Air Neck Traction

Studies Using Neck Traction

Cervical radiculopathies: conservative approaches to management, Phys Med Rehabil Clin N Am 13 (2002) 589–608. "It is believed that traction is particularly useful in conditions that involve compression of the nerve root. Traction seems to provide this benefit by enlarging intervertebral foramina, separating apophyseal joints, stretching muscles and ligaments, tightening the posterior longitudinal ligament to exert a centripetal force on the adjacent annulus fibrosis and enlarging the intervertebral space, diminishing disc protrusion, reducing cervical disc space pressure, separating intervertebral joints, stretching a tight or painful capsule, releasing entrapped synovial membrane, freeing adherent nerve roots, producing central vacuum to reduce herniated disc, producing posterior longitudinal ligament tension to reduce herniated disc, and relaxing muscle spasms."

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%

Elnaggar et al. concluded, "Both of the intermittent and the continuous cervical traction had a significant effect on neck and arm pain reduction, a significant improvement in nerve function, and a significant increase in neck mobility." Egypt J. Neurol. Psychiat. Neurosurg. Vol. 46 (2) - July 2009

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.

Spine Volume 34, Number 16, pp 1658–1662 2009, The Influence of Cervical Traction, Compression, and Spurling Test on Cervical Intervertebral Foramen Size showed that inducing cervical traction increased the crosssectional area of the right C4/C5–C6/C7 intervertebral foramen to around 120% of its original size in young healthy subjects.

In Vopr Kurortol Fizioter Lech Fiz Kult. 2013 May-Jun;(3):11-5, The application of physical factors for the rehabilitative treatment of vertebrogenic cerebral dyscirculation: The authors indicated that, along with massage, the effects of traction on arterial pressure in the patients with concomitant arterial hypertension was reduced in conjunction with the improvement of venous outflow characteristics.

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.

A study in the European Spine Journal. 2009 Jun 16, Comparison of the intervertebral disc spaces between axial and anterior lean cervical traction, documented the application of anterior lean traction, the statistical increases were detected both in anterior and in posterior disc spaces compared to the baseline (0.29 mm and 0.24 mm) and axial traction (0.16 mm and 0.35 mm; both). The greater intervertebral disc spaces obtained during anterior lean traction might be associated with the more even distribution of traction forces over the anterior and posterior neck structures. The neck extension moment through mandible that generally occurred in the axial traction could be counteracted by the downward force of head weight during anterior lean traction. This study quantitatively demonstrated that anterior lean traction in sitting position provided more intervertebral disc space enlargements in both anterior and posterior aspects than axial traction did.

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.

Voltonen et al. : Comparative radiographic study of intermittent and continuous traction on elongation of cervical spine. J. Ann. Med. Intern. 1996; 57: 143-146. concluded, concluded that traction relieves muscle spasm and significantly decreases electrical activity in the muscles producing relaxation, which leads to systematic relief of pain.

The Journal of Orthopaedic Science. Volume 7, Number 2: March, 2002, published an article titled Research on the effectiveness of intermittent cervical traction therapy, using short-latency somatosensory evoked potentials. Changes were noted in SSEPs following traction, the interpeak latencies for patients with type I and II myelopathy decreased, and the severity of myelopathy was inversely related to the degree of decrease. The interpeak latencies for patients with cervical radiculopathy decreased, and patients with cervical sprain accompanied by autonomic nervous symptoms also decreased. They concluded, "Traction therapy might improve conduction disturbance primarily by increasing the amount of blood flow from the nerve roots to the spinal parenchyma." This article indicates that cervical traction was effective for mild myelopathy, radiculopathy and cervical sprain (e.g., whiplash).

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. The article illustrates the potential for successful treatment with cervical traction in patients with large-volume herniated cervical disks or with recurrent episodes of radiculopathy. The authors state, "Because large and extruded disks have wider exposure to these resorption mechanisms, they tend to regress more rapidly and the response to early therapeutic intervention is better."

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.

McElhannon, J. E. (1984). Physio-therapeutic treatment of myofascial disorders. Anaheim Hills, CA: In the cervical area, he states that traction of the cervical spine should never start with less than 15 pounds, and never less than 50 pounds in the lumbar, as this poundage is necessary to overcome muscle tension, and less pounds will actually aggravate the patient by introducing reflex spasm. He recommends 3 days of steady traction and then three times a week for 6-8 weeks, with considerable improvement expected after three to five treatments. If the patient does not improve after three treatments, the poundage is increased by 10 pounds. Cervical traction goes up to 60 pounds, and even higher in large male patients, and lumbar traction goes up to 125 pounds.

In Advances in Physiotherapy Volume 5, Issue 3 September 2003 , pages 114 - 121, Evaluation of Effects of Cervical Traction on Spinal Structures by Computerized Tomography. "The herniated disc level was C5-C6 in eight of the patients. Changes following traction were: regression of herniated disc area, increase in spinal canal area (11.21 mm2), spinal column elongation between C2 and C7 (l.39 mm) and intervertebral discal space widening at the C5-C6 level. Cervical traction has a significant biomechanical effect on spinal structures, which can be demonstrated by CT evaluation before and after traction."

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.

In the Nippon Medical Journal. Apr;61(2):137-47, 1994: Effects of intermittent cervical traction on muscle pain. EMG and flowmetric studies on cervical paraspinals. It was concluded that cervical intermittent traction is effective in relieving pain, increasing the frequency of myoelectric signals and improving blood flow in affected muscles.

Judovich, B. D. (1954). Lumbar traction therapy dissipated force factors. Lancet, 74, 411-414. In the cervical area, this author reported that it required 30-40 pounds to demonstrate a beginning widening of the intervertebral spaces.

