Lumbar Traction - Jospt.1979.1.1.36

0000-0000/79/0001-0036$02.
00/0
THE JOURNALOF ORTHOPAEDIC AND SPORTSPHYSICAL
THERAPY
Copyright O by The University of Kansas
Lumbar Traction*
H. DUANE SAUNDERS, BS, PT
The aim of this article is to present and discuss: 1 )

types of lumbar traction; 2) effects of lumbar
traction; 3) indications and contraindications for
lumbar traction; 4 ) effective lumbar traction
techniques. There is a review of important points
that have been presented in earlier literature, as well
as the introduction of new ideas and concepts. A
portion of this article deals with the rationale-of using
lumbar traction for the treatment of herniated disc
and other lumbar spinal nerve root syndromes.
There is considerable discussion of poundages
necessary to achieve therapeutic results. Detailed
Downloaded from www.jospt.org at on January 30, 2018. For personal use only. No other uses without permission.
description of positioning is presented. The

importance of the use of proper equipment for
mechanical lumbar traction is stressed. That lumbar
traction can be a beneficial treatment for certain
musculoskeletal disorders is stressed, but that
effective treatment is not as easy and simple to
Copyright © 1979 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.
administer as it may seem.
Various forms of spinal traction have been

described, since the time of Hippocrates, for the
relief of pain. Much of the literature is incomplete
and seldom describes such things as the exact
techniques used, the body type and weight of
Journal of Orthopaedic & Sports Physical Therapy®
the subjects, the poundages used, or the dura-

tion of the treatments. Opinion varies as to indi-
cations, contraindications, poundages, and
techniques. Many physicians, therapists, and
patients recall the continuous or "bed" traction
that was used for many years with poor results.
All of this misunderstanding and confusion has
caused many physicians and therapists to be-
come disinterested in using spinal traction. How-
ever, when used correctly on appropriate con-
ditions, traction can be a very effective and ben-
eficial method of treatment."-14. l8
The word traction is a derivative of the Latin
"tractico", which means "a process of drawing
or pulling." Various authors have suggested the
word "distraction" as being more descriptive. If
the terminology "distraction" is used, the refer-
ence relates to the joint surfaces and suggests
that the joint surfaces move perpendicular to one
another. This is not always the case, as one can
From the Central Kansas Medical Center, Great Bend, KS 67530.

Reprinted by permission.
Summer 1979 LUMBAR TRACTION 37
see at the spinal segment. As traction is applied, Positional Traction
the movement produced at the segment is a
combination of distraction and gliding.'' This form of traction is applied by placing the
patient in various positions using pillows, blocks,
EFFECTS OF SPINAL TRACTION or sandbags to effect a longitudinal pull on the
spinal structures. It usually incorporates lateral
Correctly performed traction can cause the bending and is only affected to one side of the
following effects: 1) distraction or separation of spinal segment.
the vertebral bodies; 2) a combination of distrac-
tion and gliding of the facet joints; 3) tensing of INDICATIONS AND CONTRAINDICATIONS
the ligamentous structures of the spinal seg- OF SPINAL TRACTION
ment; 4 ) widening of the intervertebral foramen; Spinal traction has been used for treatment of
5) straightening of spinal curves; and 6) stretch- the following conditions: 1 ) spinal nerve root
ing of the spinal musculature. impingement: a) herniated disc; b ) ligament en-
croachment; c ) narrowing of the intervertebral
TYPES OF SPINAL TRACTION foramen; d ) osteophyte encroachment; e ) spinal
nerve root swelling; and f ) spondylolisthesis. 2)
Spinal traction can be classified into five cat-

