Saturday, September 8, 2012

Best Results With Cervical Neck Traction

Cervical traction is a physio-therapeutic modality (treatment) whereby a linear stretching force is applied to the head in an effort to reduce compression of the spinal structures by increasing space between vertebrae of the spine. These methods becomes therapeutic when any of the following desired results are achieved. Traction can be applied (1) in the supine or “lying face up” position or (2) from a sitting up position utilizing an over-the-door traction type of device. Although some users experience relief from the simple over-the-door units, the associated traction harness tends to place undo stress on the jaw and can cause problems like TMJ. Additionally, only 20 lbs. of traction can be applied by the over-the-door method. Supine cervical traction devices like Comfortrac Cervical Neck Traction or the Saunders Cervical Traction units are the units preferred by most doctors.

  • to reduce nerve pressure
  • to overcome muscle spasm
  • to reverse the forces of gravity
  • to break the cycle of pain/spasm/pain/spasm
  • to facilitate disk hydration and healing

One important functional benefit of traction is that such application of tensile force to the interwoven fibers of the spinal disks, literally creates a vacuum effect that may pull back to center a bulging or herniated nucleus pulposus (center material of disk). Such herniations are often responsible for the pain that radiates to the shoulder, arm and hand. When utilized in a safe, proper manner; traction can offer effective therapy for:
  • reduction of disc herniation and associated symptoms
  • improvement of joint mobility
  • relief of nerve and disc compression
  • improvement of posture
  • relief of pain

The disc spaces
Before Traction and During Traction
applied by a Comfortrac Supine Cervical Traction Device
Cervical Spine Before Traction with Comfortrac
Cervical Spine During Traction with Comfortrac

ANATOMY OF CERVICAL TRACTION To better understand the therapeutic value of traction it is important to have at least a basic understanding of anatomy and structures of the cervical spine (neck). As a matter of fact, Medicare and Medicaid authorities define a cervical traction device as one that applies traction to the cervical “anatomy”. Why this is true may be explained by anatomical facts like the following: There is a ligament or band of strong binding material that runs the length of the back side of the cervical spinal vertebrae, actually tying them together. It is interesting to note that when traction is applied to this band, also known as the “posterior longitudinal ligament”, the resulting pull on fibers of the spinal disk causes movement of fluid that creates and draws a vacuum, literally sucking a herniation or bulge back toward the center of the involved disc.

  • VERTEBRAE OR BONES OF THE NECK - The cervical neck vertebrae are the smallest of all the spinal vertebrae. The purpose of the cervical spine is to house and protect the spinal cord, support the skull, and enable versatile head movements like rotation, flexing forward, and extending backward. The cervical spine is composed of 7 vertebrae with shock-absorbing, space-occupying disks in between the vertebral bodies of each vertebrae. Behind the vertebral bodies and in front of the weight bearing joints of the vertebrae is the spinal cord. Nerves come off the spinal cord and exit through holes formed at joining portions of each pair of vertebrae. These nerves sense pain and control muscles and organs.
  • POSTURE AND CURVE OF THE NECK - the neck has a special curvature called a cervical lordosis that transfers the weight of head to supportive joints rather than the placing pressure on the disks. Spinal disks would wear out quickly if they were forced to carry the weight of our head. This natural curve helps protect our spinal disks.
  • SHOCK ABSORBING DISKS - spinal disks are sort of like the inside of a golf ball. They have a gel-like center (nucleus) that is contained by woven rubber-band like structures known as fibro-cartilage. The gel being contained within these fibers acts like a hydraulic shock absorber similar to what is on your car. The disks are also 75% water, functioning to bring nutrients to the live fibro-cartilage cells. Loss of such water decreases nutrient supply and shock absorption, leading to weakness in the fibers that hold the gel nucleus. Weakness can lead to a bulge known as a herniation and can place pressure on the nerves as they exit the spine. Understanding the anatomy helps us understand the physiology of developing symptoms and helps us develop a comprehensive therapeutic approach including sensible lifestyle modifications and good nutrition for the healing spinal disks. With this understanding it is often possible to resolve associated nerve irritation and symptoms without surgical intervention.

