Does Traction Work for Disc Injuries?

The disc is the “small cushion” between each one of the spine bones (vertebrae). They are made up of a firm, rubbery outer “annulus” and a thick, jelly-like center “nucleus pulposus”. The main purpose of the disc is to act as a “shock absorber”. Throughout the day as one sits or stands, by gravity, the spine squeezes (compresses) the discs. As it does so, the disc pressure in the central jelly-like area increases, eventually enough to “push the spine bones apart”. This activity occurs continually throughout the day except for when one is lying down. A sudden squeezing or compressing force often occurs in trauma, such as a vehicle related accident. Significant force is placed on the disc, and the pressure of the jelly/nucleus pulposus increases dramatically, beyond what the outer rubbery annulus can withstand. This can lead to a portion of the disc “pouching out” much like a bubble on a car tire or a long balloon if you squeeze it in the middle. The area that “pouches out” is called a disc protrusion/herniation. The symptoms will differ depending upon which nerves are compressed or “pushed on”. If it is the small central nerves, patients normally describe a central aching sensation that is worse with sitting. If it presses sideways, it can pinch the larger nerves that radiate or “shoot down” the arms or legs. If the force is very severe, the outside annulus can rupture and the jelly-like nucleus pulposus can leak into the surrounding tissues. This can further aggravate symptoms by causing a “chemical burn”.

These are serious injuries and need to be addressed by somebody who is experienced in managing them. Although disc protrusions/herniations are often suspected by the mechanism of the injury, the clinical symptoms, and certain tests that are performed on physical exam, they can only be confirmed by an MRI (magnetic resonance image). This is essentially a “fancy picture” of the spine and disc, but it does not involve any radiation. It is a very safe procedure but expensive to perform. If you have any internal heart device, such as a pacemaker, a pain-blocking device that has been installed in your spine, or any metal fragments from previous trauma or surgery, the test may not be able to be safely performed. Once a disc protrusion/herniation has been diagnosed you should avoid prolonged sitting and forward stooping, as this further squeezes or compresses the disc. Generally, lying down or leaning backwards (extending your spine) will bring relief. Antiinflammatories (if you do not have any history of ulcers/reflux and are not taking blood thinners) may be helpful. However, the centerpiece of initial therapy is cervical (neck) or lumbar (low back) home traction. This equipment is inexpensive and safe to use. We have used this form of management on 2,000 patients over the last nine years with MRI scan-confirmed disc protrusions/herniations with an 80% overall success rate. To get this level of success, careful instruction is performed in our office and additional handouts given. It is critical that these be followed precisely if you wish to obtain the excellent 80% healing rate. Healing with home traction units usually takes up to three months of performing the traction morning and night for approximately 15 minutes each time. If cervical and/or lumbar home traction is not effective, this leaves you with only four options (all of which are not great): (1) Modify your lifestyle and “suck it up and put up with the pain”. (2) Same as #1 but with the help of potentially addicting painkillers. (3) Undergo a series of epidural injections to the affected area. In the vast majority of cases, at best these will provide good temporary relief lasting up to three months. It is rare that relief lasts longer than this. Thus repeated injections will be required. (4) Undergoing some form of spinal disc surgery.

In summary, disc injuries are extremely common in vehicle accidents. An MRI scan will likely be needed to make a definitive diagnosis. We strongly recommend a trial of up to three months of home traction. If you are the fortunate 80%, no additional management will be required (outside of being shown an aggressive home core-strengthening program). If you are the unfortunate 20% that traction is not effective for, then unfortunately you will be left with choosing one of the above four options.

A Better Way to Get Better,
Adrian Lewis
Adrian Lewis, MD