SPINAL TRACTION: CERVICAL
Background A 22-year-old woman noted an ache in the right midcervical area upon awakening this morning. While driving to work, she turned her head to the right before changing lanes, and noted an audible click with severe pain in the right midcervical area. After arriving at work, she continued to experience localized pain that gradually worsened over the next hour. She presented to the emergency room, where an examination (including radiographic) revealed no neurologic or bony injury. She was referred for treatment of an acute neck sprain. She does not have radiating pain, and the neurologic examination is negative. She holds her head tilted and rotated to the left, and any attempt at side bend or rotation to the right produces severe, localized right midcervical pain. She is very tender over the right articular pillar at C4–5, and passive mobility testing reveals a markedly restricted joint play at C4–5. Impression Acute locking of the cervical spine (C4–5).
Treatment Plan Manual cervical traction was initiated. With the patient supine on a treatment table, the athletic trainer placed one hand under the patient’s head, with the palm over the occiput, thumb over one mastoid process, and fingertips over the opposite mastoid process. The athletic trainer’s other hand was placed over the patient’s forehead to avoid compressive forces on the temporo-mandibular joint. A gentle distraction force was applied (approximately 5 kg), with the line of force parallel to the long axis of the spine. The force was held for 3 seconds, then released for 10 seconds. This was repeated 10 times, with the distraction force gradually increased to a maximum of approximately 15 kilograms.
Response A reassessment was performed after the tenth force application, and the patient was able to hold her neck in a neutral position. The cycle was repeated four more times, with a gradual improvement in cervical range of motion and a reduction in pain each time. After the fifth cycle, she was able to attain rotation and side bending to the right equal to approximately 80% that of the motion to the left. She was treated the following day with the same approach, and attained full, pain-free range of motion.