What Is Cervical Traction?

Definition: Cervical traction involves applying a pulling force to the head to create separation between cervical vertebrae, thereby:

• Increasing the size and height of cervical neural foramina (openings where nerve roots exit)
• Relieving pressure on compressed nerve roots
• Reducing muscle spasm through gentle stretching
• Improving circulation to affected tissues
• Promoting intervertebral disc hydration (via imbibition—fluid movement into disc)

Types of cervical traction:

• Manual traction: Performed by physical therapist or chiropractor using hands to apply controlled pulling force
• Mechanical traction: Uses devices (pulleys, weights, or motorized units) to apply consistent force
• Over-the-door traction: Home device using pulley system and water bag for adjustable weight
• Inflatable/pneumatic traction: Collar-style device inflated with hand pump to create vertical stretching force

Positioning:

• Supine (lying down): More comfortable, better for relaxation, reduces muscular guarding
• Seated (over-door traction): Allows functional positioning, adjustable angles

Clinical Evidence 2024-2025: What Research Actually Shows

Ongoing Major Clinical Trial: TracCerv2 (2024-2027)

The most significant recent development in cervical traction research is the TracCerv2 trial, a national, multi-center, randomized, placebo-controlled, single-blinded study launched in March 2024 across seven centers in France.

Study details:

• Participants: 206 individuals with cervical radiculopathy diagnosed 3-12 months previously
• Intervention: Intensive cervical traction protocol—2 × 30 minutes per day for 5 consecutive days
• Experimental group: Maximum weight ≤ 12 kg (26.4 lbs)
• Placebo group: Maximum weight ≤ 600g (1.3 lbs)
• Primary outcome: Disability improvement measured via Neck Disability Index (NDI)
• Completion: September 2027

Significance: This is the largest, most rigorous trial to date examining cervical traction for radiculopathy. Results (expected 2027-2028) will provide the strongest evidence yet on traction efficacy.

2025 Systematic Review & Network Meta-Analysis

A comprehensive systematic review published in 2025 (searching databases through June 2024) evaluated manual therapy and traction for cervical radiculopathy.

Key finding: Manual therapy (MT) alone should be considered the first-line conservative treatment for cervical radiculopathy, and the role of traction requires further investigation before it can be widely recommended.

When traction MAY be considered (per 2024-2025 evidence):

• Patient exhibits severe nerve root compression symptoms (persistent radicular pain, neurological deficits, significant motor weakness)
• Imaging confirms foraminal stenosis or disc herniation with nerve root impingement
• Conservative manual therapy alone has provided insufficient relief after adequate trial (6-8 weeks)

When MT alone is prioritized (per 2024-2025 evidence):

• Patient has mild to moderate cervical radiculopathy with no severe nerve compression
• Goal is to improve mobility, muscle strength, pain relief without excessive mechanical strain
• Patient has no contraindications to manual therapy (osteoporosis, inflammatory arthritis)

Earlier Meta-Analysis Findings (Still Relevant)

A 2018 systematic review and meta-analysis examining cervical traction for cervical radiculopathy concluded:

• Modest support for adding traction to physical therapy for pain reduction
• Lesser effects on function/disability compared to pain outcomes
• Current literature lends some support to mechanical and manual traction for cervical radiculopathy in addition to other PT procedures

Honest Evidence Assessment

What the science tells us (as of 2024-2025):

• Pain relief: Moderate evidence that traction can reduce radicular pain when combined with other PT interventions
• Function/disability: Weaker evidence for functional improvements
• Long-term efficacy: Limited data; most studies examine short-term outcomes (weeks to months)
• Traction alone: Insufficient as standalone treatment; must be combined with manual therapy, exercises, education
• Overall conclusion: Evidence is inconclusive but promising for specific populations (severe radiculopathy with imaging-confirmed nerve compression)

Bottom line: Cervical traction is not a magic cure, but it may provide additional symptom relief for select patients when used as part of a comprehensive treatment plan. The 2024-2027 TracCerv2 trial will provide much-needed clarity.

Who Benefits from Cervical Traction?

