Cervical traction by PT is stipulated by Dr Gilete and Bolognese as a diagnostic tool, but what kind of Cervical traction?

[pattismith]

For those who found benefit from cervical traction by PT and who got a diagnostic of cervical instability, would explain what kind of cervical traction the PT carried out on you.
Was it supine or standing?
was it manual or with a machine?

If it was a machine, how much kilogrammes was needed to relieve your symptoms?

(I wish I could have cervical traction by a PT, but I don't know were to find one that is able to do so in my area, and I was wondering if I need to find one with a special equipment).

 

[Hip]

You can buy over-the-door neck traction devices for as little as £15.

The model I bought though can exert 20 kg (44 pounds) force — a slightly worrying amount!

In my case, I tried over-the-door neck traction at 5 kg force for 15 minutes, and then later neck stretching at 10 kg force for 7 minutes (this higher force actually seemed to permanently relax or loosen my neck, which may or may not be a good thing).

I did not notice any improvements in symptoms while on traction.

Over-the-door traction devices are designed to be used while you are seated in a chair, but I adapted my device so that I could use it while lying horizontally down in bed (more comfortable).


Bolognese indicated in this 2018 video at 58:31 that when he uses invasive traction (where screws temporarily placed in the skull to facilitate traction), up to 35 pounds (16 kg) force is used to pull skull upwards.

Jeff_w says:

So if your issue is CCI, you will need a certain amount of traction to sufficiently free your brainstem from compression/distortion. The amount of traction needed varies from person to person, but I've seen most people need between 20-35 lbs. 1

I've heard of 40 lbs being used by top neurosurgeons. 1

However, if you have tethered cord, then apparently neck traction can worsen this condition. I've also heard of one ME/CFS patient who tried neck traction and became worse afterwards. So there may be risks involved in trying traction.

Neck traction (also called cervical traction) is often used by physical therapists, so you can search Google for more info about the techniques and forces they use.

This article says:

For cervical treatment, pull is determined by patient comfort and may be progressively increased with subsequent treatments. To achieve separation of the C0-C1 and C1-C2 joints, it takes 10 pounds. (Wong 1992) For the rest of the vertebral components, at least 20-25 lbs is necessary to produce measurable separation of the cervical structures (Judovich 1952, Harris 1977, Saunders 1983). The usual range of treatment weight is 25 to 45 lbs. If the patient resists with muscle tension, no benefit will be achieved.

This article on cervical traction for neck pain says:

Can I Do Cervical Traction at Home?

Traction can be applied to your neck at home; this is most easily accomplished by an over-the-door traction unit that's available at many medical supply stores. If you purchase one, your physical therapist can help you learn how to use the device, and can provide advice on the appropriate amount of force to use for your specific condition.

If you benefit from the mechanical traction in the physical therapy clinic, smaller traction units for home use are available that mimic the device used in the clinic. These devices are a bit more expensive than over-the-door traction units, but they're less cumbersome and easier to use than the door-mounted units. Your physical therapist can help you obtain a home mechanical traction unit if it's felt that you would benefit from one.

It is not a good idea to have someone who is not properly trained to perform cervical traction on your neck. You may injure your neck or worsen your condition if the correct application of traction is not performed.

 

[pattismith]

@Hip
thank you for your precious help. I had a look to the one you used, it's a manual kind.
I don't understand how it works, how do you do to know the weight of the traction you apply?

 

[Hip]

thank you for your precious help. I had a look to the one you used, it's a manual kind.
I don't understand how it works, how do you do to know the weight of the traction you apply?

From what I have seen, there are two types of over-the-door traction devices:

The first type is very simple and uses a weight to create the force. They provide a plastic container which you fill with water to a certain level to create the desired weight.

The second type (the type I bought) uses a spring weighing scale (labelled "dynamometer" in your picture) and a ratchet wheel system (labeled "traction frame") to create the force. With this type, you have a string hanging down from the ratchet wheel, which you pull on, and each time you pull it, it turns the wheel through one notch on the ratchet wheel, which increases the force. There is also a second string hanging down which you can pull on, and this releases the ratchet wheel, so if you pull on this second string, all the force is released.

