Who Benefits from Cervical Traction?
Reference:Raney NH et al Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009 Mar;18(3):382-91.
Traction is a controversial treatment option for neck pain, as to date no RCTs have supported its use. Frankly that is because the studies have been ridiculous! They take everyone with neck pain and randomly allocate half of them to traction and the other half to no traction, and inevitably conclude that traction is useless.
Can you see how silly that is? In reality, the far majority of patients in a typical orthopaedic setting will have little benefit from traction, but there is a small subgroup of patients who may potentially get positive results with it. If we could only identify this subgroup of patients, then we could be discriminate in our patient selection.
The objective of the study was to develop a clinical prediction rule (CPR) to identify patients with neck pain likely to benefit from 6 sessions of intermittent cervical traction and cervical strengthening exercises.
The patients attended PT twice a week and a ‘successful’ outcome was considered if they admitted to being “A great deal better” after 3 weeks. A CPR with five variables was identified:
Variable #1: Age >55 Consider tractioning older adults with neck pain more than 20 year olds!
Variable #2: Pain peripheralization with lower cervical spine (C4-7) mobility testing
Basically if PA?s to the mid c-spine produced shoulder, arm or forearm pain ?consider traction.
Variable #3: Positive shoulder abduction test
Have the patient actively abduct their shoulder and place their palm on top of their head. If their peripheral symptoms improve or disappear, try traction.
Variable #4: Positive Median nerve neurodynamic test (NDT)
If there is an asymmetry in ROM, quality of tone and symptom reproduction with NDT …consider traction.
Variable #5: Positive neck distraction test
Pull on the head and apply a manual traction. If this procedure centralizes the pain, obviously consider traction.
Having at least 3 out of 5 variables increased the likelihood of success with cervical traction to 79%. Having at least 4 out of 5 variables increased the likelihood of success with cervical traction to 95%.
Although this CPR still requires validation, for now it is the best method a PT has to identify patients with neck pain who are likely to benefit from cervical traction and exercise.
Posted on: December 16, 2012
Categories: Cervical Spine