Traction Flashcards
traction definition
mechanical force applied to the body
separates joint surfaces and elongates the soft tissue surrounding a joint
what does traction require
2 opposing forces
- traction
- countertraction
durations of distraction
continuous
sustained/static
intermittent
modes of mechanical traction
electrical and weighted mechanical
modes of manual traction
manual traction
explain billing for traction to peripheral joints
manual therapy rather than mechanical modality
– always done manually
what is self-traction? positional traction?
self - done by self using body weight
positional - positioned to utilize external forces to do the work
explain process of static traction
constant amount of traction force is applied throughout the treatment intervention
explain the process of intermittent traction
force alternated between 2 set points during treatment intervention
what are the specific guidelines for intermittent traction
a higher level of force is maintained for a given period of time then reduced to 50% of that max for a given time
- may be progressive or regressive
effects of traction on joint surfaces
reduction of compression on the joint surfaces
reduction of:
articular pressure
pressure on intra-articular structure
pressure on nerve roots
in what manner should traction be applied to joint surfaces
perpendicular to the plane of articulation
what % force of body weight must be applied to elongate soft tissue? what about joint surfaces?
- lumbar
- cervical
lumbar
25% = elongation of tissue
50% = joint separation
cervical
7% = joint separation
physiological effects of traction
decreased pain
increased mobility
how does traction reduce pain
mechanoreceptor stimulation
decreased muscle tension
nerve pressure relief (decreased disc material protrustion)
how does traction increase mobility
stretch soft tissue
relaxation of muscle
joint mobilization
explain the reduction of disc material protrusion? what does this do as a result?
traction creates a suction phenomenon when intradiscal pressure is reduced
- displaced material will be pulled back to center of the disc
-reduction of herniation size / increased spinal canal space
traction applied to what structure will cause disc material protrusion to decrease?
traction of the posterior longitudinal
- pushes material anteriorly
what forms of traction are indicated for disc material protrusion reduction
higher amounts of force are needed = mechanical
self and manual are not enough for intended benefits
explain disc protrusion size and efficacy of posterior longitudinal ligament traction
- minimally effective with large disc protrusion, herniation, or calcification
- moderately effective with small to moderate disc protrusion
explain the relationship between degree of force and duration if the goal is soft tissue stretch
lower forces of traction
prolonged durations
- should improve ROM / mobility that would in turn decrease compression force on joint surface
explain effect of intermittent traction on relaxation of muscles
will stimulate mechanoreceptors and cause pain gating
- reduction of pain = reduction of spasms
explain effect of static traction on relaxation of muscles
stretches golgi tendon organs
- inhibits alpha motor neuron firing
- inhibits muscle tone
explain how low loads of traction effect mobilization of joints
pain gaiting allows for mobility increases
- will not be adequate to separate the joint structures
explain how high loads of traction effect mobilization of joints
stretch of surrounding tissue
separation of joint structure
– both lead to greater amounts of motion
explain the role of manual techniques if considering traction
can be more effective to isolate specific joints
- with mechanical traction it can be difficult to isolate a specific vertebral segment
indications for spinal traction
disc herniation/bulge
nerve root impingement
joint hypomobility
subacute joint inflammation
subacute joint pain
paraspinal muscle spasm
osteophytes
degenerative joint disease
consideration when using traction for joint hypomobility
hypomobility in one area can result in hypermobility in another area
traction could possibly increase mobility in the hypermobile joint
how does traction help sub-acute joint issues? any considerations?
reduced pressure on inflamed joint surface
pain gaiting
fluid exchange induced by motion
- want to avoid intermittent traction during acute stage
how to target paraspinal muscle spasms with traction
static or intermittent low loads
– will interrupt the pain-spasm pain cycle due to GTO activation
contraindications for traction
spinal fusion / fracture / recent surgery
progressive neuro deficit
acute injury/inflammation
VBI
ankylosing spondylosis
joint hypermobility or instability
uncontrolled HTN
increased BP with traction
if traction is peripheralizing symptoms
what conditions may cause an individual to have joint hypermobility or instability
pregnancy
RA
down syndrome
osteoporosis
explain traction considerations for TMJ disorders
need to keep dentures in
- maintains TMJ position
can limit the types of traction applicable
precautions when using traction
immature/young patients
claustrophobic patients
obesity
respiratory/CV problems
malignancies
what special tests would need to be negative before indicating cervical traction
alar ligament
transverse ligament
sharp pursor
VBI testing cluster
what are the parameters for traction
patient positioning
static vs intermittent
hold/relax time
force
total duration
total frequency
explain supine positioning and traction relationship
will flex spine
- traction will be greater on posterior structures/tissues
- good for paraspinal spasms/facet joint manipulation
- more flexion will cause greater pull on upper lumbar and lower thoracic segments
explain prone positioning and traction relationship
will extend the spine
- traction greater on anterior structures/tissues
- good for disc problems
- pulls on lower lumbar area more
explain sitting position and lumbar mechanical traction relationship
will put spine in neutral
gravity will provide further pull
explain supine position and cervical mechanical traction relationship
more flexion = more posterior / lower vertebra
less flexion = more anterior / higher vertebrae
explain degree of flexion for:
C1-2
C2-5
C6-7
0-5 degrees
10-20 degrees
25-35 degrees
maximal posterior pull = 25-35 degrees
– general rule for treatment
findings that would indicate static vs intermittent traction
static
- inflamed tissues
- symptoms increase with motion
- disc protrusion causing symptoms
intermittent
- disc protrusion (will include longer hold time)
- joint dysfunction (will include shorter hold time)
explain the qualitative ratio associated with hold and relax times
hold - maximal force
relax - minimal force
hold/relax ratio for
- disc protrusion
- spinal joint dysfunction/hypomobility
disc = 60:20
dysfunction/hypo = 15:15
for those with severe symptoms, what is the proper hold/relax time
longer hold and relax times / less movement
as symptoms improve, decrease time so that more movement occurs
what determines force of traction
tratment goal
patient position
treatment area
- equal to % body weight of application area
what forces are indicated in lumbar traction
facet joint separation = 50-60% BW
ST stretch = 25-50% of BW (15-30# typically)
- generally do not apply more than 50-60% of BW
for initial visit of lumbar spine treatment, what is the recommended load
30-45 lbs
increase by 5-15 lbs
what forces are indicated in cervical traction
facet jt separation = 7% of BW
– in neutral position:
8-10 lbs (upper) / 25-30 lbs (lower)
ST stretch = 12-15 lbs
– generally do not exceed 30 lbs
for initial visit of cervical spine treatment, what is the recommended load
8-10 lbs
increase by 3-5 lbs
explain initial treatment duration and symptom response
if severe = 5 minutes
moderate or minimal = 10-15 minutes
if symptoms improve = stay same length or slowly increase time
if symptoms stay the same = slowly increase time
if symptoms worsen = discontinue treatment
associated duration for disc protrusions
start at 20 min
gradually increase up to 40 if needed
