Ancient roots of joint traction

Hippocrates Falling Ladder

Joint traction and manual manipulation have been used for musculoskeletal treatment since early times. Woodcuts, stone reliefs, and statues illustrate traction treatments in use over 5000 years ago. Today, joint traction and manual therapy are integrated into the practice of many disciplines.

Following is a brief pictorial history of joint traction in musculoskeletal treatment. The history illustrates the refinement of joint traction techniques over the ages and its evolution into its modern forms. Today, Nordic System Orthopedic Manual Therapy incorporates joint traction into all its manual joint techniques, in various subtleties and degrees.

Traction treatment in early times
(3000 to 400 BC)

One of the earliest known traction treatments for the spine was the „Falling Ladder“ maneuver, in which a patient was fastened to a ladder that could be raised and then dropped suddenly, producing a non-specific traction thrust through the spine.

Falling Ladder Lumbar Traction Ancient
“Falling Ladder” Ancient Lumbar Traction Technique

Traction treatment in ancient medicine
(400 BC – 200 AD)

Hippocrates, the famous Greek physician and forefather of ancient medicine, utilized traction extensively. In the year 1500, manuscripts were discovered in Greece on the island of Crete, attributed to Niketas (circa 900 AD) with references to Appolonius (circa 50 AD) that refer to Hippocrates. The manuscripts included 30 drawings of various traction and manipulation techniques for the spine and extremity joints attributed to Hippocrates. Among these manuscripts are the first documented examples of manual therapy and traction for the extremity joints.

Hippocrates (460 – 377 BC)

Hippocrates began with general techniques including the “Falling Ladder.” Another interesting traction technique attributed to Hippocrates, illustrates a patient in a kyphotic posture draped over another person‘s back. Hippocrates called this technique “Stretching Kyphosis”. It may be the first documented traction treatment in the “Actual Resting Position.”

Hippocrates using traction to stretch kyphosis
Hippocrates “Stretching kyphosis” with traction

Hippocrates is also known to have used traction for extremity joint treatment. This is the first documented example of manual therapy incorporating traction for the extremity joints.

Hippocrates Elbow Traction
Hippocrates using traction to treat the elbow
Hippocrates Hip Traction
Hippocrates applying traction to the hip

Figures were copied with permission from Schiøtz. The original works are held as a “valuable treasure” in the library Biblioteca in Firenze, Italy, as “Codex Laurenzianus LXXXIV,7”.

Traction treatment in the Middle Ages

(200 AD – 1500)

During the Middle Ages, joint traction and some manual joint techniques continued to be practiced by physicians. However, many physicians abandoned treatments involving physical contact due to fear of infection following the Black Plague (1347- 1350).

Dissatisfied with the musculoskeletal care provided by the medical practitioners of the time, lay people without professional training also treated joints, both with traction and manipulative thrusts. These “folk medicine” practitioners were known as “bone setters” in English-speaking countries, and as “joint setters” in Norway.

Several contemporary manipulative disciplines began in the 1800’s and early 1900’s, including Osteopathy, Chiropractic, Naprapathy, and Swedish Medical Directors, a branch of the Swedish Gymnastik discipline, whose practice influenced Kaltenborn’s early professional training. The use of manual treatment methods by physical therapists was documented as early as 1813 in Sweden.