TRACTION

Cervical Traction

Cervical
Harness
Lumbar Traction
Traction Table

Stainless
Steel
Spreader Bar
 Traction Harness
Cervical Harness

Lumbar
Harness
• Traction - the application of a mechanical
force to the body in a way that separates,
or attempts to separate, the joint surfaces
and elongate the surrounding soft tissues.
• Can be applied manually by a clinician or
mechanically by a machine.
• Can be applied by the patient using body
weight and the force of gravity to exert a
force.
• Can be applied to the spinal or peripheral
joints.
Lumbar Spinal Stenosis
Causes, Narrowing
Lumbar Spinal Stenosis
Causes, Spinal
Instability
Lumbar Spinal Stenosis
Causes, Herniation
 Effects of Spinal Traction
1.Joint distraction
2.Reduction of disc protrusion
3.Soft tissue stretching
4.Muscle relaxation
5.Joint mobilization
6.Patient immobilization
 All of these effects may reduce pain
associated with spinal dysfunction.
 Joint Distraction
• defined as the separation of two articular
surfaces perpendicular to the plane of the
articulation
• distraction of the spinal apophyseal
joints may prove beneficial for the patient
who has signs & symptoms related to
loading of these joints or compression of
the spinal nerve roots as they pass
through the intervertebral foramina
• reduces compression on the joint surfaces &
widens the IV foramina, potentially reducing
pressure on articular surfaces, intraarticular
structures or the spinal nerve roots
• may reduce pain originating from joint injury
or inflammation or from nerve root
compression
• for distraction to occur, the force applied
must be great enough to cause sufficient
elongation of the soft tissues surrounding the
joint to allow the joint surfaces to separate
• smaller amounts of force will increase
the tension on, or elongate the soft
tissues of, the spine without separating
the joint surfaces
• the amount of force required to distract
the spinal joints varies with the location
& health of the joints
• in general, larger lumbar joints, which
have more & tougher surrounding soft
tissues, require more force to achieve
• distraction of the lumbar apophyseal joints
require a force equal to 50% of TBW, & a
force equal to approx. 7% of TBW is sufficient
to distract the cervical vertebrae

Reduction of Disc Protrusion

• accdg. to Cyriax, traction is the treatment of
choice for small nuclear protrusion
• lumbar traction using a force of 27 - 55 kg
(60 – 120 lb), can reduce disc prolapse,
cause retraction of herniated discal material,
& result in clinical improvement
 Soft Tissue Stretching
• elongation of the spine & increases the
distance between the vertebral bodies & the
facet joint surfaces due to increased length of
the soft tissues in the area such as muscles,
tendons, ligaments & discs
• moderate-load, prolonged force
• clinical benefits: spinal joint distraction or
reduction of disc protrusion, increase spinal
ROM, and decrease pressure on the facet joint
surfaces, discs & intervertebral nerve roots
 Muscle Relaxation
• paraspinal muscles
• pain reduction due to reduced pressure on
pain-sensitive structures or gating of pain
transmission by stimulation of
mechanoreceptors by the oscillatory
movements produced by intermittent traction
• static traction – depression in monosynaptic
response
• intermittent traction – stimulation of GTO
(inhibition of alpha motor neuron firing)
 Joint Mobilization
• high-force traction due to stretching of
the surrounding soft tissue structures

Patient Immobilization
• very low-load, prolonged static
traction, using 4.5 – 9 kg (10 – 20 lb)
applied for long periods of hours to
days
 Clinical Indications for the
Use of Spinal Traction
 Presence of back or neck pain, with or
without radiating symptoms due to the
following:
1.Disc bulge or herniation
2.Nerve root impingement
3.Joint hypomobility
4.Subacute joint inflammation
5.Paraspinal muscle spasm
 Contraindications
 when traction is first applied, it should be
applied in a less aggressive manner, using
a small amount of force, & the patient’s
response to treatment should be closely
monitored
 if the patient’s condition worsens in
response to traction, with symptoms
becoming more severe, peripheralization,
increasing in distribution, or progressing to
other domains (from pain to numbness or
 If patient’s signs or symptoms do not
improve within 2 or 3 treatments,
treatment approach should also be re-
evaluated & changed or referred the
patient to a physician for further
evaluation

