Spinal traction is a technique that applies a distractive force to stretch soft tissues and separate joint surfaces in the spine. Cervical traction is commonly used to treat cervical injuries like herniated discs by relieving pressure on nerves. Lumbar traction requires higher forces, around 30-50% of body weight, to separate vertebrae in the lower back. Studies on lumbar traction's effectiveness in relieving pain and improving mobility have had mixed results. Traction can be contraindicated for conditions like unstable spines, rheumatoid arthritis, or tumors.

1. SPINAL TRACTION
(Cervical & Lumbar)
Aditya Johan Romadhon

2. Introduction
Traction is the technique in which a
distractive force is applied to a part of
the body to stretch soft tissues and to
separate joint surfaces or bone
fragments
Cyriax popularized traction in the
1950s as a treatment for lumbar disc
lesions
Prior to that, traction
was mainly used in the
treatment of fractures

3. Cervical traction effect
Cervical traction is used for a number of cervical spine injuries
Cervical herniated nucleus pulposus, radiculopathy, strains,
zygapophyseal joint syndromes and myofascial pain
The main reason for its use is relief of pain
Pain relief may occur through one of several mechanisms
Rest through immobilization and support of the head
Distraction of the zygapophyseal joints and associated
improved nutrition to the articular cartilage
Decreasing intradiscal pressure
Relieving nerve root pressure via increased foraminal diameter
Elongating muscles to improve blood flow and reduce spasm

4. Cervical traction applied
Usually 25–40 pounds is necessary (11.3 to 18 Kg)
In sitting, the pull must be sufficient to support the head
Eight to ten pounds is a usual starting point (3.6 to 4.5 Kg)
In the supine position, the force must be sufficient enough to overcome friction and must have a pull of at least half the weight of the head
The supine position may be more effective than sitting, as it allows more relaxation
With cervical traction, the optimal angle of pull (to obtain the most distractive force with the least weight) is 20–30˚ of head flexion
The direction of pull can be vertical, horizontal or at an angle
Traction can be delivered manually, through weights and pulleys or via a mechanical device

5. Cervical traction can be continuous or
intermittent
Continuous traction will allow quieting of
the stretch reflex and decrease muscle
guarding
It will also allow separation of the posterior
structures (zygapophyseal joints) if
maintained for at least 7 s at a time
Intermittent traction is believed to act by
cyclically causing muscle contraction and
relaxation thereby increasing blood flow in a
‘massage-like’ action

6. Lumbar traction applied
de Seze S, Levernieux J. Pratique rheumatologie des tractions vertebrales. Sem Hop Paris
1951; 27:2085.
For conditions requiring separation of the intervertebral spaces for a therapeutic effect, a relatively high force (40-50% of the body weight)
and low treatment times (8-12 minutes) are recommended
The maximum force that a patient can tolerate is often used
Generally, at least onequarter of the body weight must be used just to overcome the friction of lumbar traction
And 810 pounds (367 Kg) were required to obtain a separation of 2 mm at the L3–4 level
de Seze and Levernieux estimated that a tractive force of 730 pounds (331 Kg) was required to obtain a separation of 1.5 mm at the L4–5
vertebral level
The traction load necessary to produce vertebral separation in the lumbar spine is much greater than that required to produce vertebral
separation in the cervical spine

7. Lumbar traction effect
Meszaros et al, attempted to
determine the effects of three
different amounts of force
(10%, 30% and 60% body
weight) on pain free mobility
as measured by a straight leg
raise (SLR) test
The mean SLR
measurements significantly
increased from pre-traction
levels for both the 30% and
60% of body weight traction
groups but not the 10% body
weight group
Meszaros TF, Olson R, Kulig K, Creighton D, Czarnecki E. Effect of 10%, 30%, and 60% body weight
traction on the straight leg raise test of symptomatic patients with low back pain. J Orthop Sports Phys
Ther 2000; 30:595–601.

8. Lumbar traction effect
Christie’s controlled study of traction
in the treatment of acute and chronic
lumbar pain – with and without root
signs – showed that traction, when
effective, was most useful in patients
with chronic backaches with root
signs
Weber’s double-blinded, controlled
study of patients with sciatica from a
prolapsed disc treated with traction or
simulated traction failed to show any
significant difference in pain, mobility
of the lumbar spine, or the presence
of neurologic signs in either group
Beneficial effects of lumbar traction
were suggested in only 3 of 14
randomized studies and in only 1 of
the 11 studies that the authors
considered to be of better quality
Crisp EJ, Cyriax JH, Christie BG. Discussion on the treatment of backache by traction. Proc R Soc Med 1955;
48:805–814.
Weber H. Traction therapy in sciatica due to disc prolapse. J Oslo City Hosp 1973; 23:167.

9. Contraindications to the use of spinal traction
Unstable spine
Ligamentous instability
Vertebrobasilar artery insufficiency
Atlantoaxial instability
Rheumatoid arthritis
Osteomyelitis
Discitis
Neoplasm
Severe osteoporosis
Untreated hypertension
Severe anxiety
Cauda equina syndrome
Myelopathy

10. THANKS
Press, J. M., & Bergfeld, D. A. (2007). Physical Modalities. Clinical Sports Medicine, 207–226. doi:10.1016/b978-
141602443-9.50019-2