Spinal Traction Flashcards
Define static traction.
a constant pull exerted throughout treatment with no release phase
When is static traction used?
- Discs
- muscle spasms- low load, long duration stretch indicated
- capsular tightness- low load, long duration stretch indicated
- decreased treatment time and decreased amount of force should be used for static
- static pull may be uncomfortable during treatment, may cause irritation, evidence conflicting as to whether it is more effective
Define intermittent traction.
the alternating application and release of the traction force
When is intermittent traction used?
- Facet joint problems: short equal periods of pull and release (10 pull, 10 sec off)
- Discs: pull and release periods longer and unequal (60 sec pull, 20 sec off)
- Used more frequently than static
- generally more comfortable for patients
- allows more pounds of force to be used
Define hypermobility.
from internet:
-increased ROM at joints, and joint laxity
Define hypomobility.
from internet
-decrease in the normal movement of a joint or body part -may result from an articular surface dysfunction or from disease or injury that affects a bone, muscle, or joint
Define distraction
from internet:
-separation of joint surfaces without rupture of the binding ligaments and without displacement
Define herniated nucleus pulposus (HNP).
disc material is protruding into the intervertebral foramen and putting pressure on spinal nerve roots. (notes)
from internet:
a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk (nucleus pulposus) is forced through a weakened part of the disk, resulting in back pain and nerve root irritation
Define osteoporosis.
low bone density susceptible to fractures (notes)
internet:
a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D
Define stenosis.
space between the bones in the intervertebral foramen decreases causing bony pressure on the nerve root, can be from degenerate disc or osteophytes
Define osteophytes.
from internet:
a bony outgrowth associated with the degeneration of cartilage at joints
- aka bone spurs
What are the effects of spinal traction?
Physiological effects:
- increase in vertebral separation and lateral foramen opening
- Decrease in intradiscal pressure
- Disc protrusion reduced
- Distraction of facet joints
- Decrease in muscle activity
* Research studies are conflicting about the efficacy of traction and whether or not these effects consistently occur
What are the signs and symptoms of nerve root impingement?
- When comparing right and left sides, a significant difference in muscle strength of muscles that are innervated by a particular level of spinal nerve.
- A significant difference in DTRs when comparing right and left.
- loss of sensations along dermatomes
- Radicular symptoms. ex: pain radiating down the back of the leg (sciatica)
What is a sign?
can be measured by a therapist using an objective test
What is symptom?
something a patient can describe. ex: pain
A weak hip flexor on the right would suggest impingement of what spinal nerve?
Right L1 or L2
Weak quadriceps on the right would suggest impingement of what spinal nerve?
Right L3 or L4 nerve root
Weaker dorsiflexors and big toe extensors would suggest impingement of what spinal nerve?
L5 or S1
Weaker plantar flexors or hamstrings would suggest impingement of what spinal nerve?
S2
A weaker right patellar tendon reflex suggests impingement of what spinal nerve?
Right L3/L4
A weaker Achilles tendon reflex suggests impingement of what spinal nerve?
S2
Loss of sensation from the big toe, up the front of the calf, over the knee, to the lateral thigh suggests problems at what spinal nerve?
L4
What are the indications for spinal traction?
- Disc Herniation
- Degenerative Joint Disease
- Muscle spasm
- Generalized hypomobility of the cervical or lumbar spine
- Facet impingement
- Tension headache
- Radiculopathy
What are contraindications for spinal traction?
- Spinal infections such as meningitis
- Spinal cancer
- traction could cause metastasis or fractures - Spinal cord pressure as evidenced by bilateral neural signs.
- This could indicate cancer, serious disc problems or severe osteophytes. Traction might worsen an already severe situation - Rheumatoid Arthritis (RA) or other acute inflammatory joint disorders
- RA can cause ligamentous laxity, most significantly at the atlantoaxial joint; traction could cause subluxation and spinal cord injury. - Osteoporosis
- low bone density with susceptibility to fractures; bones are compromised and traction could cause fractures. - Unhealed fracture
- traction could misalign the fracture - For lumbar traction this, any conditions that prohibit increased abdominal pressure caused by application of the harness.
