Back Pain: Home Managements #7 - Lumbar Traction

The Lumbar Traction is a specific treatment modality for the relief of low back pain.The physiological benefit attained from Lumbar Traction is, to some extent, controversial. But Ipersonally feel that the Lumbar Traction do play an important role in relieving low back pain,especially when the patient feels radiating pain down the lower limbs. The way in which the Lumbar Traction is given is also controversial. But I prefer thetraction to be given in a horizontal manner with the patient supine with his hips and knees flexedand the lower legs resting on a small stool. When the patient is in an erect position, the antigravitymuscles of the back go into protective spasm to splint and to prevent the movement of theinflamed vertebral unit. So if Lumbar Traction is given in an erect position, the splintingphenomenon and the spasticity of the antigravity muscles may adversely interfere with theLumbar Traction. If the patient lies supine, this activity of the antigravity muscles can beneutralised to a great extent.

The functional or the structural unit of the spine consists of two adjacent vertebraeseparated by a disc. When traction is given, the distraction of the component parts of thefunctional unit of the spine occurs. The traction causes some degrees of vertebral distraction. Inorder to achieve a significant distraction a huge force of traction is needed. But application of sucha force of greater magnitude is not advisable as it is not physiologically possible. I feel it isadvisable to give one third of the body weight of the patient for Lumbar Traction. The weightwhich is to be used for traction may vary depending upon the weight, posture and the overallcomposition of the patient. The disease condition of the patient also has a role in choosing thecorrect weight to be used.

The traction is given with the patient in the supine position. A pelvic band wraps around the pelvis which is held in position with the help of adequate straps. To this band two straps are attached one on either side. Other ends of these straps are attached one on either side of a metallic spreader bar. A rope attached to the middle of the spreader bar passes over a pulley to which weights of varying magnitudes can be added. In the physiotherapy department Lumbar Traction is given by using computerised Traction units. These machines are very compact in nature. These computerised traction units helps us to choose different treatment programmes depending upon the necessity of the patient. The traction is given in a horizontal manner with the patient supine with his hips and knees flexed and the lower legs resting on a small stool. The traction may be of continuous or intermittent in nature.

The Lumbar Traction relieves the low back pain as it decreases the Lumbosacral lordosis. Now let us see how the decrease in lordosis of the low back helps in relieving the low back pain.

1. It opens the intervertebral foraminae through which the nerve root and the dorsal root ganglia of the lumbosacral plexus (the Sciatic and Femoral Nerves) emerge from the spinal canal – thus relieves any pressure at the intervertebral foraminae.

2. Separates the facet joint surfaces - the facet joints of the spine are mainly responsible for the movement of the functional units of the spine. Excessive flexion and rotation of the spine can sublux the joint with stretching or tearing the joint capsule. Traction may relieve the pain of low back due to facet joint problems.

3. Stretches the Erector Spinae Muscles – the Erector Spinae Muscles are the prime extensors of the spine. This muscle may go into protective spasm if there is any injury to low back, which causes an increase in the intensity of low back pain. When the muscle is stretched, it helps in reducing the muscle spasm and also the pain.

4. The “Annular Effect “ – When Lumbar Traction is given, it decreases the intrinsic force within the nucleus of the disc. This phenomenon “stiffens” the annular fibres of the disc and thus minimises the annular “bulging”. This relieves the back pain.

5. When the low back is in the “full” lordotic state, the length of the nerve roots and their duramater is increased and is in the maximum stretched position. As a result these soft tissues will be in a state of tension which may increase the magnitude of low back pain. The Lumbar Traction decreases the lordosis of the low back and hence decreases the length of the nerve roots and the duramater. This phenomenon decreases the tension and also the pain of the low back.

During the acute stage a simple home Lumbar Traction is possible. In the acute stage the Lumbar Traction is given to stretch the Erector Spinae Muscles. The Erector Spinae Muscles which are the prime extensors of the spine may go into protective spasm if there is any injury to the low back, which may cause an increase of the low back pain. When this muscle is stretched, it helps in reducing the protective muscle spasm which in turn reduces the pain.

The patient lies supine with his hips and knees flexed and the lower legs resting on a small stool. Now the patient elevates his low back from the bed. The low back is held in this elevated position for 5 – 10 minutes. This reclining position decreases the lumbar lordosis and stretches the Erector Spinae Muscles. This exercise may be repeated 5 times. The whole exercise programme may be done twice a day. This home programme exercise is very effective If it is done after the application of ice (Ice Therapy is discussed in the earlier chapter “How to take care of your low back – Introduction”). More stretching effect can be attained if the pelvis is tilted further if the patient is still in the reclining position.