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Spinal traction

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What is Spinal Traction?

Spinal Traction is a therapeutic technique that involves applying a pulling force (distraction force) to the spine, either the cervical (neck) or lumbar (low back) region (1, 2). This force can be applied manually by a therapist or mechanically using specialized devices or traction tables.

The primary goal is often to relieve pressure on spinal structures, including intervertebral discs, nerve roots, and facet joints, potentially alleviating pain and improving mobility (1).

Proposed Mechanisms of Action

Several mechanisms have been proposed for how spinal traction might exert its effects, although the exact physiological processes are not fully understood and may vary depending on the technique and patient factors (1, 2, 3):

  • Vertebral Separation / Distraction: Applying force may temporarily increase the space between vertebrae.
  • Disc Decompression: Theoretically, distraction might reduce pressure within the intervertebral disc, potentially encouraging retraction of disc bulges or herniations (though evidence for significant, lasting retraction is debated). Claims of active "rehydration" are likely oversimplified.
  • Foraminal Widening: Increasing the space between vertebrae could temporarily enlarge the intervertebral foramina, potentially reducing pressure on exiting nerve roots.
  • Facet Joint Gapping/Mobilization: Traction may stretch the joint capsule and mobilize the facet joints.
  • Soft Tissue Stretching: Elongation of muscles, ligaments, and tendons surrounding the spine.
  • Muscle Relaxation: Gentle, intermittent traction might help reduce protective muscle spasms through effects on stretch reflexes or by promoting relaxation.
  • Improved Circulation: Changes in pressure and movement might influence local blood flow.

Types of Spinal Traction

Traction can be classified in several ways (1, 2):

  • Manual vs. Mechanical:
    • Manual Traction: Force applied by the therapist's hands. Allows for precise control and feedback but is operator-dependent and difficult to sustain for long periods.
    • Mechanical Traction: Force applied via a motorized unit connected to harnesses or head halters. Allows for controlled, sustained, or intermittent forces over longer durations. Often performed on specialized traction tables.
    • Mechanical traction tables utilize harnesses and controlled forces for spinal decompression therapies (1).

    Mechanical traction can be applied to the cervical (neck) or lumbosacral (low back) spine using specific harnesses and table configurations (1).

  • Cervical vs. Lumbar: Targeted application to the neck or low back.
  • Application Mode:
    • Static/Sustained Traction: Continuous force applied for a set duration.
    • Intermittent Traction: Alternating periods of pulling force and relaxation.
  • Patient Position: Can be applied with the patient lying supine (on back) or prone (on stomach), or sometimes seated (for cervical traction).

Some modern traction tables incorporate features like heat or vibration, aiming to enhance muscle relaxation and patient comfort during the procedure, but these are additions to the core principle of applying distractive force.

Indications for Spinal Traction

Spinal traction is sometimes used as part of a physical therapy program for conditions such as (1, 2, 4):

  • Cervical or Lumbar Radiculopathy: Pain, numbness, or tingling radiating down the arm or leg due to nerve root compression (e.g., from a herniated disc or foraminal stenosis). Traction aims to potentially decompress the nerve root.
  • Degenerative Disc Disease (DDD): To possibly reduce pressure on discs and facet joints.
  • Herniated or Protruding Intervertebral Discs: With the theoretical goal of reducing intradiscal pressure or encouraging bulge retraction (effectiveness debated).
  • Facet Joint Dysfunction/Impingement: To gap or mobilize hypomobile facet joints.
  • Muscle Spasm: Gentle intermittent traction may help reduce muscle guarding and associated pain.
  • Generalized Neck or Low Back Pain/Stiffness: Sometimes used to improve mobility and reduce symptoms, although evidence is often weaker than for radiculopathy.

The decision to use traction depends on a thorough clinical assessment and is often combined with other therapies like exercise and manual therapy.

Contraindications and Precautions

Spinal traction is not appropriate for all patients. Key contraindications and precautions include (1, 2, 4):

  • Absolute Contraindications:
    • Spinal Instability (e.g., fracture, severe spondylolisthesis, post-surgical instability before fusion is solid)
    • Spinal Infection (e.g., Osteomyelitis, discitis)
    • Spinal Malignancy (Cancer)
    • Acute Spinal Injury (e.g., recent severe sprain/strain)
    • Cauda Equina Syndrome or Progressive Myelopathy
    • Severe Osteoporosis (risk of fracture)
    • Rheumatoid Arthritis involving spinal instability (especially C1-C2)
    • Conditions worsened by traction
    • Patient inability to tolerate the position or procedure
  • Relative Contraindications/Precautions:
    • Pregnancy (especially lumbar traction)
    • Hiatal Hernia, Abdominal Hernia (lumbar traction)
    • Claustrophobia
    • Temporomandibular Joint (TMJ) Dysfunction (cervical traction with halter)
    • Severe Respiratory or Cardiovascular Disease
    • Cognitive Impairment
    • Connective Tissue Disorders affecting ligamentous integrity
    • History of spinal surgery (requires careful consideration)