joint hypomobility; 3) degenerative joint disease;
egories.
4 ) extrinsic muscle spasm and muscle guarding;
5) discogenic pain; 6) joint pain; and 7)compres-
Continuous Traction sion fracture.
Continuous spinal traction is applied for up to Spinal traction is indicated for the treatment of
several hours at a time. This long duration re- the herniated disc.=,l4 There is evidence that the
quires that only small amounts of weight be used. bulging protrusion of the disc can be reduced
It is generally believed that this type of traction and spinal nerve root compression symptoms
is ineffective in actually separating the spinal relieved when spinal traction is a ~ p l i e d .23
' ~Ma-
structures. In other words, the patient cannot thews has studied patients thought to have lum-
tolerate poundages great enough to cause sep- bar disc protrusion, by epidurography. Epidu-
aration of the vertebrae for that length of time. rography is a radiological technique for outlining
disc protrusions by injecting a water soluble
contrast medium into the epidural space. Using
Sustained Traction
sustained traction forces of 120 pounds, Ma-

This term denotes that a steady amount of thews was able to show that the protrusions were
traction is applied for periods from a few minutes flattened and that the contrast material was
up to % hr. This shorter duration is usually cou- drawn into the disc spaces. He also found that
pled with stronger poundage. This method is the situation was somewhat unstable, in that
most widely used in Europe and much of the partial reoccurence of the bulging defects reap-
literature describes various applications of sus- peared later.237 24
tained traction. Sustained traction is sometimes The inferences from these studies are that
referred to as static traction. traction can indeed separate lumbar vertebrae;
lead to a decreased pressure at the disc space
with a resulting suction force; and that material
Intermittent Mechanical Traction
can be drawn from the epidural space into the
This form of traction involves a mechanical disc space. Similarly, one may deduce that any
device with traction alternately applied and with- anatomical correction produced is unstable.
drawn every few seconds. This is probably the As with all conservative treatment approaches
most popular form of traction being used in the of the herniated disc, patient education and
United States. gradual, cautious return to activities is absolutely
necessary if the traction treatment is to be suc-
Manual Traction cessful. Once a lumbar herniation is reduced
and the spinal nerve root symptoms have been
Manual traction is usually applied for a few relieved, the patient may need the support of a
seconds duration or can be applied as a sudden, modified-Taylor, or chair-back brace. This brace
quick thrust. limits the patient's activities, especially forward
38 SAUNDERS Vol. 1 , No. 1
bending, and also relieves some of the compres- Mathews was able to demonstrate the movement
sion force on the disc, when the patient is stand- of contrast medium into the disc space. This
ing or sitting. decrease in pressure is only maintained for a
N a c h e m ~ o n ' swork
~ ~ on intradiscal pressures short time as the osmotic forces soon equalize
should be taken into account when educating pressure with that of the surrounding tissue.
the patient concerning unsafe positions and ac- When the pressure is equalized the "suction"
tivities for them while convalescing (see Scheme effect upon the herniation is lost. If this has
1). He found that sitting causes more intradiscal occurred and the patient is then released from
pressure than standing. Forward bending also traction the intradiscal pressure could, at least
increases intradiscal pressure and causes pos- theoretically, increase in relation to the sur-
terior movement of the nucleus pulposa." The rounding tissue. If this is the case, increased
patient should avoid these positions and activi- pain may appear after the treatment is com-
ties during early treatment of the herniated disc. pleted. We have not observed this adverse effect
Return to normal activities should be gradual and if treatment times are kept under 15 minutes for
only after the injured disc has had a chance to intermittent and under 10 minutes for sustained
heal and stabilize itself. If the patient is hospital- traction.
ized the first few days of treatment, he should be The poundages should be relatively high to
confined to bedrest, except for bathroom privi- cause separation of the spinal structures. One-
leges. Since sitting increases the intradiscal half of the patient's body weight is the minimum
pressure, the patient may need to be taken to force for lumbar spinal traction. Sustained trac-
and from physical therapy on a cart for the first tion is probably superior to intermittent, when
few days of treatment. He should then progress treating a herniated disc, although favorable re-
to walking to and from physical therapy, thus sults have been reported with both.
