TRACTION

Traction

 Traction is a mechanical force applied to the body in

a way that separates the joint surfaces and elongates
surrounding soft tissue.
 Traction can be applied manually or mechanically
 Also can be applied by using body weight and gravity
to apply a force.
 It can be applied to spinal and peripheral joints.
 Principles

 Patient must be placed in correct body alignment in

center of bed to maintain line of pull.
 Indications for the use of spinal traction

 Disc bulge or herniation.

 Nerve root impingement.
 Joint hypo mobility.
 Subacute joint inflammation.
 Paraspinal muscle spasm.
Contraindications for the use of spinal traction

 Where motion is contraindicated.

 Acute injury or inflammation.
 Joint hypermobility or instability.
 Peripheralisation of symptoms with traction.
 Uncontrolled hypertension.
 Structural disease or condition affecting the spine.
 Displaced annular fragment.
 Inability to tolerate prone or supine position.
 Disorientation.
 Effects of spinal traction

 Joint distraction.
 Reduction of disc protrusion.
 Soft tissue stretching.
 Muscle relaxation.
 Joint mobilization.
 Types of spinal traction

 Manual traction
 Mechanical traction
 Positional traction
 Self traction
 Gravitational traction
 Auto traction
 Manual traction

 It is the application of force by therapist in the

direction of distracting the joint.
 It can be used for the cervical and lumbar spine.
 Applied to peripheral joints which, Improve a joint
mobility.
 Reduce pain & muscle spasm.
 Improving circulation.
 Positional traction

 It involves prolonged placement of the patient in a

position that places tension on only one side of the
lumbar spine.
 The low load associated with this form of traction is
unlikely to cause joint distraction, it may effectively
decrease muscle spasm, stretch soft tissue, or exert a
centripetal force on the disc by spinal elongation
without joint surface separation.
 It may be used to treat unilateral symptoms
originating from lumbar spine.
 Self traction

 It is a form of traction that uses gravity and the

weight of the patient’s body or force exerted by the
patient, to exert a distractive force on the spine.
 In this minimal or no equipment is needed
 Easy for the patient to perform.
 Gravitational traction

 Traction effect is produced by gravity & pts own

body wt.
 Method: secure trunk to top of table and table is
tilted to vertical position. free wt. of legs and hips
exerts a traction on lumbar spine.
 Autotraction

 Involve use of a special traction bench composed of

two sections that can be individually angulated &
rotated.
 Pt applies traction by pulling with own arms.
 Mechanical traction

 Mechanical traction can be applied to the lumbar or

cervical spine.
 A variety of belts and halters as well as patient
treatment position, can be used to apply traction to
particular areas of spine and to focus the effect on
different segment or structures.
 Types: Electrical traction unit
Over the door cervical traction
Other home traction
 Advantages of mechanical traction

 Force and time well controlled

 Once applied, does not require the clinician to be
with the patient throughout treatment.
 Electrical mechanical traction unit allow the
application of static or intermittent traction.
 Static weighted device such as over the door cervical
traction are inexpensive and convenient for
independent use by the patient at home.
Disadvantages of mechanical traction

 Expensive electrical mechanical devices.

 Time consuming to set up
 Lack of patient control or participation
 Restriction by belts or halter poorly tolerate by some
patient.
 Mobilize broad region of the spine rather than
individual spinal segment
 Potentially including hypermobility in normal or
hypermobile joints.
 Continuous traction

 Light weight applied for prolonged periods of time.

 Used to align & stabilize adjacent body parts in case
of fracture or dislocation.
 Eg; Halo device used in fracture of cervical spine.
 STATIC TRACTION
 Greater traction force (5-15lb) for shorter period of
time(few min-30min).
 INTERMITTENT TRACTION
 Different traction forces alternately applied &
released(hold or rest).
 Moderate traction force 30-60sec ‘hold time’.
 Less traction force 10-20sec ‘rest period’.
 Commonly used for dysfunction & degenerative disc
disease.
 Lumbar traction

 Method used to apply traction to the lumbar spine.

 MODE: sustained / intermittent.
 Disc protrusions: sustained traction/with longer
hold rest periods of intermittent traction 60 sec hold;
20 sec rest.
 Joint dysfunction & degenerative disc disease usually
respond to shorter hold rest periods of intermittent
traction(30 sec hold; 10 sec rest).
 Relax the patients.
 Determine optimal patient position.
 Apply appropriate belt or halter.
 Connect the belt or halter to the traction device.
 Pt should be provided with a hand held control to
stop the traction device.
 Set the appropriate traction parameters.
 Start traction.
Parameters:
 Poundage: The traction force to the lumbar spine
should start at between 13 and 20 kg ( 30 & 45 Ib)
 For joint distraction: 50 % of the body weight
 Decreased muscle spasm: 25% of the body weight
 Disc problem or stretch of soft tissue: 25% of body
weight
 Traction force to the lumbar spine should not exceed
50% of the body weight
 Pt position: Prone or supine, amount of flexion or
extension used depend on the disorder being tested.
 Duration: Spinal traction is applied in 20 mints
increments.
 Joint distraction , should be treated using a 1 to 1
ratio of hold and rest( 15 sec hold; 15 sec rest).
 Disc herniation should be treated with a longer hold
and rest cycle(60 sec hold ; 20 sec rest).
 Treatment frequency: Daily treatment is
suggested for the first 3 days followed by 3 Times
weekly for 2-3 weeks.
 If traction is to be helpful some relief should be seen
within the first 3-5 treatments.
 Cervical traction

 Relax the patients.

