Spinal Traction Flashcards
is traction a manipulation?
no it is much slower
what are the biomechanical and physiological effects of cervical traction?
Increase space bw vertebrae
Decrease amount of herniation
Decrease pain
Increase disc height
Soft tissue stretching
Ms relaxation
Jt mobilization
May improve blood flow
what are the biomechanical and physiological effects of lumbar traction?
Increased ms activity (initially)
Increased SLR ROM (when pain is distal to the knee)
Decreased disc material beyond borders of vertebral body
what are the components of the traction table?
traction unit
electric motor and control panel
cables attached to traction harness
removable harness
pt control safety switch
what are the parameters we can adjust on traction?
duration
cycle times
tension levels
progressive/regressive steps in tension
t/f: split tables help reduce friction
true
t/f: the pt must be comfortable and relaxed during tx
true
what is involved in prep of mechanical traction?
adjust the harness to accommodate the pt
increase/decrease flexion
increased flexion of the traction target what cervical segments?
lower cervical segments
a more neutral flexed position targets what cervical segments?
upper cervical segments
what are the indications for traction?
radicular complaints
cervical or lumbar spine pain with radiculopathy
presence of sx distal to the knee, worsened with extension along with crossed SLR and neuro deficits
pts who have reduction in sx with manual traction
what radicular sx would be an indication for traction?
scapular pain, shoulder, arm, distal UE pain, numbness, paresthesia, motor changes
would traction be the first choice tx for neck pain and loss of motion?
no
do we start with mechanical or manual traction?
manual traction to trial for PT response and reactivity
is mechanical traction with exercise and mobs or stand alone manual traction more effective?
mechanical traction with exercise and mobs
how many lbs of force should we start with in cervical traction?
10 lbs
how much should we inc the force by at a time with cervical traction?
3lbs
what is the max force to use in cervical traction?
20-25 lbs
t/f: with shorter hold times in traction, more movt is performed within a tx session
true
what is the typically on/off hold with traction?
30-60 sec on, 10-30 sec off
should we inc or dec on/off time as the pt gets better?
decrease it
what tx time should we start with?
10 min and work up to 20 based on pt response
what are the typical starting parameters for cervical traction?
10-15 lbs for 10 min and inc force and duration in subsequent tx
when would we put a pt in prone?
when they have an extension bias
when would we put a pt in supine?
most times
when they have a flexion bias
why do we put pts in 90-90 position?
for relaxation/comfort
where do we secure the thoracic harness in lumbar traction?
just under the ribs
where do we secure the pelvic harness in lumbar traction?
at the illiac crests
t/f: there is limited evidence to support the effectiveness of lumbar traction
true
is there universal agreement on the parameters for traction?
nope
if the jt is irritable, should we be fast or slow to progress?
slow
if adequate improvement isn’t maintained, should we be fast or slow to progress duration?
quickly increase duration
what increment should we increase the duration for traction at a time?
3-5 min at a time
after ___ tx attempts of traction and there is no change in sx, we should consider a dif approach
3
with severe sx/high reactivity, should we use longer or shorter holds and rest periods?
longer holds and rest periods
as sx become less severe and irritability decreases, should we increase or decrease the hold and rest periods?
decrease holds and rest periods
t/f: positioning on the floor is required with a home lumbar traction unit to be stable
true
is there more or less tension produced in a home traction compared to a clinical unit?
less
what is gravity-facilitated traction?
the body is placed in an inverted position
what are the risks of gravity-facilitated traction?
it increases intraocular pressure, causes alterations in BP, and may induce anxiety, dizziness, and vertigo
t/f: safety and adverse effects a re major concern with inversion traction
true
t/f: there is strong evidence for PT outcomes with traction
false, it is lacking
does cervical or lumbar traction have moderately higher evidence?
cervical
what do we need to document about traction?
duration
tolerance
force
pain
fxn
walking tolerance
the evidence shows that 50% of _____ pts who regularly use inversion therapy are less likely to need surgery
sciatica
what are the PT reports in the literature following inversion therapy?
decreased pain
decreased sensory impairment
some eliminated analgesic meds
increased ROM
improved reflexes
improved fxnal mobility that was limited by LBP
post-traction, what should we do?
have the pt rest for 5 min
watch for “rebound effect”
measure outcomes
what is traction reaction?
as you are releasing the traction, the body goes into a sympathetic response
what is “rebound effect”?
decreased sx during traction but increases sx after
what outcomes should we measure after traction?
sx
ROM/strength
ADLs
reflexes/sensation
what are the contraindications for traction?
Acute spine trauma
Joint hypermobility or instability
RA and ankylosing spondylitis
Hx of osteoporosis or osteopenia (any recent fx=don’t do traction)
Hx of steroid use
Pts who have received surgical stabilization or decompression, spine implants, or prosthetic discs
Pregnancy (lumbar traction)
uncontrolled HTN
peripheralization of sx with traction
pain of non-mechanical/unknown origin
when motion is contraindicated (fx, cord compression, post spinal surg)
acute injury/inflammation
what are the precautions for traction?