avoiding sitting postures until more stabilization Swelling and/or thickening of the ligamentum
has occurred. No absolute rules can be estab- flavum can cause encroachment upon the spinal
lished for the patient recovering from herniated nerve root in the intervertebral foramen. Traction
disc, but he should understand potentially harm- may be an effective treatment for this syndrome.
ful positions and activities. He should understand If the traction is of sufficient force to widen the
that progress and the return to activities will be intervertebral foramen it would allow the spinal
gradual. nerve root more space, perhaps relieving the
When treating a herniated disc with spinal impingement. This same rationale can be applied
traction the treatment time should be short. As in cases of the narrowed disc space and the
the disc space is widened, the intradiscal pres- resulting encroachment caused by the narrowed
sure is decreased in relation to its surroundings. intervertebral foramen.
This is a beneficial effect and is the reason Osteophyte encroachment of the nerve root is
Scheme 1 . lntradiscal pressures in various positions and activities (adopted from NachemsonZ5).
another cause of nerve root syndrome that can With this in mind, one might select a more spe-
sometimes be relieved by traction. This condition cific technique, but traction should not be over-
is more common in the cervical spine but does looked as a possible method of mobilization.
occur in the lumbar spine.
The argument is often raised that even though Degenerative Joint Disease
traction can cause a separation and widening of
the intervertebral foramen, the effect will only be Degenerative joint disease is often related to
temporary. It is true that the separation shown joint h y p ~ m o b i l i t y Many
. ~ ~ patients with degen-
on x-ray will at least partially disappear soon erative joint disease also have limited range of
after the traction has been discontinued. If a motion in the involved segments. Traction can
patient with a degenerative, narrow disc space be an effective method of restoring the move-
is given traction it will not restore that disc space ment of these segments; thus, at least theoreti-
to its original size and structure. What then cally, interrupting the degenerative process. It is
causes these patients to have relief with the certainly true that many of these patients expe-
traction treatments? We know that many people rience pain relief as mobility is restored to the
have narrowing of the disc space and interver- joints.
tebral foramen without signs and symptoms of
nerve root impingement. The same can be said Extrinsic Muscle Guarding & Spasm
of the presence of osteophytes that do not cause Traction is usually beneficial in reducing ex-
symptoms. There must be a very fine line be- trinsic muscle guarding and spasms, and may be
tween those cases that do and those that do not effectively used when these conditions are pres-
encroach upon the nerve root. Sometimes the ent. Intermittent traction is usually preferred over
traction treatment must mobilize or separate the sustained traction when it is used for mobilization
segment in such a way to relieve the impinge- of a hypomobile spinal segment or in the treat-
ment. ment of muscle guarding and muscle spasm.
Nerve root swelling or neuritis may also pro-
duce nerve root impingement signs and symp- Discogenic Pain
toms. If this is the case, spinal traction should
give relief, although rest and treatment with mo- Spinal pain of a discogenic nature may re-
dalities would probably be more appropriate. spond favorably to traction treatment. Theoreti-
Cyriax5 advocates spinal traction for relief of cally, pain that is of a discogenic nature is
spondylolisthesis, if nerve root encroachment caused by anatomical changes in the disc struc-
signs are present. Consideration should be given "
t ~ r e . ~ .Any modification or restoration of this
to the possibility of an unstable or hypermobile anatomy may produce favorable effects.
spondylolisthesis. In this case, traction would
probably aggravate the condition, rather than Joint Pain
allow relief. It is also common to see patients
with a herniated disc at the level above the Both K a l t e n b ~ r n and
' ~ Maitland*' report mo-
spondylolisthesis and care should be taken to bilization and traction within the normal range of
evaluate the patient correctly. Often the patient joint movement for relief of joint pain. One expla-
is given the label "spondylolisthesis" because nation of why small movements within normal
of the x-ray findings, when they are actually range of motion relieves pain is that it causes
suffering from a herniated disc at the level stimulation of the mechanoreceptors. The im-
above.2 pulses from these fast conducting sensory fibers
can "block" pain arising from slower conducting
Joint Hypomobility pain fibers.
Traction can be regarded as a form of mobili- Compression Fracture

