Spinal Traction and Head Halter Traction

Spinal Traction

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 in case of lower cervical regions or flattening the spine by flexing 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.

Head Halter Traction

Head halter traction is skin traction equivalent of spinal traction. Head halter traction is used in cervical ailments and injuries. It is usually used for shorter periods owing to discomfort it can cause.

Head Halter traction is of two types

Canvas type

This is most commonly used type of head halter traction. On part of the traction is slided under the head to rest on the occiput and other is rested on the chin.

A metal spreader hooks on to the two side pieces to avoid lateral compression of the soft tissues when traction is applied.

A cord from the metal spreader passes over a pulley fixed to the top of the bed or to a stand in case of traction applied in sitting position.head-halter-traction

The cord is attached to the weights thta would provide traction. maximum weight that can be used is 1.5 – 2.5 kgs.

The head end of the bed must be raised to provide countertraction.

This kind of traction is dofficult for long times due to complications it can cause.

Crile Type

A padded metal bar resemblinfg horse collar is placed under occiput. Another padded portion is attached to the one put under occiput.

Advantage is that chin can be kept free.

A canvas head halter traction is often used to treat problems of the cervical spine that require only short-term immobilization. When the head halter is applied, care must be taken to see that the traction pull is parallel to the long axis of the body. The traction rope must not be allowed to rub on a high headboard or the mattress.

If necessary, the traction may be applied with the patient lying head down in bed so that the lower footboard is the site of attachment of the traction hardware. No more than 2.3 kg of weight should be applied to canvas traction.

Complications of Head Halter Traction

Pressure on the Chin

Pain and skin excoriation on the chin are caused by excessive weight of traction, inadequate padding of the chin strap, or traction pull that is not evenly distributed between the chin strap and the occipital strap.

Excessive pull on the chin can be relieved by changing the direction of the traction rope and apparatus so that more pull is placed on the occipital strap.

The traction should be discontinued temporarily if pain is persistent.

Pressure on the Occiput

it may cause skin trauma, headaches, or occipital neuritis. Adequate padding can prevent most skin trauma. Occipital headaches are relieved when pressure on the occiput is decreased or  the line of pull must be lowered to place more pull on the chin.

A constant dull pain in the occipital area may suggest occipital neuritis. It usually is not relieved by temporary discontinuation of the traction, and the traction may have to be permanently discontinued.

Pressure at the Temporomandibular Joint

Pain in the temporomandibular area develops when a large amount of weight is used over a long period. The most prominent symptom is pain in the angle of the jaw, often radiating into the ear. The use of a bite block usually relieves temporomandibular pain,   but   if   pain   persists,   traction   should   be discontinued.

Other Problems

Mechanical problems include weights resting on the floor, breaking the rope, and tangling the rope in the pulley. Mechanical problems can be prevented by close observation of the traction setup.

Uncooperative or patient not able to cooperate are not good candidates for head halter traction. Disoriented or restless patients may be unsuited to this type of cervical traction, and a more rigid traction device may have to be employed.