COPD
claustrophobia
what are the types of traction?
cervical/lumbar
manual/mechanical
auto traction
inversion
aquatic therapy
what is spinal traction?
applying tensile forces to the long axis of the spine
t/f: traction can have effects on autonomic fxn
true
how many lbs does it take to reduce lumbar discs?
60-120 lbs
how many lbs does it take to reduce the cervical spine discs?
15-30 lbs
what soft tissue may be stretched by traction?
ms
tendons
ligs
discs
what is autotraction?
traction where the pt actively participates and adds resistance by pushing (legs) and pulling (arms)
what is the technique for using auto traction for lumbar radiculopathy?
start in the least painful position (protective position) until sx quiet down using just gravity traction, then have them push and pull
t/f: auto traction shows superior results in the literature compared to standard traction
true
t/f: autotraction is used a lot in the US
false
why isn’t autotraction frequently used in the US?
bc of the cost, training, time, and ease of other approaches
t/f: autotraction is traction used to recover motion without pain
true
what pts are we often using auto traction with?
VERY acute pts
what is autotraction billed as?
neuromuscular re-ed
is inversion therapy available without a prescription?
yes
if a pt has an ankle injury, what form of traction would we avoid using?
inversion traction
t/f: inversion traction shows increased lumbar IV space post tx
true
what does the literature say about the effects of inversion therapy?
it may be effective only for reducing pain in LR short term
it is preferred to passive tx like bed rest and meds
no sig effects on activity due to LR
insufficient data that it given additional benefits when combined with PT tx
what is aquatic traction?
aquatic vertical suspension in deep water
how long is aquatic traction in duration usually?
10-20 min
what does the indirect traction load in aquatic traction do?
removes compressive pre-loading of body weight
removes ms forces
what does the direct traction load in aquatic traction do?
active tensile forces due to buoyancy and leads placed on the ankles
what does the evidence say about aquatic traction?
there is limited evidence for lumbar radiculopathy
what is positional traction?
providing traction with different positioning like rotation and lateral flexion in SL
what is the manual unloading test (MUT)?
the PT applies low grade lifting force to the pt in standing
what is a (+) MUT?
sx reduction
if a pt has pain at rest, how should we perform the MUT?
the pt stands with arms crossed
PT stands in the painful side and grasps around the pt’s lower aspect of the rib cage
gradually apply a low grade vertical lifting force until the pts upper body begins to lift
if the pt has no pain at rest, but pain with SB, how do we do the MUT?
PT stands on side opposite to the painful direction of SB
the pt moves into the pain provoking direction until pain is reproduced
PT applied a vertical unloading force (pos or neg)
if the pt has no pain at rest, but pain with flex/ext, how do we do the MUT?
PT stands on side of least pain and applies a vertical unloading force
what does the evidence say about the MUT?
it is reliable measure with a (+) result found to be moderately to strongly correlated to the immediate response following a single session of mechanical traction
what are the neurophysiological effects of traction?
traction stimulates proprioceptors, vertebral ligs, and monosegmental ms
traction “shocks” dysfxnal higher centers by relaying u physiological proprioceptive info centrally, “resetting” the dysfxn
what traction variables are up to the practioner’s discretion in delivery of cervical traction?
static/intermittent traction
angle of application
dosage
supine vs prone
positioning of LEs
what is the most important consideration in spinal traction?
pt comfort
t/f: amount of tension in traction should not produce peripheralization/sx worsening
true
what should we do if traction produces peripheralization or sx worsening?
cease tx, reconsider the doe and consider other tx options
what is a normal/common response to traction?
a mild stretching or pulling sensation often described as “feels good”
what position should we consider for unilateral conditions?
SL
with continuous mode traction, ____ tension and duration are used
less
what safety measures do we use with spinal traction?
the pt switch bell
telling pts not to get up and move for a few minutes after
what changes in sx do we hope to see with traction?
centralization/decreased sx
increased ROM
improved strength/sensation/reflexes/fxn
it is common practice to start lumbar spinal traction with what force?
30-45 lbs
what % body weight can we get up to wit lumbar traction?
50-60% body weight
what is the typical cycle timing used in lumbar traction?
30 sec higher tension, 10 sec lower tension
is static mode more frequently used in lumbar or cervical traction?
lumbar traction
what is the typical duration of lumbar traction?
10-20 min depending on pt response
is the rebound effect more pronounced in the cervical or lumbar spine?
lumbar spine
how can we minimize risk of adverse effects with traction?
start with low force
monitor pt response
when would pressure from the pelvic belt in lumbar traction be hazardous?
Hiatal hernia
Compromised femoral arteries
Osteoporosis-thoracic belts, ribs
Trouble breathing-thoracic belts
Compromised circulation to brain
what are possible adverse effects of mechanical cervical traction?
HA, dizziness, nausea after tx
stretching of baroreceptors in the carotid sinus
what are the dif home cervical traction units?
overhead
supine
when are home traction units indicated?
for short/long term management of sx, implants, and nerve ablation
to enhance effects achieved clinically
to empower the pt in their own recovery
what should a PT do b4 letting a pt use a home traction unit?
take pt through tx set up while still under supervision
provide written instructions
provide safety instructions-timer, avoid falling asleep
review adverse rxns, problem solving