  • Lack of mobility (hypomobility)
  • Spinal misalignment
  • Disc bulging or herniation
  • Cervical spinal nerve impingement
  • Cervical spondylosis, osteoarthritis or degenerative disks
  • Muscle spasm and general tightness in the neck and shoulders
  • Shoulder, arm and wrist pain or numbness
  • Cervical neuralgia or radiculo-neuropathy

Good News - when traction is applied to the spine it tenses the fibrous outer portion of the discs. This tension will open channels for the influx of nutrients and water (hydration) to the cartilage cells, helping restore normalcy to injured disks.
Bad News - however, if application of traction is prolonged beyond a certain threshold, the fluid entering the disk can create excessive osmotic pressure and predispose a disk to rupture. Understanding things like this creates awareness of the need for professional guidance prior to embarking on self treatment with traction.

First and foremost, never utilize traction without first consulting an attending physician for proper protocol.

Furthermore, let me begin by saying that the use of any mechanical traction should always be preceded by the use of manual traction (i.e. done by hand) performed by your chosen practitioner, whether a skilled chiropractor, physical therapist or orthopedic doctor. This is most safely applied with one hand under the occiput of the skull and the opposing hand on the forehead of the patient. Pressure applied to the jaw puts excessive pressure on the TMJ joint and is not recommended by this writer or most experienced neuro-musculo-skeletal practitioners.

This consult should be concluded with a suggested and monitored course of therapeutic traction. Supine home traction devices can be extremely beneficial if this protocol is followed. Conversely, without proper direction, one could cause more harm than benefit.


It is this writer’s opinion and upon the recommendation of most savvy physicians, supine cervical traction units like Comfortrac Cervical Neck Traction or the Saunders Traction Unit are the most suitable for safe home use. They both use pneumatic pumps that can easily be operated by the user and offer both intermittent or continuous traction. See more details in the 2nd paragraph of this article above.


  1. Two Traction Protocols: sustained or intermittent traction can be applied in a sustained or intermittent manner. Pneumatic supine traction units can administer sustained or intermittent traction.
  2. Sustained traction is recommended when treating degenerative disc disease, muscle spasm and nerve root impingement. Care must be taken not to apply sustained traction whereby the amount of time exceeds that recommended by an attending physician.
  3. Intermittent traction is recommended for treating facet joints and disc protrusion.
  4. When applying intermittent traction, the “rest ” period involves a reduction of traction force (about 50%), not the complete removal of force. Some authorities recommend to reduce the force by 1/3 during the rest phase.
  5. Cervical Traction Application to Open Up Space: a minimum of 15 degrees of flexion is necessary to open the cervical posterior facets. To maximally separate the cervical posterior facet articulations, open the intervertebral space, widen the intervertebral foramen and stretch the posterior tissues, 25-30 degrees of flexion is recommended. This position also straightens the normal cervical lordosis.
  6. Applying Force to Upper or Lower Neck: traction in the neutral cervical spine position causes the greatest separation in the upper cervical spine; 30 degrees of flexion directs the forces more to the lower cervical spine.
  7. Supine Cervical Traction Best: cervical traction should be applied in a supine position for optimal benefit.
  • Traction contraindicated for cervical distraction injuries at any level (this includes acute and/or unstable, severe sprain/strain injuries of the cervical spine as might occur in a whiplash).
  • Traction contraindicated for certain fractures like Type IIA hangman's fractures
  • Traction contraindicated for joint hyper-mobility
  • Caution must be exercised when performing traction on anyone with TMJ problems. As suggested above, supine cervical traction whereby forces are not exerted on the jaw is not only better traction protocol, but safer for those who already suffer with a TMJ condition.

