Following completion of this chapter, the student will be able to:
Analyze the physical effects and therapeutic value of traction on bone, muscle, ligaments, joint structures, nerve, blood vessels, and intervertebral disks.
Evaluate the clinical advantages of using positional lumbar traction and inversion traction.
Describe the clinical applications for using manual lumbar traction techniques including level-specific manual traction and unilateral leg pull manual traction.
Explain the setup procedures and treatment parameter considerations for using mechanical lumbar traction.
Articulate the advantages of using a manual traction technique of the cervical spine.
Demonstrate the setup procedure for mechanical traction techniques for the cervical spine.
Traction has been used since ancient times in the treatment of painful spinal conditions.22 These treatments have also been referred to as distraction, or decompression therapies.
Traction may be defined as any method of applying a force directed along the inferior-superior axis of the spine that separates the vertebrae.1,2 In the clinical setting, traction may be performed mechanically, using a traction machine or ropes and pulleys to apply a traction force, or it may be performed manually by a clinician who understands the appropriate positions and intensities of the force being applied to the joints of the spine or the extremities. Some of the concepts of traction discussed in this chapter are generalizable to the treatment of the extremities; however, this discussion has been aimed specifically at cervical and lumbar spinal traction.
THE PHYSICAL EFFECTS OF TRACTION
Effects on Spinal Movement
Traction encourages movement of the spine both overall and between each individual spinal segment.3 Changes in overall spinal length and the amount of separation or space between each vertebra have been shown in studies of both the lumbar and the cervical spine (Figure 14–1).4–9 Although, traction has been shown to separate intervertebral segments the clinical value of this separation is unknown.7 It is most likely to be clinically relevant in patients complaining of low back pain with radicular symptoms.7
(a) Spine in normal resting position. (b) Spine under traction load with overall increase in length and overall increased separation between each vertebra.
The amount of movement varies according to the position of the spine, the amount of force, and the length of time the force is applied. Separations of 1–2 mm per intervertebral space have been reported. This change is very transient, and the spine quickly returns to the previous intervertebral space relationships when traction is released and the erect posture is assumed.3,4,6–8 Decreases in pain, paresthesia, or tingling while traction is applied may be caused by the physical separation of the vertebral segments and the resultant decrease in pressure on sensitive structures. If these changes occur while ...