Application Techniques of

Mechanical Traction

RAAED ALOBAIDI
B.M.Tech. Physiotherapy,M.Sc. Physiotherapy
 Equipment Required for Electrical Mechanical
Traction

• Traction unit
• Thoracic and pelvic belts
• Spreader bar
• Extension rope
• Split traction table (optional)
When using mechanical traction, we will have to select and adjust
the following seven parameters of the traction equipment and
patient position.
Traction will return disk nucleus to a central position.
•Body position: prone, supine, hip position, bilateral, or
unilateral direction of pull.
•Force used.
• Intermittent traction: traction time and rest time.
•Sustained traction.
•Duration of treatment.
•Progressive steps.
•Regressive steps.
 Patient Setup and Equipment

A split table or other mechanism to eliminate

friction between body segments and the table
surface is a prerequisite to effective lumbar
traction.
A non slip traction harness is needed to transfer
the traction force comfortably to the patient and
to stabilize the trunk while the lumbar spine is
placed under traction.
 Clothing between the harness and the skin will also
promote slipping.
 The vinyl-sided harness does not have to be as
constricting as the cotton-backed harness to prevent
slippage, thus increasing the patient’s comfort
 The harness can be applied when the patient is standing.
 The pelvic harness is applied so the contact pads and
upper belt are at or just above the level of the iliac crest.
 The contact pads should be adjusted so that the harness
loops provide a posteriorly directed pull, encouraging
lumbar flexion. The harness firmly adheres to the
patient’s hips.
 The rib belt is then applied in a similar manner with the rib
pads positioned over the lower rib cage in a comfortable
manner. The rib belt is then snugged up and the patient is
positioned on the table.

The standing application of the traction harness is easier and

more effective if the patient is to be placed in prone position
for treatment.
The traction harness can also be applied by laying it out on the
traction table and having the patient lie down on top of it.
 Body Position

When positioning the patient, try to achieve a

comfortable position that allows muscle relaxation
while maximizing the separation between involved
structures.

•The relative degree of flexion or extension of the

spine during traction determines which surfaces are
most effectively separated.
The flexed position results in greater separation of
posterior structures, including the facet joints and
intervertebral foramina,
•The neutral or extended position results
in greater separation of anterior
structures, including the disc spaces.
•If the patient presents with unilateral
symptoms, a unilateral traction force that
applies more force to one side of the
spine than to the other may prove more
effective.
•In patients with protective scoliosis, when the
patient leans away from the painful side, the traction
should be applied on the painful side. When the
patient leans toward the painful side, the traction
should be applied on the non-painful side
• In patients with scoliosis caused by muscle
spasm, the traction force should be applied
from the side with the muscle spasm.

•In unilateral facet joint dysfunction, the traction

should be applied from the side of most
complaint.
 Traction Force
 Several researchers have indicated that no lumbar
vertebral separation will occur with traction forces less
than one-quarter of the patient’s body weight.

The traction force necessary to cause effective

vertebral separation will range between 65 and
200 pounds(30-90 k.gm).

A force equal to half the patient’s body weight is

a good guideline to use in selecting a force high
enough to cause vertebral separation.
 Recommended Parameters for the
Application of Lumbar Spinal Traction
Area of Spine and Goals of Force Hold/Relax Total
Treatment Times Traction
(seconds) Time
(minutes)

Initial/acute phase 13-20 kg (29-44 lb) Static 5-10

22.5 kg (50 lb); 50% of

Joint distraction 15/15 20-30
body weight

Decreased muscle spasm 25% of body weight 5/5 20-30

Disc problems or stretch of

25% of body weight 60/20 20-30
soft tissue
 Intermittent versus Sustained Traction
Intermittent traction with long hold times may be
effective for treatment of symptoms related to disc
protrusion, whereas shorter hold and relax times are
recommended for symptoms related to joint dysfunction.

Sustained traction is favored in treating intervertebral

disk herniation because sustained traction allows more
time with the disk uncompressed to cause the disk
nuclear material to move centripetally and reduce the
disk herniation’s pressure on nerve structures. When
used for this purpose, sustained traction may be superior
to intermittent traction.
 Duration of Treatment

Recommendations for the duration of subsequent

treatments vary from as short as 8 to 10 minutes for
treatment of a disc protrusion to as long as 20 to 30
minutes for this and other indications.

Treatment for longer than 30 minutes is generally

thought to provide no additional benefit.
 Progressive and Regressive Steps

o Some traction equipment is built with

progressive and regressive modes.
o The machine progressively increases the traction
force in a preselected number of steps.
o A gradual increase in pressure lets the patient
accommodate slowly to the traction and helps
him or her to stay relaxed.
 Progressive and Regressive Steps

o A gradual progression of force also allows the

therapist to release the split table after the slack in the
system has been taken up by several progressions.
o Regressive steps do just the opposite and allow the
patient to come down gradually from the high loads.
o Again, patient comfort is the primary consideration
because no research supports any protocol.
 Start the traction.

 When applying traction to the lumbar spine, first allow

the traction to pull for one hold cycle to take up the
slack in the belt and rope, and then during the
following relaxation of the traction, release the
sections of the table slowly.
 If static traction is being used, the sections of the table
may be released after the traction force is applied.
 The therapist should manually control the rate of
separation of the sections to prevent sudden motion of
the patient and the lower section of the table.
 Start the traction.

 When a split table is used, once the sections are

released, the force of the traction pulls the patient and
the lower section of the table simultaneously, and so
does not have to overcome friction between the
patient and the surface of the table.
 The physiotherapist should observe the traction being
applied and movement of the table for a few cycles,
and then should make any necessary adjustments to
ensure that the traction is producing the desired effect.
 Assess the patient’s response.

It is recommended that the physiotherapist assess the

patient’s initial response to the application of traction
within the first 5 minutes of treatment, so that any
needed adjustments can be made at that time.
 Give the patient a means to call you and to stop
the traction.

Most electrical mechanical traction units are

equipped with a patient safety cutoff switch that
turns off the unit and rings a bell when activated.
Instruct the patient to use this switch if he or she
experiences any increase in or peripheralization of
pain or other symptoms.
 Release traction and assess the
patient’s response.

When the traction time is completed, lock the split

sections of the table, release the tension on the
traction ropes, and allow the patient to rest briefly
before getting up and recompressing the joints.
Then reexamine the patient.
Thank you for attention
 References

1. Clayton's Electrotherapy (Physiotherapy Essentials) Paperback – Import, 24 Nov

1995 by Sheila Kitchen MSc PhD DipTP MCSP Professor (Author), Sarah Bazin
MCSP (Author)
2. Physical Agents : Theory and Practice,3rd Edition ,Barbara J. Behrens PTA, MS
,Holly Beinert PT, MPT
3. Physical Agents in Rehabilitation: From Research to Practice ,Fourth Edition, by
Michelle H. Cameron, MD, PT, OCS
4. Therapeutic Modalities For Sports Medicine and Athletic Training, Sixth Edition by
William E. Prentice , Ph.D., A.T.C., P.T.
5. Textbook of Electrotherapy Kindle Edition by Singh Jagmohan (Author)
6. Practical Electrotherapy: A Guide to Safe Application ,by John Fox and Tim
Sharp, 2007