Note: This article on traction relates to traction used in physiotherapy. For traction for acute problems, please refer to other article.
This is a stretching force applied in a longitudinal direction of the spine. Traction is supposed to separate vertebral bodies, stretches fibrous tissue, improve movements of facet joints, better drainage of fluid around the nerve roots, and improves circulation.
Traction is of two types – sustained and oscillatory. While sustained hold is used for injuries, root compression and muscle spasm, oscillatory is used for degenerative changes.
Position
In cases where the traction is used to treat the root pain or spasm of the muscles, the spine position is adjusted to enable the force to be effective at the target segment.
For example flexing the spine incase of lower cervical regions or flattening the spine by flexinge knees and hips and tilting the pelvis backwards in cases of lower lumbar traction.
Force
Smallest force providing pain relief should be utilized. For nerve root pain, the aim should be 50 % reduction. If more weight is used, the pain can be drastically increased when the traction is removed.
For stiffness and degenerative changes, effective force varies from 3 kg to 7 kg.
Time
For nerve root pain, sustained traction may be left on for 20-30 minutes, released for 5-10 minutes and then re-applied for a further 20-30 minutes. Treatment is generally based on a daily basis until the overall pain reduction is 75 percent.
For degenerative changes or regional stiffness, 10-20 minutes, repeated three times a week until improvement stops.
Sustained or oscillatory Traction
Oscillatory traction is useful for degenerative joint stiffness.
Follow Up
Improvement is noted by reduction in pain intensity, longer pain free spells or increased mobility.
Immediately after sustained traction is removed, spinal mobility is often reduced. This effect wears off in 1-2 hrs. Testing movements therefore should be delayed until the next treatment.
If after four treatments with tractions there is no improvement, other modalities should be considered. A combination of passive oscillatory movements (given first) and traction is often more effective for general stiffness.
Postural training and exercises are essential components of pain management.
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