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.

Clinical trial of cervical traction modality with electromyographic biofeedback. Am J Phys Med Rehabil 76(1):19-25, 1997, Wong et al. [36] reported a significant decrease in paraspinal muscle activity during sitting traction with a rope angle of 25. The distribution of forces in cervical traction was documented to have a better efficacy with the neck flexion ranging from 20 to 35 degrees. They further noted, There was a significant decrease of EMG activity during the whole traction phase, especially at pull phase.

The Traction Angle and Cervical Intervertebral Separation published in Spine. 1992 Feb Volume 17 - Issue 2, "The separation of facet joint surfaces was found after traction at 15[degrees] extension, but not in the neutral or flexion positions." The article continued to note, "In all cases, the anterior and posterior intervertebral spaces were increased by traction at neutral position and in 30[degrees]flexion, but not in 15[degrees] extension."

In The effects of early mobilization and immobilization on the healing process following muscle injuries. Sports Med 15(2):78-89, 1993, low load (5-20 lb), long duration (15 minutes or more) traction will allow improved healing and function in cervical trauma.

According to the Journal of Biomechanical Engineering. 1996 Nov;118(4):597-600, Design and assessment of an adaptive intermittent cervical traction modality with EMG biofeedback., Lee MY et al. state "These results not only support the clinical use of intermittent, sitting traction to produce cervical paraspinal muscle relaxation, but also revealed that the average myoelectric activity of cervical paraspinal muscle during traction was reduced as traction force increased over the 7-week duration of traction treatment."

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.

The American Journal of Physical Medicine & Rehabilitation. Efficacy of Home Cervical Traction Therapy 78(1):30-32, January/February 1999, noted a home cervical traction modality provided symptomatic relief in 81% of the patients with mild to moderately severe (Grade 3) cervical spondylosis syndromes.

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.

Braaf, M. M., & Rosner, S. (1965). More recent concepts on the treatment of headache. Headache, 5, 38-44. "Cervical traction is the most effective method, not only for giving symptomatic relief, but also for preventing the occurrence of headache on a permanent basis .... Chronic headache can be prevented by early recognition of the cervical lesion as a cause of the headache followed by adequate treatment directed towards the cervical spine."

Cervical traction increases blood flow to neck mucscles 2 minutes after it is applied according to Shirai Y, et al: Intermittent cervical traction in subjects with neck and shoulder pain-Analysis of a blood flow volume and EMG signals. Sogo-Riha 23: 25-30, 1995 (In Japanese)

In the Spine Journal. 2008 Jul-Aug;8(4):619-23, Quantitative changes in the cervical neural foramen resulting from axial traction, noted a significant increase in intervertebral foraminal area and height after each 5-kg increment in traction weight compared with the position in which no weight was applied.

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.

In relation to clinical reasoning for traction therapy and disc degeneration, Spine. 2006 Jul 1;31(15):1658-65, Guehring T, et al.: Disc distraction shows evidence of regenerative potential in degenerated intervertebral discs as evaluated by protein expression, magnetic resonance imaging, and messenger ribonucleic acid expression analysis noted, "Distraction results in disc rehydration, stimulated extracellular matrix gene expression, and increased numbers of protein-expressing cells." Further notes: "Axial distraction not only influences hydration but may also impact disc nutrition. Fluid movement in and out of the disc affects nutrient transportation. The major pathway is through the cartilage endplate via capillaries from the vertebral body. Disc injuries, endplate sclerosis, and mechanical environment can restrict nutrient supply." It is stated in the conclusion: "Disc repair fundamentally depends on the stage of disc degeneration. Once nutrition is impaired, it seems unrealistic that biologic methods such as cell or gene therapy are successful, and, therefore, there is a definite need for a prior improvement of disc nutrition. As a conclusion of this study and with respect to previous reports, disc distraction enhances hydration in the degenerated disc and may also improve disc nutrition via the endplates. This process leads to stimulated matrix gene expression as potential expression of improved cellular environment."

Spine Volume 31, Number 2, pp E39–E43 2006, indicated there was no statistically significant difference in posterior intervertebral separation comparing traction angles of 0° and 30°. It was further discussed, "Increasing the rope angle and flexing the cervical spine may produce undesirable effects to the foramen and soft tissue. The intervertebral foramina enlarge with flexion and narrow with extension. However, research suggests that flexing the cervical spine beyond the straight position (reversal of the lordosis) decreases the space available for the spinal nerves within the intervertebral foramen. As the rope angle increases, the myoelectric activity of the cervical musculature during traction also increases. Muscle contraction could negate the effect of traction and cause a narrowing of the foramina. Subjects with neck pain, positioned at a 0° rope angle, recorded no myoelectric activity as measured by electromyogram."

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.

Lawson, G. A., & Godfrey, C. M. (1958). A report on studies of spinal traction. Medical Services Journal of Canada, 14, 762-771. These authors used spinal traction with weights up to 100 pounds on the cervical area and 150 pounds on the lumbar region for varying amounts of time and showed increases of up to 4 mm with the disc spaces in the lumbar area.

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.

Braaf, M. M., & Rosner, S. (1960). Chronic headache: A study of over 2,000 cases. New York State Journal of Medicine, 60, 3987 3994. headache, chronic headache of cervical origin is a referred symptom caused by compression or irritation of one or more cervical nerve roots or portions thereof, trauma to the cervical spine is the prime factor in producing cervical nerve root irritation, and headache can be treated successfully by cervical traction. They state that 80% are completely relieved on a permanent basis with traction. Another 15% obtain satisfactory relief to carry on normal existence with this approach. They consider neck traction specific for headache of cerebral origin and by far the most effective method.