Introduction

If you have a broken bone or a condition affecting your muscles, neck or spine, you may find that traction is used as part of your treatment.

Traction involves the medical team applying a pulling force to the limbs, soft tissues, pelvis or spine. It can either be used to stretch a single part of the body or to separate two individual parts of the body.

More specifically, traction can be used to:

• realign and fix any bone fractures into a permanent position (a fracture is a clean break in the bone that does not break through the skin)
• treat muscle spasms (sudden, uncontrollable muscle contractions)
• rest inflamed or infected joints
• stretch the soft tissues that surround a joint and reduce pain before surgery is carried out  
• correct a muscle contracture (shortening of a muscle)
• treat deformities that are caused by conditions such as scoliosis (abnormal curvature of the spine)
• reduce joint dislocations

Types of traction

There are two main types of traction that use different methods to apply the pulling force to the body or limbs. They are:

• skin traction
• skeletal traction

These are described in more detail below.

Skin traction

Skin traction uses various pieces of equipment, such as splints, adhesive bandages and braces, to apply pressure to the affected area of the body to help support it.

A pulling force is applied to the affected area of the body through the soft tissues. The soft tissues support and connect other tissues in the body. They include:

• skin
• muscles
• tendons
• blood vessels

• fat

Skeletal traction

Skeletal traction is used when a greater force needs to be placed on the traction apparatus.

The force is applied directly to the skeleton, which means that additional weight can be placed on the apparatus without damaging the surrounding soft tissues.   

Equipment that is used during skeletal traction includes:

• pins
• wires
• screws
• tongs (gripping tools)

These are surgically implanted into the affected bone.

See Traction – How it is performed for more information about skin traction and skeletal traction.

Manual traction

As well as skin traction and skeletal traction, manual traction is available too, although it is rarely used these days. It is usually carried out by a physiotherapist (a healthcare professional who uses massage and manipulation to promote healing).

During manual traction, the physiotherapist applies a pulling force manually to affected body part, either using their hands or a weights machine.

How is it performed?

Skin traction

Skin traction is often used to treat fractures of the limbs and hips. The pulling force helps to keep the fractured bones in the correct position before surgery is carried out.

Skin traction usually takes place while a person is lying in a hospital bed. It uses apparatus such as:

• adhesive tape
• bandages
• gloves and boots that are attached to weights

The weights and affected body parts are pulled up using a pulley system that is attached to the bed.

Skeletal traction

Skeletal traction is used to treat fractures that require more pulling force than skin traction can supply or when splinting (the use of a rigid support) has not been effective. The skin can usually only support up to 3.5kg (8lb), whereas the skeleton can support up to 12kg (25lb).

During skeletal traction, pins or screws will be surgically implanted directly into the bone. This can be done using either a local anaesthetic or general anaesthetic.

Local anaesthetic is where the affected area is numbed so that no pain or discomfort is felt during the procedure. If you have a general anaesthetic you will be completely unconscious.

After the pins or screws have been implanted, weights will be attached to them to pull the affected body part into the correct position. The amount of time that skeletal traction is required will depend on how severely injured the bones are.

Does traction work?

Despite being widely used for hundreds of years, there is little in the way of clinical evidence to support the use of traction. For example, there is little evidence to prove that manual traction is an effective treatment for spinal conditions such as:

• neck pain
• back pain 
• sciatica – pain that is caused by irritation to, or compression of, the sciatic nerve

Several studies have been carried out that either produced inconclusive results or concluded that there were more effective treatments than manual traction, such as physiotherapy and exercise.

Skin and skeletal traction do seem to be effective in treating some types of fracture, although some healthcare professionals believe that traction is unnecessary in treating minor fractures.