Procedure Overview

During mechanical traction:

  • The patient is positioned comfortably on the traction table (supine or prone for lumbar; supine or seated for cervical).
  • Harnesses are applied securely (pelvic and thoracic for lumbar; head halter for cervical).
  • The traction unit is set according to prescribed parameters: force (amount of pull, often based on body weight percentage for lumbar, or a set weight for cervical), duration (e.g., 10-20 minutes), mode (static or intermittent with specific hold/rest times), and angle of pull.
  • The force is applied gradually and monitored by the therapist.
  • The patient should feel a gentle pulling sensation, not significant pain. Any adverse symptoms should be reported immediately.

Scientific Evidence and Perspective

The effectiveness of spinal traction remains a topic of debate, with mixed evidence from clinical trials (1, 2, 4, 8):

  • Lumbar Traction: High-quality evidence supporting the effectiveness of lumbar traction (especially when used alone) for acute or chronic non-specific low back pain is generally lacking (8). Some studies suggest potential benefit when combined with other therapies for specific subgroups, such as those with radiculopathy (sciatica), but results are inconsistent (4).
  • Cervical Traction: There is some moderate evidence suggesting that intermittent cervical traction may provide short-term relief for neck pain, particularly when associated with radiculopathy, often when combined with exercise (4, 9). Evidence for long-term benefit is less clear.
  • Overall: Traction is often used based on clinical reasoning and patient response rather than strong, consistent evidence for many conditions. Its role is typically as an adjunct within a broader rehabilitation program including exercise and education (4).

Post-Traction Considerations

After a traction session:

  • The tension is released gradually.
  • Patients are typically advised to rest briefly before getting up slowly to avoid dizziness or potential symptom rebound.
  • Avoiding sudden movements, heavy lifting, or strenuous activity immediately after the session is generally recommended to allow tissues to adapt.
  • Following up with prescribed exercises or postural advice is important.

Differential Diagnosis

Before considering traction for neck or back pain, it's crucial to rule out conditions where it might be ineffective or contraindicated:

Pain Area Conditions Requiring Different/Urgent Management
Low Back +/- Leg Pain Cauda Equina Syndrome, Spinal Infection, Spinal Tumor, Unstable Fracture, Severe Osteoporosis, Inflammatory Spondyloarthropathy, Non-Spinal Causes (AAA, Kidney Stones, etc.).
Neck +/- Arm Pain Cervical Myelopathy, Spinal Infection/Tumor, Unstable Fracture/Ligament Injury, Severe Osteoporosis, Vascular Issues (Dissection), Meningitis, Inflammatory Arthritis Flare.

References

  1. Michlovitz SL, Bellew JW, Nolan TP Jr. Modalities for Therapeutic Intervention. 6th ed. F.A. Davis Company; 2016. (Chapter on Spinal Traction)
  2. Prentice WE. Therapeutic Modalities in Rehabilitation. 5th ed. McGraw-Hill Education; 2016. (Chapter on Spinal Traction)
  3. Krause M, Refshauge KM, Dessen M, Boland R. Lumbar spine traction: evaluation of effects and recommended application for low back pain. Man Ther. 2000;5(2):72-81. doi:10.1054/math.1999.0221 (Review of mechanisms/effects)
  4. Wong JJ, Côté P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain. 2017;21(2):201-216. doi:10.1002/ejp.931 (Addresses traction for LBP)
  5. Thoomes EJ, Scholten-Peeters GGM, Koes BW, Falla D, Verhagen AP. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013;29(12):1073-1086. doi:10.1097/AJP.0b013e31828441fb (Includes traction for cervical radiculopathy)
  6. Saunders HD, Saunders R. Evaluation, Treatment and Prevention of Musculoskeletal Disorders. Vol 1: Spine. 4th ed. Saunders Group; 2004. (Classic text on traction techniques)
  7. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34. doi:10.2519/jospt.2008.0303
  8. Clarke JA, van Tulder MW, Blomberg SE, et al. Traction for low-back pain with or without sciatica. Cochrane Database Syst Rev. 2007;(2):CD003010. doi:10.1002/14651858.CD003010.pub4 (Cochrane review on lumbar traction)
  9. Graham N, Gross A, Goldsmith C, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008;(3):CD006408. doi:10.1002/14651858.CD006408.pub2 (Cochrane review on cervical traction)