Traction is a conservative treatment for neck and low back pain. During treatment, the following happens:
- Intervertebral spaces are widened and the foramina (tunnels or holes), through which nerve roots pass, are widened, too.
- Protruded discs are reduced by suction of negative pressure on disc.
- For most patients, the associated muscle stretch can relieve stress and relax the muscle. However, for others, the muscles may tighten up more, depending on the individual. So it is important to closely observe the effects on the first trial.
- Traction treatment often immediately removes symptoms of radiating pains with numbness in the arms or legs.
Neck Traction (Cervical Traction)
Cervical traction can be administered by various techniques ranging from supine, manual (by a physical therapist) or mechanical traction to seated cervical traction using a motorized device or an over-the-door pulley support with attached weights.
Symptom relief is often achieved after 15 to 20 minutes. Over-the-door traction should not use more than 20 pounds of force. Pneumatic cervical traction devices (e.g., Pronex or the Hometrac) were developed to deliver cervical traction in the home comparable to forces applied by a physical therapist.
Cervical tracton has been used successfully by many therapists to help eliminate neck pain associated with herniated discs. A longitudinal cohort study of 26 consecutive patients with cervical herniated discs and radiculopathy were followed for more than one year (1996) twenty-four of the 26 patients were successfully managed with aggressive nonsurgical treatment. The 24 patients returned to full time work duties. Part of the treatment was cervical traction provided in a clinic followed by home cervical traction for all patients.
The researchers concluded that a systematically applied nonsurgical treatment for a clearly defined group of patients with symptomatic cervical disc herniation had outcomes equivalent to results of similar patients treated surgically. The nonsurgical treatment included traction for all patients.
Reference: Saal JS, et.al. Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine 21: 1877-1883, 1996.
Traction for the Low Back (Lumbar Spine)
Twenty-five kilograms of traction force generally affect the posterior aspect of the vertebrae where there are nerve roots. When the traction force of 50kg weight or more is used, anterior and posterior aspects of the vertebral gaps are widened. Fifteen to twenty minutes of lumbar traction will widen about 90% of the vertebral space.
Lumbar traction can be very effective for patients who have a disc herniation and/or radicular signs A study in 1996 used magnetic resonance imaging (MRI) to evaluate morphologic changes of lumbar herniated nucleus pulposus (centre of disc) as a result of conservative treatment of 77 patients All the patients had a heriated disc with associated symptoms of unilateral lower extremity pain, muscle weakness and positive neural tension signs. The patients were treated with rest, pain relieving medications and pelvic traction at an outpatient clinic. None of the patients received epidural corticosterioid inections. All patients were evaluated more than twice using the same MRI scanner. The researchers accounte for intra and inter-observer reliability regarding the patients’ clinical evaluations and interpretations of the MRI scans.
In 64 of the patients the disc herniation was reduced on MRI to a significantly statistical difference. Thirteen patients had no changes on MRI despite clinical improvement Of the 77 patients, 62 had excellent(radicular pain disappeared, and neurological deficits showed improvement) and good (radicular pain decreased and neurological deficits improved) clinical outcomes.
The results of this study support the use of pelvic traction for the treatment of lumbar disc herniation with radiculopathy.
When would Lumbar Traction be beneficial?
Traction is most beneficial for herniated discs, any condition in which mobilization and stretching of soft tissue is desired and in any condition in which opening the neural foramen is desired.
Many studies have produced evidence that spinal traction can reduce disc protrusion and can relieve spinal nerve root compression symptoms. Also, some studies have suggested a suction effect caused by a decrease in intradiscal pressure due to the distraction force.
Traction with the McKenzie Approach
The McKenzie approach is often used with considerable success and entails postural correction and lumbar extension exercises. Some patients, however, experience a peripheralization of their symptoms when they try the posture corrction/extension exercise protocol. These patients are all too often operated on because “conervative care” has failed. Lumbar traction, if administered correctly, will often allow the patient to progress with the McKenzie program.
Clinical lumbar traction may need to be performed daily initially, due to the temporary effect of the traction. The patient can be weaned of of traction as the condition improves and he/she is able to tolerate more exercise. For chronic conditions, ongoing traction may be beneficial to manage symptoms. A major benefit of prescribing home lumbar traction is the fact that multiple treatments can be done in a single day. Many patients benefit from up to 4 sessions daily during acute and subacute phases of treatment. For chronic conditions where the patient is working, before and after work treatments are desirable. Once the patietns’s symptoms are under control, many choose to use it only as needed.