Traction Flashcards
Types of Traction
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
Purpose of traction
Reduction of symptoms and signs of cervical/lumbar spinal compression
Effects of Traction
- 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
Indications
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
Contraindications
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
Precautions
o Ligamentous strains and joint hypermobility
o Acute stages of injury
o “Traction anxiety”
o Cardiac or respiratory insufficiency
o Pregnancy
General Principles
- 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
Patient Education
-Purpose, expectations, shut-off control, treatment soreness (centralization of pain)
Patient Position
-Comfortable, relaxed, loose pack position (midway between flexion and extension), determine angle by manual traction and palpation
Determine therapeutic goals
-Facet joint stretch, increase intervertebral space, reduce muscle spasm
Determine and apply appropriate traction parameters
-amount of pull, direction of pull, length of treatment, type of pull
Static Mode
- 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
Intermittent mode
- 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
Is there any different in EMG activity of lumbar paraspinals or vertebral separation between static and intermittent?
Nope
Positioning for lumbar traction: Supine-Hooklying
-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
Positioning for lumbar traction: Prone
- more appropriate for disc conditions (especially posterolateral bulging or protrusions)
- pulls anterior
Type of Pull
- Bilateral vs Unilateral may be adjusted by altering harnesses
-Amount of flexion/extension angle of pull may be adjusted by table height
Positioning for cervical traction - supine
- Improved muscle spasm relaxation
- Increased vertebral separation
- Easier countertraction
- Pillow under knees
Cervical angles
◦ C1-C2 = 0-5 degrees of flexion
◦ C2-c5 = 10-30 degrees of flexion
◦ C5-c7 = 25-30 degrees of flexion
Positioning for Cervical Traction - Sitting
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)
Unilateral vs bilateral
- Base decision on patient’s symptoms, desired treatment outcomes, and which technique elicits greater symptom relief with manual traction trial
What is unilateral pull good for?
- Unilateral has been advocated for unilateral joint hypomobility, muscle guarding, and protective scoliosis
How do you know if someone would benefit from unilateral pull?
manual traction
Intensity/ Force for Cervical
-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)
Intensity/Force for Lumbar Pull
-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
What determines duration
presenting signs and symptoms and the mode of traction used
what is the duration typically for nerve root irritation or discogenic pain?
shorter duration initially (10 mins)
how long do you typically do traction for stiffness?
20 mins
how long is intermittent mode usually
longer
20-30 mins
how long is static mode usually
10-20mins
what might indicate longer or shorter times
patients comfort and response to treatment (reaction in signs and symptoms)
what should the duration be during initial treatment?
-Shorter durations advocated during initial treatment to assess the patient’s reaction (3-5 min)
Frequency
No clinical research stating optimal frequency, based upon patient’s response
Daily, 2x/daily, or 2-3x per week
Traction should only be part of the equation
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
See general guidelines for treatment modification
Home traction:
- 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
Positional Traction
- 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
Lumbar guidelines
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)
Cervical Guideliens
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)
See the rest of the traction guidelines on the powerpoint
