Chapter 20
Traction
Outline
Effects of Traction
Clinical Indications for Traction
Contraindications, Precautions, and Adverse
Effects
Application Techniques
Documentation
Effects of Spinal Traction
Joint distraction
Reduction of disc protrusion
Soft tissue stretching
Muscle relaxation
Joint mobilization
Joint Distraction
The separation of two articular surfaces
perpendicular to the plane of articulation
Reduces joint compression and widens
intervertebral foramina
May reduce pressure on articular surfaces,
intraarticular structures, or spinal nerve roots
Requires enough force
50% of body weight for lumbar facet joints
7% of body weight for cervical facet joints
Reduction of Disc Protrusion
(pp. 416-417)
Requires sufficient force
Lumbar spine
• 60 to 120 lbs, 30% to 60% body weight
Cervical spine
• 15 to 30 lbs
Soft Tissue Effects
Soft tissue stretching
May contribute to spinal joint distraction, reduction of
disc protrusion, or increase in spinal ROM
Moderate load, prolonged force
Muscle relaxation
Due to reduced pressure on pain sensitive structures
or gating by intermittent traction
Oscillatory/Intermittent traction OR Static traction
Joint Mobilization
By high force traction or repetitive intermittent
(oscillatory) traction
Traction mobilizes many joints at once
Manual techniques can be more localized.
Clinical Indications for Traction
(Clinical Pearl on p. 417)
Spinal disc bulge or herniation
Spinal nerve root impingement
Joint hypomobility
Subacute joint inflammation
Muscle spasm
Disc Bulge or Herniation
In theory, lumbar traction may decrease the size
of the herniated disc material.
Reduces compression on spinal nerve roots
Lack of significant clinical benefit in lumbar spine
may be related to severity or location of disc
protrusion.
More positive outcomes noted in cervical spine
Nerve Root Impingement
For impingement associated with
Disc bulge, ligament encroachment, foraminal
stenosis, osteophyte, nerve root swelling, or
spondylolisthesis
Best applied
Shortly after onset of symptoms
In patients with worse symptoms with spinal loading
and decreased symptoms with decreased spinal
loading
Joint Hypomobility
Traction can glide and distract spinal facet joints
to increase mobility.
Effect is nonspecific, affecting multiple joints.
Increased flexion localizes force to upper and
lower thoracic.
Neutral/extension localizes force to lower
lumbar.
Subacute Joint Inflammation
Force reduces pressure on inflamed joint
surfaces.
Small movements may gate pain and help
maintain normal fluid exchange in the joints.
Muscle Spasm
Static traction or low-load intermittent traction
may interrupt pain-spasm-pain cycle.
Higher load traction
may reduce underlying cause of pain.
Contraindications
Where motion is contraindicated
Acute injury or inflammation
Joint hypermobility or instability
Peripheralization of symptoms with traction
Uncontrolled hypertension
Precautions
Structural disease/conditions affecting spine
When belt pressure may be hazardous, for
example, pregnancy
Displaced annular fragment
Medial disc protrusion
When severe pain fully resolves with traction
Claustrophobia
Inability to tolerate prone or supine position
Disorientation
Effects of Traction on Lateral Versus Medial
Disc Protrusion
Nerve root compression by lateral disc
protrusion relieved by traction
Nerve root compression by medial disc
protrusion aggravated by traction
Precautions (Cont.)
For cervical traction
TMJ problemsno bc
jaw
Denturesjaw and
denture poppin out5
Adverse Effects
Excessive force may increase symptoms.
Rebound increase in pain
Start low, increase slowly
Lumbar radicular discomfort after cervical
traction
Mechanical Spinal Traction
Various
Belts and halters
Positions
Devices
Continuous versus intermittent
Application Technique—General
(pp. 425 – 430, 20.1 & 20.2)
Evaluate the patient.
Determine appropriateness and safety.
Select appropriate form of traction.
Explain procedure and rationale to the patient.
Apply traction.
When treatment is complete, assess outcome.
Document.
Recommended Parameters for Lumbar
Spinal Traction (Table 20.1, p. 428)
Initial/Acute
13-20 kg, Static, 5-10 min
Joint Distraction
22kg/50% lumbar body weight,
15sec hold/15sec relax, 20-30 min
Decreased Muscle Spasm
25% body weight, 5sec hold/5sec relax, 20-30min
Disc Problems/Stretch of Soft Tissue
25% body weight, 60sec hold/20sec relax, 20-30min
Recommended Parameters for Cervical
Spinal Traction (Table 20.2, p. 430)
Initial/Acute
3-4 kg, Static, 5-10 min
Joint Distraction
9-13kg/7% body weight,
15sec hold/15sec relax, 20-30, min
Decreased Muscle Spasm
5-7 kg, 5sec hold/5sec relax, 20-30 min
Disc Problems/Stretch of Soft Tissue
5-7 kg, 60sec hold/20sec relax, 20-30 min
Mechanical Spinal Traction (Cont.)
Advantages
Force and time
readily controlled,
graded, and
replicable
Does not require
continuous
supervision
Static weighted
devices inexpensive
and convenient for
independent use
Disadvantages
Expensive electrical
devices
Time consuming setup
Lack of patient control
or participation
Restriction by belt or
halters
Mobilizes broad
regions of the spine
Suggested Positions for Application of
Mechanical Hip traction
Pain Relief
20-30 degrees hip flexion
15-30 degrees hip abduction
Maximum external rotation
Increase ROM
Extension as tolerated
Abduction as tolerated
Maximum internal rotation
Suggested Parameters for Mechanical
Hip Traction
Days 1-7
1 minute hold time, 30-40 pounds of force, 6-8’
treatment time
Days 8-14
1-3 minute hold time, 40-50 pounds of force, 12-15’
treatment time
After Day 14
1-5 minute hold time, progress gradually from 40 to
more than 100 pounds of force, 15-20’ treatment time
Self and Positional Spinal Traction
Uses body weight to exert distractive force of the
spine
Can be used for lumbar but not cervical spine
Good when low forces are required
Inversion Traction
In a head down position, uses the weight of the
patient’s upper body to apply traction to the
lumbar spine
Precautions??
Courtesy Teeter
Manual Traction
Application of force by a therapist in the direction
of distracting the joints
Documentation
Type of traction
Area of body where traction applied
Patient position
Type of halter
Maximum force
With intermittent traction
Hold time, relax time, force during relax time
Treatment duration
Response to intervention
Case Studies for Class Discussion
20.1 p. 439
20.3 p. 442
Clinical guidelines: Blanpied, P – 2017. pdf
Clinical Prediction Rule:
Raney NH, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD,
Childs JD. Development of a clinical prediction rule to identify patients
with neck pain likely to benefit from cervical traction and exercise. Eur
Spine J. 2009 Mar;18(3):382-91. doi: 10.1007/s00586-008-0859-7.
Epub 2009 Jan 14. PMID: 19142674; PMCID: PMC2899424.
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