Spinal Mechanical Traction - Lecture 3 (modalities) Flashcards
Application of tensile forces to the long axis of the spine
Traction
What 4 things that traction can be
1) Mechanical
2) Manual (w/ hands)
3) Gravity (think inversion table)
4) Active (pt does it themselves)
KNOW: traction was initally done for disc herniations (get the herniated materal to go back in)
KNOW: Traction can be intermittent or continuous
Continuous = inversion table (until you flip yourself back over)
Intermittent = better / more tolerance by pts
KNOW: In cardver subjects its been shown to
* Increase intervertebral space
* INcrease intervertebral forman space
* more room for nerve root
Adding flexion w/ traction showed inconsistent findings (not very beneficial)
In animal models fluid exchange and nutrient transport MAY be enhanced
All in cervical spine
What does traction do to disc herniation size in live subjects? (cervical)
Reduces it immeditly - however - we dont know how long those effects last
* ~30 pounds of traction was used
What does traction do to muscular changes? (cervical)
nothing
What happens to muscle activation w/ lumbar spine traction
Increases it but stop immediately after traction
KNOW: Young people w/ traction get increased disc height in lumbar spine - middle age get enhancted water diffusion
Volume of disc hernaition is reduced w/ lumbar spine traction on average
How long did the effects last w/ lumbar traction on volume of disc herniation (it running out)
Only a few minutes
however - it can take someone a while to get set up so might not be worth doing
KNOW: traction is slowly done (little tension –> more tension)
* Known as intermittent traction
Occipital harness = cervical traction
* wedges
* Pad
* Strap
Where do the harnesses go for lumbar traction
One above the iliac crest
One below the iliac crest
NOTE: Can also have a stool or bolster for LE support
can also have a thoracic harness
Some therapist still want to add some kind of flexion - even though there isnt much evidence for it
* dont to pt confomert
observe for how long after leaving pt on traction
2-3 mins
what should traction feel like
gentle puling
KNOW: We dont want traction to be painful
Allow pt to lay in supine for a few minutes after removing the traction to let everything calm down
* may be dizzy
Whats used more static or intermittent traction
intermittent
100% tension –> 50% –> 100
How much tension should tension be?
10-25 pounds
Ho long should cervical traction last
10-20 minutes
For intermittent traction we have a cycle
minimum = 30sec max = 10sec back and forth
Can have ascending or descending steps for tension where we work our way up then back down
What is a rebound effect for tension
Traction helping at first then after its stopped it getting really painful
* should go away really quickly
If these symptoms last a long time we wont do traction in the future
MAKE SURE TABLE IS LOCKED BEFORE PT IS ON
Once were ready to go unlock the table
KNOW: Lumbar traction only varies from cervical is that the pt can be in prone and supine
* and the tension will be a max of 50% body weight
Entering parameters
Best traction home ones are the ones w/ a pneumatic pump so they can pup up the tension themselves
What is pneumatic traction
where you pump it up
Contraindications to traction
* Acute cervical trauma (especially whiplash because theres typically injury to m tissue - dont want to pull on messed up tissue)
* Osteoproris - dont pull on briddle bones
* Use of steriods or other mediations that can ecompromise bone integrity
* RA ankylosis som=ndylitits (things that alter joint mechancis)
* Joint hypermobility / instability
* Pregnancy
* Prior surgical stabilization or decompression
* Spinal implants/prosthetic discs
* Non mechanican pain
Pre-cautions w/ traction
* Claustrophobia
* COPD - watch for difficulty breathing - amount of pressure w/ harness
* Pt positioning (comfertable?)
* Robound efects (is this really worth it)
Always start w/ more conservative settings
Indications for traction
Lumbar:
* Treatment based = certain presentation equate to you treat people this way - if you treat poeple this way they tend to get better
* Impairment based = group them based on impairments and you treat them this way
* No specifc group of patients to use this on
Cervical
* Group of pts that tend to do better are radiating UE symptoms (radiculopthy)
* Weaker support of mobility deficits (stiffer)
Proposed cervical traction prediction rule (if they present w/ these they will do better w/ traction)
* Peripheralization of pain with lower cervical mobility testing
* Positive shoulder abduction test
* ≥55 yrs old
* Reduction in symptoms with distraction
Positive ULTT
NOTE: Not a stand alone treatment - goal is to get pts off of traction ASAP