Spinal Traction: Who Needs It and Who Doesn't

Traction is one of the most requested treatments for back and neck pain. Many patients arrive expecting it. It can help the right person, but it isn't suitable for everyone, and it works best as part of a bigger plan.

What traction is

Traction applies a gentle, controlled pulling force along the spine. It can be done by a machine, or by hand with the physiotherapist pulling. The aim is to slightly increase the space between the vertebrae, which may reduce pressure on an irritated nerve and relax tight muscles for a while.

There are two main types:

• Lumbar traction for the lower back, usually lying down with a harness around the pelvis and chest
• Cervical traction for the neck, lying or sitting with a support under the head

Who it may help

• People with nerve pain spreading down the leg (sciatica) or down the arm (pinched nerve in the neck)
• People whose symptoms ease when the spine is gently stretched or unloaded, which your physiotherapist checks first
• As short-term relief that makes it easier to start exercising

Who should avoid it

Traction is usually not suitable if you have:

• Osteoporosis or fragile bones
• A recent spinal fracture, spinal infection or tumour
• Pregnancy (for lumbar traction)
• Uncontrolled high blood pressure, or serious heart or breathing problems
• Spinal instability or recent spinal surgery
• Pain that gets worse during a trial of traction

What the research says

Studies on traction as a standalone treatment show mixed results. Some people, particularly those with nerve-root symptoms, feel better; others don't. On its own, traction rarely solves a back problem. It works best combined with exercise, movement advice and manual therapy.

How we use it

We only use traction after a full assessment. We often start with a short trial to see how your symptoms respond. If leg or arm pain eases, we may continue for a limited number of sessions while building up your strength and movement. If it doesn't help, we stop and use something else.

The bottom line

Traction is a tool, not a cure. If someone offers traction alone, session after session, with no exercises or plan to get you independent, ask what the next step is.