Mechanical Traction

Question 1

Physics

Answer 1

Application of a mechanical distraction force along the long axis of the spine

Question 2

Physiologic Effects

Answer 2

Physiologic Seperation of tissues
- Facet joint gapping with supine traction application
- Interverterbral foramin size increasses
- Intradiscal pressues reduce
- Increase diffusion of water into the disc and changes in disc height (Important because discs don’t have blood flow but are living tissues; Nutrients, Oxygen in, Waste products out
- Reduction of disc herniation (bulding of disc tissue)
- Increased joint mobility

Question 3

Disc Injury

Answer 3

• Annulus Fibrosis breaks down, Nucleus pulposus slowly leaves
• Generally breaks down posterior laterally
• 4 Stages: Protrusion, Prolapse (tunneling), Extrusion (Fibrosus disrupted, Sequestration (Free nuclear material)

Question 4

Radicular Pain

Answer 4

• Goes down limb
• Dermatomal distribution
• Thoracic radicular pain is rare
• Cervical and lumbar radicular are common

Question 5

Physiologic Effect - Main

Answer 5

Pain modulation (May be secondary to tissue seperation/water diffusion, or secondary stimulus (creates sensation - gives relief))
- Centralization may occur (Goal)
- Should be quick relief

Question 6

Centralization

Answer 6

Back pain dominant
What we want!! Good Prognosis

Question 7

Peripheralization

Answer 7

Limb pain dominant
Ex: Leg Pain
After adjustment if occurs, likely spinal surgery required; poor prognosis

Question 8

Indications for Traction

Answer 8

Specific criteria remain elusive
Most agreed upon indications include:
- Radicular symptoms (arm or leg)
- Positive neural tension and provocation tests (Reproduce radicular response)
- Relief of symptoms with manually applied traction

Not For Chronic Back Pain

Question 9

Contraindications for Traction

Answer 9

• Acute Trauma
• Osteoporosis or osteopenia
• Chronic Steroid Use
• Rheumatoid Arthritis (Hypermobile in Cervical)
• Ankylosing Syndrome (Vertebrae are fused)
• Down’s Syndrome (Hypermobile, especially cervical)
• Systemic Joint Hypermobility
• Pregnancy (Due to Hormones, very flexible)
• Previous surgical stabilization or decompression
• Previous surgery with spinal implants/prosthetic discs
• Peripheralization with traction

Bone Meds also weaken bones, suggest against traction

Question 10

Precautions for Traction

Answer 10

• Claustrophobia
• COPD or other respiratory disorders
• Dizziness, fainting and nausea have rarely been reported adverse effects
• Hypertension

Question 11

Treatment Considerations - Parameters

Answer 11

Traction type: mechanical device (clinic or home), manual, positional

Question 12

Why does seated traction not work?

Answer 12

• Doesn’t take enough pressure off
• Compresses TMJ (lead to jaw pain)

Question 13

Why do manual traction? How long?

Answer 13

• 1-2 minutes
• Gives indication if traction gives patient relief
• Short term treatment

Question 14

Positional traction

Answer 14

• Placing patient in a comfortable position that alleviates radicular symptoms
• Askj patient what does and doesn’t relieve their symptoms

Question 15

Explain which side is alleviated

Answer 15

Right leg is side of radicular pain. Putting someone in this position allows for relief. Always have effected leg toward the ceiling

Question 16

Treatment Considerations

Answer 16

Traction mode, Traction cycle, Position and Angle of Application, Traction Force, Traction Duration, Patient Education, Watch Patient, Delegation, Documentation, Home Units

Question 17

Traction Mode

Answer 17

• Static: Pulls until specific length then holds; More consistent with seperation of facets
• Intermittent: Pulls till specific length, then relaxes, repeats; Tends to be more comfortable

Let patient comfort lead patient treatment

Question 18

Traction Cycles

Answer 18

If intermittent:
- Tension: Rest Ratios (30s on:10 off common)
- Ascending/Descending steps
- Clinician discretion based on patient comfort

Question 19

Position and Angle of Application

Answer 19

• 5 to 15 degrees of cervical flexion
• For lumbar (Supine, supine 90/90, prone, or laterally shifted
• Goal is centralization

Question 20

Traction Force

Answer 20

Cervical
- Begin with 10 lbs initially, gradually work up to 25 lbs
- This may be during one visit or over a couple of visits
Lumbar
- Begin with 30-50% of body weight
- Do not exceed 100% of body weight

Question 21

Traction Duration

Answer 21

• Generally 10 minutes, working up to 20 minutes
• Allow a few minutes of rest without tension before rising

Question 22

Patient Education - Traction

Answer 22

• Uncomfortable stretch sensation
• Centralization is desirable, sometimes associated with increased central pain
• Should not be peripherlization, no dizziness
• Sometimes a rebound effect particularly on 1st treatment (Increase symptoms minutes to hours after)
• Consider severity/duration of rebound, distribution of symptoms and modify accordingly

Question 23

Watch Patient

Answer 23

Patient observation - at 2-3 cycles
Emergency stop button for patients (IN HAND BEFORE YOU PRESS START)
- Call Mechanism

Question 24

Delegation

Answer 24

Based on assistant experience and need for ongoing assessment

Question 25

Documentation

Answer 25

Type, mode, cycle, position/amgle, force, suration, patient response

Question 26

Home Units

Answer 26

• Good options
• Up tp $600-800
• Use similar force and duration parameters
• Don’t let patient fall asleep on device