The Saunders Cervical HomeTrac® Deluxe

Distinguishing Features and Therapeutic Benefits

The Saunders Cervical HomeTrac Deluxe is different from any other home cervical traction device on the market. It is not appropriate to substitute a different cervical traction device when the physician specifically requests a Cervical HomeTrac Deluxe.

Here are the reasons why:

1. The Cervical HomeTrac Deluxe provides a therapeutic force of up to 50 lbs. No other home cervical traction device delivers adequate force to treat conditions requiring intervertebral separation.

Most home cervical traction devices are limited to 20 lbs force. Twenty pounds is not a sufficient therapeutic force for many patients, especially those with diagnoses requiring separation of the intervertebral spaces for therapeutic effect (e.g., herniated disc, degenerative disc disease, foraminal stenosis, etc...).

The medical literature clearly indicates that 25-45 lb (11-20 kg) force is necessary to demonstrate a measurable change in the posterior cervical spine structures.2,3,11,14 There is no evidence that mid and lower cervical spine separation occurs at forces less than 20 lbs.

2. The Cervical HomeTrac Deluxe allows traction in the supine position. Traditional over-the-door traction is applied in the seated position. Research reveals that supine cervical traction is superior to sitting. Deets, et al7 found compression or narrowing of the joint space with cervical traction applied in the sitting position.

When the same force was applied in supine, separation was noted. The authors attributed the problem to muscle guarding and inability to relax during the seated treatment.

3. The Cervical HomeTrac Deluxe ensures continuity between home and clinical treatments. Many clinicians prescribe home traction after it has been shown that the patient benefits from traction treatments in the clinic.

The most common method of administering clinical traction is with the Saunders Clinical Traction Device. The Saunders Cervical HomeTrac Deluxe is the only home device that truly replicates the treatment received in the clinic.

4. The Cervical HomeTrac Deluxe ensures accurate force delivery. The Cervical HomeTrac Deluxe is the only home cervical traction device available that has a gauge to indicate exactly how much force is being applied.

Patients can follow their health care practitioner’s instructions precisely, ensuring a safer, more effective home treatment.

5. The Cervical HomeTrac Deluxe does not aggravate TMJ disorders. The Cervical HomeTrac Deluxe does not contact the chin or place any force on the temporomandibular joints (TMJ).

Conventional cervical traction methods use head halters that fit under the chin, which transmits force through the teeth to the TMJ. This can cause aggravation of the temporomandibular joints.

Saunders Cervical Traction Frequently Asked Questions

What are the Indications for Cervical Traction?
Cervical traction is most beneficial in these cases:

A) herniated disc;
B) any condition in which mobilization and stretching of soft tissue is desired; and
C) any condition in which opening the neural foramen is desired.

Cervical traction can also help relieve headaches and soft tissue
stiffness if done correctly (with the force pulling from the occiput and not the chin).

Why Should I Avoid Head Halters That Contact the Chin?
Conventional cervical traction methods use head halters that fit under the chin. During a cervical
traction treatment using one of these head halters, force is transmitted through the chin strap to
the teeth and the temporomandibular joints become weight bearing structures.

This can cause aggravation of the temporomandibular joints. The exact amount of force on the chin depends
upon the design and adjustment of the head halter, the direction (flexion or extension) of the
traction force and the amount of the traction force. Some head halters are better than others.

Nevertheless, even when the utmost care is taken to minimize the force on the chin, there often
exists enough force to cause an undesirable effect on the temporomandibular joints.
Crisp and Shore, Frankel and Hoppenfeld have shown that some patients experience
considerable discomfort in the temporomandibular joints with traditional cervical traction.

This is particularly true if an abnormal dental occlusion exists such as the absence of posterior teeth.
In some cases, the discomfort is so great that the treatment has to be discontinued. With
advancing age, the tissues become more susceptible to disruption and joint trauma, which may
be irreversible.

Franks suggests that cervical traction involving force on the jaw should be carried out with caution.
He reports that, in the older patient particularly, excessive pressure on
the jaw can lead to intracapsular bleeding and hematoma in the temporomandibular joint.10

Another undesirable effect of the head halter is that the force applied to the chin tends to cause
cervical extension. Since many patients with cervical problems have a forward head posture, it
is almost always undesirable to increase upper/mid cervical extension.

What Is the Optimum Angle for Cervical Traction?
Traditionally cervical traction has been done with the head and neck in some degree of flexion.
Some clinicians believe that the greater the angle of flexion, the greater the intervertebral
separation in the lower cervical spine. Thus it is a common belief that an angle of 20° to 30° of
flexion is best for treating a lower cervical problem. The reference most often cited for the
rationale is a study by Colachis and Strohm.

While this study does indeed state in the abstract and conclusion that, “... the amount of
separation increases with flexion of the cervical spine”, the clinical relevance of this fact should
be questioned when one takes a closer look at the data presented @The Saunders Group

While it is true that posterior separation does increase with more flexion, anterior separation
decreases with flexion. Compression actually occurs at 20° and 24° of flexion. Thus, the
commonly held belief that separation is greater with increased angles of flexion is only true
when referring to the posterior vertebral bodies.

Clinicians must first address exactly what it is that they want to separate when deciding upon
the optimal angle of cervical traction. In most cases, clinicians should try to achieve a
combination of a posterior and anterior stretch. Since the most common postural problem
related to the cervical spine is the forward head posture, treatment goals should be to increase
upper/mid cervical spine flexion and lower cervical/upper thoracic spine extension.

