• Wednesday, January 15, 2014RSS Feed

    Mechanical Traction's Benefits Documented

    A recent study is helping to strengthen the argument that mechanical traction can lead to greater improvements than exercise alone in patients with cervical radiculopathy.

    In a study (abstract only available for free) in the Journal of Orthopaedic and Sports Physical Therapy, 86 patients with cervical radiculopathy were divided into 3 treatment groups: exercise alone, exercise and use of an over-the-door home traction device, and exercise and mechanical traction delivered at clinic sessions. Participants reported on pain and movement at 4 weeks, 6 months, and 12 months after completion of the program.

    Authors of the study wrote that the results "more strongly favored the effectiveness of cervical traction delivered in supine using a motorized device than prior studies" that may have been affected by patient selection and other factors. At all reporting intervals, patients who underwent mechanical traction reported lower scores on neck disability, neck pain intensity, and arm pain intensity, with "particularly notable" improvements at the later follow-ups.

    Although patients who were assigned the in-home over-the-door traction device in addition to exercise tended to fare better than the exercise-only group, the improvements still lagged behind the mechanical traction group. Researchers described the differences as "an interesting result considering the patients provided the home unit could continue using the device beyond the study treatment period while those receiving mechanical traction could not."

    Looking for more evidence-based research? Visit PTNow for access to the information you need, including clinical practice guidelines for the diagnosis and treatment of cervical radiculopathy from degenerative disorders.


    Comments

    Cyriax told us this 30 years ago. Now we need outcome studies? If the outcome studies help us promote our intervention Im all for it however lets not forget about talking to the patient. My experience using cervical traction for radiculopathies ( cervical origin pain distal to the proximal most portion of the shoulder, my criteria) is that it is irreplaceable and in 8 of 10 patients is highly effective with in the first 6 visits measured by the patients subjective report of decreased pain directly related to their visit that included traction. My point is that the patients dramatic response makes them realize that it is the visit that included the traction modality , not the steroid they may have received, that they credit for their , typically full, recovery. We do not need to wait for outcome studies to provide excellent intervention. We need to utilize the information that is available to us, Cyriax and others who had most of this stuff figured out. Similarly , we need to stay away from ineffective palliative treatment. What we do need to do is provide excellent intervention that is efficient and effective and eliminate the liberal acceptance of a multitude of modalities that have no, limited or inefficient effect on orthopedic diagnoses and that dilute the respect that we deserve as educated clinicians. Go back to the study above , were the exercises done? how much ? what was the severity or level of radiculopathy. As is typical with most studies it is difficult to control enough factors to be able to relay a strong recommendation on their outcome. Yes we all need to contribute to extending our research , I do it and support it. However, lets talk to the patient and provide treatment that is orthopedically sound, cures the problem vs simply making the patient feel better .
    Posted by Tom Depaulis PT on 1/18/2014 4:31 PM
    Can the supine technique of home traction be more effective in sustaining the clinical outcome? Over the door traction and its partnership with gravity would appear to be disadvantageous in comparison.
    Posted by JP Long, PT,DPT,MA,CSCS on 1/19/2014 10:38 AM
    Any evidence regarding manual traction instead of using a motorized devise?
    Posted by Kyriakos on 1/20/2014 9:56 AM
    Even though past research seems to say traction does not have any long term benefits I have always seemed to get good results with cervical traction with pts. that have radiculopathy. I prefer manual traction as I can control the amount of traction and angle of pull. I know everything now needs to be evidence based but sometimes I think we feel if it's not in the literature then it can't be done rather than sometimes relying on our own clinical experience and results we have achieved over time with a particular technique, exercise etc.
    Posted by Bill on 1/20/2014 10:42 AM
    How about a study comparing manual vs mechanical traction outcomes. Might help us further to get out of the anecdotal world.
    Posted by Al Jones on 1/20/2014 7:46 PM
    Of course there was no group where manual traction and exercise was performed. It seems that we as a profession have forgotten how much more specific and integrative we can be when manual traction is used. Or is it just that we want something that we can charge for without being there??
    Posted by tim fearon on 1/21/2014 11:01 PM
    i use manual traction so that i can target different neck angles..
    Posted by Clarence Luna -> @MX]DO on 1/22/2014 11:53 PM
    History repeats itself. The Romans used traction for neck and back pain literally hanging themselves as treatment. Dr JW Fielding , Chief of Orthopedics at St Lukes in NYC for many years in the 70 's and 80's (and cervical author) use to hospitalize cervical patients for weeks for supine traction with physical therapy . I know this for a fact as I was one of his patients that avoided cervical spinal surgery from this treatment . I continue to use supine mechanical traction in my practice successfully for cervical radiculopathy. Manual traction is effective it's just not long enough to be long lasting. I also returned to skiing , tennis and being a physical therapist after my treatment .
    Posted by Gail Bock-Frankel on 1/23/2014 7:40 AM
    Please attach above info to my comment
    Posted by Gail Bock-Frankel. Pt MA on 1/23/2014 11:00 PM
    While many interventions may have been espoused for several decades, this doesn't preclude the need for outcomes studies. The studies serve purposes beyond our own profession and can justify reimbursement for our services in the changing healthcare environment. Unfortunately, it doesn't matter one bit if patients feel better if the don't show improvement in functional outcomes. We have plenty of interventions that provide significant immediate benefit that are not associated with long-term functional improvement (e.g. US, ES, and almost any passive intervention). And if there is no solid proof that we can provide value to insurers, we are unlikely to continue to receive even the meager reimbursement that we currently enjoy.
    Posted by Roy Film on 2/14/2014 10:54 PM
    I use an at home over-the-door traction device & have hugely benefitted from its use.
    Posted by Mark Winchester on 8/14/2014 12:12 AM
    Leave a comment
    Name *
    Email *
    Homepage
    Comment

  • ADVERTISEMENT