From the Guidelines
Cervical traction is not recommended as an effective treatment for low back pain, but may be considered for cervical radiculopathy and some mechanical neck disorders, with a recommended frequency of 15-20 minutes per session, 2-3 times daily, and intensity starting at 5-10% of body weight. The evidence from the provided studies does not strongly support the use of cervical traction for low back pain, with a higher-quality Cochrane review finding traction no more effective than placebo, sham, or no treatment for any reported outcome 1. However, for cervical radiculopathy and some mechanical neck disorders, moderate evidence supports its use. Some key points to consider when using cervical traction include:
- Starting with a low intensity, around 5-10% of body weight, and gradually increasing as tolerated, with a 5%–10% increase in intensity generally well tolerated 2
- Using a frequency of 2-3 times daily, with each session lasting 15-20 minutes
- Proper positioning of the neck in 20-30 degrees of flexion for optimal intervertebral separation
- Combining traction with other treatments like exercise and manual therapy for optimal effectiveness
- Discontinuing treatment if symptoms worsen, and being aware of contraindications such as acute inflammation, instability, rheumatoid arthritis, severe osteoporosis, and vertebrobasilar insufficiency. It's essential to weigh the potential benefits and risks of cervical traction and consider the individual patient's condition and needs before initiating treatment.
From the Research
Cervical Traction Evidence
- Cervical traction may be used to temporarily decompress nerve impingement in patients with cervical radiculopathy 3
- There is low-level evidence that traction is no more effective than placebo traction and very low-level evidence that intermittent traction is no more effective than continuous traction 4
- A study found that an intensive cervical traction protocol, consisting of 30-minute sessions twice a day for five consecutive days, improved disability and pain in patients with cervical radiculopathy 5
Best Frequency and Intensity
- The optimal frequency and intensity of cervical traction for patients with cervical radiculopathy are not well established 4
- One study used a protocol of 30-minute cervical traction sessions, twice a day, for five consecutive days, and found significant improvements in disability and pain 5
- Further research is needed to determine the most effective frequency and intensity of cervical traction for patients with cervical radiculopathy 3, 4
Conservative Treatment Options
- Conservative treatment options for cervical radiculopathy include physical therapy, collar, traction, and medications 3, 4
- There is low-level evidence that a collar is no more effective than physiotherapy at short-term follow-up, and very low-level evidence that a collar is no more effective than traction 4
- Patients with cervical radiculopathy may improve over time, regardless of the intervention assigned, indicating a favorable natural course 4