Clinical UM Guideline

This document addresses the different devices used in the home for cervical traction, including “over-the-door” and pneumatic devices. There are several types of home cervical traction devices, including:

• Over-the-door
• Pneumatic
• Units attached to the headboard
• Freestanding

Intermittent cervical traction is an accepted technology for treatment of a variety of musculoskeletal disorders of the neck, including but not limited to, neck muscle spasm (such as whiplash), radiculopathy, discogenic pain and degenerative changes.

Note: For additional information, please see the following documents:

• CG-DME-39 Dynamic Low-Load Prolonged-Duration Stretch Devices
• DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Medically Necessary:

A home cervical traction device is considered medically necessary when all of the following criteria (A, B, C and D) are met:

1. The cervical traction device is an “over-the-door” design; and
2. The individual has a musculoskeletal or neurologic impairment requiring traction equipment; and
3. The appropriate use of a home cervical traction device has been demonstrated to the individual; and
4. The individual is able to tolerate the device.

Not Medically Necessary:

A home cervical traction device is considered not medically necessary when the criteria above are not met.

This document describes clinical studies and expert recommendations, and explains whether cervical traction devices are clinically appropriate for home use. The following summary does not replace the medical necessity criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your healthcare provider for any advice about your health.

Key Information

Home cervical traction devices are tools used to help treat neck pain by gently stretching the neck. Common types include over-the-door devices, pneumatic (air-powered) devices, and units attached to a bed or freestanding frame. These devices may help people with muscle strain, nerve pain, or wear and tear in the neck. The most commonly used type is the over-the-door device, which uses a pulley system and a weight to pull the head upward. Traction is usually used along with other treatments like exercise or physical therapy, not by itself. Some people may feel short-term pain relief and better movement, but results vary. Risks may include discomfort, worsening pain, or injury if used incorrectly; so proper training and tolerance are important.

What the Studies Show

Cervical traction works by gently pulling the head away from the body. This may increase space between the bones in the neck, stretch muscles and ligaments, and reduce pressure on nerves. Devices can be used in different ways, such as steady pulling or repeated cycles of pulling and relaxing. Over-the-door devices usually provide lower force, while pneumatic devices can apply higher force.

Research results are mixed. Some studies show that adding traction to exercise may improve pain and movement more than exercise alone. A review of several studies found that traction may reduce pain for a short time, but there was no lasting benefit at follow-up. One study found that people using traction with exercise had better pain and function scores than those using exercise alone, but results were not always consistent. Better studies are needed to know if different types of traction devices improve long-term health. Using traction without guidance or as a stand-alone treatment may not provide a lasting benefit and could lead to discomfort or injury.

When is Home Cervical Traction Clinically Appropriate?

Home cervical traction devices (over-the-door type) may be appropriate in these situations:

• The device is an over-the-door design; and
• The person has a muscle, bone, or nerve condition that requires traction; and
• The person has been shown how to use the device correctly; and
• The person can safely tolerate the device

When is this not Clinically Appropriate?

Home cervical traction devices are not clinically appropriate when the above criteria are not met. Studies show that benefits are limited and not consistent, especially for other device types like pneumatic systems. These devices have not been proven to improve long-term health compared to standard care. Using devices without proper need, training, or tolerance may lead to discomfort, worsening symptoms, or injury. Unnecessary or unproven tests or treatments can lead to needless worry, or to treatment that does not help.

Home cervical traction devices are not clinically appropriate in scenarios other than those listed above.

(Return to Description)

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

When services are Not Medically Necessary:
For the procedure code listed above when criteria are not met.

When services are also Not Medically Necessary:
For the following procedure codes; or when the code describes a procedure designated in the Clinical Indications section as not medically necessary.

Summary

Cervical traction is a noninvasive modality used in the management of neck disorders involving mechanical loading or nerve root irritation. It is delivered through manual or mechanical devices that apply distractive force to the cervical spine, including home traction units. In practice, traction is typically incorporated into a broader conservative treatment approach alongside exercise, manual therapy, and education, rather than used as a standalone intervention.

