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Neck Traction and Insurance Coverage
Causes and level of Neck Disorders
The prevalence of non-traumatic mechanical neck disorders (neck pain) in the
United States is 10%. The anatomic source may be myofascial, ligamentous,
osseous, neurologic, cutaneous, or visceral.
Possible causes include:
1) compression of neural structures resulting in spasm and radiculopathy;
2) inflammatory, neoplastic, infectious, or degenerative processes; or
3) disruption of tissue secondary to trauma.
Acute phase treatment of neck pain in the physical therapy outpatient setting
includes moist heat, gentle massage
and temporary immobilization with a
cervical collars that holds
the neck in slight flexion.
Ultrasonic treatments, especially combined with low frequency current
electrotherapy of the muscles may be helpful. Therapy with low frequency
pulsating electromagnetic field and laser photobiostimulation have also been
proved successful. Patients with cervical herniated nucleus pulposus and
radiculopathy are usually treated with an aggressive physical rehabilitation
program. For chronic neck pain, no treatment is necessary except for
non-narcotic analgesics for symptoms, and avoiding any type of activity or work,
which causes strain of the neck.
For decades, cervical traction has been applied widely for pain relief of
neck muscle spasm or nerve root compression. It is a technique in which a force
is applied to a part of the body to reduce para-vertebral muscle spasms by
stretching soft tissues, and in certain circumstances separating facet joint
surfaces or bony structures. Additional pounds for cervical traction is usually
utilized in the hospitals or clinics for temporary use and in certain situations
and under observation with occasional imaging, making sure of not to destabilize
the spine. Studies have shown that traction must be constant so that the muscles
may tire and the strain fall on the joints. It generally takes 2 minutes of
sustained traction before the intervertebral spaces begin to widen. Forces
between 20 and 50 pounds are commonly used to achieve intervertebral separation.
Cervical traction is administered by various techniques ranging from supine
mechanical motorized cervical traction to seated cervical traction using an
over-the-door pulley support with attached weights. Duration of cervical
traction can range from a few minutes to 30 min, once or twice weekly to several
times per day. Anecdotal evidence suggests efficacy and safety, but there is no
documentation of efficacy of cervical traction beyond short-term pain reduction.
In general, over-the-door traction at home is limited to providing less than 20
pounds of traction.
The devices were developed to deliver cervical traction in the home
comparable to forces applied by physical therapists in the outpatient setting.
The patient is instructed in home traction to relieve symptoms, an exercise
routine to relieve spasm and discomfort, and to report any weaknesses, eye
symptoms, bladder or bowel incontinence immediately. No matter how clinically
effective a therapy is found to be, the treatment process, especially when it is
dependent upon home use, is highly dependent upon patient compliance. So, these
patients must undergo adequate follow-up to assure proper usage.
The majority of published data reflects surgical outcomes, with little
available data regarding the outcome of non-operatively treated patients.
Recently, however, several studies have demonstrated that cervical traction in
the home can provide symptomatic relief in 81% of the patients with mild to
moderately severe (Grade 3) cervical cervical spinal syndromes.
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