Traction
Gerry Catapang, PT, DPT, MGS
Traction can be defined as separation of joint surfaces. The result
of applied traction is distraction. Distraction means, “ to pull apart
or to draw away”. Traction is a force and does not denote a change
in position. Keep in mind that traction is supposed to achieve
distraction.
Types of Distraction
Distraction can be manual or mechanical. Manual distraction is
applied via hands. Alternatively, mechanical distraction is delivers a
force that can be sustained or intermittent.
Manual distraction can be (1) inhibitory, (2) graded, (3) rhyth-
mic, (4) adjustive, or (5) positional. Mechanical distraction can be
three dimensional or three dimensional with autotraction.
Inhibitory or inhibitive distraction is compression placed
over muscles or tendons of insertion, while the joint underneath is
stretched.1 An example of this is subcranial distraction. This type
of distraction is based on the theory that pressure on the origin
or insertion of a muscle fires the Golgi tendon apparatus (GTO)
which, as a result, relaxes the muscle. With the muscles relaxed
(inhibited), they do not resist the stretch being applied to the
underlying joints.
Graded distraction has three grades of joint play movement.
The joint surfaces in grade I are nearly unweighted; grade II takes
up the slack of the capsule; and grade III stretches the capsule and
ligaments. Grade II is used to evaluate end feel. If the slack is taken
up too early, then treatment is applied to restore joint play. Grade
III is a stretch treatment.
Rhythmic distraction is a series of distraction motions with
alternate rest periods. With this, there is a possibility of “gating the
pain”, “pumping fluids”, or both. This technique is used to decrease
pain, not to increase range of motion.
Adjustive distraction is a high velocity thrust often used in a
joint such as the hip. The gross degree of distraction available can
be determined by placing the patient supine, stabilizing one foot
against the clinician’s thigh, and then applying traction on the thigh
to be examined.
Positional traction by Paris2 is most useful in the spine where
two vertebrae are so positioned that the intervertebral foramen
between them opens to relieve nerve root pressure. The patient lies
over pillows and perhaps is held or assisted by straps.
The three-dimensional mechanical traction table allows posi-
tioning of the patient such that the traction force results in a distrac-
tion at the spinal level and the side that is desired. The most recent
traction tables are designed by Kaltenborn, Paris, and others.2
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Three-dimensional mechanical autotraction allows the patient
to perform traction themselves against gravity or with the assistance
of a distraction table. Some traction tables can help the patient find
the position of maximum comfort and allow the patient to apply
the traction force.
Therapeutic Effects
When performed correctly, cervical and lumbar traction can cause
many effects such as distraction or separation of vertebral bodies;
a combination of distraction and gliding of the facet joints; tensing
of the ligamentous structures of the spinal segment; widening of
the intervertebral foramen; straightening of the spinal curves; and
stretching of the spinal musculature.3 Some practitioners believe
fluid exchange occurs within the spinal disc during traction.4
The therapeutic efficacy of traction will be determined by the
following: (1) strength of the applied force; (2) direction of the applied
force; (3) position of the body; (4) state of rest or motion of the body
to which the force is applied; (5) contour and texture of the body to
which the force is applied; and (6) the surface on which the body rests.
It is generally accepted that cervical and lumbar traction can be
helpful in centralizing a pain process and in reducing radicular symp-
toms.5-8 Xin9 suggests that cervical traction helps with vertebrobasi-
lar insufficiency resulting from spondylosis when combined with
enhanced external counterpulsation. Others believe more definitive
studies are needed to fully understand the benefits of traction.10,11
Sustained or Intermittent Mechanical Traction
and Manual Traction
Keep in mind that traction is a force and not a result.1 Results of
sustained or intermittent mechanical traction include: (1) foraminal
distraction; (2) flattening of any disc bulge; (3) relief of pressure on
the nerve root. Conversely, manual traction can be sustained only
for a short period of time. The techniques are often much stronger
than mechanical traction techniques and the results include stretch
to the myofascia; stretch to facet capsules; and occasional reposi-
tioning of vertebrae.
Clinical Studies
Katavich,12 indicated in her research, that a stretch generated in
cervical muscles and skin during cervical traction has the potential
to influence the excitability of motor neurons. She believes manual
cervical traction relieves pain and muscle spasm in the neck and
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