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Home Made Neck Traction Device to Mimic Invasive Neck Traction
Neck traction (cervical traction) is a mean to diagnose craniocervical instability (CCI). Those with CCI will usually experience a dramatic and near instant improvement in symptoms when placed under neck traction.
However, not all forms of neck traction are equal.
It's not uncommon for patients with CCI to have no improvement in symptoms when trying home over-the-door neck traction or physiotherapist-applied manual neck traction, but experience major improvements in symptoms under invasive cervical traction performed by a neurosurgeon.
Invasive cervical traction involves a neurosurgeon temporarily placing metal screws into your skull bone just above your ears in order to attach a hoist to pull your head upwards. Invasive traction is considered the gold standard of neck traction. Upwards forces of 35 lbs and sometimes more are used.
So if you get positive results (ie, a major improvement in symptoms) from over-the-door or physiotherapist (PT) manual traction, then this is diagnostic for CCI. But if your symptoms fail to improve, then you still might have CCI, but you may only observe major improvement in symptoms when you are placed under invasive neck traction. Invasive traction is the gold standard traction method for CCI diagnosis.
But invasive neck traction can only be performed by a neurosurgeon in his office, so this is not something you can try at home.
Or can you? Because in a moment I am going to detail a home-made neck traction device that I set up which I suspect can go some way to mimicking invasive cervical traction (but without needing to place screws in your skull!).
But first of all, let's try to understand the mechanics of why home over-the-door or PT-applied traction sometimes does not relieve symptoms, but invasive traction does. If you are applying the same upwards force, you might expect to get the same result from all traction methods.
But if we consider over-the-door traction, the two purchase points (where force is applied) are located at the front and rear of the skull (under the jaw and at the nape of the neck). This is obvious if you look at a picture of an over-the-door device:
Because of the triangular configuration of the harness, those two purchase points, as well as applying an upwards force to the skull, will also apply a horizontal compressive force on the skull (ie, they will push the back of the skull and the front of the skull towards each other).
So this horizontal compressive force will to a degree distort the shape of the skull. And if you are a CCI patient with retroflexed odontoid (where the odontoid is tilted towards and is pushing into the brainstem), that horizontal compressive force may act to push the odontoid further into the brainstem, thus worsening the CCI, and nullifying any benefits the upwards force has.
PT manual traction is also often applied under the jaw and at the nape of the neck, resulting in a similar issue of distortion of the shape of the skull.
So I think this is what may differentiate over-the-door traction and PT manual traction from the gold standard of invasive cervical traction: in the case of invasive traction, there is a clean upwards-only force with no horizontal force components to distort the skull shape. This is because the purchase points in invasive cervical traction are screws attached to the coronal midline of the skull (the screws are screwed into the skull about one inch above the top of each ear).
So this is my theory of why home or PT traction may not relieve symptoms, when invasive traction does.
Dr Bolognese says a similar thing in this 2018 video at 1:02:57: he says that there is a big difference between non-invasive traction and invasive traction, and this is because the because the temporomandibular joint (TMJ) interferes. When you use over-the-door traction, this applies a force to your TMJ, but you do not get such a force with invasive traction.
So this theory got me thinking: is it possible to create a clean upwards-only force on the skull using simple equipment at home? Well, if you look at your rear upper molar teeth, these are located closer to the coronal midline of your head than your lower jaw is. So I thought, what if it were possible to apply an upwards force on the rear upper molar teeth? That should provide a cleaner upwards force on the skull than the over-the-door device.
It turns out that it's quite easy to apply an upwards force on the rear molars, using a small plank of wood as a lever. I was lucky to find in my garage a perfectly-shaped piece of wood ideal for the purpose. The piece of wood I found was 70 cm long, 1 cm thick, and 6 cm wide (which as we will see in a moment, is the perfect width).
I made a seesaw out of this small plank of wood, by placing a biro pen on a table, and placing the plank over the biro, with the biro in the middle of the length of the planck, so that the two sides of the plank could rock on the biro. At one end of the Planck I placed a weight (there happened to be an 8 kg bust ornament in my house which I used as a weight). Here's what my set up looks like:
Then I opened my mouth and placed the other end of the plank resting on upper rear molars (this is why the plank width of 6 cm was perfect: 6 cm is the distance across the back of my jaw, from my left rear molars to my right rear molars).
As I let my body slump downwards, the force of the 8 kg weight was then applied to my rear upper molar teeth by this levered plank of wood, thereby applying an upwards force of 8 kg (around 18 lbs) to my skull. This I upwards force held for a few minutes.
In my case, just as with over-the-door traction, I did not notice any improvement in symptoms via this rear molar-applied neck traction. However, I suspect I do not have CCI, because I have very few cervical medullary syndrome symptoms (most people with CCI have quite a few CMS symptoms), and do not have neck pain or headaches.
