PHYSIOTHERAPY: MANIPULATIVE PROCEDURES-TRACTION

This is a longitudinal stretching force applied along the axis of the tissues and is a form of regional mobilisation. It has been known for centuries that back pain can sometimes be relieved in this way. It is not known, however, why traction works when it does. Some practitioners have claimed that pulling the vertebral bodies slightly apart eases the pressure on a prolapsed disc. But this in itself would not make the extruded disc material shrink back, nor repair the ruptured outer casing. One theory was that the vacuum produced in the intervertebral space would withdraw the extruded disc material away from the nerve, but bio-engineering experiments have now shown this to be unlikely. Studies have suggested that the amount of traction necessary to achieve actual separation of vertebral bodies is far greater than that ever applied by way of pelvic traction in a physiotherapy department. Possibly traction works by increasing input into the spinal nerves ‘blocking’ the pain pathways or by reducing tension or spasm in the back and hip muscles, or by easing the strain on the facet joints. There is no conclusive evidence. Many people have found relief in this way, but if you are one of the people for whom it does not work, there is no point in persisting with it.

There are several ways of applying traction involving, in many cases, the use of special apparatus. The magnitude of the pulling force, the position in which it is given and the time for which it is applied will determine the effects of the traction. If the traction makes the pain worse at the time, the treatment is stopped. If the pain is worse after traction, the treatment should be discontinued. Patients with severe back pain may be admitted to hospital for traction.

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