Traction Flashcards
what is traction?
Tensional mechanical force applied to body to spread joint surfaces & elongating tissues
what are the effects of traction?
Distract Joint surfaces
Elongate/Stretch soft tissue
Reduce disc protrusion
what are the physical effects of traction on spinal joints?
Shown to increase spinal length & space b/w joints in both cervical & lumbar spine
Aprox how much of a person’s body weight does it take to increase length of lumbar spine?
25%
Aprox how much of a persons body weight does it take to distract lumbar facet joints?
50%
aprox how much of a persons body weight does it take to distract cervical facet joint?
7%
why is mechanical tension thought to reduce disk protrusion?
- Traction increases separation of vertebral body resulting in decreased central intradiscal pressure pulling disc back towards central position (vacuum effect)
- Tension of PLL may help to push disc back
what is lumbar traction (60-120lbs) or cerivcal traction (7-13 lbs) shown to do at intervertebral disc?
Reduce disc prolapse
Reduce size of disc herniation
Increase space w/ spinal canal & spinal foramina
Improvement in clinical signs
why has traction been shown to cause relaxation of paraspinal muscles?
- Alleviating pressure on pain sensitive structures
- Changes in muscle tension that produces relaxation by stimulating GTO
- Interrupt pain-spasm-pain cycle by stimulating mechanoreceptors resulting in decrease in motor neuron firing
what are the effects of traction on soft tissue?
-Prolonged moderate loads have been shown to increase length or tendons, muscles, & increase joint mobility
- May cause relaxation of paraspinal muscles
does research support traction of lumbar and cervical spine?
Research does not really support traction for low back pain w/ or w/o lumbar radiculopathy
Studies seem to support use of traction for cervical spine & cervical radiculopathy
what are the clinical practice guidelines for those with neck pain?
- Neck pain w/ radiating pain
- Clinicians should provide mechanical intermittent cervical traction w/ other interventions (stretching & strengthening exercise plus cervical & thoracic mobilization/manipulation)
- Clinicians should provide education & counseling to encourage participation in occupational & exercise
what are the clinical practice guidelines for those with low back pain?
PT should not use mechanical traction for patients w/ chronic LBP w/ leg pain
what are clinical indication for spinal traction?
Spinal Disc Bulge or Herniation
Nerve Root Impingement
Joint Hypomobility
Muscle Spasm
when should one stop traction?
- Patients symptoms become more severe
- Peripheralization is seen
- Increase in symptoms ( pain → numbness → weakness)
what should you start with before applying mechanical traction?
manual traction
what are contraindications for traction?
Unstable fracture, cord compression, spinal surgery
Acute injury or inflammation
Joint Hypermobilty or Instability
Peripheralization of symptoms with traction
Uncontrolled hypertension
what are some precautions for traction?
Claustrophobic
Pressure of belts are hazardous
Displaced annular fragment
Osteoporosis
Tumor
Infection
Systemic steroid use (eat away at ligament & tendon)
TMJ issues or dentures
what are some adverse events from spinal traction?
Rebound Pain → (apply traction → feel pain → then hurts)
Discomfort from belts
what position should the patient be in to treat the lower C-spine?
Flex to 20 - 30 degres
what position should the patient be in to that upper C-Spine?
Neutral
how should the belt be placed for lumbar traction?
Harness can be applied when patient is standing next to traction table prior to treatment
Pelvic belt placed just above iliac crest
Rib belt placed inferior margin of ribs
what are the parameters in the lumbar spine for initial phase?
30-40 lbs force → static (Hold/relax (s)) → 5-10 min
what are the parameters in the lumbar spine for joint distraction?
50% of BW → 15/15 (Hold/Relax) → 20 - 30 min
what are the parameters in the lumbar spine for muscle spasm?
25% of BW → 5/5 (Hold/relax (s)) → 20 - 30 min
what are the parameters in the lumbar spine for disc problems?
25% of BW → 60/20 (Hold/relax (s)) → 20 - 30 min
what are the parameters for soft tissue stretch in lumbar spine?
25% of BW → 60/20 (Hold/relax (s)) → 20 - 30 min
what are the paramenters for the initial phase in cervical spine?
7-9 lbs force → Static (Hold/relax (s)) → 5-10 min
what are the parameters for joint distraction in the cervical spine?
20-29 lbs (7% BW) → 15/15 (Hold/relax (s)) → 20-30 min
what are the parameters for muscle spasm in the cervical spine?
11-15 lbs force → 5/5 (Hold/relax (s)) → 20 - 30 min
what are the parameters for disc problem in the cervical spine?
11-15 lbs force → 60/20 (Hold/relax (s)) → 20 - 30 min
what are the parameters for soft tissue stretch in the cervical spine?
11-15 lbs force → 60/20 (Hold/relax (s)) → 20 - 30 min
what is the clinical prediction rule?
Patient reported peripheralization w/ lower cervical spine (C4-7) mobility testing
+ Shoulder abduction test → Bakody’s Sign (C5/C6) (hand on head)
Age > 55
+ upper limb tension test A
+ neck distraction tes