- Ex: pregnancy, hernias, severe hypertension, aortic aneurism, and severe hemorrhoids - Joint hypermobility
- traction may aggravate or worsen the condition
What are the precautions for spinal traction?
- Acute injury with inflammation and edema
- “Traction Anxiety” or claustrophobia
- Cardiac or respiratory insufficiency for lumbar mechanical traction
- Pregnancy is a precaution for cervical mechanical traction since hormones cause laxity during pregnancy. Manual cervical traction is preferred during pregnancy.
- TMJ dysfunction for cervical traction, especially if using a chin strap
- Blood pressure issues, especially for cervical traction
- Patients with previous history of traction use, where symptoms increased.
What are the responses to spinal traction treatment?
- Decreased pain and decreased neural signs = good response
- “centralized pain”- peripheral pain decreases while central pain remains or increases, especially if accompanied by decrease in neural signs, indicate decreased nerve root pressure = good response
- “Peripheralization” of pain should be reported immediately to evaluating PT. First adjust parameters, if doesn’t help stop the treatment.
- Any increase in neural signs after treatment should be reported immediately to PT.
- Any report by the patient that the last treatment decreased the patient’s level of function after the treatment should be reported to evaluating PT prior to starting treatment.
What is spinal traction?
the use of force to pull one segment of the spine away from another segment of the spine in order to increase the space between them, decrease pressure on spinal nerve roots, and thereby decrease nerve root symptoms, such as pain, muscle weakness and loss of sensation.
What are the modes/techniques of spinal traction?
manual, positional, and mechanical
Why position someone in lumbar flexion for traction?
- release pressure on the posterior structures
- indicated for facet joint problems, intervertebral foramen stenosis, etc.
What is the patient’s position when desiring to produce lumbar flexion?
- pt is supine
- legs placed on stool–> hips flexed to 90
- Some research studies show that 70 degrees of hip flexion increases lumbar flexion separation at all levels.
Why position someone in lumbar extension?
- mild extension or neutral can release pressure on the anterior structures, places pressure on posterior structures
- For herniated disc- encourages disc to move back towards the intervertebral space and away from the nerve roots
What is the patient’s position when desiring to produce lumbar extension or neutral?
-pt is prone or supine with legs completely extended on the treatment table.
Why position someone in cervical flexion?
-facet problems below C-2 level
What is the patient’s position when desiring to produce cervical flexion?
- pt is supine
- 20-30 degrees of flexion–> flattens normal lordosis, more than 30 degrees decreases the intervertebral foramen space
Why position someone in cervical neutral?
- treating disc problems
- treating facet problems at atlantoaxial joint (C1-C2)
What is the patient’s position when desiring to produce cervical neutral?
- pt supine
- normal lordosis
- do not have pt head on an angle
What is the duration when treating a disc problem?
NEVER let duration of full traction load exceed 8 minutes
-too long causes fluid to be pulled into the disc which results in additional pressure on the nerve roots
What is the duration when treating muscle spasms, facet joints, osteoarthritis, etc?
20-25 minutes
What is the poundage for lumbar traction?
-50% of body weight on a split table –> may need several treatments to work up to this
-needs to be >25% of body weight to be effective
-if NOT a split table need to consider coefficient of friction (0.5); poundage must be greater than that being caused by coefficient of friction/friction force.
Ex: 180 lb person. 90 lbs upper, 90 lbs lower. Must consider coefficient of friction for lower half so 90x0.5= 45lbs. Poundage must be >45lbs to over come friction and exert force on the body.
What is the poundage for cervical traction?
-to achieve separation of vertebral components requires 20lbs or more
-Avg head weighs 12-14 lbs
-Coefficient of friction between the head and the table = 0.62
Ex: head 14 lbs, 8.68 pounds is the frictional force so 14+8.68= 22.68 lbs
Where/when is the pelvic harness applied?
- directly to skin
- top margin just above iliac crests, often top portion will cross the umbilicus
- tighten as much as possible
- applied before the thoracic harness
Where/when is the thoracic harness applied?
- applied so overlaps the pelvic harness
- top portion wraps approx. ribs 8-10
- does not compress the breasts
- tighten as snug as possible
Describe home traction units.
- can be used to manage symptoms between PT visits
- over-the-door cervical units puts pt in sitting and generally less effective
- units used in supine are generally more effective
