Overview of Cervical Traction
Spinal traction is a practice that has its roots in the fourth century BC. It was first described by the ancient Greek physician Hippocrates as a way to treat a condition called kyphosis, which causes a hunched back. Since then, spinal traction has been used to treat other spine-related issues, like neck pain and myelopathy, a disease affecting the spinal cord.
Fast forward to the1600s, German doctors started using a special technique called cervical traction, often used alongside other treatments to manage neck dislocations and fractures. Much later, in 1929, the Halter device was invented to help treat neck injuries. Since then, many other devices have been created to perform cervical traction more effectively.
Despite its history, we still don’t have a clear understanding of exactly how cervical traction works to alleviate pain. Some believe that the procedure widens the gaps between the bones in the spine, which can relieve pressure on the roots of the nerves, and therefore reduce the symptoms of radiculopathy, a condition caused by damage to the nerve roots resulting in pain or weakness. Others theorize that the procedure helps the muscles in the neck to relax, without necessarily creating a separation between the vertebrae, the small bones that make up the spine.
Why do People Need Cervical Traction
Cervical traction is a treatment technique used for different conditions affecting the neck, including disc disease, fractures, joint dislocation, and more. Let’s explain some of them:
- Cervical Disc Disease: This is a condition that occurs when one of the discs in the spine deteriorates or gets damaged.
- Cervical Spine Fracture: It’s a break or a crack in one of the bones in the neck region of the spine.
- Facet Joint Dislocation: This happens when one of the small joints at the back of the spine dislocates or moves out of its normal position.
- Spondylosis: It’s a type of arthritis sparked by wear and tear to the spine.
- Radiculopathy: This condition occurs when a nerve in the spine is compressed, causing pain, numbness or a tingling feeling.
- Foraminal Stenosis: This is a spinal nerve condition where the space for nerves to exit the spinal column becomes narrower causing pain or discomfort.
- Myofascial Tightness: This happens when the protective layer called fascia that covers your muscles becomes tight and cause pain or discomfort.
However, it’s worth knowing that the research on this treatment isn’t of high quality and the studies involve small numbers of people. There isn’t any solid evidence to show the benefits of cervical traction in the long term, but it has been found to provide some short-term relief. The treatment also shows no real difference whether it’s applied continuously or intermittently. But for certain conditions like fractures and facet joint dislocations, it proves to be an important step when combined with other treatments.
Cervical traction is also used in children for a condition called atlantoaxial subluxation, which is the abnormal positioning of the first two neck bones. This treatment is considered second-line, if the standard treatment doesn’t work. After that, if no improvement is seen over three weeks, surgery may be required. For occipitocervical synopsis, a condition where there are problems connecting the bottom part of the brain and the spine, cervical traction is followed by a trial of a neck brace if the symptoms are only causing pain. However, if there are signs of neurological problems, a surgical examination is needed.
When a Person Should Avoid Cervical Traction
There isn’t any solid scientific research that clearly lists the reasons why a person might not be able to have cervical or lumbar traction therapies. However, there are a few conditions and situations that likely make these treatments not suitable. These may include:
Acute torticollis, which is a sudden onset of neck stiffness and pain.
An aortic aneurysm, which is a balloon-like bulge in the large artery that carries blood from your heart to the rest of your body.
Active peptic ulcer disease, characterized by painful sores or ulcers in the lining of the stomach.
Diskitis, an infection in the spaces between the bones of your spine.
Being elderly or having conditions like osteomyelitis, an infection in the bones, or osteoporosis, a condition that weakens bones and makes them more likely to break.
Instability of the ligaments, which are strong bands of tissue that connect one bone to another.
Presence of a primary (original) or metastatic (spread from another part of the body) tumor, as well as a spinal cord tumor, which is a growth in the spinal cord.
Myelopathy, which is an injury to the spinal cord due to severe arthritis or spine degeneration.
Being pregnant.
Experiencing severe anxiety.
Having untreated high blood pressure.
Having vertebral-basilar artery insufficiency, which means reduced blood flow in the rear of the brain.
Midline herniated nucleus pulposus, a condition where the jelly-like substance in your spinal discs seeps out due to a tear or rupture.
