Conservative Care: History of Traction

The History of Spinal Traction

Skeletal traction (also referred to as distraction), is one of the most ancient (as well as one of the most modern) medical treatments known. The Egyptian papyri (circa 3,000 B.C.), uncovered by Edwin Smith in 1862 identify the use of axial traction for the purpose of reducing spinal fracture dislocations as well as the treatment of many other other less serious conditions. The modern era of science related clinical care in regard to externally applied spinal traction began in 1933 when W. Gayle Crutchfield (1900-1972) first introduced his cranial tongs for the purpose of cervical spine traction in order to restore normal vertebral alignment.

Effective and controlled lumbar traction for the purpose of restorative spine care began at the Sister Kenny Institute in Minneapolis in 1974 with the introduction of the "Gravity Lumbar Reduction Therapy Program" (first edition 1976, second edition 1982). This form of spine distraction had an important safety control which was the weight of the lower portion of the body serving as a "governor" to avoid excessive force being directed to normal spine structures. It was intended to be used by the patient on a long-term basis. Although clinically effective the system was cumbersome and user-unfriendly.

One of the leading physician proponents of extended recumbent axial lumbar traction in the 20th century was Scandinavian physician Gertrude Lind, who developed auto-traction (Lind GAM: Auto-traction. Treatment of Low Back Pain and Sciatica. Thesis. Univ. of Linköping, 1974). Dr. Lind's work suggested that the majority of patients, with verified disc prolapses, treated with this modality could avoid surgical discectomy. The Editor's clinical experience has also confirmed this observation.

Others studying auto-traction found generally good results with 25% of patients being able to avoid surgical intervention (Ljunggren AE, Weber H, Larson: Autotraction versus Manual Traction in Patients with Prolapsed Lumbar Discs Scand J Rehabilitation Med 16:117-24, 1984). An important conclusion that was drawn from the Scandinavian research was that after 10 years of clinical experience: "no valid difference could be shown between operated and non-operated patients with prolapsed lumbar discs."

A 1985 CT evaluation of acute auto-traction performed on 25 patients at the Karolinska Hospital in Stockholm Sweden did not demonstrate change in disc geography under CT but was associated with beneficial clinical results (Gillstrom R, Ericson K, Hindmarsh T: Computed tomography examination of the influence of autotraction on herniation of the lumbar disc, Arch Ortho and Trauma Surg., Vol. 104, Number 5, pp. 289-293, Dec. 1985).

The Scandinavian research has been important in demonstrating, in selected patients, the possibility of meaningful non-invasive therapy as opposed to surgery.

The initial clinical success of the initial Sister Kenny Institute traction techniques led, in 1987, to the launching of a multi-specialty research effort to applying axial lumbar traction in a more ergonomic and user-friendly manner. Carefully documented patient outcome data from over the past decade has served to not only to continually support the Scandinavian experience but has also initiated an entirely new paradigm in the prevention of genomic spinal disease.

Along with the scientifically studied and documented use of spinal traction to treat and prevent spinal disease the history of this important treatment modality is also replete with examples of mechanically ineffective spinal traction devices. A classic example of this has been the use of "pelvic traction" on hospitalized patients in the past. Fortunately, the use of this modality, whose only real benefit was enforced bed rest has "fallen into disuse." To some extent this has reflected a number of clinical studies which have well documented the lack of efficacy (i.e. Cheatle M, Esterhai JL: Pelvic Traction as Treatment for Acute Back Pain Spine 16:1379-81, 1991).

Present Outpatient Lumbar Traction Devices

There now exist a number of recumbent axial traction techniques and devices . Typically these modalities are used on a short-term basis (weeks). The major liability with this that meaningful results require conscientious long-term application. Shown below are examples of pneumatic devices often provided in conjunction with physical therapy programs developed by Duane Saunders, P.T..

Shown to the left is the VAX-D (acronym for vertebral axial decompression) therapeutic table developed by Allan Dyer, M.D. The VAX-D is a motorized version of the Lind Autotraction described above. Cost of the system is about $125,000.

Being motorized, there is concern theVAX-D device can develop forces which are in excess of tissue compliance. Typical use is limited to multiple sessions carried out over a period of 2-3 weeks. Efficacy of safe axial traction is clearly dependent on extended (3-6 months or longer) use of the traction device. Not many VAX-D patients have purchased a unit for home use.

Reminiscent of the early days of "Faradization" the marketing of VAX-D seems to be frequently associated with ads such as this promising unrealistic expectations to back pain patients.

Summary Observations from the Burton Report^®

From the standpoint of clinical observation and study regarding axial spine traction over a period of 25 years the following observations by the Editor are offered:

The major liability of axial traction on the lumbar spine is the inability of being able to directly measure the distractive force in order to assure that this force does not exceed the compliance of normal body tissues and cause harm to the patient.

Those traction devices operated by the patient or where the distractive force in limited by gravity tend to be the safest.

The primary benefit of safe and effective lumbar axial traction is its use over extended periods of time.

The greatest benefit of lumbar axial traction in preventing and managing genomic spine disorders is daily use on a lifetime basis.

Short-term use programs appear to be beneficial only only over the short-term.

In both surgically operated and non-operated patients the quality of the outcome viewed after ten years directly reflects whether or not the patient was given, or has cooperated in, a daily (self-administered) health maintenance program.

Patients are more compliant with the use of daily traction program if it is basically user friendly and allows them to perform other tasks or work (i.e. desk or in front of a computer) during self-treatment.