Air Neck Traction

Studies Using Neck Traction

An MRI study on the effects of neck traction was performed in 2008 and approved by the IRB from the Holos University Graduate Seminary by C. N. Shealy, MD, PhD. 36 individuals were enrolled for a comparative MRI study with a baseline and then during traction. Disc and other soft tissue protrusions into the anterior subarachnoid space were noted on the initial scan in 35 of 36 subjects. During traction subarachnoid protrusions were reduced in 25 of 35 subjects or 71%. Disc height measurement during traction using digital calipers and measuring to 100th of a millimeter indicated an average posterior disc expansion of 19.02%. Increases in range of motion were noted post traction, however, specific measurements were not indicated.

The fact that protrusions were reduced and eliminated by the decompressive action of the neck traction device supports the belief that disc expansion creates a "bellows like action" possibly imbibing fluid into the disc proper, hydrating the disc.

In Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association presented in Journal of Orthopedic Sports and Physical Therapy. 2008;38(9):A1-A34, they state, "Clinicians should consider the use of mechanical intermittent cervical traction, combined with other interventions such as manual therapy and strengthening exercises, for reducing pain and disability in patients with neck and neck-related arm pain.

A recent article by Raney NH, Petersen EJ, Smith TA, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. In press; indicates 5 variables for likely improvement with neck traction;

1. Patient reported peripheralization with lower cervical spine (C4-7) mobility testing
2. Positive shoulder abduction sign
3. Age greater than 55 years
4. Positive upper limb tension test (median nerve bias utilizing shoulder abduction to 90 degrees)
5. Relief of symptoms using manual distraction test

Having at least 3 out of five of these variables increases the likelihood of success with traction to 79.2%. If at least 4 out of five variables are present, the chances of improvement with cervical traction to 90.2%

A systemic review by Graham and colleagues in the Journal of Rehabilitation Medicine. 2006 May;38(3):145-52; indicated moderate evidence for the use of intermittent traction for mechanical neck disorders. "Indications for this type of intervention include herniated disc, degenerative disc disease and hypomobile facet joints. The physiological effects of such treatment may include separation of vertebral bodies, distraction and gliding of facet joints, widening of the intervertebral foramen, tensing of ligamentous structures, straightening of spinal curves and stretching of spinal musculature. Traction has also been reported to decrease pain by providing muscle relaxation, stimulation of mechanoreceptors and inhibition of reflex muscle guarding."

In Physical Therapy Journal. 2007 Dec;87(12):1619-32, Predictors of short-term outcome in people with a clinical diagnosis of cervical radiculopathy; One of the predictors for success in their multi-modal physical therapy approach for cervical radiculopathy was traction. They indicate ..."it appears that intermittent cervical traction, manual therapy, and deep neck flexor muscle strengthening may be beneficial in the management of cervical radiculopathy." The mean duration of traction was 17.8 minutes with an average force of 24.3 pounds.

In the Journal of Orthopedic Sports and Physical Therapy. 2004 Nov;34(11):701-12, Neck traction has been indicated for the treatment of patients with herniated disc and has been suggested to be helpful for patients with cervical compressive myelopathy. It was noted in this study that neck traction showed a reduction of pain scores and level of disability in patients with mild cervical compressive myelopathy attributed to herniated disc.

Presented in Neurosurgical Focus. 2002 Feb 15;12(2), Cervical radiculopathy was diagnosed in patients if they suffered from radiating arm pain made worse by neck movement and at least one of the following: reflex loss, dermatomal numbness, and/or myotomal weakness. Patients with neck pain alone or arm pain without neurological deficit were excluded from analysis. Those patients without excruciating pain, severe weakness, or evidence of myelopathy were offered a course of neck traction before surgery was to be considered. It was further noted that Sixty-three (78%) of 81 patients responded to neck traction, experiencing significant or total pain relief, three could not tolerate the traction, and traction failed in 15 patients. They concluded that It would appear that in patients in whom symptoms of cervical radiculopathy were present for approximately 6 weeks that 75% will respond to further neck traction and cervical collar over the next 6 weeks.

According to Zylbergold RS, Piper MC: Cervical Spine Disorders – A Comparison of Three Types of Traction. Spine 10:867-871, 1985: Patients receiving traction had better outcomes in terms of cervical spine mobility, decreased pain and less medication use. The authors concluded that cervical traction should be included in the treatment of cervical disorders.

In Arch Phys Med Rehabil 57:12-16, 1976, Honet JC and Puri K: Cervical Radiculitis: Patients were classified as to the severity of radicular symptoms. Depending upon severity, 82 patients were placed in treatment groups. Patients with minimal symptoms received over the door home traction at 15-20 lbs. Patients noted to have moderate pain with more profound clinical neurological deficit were treated as outpatients and required relatively heavier force (15-55 lbs cervical traction). It was noted that patients with moderately severe cervical radicular pain can benefit from relatively high force cervical traction.

Improvement in herniated cervical disc was noted using a portable, air inflated neck traction device as documented in Radiology. 2002 Dec;225(3):895-900, where elongation of the neck was visualized on MRI with traction application. In this study, out of 29 patients, 3 herniated discs were completely resolved and 18 showed a reduction of the herniated discs. It should be noted that our basic air neck traction models have no magnets and are suitable for study using imaging techniques.

