Traction

Question 1

what is traction?

Answer 1

Tensional mechanical force applied to body to spread joint surfaces & elongating tissues

Question 2

what are the effects of traction?

Answer 2

Distract Joint surfaces
Elongate/Stretch soft tissue
Reduce disc protrusion

Question 3

what are the physical effects of traction on spinal joints?

Answer 3

Shown to increase spinal length & space b/w joints in both cervical & lumbar spine

Question 4

Aprox how much of a person’s body weight does it take to increase length of lumbar spine?

Answer 4

25%

Question 5

Aprox how much of a persons body weight does it take to distract lumbar facet joints?

Answer 5

50%

Question 6

aprox how much of a persons body weight does it take to distract cervical facet joint?

Answer 6

7%

Question 7

why is mechanical tension thought to reduce disk protrusion?

Answer 7

• 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

Question 8

what is lumbar traction (60-120lbs) or cerivcal traction (7-13 lbs) shown to do at intervertebral disc?

Answer 8

Reduce disc prolapse
Reduce size of disc herniation
Increase space w/ spinal canal & spinal foramina
Improvement in clinical signs

Question 9

why has traction been shown to cause relaxation of paraspinal muscles?

Answer 9

• 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

Question 10

what are the effects of traction on soft tissue?

Answer 10

-Prolonged moderate loads have been shown to increase length or tendons, muscles, & increase joint mobility
- May cause relaxation of paraspinal muscles

Question 11

does research support traction of lumbar and cervical spine?

Answer 11

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

Question 12

what are the clinical practice guidelines for those with neck pain?

Answer 12

• 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

Question 13

what are the clinical practice guidelines for those with low back pain?

Answer 13

PT should not use mechanical traction for patients w/ chronic LBP w/ leg pain

Question 14

what are clinical indication for spinal traction?

Answer 14

Spinal Disc Bulge or Herniation
Nerve Root Impingement
Joint Hypomobility
Muscle Spasm

Question 15

when should one stop traction?

Answer 15

• Patients symptoms become more severe
• Peripheralization is seen
• Increase in symptoms ( pain → numbness → weakness)

Question 16

what should you start with before applying mechanical traction?

Answer 16

manual traction

Question 17

what are contraindications for traction?

Answer 17

Unstable fracture, cord compression, spinal surgery
Acute injury or inflammation
Joint Hypermobilty or Instability
Peripheralization of symptoms with traction
Uncontrolled hypertension

Question 18

what are some precautions for traction?

Answer 18

Claustrophobic
Pressure of belts are hazardous
Displaced annular fragment
Osteoporosis
Tumor
Infection
Systemic steroid use (eat away at ligament & tendon)
TMJ issues or dentures

Question 19

what are some adverse events from spinal traction?

Answer 19

Rebound Pain → (apply traction → feel pain → then hurts)
Discomfort from belts

Question 20

what position should the patient be in to treat the lower C-spine?

Answer 20

Flex to 20 - 30 degres

Question 21

what position should the patient be in to that upper C-Spine?

Answer 21

Neutral

Question 22

how should the belt be placed for lumbar traction?

Answer 22

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

Question 23

what are the parameters in the lumbar spine for initial phase?

Answer 23

30-40 lbs force → static (Hold/relax (s)) → 5-10 min

Question 24

what are the parameters in the lumbar spine for joint distraction?

Answer 24

50% of BW → 15/15 (Hold/Relax) → 20 - 30 min

Question 25

what are the parameters in the lumbar spine for muscle spasm?

Answer 25

25% of BW → 5/5 (Hold/relax (s)) → 20 - 30 min

Question 26

what are the parameters in the lumbar spine for disc problems?

Answer 26

25% of BW → 60/20 (Hold/relax (s)) → 20 - 30 min

Question 27

what are the parameters for soft tissue stretch in lumbar spine?

Answer 27

25% of BW → 60/20 (Hold/relax (s)) → 20 - 30 min

Question 28

what are the paramenters for the initial phase in cervical spine?

Answer 28

7-9 lbs force → Static (Hold/relax (s)) → 5-10 min

Question 29

what are the parameters for joint distraction in the cervical spine?

Answer 29

20-29 lbs (7% BW) → 15/15 (Hold/relax (s)) → 20-30 min

Question 30

what are the parameters for muscle spasm in the cervical spine?

Answer 30

11-15 lbs force → 5/5 (Hold/relax (s)) → 20 - 30 min

Question 31

what are the parameters for disc problem in the cervical spine?

Answer 31

11-15 lbs force → 60/20 (Hold/relax (s)) → 20 - 30 min

Question 32

what are the parameters for soft tissue stretch in the cervical spine?

Answer 32

11-15 lbs force → 60/20 (Hold/relax (s)) → 20 - 30 min

Question 33

what is the clinical prediction rule?

Answer 33

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