How to do angled manual traction on dorsal nerve

Proper technique for performing angled manual traction on the dorsal nerve (cervical region):

• The patient lies supine with pillows used to gently elevate the head and neck so that the cervical spine is anteriorly flexed to an angle that helps relieve pain or numbness in the cervicobrachial region.
• The therapist, seated at the cranial end of the table, supports the occiput with the palm of the dominant hand, placing the thumb-index finger web at the occipito-cervical junction, while the other hand cradles the chin using the hypothenar eminence.
• This positioning stabilizes the patient's head and neck at the chosen angle of anterior flexion to target dorsal nerve root compression effectively.
• The therapist applies a longitudinal pulling force along the cervical spine axis, directed away from the body, producing traction with the neck held in this flexed position.
• Traction angles are selected dynamically based on the pathoanatomic level and type of nerve root compression; for dorsal degenerative changes, these angles typically range within specific flexion degrees designed to decompress the affected dorsal nerve roots.
• The force is gradually increased until passive movement is observed distally (such as in the toes), indicating effective traction without discomfort, maintained intermittently with repeated cycles of approximately 30 seconds traction followed by 10-15 seconds rest, repeated about five times.
• This manual intermittent traction is complemented by pressing-kneading manipulation of the nuchal muscles around the dorsal cervical spine to relax surrounding soft tissues, applied using finger pulps along transverse, zygapophyseal, and spinous process lines.
• The sequence concludes with mechanical traction maintaining the same traction angle as manual traction, usually with a force about 10% of body weight for approximately 15 minutes to sustain decompression.

This detailed procedure specifically targets dorsal nerve root impingement by adjusting the traction angle and force to the patient's tolerance and symptom relief, focusing on improving foraminal height and neural mobility in cervical radiculopathy.

Note: While UK guidelines acknowledge traction-oriented manual therapy as an effective form of treatment for cervical radiculopathy, specific technical details of angled manual traction targeting dorsal nerves are derived from recent clinical trials developing angled manual traction protocols, which emphasize the importance of cervical anterior flexion angles tailored to the degenerative pathology affecting the dorsal nerve roots (e.g., hypertrophied zygapophyseal joints, disk herniations) Liao et al. 2025 NICE CKS,NICE CKS,NICE CKS,Liao et al. 2025.