1.Where motion is C/I (unstable fracture,

cord compression, shortly after spinal
surgery)
3. Joint hypermobility or instability (recent
fracture, joint dislocation, or surgery; old
injury, high relaxin levels during pregnancy
& lactation, poor posture or congenital
ligament laxity; joint hypermobility or
instability in C1-C2 articulations among RA,
Down syndrome, & Marfan’s syndrome due
to degeneration of the transverse atlantar
ligament)
4. Peripheralization of symptoms with traction
(worsening of nerve function & increasing
 Precautions
1. Structural diseases or conditions affecting the
spine (tumor, infection, RA, osteoporosis or
prolonged systemic steroid use)
2. When pressure of the belts may be hazardous
(pregnancy, hiatal hernia, vascular compromise,
osteoporosis)
3. Displacement of annular fragment
4. Medial disc protrusion (increase impingement of
the disc on the nerve root)
5. Severe pain fully relieved by traction (complete
nerve block)
6.Claustrophobia (psychological aversion
to traction)
7.Patients who cannot tolerate the prone
of supine position
8.Disorientation
9.TMJ problems (for cervical traction)
10.Dentures
 Patient Recommendations
and Instructions
• Instruct the patient to avoid sneezing or
coughing while on full traction because these
activities increase intraabdominal pressure &
can thus increase intradiscal pressure.
• Patient should empty first the bladder & not
to have a heavy meal before lumbar traction
since the constriction of the pelvic belts may
cause discomfort on a full bladder or
stomach.
• It is generally recommended that traction
force be kept low for the initial treatment
& then be gradually increased until
maximum benefit is obtained.
• Specific recommendations for the amount
of traction force to be used for different
regions of the spine & different spinal
conditions.
 Application Techniques
1.Using electric & weighted
mechanical devices
2.Self-traction
3.Positional traction
4.Manual traction
5.Inversion techniques
6.Auto-traction
• When selecting the type of spinal
traction, patient position, traction force,
and duration & frequency of treatment to
be used, the effects of these different
parameters of treatment, the nature of
the patient’s problem, and the patient’s
response to prior treatments should be
considered.
 A. Inversion traction
• it is applied by placing the patient in a device that
requires a head-down position, uses the weight of
the patient’s upper body to apply traction to the
lumbar spine
• this type of traction could increase the risk of a CV
accident or MI in the patient with uncontrolled HPN

B. Auto-traction
• a form of self-traction that requires the use of a
purpose-built table with sections that can be
moved apart by the patient during treatment
 C. Mechanical traction
• it can be applied to the lumbar or cervical
spine using either static or intermittent
traction
• Static traction – the same amount of
force is applied throughout the treatment
session.
• Intermittent traction – the traction
force alternates between two set points
every few seconds throughout the
treatment session. The force is held at a
 Mechanical LUMBAR Traction Procedure:
1. Select the appropriate mechanical traction
device.
 The choice depends on the amount of force to
be applied, whether static or intermittent
traction, & the setting in which the treatment
will be applied.
2. Determine optimal patient position.
 Try to achieve a comfortable position that
allows muscle relaxation while maximizing the
separation between the involved structures.
 The relative degree of flexion or
extension of the spine during traction
determines which surfaces are most
effectively separated.
a. Flexed position results in greater
separation of the posterior structures
including the facet joints & IV foramina
b. Neutral or extended position results in
greater separation of the anterior
structures including the disc spaces
a. Prone – symptoms of discal origin with the
lumbar spine in neutral or extended position. It
also localizes the force of the traction to the
lower lumbar segments.
b. Supine – symptoms due to facet joint dysfunction
with the hips flexed. It localizes the traction force
to the upper lumbar & lower thoracic segments.