zation, since it involves the passive movement of
joints by mechanical or manual means. Any con- Some patients with compression fractures
dition of joint stiffness or joint hypomobility may continue to have pain in the subacute stage and
respond favorably to traction. One argument even after the fracture is completely healed.
against using traction for mobilization is that it is Although traction is not considered routine treat-
nonspecific and affects several joints at one time. ment for a compression fracture, the patient who
continues to have pain beyond the subacute cause the patient to slide to the foot of the bed.
stage may respond remarkably well to traction ~ o t h e n b e r g , ~at' surgery, observed no change
treatments. Of course, many compression frac- in the disc or no separation between vertebrae
tures are in the thoracic spine where traction with traction weights of 25 pounds. Nowhere in
cannot be used effectively. the literature were we able to find any evidence
Contraindications for spinal traction include that traction weights of 'h of the patient's body
disease processes and other conditions for weight affected any change in the structures of
which movement is contraindicated. Acute the lumbar spine.
strains, sprains, and inflammations may be ag- How much force is necessary to affect struc-
gravated by traction. Traction given to patients tural changes in the lumbar spine? Hood and
with hypermobility of the spine may cause further Chrismani4 report favorable results with a series
strain. Some attention should be given to the of patients using 65-70 pounds of intermittent
patient with respiratory problems or patients who lumbar traction. Cyriax7 reported a visible sepa-
develop claustrophobia with traction, a s ~ o d i f i - ration with sustained traction of 120 pounds for
cations will need to be made. 15 minutes. Other studies report measurable
~ r h a r d "recommends a trial of normal traction separation in the lumbar spine at poundages
ranging from 80-200 pound^.'^^ 15. ''.23 Judov-
and compression tests to ascertain if a patient is

a suitable candidate for traction. He maintains ichi5 advocates a friction free force equal to '/2
that if manual traction causes no pain or gives of the patient's body weight as a minimum to
the patient relief, they are suitable candidates cause therapeutic effects in the lumbar spine.
for traction. If, however, traction aggravates the This does not mean that the first treatment has
patient's condition, they are not candidates for to be given at that poundage, nor does it mean
traction. The trial treatments of manual traction that the minimum amount necessary to cause a
should be given in varying degrees of flexion, measurable separation will always be enough to
extension, and lateral bending. The most com- achieve satisfactory results. It is important in
fortable position is more apt to be the most every case that the patient's reaction and the
therapeutic. results of the treatment be assessed with adjust-
ments being made until satisfactory results are
LUMBAR TRACTION TECHNIQUE achieved.
Research has been done concerning the
As previously mentioned, the disappointment poundages to effect damage to vertebral struc-
of continuous or "bed" traction has caused tures. The most often quoted is a study by Rainer
many physicians and physical therapists to lose using fresh cadavers. DeSeze and LevernieuxQ
interest in using any form of lumbar traction. reported that Rainer found a force of 440 pounds
Even some patients will be reluctant to have was necessary to produce a rupture of the dor-
"traction" treatment recalling the continuous sal-lumbar spine (T-11, T-12).
traction they may have had at an earlier time. Harrisi3 indicated that enormous traction
Any benefit accredited to this technique has forces were necessary to cause damage to the
probably been the result of the rest and immo- lumbar spine, and that the breaking load may be
bilization that the patient has had while undergo- as high as 880 pounds.
ing treatment.l4, "
The coefficient of friction of the human body
lying on a couch or mattress is 0.5. In other
words, a force equal to % of the patient's body
weight is required to move the body horizontally.
As one-half the body weight lies beneath L-3, a
force equal to % x 0.5 = '/4 of the body weight
is lost in overcoming friction. Therefore, that
amount of weight between '/4 and '/2 of the pa-
tient's body weight is all that can effectively
cause a traction force, if conventional bed trac-
tion techniques are applied. Any less than '/4 of
the patient's body weight will not be enough to
overcome friction, and any more than % will Fig. I. Split table for lumbar traction.
tient's thighs may support them better and help
them relax (Fig. 4).
Brodin' discusses varying the patient's leg
position or amount of lumbar flexion to focus the
tractive force to specific levels. He states that
traction occurs in the lower lumbar region when
there is little or no lumbar flexion and that the
tractive force is directed to the upper lumbar and
lower thoracic region when the knees are flexed
against the chest. Although Brodin's reasoning
may have some applications, flexing the lumbar
Fig. 2. A type of sustained lumbar traction.
As mentioned previously, it is the effective

