Traction

Rating

Category: Allied Health Options

Injury Type: Acute

What is it?

Traction of the neck involves a stretching force applied to the neck via a mechanical system. The traction device consists of a head halter and pulley system operated either manually using weights or mechanically using an electrical device. The patient is positioned in sitting, reclining or lying on their back and the halter is worn on the head.

Various factors are taken into consideration (such as extent of the injury, pain levels, other symptoms, injury severity, injury irritability, diagnosis, patient size, patients tolerance level etc) when making decision about the weights attached to the pulley. Once it is attached, the spine is gently stretched and distracted. This can be applied continuously or intermittently. A variation of this is manual traction, where the health professional uses their hands to create the distraction force.

How does it work?

Traction aims to stretch and mobilise the spine. Specifically, traction may widen the spaces between the vertebral bones, stretch the joints in the spine, widen the spaces in the spine, tense ligaments, straighten spinal curves and stretch out tight spinal muscles. Traction is also thought to provide muscle relaxation by minimising muscle guarding which may ultimately result in reduced pain.

Is it effective?

A recent review of the literature investigated effectiveness of traction for patients suffering from a variety of neck problems, including whiplash. This high level, high quality research found that there was inconclusive evidence for both continuous and intermittent traction because of the low quality of available literature. They did find that intermittent traction was beneficial in reducing pain; however this finding was not specifically focussed on patients with whiplash and included all patients suffering from chronic neck pain.

They also found that continuous traction did not provide any benefit at all. Another two recent systematic reviews which were specific to whiplash found no evidence to support the use of traction following whiplash injury. One recent systematic review found traction to be effective in reducing pain and improving function following whiplash injury, when the pain was caused by compression of the nerve roots in the neck (radiculopathy). However the authors did not specify whether these changes were maintained in the long term.

Are there any disadvantages?

Traction is not for everyone. Patients whose spinal structural integrity is compromised (such as osteoporosis, tumour, infection, rheumatoid arthritis, fracture) and those with some physical conditions (such as jaw problems) cannot receive traction. People with anxiety problems may not be able tolerate the treatment. Some patients may have headaches after this treatment. You should be provided with a stop button that will release the tension on your neck should you need to. All symptoms during and after traction should be reported to the health professional.

Where do you get it?

Traction is usually performed as part of treatment by a registered health professional. This can include Physiotherapists, Chiropractors and Osteopaths. Some health professionals might provide a home kit where by the patient can utilise home based traction. However, the suitability of this should be determined by the relevant health professional and instructions for use should be provided.

Recommendations

Based on available material, there in inconclusive evidence to suggest that traction is a viable treatment option for patients suffering from whiplash injuries. While there is emerging evidence to suggest that intermittent traction may be beneficial for patients suffering from neck pain, more research is needed to guarantee this produces consistently positive benefits for patients suffering from whiplash injuries.

Key References

  • Graham, N, Gross, AR, Goldsmith, C & The Cervical Overview Group 2006, 'Mechanical Traction for Mechanical Neck Disorders: A Systematic Review', Journal of Rehabilitation Medicine, vol.38, no.3, pp. 145-152.
  • Poorbaugh, K, Brismée, J, Phelps, V & Sizer, P 2008, 'Late whiplash syndrome: a clinical science approach to evidence-based diagnosis and management', Pain Practice, vol. 8, no. 1, pp. 65-89.
  • Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, 'Conservative treatments for whiplash', Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.
  • Yadla, S, Ratliff, J & Harrop, J 2008, 'Whiplash: diagnosis, treatment, and associated injuries', Current Reviews in Musculoskeletal Medicine, vol. 1, pp. 65-68.
Copyright © Centre of National Research on Disability and Rehabilitation Medicine (CONROD)