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Process of drawing, or pulling apart, of a

body segment
Mechanical Traction - using a traction
machine or ropes/ pulleys to apply a traction
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

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
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

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

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

Decreases herniation and pressure on sensitive

structures in the area

Effects of Traction: Articular Facet

Facet joints are separated releasing impinged


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


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

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
intervertebral foramen
size of superior side of
lumbar spine

Side-lying Position: Unilateral

Foramen Opening
Maximum opening of

Achieved by flexing
upper hip and knee
and rotating
shoulders in
opposite directions

Maximum opening of left side

Supine Position: Bilateral Foramen

Knees to chest

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

Manual Lumbar Traction

Used prior to mechanical traction
Helps determine degree of lumbar flexion,

extension, or side-bending that is most

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
Palpate interspinous
Upper spinous
process is where
maximum effect is

Level-Specific Manual Traction

When motion of lower

spinous process can

be palpated, place
foot against opposite
leg to prevent further
Trunk is then rotated
toward the upper
shoulder until motion
of upper spinous
process can be

Level-Specific Manual Traction

Place chest against

ASIS and upper hip

Lean toward
patients 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

Thoracic countertraction 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

harness, strap is
placed through groin
and secured to table
Hold ankle and move
hip into 30o flexion and
15o abduction
Apply steady traction

Mechanical Lumbar Traction:

Use split table to eliminate friction between body

Non-slip traction harness stabilizes trunk

Mechanical Lumbar Traction:

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

Allows for largest
foramen opening
before traction is
Usually position of
choice whether
prone or supine

Mechanical Lumbar Traction:

Body Positioning
Increases posterior

Puts pressure on
disk nucleus to
move posterior
Other soft tissue
may also close
foramen opening

Mechanical Lumbar Traction:

Body Positioning
Closes foramen

because bony
arches come closer

Mechanical Lumbar Traction:

Body Positioning
Prone position
Used with normal to

slightly flattened lumbar

Best for disk protrusions
Place pillows under
Other modalities may be
Allows for assessment of
spinous process

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

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

Must use progressive steps to comfortably
reach therapeutic loads

Intermittent vs. Sustained Traction

Intermittent Traction
Effective for posterior intervertebral
No firm recommendations for on/off times

Sustained Traction
Recommended for disk protrusion and

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
Improves arterial, venous, and lymphatic flow

Manual Cervical Traction

Variety of head and neck

Hand should cradle neck
contacting one mastoid
Other hand on chin
Gentle pull, < 20 pounds
Intermittent pull, 3 - 10 sec
Treatment time, 3 - 10 min

Mechanical Cervical Traction

Neck flexed 20 - 30

Traction harness pulls on

Intermittent pull

Forces up to 50 pounds
may produce increased
intervertebral separation.

> 20 pounds
Minimum of 7 seconds
Adequate rest time for

Treatment time, 20 - 25 min

Mechanical Cervical Traction

Wall-mounted device


Static traction most easily


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

Disk herniation
Narrowing within
intervertebral foramen
Osteophyte formation
Degenerative joint
Subacute pain

Joint hypomobility
Discogenic pain
Muscle spasm or

Muscle strain
Spinal ligament or
capsular contractures
Improvement in
arterial, venous, and
lymphatic flow

Contraindications for
Spinal Traction
Acute sprains or

Acute inflammation
Vertebral joint
Any condition in which
exacerbates existing

Bone diseases
Infections in bones or

Vascular conditions
Pregnant females
Cardiac or pulmonary