Valtonen EJ, Kiuru E: Cervical Traction As A Therapeutic Tool in the Scandinavian Journal of Rehabilitation Medicine 2:29-36, 1970 treated patients diagnosed with cervical syndrome with cervical traction and concluded that cervical traction is a relatively good means of relieving symptoms of cervical syndrome. Aditionally, the authors felt the infrequent use of traction and the short treatment duration was a significant factor in the failure rate of 39% of the subjects. In spite of these limitations, however, 19% had complete cure and 42% had marked improvement with traction. It is theorized that reversal of symptoms will often require patients to use home traction over an extended period of time to obtain relief of symptoms.

Saal JS, et al: Nonoperative Management of Herniated Cervical Intervertebral Disc With Radiculopathy. Spine 21:1877-1883, 1996. Patients with cervical herniated nucleus and radiculopathy were followed for more than one year. The authors concluded that a systematically applied nonsurgical treatment including cervical traction for a clearly defined group of patients with symptomatic cervical disc herniation had outcomes equivalent to results of similar patients treated surgically.

According to the Journal of Manipulative and Physiological Therapeutics. 2002 Mar-Apr;25(3):188-92, Neck traction could be considered as a therapy of choice for radiculopathy caused by herniated discs, even in cases of large-volume herniated discs or recurrent episodes.

In the Journal of Orthopedic Sports and Physical Therapy. 2005;35(12):802-811, a case series was performed using manual physical therapy, cervical traction, and strengthening exercises in patients with cervical radiculopathy. Ninety one percent of patients with cervical radiculopathy in this case series improved, as defined by the patients classifying their level of improvement as at least "quite a bit better" on the global rating of change and achieved clinically meaningful improvement in pain and function.

Martin GM, Corbin KB: An Evaluation of Conservative Treatment for Patients with Cervical Disk Syndrome Archives of Physical Medicine and Rehabilitation 35:87-92, 1954. Patients were diagnosed with cervical disc syndrome by a neurologist. Heat and massage were given to prepare the patient for traction. Fifty-seven percent of the patients continued with home cervical traction, and many continued to use traction for several months following dismissal from the clinic. The authors concluded that the primary reason for patient improvement was due to the traction.

A case series, Clinical outcome from mechanical intermittent cervical traction for the treatment of cervical radiculopathy: Journal of Orthopedic Sports and Physical Therapy. 2001;31(4):207-213, in this series demonstrated complete pain resolution in 53% of patients.

Ellenberg MR, et al: Cervical Radiculopathy. Archives of Physical Medicine and Rehabilitation 75:342-352, 1994. This review article is based on a 10 year Medline search and the references listed in the literature obtained from the search. The authors described the cervical radiculopathy clinical picture, causes, diagnosis and treatment. Home traction treatment is recommended and the authors recommend at least 20 lbs distraction force. The authors caution that over the door traction must be instructed properly as TMJ problems may result. Traction at home may be applied several times per day and some patients benefit from using traction on a long-term basis.

Braaf MM, Rosner S: The Treatment Of Headaches. New York State Medical Journal 53: 687-693, 1953. A clinical report of headache treatment using cervical traction. The authors reported complete alleviation of headaches in 60% and good results (greater than 50% improvement) in 30% of their cases. The report concludes with two case histories describing the treatment and results and the conclusion that permanent relief to symptoms is possible for the majority of chronic headache sufferers.

The Bangladesh Med Res Counc Bull. 2002 Aug;28(2):61-9. Effects of cervical traction and exercise therapy in cervical spondylosis indicates that the improvement of the patients with chronic cervical spondylosis was more in patients using neck traction plus exercise than analgesics. Rehab using cervical traction with neck muscle strengthening exercise have more beneficial effects than NSAIDs on chronic cervical spondylosis.

Clinical Rehabilitation. 2004 Dec;18(8):879-87 used neck traction combined with conventional therapy on grip strength on patients with cervical radiculopathy and noted that the application of neck traction combined with electrotherapy and exercise produced an immediate improvement in the hand grip function in patients with cervical radiculopathy.

The Nigerian Postgraduate Medical Journal. 2006 Sep;13(3):230-5, established 10% Total Body Weight for cervical traction as the ideal weight with minimal side effects and with highest therapeutic efficacy. It was recommended that clinicians could adopt this weight in managing neck disorders requiring traction.

In the Journal of Orthopedic Sports and Physical Therapy. 2006;36(3):152-159, A case series involving diagnosis and treatment of cervical radiculopathy using a clinical prediction rule and a multimodal intervention approach which included intermittent neck traction showed up to 88% reduction in disability.

According to Crisp E: Disc Lesions. Livingstone, Edinburgh 1960. and Shore N, Frankel V and Hoppenfeld S: Cervical Traction and Temporomandibular Joint Dysfunction. Joul Am Dental Assoc. 68(1):4-6, 1964 some patients experience considerable discomfort in the temporomandibular joints with traditional cervical traction. This is particularly true if an abnormal dental occlusion exists such as the absence of posterior teeth. In some cases, the discomfort is so great that the treatment has to be discontinued.

Frankel V, Shore N and Hoppenfeld S: Stress Distribution in Cervical Traction Prevention of Temporomandibular Joint Pain Syndrome. Clin Orth 32:114-115, 1964 Indicate with advancing age, the tissues become more susceptible to disruption and joint trauma, which may be irreversible.

Franks A: Temporomandibular Joint Dysfunction Associated with Cervical Traction. Ann Phys Med 8:38-40, 1967 suggests that cervical traction involving force on the jaw should be carried out with caution. He reported that excessive pressure on the jaw can lead to intracapsular bleeding and hematoma in the temporomandibular joint.