What Does Spinal Decompression Do?

Traction is the Treatment – Decompression is the Result

Traction is the process of drawing or pulling. When we utilize our hands or some mechanical device to apply this force to the spinal column it is called spinal traction. Decompression by Webster’s definition is “to release or reduce the physical pressure on something or to have the physical pressure released or reduced.”

It is here that we must make a distinction regarding the current use of the term spinal decompression. While the term is now used interchangeably, by pure definition the treatment is called spinal traction and the goal or result is spinal decompression. For the purposes of this article I will use both terms by the above definitions.

What exactly does it do? Spinal traction has the following proposed effects:

Mechanical Elongation of the Spine

As a result of the spinal traction, there is decompression. The term decompression in this context refers to mechanical separation of the vertebrae, which in turn:

1. Stretches the spinal muscles
2. Exerts mild tension on the ligaments and facet joint capsules
3. Expands the intervertebral foramina
4. Straightens the spinal curves
5. Slides the facet joints

Facet Joint Mobilization

The facet joints, (or zygapophysial joints, zygapophyseal, apophyseal, or Z-joints) are a set of synovial, plane joints between the articular processes of two adjacent vertebrae. There are two facet joints in each spinal motion segment.

The effects on the facet joints include a sliding or translation of the facet surfaces, distraction or a separation of the facet surfaces and compression or an approximation of the facet surfaces. While not empirically proven, this movement of the joints allows for an increase in range of motion and blood components at the joint. Teodorczyk-Injeyan et al (2006) found that mobilisation effected the levels of blood components, with a reduction in inflammatory proteins. Therefore, it was suggested that mobilisation could be a potential therapeutic modality to reduce inflammatory response – working as an anti-inflammatory mechanism. 

 

Muscle Relaxation

There is a decrease in the pain produced from muscle guarding and spasm as well as greater vertebral separation as the muscles relax. Relaxation of muscles occurs through a neurophysiological process as stress/stimulation of joint mechanoreceptors and muscle sensory organs reduce the contraction and tension of muscles. Both effects are beneficial as far as relieving stress on the vertebral column.

Reduction of Pain

The following are proposed effects of traction that impacts the reduction of pain from spinal traction:

1. There is an increased circulation because of the movement. This may reduce stricture from circulatory congestion. Improving this circulation appears to help decrease the concentration of painful chemical irritants in the joints.
2. Separation of the vertebra increases (widens) the space where the nerve exits (the neuroforamen). This can reduce the pressure exerted on an impinged nerve root.
3. Stretching of tight tissue can increase the motion at that segment reducing the pain from stress or strain on nociceptors (pain nerve endings).
4. Tension on the facet joint capsule or distraction of the surfaces can release entrapment of the meniscus (cartilage between the joints).
5. Stimulation of joint mechanoreceptors can gate (block) the transmission of painful stimuli at the brain stem level thereby providing pain relief.
6. There can be neurophysiological inhibition of reflex muscle guarding and therefor reduction in myospasm.

 

Specific Effects on the Lumbar and Cervical Discs

• Create a negative intradiscal pressure to promote retraction or repositioning of the herniated or bulging disc material.
• Create a lower pressure in the disc that will cause an influx of healing nutrients and other substances into the disc. This can foster a better healing environment.

Is Spinal Traction – Decompression right for you?

As you can see, there are many ways that spinal traction can relieve pain in the spinal column. The key is still in determining whether the treatment is right for you. Its all about the right treatment for the right person, for the right condition at the right time. This depends on the diagnosis, stage of injury and most specifically a trial to determine that it is safe for you.

It is very important to know that not all spinal conditions respond to spinal traction / decompression. In fact, there are conditions that can be aggravated by it. Assessment by a qualified medically trained professional will identify contraindications (reasons to exclude the treatment).

Mechanical Traction

What Is Mechanical Traction?

Mechanical traction is when we use a machine to produce a steady and controlled traction or decompression force on the lumbar spine. This takes the pressure off the joints and the discs in the spine, giving pain relief for many lower back pain conditions.

What Should I Expect?

You will lie on your back on the physio bed and two velcro belts will be strapped around you - one around the lower ribcage and one just above the pelvis. Once you are comfortable, the traction machine is started and it works by gently pulling down the belt that is attached above the pelvis, whilst the belt below the ribcage is maintaining your body up the bed. This produces a gentle, steady pull on the lower back for the allocated time, all you have to do is lie back and relax!

Will It Hurt?

Mechanical traction shouldn’t hurt. All it is doing is stretching your back in a way that is difficult to do on your own, so it will just feel like stretching does. Most people find traction very relaxing but like when you try a new stretch for the first time, your muscles may feel slightly achey afterwards but this doesn’t last long.

Spinal Anatomy

The spine is made up of 32 bones (vertebrae) that sit on top of each other, each separated by a shock absorbing disc. From the moment we get up in the morning until we go to bed at night, there is a compression force going through our spine putting pressure on the bones, discs, and joints. If there is an injury to any of these structures such as a ruptured disc, the compression force can really aggravate the injury. Likewise, continuous compression on a joint or disc will eventually lead to wear and tear and arthritis. This is why the lower back is most commonly prone to degenerative changes as it is at the bottom of the spine with the most load above it, and therefore is under the most compression.

