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Manual Traction therapy

Joint traction is an old and proven method that has been used for musculoskeletal treatment since early days.

Manual traction is a mobility technique accepted in clinics and used by physiotherapists, physicians, osteopaths and chiropractors to reduce pain and other symptoms. During a traction treatment, a care provider is slightly distracting the joint, allowing the joint-capsule to stretch which decreases intra-articular pressure giving more space in the targeted area.

The knee and hip-joint contain synovial fluid that acts as lubrication between the moving surfaces in the joint. When the surrounding soft tissue is too tight or/and the movement mechanics are of a poor quality, the surfaces inside the joint can compress and experience an array of problems. One of which is that the synovial fluid gets pushed out of the joint-capsule and the joint cartilage is damaged because there Is too little space. This thinning of the synovial fluid and wearing away of the cartilage lead to the symptoms of osteoarthritis. As traction slightly separates the bones in the affected joint, it results in immediate pain relief and for nutritious synovial fluid to flow back to the joint-capsule, thus strengthen the cartilage and joint.

The TracPal device helps to perform manual self-traction therapy of the hip joint (Long Axis Hip Traction) and the knee joint (Tibio Femoral Traction). Manual traction therapy is one important part of a line of combined options for treating hip and knee-joint disorders.

Hip Traction Therapy with a manual therapist

The patient is positioned supine, with hip in slight flexion and knee extended. A belt or therapist’s hands are placed firmly around the patient’s ankles. Distraction of the hip can be produced by the therapist leaning backward, producing slight joint gapping at the femoral acetabular joint. This technique can be used for decreasing muscle spasm or pain, and is also useful to increase accessory joint movement for flexion and abduction movements.

Hip Traction Therapy with the TracPal device
TracPal imitates hip traction therapy

TracPal imitates hip traction therapy


Knee Traction Therapy with a manual therapist

The patient is sitting with the leg hanging of a bench. The therapist’s hands are placed firmly around the patient’s ankle. Distraction force is gained by pulling down the leg along the line of tibia. This technique is particularly effective for pain control. Other positions may also be used to increase joint play and flexion.

Knee Traction Therapy with the TracPal device
TracPal imitates knee traction therapy

TracPal imitates knee traction therapy


Evidence Based Research

Hip Osteoarthritis – Wright 2011 Phys Ther. 2011

A single-blind, randomized clinical trial of 109 hip OA patients was carried out in the outpatient clinic for physical therapy of a large hospital. The manual therapy program focused on specific manipulations and mobilization of the hip joint. The exercise therapy program focused on active exercises to improve muscle function and joint motion.

Of 109 patients included in the study, 56 were allocated to manual therapy and 53 to exercise therapy. Success rates after 5 weeks were 81% in the manual therapy group and 50% in the exercise group. Furthermore, patients in the manual therapy group had significantly better outcomes on pain, stiffness, hip function, and range of motion. Effects of manual therapy on the improvement of pain, hip function, and range of motion endured after 29 weeks.

Hip Osteoarthritis – MacDonald 2006, J Orthop Sports Phys Ther.

Seven patients referred to physical therapy with hip osteoarthritis and/or hip pain were included in this case series. All patients were treated with manual physical therapy followed by exercises to maximize strength and range of motion. Although we cannot infer a cause and effect relationship from a case series, the outcomes with these patients are similar to others reported in the literature that have demonstrated superior clinical outcomes associated with manual physical therapy and exercise for hip osteoarthritis compared to exercise alone.

Knee Osteoarthritis – Deyle Ann Intern Med. 2000 Feb

Manual therapy and exercise was compared to placebo ultrasound. Patients were followed up to one year. There was a significantly greater improvement in the manual therapy and exercise group compared to the placebo ultrasound group at four weeks and the improvements were maintained at one year. They used an impairment-based approach that included mobilizations of the tibiofemoral joint, patellofemoral joint, proximal tibiofibular joint, and surrounding soft tissue.

Knee Osteoarthritis – Deyle Phys Ther. 2005 Dec

Manual therapy and exercise were compared to a home exercise program. Both interventions provided an improvement in pain and function but at the one year mark, the manual therapy and exercise group was significantly better. They used the same techniques as in the first trial.

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