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Slide 1
Traction
Tara Manal PT, OCS, SCS
Slide 2
Spine Pain with
Radiculopathy

Neurological deficits
– Mechanical compromise
– Ischaemia of the nerve nerve root/nerve/dorsal
root
• Mechanical compromise of venous outflow
• Ischemia and fibrosis
– Inflammation of the nerve root/nerve/dorsal root
• Intervertebral disc lesion/disease
• Osteophytic encroachment
• Facet inflammation
– Chemical response of the nerve to nucleus
material
Slide 3
Hypothesis of Traction
Biomechanical
 Intervertebral
Separation
 Reduction of disc
protrusion
 Altered Intradiscal
pressure
 Normalization of
conduction
 Increased Joint Mobility
Neurophysiological
 Pain Relief
 Decrease of Radicular
symptoms
Slide 4
Intervertebral Separation

Strong in vivo and in vitro evidence of
separation of intervertebral segments
• 9kg (20lbs)for 30 minutes to l-spine in vitro
• Most with hips 90º/ cervical ~30º
• In vivo occurred at 50lbs

Clinical Implications are unknown
» Colachis & Strohm 1969, Twomey 1985, Lee & Evans
1993
Slide 5
Reduction of Disc
Protrusion

Weak Evidence
• Contrast dye injected in 3 patients
• Pre and post traction radiographs
• Saw reduction gone in 14 minutes
•
•
•
•
Study re-done in 1992 with CT
4 patients with traction until recovery
2 had disc reduction/ 2 did not
All recovered
» Matthews 1968 David 1992
Slide 6
Altered Intradiscal
Pressure

Weak Evidence
– Single study of healthy discs
– No pressure change with mechanical
– Increased pressure with patient generated
traction (500N)
• Anderson et al 1983
Slide 7
Normalization of
Conduction

Weak Evidence and Mixed Results
– Some authors show normalized sensation,
reflexes and muscle power others do not
– Increased intervertebral foramen
• Reducing ischemia to nerve
• Improving removal of inflammatory agents
• Reduce mechanical compression
• Knutsson 1988, Onel 1989, Tesio 1989, Pal 1986
Slide 8
Increased Joint Mobility
Transitory Increase in cervical range
following traction
 Elongation of tissue is greater in healthy than
in presence of DJD
 Longer duration needed (30min) in old vs
young

» Some evidence for transitory increases
Slide 9
Neurophysiological

Ectopic Impulse Generators
– Spontaneous signals in dorsal root resulting from
inflammation
– Separation may silence these impusles
– Mechanical stimulation of large diameter fibers
overrides DRG

Moderate evidence in the animal model
» Howe 1977, Bini 1984
Slide 10
Neurophysiological

Response to Pain Generation
– Central Sensitization
– Expansion of Receptive Fields
• Thamus and PAG (decreased inhibition)
– Peripheral Receptor Hyperactivity

Hypothesis of Traction effects
– Increased non-nociceptive input
– Recruitment of descending inhibition
» Untested
Slide 11
Application of Traction

Patient Selection

Radiculopathy
– Nerve root
– Stenosis
– Worsens with active movement testing
Acute Phase (<6 – 12 wks)
 Don’t rule out long standing (stenosis)

Slide 12
Traction Dose

Type of Traction
– Mechanical vs. Manual
– At 25lbs cervical traction for radicular and non
radicular complaints
• No difference between intermittent, static and manual
Slide 13
Traction Dose

Magnitude
– Minimum needed to achieve goal
• ~20-50% BW needed to separate IV
• ~4% BW needed to overcome friction
– Split table reduces friction
– Split table at level of most desired traction
• Cervical- 20-25lbs to overcome lordosis
– 50lbs had greater separation than 30
Slide 14
Traction Dose

Duration
– Minimum needed to achieve goal

Static vs Intermittent
– Some evidence need static to overcome muscle
contraction
– Intermittent often less aggressive and less
rebound at end
Slide 15
Traction Dose

Body Position

Angle of the pull
– Best for goal
– Level
– Up at an angle
Slide 16
Flexion Worsens

Prone Traction
Slide 17
Extension Worsens

Supine Traction
Slide 18
Monitoring Response
Oswestry
 Neck Disability Index
 MMT
 Reflexes
 Centralization
 Pain complaints


Immediate vs over 2-3 Tx’s
Slide 19
Contraindications

Compromised spinal integrity
– Malignancy, osteporosis, tumor, infection
Unstable fracture
 Ligamentous instability (ie alar lig)
 Recent Fusion (3-6mo)
 Pregnancy (when can’t use belts)

Slide 20
Precautions
Loose fitting dentures (remove)
 Respiratory conditions
 Claustophobia
 Early pregnancy

– May consider manual traction
Slide 21
Traction Options
Occipital head contact
 Chin halter strap


Autotraction
– Pelvis is secure and traction forces are
generated by grasping and pulling and pushing
on bars on the ends of the table
Slide 22
Traction Options

Positional Traction
– Self unweighting on desk or counter