Restrictive lung disease, which makes it harder to fill your lungs with air.
Lastly, having a hernia, which is when an organ pushes through an opening in the muscle or tissue that holds it in place.
Preparing for Cervical Traction
Doctors need to check the patient’s important health signs, like heart rate and blood pressure, before and right after using a neck stretching method called cervical traction. This is especially crucial in patients who have high-risk conditions like heart diseases or high blood pressure. To make sure cervical traction is safe, the doctor will ask about the patient’s medical history and do a thorough check-up. This helps in identifying any possible reasons why this treatment shouldn’t be used.
How is Cervical Traction performed
Cervical traction is a treatment often used for neck pain and discomfort. It works by gently pulling your head away from your neck to create space and relieve pressure. Let’s look at how this is done in three different ways: manual cervical traction, mechanical cervical traction, and over-the-door traction.
Manual Cervical Traction
This type of cervical traction is often used for diagnostic reasons. It can confirm a suspected diagnosis if the symptoms are relieved after treatment. Healthcare professionals do this by holding your head and neck in their hands and applying a gentle pulling force. This may be done in short bursts where each position is held for about 10 seconds. This method also allows for precise pressure on specific sore points. Usually, your head is tilted at a 20-degree angle. However, your healthcare provider will also try different angles including bending your neck backward and turning your chin, to evaluate what works best for you.
Mechanical Cervical Traction
Mechanical traction may involve using a device known as a Halo, which is fitted around your head. Pins are placed around your skull to secure it. This may be essential if you need extra stabilization. You wear a harness while lying down on your back. This harness is attached to a machine that applies the pulling force, which can be adjusted as needed. In certain mechanical traction devices, such as Gardner-Wells tongs, two pins are placed below the sides of your temporal ridge (the line from your temple to ear). In both scenarios, pin placement is done carefully, with a specific amount of force depending on whether the patient is a child or adult. For neck issues involving the first two neckbones (C1 and C2), a straight pulling force is used. For issues below these bones, a 20-degree flexion angle is used. The force applied during pulling should not exceed specific amounts depending on the cervical region involved.
Over-the-Door Traction
This kind of cervical traction is practical and easy to implement even outside a clinical setting. In this technique, while seated, you wear a harness that is attached to a rope in a pulley system over a door. The force comes from weights (such as a sandbag or a waterbag) attached to the other end of the rope.
Intermittent traction can also be used, where a sequence of rest and traction is applied with the belief that it increases blood flow to nerve roots and spine. Importantly, during the rest phase, the tension isn’t completely released. Intermittent traction is generally preferred for degenerative disc disease or limited joint movement. Sustained traction, on the other hand, is used mostly for neck pain that results from muscle or soft tissues issues, and disc herniations.
Finally, cervical traction can be done while the patient is lying down (supine) or seated. Laying down is generally preferred as it puts less strain on the jaw joint and allows neck muscles to relax, however, if a patient can’t lay down for a long time, the seated position is used.
Possible Complications of Cervical Traction
It’s not common for people to face additional problems after their procedure, especially if their doctors have properly checked beforehand for health issues that can make the procedure more risky. Yet, there could be some warning signs to look out for. These include an unusual increase in pain in the nerves of the arms or legs, an increase in neurological symptoms like numbness or tingling, or a sudden absence of pain in the upper body or middle of the back. These could potentially indicate that too much strain was placed on the spinal cord during the procedure.
What Else Should I Know About Cervical Traction?
Cervical traction is a straightforward procedure typically carried out by physical therapists or doctors. It’s used in different ways depending on the type of neck problem being treated. This method is proven to be effective for certain neck issues, like fractures or misaligned neck joints, and has become a go-to strategy for health experts treating these conditions.
However, its effectiveness for a long-term neck condition called cervical spondylosis, where the neck’s bones and cartilage wear down, isn’t entirely sure yet. To help clear this up, scientists could perform studies where they compare outcomes for people who received cervical traction with those who just thought they were receiving it. This would greatly benefit our understanding of how cervical traction can help those with spinal cord spondylosis, a condition where the spinal cord’s bones and cartilage break down.