I don't think forces of around 10 kg on your rear molars will cause any damage to the teeth, as the biting force of human molars is 120 kg. Ref: 1 Unless of course you have weak teeth.
Make sure that the balancing point (the biro) is in the middle of the length of the plank: this ensures that the downwards force from the weight place at one end is the same as the upwards force applied to your upper teeth.
As far as I can see, this rear molar-applied neck traction should be as safe as over-the-door traction, but obviously I cannot be sure about that. So if you want to try this, you will have to proceed at your own risk.
And note that any form of neck traction applied at home or applied by a physiotherapist has to be done at your own risk. Although most people do not experience any long-term adverse effects from home or PT traction, there are a few people who do.
Note that for home or physiotherapist-applied traction, it is recommended never to go higher than 20 lbs force.
It's also worth glancing at this list of contraindications for cervical traction.
Note that neck traction will not improve symptoms if you have Chiari, only if you have CCI. So you cannot use neck traction as a mean to diagnose Chiari. It's only good for diagnosing CCI.
Horizontal Traction Force is Not Equivalent to a Vertically Applied Force
On a slightly different topic, but worth mentioning here: the stated force applied to the neck by horizontal traction devices which are operated while you are lying down (such as the Saunders cervical traction machine) may be wrong, and out by around 10 or 11 pounds, compared to vertical traction devices (like the over-the-door device).
Because the human head itself weighs quite a bit, around 10 to 11 lbs (5 kg), if using a vertical traction device like the over-the-door device (which is usually operated sitting upright in a chair), the first 10 lbs of traction force applied only serve to take the 10 lbs weight of the head, but will not apply any force to the neck. It's only when you apply forces higher than 10 lbs do you actually apply any force to the neck.
So if you apply say 20 lbs of force to your head on a vertical traction device, you would need to subtract from that the 10 lbs weight of the head, so that the actual upwards traction force on your neck is only 10 lbs.
But if you apply the same 20 lbs traction while lying down, then you are applying the full 20 lbs on your neck.
So depending on whether you apply the force vertically or horizontally, the actual force applied to the neck varies.
In my own case, I originally bought an over-the-door traction device, but I adapted it to work horizontally, while lying on my bed. While lying in this horizontal position, I applied 22 lbs of force to my head. But now I realize this is the equivalent of 22 + 10 = 32 lbs applied in the vertical position, and this is higher than the recommended 20 lbs maximum for home or PT traction.
Neck traction (cervical traction) is a mean to diagnose craniocervical instability (CCI). Those with CCI will usually experience a dramatic and near instant improvement in symptoms when placed under neck traction.
However, not all forms of neck traction are equal.
It's not uncommon for patients with CCI to have no improvement in symptoms when trying home over-the-door neck traction or physiotherapist-applied manual neck traction, but experience major improvements in symptoms under invasive cervical traction performed by a neurosurgeon.
Invasive cervical traction involves a neurosurgeon temporarily placing metal screws into your skull bone just above your ears in order to attach a hoist to pull your head upwards. Invasive traction is considered the gold standard of neck traction. Upwards forces of 35 lbs and sometimes more are used.
So if you get positive results (ie, a major improvement in symptoms) from over-the-door or physiotherapist (PT) manual traction, then this is diagnostic for CCI. But if your symptoms fail to improve, then you still might have CCI, but you may only observe major improvement in symptoms when you are placed under invasive neck traction. Invasive traction is the gold standard traction method for CCI diagnosis.
But invasive neck traction can only be performed by a neurosurgeon in his office, so this is not something you can try at home.
Or can you? Because in a moment I am going to detail a home-made neck traction device that I set up which I suspect can go some way to mimicking invasive cervical traction (but without needing to place screws in your skull!).
But first of all, let's try to understand the mechanics of why home over-the-door or PT-applied traction sometimes does not relieve symptoms, but invasive traction does. If you are applying the same upwards force, you might expect to get the same result from all traction methods.
But if we consider over-the-door traction, the two purchase points (where force is applied) are located at the front and rear of the skull (under the jaw and at the nape of the neck). This is obvious if you look at a picture of an over-the-door device:
Over-the-Door Neck Traction Device
Because of the triangular configuration of the harness, those two purchase points, as well as applying an upwards force to the skull, will also apply a horizontal compressive force on the skull (ie, they will push the back of the skull and the front of the skull towards each other).
So this horizontal compressive force will to a degree distort the shape of the skull. And if you are a CCI patient with retroflexed odontoid (where the odontoid is tilted towards and is pushing into the brainstem), that horizontal compressive force may act to push the odontoid further into the brainstem, thus worsening the CCI, and nullifying any benefits the upwards force has.
PT manual traction is also often applied under the jaw and at the nape of the neck, resulting in a similar issue of distortion of the shape of the skull.
