Is cervical traction evidence based? Dr P. Verspeelt Fysische Geneeskunde en Revalidatie UZA

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1 Is cervical traction evidence based? Dr P. Verspeelt Fysische Geneeskunde en Revalidatie UZA

2 Prevalence 26% to 71% of the adult population can recall experiencing an episode of neckpain in their life time. (Cote 1998, Makela 1991) Lifetime prevalence is as high as 78%. ( Chiu 2006, Fejer 2006, Guez 2006) An average of 10,2 million visits per year for neck pain to health care facilities in the US.( Riddle 2007)

3 Prevalence

4 Introduction Different Methods Lis ( lus ) van Glisson Saunders Cervical Traction Device Manual ( sitting or lying supine)

5 Introduction

6 Introduction

7 Introduction

8 MANY DIFFERENT PROTOCOLS Lying supine or sitting Continuous (total time) Intermittent (time traction / time relaxation) (total time) Force (% bodyweigth / fixed / progression in force) Angle of traction

9 Effect of traction on the cervical spine Effect on the intervertebral disc. The herniated portion is retracted due to a combination of negative pressure and a pushing effect on the posterior longitudinal lig. Effect on the facet. Freeing the synovial membrane. Effect on the stenosis of the intervertebral foramen. Stretching of the neckmusculature.

10 The Cochrane collaboration Mechanical traction for neckpain with or without radiculopathy ( Review) Graham N, Gross A, Goldsmith CH, Klaber Moffet J et al The Cochrane library 2008, issue 3

11 Findings of the cochrane in 2008 Database up to march citations 7 RCT s Included Our review found no evidence that clearly supports or refutes the use of continuous or intermittent traction for individuals with chronic neck disorders or radiculopathy. Important: The included RCT s did not report any harmful side effects.

12 ZYLBERGOLD RS (SPINE) 100 men and women with a disorder of the cervical spine. 12 treatments ( twice weekly) 25 static traction, 25 intermittent traction, 25 manual traction and 25 no treatment at all. Regardless of group assignment patients receiving traction performed significantly better than those assigned to the non traction group in terms of pain and range of motion.

13 DATA BASE SEARCH AFTER 2008 Jellad A Ann Phys Rehabil Med 2009 Manual or mechanical cervical traction appears to be a major contribution in the rehabilitation of cervical radiculopathy particulary if it is included in a multimodal approach of rehabilitation.

14 Khan K et al Int J Physiother (2016) 50 subjects with cervical radiculopathy treated with thermotherapy, TENS and exercises and 50 subjects with the same treatment + 12 sessions of manual intermittent cervical traction. Results: The group with the cervical traction had less pain than the control group, so cervical traction is an effective method for decreasing pain.

15 Albayrak NA et al (2012) 27 patients with C7 radiculopathy due to a herniated disc verified by MRI. The control group had thermo-therapy, exercise and massage and the experimentalgroup had the same treatment + intermittent cervical traction. Maximum grip strength measured with a dynamometer pre and post increased significant in the traction group and not in the control group.

16 Romeo A et al Phys Ther ( 2018) Cervical radiculopathy : Effectiveness of adding traction to physical therapy. A systematic review and meta-analysis of randomized controlled trials. 5 studies met the inclusion criteria. The current literature lends some support to the use of mechanical and manual traction for cervical radiculopathy in addition to other physical therapy for pain reduction but lesser effects on function.

17 Elnaggar IM (2009) An important electroneurographic finding on electromyography is the H- Reflex. The latency and amplitude of that H-reflex are highly reliable and in the case of a C7 radiculopathy can provide a tool for the clinician to assess the function of this radix. Normal values for the amplitude and latency are known.

18 Within the intermittent and the continuous traction group there was a significant increase in the amplitude and a significant decrease in the latency of the H-reflex between the pretreatment mean and the posttreatment mean. There was no significant difference between the intermittent and the continuous traction group.

Effectiveness of Intermittent Mechanical Traction in Cervical Radiculopathy: A Systematic Review

Touro College and University System Touro Scholar College of Health & Human Services (TUN) Publications and Research College of Health & Human Services 2018 Effectiveness of Intermittent Mechanical Traction