Everything There Is to Know About Traction Devices

Medical traction devices are the main instruments used for spinal decompression therapy, a type of motorized spinal stretching applied by physiotherapists and chiropractors. Traction devices are used as a conservative treatment of common orthopedic conditions like muscle contractures and stiffness, bone fractures and deformities (e.g. lordosis) and long-term muscle spasms.

For decades, spinal decompression therapy has been applied as a nonsurgical treatment for sciatica, spine disorders, and neck and lower back pain. It works by using weight and pressure, pulling on the body’s structures to stretch muscles, and to relieve tension on the spine. Thus, it provides both immediate pain relief through muscle relaxation and long-term healing by correcting the position of bony structures.  

Cervical traction is a widely used method to treat patients with chronic neck pain. The use of mechanical stretching instruments is a valuable noninvasive treatment with the major advantage of avoiding surgery and its side effects.

In this article we will cover the history of orthopedic traction devices, brands and market leaders, indications, their mechanism of action, and some alternatives that offer the same value.

History of traction devices

Orthopedic principles go back to primitive times. The primitive man applied orthopedic practices like splints and rehabilitation to treat fractures, and the Egyptians carried on these practices. 

Subsequently, the Greeks and Romans greatly improved their understanding of the skeletal system anatomy, and they were the first to describe splints, casting, and bandaging. The practice of skeletal mechanical stretching dates back to the time of Hippocrates and Galen. It was used to correct spinal disorders; however, the idea failed due to a lack of adequate instruments. 

In 1789 Jean Andre Venal introduced the spinal decompression bed as a treatment for scoliosis. Later on, in 1764, corsets and body suspension were introduced to treat pott’s disease and scoliosis. These procedures, however, were painful and not comfortable, which made their use come to an end.

During the First World War, the Thomas splint designed by the British orthopedic surgeon Hugh Owen Thomas was introduced and saved a lot of lives by better controlling the bleeding originating from femoral fractures. Modern traction instruments have been improved for the last 200 years to match the progress in orthopedics.

Indications to use cervical traction devices 

Neck pain relief , treatment of herniated neck discs and cervical spondylosis with radiculopathy are the primary indications of cervical traction.

Cervical disc disease

Intervertebral discs are structures filled with cushioning gel-like substance; they work as the natural shock absorbers of the neck. With time these discs degenerate due to repetitive stress. A degenerated disc narrows the intervertebral spaces, which causes nerve roots to compress. Surgical treatment (discectomy) for cervical disc disease is only needed after the failure of conservative treatment (pain medications and physical therapy). 

The cervical traction for cervical disc disease consists mainly of mechanical stretching, which pulls on the cervical spine. Thus, it relieves pressure on nerve roots by widening the intervertebral space. Cervical traction also stretches neck muscles, alleviating stiffness and painful spasms.

Neck Fracture (Cervical spine Fracture)

A break in one of the seven cervical vertebral bones is a common situation caused by trauma and accidents.

Immediate and complete immobilization of the injured neck area is necessary for optimal recovery. It can be done by neck braces or collars for up to 8 weeks in minor fractures. While in more severe and unstable fractures, external spinal stabilization is applied through Halo Rings, Crowns, or Vests  for at least 12 weeks.

Spine traction and immobilization is an effective treatment for neck fracture. The rates of healing are excellent without the need to perform any surgery.

Cervical spondylosis

Cervical spondylosis (osteoarthritis or neck arthritis) is a condition associated with the aging process. It affects the spine, causing dehydrated and herniated disks, bone spurs, and stiff ligaments and muscles. Eventually, osteoarthritis develops with bony projections along the edges of bones (bone spurs).

The main complication of spondylosis is a radiculopathy; the latter can be managed with spinal mechanical stretching before the nerve damage becomes permanent.

Treatment of radiculopathy associated with spondylosis is found on medications and physical therapy. 

Traction therapy using the Saunders device and high-intensity laser therapy (HILT)  offer immediate analgesic effects and improved neck flexibility. 

Facet joint dislocation

Facet joint dislocation is the anterior translocation of one vertebral body over another without a fracture. It is mainly caused by forced flexion of the cervical spine (seat belt injury). These dislocation injuries are associated with spine instability and possible nerve injury. 

