Which injury mechanism is associated with hangings?

• A. Axial loading
• B. Distraction
• C. Hyperextension
• D. Subluxation

Answer: (B)

Hangings primarily cause a distraction (traction) injury to the cervical spine. When the body is suspended, gravity pulls the head away from the torso, lengthening the neck and applying longitudinal tension along the spinal column. This traction can tear ligaments, stretch the spinal canal, and potentially injure the spinal cord even without a direct crush. This mechanism is different from axial loading, which compresses the spine along its axis (as in a fall onto the head or a heavy load), or from hyperextension, which involves the neck being forced backward and mainly stresses the posterior structures. Subluxation refers to a loss of alignment that can occur with various injuries but isn’t the defining mechanism of hangings.