Traction is a set of mechanisms for straightening

broken bone A bone fracture (abbreviated FRX or Fx, Fx, or #) is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a '' ...

s or relieving pressure on the spine and

skeletal system A skeleton is the structural frame that supports the body of an animal. There are several types of skeletons, including the exoskeleton, which is the stable outer shell of an organism, the endoskeleton, which forms the support structure inside ...

. There are two types of traction: skin traction and skeletal traction. They are used in

orthopedic medicine Orthopedic surgery or orthopedics ( alternatively spelt orthopaedics), is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal ...

Techniques

Traction procedures have largely been replaced by more modern techniques, but certain approaches are still used today: *

Milwaukee brace {{no footnotes, date=August 2013 The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures (such as scoliosis or kyphosis) in children but also, more ra ...

* Bryant's traction *Buck's traction, involving skin traction. It is widely used for

femoral fracture A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femu ...

low back pain Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can vary from a dull constant ache to a sudden sharp feel ...

acetabular fracture Fractures of the acetabulum occur when the head of the femur is driven into the pelvis. This injury is caused by a blow to either the side or front of the knee and often occurs as a dashboard injury accompanied by a fracture of the femur. The ...

s and

hip fracture A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a res ...

s.Skin Traction - Lower Extremity
from University of Stellenbosch, Department of Orthopaedic Surgery. Retrieved May 2, 2013 Skin traction rarely causes

fracture reduction Reduction is a surgical procedure to repair a fracture or dislocation to the correct alignment. Description When a bone fractures, the fragments lose their alignment in the form of displacement or angulation. For the fractured bone to heal witho ...

, but reduces pain and maintains the length of the bone. *Dunlop's traction –

humeral The humerus (; ) is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a rou ...

fractures in children *Russell's traction

Skeletal traction

Although the use of traction has decreased over the years, an increasing number of orthopaedic practitioners are using traction in conjunction with bracing (see

). Harrison et al. (2005) found that mirror image (opposite posture) postural corrective exercises and a new method of

lumbosacral tilt The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordates ...

traction resulted in 50% reduction in trunk tilt and were associated with nearly resolved pain intensity in this patient population. These researchers felt that their findings warranted further study in the conservative treatment of chronic low back pain and spinal disorders.

Spinal decompression

Spinal traction as a means of

spinal decompression Spinal decompression is the relief of pressure on the spinal cord or on one or more compressed nerve roots passing through or exiting the spinal column. Decompression of the spinal neural elements is a key component in treating spinal radiculopath ...

is often applied without directly touching bones as other methods of traction do. This is sometimes isolated inside-out by inflatable girdles or use of the

transversus abdominis muscle The transverse abdominal muscle (TVA), also known as the transverse abdominis, transversalis muscle and transversus abdominis muscle, is a muscle layer of the anterior and lateral (front and side) abdominal wall which is deep to (layered below) t ...

. It is also done in conjunction with thigh-supported flexed-hip traction (inversion chairs, back hyperextensions) or done in conjunction with whole-leg traction (boots, tables) via inverted forms of suspension. Traction of the spine (except the cervical) also occurs with upright suspension of the body from the arms, such as with

pull-ups {{unreferenced, date=March 2017 Pull-Ups is a brand of disposable training pants made under the Huggies brand of baby products. The product was first introduced in 1989 and became popular with the phrase "I'm a big kid now!" which is the product's ...

, dips,

captain's chair A power tower, also known as a knee raise station, and as a captain's chair, is a piece of exercise equipment that allows one to build upper body and abdominal muscle strength. When only the forearm pads alone are used for performing abdominal exerc ...

, chinnings (

chin up A pull-up is an upper-body strength exercise. The pull-up is a closed-chain movement where the body is suspended by the hands, gripping a bar or other implement at a distance typically wider than shoulder-width, and pulled up. As this happens, ...

exercise) or other fitness movements with the feet dangling.

Mechanical Traction in Physical Therapy

Mechanical traction can be used for patients with cervical and lumbar spinal disorders such as cervical radiculopathy or lumbar spinal stenosis. It may be applied mechanically through the use of an apparatus with two different modes: intermittent or continuous. Physiological goals: * Separation of vertebral bodies * Movement of facet joints * Expansion of intervertebral foramen * Stretch of soft tissues When mechanical traction is combined with other physical therapy modalities such as passive mobilization, massage, stretching and active exercises, it is an effective treatment for pain reduction in cervical or lumbar spine disorders. Recent guidelines have been put forward for the use of cervical traction to treat cervical

radiculopathy Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly (a neuropathy). Radiculopathy can result in pain (radicular pain), weakness, altered sens ...

. Only low quality evidence has been released and the authors of these guidelines encourage researchers to intensify studies on tractions effect on cervical

. Researchers have also demonstrated lumbar traction to be advantageous in treating

. Three studies in 2017 confirmed an increase of nutrient and water flow into the intervertebral discs after traction treatment.

Purpose

The purpose of traction is to: *Regain normal length and alignment of involved bone *Lessen or eliminate muscle spasms *Relieve pressure on nerves, especially spinal nerves *Prevent or reduce skeletal deformities or muscle contractures *To provide a fusiform

tamponade Tamponade () is the closure or blockage (as of a wound or body cavity) by or as if by a tampon, especially to stop bleeding. Tamponade is a useful method of stopping a hemorrhage. This can be achieved by applying an absorbent dressing directl ...

around a bleeding vessel In most cases traction is only one part of the treatment plan of a patient needing such therapy. The physician's order will contain: *Type of traction *Amount of weight to be applied *Frequency of neurovascular checks if more frequent than every four hours *Site care of inserted pins, wires, or tongs *The site and care of straps, harnesses and halters *The inclusion of any other physical restraints / straps or appliances (e.g., mouth guard) *The discontinuation of traction

Future

The variability of traction delivery protocols causes a gap that may be the reason for negative conclusions that traction has no positive effects. A key to the future success of traction may be finding the proper therapeutic dosage levels. Suboptimal dosage choices may be a key for the negative conclusions on traction. Different dosage levels for aspects such as traction force, traction rhythm, duration of treatment, and frequency could be the key to providing efficient effects. Proper dosage levels for any therapeutic treatment will be vital for recovery efficiency. Patients may have a “directional preference” to an axial force which may be an underlying cause for positive results. Future research is needed to discover if directional preference has a positive therapeutic effect within traction.

References

External links

*
"Split Russell's / Buck Traction"
*{{WhoNamedIt, synd, 2984 - Bryant's traction
"Physio-pedia about another spinal traction therpay method"