By Andy Parsons, PT, DPT
Many practitioners recommend cervical traction as a treatment option for clients with neck pain. Research has been somewhat mixed about the effectiveness of cervical mechanical traction. Can we predict when cervical traction will be successful?
Some speculate that only a specific subgroup of patients will benefit from cervical traction and this accounts for mixed results in previous research. In response, Raney et al. did a prospective study trying to identify which factors predicted success with cervical traction. They proposed the following criteria as a preliminary clinical prediction rule (CPR) in 2009 (1):
- Age ≥55
- Positive shoulder abduction test
- Positive upper limb tension test (position A)
- Symptom peripheralization with central posterior-anterior motion testing C4-7
- Positive neck distraction test
Patients were considered to be positive on the rule if >3 of 5 factors. I.e. these patients were predicted to have a high likelihood of successful treatment with cervical traction(1,2).
Raney's study is only a preliminary study, however. Clinical prediction rules need to go through three steps prior to clinical utilization: 1. preliminary identification of rule factors 2. validation of the rule 3. Impact analysis of the rule.
Fritz et al. published somewhat of a follow-up study in 2014 (2). They studied 3 groups: exercise, exercise + mechanical traction, & exercise + over-the-door traction. Their data were anlayzed to see with Raney et al's CPR predicted increased level of success of the traction. The CPR was only better than random selection of traction at 6 month follow up and not 4 week or 12 month follow up. This study is not a true validation study, however. Subjects were included only if they had radicular pain; non-specific neck pain subjects were excluded.
The Frizt et al study did support exercise & traction as superior to exercise alone and ex and over the door traction at 6 and 12 month follow up in terms of pain and neck disability index (2).
Fritz et al 2014. See http://dx.doi.org/10.2519/jospt.2014.5065
Fritz et al 2014. See http://dx.doi.org/10.2519/jospt.2014.5065
These two studies highlight the importance of our need to actually validate and perform impact analyses on CPRs. The musculoskeletal world is littered with clinical prediction rules that have not made it past stage one.
The results, however, are promising for cervical traction in the correct patients. Radicular pain appears to be a be key to success but the jury is still out on some of the other factors from the CPR.
Do you use cervical traction in your practice? If so what clinical signs make you lean toward traction? Will these studies change your utilization patterns?
References:
1. Raney, Nicole H., et al. "Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise."European Spine Journal 18.3 (2009): 382-391.
2.Fritz JM, Thackeray A, Brennan GP, Childs JD. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014;44:45-57. http://dx.doi.org/10.2519/jospt.2014.5065
**This information is not intended to replace the advice of a physician/ physical therapist. Andy Parsons, PT, DPT disclaims any liability for the decisions you make based on this information.