Best Candidates

• Cervical radiculopathy with imaging-confirmed nerve root compression (MRI showing disc herniation or foraminal stenosis)
• Symptoms: Radiating arm pain, numbness, tingling, weakness following dermatomal pattern
• Positive clinical tests: Spurling test positive, upper limb tension test positive, relief with cervical distraction test
• Failed initial conservative treatment: PT alone for 4-6 weeks with partial but insufficient relief
• Not surgical candidates (yet) or patient prefers conservative management

May Also Benefit

• Chronic neck pain with muscle spasm (though evidence weaker than for radiculopathy)
• Cervical spondylosis (degenerative changes) with foraminal narrowing
• Post-whiplash syndrome (in specific cases)

Unlikely to Benefit

• Acute neck strain without nerve involvement
• Mechanical neck pain without radicular symptoms
• Cervicogenic headaches without disc/nerve pathology
• Conditions better treated with other modalities (e.g., myofascial pain responds better to manual therapy alone)

Contraindications: When Cervical Traction Is Dangerous

Absolute Contraindications (NEVER use traction)

• Osteoporosis or severe osteopenia: Risk of fracture from traction force
• Cervical spine infections or malignancies: Traction may spread infection or damage tumor-weakened structures
• Cervical vascular insufficiency: Vertebral artery compromise, history of stroke/TIA
• Ligamentous instability: Atlantoaxial instability, acute ligament tears, post-traumatic instability
• Connective tissue disorders: Rheumatoid arthritis, ankylosing spondylitis, Ehlers-Danlos syndrome (ligamentous laxity)
• Prior cervical fusion surgery: Traction may stress hardware or adjacent segments
• Atlanto-occipital dislocation: Traction is NOT recommended and associated with 10% risk of neurological deterioration
• Acute cervical fracture or dislocation: Requires immediate medical/surgical management, NOT traction
• Cord compression with myelopathy: Upper motor neuron signs (hyperreflexia, Babinski positive, gait disturbance) require urgent evaluation, not home traction

Relative Contraindications (Use with extreme caution or avoid)

• Pregnancy: Hormonal changes increase ligament laxity
• Hiatal hernia: Traction force may exacerbate symptoms
• Claustrophobia: Some patients cannot tolerate traction apparatus
• Temporomandibular joint (TMJ) disorders: Halter-type traction may aggravate jaw pain
• Acute inflammatory phase: Wait until inflammation subsides before adding traction
• Severe pain with traction: If pain increases significantly during or after traction, discontinue immediately

Warning Signs to STOP Traction Immediately

• Increased radiating pain or numbness
• New weakness in arms or hands
• Dizziness, visual disturbances, nausea (possible vertebral artery compromise)
• Difficulty swallowing or breathing
• Severe headache during or after traction
• Balance problems or gait disturbance

If any of these occur, STOP traction and seek immediate medical evaluation.

Evidence-Based Home Traction Protocols

Professional Survey Data (2017)

A survey of physical therapists in the United States found:

• 76.6% of PTs reported using traction
• 93.1% would use traction for patients with signs of nerve root compression
• Most common indications: cervical radiculopathy, disc herniation with nerve involvement

Protocol Parameters Based on Research

1. Force/Weight

• Minimum effective force: 25-30 lbs required to produce measurable cervical vertebral separation
• Typical therapeutic range: 20-50 lbs (9-23 kg)
• TracCerv2 trial protocol: Up to 26 lbs (12 kg)
• Start low, progress gradually: Begin with 10-15 lbs, increase by 5 lbs weekly as tolerated
• Individual variation: Larger individuals may require more force; smaller individuals may respond to less

2. Neck Angle/Position

• Upper cervical (C1-C2): 10° flexion
• Middle cervical (C3-C5): 15° flexion
• Lower cervical (C6-C7): 20° flexion
• General recommendation: 15-20° flexion (slight chin-down position) for most cervical pathologies
• Supine position often preferred: Promotes muscle relaxation, reduces guarding

3. Duration

• Initial sessions: 5-10 minutes
• Standard duration: 15-20 minutes per session
• Maximum duration: 30 minutes per session
• TracCerv2 intensive protocol: 2 × 30 minutes daily for 5 days (under clinical supervision)

