What is a Cervical Traction, its Types, Contraindication
What is Cervical Traction?
Cervical traction is a therapeutic tool used in physical therapy for management of neck pain and other conditions such as cervical radiculopathy. The human spine is made up of spinal bones called as vertebrae, which are stacked upon each other. In the neck region, there is a disc present between each of these vertebrae and they are known as cervical discs. Cervical traction works on the principle of releasing abnormal pressure build up over these cervical discs by separating the vertebrae in the neck. Cervical traction helps in reducing the compressive forces over the affected portion on the neck. It also helps in widening the spaces between the cervical bones, through which nerves exit the spinal canal. This in turn provides relief to the compressed nerves. Cervical traction also helps in pain management by stretching the muscles and joints around the cervical area.
Types of Cervical Traction
There are 3 types of cervical traction – Manual cervical traction, mechanical cervical traction, and over-the-door traction. Based on the extent and severity of the condition, cervical traction is used for treatment of the following conditions:
- Bulging discs in the neck or herniated discs
- Cervical arthritis or neck arthritis
- Muscle strain over the neck
- Cervical muscle spasms
However, certain precautions and safety measures should be taken while carrying out cervical traction. Cervical traction is not necessarily beneficial in all cervical issues and it is contraindicated in certain conditions as it may lead to worsening of the condition.
Cervical Traction Contraindications
Although there are no specific scientific report stating the contraindications of cervical traction, most of the experienced physicians believe that cervical traction should be avoided in presence of the following conditions:
Acute Cervical Injury:
Cervical traction should be avoided in presence on acute cervical injury as the mechanical force used during cervical traction procedure may worsen the condition. Cervical traction may aggravate the existing pain and inflammation and may lead to development of new strains, muscle sprains and ligament injury over the neck region.
Osteomyelitis as a Contraindication of Cervical Traction:
A large number of physicians believe cervical traction should not be considered for management of neck pain in the presence of osteomyelitis or bone infection. Additional pressure over the affected area may lead to spread of infection to other area. It can also cause weakening of the cervical bones and even fracture.
As per the Canadian Chiropractic Association, cervical traction is strictly contraindicated in presence of cervical instability such as unhealed fractures, acute vertebral fractures, ligamentous instability, severe osteoporosis etc. Cervical traction in these conditions can lead to worsening of the symptoms.
In the presence of neck condition associated with excessive joint motion or hypermobility, cervical traction should not be a choice of treatment. Cervical traction can lead to an injury if a stretch force is applied to hyper mobile vertebrae.
Cervical traction should be avoided in patients who are known to have tumors in the cervical region. Mechanical force applied during cervical traction procedure can disrupt the existing tumor and could cause damage over the spinal cord. This can also lead to metastasis or spread of malignancy to other body parts of the patient.
As per a study done by Kisner and Colby, cervical traction is contraindicated in presence of rheumatoid arthritis. This is because rheumatoid arthritis is an auto immune disease which causes weakening and damage of ligaments that support the cervical vertebrae. Any additional traction force can lead to spinal cord injury from dislocation of the cervical spine. It should be also noted that patients with advanced rheumatoid arthritis or any other connective tissue disease are at a higher risk of developing a condition called as atlantoaxial instability, if the patient is exposed to cervical traction.
Other Contraindications of Cervical Traction Includes but not Limited to:
- Old age
- Ligamentous instability
- Clinical signs of myelopathy
- Severe anxiety
- Uncontrolled hypertension
- Presence of vertebral artery insufficiency (increased susceptibility to cerebrovascular complications)
- Midline herniated nucleus pulposus
- Acute torticollis
- Restrictive lung disease
- Cervical hernia
- Aortic aneurysm
- Active peptic ulcer
- Systemic anti-coagulation treatment
- Severe diabetes or atherosclerotic disease
- Degenerative joint disease
- Congenital joint laxity
- Aseptic necrosis
- Local aneurysm
Cervical traction should not be considered as the main option of treatment for management of neck pain. It should rather be considered as an adjunct to the conventional treatment methods. It is considered safe as far as it does not worsen the existing condition and is used gradually within tolerable and comfortable stretch. Minor soreness and discomfort over the neck post traction is considered normal; however, anything beyond that is considered abnormal. Cervical traction is particularly contraindicated in the presence of conditions such as spinal fracture, unhealed fracture, fresh neck injury, malignancies or spinal tumors etc. It is advised to consult an experienced physician and a physical therapist for a clear diagnosis before considering these treatment options.
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