During examination, some patients do not respond to extension, flexion, or even mid-range spinal positions or motions due to the acuity of or mechanical stimuli from their condition. The person is often more comfortable lying down and may have partial or full relief with a traction test maneuver to the painful region of the spine.
For these patients, use of traction procedures or unweighting the body in a pool may be the interventions of choice until the symptoms stabilize.

Management of Acute Symptoms

Traction
Various references have reported the benefits of traction.

• Traction has the mechanical benefit of temporarily separating the vertebrae, causing mechanical sliding of the facet joints in the spine, and increasing the size of the intervertebral foramina. If done intermittently, this motion may help reduce circulatory congestion and relieve pressure on the dura, blood vessels, and nerve roots in the intervertebral foramina. Improving circulation may also help decrease the concentration of noxious chemical irritants due to swelling and inflammation.

• There may be a neurophysiological response via stimulation of the mechanoreceptors that may modulate the transmission of nociceptive stimuli at the spinal cord or brain stem level.

Harness
Various unloading devices or body weight support systems may be used, such as partially suspending the patient in a harness while he or she performs ambulation on a treadmill or gentle extremity exercises.

Pool
If a person is not fearful of being in a pool, supporting the individual with a buoyant life belt in deep water reduces the effects of gravity on the lumbar spine. If symptoms are reduced, it may be possible to begin and progress gentle stabilization exercises in this buoyant environment to meet some of the goals during the acute and subacute phases. Exercises can also be progressed by using the properties of water for resistance and stretching.

Progression
As healing occurs, the patient should begin to tolerate weight bearing. After re-examination and assessment, identify the impairments and functional limitations. If a bias toward flexion or extension is determined or if there are areas of hyper- or hypomobility, plan the interventions accordingly.

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