 Determine optimal patient position.
 Apply appropriate belt or halter.
 Connect the belt or halter to the traction device.
 Pt should be provided with a hand held control to
stop the traction device.
 Set the appropriate traction parameters.
 Start traction.
Parameters
 Poundage: Begin with traction force between 8- 10
pounds.
 For joint distraction : 7% of the body weight should
be applied.
 Decreased muscle spasm: 5- 7 kg should be applied
 Disc problem : 5- 7 kg should be applied
 Max force should not exceed 35 pound
 Pt position: Pt usually in a supine position.
 If cervical spine in a neutral or extended position
max traction effect will be on anterior intervertebral
structure.
 If cervical traction in a forward bend or flexed
position max traction force will be posterior
structures.
 In case of seated position, position of cervical spine
can be modified by altering the position of chair and
by turning the pt either to face toward or away from
the apparatus.
 Duration: For cervical traction is 20 mnts.
 For joint distraction, , should be treated using a 1 to 1
ratio of hold and rest( 15 sec hold; 15 sec rest).
 Disc herniation should be treated with a longer hold
and rest cycle(60 sec hold ; 20 sec rest).
 Frequency: Same as for lumbar traction
 Evidences
 Conventional physical therapy with lumbar traction; Clinical
evaluation and magnetic resonance imaging for lumbar disc
herniation
Kamanli A, Karaca-Acet G , Kaya A, Koc M, Yildirim H . 2010
Objective: This study measures and compares the outcome of
conservative physical therapy with traction, by using magnetic resonance
imaging and clinical parameters in patients presenting with low back pain
caused by lumbar disc herniation.
Methods: A total of 26 patients with LDH (14F, 12M with mean aged 37
±11) were enrolled in this study and15 sessions (per day on 3 weeks) of
physical therapy were applied.
Outcome measurs visual analogue scale, functional disability by HAQ,
Roland Disability Questionnaire, and Modified Oswestry Disability
Questionnaire were assessed.
Results: All patients completed the therapy session. There were
significant reductions in pain, sleeping disturbances, patient and
physician global assessment and disability scores, and significant
increases in lumbar movements between baseline and follow-up periods.
There were significant reductions of size of the herniated mass in five
patients, and significant increase in 3 patients on magnetic resonance
imaging after treatment, but no differences in other patients.
Conclusions: This study showed that conventional physical therapies
with lumbar traction were effective in the treatment of patient with
subacute LDH.
 Intermittent Cervical Traction and Thoracic Manipulation for
Management of Mild Cervical Compressive Myelopathy
Attributed to Cervical Herniated Disc: A Case Series
David A. Browder, PT, MS, OCS Richard E. Erhard, PT, DC, FAAOMPT
Sara R. Piva, PT, MS, OCS, FAAOMPT
2004 Journal of Orthopaedic & Sports Physical Therapy
Objective: To describe the management of 7 patients with grade 1
cervical compressive myelopathy attributed to herniated disc using
intermittent cervical traction and manipulation of the thoracic spine.
Methods and Measures: Seven women with neck pain, 35 to 45 years of
age, were identified as having signs and symptoms consistent with grade
1 cervical compressive myelopathy. All patients were treated with
intermittent cervical traction and thoracic manipulation for a median of 9
sessions (range, 2-12 sessions) over a median of 56 days .
Outcome measures: Numeric Pain Rating Scale and Functional Rating
Index scores served as the outcome measures.
Results: The median decrease in pain scores was 5 from a baseline of 6
and median improvement in Functional Rating Index scores was 26%
from a baseline of 44% .Dizziness was eliminated in 3 out of 4 patients
and chronic headache symptoms were improved in 3 out of 3 patients.
There were no adverse events or outcomes.
Conclusions: Intermittent cervical traction and manipulation of the
thoracic spine seem useful for the reduction of pain scores and level of
disability in patients with mild cervical compressive myelopathy attributed
to herniated disc.
 References

 Physical agents in rehabilitation 4th edition -

Michelle H Cameron.
 Therapeutic Modalities – The art and science 2nd
edition – Kenneth L knight & David O Drooper
 Manual Physical Therapy of the Spine 2nd edition –
Kenneth A Olson
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