In other words, the goal of treatment is to decrease the curves of the cervical and upper thoracic spine.
Thus, the ideal traction device will flex the head and neck somewhat, but pull at a relatively flat
angle. A 15° angle accomplishes this because the posterior aspect of the head is slightly in front
of the posterior aspect of the trunk in a normal, desired standing posture.

If the clinician’s goal is to increase the space in the intervertebral foramen, it might be tempting to increase the flexion
angle beyond 15°. However, caution should be used when increasing the flexion angle for this
purpose, since the space available for the spinal nerve in the intervertebral foramen may
decrease with flexion beyond the neutral or straight position of the spine.

To summarize, we recommend the 15° angle of pull for nearly every clinical indication. In some
cases, a greater angle may be necessary for patient comfort or to accommodate severe postural
deformities.

How Much Force Should Be Used for Cervical Traction?
We have found that 25-40 lbs of force for the mid and lower cervical spine is often clinically
effective in conditions where a separation of the intervertebral space is desirable. Examples of
these conditions include herniated cervical disc, interforaminal nerve root encroachment,
degenerative disc or joint disease and facet joint impingement.

In other conditions where the muscles are primarily affected, less force may be effective. Examples include suboccipital or
upper trapezius muscle tension or shortening. As little as 10 lbs force may be necessary when
treatment is directed to the upper cervical area.

How much is too much? Certainly, patient comfort and clinical response should be the guide.
We have successfully used up to 50 lbs without any adverse results when working up to this
level gradually. However, we have found that 50 lbs is rarely needed for good clinical results,
and our experience and the clinician feedback we have received confirm that 25-40 lbs is
typically an adequate and effective force.

Why Should I Insist on the Supine Position for Cervical Traction?
Traditional over-the-door cervical traction devices require a seated treatment position. We do
not believe the seated position is effective, and in some cases it can actually cause more
problems. Research confirms that the supine position is superior.

Why is this so?

First, it is difficult to relax in the seated position, particularly with an awkward contraption
around the face and jaw. Some researchers have actually found compression or narrowing of the
joint space with application of seated cervical traction. This narrowing is often attributed to
muscle guarding and the patient’s inability to relax during traction.

Second, it is difficult to prescribe the correct amount of force when traction is applied in the
seated position. The average head weighs 10-12 lbs (4-6 kg). Since the seated position requires
that the traction force must lift the weight of the head, should the clinician add 10-12 lbs to the
recommended treatment force? If the patient is co-contracting the cervical muscles during
treatment, how much force is actually being applied to the structures of the spine?

What is the proper balance of adequate therapeutic force vs. excessive force that causes muscle guarding or
inability to relax? If cervical traction was applied in the supine position during clinical
treatments (most common), how does this translate to a seated home unit? Questions like these
lead to guesswork and poor patient compliance.

Finally, it is not possible to achieve adequate treatment force in the seated position with an overthe-
door device, because over-the-door devices deliver a maximum of 20 lbs force.

Can You Give Me Some Common Treatment Guidelines for Using the Cervical HomeTrac?
While every patient will need individualized consideration, here are some general guidelines for
cervical traction treatment. These guidelines are not meant to be a substitute for good clinical
judgment and experience. For more detailed information, refer to the textbook, Evaluation,
Treatment and Prevention of Musculoskeletal Disorders, Part I - The Spine, 4th Edition.21

Note that if home traction is being used to supplement or follow clinical treatment, the same
protocol that was used in the clinic should be followed at home.

1. Treatment Forces: Generally, 25-40 lbs of force is both safe and effective for most
clinical conditions. However, if this is your patient’s first trial with traction, or if the patient’s
condition is irritable, it is wise to start at a lower level and gradually increase the force over
several sessions. The patient’s symptoms should always be the guide. A little post-treatment
muscle soreness in the neck is common, but too much soreness or an increase in peripheral
symptoms is a sign that the force may have been increased too quickly.

2. Treatment Times: For treatment of herniated disc, we recommend keeping the treatment
times relatively short—in most cases 5-10 minutes. Herniated disc treatment is based on the
theory that traction causes decreased intradiscal pressure. The resulting "suction force" causes
disc reduction.

A lengthy treatment period may cause the disc to imbibe excessive fluid and
reverse any beneficial effects.21 For non-disc conditions, a 10-20 minute session is
recommended. The general rule is: The higher the force, the lower the treatment time. We rarely
use traction for more than 20 minutes.

3. Frequency and Duration: Initially, cervical traction may need to be performed daily.
Patients can be weaned off traction as the condition improves and they are able to tolerate more
exercise. For chronic conditions, ongoing traction may be beneficial to manage symptoms. A
major benefit of prescribing home cervical traction is the fact that multiple treatments can be
done in a single day—this is particularly beneficial for acute and subacute conditions.

4. Static vs. Intermittent Mode: In most cases, the static mode of traction is preferred,
especially when treating herniated disc or irritable conditions. Sometimes, an intermittent
method is preferred for patient comfort. In such cases, we recommend at least a 60 second hold
period (e.g., 60 second hold, 10 second rest).

These FAQ's were taken from a document provided by the Saunders Group on the research behind their Cervical Hometrac.

To view this document in it's entirety, along with a complete list of medical paper references, check out The Saunders Group.