traction Flashcards
what is traction?
a tensional mechanical force applied to the body for the purpose of separating joint surfaces and elongating tissues. aka decompression
how can traction be applied?
manually or mechanically
when did traction of the spine gain popularity?
in the 1950s 1960s
is traction equally as effective throughout the body?
no differed depending on region. may not be as effective as once thought
what are some effects of traction?
distract joint surfaces
elongate/stretch soft tissues
reduce disc protrusions
what are some of the physical effects of traction on spinal joints?
traction has been shown to increase the spinal length and space between joints in both the cervical and lumbar spine
clinical value is unknown
how much do the IV joints separate during traction?
1-3mm
what patients may be most clinically relevant for traction?
those with spinal pain and radicular symptoms
what percent of body weight is needed to distract the cervical facet joints?
7%
how much movement is achieved at the spine with traction?
depends on area of the spine, amount of force, and length of time. force must be sufficient to elongate soft tissue before the joint space is separated
what percent of body weight is needed to distract the lumbar facet joints?
50%
what percent of body weight has been shown to increase the length of the lumbar spine?
25%
what are the effects of traction on the IV disk?
mechanical tension created by traction is thought to reduce disk protrusions
traction increases separation of the vertebral body which results in decreased central intradiscal pressure pulling the disk back towards the central position
tension of PLL may help push the disc back
what has lumbar traction using 60-120lbs or cervical traction using 7-13lbs been shown to do?
reduce disc prolapse
reduce size of disc herniation
increase space within spinal canal and spinal foramina
improvement in clinical signs
what are some effects of traction on soft tissues?
prolonged moderate loads have been shown to increase the length of tendons, muscles, and increase joint mobility
may cause relaxation of paraspinal muscles which decrease in EMG activity w/ traction
why do we see the some of these effects on soft tissue from traction?
because we are alleviating pressure on pain sensitive structures, changes in muscle tension that produces relaxation by stimulating GTOs, interrupt pain-spasm-pain cycle by stimulating mechanoreceptors resulting in a decrease in motor neuron firing
what is stimulated in grade 1 and grade 2 joint mobilizations?
mechanoreceptors
what is stretched in grade 3 and grade 4 joint mobilizations?
stretch surrounding muscles and joints
what is the most important effect of traction on the IV disk?
decreased central intradiscal pressure
can you traction only a specific segment of the spine?
no theres no way to internally stabilize to only partially apply traction
what are some clinical indications for spinal traction?
spinal disc bulge or herniation
nerve root impingement
joint hypomobility
muscle spasm
what are some clinical tips for safety with traction?
traction should be applied using a small amount of force for the first visit and gradually increased
when should you stop traction?
if patients symptoms become more severe
is peripheralization is seen
if there is an increase in symptoms (pain-numbness-weakness)
what are some contraindications for traction?
where motion is contraindicated
acute injury or inflammation
joint hypermobility or instability
peripheralization of symptoms with traction
uncontrolled hypertension
what are some examples of why it is a contraindication to do traction where motion is contraindicated?
unstable fracture, cord compression, or spinal surgery
what are some examples of why it is a contraindication to do traction on joint hypermobility or instability?
RA, pregnancy, down syndrome, marfan syndrome
why is it a contraindication to do traction when there is peripheralization with traction?
decreased reflex response
decreased strength
decreased sensation
what are some precautions to traction?
claustrophobia
pressure of belts may be hazardous
displaced annular fragment- traction not likely to help
osteoporosis
tumor
infection
systemic steroid use
TMJ issues or dentures
pressure of belts may be hazardous for traction when patients have?
hiatal hernia
vascular compromise- AAA
pregnancy
what are some adverse events from spinal traction?
rebound pain
discomfort from belts
how should the patient be positioned for lumbar traction?
want comfortable position that allows for muscle relaxation
what effect does placing a patient in flexion for lumbar traction?
greater degree of separation of facet joint and IV foramen
what effect does placing a patient in extension for lumbar traction?
greater separation of disc spaces
what patient position is most common for lumbar traction?
supine is commonly used but you get greater lumbar paraspinal relaxation in prone traction
what area is effected when placing a patient in neutral traction for lumbar traction?
lower lumbar segments
what area is effected when placing a patient in flexion in supine for lumbar traction?
upper lumbar segments
what area is effected when placing a patient spine’s in neutral for cervical traction?
Upper cervical spine (C1-C4/C5)
what area is effected when placing a patient spine’s in 20-30º flexion for cervical traction?
Lower cervical spine (C5-C7)
Where should the occipital pads be placed for cervical traction?
Just below mastoid processes
When should the belt for lumbar traction be applied?
When the patient is standing next to the table prior to treatment
Where should the pelvic belt be placed for lumbar traction?
Just above the iliac crest
Where should the rib belt be placed for lumbar traction?
At inferior margin of ribs
What are progressive and regressive steps on the traction machine?
The machine will progressively increases the traction force in a preselected number of steps. A gradual increase in pressure lets the patient accommodate slowly to the traction
What is the clinical prediction rule to identify a person that would likely benefit fro cervical traction?
Patient reported peripheralization with lower cervical spine (C4-C7) mobility testing
Positive shoulder abduction test (Bakody’s sign)
Age > 55
Positive upper lib tension test A
Positive neck distraction test
If a patient has 1 or less of the predictors from the clinical prediction rule what is their probability of success with cervical traction?
47.6%
If a patient has 2 or less of the predictors from the clinical prediction rule what is their probability of success with cervical traction?
53.2%
If a patient has 3 or less of the predictors from the clinical prediction rule what is their probability of success with cervical traction?
79.2 %
If a patient has 4 or less of the predictors from the clinical prediction rule what is their probability of success with cervical traction?
94.8%