Non-operative treatment consists of cervical orthosis or external immobilization for 6-12 weeks. The reduction of facet dislocation is made by skeletal traction of the skull using weights up to 20 kg with lateral X-ray taken to determine reduction.

Cervical radiculopathy

Cervical nerves exiting the spinal canal through the intervertebral foramen can get injured or damaged by various processes. Cervical radiculopathy is usually caused by:

foraminal stenosis

- osteoarthritis 

- degenerative disc disease

- osteophytes (bone spurs)

A herniated disc is the main cause of radiculopathy among young people.

Other causes of neuropathy are fractures, tumors, infections, and sarcoidosis. Signs and symptoms are related to the affected nerve area. They include pins-and-needles tingling, numbness, and pain, usually radiating to the shoulders and arm. These signs are typically one-sided, but they can occur on both sides.

The treatment for cervical radiculopathy consists mainly of relieving the underlying cause of radiculopathy. Nonsurgical treatments are considered first. They typically include:

- Medications for pain relief (Over-the-counter NSAIDs and steroid injections)

- Physical therapy: a set of exercises and stretching routines may be prescribed by the physical therapist to improve posture and back’s strength

- Cervical traction: Mechanical traction is applied by the therapist in a clinical setting, and if it offers pain relief, a home traction device (over the door traction) is recommended.

Other indications of spine traction 

Decompression therapy is not solely used to treat cervical spine disorders. It is also performed to alleviate the common complaint of lower back pain, which is mostly caused by the same pathological processes affecting the neck vertebrae.

Sciatica is the name referred to radiculopathy when it affects the sciatic nerve. In this case, spinal traction has better outcomes when combined with other physical therapy modalities such as stretching and rehab exercises.

Complications of using cervical traction devices

Using Over-the-Door devices with their various types is safe, with little side effects. Complications are mainly caused when the instructions are not followed. If one is not familiar with the device, there is a chance to injure oneself or aggravate current injuries like osteoarthritis or osteoporosis. The common complaint after misuse of the instrument is jaw pain due to Temporomandibular joint compression.

The Journal of Orthopaedic & Sports Physical Therapy released a paper, confirming the efficiency of these instruments “Adding mechanical traction to a standard exercise program for patients with neck pain and signs of cervical radiculopathy resulted in lower disability and pain intensity ratings when compared to exercise alone or exercise with the addition of an over-door traction device.”

However, the Halo devices, mainly used for fractured necks, are associated with the following complications:

- Pressure sores: they can develop under a halo plaster cast or a prefabricated vest.

- Pin-Loosening or penetration: rather than being secured to the skull, the pin can twist freely, which may cause infections.

General specifications of cervical traction devices

There are many types of traction devices with different designs and indications. We will cover the three basic options along with their specifications.

The over-the-door traction device relieves tension on the neck and spine by pulling the user’s chin upwards through the use of a counterweight (suspended bag).

Common specifications:

- Water Bag Capacity: 20 lb

- Halter Size: Universal

Pneumatic Inflatable Collar Device: this apparatus resembles a neck pillow that allows for gentle spinal stretch. The user controls the pressure.

Common specifications:

-Maximum Inflation: 7 inches

-Manufacturer Warranty: 1 Year

Posture pumps are used while the user is lying on his back; it maintains a good spinal posture and relieves nerve pain.

Common specifications:

- Weight: 2.5 to 10 lbs

- Pressure Level: Moderate.

Brands and market leaders 

1. Saunders Cervical HomeTrac: this apparatus is among the highly-recommended and positively-reviewed devices. Mainly because it offers high precision through the patient’s control of the pressure delivered by the gauge, it also has the advantage of preventing compression of the TMJ.

2. CerviCo2000 Cervical Decompression by Meditrac: with its revolutionary 3-dimensional structure, it offers therapeutic effect while the user remains active.

3. Pronex Pneumatic Cervical Traction System by RS Medical: this device is simple and easy to use. There is no need for assembly or management of cables, springs, or levers.

Conclusion

Traction therapy has greatly improved for the past 200 years. Today various traction devices and instruments are used as a conservative treatment to avoid orthopedic surgery and the side effects of medications. Traction devices provide both instant relief of the common neck pain and long-term correction of cervical spine disorders.

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