Traction

Question 1

Types of Traction

Answer 1

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

Question 2

Purpose of traction

Answer 2

Reduction of symptoms and signs of cervical/lumbar spinal compression

Question 3

Effects of Traction

Answer 3

• 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

Question 4

Indications

Answer 4

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

Question 5

Contraindications

Answer 5

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

Question 6

Precautions

Answer 6

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

Question 7

General Principles

Answer 7

• 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

Question 8

Patient Education

Answer 8

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

Question 9

Patient Position

Answer 9

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

Question 10

Determine therapeutic goals

Answer 10

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

Question 11

Determine and apply appropriate traction parameters

Answer 11

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

Question 12

Static Mode

Answer 12

• 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

Question 13

Intermittent mode

Answer 13

• 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

Question 14

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

Answer 14

Nope

Question 15

Positioning for lumbar traction: Supine-Hooklying

Answer 15

-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

Question 16

Positioning for lumbar traction: Prone

Answer 16

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

Question 17

Type of Pull

Answer 17

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

Question 18

Positioning for cervical traction - supine

Answer 18

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

Question 19

Cervical angles

Answer 19

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

Question 20

Positioning for Cervical Traction - Sitting

Answer 20

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)

Question 21

Unilateral vs bilateral

Answer 21

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

Question 22

What is unilateral pull good for?

Answer 22

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

Question 23

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

Answer 23

manual traction

Question 24

Intensity/ Force for Cervical

Answer 24

-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)

Question 25

Intensity/Force for Lumbar Pull

Answer 25

-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

Question 26

What determines duration

Answer 26

presenting signs and symptoms and the mode of traction used

Question 27

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

Answer 27

shorter duration initially (10 mins)

Question 28

how long do you typically do traction for stiffness?

Answer 28

20 mins

Question 29

how long is intermittent mode usually

Answer 29

longer 20-30 mins

Question 30

how long is static mode usually

Answer 30

10-20mins

Question 31

what might indicate longer or shorter times

Answer 31

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

Question 32

what should the duration be during initial treatment?

Answer 32

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

Question 33

Frequency

Answer 33

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

Question 34

Traction should only be part of the equation

Answer 34

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

Question 35

See general guidelines for treatment modification

Question 36

Home traction:

Answer 36

* 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

Question 37

Positional Traction

Answer 37

* 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

Question 38

Lumbar guidelines

Answer 38

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)

Question 39

Cervical Guideliens

Answer 39

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)

Question 40

See the rest of the traction guidelines on the powerpoint