TRACTION

Defn:-
Traction is the “process of drawing or pulling”. When traction is used to
draw or pull on the spinal then it is called “spinal traction”
Traction is a technique that applies a longitudinal force to the spine and the
associated structures, distracting the vertebrae.
The distracting force can be administered by gravity (weight or body
weight) a machine, the clinician or by the position of the patients body.
Mechanical force can be applied with the continuous or the intermittent
tension by several different methods.
The force of traction can occur in one plane or multiple planes (poly axial
traction)
Cervical and lumbar traction are applications of a force that separates the
vertebra and opens the intervertebral space in the treated area.
The increased space will reduces the pressure on the IV disc & the Spinal
root, thus it elongates the soft tissue open facet joints

Contents
1) Effects of spinal traction
2) Definition of the types of traction
3)
a) Indications
b) Limitations
c) Contraindications and precautions for the use of spinal traction
4) Safe rules & procedures for mechanical and manual traction techniques
5) Apply basic mechanical, positional and manual traction techniques to the
spine.

Effect of spinal traction:-

1) Mechanical elongation of the spine

 Stretches the spinal muscles.
 Widens the intervertebral foramina or relieving pressure on the
intervertebral discs and assisting in the reabsorption the nucleus
pulposus
 Relieves pressure on the spinal nerve roots caused by narrowing of
the intervertebral foramina.
2) Zygapophyseal (facet) joint mobilization :-
  Effects of mobilization from various positions and forces on the
spine.
i. Sliding / traction of the facet surfaces.
ii. Distraction / a separation of the facet surfaces.
iii. Compression / approximation of the facet surfaces.
3) Muscle relaxation
4) Reduction of pain

Principles of Traction
The effects and effectiveness of the traction is related to the
1. Position of the body part (Spinal position)
2. Position of the patient(Lying in supine, sitting)
3. Angle of pull
The angle of pull of the traction force affects the amount of flexion
of the spine.
Angle of applied traction is related to the long axis of the vertebral
column.
In the cervical spine, the angle of pull creating the greatest
posterior elongation is at 35o

4. Amount of force:-
The effective force is influenced by the body position, weight of the
treatment table, method of traction is used, amount of patient
relaxation, the equipment it self.

Generally for vertebral separation:-

a. In the cervical spine = 7% of the total body weight separates the
vertebrae.
The greatest amount of separation occurs during the first few
minutes of treatment at a given force.
b. In the lumbar spine:- a minimum traction free force of the half of
the body weight is necessary for mechanical separation.
5. Comfort and Relaxation
6. Duration and frequency of treatment
 Types of application of traction

Static / constant Intermittent traction

traction

The force is
Continuous / Sustained alternatively applied
prolonged traction and released at
traction frequency interval.
Usually in rhythmic
A static traction A static pattern
in wich the traction in
force is wich the force
maintained for is maintained
several hours to from a few
several days. minutes up to
Often applied in a 11/2 hour
bed for with
immobilization. maximum
load

Modes of application

Mechanical Manual Positional

Traction Traction Traction

Through the position Through

Continuous Intermittent and handling the positioning a
physiotherapist’s sustained force on
Objective applies the traction specific segments
indication for force to the desired of the spinal
measuring spinal segment. column can be
the amount (Subjective only) obtained.
of force It may be
applied. asymmetric /
symmetric
Indication for spinal traction

1. Spinal nerve root impingement

a. From a heamiated nucleus pulposus.
b. From spinal or foraminal stenosis caused by ligament encroachment,
spondylosis, oedema, spondylolisthesis.
2. Hypo mobility of the joints from dysfunction or degenerative changes.
3. Joint pain from symptomatic facet joint.
a. Acute stage Gentle traction

Stimulates mechanoreceptor

(No stretch, no movement) Block pain perception at the spinal level

4. Muscle spasm / auarding
5. Meniscoid blocking
6. Disko genic pain post compression fracture,

Traction, immobilization and bed rest were once the common treatments of
choice for the spinal and back pain.
Traction with active exercises are effective in recent trends.

Limitations
1. The effect of the vertebral separation is temporary.
Although, the temporary relief may be enough to help break into a reflex
pain cycle.
2. No consistent protocols exist:
Rationale is hypothetical with inconsistent clinical results.
Personal experience and the patient’s response dictate method, force,
duration and the frequency of treatment.
3. The longitudinal traction force is non specific as to vertebral level. It affects
the entire region.

Contra indications:-
1. Any spinal condition or disease process in which ‘movement’ is
contraindicated.
Ex.:- acute spinal injury, vertebral fracture, dislocation, subluxation
2. Unstable spine.
3. Disease affecting the vertebrae or the spinal cord.
Ex.:- Neoplasm (cancer)/ tumors / meningitis
4. Acute strains, sprains and inflammation or any painful symptoms
aggravated by initial traction treatments.
 5. Stretch force to areas of ‘spinal hyper mobility’.
6. Rheumatoid arthritis of the cervical spine.
7. Any spinal condition in which structural integrity is compressed, such as
spinal malignancy, osteoporosis & infection.
8. Extruded disc fragmentation.
9. Spinal cord compression.
10. Positive vertebrae artery test (for cervical traction).
11. Conditions in which vertebral flexion or extension is contraindicated.
12. Pregnancy, uncontrolled hypertension, aortic aneurysm, severe
hemorrhoids, cardiovascular diseases, abdominal hernia, hiatus hernia are
contraindicated for lumbar region.

Precautions:-
1. Mandibular occipital harness should not be used if suffering from temporo-
mandibular joint pathology.
2. Only sustained/continuous traction should be used when motion is contra
indicated.
3. Some of the condition listed under contra indication may benefit from
carefully applied traction.
When mechanical traction is too forceful for the condition manual or
positional traction may be appropriate alternatives.
4. The patient must be closely monitored through out the treatment and the
treatment should be immediately discontinued.
If the symptoms increase or if pain or Paraesthesia is experienced.
5. Excessive duration / traction weight can cause thrombosis of the internal
jugular vein.
6. Low tension (force) should be used when hyper mobility is present. (check
with a physician prior to treatment)

Treatment duration:-
 For Facet joint pathology: 25 min.
 Degenerative disc disease: 10 min.
 Disc protrusion: 8 to 10 min.
 Muscle spasm: 20 min.
(Approximate treatment duration.)

Cervical traction can be used for:

 Radicular pain.
 Facet joint pathology limiting rang of motion including hypomobile
facet joint.
 Muscle spasm caused by nerve root impingement.
 Degenerative disc diseases.