Lumbar Traction
Clinically, there is disagreement about the utility and therapeutic effects of lumbar traction. It remains a core component of PT and PTA curriculum, including understanding of its theoretical basis for application ask well as the practical skill of safely applying manual and mechanical traction
Physiological Effects
Note: many of these are unsupported or conflict in the literature.
- increase vertebral separation
- decrease intradiscal pressure
- reduction of disc protrusion
- increase lateral foraminal opening
- distract apophyseal joints
- temporary reduction of scolosis
- temporary increase in lordosis
- decrease lumbar paraspinal activity
- temporary increase in height
Mechanical Techniques
- most typical position is supine in with hips and knees flexed
- greater than 70 degrees of hip flexion increases effect of traction on vertebral separation
- prone positioning allows for access to posterior structures for application of modalities
- position may also depend on spinal pathology
- supine with legs extended ---> line of pull in extension ---> increases lumbar lordosis with traction ---> decreased pressure on protruding disc
- supine with legs flexed ---> line of pull in flexion ----> decreases compressive forces from stenosis
- minimum power necessary to overcome friction is 25% of body weight
- therapeutic force ranges from 30% to 60+% body weight
Demonstration video of home lumbar tracction unit
Angle of pull
- generally perpendicular to table for L1-L5
- line of pull needs to change at L5-S1 to accommodate for the lumbosacral angle (30 degrees)
- in supine, 90/90 position facilitates traction force at L5-S1
- in prone, angle of pull should be at 30 degrees from table to reach L5-S1 disc space
- unilateral traction can be used to target a specific segment (see Cervical spine page)
Inversion traction
Form of gravity-assisted traction which uses inversion force to create a lumbar traction force
Amount of force generated = approximately 40% of body weight
Contraindicated for persons with cardiopulmonary or cardiovascular compromise