traction force on the spine that is important and
any friction involved must be considered. A split-

table essentially eliminates friction (Fig. 1).
There are special techniques, such as the one
in Figure 2, that have proven beneficial. Such a
technique would involve heavier total poundages
than those using a split-table because of the

necessity of lifting % of the patient's body weight
off of the table.
The amount of force alone does not determine
the effectiveness of the traction treatment. The
comfort of the patient is of utmost importance. If
the patient is unable to relax with the treatment,
it will probably be ineffective. Evidence shows
that a narrowing of the intervertebral spaces can
occur with inability to relax.' For the patient to

relax, the treatment must not aggravate his/her
condition, and he/she must feel secure and well
supported. It may be beneficial to administer
modality treatments before the traction applica-
tion. Such treatment as ice, heat, ultrasound, or
massage is often effective.
The use of a heavy duty nonslip traction har- Fig. 3. Heavy duty lumbar traction harness.
ness is essential. If the patient does not feel
secure he or she will almost certainly remain
tense during the treatment. An effective, one size
fits all, heavy duty lumbar traction harness is
seen in Figure 3.
This harness is lined with a vinyl material that
causes it to adhere to the patient's skin, thus
eliminating the slipping that is common with cot-
ton-lined belts. Both the pelvic and thoracic pads
should be placed next to the patient's skin. If
clothing is left under the harness, it will be more
likely to allow slippage. Clothing can also take
some of the traction force if it is bound tightly
under both belts. Even something as simple as
a velcr0 strap pictured below, around the pa- Fig. 4. Velcro strap used to stabilize patient's thighs
spine to a point that the lumbar lordosis is re-

