Traction

Question 1

_________ is a tensional mechanical force applied to the body in a way that separates the joint surfaces and elongates surrounding soft tissues

Two types?

Answer 1

Traction

Manual
Mechanical

Question 2

Traction can be applied to both the _______ and _______ extremity

Answer 2

lower
upper

Question 3

Effects of Traction

______ joint surfaces
_______ protrusions of nuclear disc material
______ soft tissue
______ muscles
_______ joints
________ transmission of pain by stimulation of sensory mechanoreceptors

Answer 3

distract
reduce
stretch
relax
mobilize
gate

Question 4

_______ _______ is the separation of two articular surfaces perpendicular to plane of articulation

Answer 4

joint distraction

Question 5

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

Answer 5

pain; loading

Question 6

Joint distraction may reduce pain from ______ joint injury or nerve root _______

Answer 6

facet
compression

Question 7

With traction, force applied must be enough to cause ________ of soft tissues around the joint

Answer 7

elongation

Question 8

With traction, if the force is too small it may elongate the soft tissue but not _______ joint surfaces of the spine

Answer 8

seperate

Question 9

With traction, a force of ______% body weight might elongate soft tissue

Answer 9

25

Question 10

With traction, there is a force of at least _____% body weight and max of ______% required to distract lumbar apophyseal joints

Answer 10

50
60

Question 11

With traction, there is a max force of _____% of body weight for cervical apophyseal joints

Answer 11

7

Question 12

With reduction of spinal disc protrusions: suction is caused by decreased ______ _______

Answer 12

intradiscal pressure

Question 13

With reduction of spinal disc protrusions: There is increasing tensions on the ______ ________ ligament at posterior part of disc thus pushing disc material anteriorly

Answer 13

posterior longitudinal

Question 14

Lumbar disc protrusion may be reduced with traction force of at least ____ pounds or at least _____% of body weight

Answer 14

60
50

Question 15

Cervical disc protrusion may be reduced with traction force of at least ____-_____ pounds or at least ____% of body weight

Answer 15

15; 30
7

Question 16

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

Answer 16

tendons
joint

Question 17

__________ traction: Gating of pain transmission by stimulation of mechanoreceptors by oscillatory movements

Answer 17

intermittent

Question 18

_______ traction: Depression of monosynaptic response caused by stretching the muscles for several seconds

Answer 18

static

Question 19

Traction has been recommended as a way of mobilizing _____ and _____ joints to increase joint mobility or decrease joint pain

Answer 19

spinal; peripheral

Question 20

Clinical indications: spinal pain with or without radiculopathy caused by

_____ bulge or ______
_____ ______ impingement
joint _________
subacute joint __________
________ muscle spasm

Answer 20

disc; herniation
nerve root
hypomobility
inflammation
paraspinal

Question 21

Spinal disc buldge or herniation has longer hold time in intermittent traction
______ seconds on and ______ seconds off

Answer 21

60
20

Question 22

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

Answer 22

severity
treatment
calcified
traction

Question 23

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

Answer 23

onset
cervical
enrichment; height; intervertebral; osteophytes

Question 24

With joint hypomobility and traction

Traction can glide and distract ____ facet joints and stretch surounding _____ _____ so may improve symptoms of spinal hypomobility

Answer 24

spinal
soft tissue

Question 25

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

Answer 25

flexion lumbar neutral extension flexion extension

Question 26

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

Answer 26

pressure gate control edema ACUTE

Question 27

Muscle spasm Traction can decrease pain by interrupting pain- _____- pain cycle Inhibit ______ _____ neuron firing Alleviate protective muscle spasms by decreasing underlying ______ of pain

Answer 27

spasm alpha motor causes

Question 28

Contraindications: Where ______ is contraindicated Acute ______ or ________ ________ or unstable joints Assess _______ first ____________ of symptoms with traction Uncontrolled ___________

Answer 28

motion injury; inflammation hypermobility motion peripheraalization hypertension

Question 29

Precautions for traction Structural diseases or conditions affecting the _______ in the area being treated Examples: _________ _________ ______ ________ _________