4. Frequency

• Acute phase: 1-2 times daily
• Subacute/chronic: Once daily or every other day
• Maintenance: 2-3 times per week
• Duration of treatment course: Typically 2-6 weeks; reassess if no improvement after 2 weeks

5. Continuous vs. Intermittent

• Continuous: Steady, sustained force throughout session
• Intermittent: Alternating periods of tension and rest (e.g., 2-4 minutes tension, 1 minute rest)
• Typical intermittent ratio: 2:1 to 4:1 (tension:rest)
• Evidence: Both effective; patient preference and tolerance guide selection

Sample Home Traction Protocol (Conservative Approach)

Week 1-2:

• Force: 10-15 lbs
• Duration: 10 minutes
• Frequency: Once daily
• Position: Supine, 15° flexion
• Mode: Continuous

Week 3-4 (if tolerating well):

• Force: 20 lbs
• Duration: 15 minutes
• Frequency: Once daily
• Mode: Intermittent (3 min on, 1 min off)

Week 5-6 (if continued benefit):

• Force: 25-30 lbs
• Duration: 20 minutes
• Frequency: Once daily or every other day

Reassessment: After 2 weeks, if no improvement, consult healthcare provider. After 4-6 weeks of benefit, consider maintenance schedule (2-3x/week) or wean off as symptoms allow.

Types of Home Cervical Traction Devices

1. Inflatable/Pneumatic Cervical Collars

How they work: Collar fits around neck, inflated with hand pump to create vertical stretching force

Advantages:

• Portable, easy to use
• Adjustable pressure
• Can be used seated or lying down
• Relatively affordable ($30-80)

Disadvantages:

• Limited force (typically <20 lbs)
• May not provide sufficient separation for severe cases
• Comfort varies (some find collar pressure uncomfortable)

Best for: Mild to moderate symptoms, maintenance therapy, travel

Browse our inflatable cervical traction devices, air neck stretchers, and heated inflatable traction collars.

2. Over-the-Door Traction Units

How they work: Pulley system mounts over door, head halter connects to rope/pulley, water bag provides adjustable weight

Advantages:

• Adjustable force (can reach 30-50 lbs)
• Precise weight control (add/remove water)
• Seated position allows functional positioning
• Relatively affordable ($40-100)

Disadvantages:

• Requires door clearance and setup
• Some users find halter uncomfortable on jaw/chin
• Less portable
• Learning curve for proper positioning

Best for: Moderate to severe symptoms requiring higher forces, home use with space for setup

Explore over-door traction systems and suspension stretcher belts.

3. Supine/Table-Top Traction Devices

How they work: Lie on back, head cradle with adjustable straps/weights creates traction force

Advantages:

• Most comfortable position (supine promotes relaxation)
• Eliminates jaw/chin pressure from halter
• Easier to relax muscles during traction

Disadvantages:

• Requires flat surface (bed, floor)
• Less precise force control in some models
• May fall asleep during session (not necessarily bad, but monitor time)

Best for: Chronic symptoms, relaxation-focused therapy, patients who cannot tolerate seated traction

Check out cervical traction pillows and professional-grade home traction units.

4. Cervical Collars (Soft/Rigid Support)

Note: Standard cervical collars provide support and immobilization, NOT traction. However, they may be prescribed alongside traction for specific conditions.

Soft collars: Limit motion, provide warmth, proprioceptive reminder for posture

Rigid collars (Philadelphia, Miami-J): Significant motion restriction, post-surgical or post-trauma

Browse adjustable cervical collars for supportive care.

Safety Guidelines for Home Cervical Traction

Before Starting Home Traction

1. Get professional evaluation: Do NOT self-diagnose and start traction. Consult physician or physical therapist for proper diagnosis and clearance.
2. Obtain imaging if indicated: MRI or X-rays may be needed to rule out contraindications (fracture, tumor, severe stenosis with myelopathy).
3. Receive instruction: Have PT or healthcare provider demonstrate proper setup, positioning, force levels.
4. Start supervised: Ideally, first few sessions supervised to ensure proper technique and monitor response.
5. Understand contraindications: Review absolute and relative contraindications listed earlier in this article.