Although cervical traction can be uncomfortable, it is not suppose to be painful when properly applied. Some folks will complain that they feel soreness of a different kind after application of the therapy. This is quite normal. As a matter of fact, the majority of traction users do not feel better immediately after the traction. It is more common to feel better the next day. On the contrary there are those that experience immediate relief and absolutely enjoy the entire therapeutic experience. This writer is one of those persons. I feel completely relaxed during my traction sessions and feel like the weight has been removed from my shoulders.

Now, this being said, please understand that I’m referring to traction being performed in the supine or “lying face up” position. As discussed earlier, other sitting up methods like over-the-door units present their own set of problems and they make it really hard for the user to relax.

If, after reading this article you feel you are a good candidate for cervical traction you should discuss the possibility with your health care provider. Often, they will prescribe a home cervical traction unit. Ask your doctor if he or she agrees that a supine cervical traction unit like Comfortrac Cervical Neck Traction might be better than the over-the-door type. With a prescription, you may seek reimbursement from your insurance company even though you will often have to make the purchase on your own.

Friday, February 17, 2012

Piriformis Syndrome - self diagnosis - best treatment

I received an interesting email from a lady with the following described signs/symptoms:

Hope you can send me in the right direction. For about 6 weeks I have suffered pain in my right buttock with tingling and pain down my right leg and into the calf of my leg. After reading all the posts that have been sent to you I can understand that my symptoms are likely related to the sciatic nerve. I did not have a fall but simply overdid fast walking which I think is the cause (the music in my headphones was quite lively!). Have been to the physical therapist which made it really hurt, been to the doctor who prescribed a lot of ibuprofin and a muscle relaxer. This is painful when I have to stand still but not when walking. It is painful when sitting for a long period of time. I can bend in any direction and the spine works fine with no pain. After reading online I thought perhaps it might be piriformis syndrome. I see that others recommend Stretching for that. However, you often tell people to avoid stretching because it makes sciatica worse. What to do? Are there certain diseases that can cause this (I had a bladder infection about two weeks after the pain started and took the medication for that and that is gone.) Thanks for your help.

Your self-diagnostic train of thought is remarkably intuitive. It would seem logical that you do not have a lumbar disk problem causing the sciatica, although there are rare cases of such that present with absolutely no back pain. I think you're very likely to have a "Piriformis Syndrome".  Stretching is indeed an important aspect of treatment for such in the long run. However, it is often very much contra-indicated in the initial treatment phase because it could very well have been the long strides (during your fast walking exercise) that over-stretched the Piriformis, causing the initial and likely current spasm. You will almost certainly benefit from appropriate physiotherapy modalities like electrical muscle stimulation over the belly of the muscle and perhaps some deep-pressure massage to relieve the spasm. Sleeping, especially on the side could be irritating the condition and it might be advisable to place a large, fluffy, pressure-reducing foam pillow between your knees to relieve the stretching on the piriformis muscle. The side that is is up, is the side that will get stretched. I personally use and recommend the Nimblepedic Comfort Touch Memory Foam Pillow for this purpose.

Anti-inflammatory meds and muscle relaxors I find to be pretty useless in these cases. Stretching will often irritate until the initial spasm is overcome. This is because stretching the tight muscle often forces it into contact with an already inflamed sciatic nerve. In the long run you might need to have your gait evaluated to note whether there is a problem with shoes or bio-mechanical dysfunction of the foot and ankle that might have led to the onset. For example, pronation, a functionally short leg, or toeing out while walking can all be related. Shoes and/or orthotics can often be a sensible solution. I suspect that the reason walking is not seeming to exacerbate the pain is because you are not being as overzealous with your stride as you were before. However, this does throw up a red flag that makes us want to make sure that your lower abdominal or pelvic organs are not referring pain down your leg. You should have a good evaluation from you internist as well.

When it comes to conditions affecting nerves from the lumbo-sacral area, the nervous system regulation of organs in that region can be affected, leading to a weaker organ that is more prone to infection. Although it may have indeed been coincidental, either condition could have impacted the other.

I think this case is an interesting one that a lot of folks might relate to, so I decided to make a post of my advice to her.