Answer 29

tissue tumor rheumatoid arthritis osteoporosis

Question 30

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

Answer 30

annular

Question 31

_______ _______ protrusions: Medial movement of the nerve root by the traction force may increase impingement of the disc on the nerve root

Answer 31

medial disc

Question 32

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

Answer 32

increased nerve root sensation

Question 33

When determining whether patient presentation is likely to respond to treatment with traction: Desired ________ effect _________/precautions _________ of treatment

Answer 33

therapeutic contraindications location

Question 33

What are two additional precautions for cervical traction?

Answer 33

TMJ; Dentures

Question 34

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 ________

Answer 34

force; time present static; intermittent inexpensive

Question 35

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

Answer 35

electrical motorized time consuming control; participation belts spine

Question 36

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 ______

Answer 36

electric motor forces static; intermittent 70; 154 positioning pain; location

Question 37

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)

Answer 37

flexed posterior extended anterior paraspinal EMG

Question 38

Positioning of patient: Cervical Traction Allows traction force to not have to overcome _______ of gravity Patient is in _____ and can relax

Answer 38

force supine

Question 39

Cervical Traction Patient Position: Upper Cervical: ____-______ degrees flexion Mid Cervical: _____-______ degrees flexion Lower Cervical: ____-_____ degrees flexion

Answer 39

0; 5 10; 20 25; 35

Question 40

REMINDER: For lumbar traction you must use a _____ traction table with the area of. spine to be distracted positioned over the split

Answer 40

split

Question 40

Safety issues: Purpose is ______ friction which allows improved traction _____

Answer 40

decreased; force

Question 41

Safety issues: Don't forget to ______ table as the last step before starting traction

Answer 41

unlock

Question 42

Always give the patient the _______ _______!!!

Answer 42

safety switch

Question 43

Parameters for Lumbar Traction Goal of treatment: Initial/acute phase Force: ___-____ lbs Hold/Relax Times: ______ Total Traction Time (min): ___-_____

Answer 43

30; 45 static 5; 10

Question 44

Parameters for Lumbar Traction Goal of treatment: Joint distraction Force: ______ % body weight Hold/Relax Times: ___/____ Total Traction Time (min): ____-____

Answer 44

50 15 20; 30

Question 45

Parameters for Lumbar Traction Goal of treatment: Decrease ms. spasm Force: ______ % body weight Hold/Relax Times: ___/____ Total Traction Time (min): ____-____

Answer 45

25 5; 5 20; 30

Question 46

Parameters for Lumbar Traction Goal of treatment: Disc problem or stretch soft tissue Force: ______ % body weight Hold/Relax Times: ___/____ Total Traction Time (min): ____-____

Answer 46

25 60; 20 20; 30

Question 47

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.

Answer 47

30; 45

Question 48

Parameters for Cervical Traction Goal of treatment: Initial/acute phase Force: ___-____ lbs Hold/Relax Times: ______ Total Traction Time (min): ___-_____

Answer 48

8; 10 static 5; 10

Question 49

Parameters for Cervical Traction Goal of treatment: Joint distraction Force: ______ % body weight or ____-____ lbs Hold/Relax Times: ___/____ Total Traction Time (min): ____-____

Answer 49

7 20; 29 15; 15 20; 30

Question 50

Parameters for Cervical Traction Goal of treatment: Decrease ms. spasm Force: ____-_____ lbs Hold/Relax Times: ___/____ Total Traction Time (min): ____-____

Answer 50

11; 15 5; 5 20; 30

Question 51

Parameters for Cervical Traction Goal of treatment: Disc problems or stretch of soft tissue Force: ____-_____ lbs Hold/Relax Times: ___/____ Total Traction Time (min): ____-____

Answer 51

11; 15 60; 20 20; 30

Question 52

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 ______ ______

Answer 52

static; intermittent application dosage tension duration duty cycle ascending; descending patient functional activity