During Traction Sessions

1. Find quiet, comfortable space: Minimize distractions, ensure you can relax fully.
2. Check device setup: Verify all components secure, weights/inflation appropriate, positioning correct.
3. Start with low force: Begin conservatively (10-15 lbs), increase gradually based on tolerance.
4. Monitor symptoms: Mild discomfort/stretching sensation normal; sharp pain, increased radiating symptoms, dizziness = STOP immediately.
5. Set timer: Don't exceed recommended duration (falling asleep during traction can result in excessive time).
6. Breathe and relax: Deep breathing promotes muscle relaxation, enhances traction effectiveness.
7. Avoid distractions: Don't read, watch TV, use phone during traction—focus on relaxation.

After Traction Sessions

1. Remove traction slowly: Gradual release of force, avoid sudden movements.
2. Rest briefly before standing: Give muscles time to re-engage, prevent dizziness.
3. Gentle range of motion: Slow neck rotations, flexion/extension to restore normal mobility.
4. Monitor post-session symptoms: Mild soreness normal first few sessions; severe pain or neurological changes require medical evaluation.
5. Track response: Keep log of force used, duration, symptoms before/after to identify optimal parameters.

Red Flags Requiring Immediate Medical Attention

• Sudden severe headache
• Vision changes, double vision, dizziness
• Difficulty swallowing or breathing
• New or worsened arm weakness
• Loss of bowel/bladder control (sign of cauda equina or severe spinal cord compression)
• Gait disturbance, balance problems
• Upper motor neuron signs (hyperreflexia, clonus, Babinski sign)

Combining Traction with Other Treatments

Evidence-based principle: Traction alone is insufficient. Best outcomes occur when traction is combined with:

1. Manual Therapy

• Joint mobilization to restore segmental mobility
• Soft tissue release to reduce muscle guarding
• Manipulation (when appropriate) for specific joint restrictions

2. Therapeutic Exercise

• Deep cervical flexor strengthening: Chin tucks, supine head lifts
• Scapular stabilization: Rows, scapular retractions
• Postural exercises: Address forward head posture, rounded shoulders
• Nerve gliding exercises: Promote nerve mobility, reduce adhesions

3. Modalities

• Heat before traction: Warm muscles, improve extensibility (15 minutes moist heat)
• Ice after traction (if inflamed): Reduce inflammation from stretching
• Electrical stimulation: May reduce muscle spasm

4. Ergonomic Modifications

• Monitor height at eye level
• Proper pillow support (cervical contour pillow maintaining natural curve)
• Avoid prolonged static positions
• Frequent positional changes (every 30 minutes)

5. Education and Self-Management

• Understanding pain mechanisms
• Activity pacing strategies
• Posture awareness and correction
• Stress management (stress increases muscle tension)

Comprehensive treatment addressing all factors produces better outcomes than traction alone.

Realistic Expectations and Timelines

What to Expect Week-by-Week

Week 1-2:

• May experience mild soreness after sessions (normal as tissues adapt)
• Some patients report immediate symptom relief during/after traction; others notice gradual improvement
• Focus on establishing tolerance, finding optimal parameters

Week 3-4:

• If beneficial, should notice reduced radiating pain, improved arm function
• Soreness from traction should decrease
• Can begin increasing force if symptom improvement continues

Week 5-6:

• Reassessment point: Is traction providing meaningful benefit?
• If yes, continue with maintenance schedule (reduce frequency to 2-3x/week)
• If no significant improvement, consult provider—may need different treatment approach

Month 3+:

• Some patients continue maintenance traction long-term (especially degenerative conditions)
• Others wean off as symptoms resolve and exercises maintain gains
• Periodic "tune-up" sessions during symptom flares

How to Know If Traction Is Working

Positive indicators:

• Reduced radiating arm pain (primary outcome)
• Improved range of motion (easier to turn head, look up/down)
• Decreased numbness/tingling in arm/hand
• Improved strength in previously weak muscles
• Better sleep quality (less night pain)
• Ability to perform activities previously limited by pain

