What Is Cervical Traction? – Indications, contraindications

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What Is Cervical Traction?/Cervical traction gently extends the neck, opening the spaces between the cervical vertebrae. This temporarily alleviates pressure on the affected discs.

The practice of spinal traction goes back to the fourth century BC, where Hippocrates first described it as a treatment for kyphosis. It was subsequently implemented in other spinal pathologies including cervical pain and myelopathy. In the 1600s, the Germans employed cervical traction in their medical practice, as an adjunct to open reduction of cervical dislocations, and fractures. In 1929, the Halter device was introduced for the reduction of cervical injuries; then several other devices followed to ensure more efficient traction. To date, there is no accurate description of the mechanism of relief provided by cervical traction. The theory behind its efficiency emphasizes on the widening of the intervertebral foramen upon traction, with separation of the facet joint. This will relieve the sustained pressure on the nerve roots, and hence alleviate symptoms of radiculopathy. Other theories suggest that traction allows for cervical muscle relaxation, and is not involved in intervertebral separation.

Types of Cervical Traction

  • Manual cervical traction – Manual cervical traction is done by a physical therapist. While you’re lying down, they’ll gently pull your head away from your neck. They’ll hold this position for a period of time before releasing and repeating. Your physical therapist will make adjustments to your exact positioning in order to get the best results.
  • Mechanical cervical traction – Mechanical cervical traction is done by a physical therapist. A harness is attached to your head and neck as you’re lying flat on your back. The harness hooks up to a machine or system of weights that apply a traction force to pull your head away from your neck and spine.
  • Over-the-door cervical traction – An over-the-door traction device is for home use. You attach your head and neck to a harness. This is connected to a rope that’s part of a weighted pulley system that goes over a door. This can be done while sitting, leaning back, or lying down.

Indications of Cervical Traction

Cervical traction has been used in a variety of cervical pathologies:

  • Cervical disc disease
  • Cervical spine fracture
  • Facet joint dislocation
  • Atlantoaxial subluxation
  • Occipitocervical synopsis
  • Spondylosis
  • Radiculopathy
  • Foraminal Stenosis
  • Myofascial tightness

Overall, most published studies on cervical traction for spondylosis and myelopathy are of low quality and include a small number of participants. Among the few studies with adequate statistical power, there is no evidence on the long-term benefits of cervical traction, although many articles suggest a definitive temporary relief. Likewise, intermittent traction was not able to achieve a more favorable outcome than its sustained counterpart, despite its theory of increasing blood flow to the spine parenchyma and nerve roots. However, the practice of cervical traction in fractures and facet joint dislocations is important when used along with closed reduction and fixation. In cases of facet joint dislocation, failure of traction suggests the need for surgical intervention. 

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Moreover, the use of cervical traction for atlantoaxial subluxation is well established in the pediatric population as a second-line treatment. Failure to improve after a trial of soft collar and pain management for two weeks necessitates cervical traction. In cases of no improvement after the third week, surgical management is required. Cervical traction is also a standard of practice in occipitocervical synopsis where symptoms are limited to pain, along with a trial of a cervical collar. If neurological deficits are suspected, surgical evaluation is warranted.

Contraindications of Cervical Traction

There are no scientific reports that accurately describe the contraindications and relative contraindications for cervical traction. Probable contraindications and/or relative contraindications to cervical or lumbar traction include the following:

  • Acute torticollis
  • Aortic Aneurysm
  • Active peptic ulcer disease
  • Diskitis
  • Old age
  • Osteomyelitis
  • Osteoporosis
  • Ligamentous instability
  • Primary or metastatic tumor
  • Spinal cord tumor
  • Myelopathy
  • Pregnancy
  • Severe anxiety
  • Untreated hypertension
  • Vertebral-basilar artery insufficiency
  • Midline herniated nucleus pulposus
  • Restrictive lung disease
  • Hernia

Preparation

The patient’s vital signs should be monitored before and immediately following the application of cervical traction in all high-risk patients, especially in those with high blood pressure or cardiac problems. It is important to obtain a detailed history and perform a systematic physical exam, before cervical traction, to rule out any contraindications.

Technique

There are different ways to apply cervical traction to the cervical neck. 

Manual Cervical Traction

Manual traction is mainly for diagnostic purposes, with the ability to confirm a suspected diagnosis after successful relief of symptoms.

  • The head and neck are held in the hands of the practitioner, and then gentle traction of a pulling force is applied.
  • Intermittent periods of traction can be applied, holding each position for about 10 seconds.

It also allows the performer to apply controlled pressure on pressure points, which helps alleviate the patient’s pain. Ideally, it is done at a 20-degree angle of flexion, but the examiner must explore all angles, including the extension of the neck and chin rotation, with a thorough assessment of each position.

Mechanical Cervical Traction

Mechanical traction includes pinning, with the placement of a Halo device around the head; where anterior pins are placed 1 cm above each of the eyebrows, and two posterior pins are placed on the opposite end of the skull. The addition of pins can be essential if further stabilization is required.

  • A harness attaches to the head and neck of the patient while he is laying down on his/her back.
  • The harness is itself attached to a machine that applies a traction force, which can be regulated through a control panel.

