Closer to neutral will preferentially distract the lower lumber spine
Mid and upper lumber will be preferentially distracted as angle increases

Considerations

Static when area is inflammed or aggravated
intermittent with long hold times for disc protrusions
Short hold and relax for joint dysfunction
Initial session should be low force and brief (5-10 minutes) to assess tolerance

Cervical Traction