General Modality Information
Mechanical Traction Lesson 1
Lesson 1 of 4
Overview
Traction has been used to treat neuromusculoskeletal conditions for centuries, and possibly millennia. In the mid-19th century, explorer Edwin Smith discovered devices in the Egyptian papyri used for traction in treating spinal conditions, dating 3,000 B.C. Hippocrates also has recorded accounts of using manual traction several centuries ago, “Hippocrates advocated that the patient be given a steam bath and then placed prone, bound to a board, and traction applied by assistants, pulling on head and feet. While this was being done, the physician would press sharply on the affected area, or sit on the back and bounce up and down or even stand on the back.”
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Mechanical Traction Lesson 2
Lesson 2 of 4
Anatomy Review
To better understand the effects of traction, as well as the indications and treatment parameters, it would be helpful if to review the anatomical structures associated with the spine.
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Mechanical Traction Lesson 3
Lesson 3 of 4
Effects of Mechanical Traction
The effects of mechanical traction are similar to applying distraction to other parts of the body. However, as described in the anatomy review, some dissimilarity exists. First is the presence of intervertebral discs. Although there is fibrocartilage in other areas of the body, the presence of IVDs further complicates the other major dissimilarity, the spinal cord and associated structures, to include spinal nerve roots.
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Mechanical Traction Lesson 4
Lesson 4 of 4
Determination of Protocol
When determining the protocol to use on a patient, there are two most important factors. First, is the stage of injury and healing. As with other modalities and therapies, improper protocols can result in misapplication and/or delay healing. As seen in previous years, application of traction using older protocols limited the outcome and many patients were treated improperly and too rapidly. Second, the diagnosis must be made. When a diagnosis is not made, we cannot expect the same protocol to treat a multitude of conditions, much in the same fashion the application of any other modality should be based on patient indications.
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Traction Case Study 1
Case Study
History
Patient: 50-year-old female
Date of Onset: 3/3/06
Symptoms: Lumbar pain: 5-7 out of 10. (L) low back pain and (L) leg symptoms including pain/paraesthesias into (L) calf region.
MRI Findings: Positive for disc pathology @ L5-S1, encroaching the left foramen
Functional activities (ADL): Patient has functional deficits related to transitional pain and difficulty gaining an erect, upright posture. Painful, initiation of the gait cycle and difficulty with sustained flexion oriented activities.
Medication: No known meds
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Traction Case Study 2
Case Study
History
Patient: 51-year-old male
Date of Onset: December 2005
Symptoms: Lumbar pain, developed lower back and (L) leg symptoms, especially in the (L) posterior calf region. Pain was worse with standing and walking. Patient rated pain at 5-9 out of 10 upon initial visit.
MRI Findings: L4-5 disc herniation
Functional activities (ADL): Decreased capacity to sleep as a result of trouble with turning and changing position in bed.
Medication: No known meds
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Traction Case Study 3
Case Study
History
Patient: 54-year-old male
Symptoms: Lumbar pain at worst: 6 out of 10 with gradual onset. Trunk and back stiffness and limited mobility present during the first 4 hours of the day or following prolonged sitting activities, which aggravate the pain.
Functional activities (ADL): Patient currently working full-time and works a regular schedule despite pain.
Past medical history: Patient has a 5-year history of L4-L5 HNP with laminectomy, Cervical Spondylosis, and leukemia.
Medication: No known meds related to back issues
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Traction Case Study 4
Case Study
History
Patient: 55-year-old male
Symptoms: Neck pain started 37 days prior to evaluation. Left arm pain started 7 days prior to evaluation and radiated to the wrist and hand. Neck pain at worst: 6 out of 10; arm and hand pain 8 out of 10.
Functional activities (ADL): Prior to his arm pain the patient worked full time and performed his normal duties. In the past week the arm pain and tingling decreased his ability to work full duty with reduced shoulder to overhead reaching activities. Time overhead or shoulder height job function was reduced to less than 10 minutes.
