Spinal Traction: Cervical & Lumbar

Spinal Traction

• Spinal traction is the process of drawing or pulling the spinal column to apply a longitudinal force to the spine and associated structures, separating the vertebrae and opening the intervertebral space.
• It is a therapeutic tool used in exercise because of its effect on the musculoskeletal system and its use in stretching and mobilizing techniques.

Types of Traction

• Static or Constant Traction: may be continuous or prolonged (several hours) or sustained (few minutes to one-half hour).
• Intermittent Traction: traction is applied and withdrawn at frequent intervals.

Mode of Application

• Mechanical: using various types of equipment.
• Manual: administered by the therapist.
• Positional: through positioning to elongate the involved tissue.

Indications

• Muscle spasm.
• Hypomobility of joints from joint dysfunction or degenerative disk changes.
• Herniated or protruding disks.
• Nerve root compression.
• Facet joint pathology.
• Capsulitis of vertebral joints.
• Anterior/posterior longitudinal ligament pathology.

Contraindications

• Spinal infections.
• Spinal cancer.
• Spinal cord pressure.
• Rheumatoid arthritis.
• Osteoporosis.

Precautions

• Ligamentous strains and hypermobility.
• Acute stage of injury.
• Traction anxiety.
• Vertebral basilar artery insufficiency.
• Pregnancy (increased ligamentous laxity and risk for abdominal compression).
• TMJ dysfunction (cervical) if using chin strap.
• Can cause thrombosis of internal jugular vein if excessive duration or traction weight is used.

Cervical Traction

• The force used is approximately 20% of body weight.
• The human head accounts for around 8.1% of body weight (8-14 lbs).
• Greater force is needed to widen areas.
• Cervical traction setup involves placing the neck in 25-30° flexion, straightening the normal lordosis of the C-spine.
• The body must be in straight alignment, and the treatment duration is typically 10-20 minutes.

Cervical Treatment Setup

• Align the unit for 25-30° of neck flexion.
• Remove any slack in the pulley cable.
• Use an on:off sequence of 3:1 or 4:1 ratio.
• Following treatment, gradually reduce tension and gain slack.
• Have the patient remain in position for a few minutes after treatment.

Manual Cervical Traction

• The clinician sits at the head of the table facing the patient.
• The head is cradled to allow distraction of cervical vertebrae without hurting the patient.
• Traction is applied, and the head is slowly moved to maximize relaxation and comfort.

Cervical Traction Positioning

• Supine position: support the lumbar region and allow musculature to relax.
• The therapist stands at the head of the treatment table, supporting the weight of the patient's head in their hands.
• Flex the head until motion of the spinous process just begins at the determined level.

Mechanical Cervical Traction

• Harness traction device hung over a doorway.
• Amount of tension adjusted by the patient.

Lumbar Traction

• There are more types of lumbar traction than cervical traction.
• Lumbar traction force: no separation < ¼ BW.
• Can be delivered in either sustained or intermittent mode.

Lumbar Positional Traction

• Bilateral foramen opening: athlete in supine, hip/knees flexed.
• Unilateral foramen opening: sidelying position, pillow between iliac crest and lower border of ribs, flex hip/knees until LS is forward, trunk rotation toward superior shoulder.
• Supine: knees to chest, forward bend of lumbar spine, separation of spinous processes, and increased size of intervertebral foramen.

Unilateral Lumbar Positional Traction

• Sidelying position, pillow between iliac crest and lower border of ribs, flex hip/knees until LS is forward, trunk rotation toward superior shoulder.