Traction

Question 1

Theorized Effects of Spinal Traction

Answer 1

Joint Distraction (increase space only during tx)
Reduction of Disc Protrusion (Neg P)
Soft Tissue Stretching
Muscle Relaxation
Joint Mobilization

Question 2

You are seeing a patient who was in a recent MVA yesterday and is having sx of radiculopathy. She has a positive crossed straight leg raise. What is the most appropriate modality?

Answer 2

NONE. Pt has contraindication of acute injury w/in 72 hours. If this has occurred a week ago, traction would be appropriate.

Question 3

Contraindications of Traction

Answer 3

• Where motion is contraindicated
• Acute injury/inflammation
• Joint Hypermobility/instability (spndy)
• Peripheralization of sx w/traction
• Uncontrolled HTN
• Osteoporosis
• Prego
• Hx of surgical intervention w/ or w/o instrumentation
• RA/Marfan Syndrome/Downs/AS

Question 4

Your patient is a 62 y/o female. She has hypomobile L4/5 segments with hypermobility in L2/3 and has nerve root impingement. Her BP is 135/88. What are the contraindications?

Answer 4

• Hypermobility
• Possible osteoporosis
• Uncontrolled BP

Question 5

Precautions for Traction

Answer 5

Structural Disease 
Pressure (hernias)
Displace annular fragment
Severe pain
Claustrophobia
Inability to tolerate positioning
Disorientation

Question 6

According to the Clinical Practice Guidelines for Lumbar Spine, who will benefit from intermittent traction in PRONE?

Answer 6

Pt’s w/ radiculopathy and a + crossed straight leg raise. Requires more than one treatment.

Question 7

What do the clinical PRACTICE guidelines say about cervical traction?

Answer 7

There is poor evidence for cervical traction as a stand alone intervention. Intermittent is better than static….

Question 8

What is the clinical PREDICTION rule for cervical spine?

Answer 8

Peripheralization w/lower cervical mobs
\+ Shoulder Abd Test
>55 y/o
\+ ULTT
\+Distraction Test

Question 9

What is the clinical PREDICTION rule for lumbar spine?

Answer 9

s/s of nn root compression

no movements centralize sx

Question 10

Name the different types of traction

Answer 10

1. ) Mechanical
2. ) Manual
3. ) Positional

Question 11

You want to do full lumbar distraction on your patient. How do you position their legs?

Answer 11

90/90 hip knee angle

Question 12

You patient has a hypo-mobile L4/5 segment. How should you position them?

Answer 12

Decrease the angle of the hip and knees to ehlp distract lumbar spine at lower levels

Question 13

What are the landmarks for the lower lumbar strap?

Answer 13

Top goes along illiac crest
Middle at ASIS
Lower border above g. troch of femur

Question 14

Upper stap position

Answer 14

Below the widest lateral dimensions of ribcage

Question 15

Why would you choose prone position over supine for lumbar traction?

Answer 15

Greater distraction force, easily perform extension exercise and manual therapy following tx, directional preference

Question 16

You pt has a hypomobile C3/4 segment. Where should you place the angle of the machine?

Answer 16

Lower the angle of inclination=the higher up cervical spinal segments get distracted

(Larger angle of inclination=lower cervical spine segment distraction)

Question 17

Your patient is “acute” and is having cervical traction for the first time. What are your parameters?

Answer 17

7-9lbs, static hold, 5-10mins

Question 18

Your patient has a cervical disc pathology or a mm spasm. What are your parameters?

Answer 18

11-15 lbs, 60/20 hold, 20-30 mins

Question 19

Your patient is getting traction for the purpose of cervical distraction. What are your parameters?

Answer 19

7%BW (NEVER EXCEED THIS), 60/20 hold, 20-30 mins

Question 20

Your patient is getting lumbar traction for “acute” first time session. What are the parameters?

Answer 20

30-45 lbs, static, 5-10mins

Question 21

Lumbar traction for disc path or mm spasm parameters include

Answer 21

25% BW, 60/20 hold, 20-30 mins

Question 22

Lumbar traction for distraction purpose, what are the parameters?

Answer 22

50% BW, 60-20hold, 20-30 mins

Question 23

What should you do as a screen before and after?

Answer 23

Check sensation UE and LE

Question 24

You are seeing a patient who is excited to get lumbar traction since her doctor told her that it could help with her radicular symptoms. She had back surgery 6 months ago but no fixation/fusion occurred. What parameters will you use for lumbar traction on this pt?

Answer 24

NONE. A contraindication of lumbar traction includes hx of surgical intervention w/ or w/o instrumentation.

Question 25

You are trying to decide if you want to do cervical traction on your 51 y/o patient. She has a positive distraction test and positive shoulder abduction test. According to the clinical predication rule, is there a good chance that traction will reduce sx?

Answer 25

Not really…need 3/5 for a good likelihood ratio

Question 26

Because you are a well educated PT what are 2 things you will do during your patient’s first session of traction?

Answer 26

1. ) Give them the kill switch/tell them what they should feel
2. ) Supervise 100% of the time