Traction

Question 1

What is traction

Answer 1

A technique in which a force is applied to a part of the body in order to stretch soft tissues and to separate joint surfaces

Question 2

What are the types of traction techniques

Answer 2

Manual — tried first before mechanical and even done in eval
Positional traction — clinic or hEP
Mechanical
Weights and pulleys — used in hospitals

Question 3

What is the purpose of traction

Answer 3

Reduction of symptoms and signs of cervical/lumbar spinal compression

Question 4

What are the effects of traction

Answer 4

1. Stretch facet joint capsules
2. Increase inferior-superior dimensions of IV foramena
3. Decrease muscle guarding
4. Improve blood supply to soft tissue and disc
5. Decrease positive pressure, reducing building of nuclear material

Question 5

Indications for traction

Answer 5

1. Nerve root impingement with or without radiculopathy
2. Joint hypomobility of the spinal segments
3. Muscle spasms
4. Pain
5. Positive neurological signs temporarily improved by traction.

Question 6

Contraindications for traction

Answer 6

Spinal malignancy
Osteoporosis
RA
Fractures
Spinal infections
Spinal cord compression/cauda equina lesions
If neurological symptoms worsen or pain worsens with traction
For lumbar traction, abdominal or hiatal hernia , controlled HTN
Aortic aneurysm

Question 7

Precautions for traction

Answer 7

Ligamentous strains and joint hyper mobility
Acute stages of injury
Traction anxiety
Cardiac or respiratory insufficiency
Pregnancy

Question 8

What are the general principles for traction intervention

Answer 8

1. Patient education
2. Patient position — comfy, relaxed, LPP
3. Determine therapeutic goals
4. Determine and apply appropriate traction parameters
5. Monitor patient signs and symptoms before during and after Rx
6. Gently release the traction rope and allow the patient to rest for 1-2 minutes before rising
7. Always thoroughly reassess patient post traction

Question 9

What are the 2 modes for mechanical traction

Answer 9

Static
Intermittent

Question 10

What is static traction

Answer 10

Same force used throughout treatment
Can prevent stretch reflec of muscles
Often used for muscle relaxation
Used if patient’s symptoms are easily aggravated by motion

Question 11

What is intermittent traction

Answer 11

Can use higher force
Intermittent 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 12

Positioning for lumbar traction in hook lying

Answer 12

• most common and usually most comfy
• 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.
• pull will be from posterior causing flexion moment since patients like flexion

Question 13

Positioning for lumbar traction in prone

Answer 13

More appropriate for disc conditions - especially posterolateral building or protrusions
- pull will be from anterior and creating an extension moment since these patients like extension

Question 14

Positioning for cervical traction - supine

Answer 14

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

Question 15

Positioning for cervical traction in sitting

Answer 15

Support the LE’s, pelvis, lumbar and thoracic spine and UEs
If segment to be treated is below C2 place in 20-30 degrees of flexion to flatten any lordosis
IF A-A SEGMENT IS TO BE TREATED ALLOW NORMAL LORDOSIS - Neutral - degrees of flexion

Question 16

Cervical positioning angles

Answer 16

C1-2 = 0-5 Degrees of flexion
C2-C5 = 10-30 Degrees of flexion
C5-C7 = 25-30 Degrees of flexion

Question 17

What intensity/force do you use for cervical traction

Answer 17

20-25 pounds of force is recommended as minimum amount of force neeed to achieve vertebral separation/pain relief. But probs dont wanna jump right into these high forces
— It has been documented that as little as 10 pounds can cause separation in the upper C spine (A-A, A-O)

Question 18

What intensity/force do you use for lumbar traction

Answer 18

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

Question 19

How do you determine duration

Answer 19

Determined by presenting signs and symptoms and the mode of traction used.
— Longer or shorter times may be indicated based on patient’s comfort and response to treatment (reduction in signs and symptoms)
— Shorter durations advocated during initial treatment to assess the patient’s reaction(3-5 min)

Question 20

Duration for nerve root irritation or discogenic pain

Answer 20

Often treated with a shorter duration initially — 10min

Question 21

Duration for stiffness

Answer 21

Treated longer - 20 min
Static — 10-20 min
IT — 20-30 min

Question 22

What is the frequency for traction

Answer 22

No clinical research stating optimal frequency based upon patient’s responses

Daily, 2x/day, 2-3x/week

Question 23

What is home traction

Answer 23

• 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 24

What is positional traction

Answer 24

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