moved seems to be a more reasonable position.
It is the neutral or straight position of the spine
that offers the largest intervertebral foramen
opening for the spinal nerve root.21 Flexing be-
yond neutral causes the ligamentum flavum, and
other soft tissue to be pulled across the interver-
tebral foramen. Extension from neutral causes a
narrowing of the boney structure of the foramen.
One should remember that it is not only the
position of the legs and the rope angle to the
table that control the amount of lumbar flexion.
The position of the legs control hip flexion and Fig. 6. Prone lumbar traction with the correct amount of
has little effect on lumbar lordosis. Likewise, the spinal flexion.
rope angle to the table does not always effec-
tively control the amount of spinal flexion. The
choice of pelvic harness is probably the most vic harness. Prone traction can be especially
important determinent of the amount of spinal effective with the patient who has moderate to
flexion achieved. If the pelvic harness pulls from severe pain and/or muscle guarding. The patient
the sides only, it is possible to maintain consid- can be positioned prone for modality treatments
erable lumbar lordosis. For this reason a pelvic and the traction can follow without moving the
harness that pulls from the posterior is essential. patient. Another advantage of prone traction is
The knees and hips can be flexed moderately for that the therapist can palpate the interspinous
comfort, while the rope angle to the table should spaces to ascertain the amount of movement
remain relatively straight. This is especially true, that is taking place during the treatment (Fig. 6).
if heavier poundages are used. It should be noted As previously mentioned, some conditions,
that certain commercial traction tables are not such as herniated disc seem to respond better
recommended for heavy poundages unless a to sustained traction, while conditions such as
straight or 0" rope angle to the table is main- joint hypomobility and muscle guarding are usu-
tained (Fig. 5). ally treated more effectively with intermittent
Lumbar traction can be effectively adminis- traction. It is important to remember that the
tered in the prone position as well as supine. patient's comfort and his ability to relax with the
Patient comfort and the ability of the patient to treatment is the most important consideration
remain relaxed during the treatment are consid- when choosing between intermittent or sus-
ered when choosing which position to use. When tained technique.
using prone traction, the amount of lumbar flex- Some mechanical traction devices are rela-
ion can be controlled by pillows under the pelvis tively ineffective in administering sustained or
and, as mentioned above, using the correct pel- static traction because of the inability to take up
slack during the course of the treatment time. To
be effective it is essential that a mechanical
traction device continue to take up slack as the
patient relaxes.
The heavy duty lumbar traction harness de-
scribed earlier can also be used to administer
unilateral lumbar traction by simply coupling only
one side of the pelvic harness to the traction
source. It has been theorized that unilateral lum-
bar traction is superior to bilateral in cases that
involve unilateral pathology and/or a protective
scoliosis. Using this method, unilateral traction
can be administered either prone or supine (Fig.
7).
Fig. 5 . Supine lumbar traction with the correct amount of uses manual lumbar traction for treat-
spinal flexion. ment of the herniated disc. These techniques are
uO!lEJ€?dasIeJalel!un e s! pa44a a41 ' ~ n m o01 s! '(8'6!j)JuawleaJl ayl Jals!u!wpe o l
uO!l€?JT3daSJO u o ! l ~ eaql
~ l aJaqM au!ds a q l j o laAal 4 3 ! y ~U! uo!pa~!palqel~ojwo3lsow ayl pug 01
aq plnoys pue Jalawe!p u! s a ~ p u8!
aql l e p a ~ e l d pue u o ! l ~ ejo
~ la3ue~alols,lua!led ayl ,,lsal,, 01
-9 KlaleUJ!xo~ddeaq plnoys l l o ~a y l 'layuelq JO pasn aq osle ue3 uoil3e~lpw?u'Ja!l~eapauo!l
~oll!d palloJ e Jaho uo!l!sod 6u!Kl apis e U!lua!$ed -uaw st/ .uo!$ez!l!qow leu!ds 40 asodlnd aql J O ~
ayl 6u!3eld Kq pa!ldde s! uo!g3e~lleuo!l!sod pasn ale 1eq1sanb!uy~alu o ! l ~ eIenuew
~l sno!Jt?A
saq!~3sap,,uJoqual(ey 'Klle~ale(iunpapaJ!p aq
ue3 pue ' l s n ~ y uappns
l e y l ! pasn
~ saw!lawos
.(uojjoq) ~ U O pue
J ~ (doj) au!dns
Fig. 8. L u m b a r m a n u a l traction techniques.