So I think this is what may differentiate over-the-door traction and PT manual traction from the gold standard of invasive cervical traction: in the case of invasive traction, there is a clean upwards-only force with no horizontal force components to distort the skull shape. This is because the purchase points in invasive cervical traction are screws attached to the coronal midline of the skull (the screws are screwed into the skull about one inch above the top of each ear).
So this is my theory of why home or PT traction may not relieve symptoms, when invasive traction does.
Dr Bolognese says a similar thing in this 2018 video at 1:02:57: he says that there is a big difference between non-invasive traction and invasive traction, and this is because the because the temporomandibular joint (TMJ) interferes. When you use over-the-door traction, this applies a force to your TMJ, but you do not get such a force with invasive traction.
So this theory got me thinking: is it possible to create a clean upwards-only force on the skull using simple equipment at home? Well, if you look at your rear upper molar teeth, these are located closer to the coronal midline of your head than your lower jaw is. So I thought, what if it were possible to apply an upwards force on the rear upper molar teeth? That should provide a cleaner upwards force on the skull than the over-the-door device.
It turns out that it's quite easy to apply an upwards force on the rear molars, using a small plank of wood as a lever. I was lucky to find in my garage a perfectly-shaped piece of wood ideal for the purpose. The piece of wood I found was 70 cm long, 1 cm thick, and 6 cm wide (which as we will see in a moment, is the perfect width).
I made a seesaw out of this small plank of wood, by placing a biro pen on a table, and placing the plank over the biro, with the biro in the middle of the length of the planck, so that the two sides of the plank could rock on the biro. At one end of the Planck I placed a weight (there happened to be an 8 kg bust ornament in my house which I used as a weight). Here's what my set up looks like:
Home Made Rear Molar Neck Traction Device
Then I opened my mouth and placed the other end of the plank resting on upper rear molars (this is why the plank width of 6 cm was perfect: 6 cm is the distance across the back of my jaw, from my left rear molars to my right rear molars).
As I let my body slump downwards, the force of the 8 kg weight was then applied to my rear upper molar teeth by this levered plank of wood, thereby applying an upwards force of 8 kg (around 18 lbs) to my skull. This I upwards force held for a few minutes.
In my case, just as with over-the-door traction, I did not notice any improvement in symptoms via this rear molar-applied neck traction. However, I suspect I do not have CCI, because I have very few cervical medullary syndrome symptoms (most people with CCI have quite a few CMS symptoms), and do not have neck pain or headaches.
I don't think forces of around 10 kg on your rear molars will cause any damage to the teeth, as the biting force of human molars is 120 kg. Ref: 1 Unless of course you have weak teeth.
Make sure that the balancing point (the biro) is in the middle of the length of the plank: this ensures that the downwards force from the weight place at one end is the same as the upwards force applied to your upper teeth.
As far as I can see, this rear molar-applied neck traction should be as safe as over-the-door traction, but obviously I cannot be sure about that. So if you want to try this, you will have to proceed at your own risk.
And note that any form of neck traction applied at home or applied by a physiotherapist has to be done at your own risk. Although most people do not experience any long-term adverse effects from home or PT traction, there are a few people who do.
Note that for home or physiotherapist-applied traction, it is recommended never to go higher than 20 lbs force.
It's also worth glancing at this list of contraindications for cervical traction.
Note that neck traction will not improve symptoms if you have Chiari, only if you have CCI. So you cannot use neck traction as a mean to diagnose Chiari. It's only good for diagnosing CCI.
Horizontal Traction Force is Not Equivalent to a Vertically Applied Force
On a slightly different topic, but worth mentioning here: the stated force applied to the neck by horizontal traction devices which are operated while you are lying down (such as the Saunders cervical traction machine) may be wrong, and out by around 10 or 11 pounds, compared to vertical traction devices (like the over-the-door device).
Because the human head itself weighs quite a bit, around 10 to 11 lbs (5 kg), if using a vertical traction device like the over-the-door device (which is usually operated sitting upright in a chair), the first 10 lbs of traction force applied only serve to take the 10 lbs weight of the head, but will not apply any force to the neck. It's only when you apply forces higher than 10 lbs do you actually apply any force to the neck.
So if you apply say 20 lbs of force to your head on a vertical traction device, you would need to subtract from that the 10 lbs weight of the head, so that the actual upwards traction force on your neck is only 10 lbs.
But if you apply the same 20 lbs traction while lying down, then you are applying the full 20 lbs on your neck.
So depending on whether you apply the force vertically or horizontally, the actual force applied to the neck varies.
In my own case, I originally bought an over-the-door traction device, but I adapted it to work horizontally, while lying on my bed. While lying in this horizontal position, I applied 22 lbs of force to my head. But now I realize this is the equivalent of 22 + 10 = 32 lbs applied in the vertical position, and this is higher than the recommended 20 lbs maximum for home or PT traction.