Signs traction may not be appropriate:

• No improvement or worsening symptoms after 2 weeks consistent use
• Increased pain during or after traction (beyond mild soreness)
• New symptoms developing (different pain pattern, additional numbness)
• Cannot tolerate force required for therapeutic benefit

When to Consider Alternatives

If home traction provides insufficient relief after 4-6 weeks trial:

• Epidural steroid injection: For radicular pain with inflammation
• Surgical consultation: If significant neurological deficits, progressive weakness, or severe symptoms affecting quality of life
• Different PT approach: Focus on manual therapy, neural mobilization without traction
• Pain management specialist: Multimodal approach including medications, injections, behavioral strategies

Frequently Asked Questions

Q: Is home cervical traction safe to do on my own?

A: Home cervical traction can be safe when used appropriately after professional evaluation and instruction. Key safety requirements: (1) Proper diagnosis ruling out contraindications (osteoporosis, ligament instability, vascular issues, infections, tumors), (2) Professional instruction on setup and use, (3) Starting with conservative parameters and progressing gradually, (4) Monitoring for warning signs (increased pain, dizziness, neurological changes). Do NOT self-diagnose and start traction without medical clearance—some conditions (cord compression, vertebral artery insufficiency) can be worsened by traction.

Q: How much weight/force should I use for cervical traction?

A: Research shows 25-30 lbs minimum is required for measurable vertebral separation, with therapeutic range typically 20-50 lbs. However, start conservatively: Begin with 10-15 lbs for first week, increase by 5 lbs weekly as tolerated. Larger individuals may require more force; smaller individuals may respond to less. The TracCerv2 trial (2024-2027) uses maximum 26 lbs (12 kg). More is NOT always better—excessive force can cause muscle guarding, defeating the purpose. Optimal force is individualized; work with PT to find your therapeutic "sweet spot."

Q: Can I sleep with a cervical traction device on?

A: NO. Do not sleep with traction device applied. Sessions should be time-limited (typically 15-30 minutes maximum) with active monitoring. Falling asleep during traction can result in excessive duration, inability to respond to warning symptoms, and potential complications. Set a timer for each session. Some cervical support pillows provide mild traction-like support during sleep, but these are NOT the same as active traction devices.

Q: Does insurance cover home cervical traction devices?

A: Coverage varies significantly by insurance plan and medical necessity criteria. Many plans cover cervical traction devices when: (1) Prescribed by physician or PT, (2) Medical necessity documented (e.g., imaging-confirmed disc herniation with radiculopathy), (3) Trial of conservative treatment documented, (4) Specific diagnosis codes met (e.g., cervical radiculopathy, disc herniation). Out-of-pocket costs for home devices range $30-$150 depending on type. Check with your insurance provider and request Letter of Medical Necessity from prescribing provider if coverage denied initially.

Q: How long before I see results from cervical traction?

A: Timeline varies by individual and severity. Some patients report immediate symptom relief during/after first session; others notice gradual improvement over 2-4 weeks. Reasonable expectations: Mild improvement possible within 1 week, meaningful symptom reduction typically 2-4 weeks with consistent use, maximum benefit usually by 4-6 weeks. If NO improvement after 2 weeks of consistent, properly performed traction, reassess with provider—traction may not be appropriate modality for your specific condition. Don't persist with ineffective treatment; explore alternatives.

Q: Can cervical traction help herniated discs or is surgery inevitable?

A: Many cervical disc herniations improve with conservative treatment including traction—surgery is NOT inevitable. Natural history studies show significant percentage of disc herniations resorb (shrink) over 6-12 months. Traction may help by: (1) Creating space for nerve root, reducing pressure, (2) Promoting disc imbibition (fluid movement), (3) Reducing muscle spasm. However, surgery IS indicated when: (1) Progressive neurological deficits (worsening weakness), (2) Severe pain unresponsive to 6-12 weeks conservative care, (3) Cord compression with myelopathy (upper motor neuron signs), (4) Cauda equina syndrome. Conservative treatment success rate varies; work with spine specialist to determine individualized plan.

