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Introduction

Cervical and lumbar traction are applications of a force that separates the vertebrae and opens the intervertebral space in the treated area. The increased space reduces pressure on the intervertebral disks and spinal nerve roots, opens the facet joints, and elongates the soft tissue.

•Traction is a technique that applies a longitudinal force to the spine and associated structures, distracting the vertebrae. The distractive force can be administered by gravity (weights or body weight), a machine, the clinician, or by the position of the patient's body. Mechanical force is applied with either continuous or intermittent tension using several different methods. The force of the traction can occur in one plane or multiple planes (polyaxial traction).

Traction is indicated in conditions in which the patient's pain is caused by mechanical pressure on the vertebrae, facet joints, or spinal nerve roots, or other conditions in which removing the mechanical stress results in pain reduction. Unless specifically prescribed by a physician, traction should not be used for acute injuries, hypermobile vertebrae, or other instances when the stability of the vertebral column is in question.

Traction, immobilization, and bed rest were once the common treatments of choice for spinal and back pain. Contemporary practice frequently emphasizes active exercise with traction being used to provide short-term, mechanical relief of pressure placed on nerve roots, articular facets, and other structures.

Principles of Traction

The effect and effectiveness of traction is related to the position of the body part, the position of the patient, the force and duration of the traction, and the angle of pull.83 To distract the vertebrae, the force applied must be sufficient to overcome the sum of resistance of the weight of the body part being treated, the tension of the surrounding soft tissues, the force of friction between the patient and the table, and the force of gravity. Friction is negligible during cervical traction and lumbar/pelvic traction when a split table is used. Gravity works against cervical spine traction when the patient is seated; when the patient is supine, gravity is not a factor.

Traction is an appropriate treatment modality for hypomobile vertebrae. Traction should not be used in the presence of hypermobility of vertebral segments. The tension may lead to subluxation or dislocation of the vertebra or further increase the hypermobility of the segment.

Types of Traction

Traction maintains the cervical or lumbar spine in an elongated position and can be delivered continuously or intermittently (Table 16-1). Sustained traction is applied with relatively small force for 45 minutes or less; the tension in continuous traction does not change over the course of hours or days. These methods of application stimulate the supporting and stabilizing functions of the spinal structures, allowing the muscles to relax.

TABLE 16-1Types of ...

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