Traction is a common form of treatment for patients with low back pain. By definition, traction is the "act of pulling a body part." That basically means traction can be applied to an arm, leg, finger, toe... virtually any body part that one can get a hold of. Here, the focus of traction is being applied to the lower part of the spine and the primary objective is for pain relief and restoring function. Traction "works" by applying a force that separates and increases the space between joints. It also stretches the surrounding soft tissues, including ligaments, joint capsules, muscles, and tendons. Spinal traction can be applied manually (with the hands) or by a device with either the use of complicated computerized equipment or by a gravity-assisted means such as using the body’s weight and gravity as the traction force.
Common conditions of the spine for which traction is often utilized include low back sprains and strains, disk herniations ("slipped disks"), and spinal stenosis. Spinal stenosis occurs when there is a narrowing of the hole or canal through which a nerve root exits the spine or where the spinal cord travels, often caused by arthritic spurs. Hence, it is most common after the age of 60 years old. Traction has been shown to improve circulation, reduce inflammation, and by movement of the joints, it may also reduce the nerve’s excitability, resulting in pain reduction.
The "dose" of traction, from a clinical experience standpoint, is determined by patient comfort. When determining the dose of traction for the first time, patients are advised to pay careful attention to the way they feel during the time traction is applied. Often, it feels good at first but may become uncomfortable as time passes. If there is sharp pain, radiating pain (such as down a leg), or if it is just not comfortable, traction should be discontinued and the recovery time should be reported.
A "typical" dose is 10-15 minutes of time, and the traction force can be continuous or intermittent, kind of like turning on a water faucet and leaving it running vs. turning it on and off. With intermittent traction, your doctor can vary the time that the force is applied such as 30 seconds on and 10 seconds off. Generally, the total treatment time can be longer with intermittent traction (such as 15 minutes) compared to continuous traction, where 10 minutes may be utilized. The traction weight or force can be gradually increased, depending on tolerance and individual patient response to the prior weight.
The Cochrane Report found traction is most effective for cases of sciatica or nerve root pressure creating leg pain. Also, it’s best when used in conjunction with other treatment approaches. In a chiropractic setting, manual traction (where the doctor uses their hands to apply the force) is often utilized along with side to side or figure-8 movements to achieve better results. Spinal manipulation, muscles massage, myofascial release techniques, exercise training for both stretch and strengthening purposes, and patient education (such as teaching proper bend/lift/pull/push techniques) are often utilized to achieve the most satisfying results when managing patients with low back pain.
