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Physical Agents II > Traction > Flashcards

Traction Flashcards

1
Q

Types of Traction

A

o Manual – tried first before mechanical
o Positional traction – clinic or HEP
o Mechanical
o Weights and Pulleys – used in hospitals, Over the door for C-spine, HEP

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2
Q

Purpose of traction

A

Reduction of symptoms and signs of cervical/lumbar spinal compression

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3
Q

Effects of Traction

A
  • Stretch facet joint capsules
  • Increase inferior-superior dimensions of IV foramina
  • Decrease muscle guarding
  • Improve blood supply to soft tissue and disc
  • Decrease positive pressure, reducing bulging of nuclear material
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4
Q

Indications

A

o Nerve root impingement with or without radiculopathy (due to disc injury or spinal stenosis)
o Joint hypomobility of the spinal segments
o Muscle spasm
o Pain
o Positive neurological signs temporarily improved by traction

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5
Q

Contraindications

A

o Spinal malignancy
o Osteoporosis
o RA
o Fractures
o Spinal infections
o Spinal cord compression/Cauda Equina Lesions o If neurological symptoms or pain worsens during traction
o For lumbar traction, abdominal or hiatal hernia, uncontrolled HTN
o aortic aneurysm

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6
Q

Precautions

A

o Ligamentous strains and joint hypermobility
o Acute stages of injury
o “Traction anxiety”
o Cardiac or respiratory insufficiency
o Pregnancy

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7
Q

General Principles

A
  • Patient education
  • Patient position
  • Determine therapeutic goals
  • Determine and apply appropriate traction parameters
  • Monitor patient’t sxs before, during, and after interventions
  • Gently release the traction rope and allow the patient to rest for 1 to 2 minutes before rising
  • Always thoroughly reassess patent post traction
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8
Q

Patient Education

A

-Purpose, expectations, shut-off control, treatment soreness (centralization of pain)

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9
Q

Patient Position

A

-Comfortable, relaxed, loose pack position (midway between flexion and extension), determine angle by manual traction and palpation

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10
Q

Determine therapeutic goals

A

-Facet joint stretch, increase intervertebral space, reduce muscle spasm

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11
Q

Determine and apply appropriate traction parameters

A

-amount of pull, direction of pull, length of treatment, type of pull

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12
Q

Static Mode

A
  • Same force used throughout treatment
  • Can prevent stretch reflex of muscles
  • Often used for muscle relaxation
  • Used if patients symptoms are easily aggravated by motion
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13
Q

Intermittent mode

A
  • Can use higher forces
  • IT with long hold times may be effective for treating symptoms related to disc protrusion
  • IT with shorter hold times are recommended for symptoms related to joint dysfunction
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14
Q

Is there any different in EMG activity of lumbar paraspinals or vertebral separation between static and intermittent?

A

Nope

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15
Q

Positioning for lumbar traction: Supine-Hooklying

A

-Most commonly used
-Usually most comfortable
-Most appropriate for improving facet hypomobility, intervertebral joint hypomobility, or stenosis
-Varying degrees of spinal flexion can increase facet and intervertebral foramen separation -Neutral spine allows for the largest intervertebral opening
- Posterior pull creating a flexion moment

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16
Q

Positioning for lumbar traction: Prone

A
  • more appropriate for disc conditions (especially posterolateral bulging or protrusions)
  • pulls anterior
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17
Q

Type of Pull

A
  • Bilateral vs Unilateral may be adjusted by altering harnesses
    -Amount of flexion/extension angle of pull may be adjusted by table height
18
Q

Positioning for cervical traction - supine

A
  • Improved muscle spasm relaxation
  • Increased vertebral separation
  • Easier countertraction
  • Pillow under knees
19
Q

Cervical angles

A

◦ C1-C2 = 0-5 degrees of flexion
◦ C2-c5 = 10-30 degrees of flexion
◦ C5-c7 = 25-30 degrees of flexion

20
Q

Positioning for Cervical Traction - Sitting

A

o Support through LE’s, pelvic girdle, lumbar & thoracic spine, UE’s
o If segment to be treated is below C2, place in 20-30 deg of flex (flatten lordosis)
o If A-A segment is to be treated, allow normal lordosis (neutral 0 deg flex)

21
Q

Unilateral vs bilateral

A
  • Base decision on patient’s symptoms, desired treatment outcomes, and which technique elicits greater symptom relief with manual traction trial
22
Q

What is unilateral pull good for?

A
  • Unilateral has been advocated for unilateral joint hypomobility, muscle guarding, and protective scoliosis
23
Q

How do you know if someone would benefit from unilateral pull?

A

manual traction

24
Q

Intensity/ Force for Cervical

A

-20-25 lbs of force is recommended as minimum amount of force needed to achieve vertebral separation/pain relief
-It has been documented, that as little as 10 lbs can cause separation in the upper C-spine (A-A, A-O)

25
Q

Intensity/Force for Lumbar Pull

A

-Force must be sufficient to overcome friction before separation is to occur (25% to 50% of patient’s body weight)
-Split tables decrease friction force (can start lower)
-Some suggest pulling 50% the weight of the body is necessary for intervertebral separation -Care needs to be used when exceeding 50% of patient’s body weight

26
Q

What determines duration

A

presenting signs and symptoms and the mode of traction used

27
Q

what is the duration typically for nerve root irritation or discogenic pain?

A

shorter duration initially (10 mins)

28
Q

how long do you typically do traction for stiffness?

A

20 mins

29
Q

how long is intermittent mode usually

A

longer
20-30 mins

30
Q

how long is static mode usually

A

10-20mins

31
Q

what might indicate longer or shorter times

A

patients comfort and response to treatment (reaction in signs and symptoms)

32
Q

what should the duration be during initial treatment?

A

-Shorter durations advocated during initial treatment to assess the patient’s reaction (3-5 min)

33
Q

Frequency

A

No clinical research stating optimal frequency, based upon patient’s response
Daily, 2x/daily, or 2-3x per week

34
Q

Traction should only be part of the equation

A

o Posture Ed (sitting, standing, sleeping)
o Ergonomics/Biomechanics/Body-Lifting
o STM/Manual therapy(joint mobilizations)
o Strengthening/Stretching
o Pain control – ice/heat and/or meds
o HEP – may include positional/inversion traction

35
Q

See general guidelines for treatment modification

A
36
Q

Home traction:

A
  • Use with successful use of manual and/or mechanical traction in clinic
  • Educate patient on purpose and instruct on how to manage device on their own or with family/friend
  • Have patient teach back to therapist in order to insure clear and thorough understanding
  • Educate patient on progression
37
Q

Positional Traction

A
  • Instructing patient to position themselves in a way to relieve symptoms
  • Can be creative to assist patient in achieving goals
  • May utilize towels, pillows, bolsters, physioball, foam rolls, wedges, etc
38
Q

Lumbar guidelines

A

Initial/acute: 25% (10 mins) (static)
Joint Distraction: 50% (10-30 mins)
Muscle Spasms: 25-50% (10-30 mins) (Static)
Disc Problems: 25-50% (10-30 mins)

39
Q

Cervical Guideliens

A

Initial/acute: 10-15# (10 mins) (Static)
Joint distraction: 20-45# (10-30 mins)
Muscle Spasm: 20-30# (10-30 mins) (Static)
Disc Problems: 20-45# (10-30 mins)

40
Q

See the rest of the traction guidelines on the powerpoint

A

Physical Agents II (8 decks)

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