Traction

THIS UNIT
sOME IMPORTANT POINTSIN mechanical force to the body in a way that separates or attempts to
separato e

Traction is the
application of a
the bone fragments.
tissues or aligns
elongates soft disk lesions causing sciatica.
joint surfaces,
traction for treatment of lumbar
Cyriax in 1950
popularized the use
of positional, or inversion type,
based on the method of
be manual, mechanical, motorized/hydraulic,
Traction can

application. and intermittent.

of pull, traction can be sustained, continuous,
Based on the nature

application of a mechanical|
Vivekananda National Institute of Rehabilitation
Traction is the
Training and Research (SVNIRTAR), Cuttack,
force to the body way that separates
in a

or attempts to separate the joint

surfaces, | Odisha, to find the long-term effect of this
bone modality on increasing the intervertebral disk
elongates soft tissues or aligns the lumbar segments, in normal
fragments. The history of traction can be traced | space of the lower
to the ages of Hippocrates, where traction was young subjects revealed immediate separation
of the disk space; however, there were no carmy
primarily being used for reducingfracture and|
dislocations and later on, it was recommended over effects. Though many controversies exist
for the treatment of spinal disorders such as regarding the effectiveness of this modality
scoliosis. in my opinion, when it is applied in a proper
Cyriax in 1950 popularized the use of way with required positioning of the segments
traction for treatment of lumbar disk lesions, | to be effected, and proper selection of tractdive
to other
causingsciatica. At present, traction is used in force, it works as an useful adjunct the
conjunction with other forms of conservative therapeutic modalities for the treatment of
pain syndromes affecting the spine, as well
as
treatment for back and neck pain, as well
as the peripheral arthritis/joint dysfunction to mobilize stiffjoints, correctdeformites,etc
to reduce pain and enhance mobility and
to correct deformity, etc. In the past, some TYPES OFTRACTION
studies done reveal that traction is very helpful Traction can be typed into two types:
for the treatment of spinal dysfunctions and 1. Based on the methods of application
derangement as the result of treatment with 2. Based on the nature of pul.
this method when compared with other
conservative procedures such as heat therapy, Based on the Methods of Application
methods of
mobilization, corset application, etc., is superior There are several
different
nch a5 -

whereas some other studies have failed to reveal traction to

| delivering patd/hvdrauli
motorized/hydraul
any superiority of this modality over other manual, mechanical, the
atient

conservative methods. A recent unpublished (placing

positional,
work done by Mrs Josni Khah, for her Master i n a device that puts the patientinthis
and
a heabook
inversion
dow
this bookto

of Physiotherapy (MPT) thesis at Swami position). Itis not the scope

 lhc all
describe all thes in
these detail;
tion which iis only Trartion 191
Ised by thepowered by the motorized
mPnt of spinal physiotherapi
reatm elertricity and force followed
sts fol hy 10 17 er onds of rest The
disorders is for the
n,
off cycle repeated for 1727 minules
is

ased on the
Nature of Pull discussed.
sed ont nature of MECHANISM OF ACTION OF
pull, traction TRACTION
Continuous traction can be: ne
rationale for
h. Sustained traction traction is based on the
mechanical and reflex
c. Intermittent traction mechanism. 5pina
elongation through an increase of the inter
(on uous Traction Vertebral joint space and the
the
spinal muscles is relaxation o
otlhod of important of the assumed to be the most
Thi traction is which traction proposedmechanisms
mostly used for by

rea, immobilization
ary
fen of a
could be effective.
Spil thereby symptomatic
relieving symptoms that Duration and Frequency of
natic
avated by spinal Traction
forc 0-20 Ib, i.e. 4.5-9movements. A low Although the duration of
long iods, ranging from kg) is applied for Some authorities suggesttractionthat
is
subjective,
hod is hours to of initial
traction should be 5-10 minutes duration
this commonly practiceddays,for and upon severity of depending
doatients, having
t at present
acute the relieved symptoms. If
symptoms
neck or back this shortsignificantly by brief low force traction,are
nain. this method
srarely used as there isof traction maintained.duration of application is to be
pli 1on isS
Tss that most patients with increased However, if the
symptoms remain
unchanged after 10 minutes, the
enefit from spinal
prolonged bed rest pain | of traction
do noi

