This document discusses different types of traction used in medicine. Traction is used to stretch tissues and separate bony structures. It can be applied to the cervical or lumbar spine through mechanical pulley systems. Traction provides benefits like pain relief and increased mobility by enlarging intervertebral spaces and stretching muscles. It is commonly used for neck/arm pain and low back pain from nerve root compression. Proper technique and forces are important to benefit patients and avoid complications.

1. Dr Manoj Kumar,Dr Manoj Kumar,
Junior Resident, Rehab. Dept., PMCH, PatnaJunior Resident, Rehab. Dept., PMCH, Patna
Dr. Ajit kumar VarmaDr. Ajit kumar Varma
MS, DNB (Rehabilitation)MS, DNB (Rehabilitation)
Patna Medical College
Traction

2. Traction
• Traction is act of drawing / pulling a force which is
used to stretch soft tissues and to separate joint surfaces
or bony fragmentation.
• In medicine, forces are applied to the body generally
to stretch a given part or separate two or more
parts.

3. Purpose
• Goal is to obtain pain relieve and functional
improvement.
• Involves applying a force of sufficient magnitude and
duration in proper direction while simultaneously
registering movement by an equal and opposite force
with proper positioning of the patient and correct angle
of pull traction is to localize to a specific spinal area.

4. Trial of traction
• The force is generally applied through a mechanical
pulley system with weights and establishing either with
a chin strap for the cervical spine for or a pelvic belt for
the lumber spine.
• Irritation or compression of nerve roots whether related
to Trauma the generative process, or compression from
the disc can be benefitted from a trial of traction.

5. Traction Machine

6. Effects of tractive force
• Most often used for neck / arm pain secondary to
cervical nerve root compromise or radiculopathy and
low backache from radiculopathy.
• Specific clinical indications for tractions are
controversial but the anatomical basis for the use of
traction is well established.

7. Anatomical Basis
• Enlarge intervertebral foramina.
• Separate apophyseal joints.
• Stretch muscles and ligaments
• Tighten the Posterior L Ligament to exert centripetal
force on the adjacent annulus fibrosus.
• Enlarge the intervertebral spaces.

8. Salient points
• Theoretically traction may be indicated for any
condition that could benefit from anatomical changes.
• Traction can be manual, mechanized or motorized. Pull
can be continuous sustained, intermittent and can
vary, based on magnitude, duration and direction of
pool.

9. Counter traction
• All the types of treatment must over come the body
resistance to traction which is equal to half of the
weight of the body segment plus resistance of the
involve soft tissue.
• Gravity can be used either to assist or resist the pooling
force .

10. Continuous Traction
• Low force over a long period of time: i.e. 22-40 hours.
• Often used in Spinal traction mostly to assure that the
person remains at rest.
• Sustained traction uses force greater than that used in
continuous traction but less than intermittent.
• It is common practice to treat In- patients daily /
Out patients three time per week.

11. Intermittent traction
• Allows use of greater forces but a shorter period of time.
• The force is gradually increased during each treatment
cycle and best administered by motorized system.
• Pre programm treatment: Time sequence can vary from
7 to 10 seconds of tractive force with 5 second rest, up
to 30 - 60 seconds of traction force followed by 10 to
15 seconds of rest. ( Total Duration 15 minutes only )

12. Intermittent Traction
• On - off cycle is repeated for 15 to 25 minutes. Used in
cervical region to allow use of progressively higher
forces up to 50 pounds which increases vertebral
separation.

13. Cervical Traction
• Posterior vertebral separation is related to angle of pull
with a maximum separation occurring between 20 to 300
cervical flexion.
• The most common reason to fail or to exacerbate
symptoms is applying the force in extension.

14. Cervical Traction
• At least 10 lbs. of force is necessary to counter the
effects of gravity of the head, while 25 lbs. of force is
necessary to provide strengthening of the cervical
lordotic curve and the earliest separation of posterior
vertebral segments .

15. Cervical Traction contd.
• The maximum separation occurs anteriorly at C4 to C5
after 25 minutes and posteriorly at C6 to C7 after 20
minutes.
• The distraction effect is short lived.
• When the patient is noted to be benefitting from the
cervical traction, it can be performed with a home over
the door unit as long as the correct angle for pool is
maintained.

16. Cervical Traction contd.
• Facing the door.
• Patient using traction at home
should never be alone as some one
might need to assist them

17. Cervical traction Sleeping

18. Cervical Air Track

19. Limitations
• Discontinue - If Nausea, dizziness, increased
pain
in soft tissues of neck.
• Cervical region: Midline disc herniation is
contraindication - since traction
could pull the cord in to
contact with the disc.

20. Limitation …. contd.
• Use with caution.
• Patients with history suggestive of Vertebrobasilar
Insufficiency
• Patients with RA and other connective tissue disorders:
High risk for Atlanto-axial insufficiency. Dislocation
and sudden death may occur

21. Lumbar traction
• Requires significantly larges forces than
cervical traction to overcome the body
resistance.
• Pelvic belts or use of gravity by tilting are
necessary to obtain sufficient tractive force to
lumbar spine.

22. Lumbar Traction

23. Lumbar Traction
• Due to the large amount of weight necessary to over
come the bodies resistance in the area, either a thoracic
of chest belt or corset is necessary to hold the upper
body in place during the traction of lower body.

24. Traction table in two pieces

25. Lumbar traction … contd.
• Split traction tables have a stationery half and a mobile
half unit.
• Lower body rests on the mobile half which separates it
from the stationery portion.
• This arrangements allows vertebral separation with
less force at the level were the table is separating.
• Force necessary to overcome surface resistance is
reduced. Treatment can be provided with as little as 80
pounds to 180 pounds