TRACTION

Dr.Muhammad Shahid Shabbir

DPT,MS.NMPT
TRACTION
 Process of drawing, or pulling apart, of a body segment
 Mechanical Traction - using a traction machine or ropes/
pulleys to apply a traction force
 Manual Traction - clinician positions patient and applies
traction force to joints of the spine or extremities
EFFECTS OF TRACTION: SPINE
Encourages movement between each
individual spinal segment
Amount of movement varies
according to…
 Position of spine,
 Amount of force, and
 Length of time the force is
applied
Transient effect
EFFECTS OF TRACTION: SPINE
 pain, paresthesia, or tingling
 Due to physical separation of vertebral segments thus
decreasing pressure on sensitive structures
As long as positive physiologic
effects occur,
traction should be
continued
EFFECTS OF TRACTION: BONE
 No immediate effects due to traction
 May result in increased spinal movement that reverses
bone weakness associated with immobilization
 May assist with increasing or maintaining bone density
EFFECTS OF TRACTION: LIGAMENTS
 Stretching effect
 Structural changes occur slowly due to viscoelastic
properties
 Ligaments resist shear forces and return to original form
following removal of a deforming load
 Sensitivity to rate of loading
 Ligament deformation results in lengthening of a
ligament caused by traction loading
 Slow loading rates allow for more deformation
EFFECTS OF TRACTION: DISKS

 Normal disk in non-compressed position

 Internal pressure (indicated by arrows) is exerted equally in
all directions
 Internal annular fibers contain nuclear materials
EFFECTS OF TRACTION: DISKS

 In an injured disk, sitting or standing compresses the disk

causing the nucleus to become flatter
 Pressure in this instance still remains relatively equal in all
directions
EFFECTS OF TRACTION: DISKS

 In an injured disk, movement in weight-bearing causes a

horizontal shift in nuclear material
 If this was forward bending, the bulge would occur in the
posterior annular fibers
 Anterior annular fibers would be slackened and narrow
EFFECTS OF TRACTION: DISKS

 Herniation of the nuclear material occurs if the annular

wall becomes weak
 Herniation may possibly put pressure on sensitive
structures in the area
EFFECTS OF TRACTION: DISKS

 When placed under traction, intervertebral space expands

thereby decreasing pressure on the disk
 Taut annular fibers create a centripetally directed force
 Decreases herniation and pressure on sensitive structures in the
area
EFFECTS OF TRACTION: ARTICULAR
FACET JOINTS
 Facet joints are separated releasing impinged structures
 Dramatic reduction in symptoms
 Joint separation decompresses articular cartilage allowing
synovial fluid exchange to nourish cartilage
 Decreases rate of degenerative changes
 Increased proprioception from facet joint structures provide
sensation of pain relief
EFFECTS OF TRACTION: MUSCLES
 Vertebral muscles can be stretched
 Initial stretch should come from body positioning
 Stretch lengthens tight muscle
 Allows for better muscular blood flow

 Activates muscle proprioceptors providing sensation of

pain relief
 Gate Control Theory
EFFECTS OF TRACTION: NERVES
 Focus of most traction treatments
 Pressure on nerves or nerve roots often associated with
spinal pain
 Unrelieved pressure on a nerve will cause
 Slowing, eventual loss of impulse conduction
 Motor weakness, numbness, and loss of reflex
 Pain, tenderness, and muscular spasm
TRACTION TREATMENT TECHNIQUES
 Lumbar Positional Traction
 Inversion traction
 Manual Lumbar Traction
 Level-specific
 Unilateral leg pull
 Mechanical Lumbar Traction
 Manual Cervical Traction

 Mechanical Cervical Traction

LUMBAR POSITIONAL TRACTION
 Patient typically on restricted activity program
 “Trial and error” process to determine position that offers
maximum comfort
SIDE-LYING POSITION: UNILATERAL
FORAMEN OPENING
 Lateral Herniation
 Patient leaning away from
painful side
 Lie painful side up
 Lie on right side over
blanket roll
SIDE-LYING POSITION: UNILATERAL
FORAMEN OPENING
 Lateral Herniation
 Patient leaning away from
painful side
 Lie painful side up
 Lie on right side over
blanket roll
 Medial Herniation
 Patient leaning toward
painful side
 Lie painful side down
 Lie on right side over
blanket roll
SIDE-LYING POSITION: UNILATERAL
FORAMEN OPENING

 Side-lying with a blanket roll

between iliac crest and rib
cage
 Increases intervertebral
foramen size of superior side
of lumbar spine
SIDE-LYING POSITION: UNILATERAL
FORAMEN OPENING

 Maximum opening of
intervertebral foramen
 Achieved by flexing upper
hip and knee and rotating
shoulders in opposite
directions

Maximum opening of left side

SUPINE POSITION: BILATERAL
FORAMEN OPENING

 Knees to chest position

 increases size of lumbar
intervertebral foramen
bilaterally
 Separation of spinous
processes
INVERSION TRACTION
 Hang upside down
 Lengthens spinal column
due to stretch provided by
weight of trunk
 Repeat inversion 2-3
times
 Observe for signs of
vertigo, dizziness, or
nausea
MANUAL LUMBAR TRACTION
 Used prior to mechanical traction
 Helps determine degree of lumbar flexion, extension, or
side-bending that is most comfortable
 Most comfortable position is usually best therapeutic
position
LEVEL-SPECIFIC MANUAL TRACTION