and of 10 may be increased duration

inactiy minutes. Further, by further a
it is
Sustain ed Traction
depending upon the suggested that,
the response of the
duration of patient,
traction in chronic
t uses force should be limited conditions
greater than that to 20-40
continuous traction and less thanused in patent improves, the traction minutes. If the
intermittent traction. The pull is that in on a daily
basis. may be applied
ar 20-60 minutes. The
maintained
s variable; the common
frequency of treatmentAPplication Techniques
practice is to treat
npatients daily and outpatients three Though various methods of
wekly. This traction is very effective times application of
traction exist, the ones most
4pplied on a split traction table when in therapy departments commonly used
purpose.
meant for the and mechanical include-motorized
the traction is weighted devices. Before
applied, it is essential to
htermittent Traction check the contraindications that include the
straction following:
technique allows the
greater forces
for a short
Ce IS gradually increased and
applicationContraindications
period of time. The Contraindications for
decreased General
for Traction
Traction
ing each treatme
cycle, and can be Osteomyelitis or diskitis
stered
a most o by pulleys or motorized
0 the equipments, the on (pull) andsystem. Bone/spinal cord tumor
lves function Unstable fracture
mCesel The time is ntrolled automatically Severe osteoporosis
10 sequence can
vary from as
Hypertension
eeonds restupseconds of tractive force with a | Cardiovascular disease
to 30-60
seconds oftractivel Inadequate expertise.
 292 / Electr otherapy ~ i!_11plifie_d _

Lum bar tract ion

• Preg nancy
• Caud a equi na comp ressi on
• Cord sign .
Cerv ical tract ion
• Central intervertebral di sk hern iatio n
• Caro tid or vertebral artery disea se
•Hypermobi lity
•Rheu mato id arthritis.
After the patie nt is found fit for the traction
the following proc edur es to be followed t~
appl y tract ion for the cerv ical and lumb ar
regions.
Fig. 19.1: Cervical tracti on using
5aun der's halter
Cervical Spine Traction
flexi on. However,
Evid ence reve als on the efficacy of tract ion it is foun d that
in decr easi ng the pres sure with in the placing the cervical
intervertebral disk and unlo adin g the structures spine in a neutral or
of the spin e by stret chin g the mus cles and sligh tly exte nded
ligam ents ( Con stan tine Con stan toya nnis , position focuses the
MD et al. 2002 ). It is prob able that tract ion trac tion force on
has an impo rtant role in brea king the "circle the uppe r cervical
pain " in cerv ical radic ulop athy , caus ed by spine, while placing
hern iated disk, caus ing entr apm ent with in the the cerv ical spin e
inter verte bral foram ina. Inter mitt ent cervical in a flexed posit ion
tract ion help s to relie ve the infla mma tory focuses the traction
reaction of nerv e roots by impr ovin g circu latio n force on the lowe r
and redu cing swel ling in the tissu es. Gen tle cervical spin e. fig. 19.2: Cervical traction
alter ation of stret chin g and relax ation of the The opti mal using mandibular hakef (For
neck soft tissu es prev ent the form atio n of fore e for cerv ical color version, see Plate 81.
adh esion of the dura l sleev e. Base d upo n tract ion varie s depe ndin g upon the method of
the finding, it is sugg ested that cerv ical spin e delivery. At least 4.5 kg of force is necessarv~0
tract ion coul d be cons ider ed as a ther apy of coun ter the effects of gravity on the bead w t'.
dloi ce for radic ulop athy caus ed by hern iated appr oxim ately 11.25 kg of force 1s . ~ n
n .
disk, even in case s of large volu me hern iated to prov ide strai ghte ning . f the cervtcn 1
o . 1
disks or recu rren t epis odes . lord otic curv e and the earlie 5t separanen,~
, ararnttt:l'
Trac tion is appl ied by the appl icati on of post erior verte bral segments. The P ·veniii
the halte rs whic h are of two type s such as: reco mme nded for cervical spine are gi
Saun d ers occi pitaJ halt er (Fig. 19.1) and Table 19.l.
man dibu lar halte r (Pig. J9.2) . The patie nt can
be plac ed in supi ne or can take the tract ion Lum
· bar Spine Traction 'l h.,1,rra-..~1,1
in sitti ng. The head shou ld be posi tion ed . ,
Rationale for the app ltea t'
10 11 of lllllVV"
....w1tlll"
prop erly depe n ding upon the segm enls to he l
to treat low hark pain put en are,n ts nw . -~
niii"-tt ·
sepa rated as Cola chi s et al. have dem onst rated to decrnasu muscle sp tlSI, n ' strt(( , 1ra!\)1
Jr
th at poS t erior verte
bral sepa ratio n is relat ed lo rupture adhesions, s·tlt· ,\trh. the. tt,ot- •ti~111
dlslfltC . J
th e an~]e of pull,
with max imu m sepa rati on a(.'.hieve int erv er te.b t·al 101ut e p~1r . 11 J11
occu rnng at 240 of flexi on. The best clini cal . 1,. • ttecreas t 11\•1
redu ce herniated t l,s .. s 1
Illl½ uiu •
'
resu lt occu rs betw een 200 and 300 of cerv ical cause ( , to beco
sp inal ligam en s
 79.kR12MStersfo cervical traction.
t
for meters Hold/relax Total time