Injuries That Mechanical Traction Is Used To Treat

• Disc bulge

• Ruptured disc (slipped disc)

• Degenerative disc

• Sciatica

• Osteoarthritis

• Stiff lower back

Physical Therapy for Neck Pain

If you have neck pain or pain in your arm coming from your neck, your healthcare provider may refer you to a physical therapist (PT) to help treat your condition. Neck pain can limit your ability to turn your head, look up or down, or perform normal activities like sleeping or exercising.

Symptoms that often come from your neck include:

• Pain in the middle of your neck
• Pain in one side of your neck
• Pain in one or both of your shoulder blades
• Occasionally, pain or numbness and tingling in your arm or hand

Since many different symptoms coming from your neck can be felt in many different places, it's important to see your healthcare provider or physical therapist to help determine the cause of your symptoms and to decide on the best way to manage your condition.

If you visit a physical therapist to help treat your painful neck condition, he or she will likely perform an initial assessment and then prescribe various treatments. One such treatment is cervical traction.

What Does Cervical Traction Do?

Cervical traction can be used for a variety of purposes.

• It can be used to help decrease compressive forces in the neck, which can help take pressure off of the discs that reside between the vertebrae (spinal bones) in the neck.
• It can also open up the spaces where nerves exit the spinal canal, which can help relieve pressure off of a compressed nerve.
• Traction can also help stretch the muscles and joint structures around the neck.

Common diagnoses that may benefit from cervical traction include, but are not limited to:

• Herniated or bulging discs in the neck
• Neck strains1
• Neck arthritis
• Cervical muscle spasms
• Radiculopathy2

If you have any of these conditions or symptoms, check in with your healthcare provider and visit your PT to see if cervical traction is right for you. Your PT can show you what to do (and what to avoid) to properly manage your neck pain.

Does Neck Traction Really Work?

When considering any medical treatment, in the PT clinic or elsewhere, it helps to understand what research is available for the treatment and how it may help your condition. So what does the research show for cervical traction?

A 2017 meta-analysis published in the journal Spine examined seven different cervical traction studies. The researchers concluded that neck traction can possibly offer short-term neck pain relief. The research is inconclusive when determining if traction offers long-term relief, and more studies need to be done on cervical traction to determine this.

When considering cervical traction for your neck pain, it's important to speak with your PT to be sure it is right for you and to have realistic expectations for the treatment.

How is Cervical Traction Applied?

Cervical traction can be applied in many different ways. Your PT can help you determine the best one.

Options include:

• Manual Cervical Traction: This type of traction is performed by your physical therapist, who holds your neck and head in his hands and then gently provides a traction, or pulling, force to your neck. Rhythmic periods of pulling and resting are usually applied, with each position being held for up to 10 seconds.
• Mechanical Cervical Traction: Mechanical traction for your neck involves using a harness that attaches to your head and neck while you're lying down on your back. The harness is attached to a machine that can provide a traction force, and the machine has a control panel so that your physical therapist can change the amount of force applied to your neck.
• Over-the-Door Traction: This type of traction can be used at home and involves strapping a harness to your head and neck while you're sitting in a chair. The harness is attached to a rope that's strung through a pulley system over your door, and traction force is applied using weights, a sandbag, or a water bag that's attached to the opposite end of the rope.

The pulling force involved will generally change depending on the patient's position, with less force being used in the supine position since you don't have to overcome the force of gravity. In this position, eight to 10 pounds is often recommended.

The force should be held for 10 to 20 seconds, and then slowly released. Increased pulling forces up to 40 to 50 pounds can be used, and rhythmic pulling and releasing should be continued for 10 to 20 minutes.

Traction can be applied several times throughout the day. Be sure to work closely with your physical therapist to help decide on the best treatment parameters for your specific condition.

 

If your symptoms worsen at any time during your treatment, notify your physical therapist immediately. He or she can make adjustments to your treatment, or traction can be discontinued altogether, and an alternative treatment can be started to treat your neck pain.

Can I Do Cervical Traction at Home?

Traction can be applied to your neck at home;4 this is most easily accomplished by an over-the-door traction unit that's available at many medical supply stores. If you purchase one, your PT can help you learn how to use the device, and can provide advice on the appropriate amount of force to use for your specific condition.

 

If you benefit from the mechanical traction in the physical therapy clinic, smaller traction units for home use are available that mimic the device used in the clinic. These devices are a bit more expensive than over-the-door traction units, but they're less cumbersome and easier to use than the door-mounted units. Your physical therapist can help you obtain a home mechanical traction unit if it's felt that you would benefit from one.

It is not a good idea to have someone who is not properly trained to perform cervical traction on your neck. You may injure your neck or worsen your condition if the correct application of traction is not performed.

A Word From Verywell

If you have neck pain, fear not. Most cases of cervical or neck pain resolve with a short course of physical therapy. Still, it is a good idea to check in with your healthcare provider if you have any condition that causes neck pain or loss of motion in your neck and cervical spine. He or she can help determine the cause of your pain and prescribe the correct treatment for your condition. Often, a referral to PT can be beneficial for neck pain, and cervical traction may be used during PT.

 

Cervical traction can be an effective treatment for neck pain and associated neck conditions, like arthritis or disc bulges and herniations. Remember that every person is different, and your physical therapy treatment should be tailored to your specific problems and needs. Your physical therapy program for neck pain should include active treatments like neck exercises and postural correction to help your condition.