Q: What's the difference between cervical traction and cervical decompression?

A: Terms often used interchangeably, but technically: Traction = mechanical pulling force applied to spine to create separation. Decompression = broader term referring to any method reducing pressure on neural structures (traction is ONE form of decompression; surgery is another). Some marketing uses "spinal decompression" to sound more advanced than "traction," but mechanism is essentially the same. Focus on evidence and proper technique rather than terminology.

Q: Can I use cervical traction for headaches?

A: Depends on headache type. Cervicogenic headaches (originating from cervical spine structures—facet joints, discs, nerves) may respond to cervical traction if caused by nerve compression or disc pathology. However, most cervicogenic headaches respond better to manual therapy, postural correction, and exercise. Tension headaches from muscle tension might benefit from traction's muscle relaxation effect, but evidence is weak. Migraines, cluster headaches are NOT treated with cervical traction. Accurate headache diagnosis is critical; see neurologist or headache specialist if chronic headaches are primary concern.

Q: Is over-the-door traction better than inflatable collar devices?

A: Depends on severity and goals. Over-the-door traction: Higher forces (20-50 lbs), better for moderate-severe radiculopathy, more precise weight control, but requires setup and some find halter uncomfortable. Inflatable collars: Lower forces (<20 lbs), portable, easier to use, better for mild symptoms or maintenance, but may not provide sufficient force for severe nerve compression. For significant disc herniation with radiculopathy, over-door traction likely more effective. For mild symptoms or maintenance therapy, inflatable collar may suffice. Consult PT to match device to your condition severity.

Q: Do I need a prescription to buy a home cervical traction device?

A: No prescription required to purchase most home cervical traction devices (they're available over-the-counter). However, prescription IS needed for: (1) Insurance coverage/reimbursement, (2) Professional guidance on proper use, (3) Ensuring appropriate diagnosis and ruling out contraindications. Strongly recommend consulting healthcare provider before self-purchasing and using traction device—starting traction with undiagnosed condition (e.g., ligament instability, vascular insufficiency) can cause serious harm. Browse our cervical traction devices, but seek professional evaluation first.

Conclusion: Evidence-Guided Approach to Home Cervical Traction

Cervical traction is a potentially beneficial adjunct therapy for cervical radiculopathy and disc-related neck pain, but it is NOT a standalone cure and does NOT work for everyone.

What the 2024-2025 evidence tells us:

• Modest support for adding traction to manual therapy and exercise for cervical radiculopathy
• First-line treatment remains manual therapy alone for most patients (per 2025 systematic review)
• Traction may provide additional benefit for severe nerve compression symptoms with imaging confirmation
• Long-term efficacy data limited—most research examines short-term outcomes
• TracCerv2 trial results (2027-2028) will provide strongest evidence yet

Your action plan:

1. Get proper diagnosis: See physician or PT for evaluation, imaging if indicated
2. Rule out contraindications: Ensure no osteoporosis, instability, vascular issues, infections/tumors
3. Receive professional instruction: Don't self-start traction; learn proper technique from provider
4. Start conservatively: Low force (10-15 lbs), short duration (10 min), progress gradually
5. Combine with other treatments: Traction + manual therapy + exercise > traction alone
6. Monitor response: Reassess after 2 weeks; if no benefit, explore alternatives
7. Choose appropriate device: Match device type to symptom severity and usage context

Browse our cervical traction devices:

• Inflatable Cervical Traction Devices (portable, mild-moderate symptoms)
• Air Neck Stretchers (adjustable inflation, home use)
• Over-Door Traction Systems (higher forces, moderate-severe symptoms)
• Heated Cervical Traction (combines traction + thermotherapy)
• Professional-Grade Home Units (comprehensive features)
• Cervical Support Collars (immobilization, post-trauma/surgery)

Complete Pain Relief & Recovery collection for comprehensive neck care options.

Cervical traction, when used appropriately as part of a comprehensive treatment plan, can provide meaningful symptom relief for select patients with nerve compression. Approach it with realistic expectations, professional guidance, and commitment to safety protocols.

Your neck health is worth the investment in proper evaluation and evidence-based care.