Traction Flashcards
_________ is a tensional mechanical force applied to the body in a way that separates the joint surfaces and elongates surrounding soft tissues
Two types?
Traction
Manual
Mechanical
Traction can be applied to both the _______ and _______ extremity
lower
upper
Effects of Traction
______ joint surfaces
_______ protrusions of nuclear disc material
______ soft tissue
______ muscles
_______ joints
________ transmission of pain by stimulation of sensory mechanoreceptors
distract
reduce
stretch
relax
mobilize
gate
_______ _______ is the separation of two articular surfaces perpendicular to plane of articulation
joint distraction
Distraction of facet joints can decrease ______ related to mechanical ______ of the joints or compression of spinal nerve roots as they pass through the intervertebral foramina
pain; loading
Joint distraction may reduce pain from ______ joint injury or nerve root _______
facet
compression
With traction, force applied must be enough to cause ________ of soft tissues around the joint
elongation
With traction, if the force is too small it may elongate the soft tissue but not _______ joint surfaces of the spine
seperate
With traction, a force of ______% body weight might elongate soft tissue
25
With traction, there is a force of at least _____% body weight and max of ______% required to distract lumbar apophyseal joints
50
60
With traction, there is a max force of _____% of body weight for cervical apophyseal joints
7
With reduction of spinal disc protrusions: suction is caused by decreased ______ _______
intradiscal pressure
With reduction of spinal disc protrusions: There is increasing tensions on the ______ ________ ligament at posterior part of disc thus pushing disc material anteriorly
posterior longitudinal
Lumbar disc protrusion may be reduced with traction force of at least ____ pounds or at least _____% of body weight
60
50
Cervical disc protrusion may be reduced with traction force of at least ____-_____ pounds or at least ____% of body weight
15; 30
7
Soft tissue stretching is using a moderate-load, prolonged force such as that provided by spinal traction has been shown to increase the length of _______ and to increase ______ mobility, even when complete joint surface seperation is not achieved
tendons
joint
__________ traction: Gating of pain transmission by stimulation of mechanoreceptors by oscillatory movements
intermittent
_______ traction: Depression of monosynaptic response caused by stretching the muscles for several seconds
static
Traction has been recommended as a way of mobilizing _____ and _____ joints to increase joint mobility or decrease joint pain
spinal; peripheral
Clinical indications: spinal pain with or without radiculopathy caused by
_____ bulge or ______
_____ ______ impingement
joint _________
subacute joint __________
________ muscle spasm
disc; herniation
nerve root
hypomobility
inflammation
paraspinal
Spinal disc buldge or herniation has longer hold time in intermittent traction
______ seconds on and ______ seconds off
60
20
Decreased efficacy in treatment of lumbar disc could be due to:
______ of disc protrusion in those studied
Too smalll sample size to see ________ effect
Disc herniation has become _______
Insufficient ______ force used
severity
treatment
calcified
traction
Nerve root impingement
More effective if used soon after _____ of symptoms
More effective in ______ spine
Can be caused by ligament _________, loss of disc ______ result in narrowing of ________ foramen, ________ or swelling of spinal nerve root or spondylolisthesis
onset
cervical
enrichment; height; intervertebral; osteophytes
With joint hypomobility and traction
Traction can glide and distract ____ facet joints and stretch surounding _____ _____ so may improve symptoms of spinal hypomobility
spinal
soft tissue
With joint hypomobility and traction:
can be improved by adjusting the degree of spinal _____ and positioning the ______ spine in more flexion localizes force to upper lumbar/lower thoracic
positioning in _____ or ______ localizes force to lower lumbar
cervical ______ localizes force to lower cervical, neutral or slight ________ focuses force on upper cervical
flexion
lumbar
neutral
extension
flexion
extension
Subacute joint inflammation
May reduce ______ on inflamed joint surfaces
May decrease pain by _____ ______ mechanism
May maintain normal fluid exchange in spinal joints to decrease _______ caused by chronic inflammation
DO NOT USE IN ______ INJURY PHASE
pressure
gate control
edema
ACUTE
Muscle spasm
Traction can decrease pain by interrupting pain- _____- pain cycle
Inhibit ______ _____ neuron firing
Alleviate protective muscle spasms by decreasing underlying ______ of pain
spasm
alpha motor
causes
Contraindications:
Where ______ is contraindicated
Acute ______ or ________
________ or unstable joints
Assess _______ first
____________ of symptoms with traction
Uncontrolled ___________
motion
injury; inflammation
hypermobility
motion
peripheraalization
hypertension
Precautions for traction
Structural diseases or conditions affecting the _______ in the area being treated
Examples:
_________
_________
______ ________
_________
tissue
tumor
rheumatoid arthritis
osteoporosis
Once an ________ fragment has become displaced and is no longer connected to the body of the disc, traction is not likely to change the position of the disc fragment, therefore treatment is not likely to improve the patient’s symptoms
annular
_______ _______ protrusions: Medial movement of the nerve root by the traction force may increase impingement of the disc on the nerve root
medial disc
If severe pain resolves fully with traction, it may indicate traction has _______ rather than decreased pressure on a _____ _____ causing a complete nerve block
Check ______, reflexes and strength before and after
increased
nerve root
sensation
When determining whether patient presentation is likely to respond to treatment with traction:
Desired ________ effect
_________/precautions
_________ of treatment
therapeutic
contraindications
location
What are two additional precautions for cervical traction?