 Position patient for

maximum effect at a
specific spinal level
 Lumbar spine flexed using
upper leg as lever
 Palpate interspinous space
 Upper spinous process is
where maximum effect is
desired
LEVEL-SPECIFIC MANUAL TRACTION
 When motion of lower
spinous process can be
palpated, place foot against
opposite leg to prevent
further flexion
 Trunk is then rotated
toward the upper shoulder
until motion of upper
spinous process can be
palpated
LEVEL-SPECIFIC MANUAL TRACTION
 Place chest against ASIS
and upper hip
 Lean toward patient’s feet

 Use enough force to cause

a palpable separation of
the spinous processes at
desired level
UNILATERAL LEG PULL MANUAL
TRACTION
 Hip joint problems or
difficult lateral shift
corrections
 Thoracic counter-traction
harness is used
 Hold ankle and move hip

into 30o flexion, 30o

abduction, and full
external rotation
 Apply steady traction force
until noticeable distraction
occurs
UNILATERAL LEG PULL MANUAL
TRACTION
 Sacroiliac problems
 In addition to thoracic
counter-traction harness,
strap is placed through
groin and secured to table
 Hold ankle and move hip

into 30o flexion and 15o

abduction
 Apply steady traction force
MECHANICAL LUMBAR TRACTION:
EQUIPMENT
 Use split table to eliminate friction between body segments
 Non-slip traction harness stabilizes trunk
MECHANICAL LUMBAR TRACTION:
SETUP
 Pelvic harness
 Applied while standing
 Contact pads and upper
belt placed at, or just
above, iliac crest

 Rib pads
 Positioned over lower rib
cage
MECHANICAL LUMBAR TRACTION:
BODY POSITIONING
 Neutral spinal position
 Allows for largest
intervertebral foramen
opening before traction is
applied
 Usually position of choice
whether prone or supine
MECHANICAL LUMBAR TRACTION:
BODY POSITIONING
 Flexion
 Increases posterior
opening
 Puts pressure on disk
nucleus to move posterior
 Other soft tissue may also
close foramen opening
MECHANICAL LUMBAR TRACTION:
BODY POSITIONING
 Extension
 Closes foramen because
bony arches come closer
together
MECHANICAL LUMBAR TRACTION:
BODY POSITIONING
 Prone position
 Used with normal to slightly
flattened lumbar lordosis
 Best for disk protrusions

 Place pillows under abdomen

 Other modalities may be

applied
 Allows for assessment of
spinous process separation
MECHANICAL LUMBAR TRACTION:
BODY POSITIONING
 Supine position
 Produces posterior intervertebral separation

 Optimal at 90o hip flexion

 Unilateral pelvic traction recommended if stronger force is

desired
 Scoliosis,
 Unilateral joint dysfunction, or
 Unilateral lumbar muscle
spasm
TRACTION FORCE
 No lumbar vertebral separation will occur with traction
forces less than 1/4 of body weight
 Effective traction force ranges between 65 and 200 pounds
 Traction force recommended = 1/2 body weight
 Must use progressive steps to comfortably reach
therapeutic loads
INTERMITTENT VS. SUSTAINED
TRACTION
 Intermittent Traction
Effectivefor posterior intervertebral separation
No firm recommendations for on/off times
 Sustained Traction
Recommended for disk protrusion and rupture
TREATMENT DURATION
 With suspected disk protrusions, total treatment time
should be relatively short
 10 minutes or less
 If treatment reduces symptoms, treatment time should
remain at 10 min or less
 If the treatment is partially successful or unsuccessful in
relieving symptoms, gradually increase time over several
treatments up to 30 min
PROGRESSIVE AND REGRESSIVE STEPS
 Traction equipment may be built with
progressive and regressive modes
 Progressive mode
Increases traction force in a pre-selected number
of steps
Allows slow accommodation to traction
 Regressive mode
Decreases traction force in a pre-selected
number of steps
 Patient comfort is primary consideration!
MANUAL CERVICAL TRACTION
 Stretches muscles and joint structures
 Enlarges intervertebral spaces and foramen

 Creates centripetally directed forces on disk and

surrounding soft tissue
 Mobilizes vertebral joints

 Increases joint proprioception

 Relieves compressive effects of normal posture

 Improves arterial, venous, and lymphatic flow

MANUAL CERVICAL TRACTION
 Variety of head and neck
positions
 Hand should cradle neck
contacting one mastoid process
 Other hand on chin

 Gentle pull, < 20 pounds

 Intermittent pull, 3 - 10 sec

 Treatment time, 3 - 10 min

MECHANICAL CERVICAL TRACTION
 Supine
 Neck flexed 20 - 30o
 Traction harness pulls on occiput

 Intermittent pull
> 20 pounds
 Minimum of 7 seconds
 Adequate rest time for recovery

Forces up to 50 pounds
 Treatment time, 20 - 25 min
may produce increased
intervertebral separation.
MECHANICAL CERVICAL TRACTION
 Wall-mounted device
 Inexpensive
 Static traction most easily employed
 Use weight plates, sand bags, or water
bags
 Intermittent traction may be used
 Sitting or prone

 Gentle pull, 10 - 20 pounds

 Treatment time, 20 - 25 min

INDICATIONS FOR SPINAL TRACTION
 Nerve root impingement  Joint hypomobility
 Disk herniation  Discogenic pain

 Spondylolisthesis  Muscle spasm or guarding

 Narrowing within  Muscle strain

intervertebral foramen  Spinal ligament or capsular
 Osteophyte formation contractures
 Degenerative joint diseases  Improvement in arterial,

 Subacute pain venous, and lymphatic

flow
CONTRAINDICATIONS FOR
SPINAL TRACTION
 Acute sprains or strains  Bone diseases
 Acute inflammation  Osteoporosis

 Fractures  Infections in bones or

 Vertebral joint instability joints

 Any condition in which  Vascular conditions

movement exacerbates  Pregnant females

existing problem  Cardiac or pulmonary
problems