The only problem with this type of device is that the spring scale cannot be seen when you are using it, because the scale is located above your head. So although you can pull on the string to increase the force, you cannot see the weight reading on the scale. I had to use a webcam connected to my android tablet in order to view the scale above my head. So this is problem. But if you have someone assisting you, then they can read the scale.

Also on the model I bought, the weight units on the spring scale were not in pounds or kg, but in some weird Chinese weight unit, so I had to recalibrate the scale in kilograms. (I did this recalibration by hanging two 5 liter plastic containers filled with water to create a 10 kg force underneath the spring scale, and then marked the 10 kg point on the scale with a marker pen).


So I think the over-the-door traction device that uses a plastic container filled with water might be easier. The only disadvantage with the plastic container type is that they tend to go up to around 10 kg maximum force, whereas spring weighing scale device I bought goes up to 20 kg maximum force.


Also, note that the model I bought only has hook, it does not have a proper door attachment. So unless you have something on your ceiling you can hook onto, this device will not work for you.

 

[valentinelynx]

Dr. Bolognese (through Dr Kaufman) first requests manual cervical traction done by a physical therapist experienced with working with EDS patients. It's done supine. The home traction he suggests is an over-the-door type with a bag of water to supply the weight (not the one you pull on). Maximum weight to be used at home is 20 lbs. Here's the one I bought (from Amazon). Note that there are several similar ones for sale on Amazon, and according to the reviews, some apparently have a head harness that is too small to use. The one that came with mine is usable, although it is also made incorrectly (the straps are attached to the wrong side). I purchased a separate head harness (this Bird and Cronin one) that is much better made and applies the pressure more evenly (the cheaply made one that came with the kit pulled too hard on my chin, hurting my chin and teeth).

Another note on the home traction devices: don't trust the printing on the bag to properly indicate the weight provided by water. For example, there are lines for 5 lbs, 10 lbs, 12 lbs, etc. Instead, I suggest estimating the weight by calculating the weight of the water you are adding: e.g. 900 ml is about 2 lbs., and then using a hand held luggage scale to weigh the bag to be sure.

 

[pattismith]

The only problem with this type of device is that the spring scale cannot be seen when you are using it, because the scale is located above your head. So although you can pull on the string to increase the force, you cannot see the weight reading on the scale. I had to use a webcam connected to my android tablet in order to view the scale above my head. So this is problem. But if you have someone assisting you, then they can read the scale.

This is exactly the problem I noticed with this one, so I may prefer the one @valentinelynx bought.
Interesting what you quoted about only 10 pounds needed to separate C0-C1-C2, whereas CCI patients report to find relief only with 20-35 pounds.

I used an inversion table, and found some effect on my cervical only in the vertical position (180°), but I'm not sure, as the nausea feeling is so strong and long lasting that it interferes with any other sensations.
Head weight is about 10-11 pounds so I may not need too much weight.

 

[Hip]

Interesting what you quoted about only 10 pounds needed to separate C0-C1-C2, whereas CCI patients report to find relief only with 20-35 pounds.

Yes Jeff_w said elsewhere that:

So if your issue is CCI, you will need a certain amount of traction to sufficiently free your brainstem from compression/distortion. The amount of traction needed varies from person to person, but I've seen most people need between 20-35 lbs.

In my case: It took 30 pounds of sustained traction to eliminate my POTS and PEM and overall ME/CFS symptoms.

When I used my device, I went up to 10 kg (22 pounds), but I was afraid to go higher than that, because even at that force, afterwards there was a slight but permanent loosening of my neck (which may not be a bad thing, because my neck and trapezius muscles are always tense). I did not want to go any higher without expert guidance. But I guess you can only rule out CCI if you do go up to 30 or 35 pounds.

 

[Bowser]

Dr. B has recommended attempting manual cervical traction as the first diagnostic step, but I'm not sure if I should rule out tethered cord syndrome first to be absolutely safe.

Should I rule out tethered cord syndrome before attempting cervical traction? I'm not sure who to consult on that.