Traction Flashcards
Uses for Traction
Distraction of Vertbral bodies Distraction and/or gliding of facets Tensing of segmental ligaments Widening of lateral foramen Stretching of spinal muscles Relaxation of spinal muscles
Types of Disc Herniation
1) protrusion
2) prolapse
3) extrusion
4) sequestered
What does traction help with?
Creates suction force to draw discs toward natural position
Alters pressure of intervertebral discs
Decreases pressure on injured tissue
Flattens lumbar curvature
Improves peripheral circulation
Indications
HNP (prolapse, protrusion, extrusion) Facet impingement/malalignment Facet joint hypermobility DDD/DJD Stenosis Muscle spasm
What does widening of the lateral foramen cause?
decrease in intradiscal pressure
symptoms decrease in LE due to compression on nerve root
How does it pull HNP back into normal position?
provides a suction effect and stretches PLL to push disc back into place
Facet Impingement
Manual is usually more effective but mechanical is used sometimes
how does Capsular impingement occur?
improper timing of contraction of multifidus or ligamentous dysfunction
Facet Hypomobility
if one joint is hypomobile surrounding joints may be hypermobile to maintain normal motion
DDD/DJD
Traction can reduce radicular S&S associated with nerve root compression from osteophyte formation
Central stenosis
Pain increased with extension
Traction may decrease symptoms may make them worse so monitor during treatment
What can cause Central stenosis
arthritis
central disc bulge
Hypertrophied ligamentum flavum
Contraindications
Acute injuries (except HNP) Unstable spine (spondylolisthesis) Vertebral fractures/dislocations RA Vertigo Fused segments Pregnancy Osteoporosis
Types of traction
Manual Positional Mechanical Bed traction Cottrell 90/90 Inversion boots Home doorway
Bed Traction
Rope, pulley, weights hanging over bed
No better than bed rest
Inversion Table
Pt suspended upside down at a variety of angles
weight of upper body acts as the traction force
Positional Traction
ideal for localizing a segment on one side
Useful for stenosis or posterolateral disc herniation
Manual Traction
more specific segment
clinician can modify depending on pt response
used in cervical spine more than lumbar spine
flexed=lower c-spine
Lumbar facet motion
Flexion= (B) facets upglide: open Side bend (L): (L) facets downglide (close), (R) facets upglide (open) Rotation (R): (R) facet joints gap (open), (L) facet joint approximates (close)
Cottrell 90/90
90/90 position places pt in posterior tilt
Good for lateral stenosis, not for HNP
Mechanical traction
lumbar and cervical
intermittent/sustained
prone/supine
split table
Precautions for mechanical traction
structural disease or condition affecting bones Where pressure of belt may be hazardous Displacement of a fragment of annulus Severe pain resolved fully with traction TMJ problems
Static used when:
area inflamed or aggravated
Intermittent used when:
long hold times for disc protrusions
short hold and relax for jt dysfunction
Lumbar Mechanical Traction Prone vs Supine
Depends on which mvmt reproduces pain
flexion reproduces=prone
extension reproduces=supine
**supine most common—aka stenotic pts
Lumbar traction technique
Supine with hips/knees flexed-produces posterior tilt
Supine with hips/knees neutral-produces anterior pull
Prone with hips flexed produces anterior pull
Prone with hips neutral=posterior pull
Force: lumbar
50% BW for nerve root or facet
stretch soft tissue: 25% BW
Increase 5-15lbs per session
Lumbar treatment parameters
Initial session=brief; assess tolerance 5-10 min
Typical 20-30 min
Cervical traction issues
may get joint compression instead of traction if pt excessively muscle guards during treatment
25-30* for flattening of cervical lordosis
Cervical traction: force
begin low (8-10lbs)
Nerve root or facet: 20-30lbs
disc, soft tissue stretch: 12-15lb
increase 3-5lbs per session