(seconds)
(min)
5-10
2ament Force
Static
34kg
20-30
15/15
9-13kg,
body
70acio ight 20-30
kg
5/5 Fig. 19.3: Lumbar traction in supine with the hips
ATEISE flexed (For color version, see Plate 8)
60/20 20-30
kg
VOblem

This traction
omobile joints.
mobilize

forces for vertebral

larger
guires q cervical traction.
The
n the
in the therapy
monly applied
p a r a t i o n

action is devices that

motorized
sing
iepartimer

belts. These belts 19.4: Lumbar traction in prone

nd thoracic Fig.
ilize pel surface directly
h the nonslip (For color version, see Plate 8).
Jeappliec
and not o v e r
the patient's skin, flexed m o r e
nContact
be securely distraction, as the m o r e the hips
oth the belts must lumbar segments.
the clothin The is the effect on the upper
rder to prevent slipping. found that with the
ened
ghtened Colachis and Strohm
stabilize the upper of 18° is
horacic b is used to an angle of pull
which the traction hips flexed to 70,
ndy abov he level at
created which provides
the greatest vertebral
to isolate the in neutral or
Cce is des d, thereby helping separation. The traction applied
appropriate spinal segments.| in greater separation
action for extended position results
to
so that its lower edge the disk
hethoracic belt is placed which the traction of the anterior s t r u c t u r e s including where
gnswith the upper limit
at a supine position,
aligned spaces. Generally
Te is desired, with its upper edge is flexed is selected
for separating
immediately spine localize the the
proximately with the xiphoid The the posterior
elements and to
70N the greatest diameter of the thorax. lumbar and thoracic
traction force to the upper
Ston of the pelvic belt should be such
that is prone, the
But when the patient
superior edge aligns with the inferior limitsegments. extended or in
neutral
lumbar spine is slightly
nich traction force is desired, generally just and the traction
force is localized
eri to the iliac crests (in supine, Fig. 19.3), | position Traction can
eTor to the lower lumbar segments.
bperior to the superior edge of thesacrum| be applied both as static
and i n t e r m i t t e n t
that static lumbar
that static
lumbar
Fig. 19.4). Split traction tables Cyriax
Cyriax
advocates that
advocates
tleas
e least
rface resistance are ofgreatbenefit| traction is beneficial in reducing spasm
of the ma
m an
nnne
errs
s..

