Traction
Traction is used to alleviate pain and improve circulation for various conditions, including a disc bulge or herniation, nerve root impingement, joint hypomobility, subacute joint inflammation, and paraspinal muscle spasms

Be sure to perform a neuro exam prior to beginning traction, in order to recognize any neurological abnormalities or changes with application of traction. Mechanical traction provides joint distraction at the apophyseal joints of the spine (temporary effects). Also, traction creates widening of the foramen (to reduce pressure on a compressed nerve), reduction of disc protrusion (thought to occur through tensing of the posterior longitudinal ligament and/or through proposed suction action at the intervertebral joint), soft tissue stretch, muscle relaxation (through decreasing pain and/or depressing the monosynaptic stretch reflex and/or acting on the GTO's to inhibit alpha motor neurons from firing, which would decrease the amount of contraction in the muscle), and joint mobilization.
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Treatments should start with low forces and shorter durations, and work up to therapeutic ranges for a given condition. Lumbar weight should increase approximately 5 lbs each session, and cervical weight should increase 2 lbs each treatment.
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When setting the patient up on a traction machine, ensure the straps are tight along the ASIS and at the level of the lower ribs. Adjust the table in a way that allows for no lumbar lordosis, and that they will not move along the table (e.g. insert arm rests, unlock table, etc). Make sure the patient has the emergency shut off button, should they need it. Always start with static hold for the first session, and move on to intermittent in subsequent sessions.

Contraindications
Peripheralization of symptoms with manual traction, acute injury or inflammation, fracture, cord compression, post surgery, rheumatoid arthritis, Down's Syndrome, Marfan's, uncontrolled hypertension (especially for inversion traction)

Precautions
Patients with hypermobility, claustrophobia, structural disease or condition affecting bones, tumor, infection, osteoporosis, prolonged steroid use, pregnancy, hiatial hernias, and femoral artery compromise


Lumbar Traction Parameters
Initial Treatment 30-45lbs Static Hold 5-10min
Joint Distraction 50% body weight 15/15 20-30min
Muscle Spasm 25% body weight 5/5 20-30min
Soft Tissue Stretch 25% body weight 60/20 20-30min

Cervical Traction Parameters​
Initial Treatment 8-10lbs Static hold 5-10min
Joint Distraction 7% of body weight 15/15 20-30min
(no more than 30lbs)
Muscle Spasm 12-15lbs 5/5 20-30 min
Soft Tissue Stretch 12-15lbs 60/20 20-30min

- Supine traction promotes flexion (used for facet dysfunction)
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Prone traction promotes extension (used for disc dysfunction)
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