Traction

Injury type: Acute/ Chronic

Category: Allied Health Options

Rating: No Research

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 systematic review¹ which updated evidence on passive physical modalities suggested that there is ‘not enough or inconsistent evidence to make determination’ with regards to the use of traction for treating recent and persistent whiplash grades I-II. Similarly, a rapid review² synthesised evidence from highest level primary studies, systematic reviews, and well-conducted clinical practice guidelines reported that traction is not recommended as an initial management option for neck pain including whiplash. A review³ identified one methodologically weak trial which compared cervical traction to attention control for patients with chronic neck pain. The trial found no short-term differences in function and pain intensity between the two groups.

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 evidence, there in inconclusive evidence to suggest that traction is a viable treatment option for patients with whiplash injuries. More research is required to warrant a firm conclusion.