TMJ; Dentures
Mechanical Traction Advantages
______ and ______ well controlled, readily graded, and replicable
Doesn’t require the clinician to be _______ with patient throughout treatment
Allows application of _____ or _______ traction
Static devices are ________
force; time
present
static; intermittent
inexpensive
Mechanical Traction Disdvantages
___________ __________ devices are expensive
_____-_______ to set up
Lack of patient _______ or _______
Restriction by _______ or halter poorly tolerated by some patients
Mobilizes broad regions of the _____ rather than individual segments, this potentially promotes hypermobility
electrical motorized
time consuming
control; participation
belts
spine
Motorized Mechanical Traction Units
Uses _____ ______ to apply traction forces to cervical or lumbar spine
Allow accurate control over _____ being applied
Can provide _____ or _______ traction
Maximum force is about ____ kg ( _____ lb)
Allow great variation in patient ______
Newer models can store clinical protocols and track patient ____ severity and ______
electric motor
forces
static; intermittent
70; 154
positioning
pain; location
Positioning of the patient
Lumbar traction:
Supine: ______ position of spine
Greater seperation of _______ structures such as facet joints and intervertebral foramen
Prone: ________ position of spine
Greater seperation of _____ structures including disc spaces
Greater lumbar ______ relaxation (less _____ firing)
flexed
posterior
extended
anterior
paraspinal
EMG
Positioning of patient:
Cervical Traction
Allows traction force to not have to overcome _______ of gravity
Patient is in _____ and can relax
force
supine
Cervical Traction
Patient Position:
Upper Cervical: ____-______ degrees flexion
Mid Cervical: _____-______ degrees flexion
Lower Cervical: ____-_____ degrees flexion
0; 5
10; 20
25; 35
REMINDER:
For lumbar traction you must use a _____ traction table with the area of. spine to be distracted positioned over the split
split
Safety issues: Purpose is ______ friction which allows improved traction _____
decreased; force
Safety issues: Don’t forget to ______ table as the last step before starting traction
unlock
Always give the patient the _______ _______!!!
safety switch
Parameters for Lumbar Traction
Goal of treatment: Initial/acute phase
Force: ___-____ lbs
Hold/Relax Times: ______
Total Traction Time (min): ___-_____
30; 45
static
5; 10
Parameters for Lumbar Traction
Goal of treatment: Joint distraction
Force: ______ % body weight
Hold/Relax Times: ___/____
Total Traction Time (min): ____-____
50
15
20; 30
Parameters for Lumbar Traction
Goal of treatment: Decrease ms. spasm
Force: ______ % body weight
Hold/Relax Times: ___/____
Total Traction Time (min): ____-____
25
5; 5
20; 30
Parameters for Lumbar Traction
Goal of treatment: Disc problem or stretch soft tissue
Force: ______ % body weight
Hold/Relax Times: ___/____
Total Traction Time (min): ____-____
25
60; 20
20; 30
For Lumbar Traction
For all treatments, force should start low ( ____-_____ lb)) the first time to assess patient response and avoid muscle guarding or spasms. Then gradually increase to optimal levels.
30; 45
Parameters for Cervical Traction
Goal of treatment: Initial/acute phase
Force: ___-____ lbs
Hold/Relax Times: ______
Total Traction Time (min): ___-_____
8; 10
static
5; 10
Parameters for Cervical Traction
Goal of treatment: Joint distraction
Force: ______ % body weight or ____-____ lbs
Hold/Relax Times: ___/____
Total Traction Time (min): ____-____
7
20; 29
15; 15
20; 30
Parameters for Cervical Traction
Goal of treatment: Decrease ms. spasm
Force: ____-_____ lbs
Hold/Relax Times: ___/____
Total Traction Time (min): ____-____
11; 15
5; 5
20; 30
Parameters for Cervical Traction
Goal of treatment: Disc problems or stretch of soft tissue
Force: ____-_____ lbs
Hold/Relax Times: ___/____
Total Traction Time (min): ____-____
11; 15
60; 20
20; 30
Documenation for Traction
should include…
______ or ______
Angle of ______
________
- amount of ____
- _______ of traction treatment
- ______ ______ (Proportion of time at max pull vs min pull)
Any _______ or ______ gradual steps
________ response (assessment)
Relate to improvement in ______ ______
static; intermittent
application
dosage
tension
duration
duty cycle
ascending; descending
patient
functional activity