Fig. 9. A, positional traction side b e n d only. 6, positional traction side b e n d and rotation
on the side opposite of the roll. The technique 2. Brown CR: Great Bend, Kansas (Personal Communication)
3. Chrisman D: A Study of the Results Following Rotatory Manipu-
can involve only sidebending or can also incor- lation in the Lumbar lntervertebral Disc Syndrome. J Bone Joint
porate rotation (Fig. 9). Surg. 46A:517-524. 1964
4. Crisp E: Discussion on the Treatment of Backache by Traction.
Proc Roy Soc Med 48:805. 1955
5. Cyriax J: The Treatment of Lumbar Disc Lesions. Brit Med J 2:
SUMMARY 1434, 1950
6. Cyriax J: Textbook of Orthopaedic Medicine, vol II, London.
Lumbar traction can be an effective method of Bailliere Tindell 8 Cassell, 1954
7. Cyriax J: Discussion on the Treatment of Backache by Traction.
treatment for a number of common musculo- Proc Roy Soc Med 48:808. 1955
skeletal disorders. Effective treatment is not as 8. Deets D, Hands K, Hopp S: Cervical Traction: A Comparison of
Sitting and Supine Positions. Phys Ther 57: 1977
easy and simple to administer as it may seem. 9. DeSeze S, Levernieux J: Les Tractions Vertebrales. Sem Hop
Many variations of technique exist and some of Paris 27:2075. 1951
10. Erhard R: Proceedings, International Federation of Orthopaedic
these techniques are of questionable value. The Manipulative Therapists. Edited by B Kent. Vail. Colorado. 1977
physical therapist who intends to treat patients 11. Farfan H: Proceedings, lnternational Federation of Orthopaedic
Manipulative Therapists. Edited by B Kent. Vail. Colorado, 1977
with spinal traction must become familiar with 12. Frazer E: The Use of Traction in Backache. Med J Aust 2:694.
the most effective techniques, and their appli- 1954
13. Harris R: Massage, Manipulation and Traction. New Haven, E
cation. Finally, one must not forget the impor- Licht. 1960
tance of the musculoskeletal evaluation, for if 14. Hood L. Chrisman D: Intermittent Pelvic Traction in the Treatment
of the Ruptured lntervertebral Disc. J Am Phys Ther Assoc 48:
the information gathered in the evaluation is in- 21 -30, 1968
correct, the treatment plan will have very little 15. Jodovich B: Lumbar Traction Therapy. JAMA, 159:549-550.
1955
chance of being effective. 16. Kaltenbom F: Proceedings, lnternational Federation of Ortho-
paedic Manipulative Therapists. Edited by B Kent. Vail. Colorado,
1977
REFERENCES: 17. Kapandji I: The Physiology of the Joints. Vol 3, Second Edition.
London Churchill Livingstone. 1974
1. Brodin H: Manuell Medicin och Manipulation. Lakartidningen 63: 18. Lawson G. Godfrey C: A Report on Studies of Spinal Traction.
1037-1 038. 1966 Med Serv J Can 14:762. 1958

19. Lehmann J. Brunner G: A Device for the Application of Heavy 24. Mathews J: The Effects of Spinal Traction. Physiotherapy 58:
Lumbar Traction; It's Mechanical Effects. Arch Phys Med 39: 64-66, 1972
696-700, 1958 25. Nachemson A: The Lumbar Spine: An Orthopaedic Challenge.
20. Maitland G: Vertebral Manipulation. Second Edition. London, Vol 1, 59-71 Spine. 1976
Butterworth and Co. Ltd. 1968 26. Paris S: Course Notes, The Spine. Atlanta, Atlanta Back Clinic
21. Maslow G. Rothman R: The Facet Joints: Another Look. Bull. NY 27. Parsons W, Cummings J: Mechanical Traction in the Lumbar
Acad Med 51 :1294-1311. 1975 Disc Syndrome. Can Med Assoc J 77:7-11. 1957
22. Masturzo A: Vertebral Traction for Sciatica. Rheumatism. 11:62. 28. Ranier J. Quoted by DeSeze S. Levernieux J: Les Tractions
1955 Vertebrales, Sem Hop Paris. 27:2075. 1951
23. Mathews J: Dynamic Discography: A Study of Lumbar Traction. 29. Rothenberg S: The Effect of Leg Traction on Ruptured Interver-
Ann Phys Med 9:275-279. 1968 tebral Discs. Surg Gynec Obstet 96565-566, 1953

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0000-0000/79/0001-0036$02.

The aim of this article is to present and discuss: 1 )

description of positioning is presented. The

administer as it may seem.

Various forms of spinal traction have been

the subjects, the poundages used, or the dura-

From the Central Kansas Medical Center, Great Bend, KS 67530.

Spinal traction can be classified into five cat-

sustained traction forces of 120 pounds, Ma-

Traction can be regarded as a form of mobili- Compression Fracture

and compression tests to ascertain if a patient is

Fig. 2. A type of sustained lumbar traction.

As mentioned previously, it is the effective

any friction involved must be considered. A split-

than those using a split-table because of the

occur with inability to relax.' For the patient to

spine to a point that the lumbar lordosis is re-

Fig. 8. L u m b a r m a n u a l traction techniques.

Summer 1979 LUMBAR TRACTION 45

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