There are many types of disorders known to cause back pain including those defined
as mechanical and/or compressive. Mechanical back pain commonly stems from injury
or a degenerative process affecting discs, joints, ligaments and/or muscles.
Pain from an irritated or 'compressed' nerve root, such as in Sciatica, is termed
compressive pain.
Conservative forms of treatment may include non-steroidal anti-inflammatory
medication, a muscle relaxant, a prescription drug for pain during the acute
phase, and physical therapy. Along with these therapies, spinal traction may
be recommended.
Therapeutic spinal traction uses manually or mechanically created forces
to stretch and mobilize the spine. Traction may alleviate back pain by stretching
tight spinal muscles that result from spasm and widen intervertebral foramen
to relieve nerve root impingement.
Traction Techniques
Techniques applied in spinal traction are dependent in part on the patient's
physical condition, disorder, individual tolerance, and the spinal level(s)
to be treated. Application of traction may be manual, positional, or mechanical.
Traction may be applied as a continuous force or intermittently. The techniques
presented below are not all inclusive.
Cervical Traction
Manual therapeutic traction is a hands' on approach. The patient lies in
a relaxed and comfortable position on the table supine. The therapist carefully
positions their hands in such a way to support the patient's head during distraction.
The force is gentle, stable, and controlled.
During traction the therapist may reposition the head to one side, flex, or
extend the neck using their hands. A change in head position during traction
may affect more positive results in reducing the patient's symptoms.
A mechanical traction device used to treat the cervical spine is comprised
of a head halter with over-the-door pulley system. Some patients are allowed
to use this system at home after the therapist teaches them how to set the system
up, wear the halter, apply the weights correctly, and duration of traction treatment.
The patient may be able to use the head halter sitting, reclining, or laying
supine.
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Manual Lumbar traction involves distracting almost half of the body's weight
and therefore requires more of the therapist's strength. After the patient is
positioned, the therapist may pull at the ankles, once again using controlled
force. Another technique involves draping the patient's legs over the therapist's
shoulders. The therapist then steadily pulls with their arms positioned across
the patient's thighs. An alternative is a pelvic belt with straps used for distraction.
Mechanical traction may incorporate the use of a motorized split-traction table.
The patient is placed in a pelvic harness secured to one end of the table. Some
motorized units are computerized enabling the therapist to program the patient's
session of therapeutic traction.
Contraindications
When the structural integrity of the spine is compromised, such as in osteoporosis,
infection, tumor, or cervical rheumatoid arthritis, traction is not a treatment
option. Physical conditions such as pregnancy, cardiovascular disease, hernia,
and in some cases TMJ, exclude patients from spinal traction. In these situations,
the forces used in traction (movement) could potentially be dangerous.
Conclusion
Therapeutic spinal traction is not a new concept. Today, the first patient
to experience spinal traction would be more than 100 years old! Since then,
many studies have been conducted to determine the efficacy of spinal traction.
However, these have proved inconclusive.