Can a physical therapist (PT) recommend an in-home traction device for a patient with neuroforaminal stenosis of the cervical spine who has shown relief with in-office traction at physical therapy (PT), and can this device be prescribed by a primary care physician (PCP)?

Home Cervical Traction for Neuroforaminal Stenosis

Yes, a physical therapist can and should recommend a home cervical traction device for your patient, and you as the primary care physician can prescribe it. Given the documented relief with in-office traction, home cervical traction represents a logical, evidence-supported extension of successful therapy that allows for more frequent treatment sessions and improved long-term symptom control.

Evidence Supporting Home Cervical Traction

Home cervical traction has demonstrated substantial clinical efficacy for cervical radiculopathy and neuroforaminal stenosis:

• In patients with cervical spondylosis syndromes ranging from mild to moderately severe (including those with radiculopathy), home cervical traction provided symptomatic relief in 81% of cases 1
• Specifically for patients with radiculopathy (Grade 3 severity), 90% showed improvement with brief home cervical traction sessions 1
• The treatment protocol that proved effective involved only 3-5 minutes of over-the-door cervical traction twice daily, making it highly practical for home use 1

Biomechanical Rationale

Cervical traction works by increasing neuroforaminal dimensions:

• Cervical neuroforaminal area, height, and width all increase during flexion positioning, which is the typical position used during traction 2
• This dimensional increase directly addresses the pathophysiology of neuroforaminal stenosis by creating more space for compressed nerve roots 2
• The effect is most pronounced at upper cervical levels (C3/C4 and C4/C5) but occurs throughout the subaxial cervical spine 2

Recommended Device and Protocol

Over-the-door pneumatic traction devices are preferred over traditional counterweight systems:

• 81% of patients preferred pneumatic traction devices to conventional counterweight systems 3
• Pneumatic devices provide easier application, steadier pull with more gradual onset, and are particularly beneficial for elderly or debilitated patients who struggle with counterweight manipulation 3
• The pneumatic system avoids the problem of patients tensing cervical paraspinal and upper extremity muscles while maneuvering counterweights 3

Treatment parameters that have proven effective:

• Duration: 3-5 minutes per session 1
• Frequency: Twice daily 1
• Position: Seated position with over-the-door setup 1
• This brief protocol achieved 77% improvement in moderate cases and 90% in radiculopathy cases 1

Critical Integration with Comprehensive Care

Home traction must be part of a broader management program, not a standalone intervention:

• Spinal traction alone has little chance of long-range benefit without a total management program that includes other forms of physical therapy 4
• Consider combining home traction with thoracic spine manipulation, which has been shown safe and effective for cervical radiculopathy when performed by trained providers 5
• The physical therapist should provide ongoing supervision and adjustment of the home program 4

Prescription Approach

As the PCP, you can prescribe the device with the following specifications:

• Write for "home cervical traction device (pneumatic preferred)" 3, 1
• Specify the PT-recommended parameters: 3-5 minutes, twice daily 1
• Include "as directed by physical therapist" to allow for protocol adjustments 4
• Request PT follow-up to monitor response and adjust treatment as needed 5

Safety Considerations and Monitoring

Perform thorough neurological screening before initiating mechanical cervical treatment:

• A complete neurological examination is essential prior to mechanical treatment of the cervical spine 5
• Monitor for any progression of neurological symptoms, which would warrant immediate reassessment 5
• Approximately 5-10% of patients may experience symptom aggravation with cervical traction and should discontinue use 1

When Home Traction May Not Be Appropriate

Recognize contraindications and failure scenarios:

• If symptoms worsen during initial home traction trials, discontinue immediately 1
• Patients with severe myelopathy require more cautious evaluation, though mild myelopathy (grade 1) has been safely treated with intermittent cervical traction 5
• Home traction should supplement, not replace, supervised physical therapy sessions for optimal outcomes 4

Expected Outcomes and Timeline

Set realistic expectations with your patient:

• Symptomatic improvement typically occurs within 2-12 treatment sessions over 14-146 days 5
• Pain reduction of 2-8 points on a 0-10 scale can be expected 5
• Functional improvement of 10-50% is typical 5
• Long-term compliance is enhanced by the brief treatment duration (3-5 minutes) compared to traditional 20-30 minute protocols 1

The collaborative approach between PT and PCP optimizes outcomes: The physical therapist identifies the appropriate device and parameters based on clinical response, while you provide the prescription authority and medical oversight to ensure safe, effective treatment 3, 1, 4.