Other shorter-term traction devices comprise the Gardner-Wells tongs, which constitute of two pins, pointing upward (towards the vertex of the head), to be placed below the temporal ridge, bilaterally. In both cases, careful pinning is to be applied with a torque pressure of 2 lb to 4 lb in the pediatric population, and up to 8 lb in adults.

Mechanical traction requires a 0-degree angle pull for C1 and C2 pathologies, and a 20-degree angle flexion for below C2 cases. Moreover, the force applied during pull tension must not exceed 10 lb in cases of C1-C2 subluxation, but can otherwise increase up to 45 lb. Some practices require a gradual increase of the pull tension, while others prefer choosing the lowest weight inciting an effective response.

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Over-the-Door Traction

This is a more practical way of applying cervical traction, that is more accessible to outpatient practices.

  • Over-the-door traction entails strapping a harness to the head and neck of the patient that is in a seated position.
  • The harness is connected to a rope in a pulley system over a door. The force is applied using weights (a sandbar or a waterbag) attached to the other end of the rope.

Furthermore, intermittent traction is another modality where a repeated sequence of rest and traction are applied. It is believed to increase blood flow to the nerve roots and spine parenchyma. One must understand that during the rest phase, tension is not entirely released. As a general rule, intermittent traction is the method of choice for degenerative disc disease and/or joint hypomobility. On the other hand, sustained traction is most often used for neck pain of muscle or soft tissue etiology, and/or disc herniations. Cervical traction can be applied while the patient is supine or seated. The supine position is preferred, allowing for more posterior pressure loading. This will ensure cervical muscle relaxation and transmit less pressure on the temporomandibular joint (TMJ). The sitting position is favored only for patients who cannot lay supine for a prolonged period of time, as in cases of patients suffering from reflux esophagitis.

Complications

Complications are rare, providing that patients are adequately screened for conditions that are contraindicated. Postprocedural increase in peripheral nerve pain and a decrease in central pain, increase in neurological symptoms, or sudden disappearance of central pain are alarming signs of traction-induced spinal cord compromise.

Side effects and warnings

Generally, it’s safe to perform cervical traction, but remember that results are different for everyone. The treatment should be totally pain-free.

It’s possible that you can experience side effects such as headache, dizziness, and nausea upon adjusting your body in this manner. This may even lead to fainting. Stop if you experience any of these side effects, and discuss them with your doctor or physical therapist.

It’s possible for you to injure your tissue, neck, or spine. You should avoid cervical traction if you have:

  • rheumatoid arthritis
  • postsurgery hardware such as screws in your neck
  • a recent fracture or injury in the neck area
  • a known tumor in the neck area
  • a bone infection
  • issues or blockages with vertebral or carotid arteries
  • osteoporosis
  • cervical instability
  • spinal hypermobility

It’s important that you follow any safety instructions and recommendations provided by your doctor or by the manufacturer. Make sure you’re performing the movements correctly and using the appropriate amount of weight. Don’t overexert yourself by doing cervical traction for too long. Discontinue use if you experience any pain or irritation or if your symptoms get worse.

Cervical traction exercises

There are several exercises that can be done using cervical traction devices. Make sure to listen to your body and go to your own edge or threshold in terms of stretching and the duration of your exercises.

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To use an air neck traction device, place it around your neck and adjust the straps as necessary. Then, pump it up and wear it for about 20–30 minutes. Do this a few times throughout the day. You can wear the device while doing activities where you tend to slouch.

To use an over-the-door neck traction device, you’ll usually you’ll start with about 10–20 pounds of pulling force, which can be increased as you gain strength. Your physical therapist can recommend the right amount of weight for you to use. Pull and hold the weight for 10–20 seconds and then slowly release. Continue this for 15–30 minutes at a time. You can do this a few times throughout the day.

A Posture Pump is used while you’re lying down. Do a warm-up before using this device. Slowly turn the head side-to-side, then forward and backward, and then lean the neck from side-to-side. Do each exercise 10 times. Then, attach the portable device to your head and increase the pressure so it tightens around your forehead. Once it’s pumped, wait 10 seconds before releasing the air. Do this 15 times. Then inflate the unit and relax in a comfortable position for up to 15 minutes. Make sure you’re not pumping it too much, especially in the beginning. Once you release yourself from the pump, keep your head in line with your spine as you come into a standing position. Repeat the warm-up routine.

You may also wish to incorporate stretching into your daily routine. You can use accessories such as exercise balls or resistance bands. Yoga is another great tool to relieve neck pain, and there is plenty of cervical traction exercises your physical therapist may be able to recommend that don’t require any equipment aside from a bed or table.

The takeaway

Cervical traction may be a safe, wonderfully effective way for you to resolve neck pain. It may provide you with numerous improvements to your body, inspiring you to do it often. Ideally, it will be effective in relieving neck pain and enhancing your overall function.

Always talk to your doctor or physical therapist before beginning any treatment. Touch base with them throughout your therapy to discuss your improvements as well as any side effects. They can also help you to set up a treatment plan that addresses exactly what you need to correct.

References

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