Evidence supporting home cervical traction is limited and mixed. Some studies suggest improved pain and mobility when traction is combined with other treatments, though findings are generally inconclusive (van der Heijden, 1995; Graham, 2006; Young, 2009). A meta-analysis reported short-term pain reduction with intermittent traction but no sustained benefit (Yang, 2017). Randomized trial data indicate that home traction added to exercise may improve outcomes compared to exercise alone, with some benefit observed for home over-the-door devices, although results were not consistently statistically significant (Fritz, 2014). Overall, while home traction is considered an accepted modality, particularly for over-the-door devices, evidence remains insufficient to determine comparative effectiveness across device types or optimal treatment parameters.

Description

Neck pain is a common occurrence that affects many people during their lifetime. The American College of Rheumatology (ACR, 2015) noted that on an annual basis, approximately 30% of the population experiences an occurrence of neck pain. Within their lifetime, 20 to 70% of the adult population will experience neck pain (Ibrahem, 2022). Typically, neck pain is acute and improves within 1 to 2 weeks with conservative treatments, which may include heat, ice, massage, stretching and pain relievers. The majority of neck pain resolves within 8 to 12 weeks (ACR, 2015; van der Heijden, 1995). However, almost half of individuals with neck pain will have residual pain or experience frequent recurrences (Cohen, 2015).

Traction is a treatment modality in which opposite forces are applied to separate parts of the body to stretch soft tissues, and/or separate bony structures. It has been proposed that cervical traction results in an expansion of the intervertebral spaces, an increase in joint mobility, and stretching of muscles and ligaments adjacent to the vertebral bodies, potentially improving the clinical outcomes in those with neck pain. After 2 minutes of sustained traction, the intervertebral spaces begin to widen. Forces between 20 and 50 pounds are frequently used to achieve intervertebral separation. Continuous or static traction can be applied in a steady amount for specific time periods. Intermittent or cyclical traction involves traction being applied and released multiple times during one treatment session. Duration of cervical traction can range from a few minutes up to 30 minutes, once or twice weekly to multiple times per day. In addition to office-based traction, individuals with long-standing pain may benefit from home-based traction.

A variety of cervical traction devices are available for use in the home. The most commonly used device employs an over-the-door design, in which an individual wears a chin strap harness attached to a counterweight that is suspended over a door using a pulley system. The counterweight pulls the chin harness upwards, extending the neck. Over-the-door units are designed to deliver no more than 20 pounds of tension. Variations of this device using the counterweight and pulley system include frames that attach to a headboard or freestanding units.

Pneumatic devices are designed to be used in the supine position with the device beneath the head and shoulders and a strap or straps holding the head in place. User-controlled pumps or bellows allow the individual to increase the tension, pulling the head away from the body. This extends the neck, stretches the affected muscles and increases the intervertebral spaces. Pneumatic devices typically can deliver up to 50 pounds of tension.

When used with other standard modalities, traction may result in greater improvements in mobility and pain compared to standard therapy alone (van der Heijden, 1995; Zylbergold, 1985). While the quality of existing evidence is low, involving small studies with limited follow-up and generally inconclusive results, the totality of data is generally supportive (Graham, 2006; Graham, 2008; Young, 2009). The use of “over-the-door” home cervical traction devices is a generally accepted modality for the treatment of musculoskeletal or neurologic impairment requiring traction equipment.

In a meta-analysis of seven randomized controlled trials (RCTs), Yang and associates (2017) evaluated the effectiveness of intermittent cervical traction (ICT) in relieving neck pain. A total of seven RCTs (n=402) were included in the analysis. The ICT groups reported lower pain scores immediately following the treatment course; there was no difference at the final follow-up (standard mean differences [SMD]=-0.57; 95% confidence interval [CI], -1.46 to 0.32; I²=83%). The authors concluded that ICT might result in short-term neck pain relief.