strarti the fixed in help

ng vertebrae, as thas gota muscles, which may
paravertebral silence
silence
mobile part and the lower body
that
distracting
rests
the
the vertebrae, a
vertebrae, as s electrical
electrical

siemobile unit separated from the fixeadistracting

w a s noted
in the
m u s c l e s of
paravertebral

Mas the tractile get static traction.

s t a r t of
m i n u t e s after
applied. force is very
region, 3
is and Onel et al. support
Ihe selection of the body position
The findings of Mathew
that vertebral
distraction

tractio
the traction.

rtant for the the view of cyriax applied in

Utant applicatiothe lumbar traction

Dtraction is app
position, static
with flexed

appliedin flexecludin|
the
occurs
oflumbar traction are
The p a r a m e t e r s
including

"Parates the posterior

incnir supine
supine.
.
structures
f o r a m i n a .

in Table
19.2.

art i
acet i ints and the intervertebral
segment
as

the
amo unt of hif
nip
flexion
affects
 3-5 seconds should be applied
TABLE 19.2:Parametersfor lumbartractioh oscillatory movements. to produre
Hold/relax Total time
Goal of The force of traction should
(min)
initially, to prevent aggravationhe ofkept ind
treatment Force (seconds)
5-10 low
Acute phase 13-20 kg Static
spasm and symptoms and to museio
Joint 22.5 kg, 15/15 20-30
determine the
patient's response to this treatment
distraction 50% body Itis recommended that
weight for all applications
25% of 5/5 20-30 the traction force for the lumbar
Decreasee should start at between 13 kg and spine
spasm body 20 kz
whereas for the cervical spine, it
weight
start at between 3 kg and 4
shoid
25% of 60/20 20-30 kg,
Disk
For the lumbar spine to cause
problem body separation
at the facet joints, thereby
(stretch soft weight freeing the
nerve roots off pressure, a tractive force of
tissue)
approximately, 22.5 kg, and approximateh
50% of the patient's body weight is
Realized
Some Salient Points to be recommended, whereas if the objective
static traction when the tisues is to decrease spasm, stretch soft tissues
Apply
are inflamed, motion of the segments and to apply a centripetal force to the disk,
the pain, as well as in acute disk by spinal elongation, without joint surface
aggravates
separation, lower force of 25% of body
protrusion.
stretch weight is used.
Static traction does not evoke
reflex of the muscles and thereby does not
For the cervical spine to cause facet joint
increase muscle spasm. separation, thereby freeing the nerve roots
when the off pressure, a tractive force of9-13 kg, or
Apply intermittent traction
objective is to treat joint dysfunction, approximately 7% of the patient's body
if the
where a short hold and rest time is recom- weight is recommended, whereas
stretch
mended. If intermittent traction is used goal is to decrease muscle spasm,
soft tissues, and to exert a centripeta
for disk protrusion, a long hold time
(say 60 seconds), and short rest time (say force on the disks by spinal elongation
force of 5-7 kg
20 seconds) are used. without joint separation, a
With intermittent traction, a greater is recommended.
traction should be verv
tractive force can be applied compared to The duration of
5-10 minutes
the static traction. low initially which may be
severity of symptoms
I f intermittent traction is selected, maxi- depending upon the
mum traction force should be applied lfsevere symptomsare
relievedsignibe an
this short curabo
during the hold time and minimum force brieflow force traction,
by maintained. Ba
should be
should be applied during the rest time. of application partiail
are
symptoms
When the patient's symptoms are II the patient's
minutes of racto
severe both relieved, atter
10
long hold and rest times duration. In cases whet
ater
this
are
recommended, whereas when the not exceed
the
mptoms

symptoms become less severe, the rest is change in duratios

the
there no
increase the
traction
time is gradually decreased. When the 10 minutes,
discomfort has reduced to a local ache, up to 20-40 minules uld be o"
should
gradually, t r e a t m e n t

reduce the hold time. In case of of

very mild The frequency
local symptoms, hold and rest times of a daily basis.