 Patient should lie on a split table with the area of

the spine to be distracted positioned over the
split, & if supine, with the LE supported on a
suitable stool.
 Supine Position- tends to increase lumbar
flexion
 Flexing hips from 45 to 60 increases
laxity in L5-S1 segments
 Flexing hips from 60 to 75 increases
laxity in L4-L5 segments
 Flexing hips from 75 to 90 increases
laxity in L3-L4 segments
 Flexing hips to 90 increases posterior
intervertebral space
Prone Position
 Used when excessive flexion of lumbar
spine & pelvis or lying supine causes pain
or increases peripheral symptoms.
 Anterior angle of pull - increases amount of
lumbar lordosis
 Posterior angle of pull - increases lumbar
kyphosis
 Too much flexion can impinge on the
posterior spinal ligaments

3. Apply the appropriate belts or halter.

 Heavy-duty non-slip thoracic (aligned approx.
with the xiphoid) & pelvic belts (superior to the
iliac crests or superior edge of sacrum if prone)
4. Connect the belts or halter to the traction
device.
5. Set the appropriate traction parameters.
Recommended Parameters for the
Application Force
Area of the Spine of Spinal Traction
Hold/Relax Total
& Goals of Times Traction
Treatment (sec.) Time (min.)
LUMBAR
Initial / acute phase 13 - 20 kg Static 5 - 10
Joint distraction 22.5 kg; 50% of 15/15 20 - 30
body weight
↓ muscle spasm 25% of body 5/5 20 - 30
weight
Disc problem or 25% of body 60/20 20 - 30
stretch soft tissue weight
6. Start traction.
7. Assess the patient’s response.
8. Give the patient a means to call you & to
stop the traction.
9. Release traction & assess the patient’s
response
 Recommended Parameters for the
Application of Spinal Traction
Area of the Spine Force Hold/Relax Total Traction
and Goals of Times (sec.) Time (min.)
Treatment
CERVICAL
Initial / acute phase 3 - 4 kg Static 5 - 10
Joint distraction 9 - 13 kg; 7% of 15/15 20 - 30
body weight
↓ muscle spasm 5 - 7 kg 5/5 20 - 30
Disc problem or 5 - 7 kg 60/20 20 - 30
stretch soft tissue
 Mechanical CERVICAL Traction
Procedure:
1. Select the appropriate mechanical traction
device.
2. Determine optimal patient position.
 May be applied in the sitting or supine
position.
 Placing the cervical spine in a neutral or
slightly extended position focuses the
traction forces on the upper cervical spine,
while placing the cervical spine in a flexed
3. Apply the appropriate belts or halter.
 Over the mandible & occiput, but pressure is
applied only on the occiput.
4. Connect the belts or halter to the traction device.
5. Set the appropriate traction parameters.
6. Start the traction.
7. Assess the patient’s response.
8. Give the patient a means to call you & to stop the
traction.
9. Release traction & assess the patient’s response.
 Advantages:
 Force & time well-controlled, readily

graded, & replicable.

 Once, applied, does not require the

clinician to be with the patient throughout

the treatment.
 Electrical mechanical traction units allow

the application of static or intermittent

traction.
 Static weighted devices such as over-the-

door cervical traction are inexpensive &

convenient for independent use by the
patient at home.
 Disadvantages:
 Expensive electric mechanical devices.
 Time-consuming to set up.
 Lack of patient control or participation.
 Restriction by belts or halter poorly
tolerated by some patients.
 Mobilizes broad regions of the spine rather
than individual spinal segments, potentially
inducing hypermobility in normal or
hypermobile joints.
 D. Self-traction
Is a form of traction that uses gravity & the
weight of the patient’s body, or force
exerted by the patient, to exert a
distractive force on the spine.
It can be used on the lumbar but NOT on
the cervical spine.
Self-traction of the lumbar spine is
appropriate for home use by the patient
whose symptoms are relieved by low loads
of mechanical traction or that are
The amount & duration of force that can
be applied by self-traction is limited to the
upper body strength of the patient and the
weight of the lower body.
Methods:
a. Sitting self-traction
b. Self-traction between corner counters
c. Self-traction with overhead bar
 E. Positional traction
Involves prolonged placement of the patient in
a position that places tension on one side of
the lumbar spine only.
It gently stretches the lumbar spine by
applying a prolonged low-load longitudinal
force to one side of the spine.
It may not cause joint distraction, but may
effectively decrease muscle spasm, stretch soft
tissue, or exert a centripetal force on the disc
by spinal elongation without joint surface
separation.
May be used to treat unilateral symptoms
originating from the lumbar spine & can be a
valuable component of the patient’s home
program during the early stages of recovery
when symptoms are severe and irritable.

F. Manual traction
Is the application of force by the therapist in
the direction of distracting the joints.
It can be used for the cervical & lumbar spine
as well as for the peripheral joints.