Mechanical Traction

Question 1

Traction: Goals/indications

Answer 1

• Decrease:
  
  • Joint stiffness,
  • meniscoid blocking,
  • muscle spasm,
  • DJD,
  • disc protrusion
• Modulate
  
  • disc pain,
  • subacute/chronic pain,
  • reduced nerve root impingement

Question 2

Traction: Precautions

Answer 2

• Acute inflammation aggravated by traction,
• acute strains/sprains,
• claustrophobia,
• hiatus hernia,
• joint instability,
• osteoporosis,
• pregnancy,
• TMJ problems with halter use.

Question 3

Traction: Contraindications

Answer 3

• Impaired cognition,
• RA,
• spinal tumors,
• spinal infections,
• spondylolysthesis,
• vascular compromise,
• very old/young.

Question 4

Traction: Cervical halter

Answer 4

• Pull of ~7% of body weight
• Seated or supine Head halter under occiput and mandible, attached to cord or spreader bar
• Cervical Position
  
  • 0-5 deg flxn to increase IV space at C1-C5
  • 25-30 deg flxn to increase IV space at C5-C7
  • 0 for disc dysfunction
  • Facet joint separation may require 15 degrees of neck extension
• Traction applied to occiput, not chin If pt experiences discomfort at TMJ, stop and adjust halter

Question 5

Traction: Cervical sliding device

Answer 5

• Head placed on padded headrest which positions the neck in 20-30 deg flxn
• Adjustable neck yoke tightened to firmly grip below mastoid
• Head strap across forehead
• Device attached to spreader bar
• Acute phase: Disc protrusion, elongation of soft tissue, muscle spasm:
  
  • 10-15 lbs or 7-10% of BW Joint distraction
  • ~20-30 lbs 5-10 mins for acute conditions.
  • 15-30 mins for other conditions.
• Duty cycle 1:1 - except joint distraction best at 3:1

Question 6

Traction: Lumbar

Answer 6

• Split table (minimize friction)
• Supine, pillow under knee or small bench under lower leg
• Prone may be preferable in case of posterior herniated disc
• 45-60 deg hip flxn for L5-S1
• 75-90 deg hip flxn for L3-4
• Apply pelvic harness with top edge above iliac crest
• Attach thoracic harness with inferior margin slightly below ribs
• Thoracic harness counteracts pull of pelvic harness
• Acute: 25-40 lbs Disc protrusion, spasm, elongation of soft tissues:
  
  • 25% BW Joint distraction:
  • 50 lbs or 50% of BW 5-10 mins for herniated disc;
  • 10-30 mins for other conditions