Past medical history: Patient has a history of heart bypass surgery, cervical and lumbar pain.
Medication: Anti-inflammatory medication and occasionally pain medication at night before bedtime.
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Traction Case Study 5
Case Study
History
Patient: 76-year-old male with a diagnosis of Cervical Spondylosis.
Symptoms: Chief complaint includes lack of range of motion and discomfort. Patient reports symptoms as a gradual tightening through the left side of his neck with pain. Pain began about 4 ½ weeks ago and became severe about 2 weeks ago, starting in the center of his back around his shoulder blades and progressed (radiating) into his left shoulder / neck as well as the right neck and scalp. Symptoms are increased with stiffness in the mornings and are decreased with medication and activity. At worst, pain on the VAS is 10 on a 0-10 scale.
Functional Activities (ADL): Patient retired 2 years ago. He is an avid fly fisherman and golfer but has been limited secondary to his pain / discomfort. Patient reports he works out on a daily basis including stretching, recumbent bike and weight lifting.
Past Medical History: Includes scoliosis in the lumbar region, Right total knee replacement, Rotator Cuff/shoulder impingement surgery and left side hernia repair.
Medications: Aspirin
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General Modality Bibliography
Traction Review of Available Literature
The purpose of this literature review is to present available evidence related to mechanical traction as a therapy for back and neck impairments and to identify limitations of the literature.
John Kelly, MPT
The purpose of this literature review is to present available evidence related to mechanical traction as a therapy for back and neck impairments and to identify limitations of the literature.
Research reports are generally encouraging on outcomes from mechanical traction and reported treatment combinations seem to improve pain, function and patient satisfaction, even to the point of reduced perception of disablement. Mechanical traction effects are well documented and anatomical changes during traction can be observed.
However, research interpretation is challenging because of sometimes confounding variables and inadequate design quality. As with many clinical applications, opinions vary regarding application methods and results.
Systematic reviews on the subject are few, leading some to refrain from using mechanical traction as a specific modality for back or neck impairments. Further high quality studies are needed to develop guidelines for evidence-based practice.
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Traction Abstract References
References
Cited References
Pensri P, Foster NE, Srisuk S, Baxter GD, McDonough SM. Physiotherapy management of low back pain in Thailand: a study of practice. Physiother Res Int. 2005;10(4):201-12.
Pickar JG. Neurophysiological effects of spinal manipulation. Spine J. 2002 Sep-Oct;2(5):357-71.
Oliphant D. Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment. J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):197-210.
Colloca CJ, Hinrichs RN. The biomechanical and clinical significance of the lumbar erector spinae flexion-relaxation phenomenon: a review of literature. J Manipulative Physiol Ther. 2005 Oct;28(8):623-31.
Dickey JP, McNorton S, Potvin JR. Repeated spinal flexion modulates the flexion-relaxation phenomenon. Clin Biomech (Bristol, Avon). 2003 Nov;18(9):783-9.
Masuda T, Miyamoto K, Oguri K, Matsuoka T, Shimizu K. Relationship between the thickness and hemodynamics of the erector spinae muscles in various lumbar curvatures. Clin Biomech (Bristol, Avon). 2005 Mar;20(3):247-53.
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Product-Specific Brochure
Triton DTS Brochure
Triton DTS Traction System Brochure
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Traction White Paper
Triton® Traction: Improved therapeutic solutions for a broader range of patients
Since the late 1950s when Dr. James Cyriax’s work established the practice of using manual traction for the treatment of back and leg pain caused by protruding discs, the use of manual and mechanical traction has steadily gained the confidence of clinicians and the gratitude of chronic pain sufferers. Traction research points to the beneficial effects of traction because it can distract joint surfaces, reduce protrusions of nuclear discal material, stretch soft tissue, relax muscles and mobilize joints. These effects provide many patients with pain relief from spinal dysfunction. The stimulation of sensory mechanoreceptors that occurs with the application
of traction may also gate the transmission of pain.
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