In an RCT, Fritz and colleagues (2014) evaluated the effectiveness of cervical traction in the treatment of cervical radiculopathy. A total of 86 adults with a primary complaint of neck pain with pain or numbness were randomized to one of three treatment groups: exercise, exercise and mechanical traction in the clinical setting or exercise with a home over-the-door traction device. Median symptom duration was 53 days with 33 (38.4%) individuals reporting presence of symptoms greater than 6 weeks and 11 (12.8%) individuals reporting the presence of symptoms for greater than 1 year. Participants received 10 physical therapy sessions over 4 weeks, with follow-up assessments completed at 4 weeks, 6 months and 12 months by a researcher blinded to the individual treatment groups. All participants were given the same exercise regimen. Intention-to-treat analyses for the primary outcome (neck disability index [NDI] score) at 6 months showed lower scores in mechanical traction compared to exercise group only (mean difference 13.3; 95% CI: 5.6, 21.0; p=0.001) and over-the-door traction group (mean difference 8.1; 95% CI: 0.8, 15.3; p=0.031). At 12 months, lower NDI scores persisted in the mechanical traction versus exercise group (mean difference 9.8; 95% CI: 0.2, 19.4; p=0.046). Mechanical traction showed lower neck pain intensity scores compared to the exercise only group at 6 months (mean difference 1.9; 95% CI: 0.7, 3.2; p=0.003) and the over-the-door traction group (mean difference 1.2; 95% CI: 2.4, 0.03; p=0.045). At 6 months, arm pain scores were lower for the over-the-door group compared to the exercise only group (mean difference 2.2; 95% CI: 0.8, 3.7; p=0.004). There were no differences in arm pain between groups at 12 months. Individuals reporting a successful outcome based on a global rating score were 53 (61.6%) at 4 weeks, 32 (37.2%) at 6 months and 35 (40.7%) at 12 months. These results generally favored the traction groups as compared to exercise only group; however, they were not statistically significant at any of the follow-up visits. The authors noted that the addition of cervical traction to a standard exercise program resulted in lower NDI and pain intensity scores in individuals with cervical radiculopathy, particularly in those individuals who received mechanical traction in the office setting. However, results showed additional benefit in the over-the-door traction group over the exercise only group as well, especially in those who were comfortable with the device.

In 2016, Chumbley and associates evaluated whether regular use of a home cervical traction device (Saunders device) could decrease the reported cervical pain levels of active pilots. Participants who completed the program (n=12) used the device three times weekly for 6 weeks. While the participants reported a modest improvement in pain in the arm using traction compared to the control group, the decrease in daily pain reports reported in the traction group did not reach statistical significance. There were no comparisons to over-the-door traction devices.

The current evidence suggests that cervical traction may offer benefits when incorporated into a treatment plan for individuals experiencing chronic pain or functional impairments due to musculoskeletal or neurological conditions. However, existing studies have yet to compare clinical outcomes between individuals utilizing over-the-door traction devices and other forms, such as pneumatic devices. While pneumatic devices provide greater tension levels compared to over-the-door models, they lack standardized guidelines regarding optimal force, duration, and frequency of application. Consequently, the available data does not substantiate the clinical appropriateness or efficacy of cervical traction devices beyond the established over-the-door devices.

Peer Reviewed Publications:

1. Borman P, Keskin D, Ekici B, Bodur H. The efficacy of intermittent cervical traction in patients with chronic neck pain. Clin Rheumatol. 2008; 27(10):1249-1253.
2. Bryans R, Decina P, Descarreaux M, et al. Evidence-based guidelines for the chiropractic treatment of adults with neck pain. J Manipulative Physiol Ther. 2014; 37(1):42-63.
3. Chiu TT, Ng JK, Walther-Zhang B, et al. A randomized controlled trial on the efficacy of intermittent cervical traction for patients with chronic neck pain. Clin Rehabil. 2011; 25(9):814-822.
4. Chumbley EM, O'Hair N, Stolfi A, et al. Home cervical traction to reduce neck pain in fighter pilots. Aerosp Med Hum Perform. 2016; 87(12):1010-1015.
5. Cohen SP. Epidemiology, diagnosis, and treatment of neck pain. Mayo Clin Proc. 2015; 90(2):284-299.
6. Colombo C, Salvioli S, Gianola S, et al. Traction therapy for cervical radicular syndrome is statistically significant but not clinically relevant for pain relief. A systematic literature review with meta-analysis and trial sequential analysis. J Clin Med. 2020; 9(11):3389.
7. Fritz JM, Thackeray A, Brennan GP, Childs JD. Exercise only, exercise with mechanical traction, or exercise with over-door traction for patients with cervical radiculopathy, with or without consideration of status on a previously described subgrouping rule: a randomized clinical trial. J Orthop Sports Phys Ther. 2014; 44(2):45-57.
8. Ibrahem ME, El-Wakad MT, El-Mohandes MS, Sami SA. Implementation and evaluation of a dynamic neck brace rehabilitation device prototype. J Healthc Eng. 2022; 2022:6887839.
9. Joghataei MT, Arab AM, Khaksar H. The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabil. 2004; 18(8):879-887.
10. Klaber-Moffett JA, Hughes GI, Griffiths P. An investigation of the effects of cervical traction. Part 1: clinical effectiveness. Clin Rehabil. 1990; 4(3):205-211.
11. Salt E, Wright C, Kelly S, Dean A. A systematic literature review on the effectiveness of non-invasive therapy for cervicobrachial pain. Man Ther. 2011; 16(1):53-65.
12. Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehab. 1999; 78(1):30-32.
13. Thoomes EJ, Scholten-Peeters W, Koes B, et al. The effectiveness of conservative treatment for patients with cervical radiculopathy: a systematic review. Clin J Pain. 2013; 29(12):1073-1086.
14. van der Heijden GJ, Beurskens AJ, Koes BW, et al. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Phys Ther. 1995; 75(2):93-104.
15. van Tulder M, Furlan A, Bombardier C, Bouter L; Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine (Phila Pa, 1976). 2003; 28(12):1290-1299.
16. Waylonis GW, Tootle D, Denhart C, et al. Home cervical traction: evaluation of alternate equipment. Arch Phys Med Rehabil. 1982; 63(8):388-391.
17. Yang JD, Tam KW, Huang TW, et al. Intermittent cervical traction for treating neck pain: a meta-analysis of randomized controlled trials. Spine (Phila Pa 1976). 2017; 42(13):959-965.
18. Young IA, Michener LA, Cleland JA, et al. Manual therapy, exercise, and traction for patients with cervical radiculopathy: a randomized clinical trial. Phys Ther. 2009; 89(7):632-642.
19. Zylbergold RS, Piper MC. Cervical spine disorders. A comparison of three types of traction. Spine. 1985; 10(10):867-871.

Government Agency, Medical Society, and Other Authoritative Publications:

1. Centers for Medicare and Medicaid Services (CMS). National Coverage Determination for Durable Medical Equipment Reference List. NCD #280.1. Effective June 9, 2025. Available at: https://www.cms.gov/medicare-coverage-database/new-search/search.aspx. Accessed on March 18, 2026.
2. Childs JD, Cleland JA, Elliott JM, et al. Neck pain: clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthapaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008; 38(9):A1-A34.
3. Graham N, Gross A, Goldsmith CH, et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database Syst Rev. 2008; (3):CD006408.
4. Graham N, Gross AR, Goldsmith C; the Cervical Overview Group. Mechanical traction for mechanical neck disorders: a systematic review. J Rehabil Med. 2006; 38(3):145-152.
5. Gross A, Forget M, St George K, et al. Patient education for neck pain. Cochrane Database Syst Rev. 2012; (3):CD005106.
6. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Noninvasive nonpharmacological treatment for chronic pain: a systematic review update. Comparative Effectiveness Review No. 227. April 2020. Available at: https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/noninvasive-nonpharm-pain-update.pdf. Accessed on March 18, 2026.
7. Washington State Department of Labor and Industries Technology Assessment. Pronex and HomeTrac Cervical Traction. August 5, 2002. Available at: https://www.lni.wa.gov/patient-care/treating-patients/treatment-guidelines-and-resources/_docs/PronexAndSaundersTA.pdf. Accessed on March 18, 2026.

1. American College of Rheumatology (ACR). Neck Pain. Updated April 2025. Available at: http://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Living-Well-with-Rheumatic-Disease/Neck-Pain. Accessed on March 18, 2026.
2. National Institutes of Health (NIH). MedlinePlus. Accessed on March 18, 2026.
   • Neck Pain. Last reviewed on February 8, 2024. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003025.htm.
   • Traction. Last reviewed on November 1, 2023. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/002336.htm.

Cervico2000
ComforTrac
HomeTrac
Pneu-Trac^®
Pratos
Pronex
Saunders
TracCollar^®

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

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