Traction

Question 1

Indications

Answer 1

1. Herniated Disc Pulposa (HNP) - Rupture of the annulus fibrosis causing pulposa to protrude.

2, Degenerative Joint Disease - ex. Spondylosis (osteoarthritis of neural foramen)

3. Joint Dysfunction (Hypomobility)
4. Muscle Spasm

Question 2

CONTRAINDICATIONS

Answer 2

1. Structural fault due to tumor or infection.
2. Of cervical spine in patients with vascular compromise (stretching an artery the diameter decreases in size, limits blood flow).
3. Where movement is contraindicated (Such as a fracture).
4. Of cervical spine in patients with Rheumatoid Arthritis
5. Of cervical spine in patient with a major neck injury until fracture of the odontoid process has been ruled out. (Or transverse/alnar ligament laxity via motor vehicle accident)

Question 3

Precautions

Answer 3

1. Acute Strains (careful if inflammation is present).
2. Pregnancy (even menstrual cycle, hormones can make you more lax).
3. Osteoporosis (a disease in which the bones become very fragile and likely to fracture).
4. Hiatal Hernia using pelvic traction (hiatal hernia is a condition in which part of the stomach stick upward into the chest, through and opening in the diaphragm.
5. Claustrophobic patients or other safety concerns

Question 4

Traction Controls

Answer 4

1. Treatment Time
2. Force
3. Duty Cycle
4. Direction of Pull

Question 5

Treatment Time

Answer 5

For Disc Problems:
3-5 minutes for first treatment. Then progress to 8-10 minutes.

For all other problems:
Treat for 15-20 minutes

Question 6

Force

Answer 6

For Cervical Spine:
10% to 20% of the patients body weight (to 35 # MAX). you must add the weight of the head if they are in the sitting position.

For Lumbar Spine:
25% to 50% of the patients body weight, additional force may need to be applied to accommodate for the friction if the table doesn’t slide.

Question 7

Duty Cycle

Answer 7

For Disc problems 60 seconds ON and 20 seconds OFF

For all other problems, 20-30 seconds ON and 10 seconds OFF

Question 8

Direction of Pull Transverse Axis

Answer 8

Disc Problems - Direction of pull should be as straight as possible.

Muscle and Facet Problems - Pull with 25 to 30 degrees of flexion.

Question 9

Direction of Pull Longitudinal Axis

Answer 9

(The patients head or trunk list to one side)

Disc Problems - Pull of the side needed to MAINTAIN the list.

Muscle and Facet Problems - Pull on the side to CORRECT the list. (Straighten the patient out)

Question 10

Physical and Physiological Effects of Traction

Answer 10

Uses for spinal traction:

1. Distraction of vertebral bodies (Unloading the disc).
2. Tensing of ligaments.
3. Widening of inter-vertebral foramen.
4. Stretching of spinal musculature.

Note: the relative magnitude of the above effects can be altered by changing the amount of spinal flexion and ectension

Question 11

Type of Spinal Traction

Answer 11

1. Continuous
2. Sustained (Static) Traction
3. Intermittent Mechanical Traction (IMT)
4. Manual Traction
5. Positional Traction
6. Auto Traction
7. Gravity Lumbar Traction

Question 12

Protective Scoliosis

Answer 12

When a protruding nucleus pulposa presses against a nerve root, the patient may lean to one side to pull the nerve root away from the bulge. Depending on where the bulge is, the patient may lean toward or away from the side of pain.

If the patient is listing (leaning) away from the side of the pain, you want to give unilateral traction on the side of the pain to reduce the bulge while sparing the nerve pain.

If the patient is listing toward the side of the pain, you want to give unilateral traction on the side opposite the pain to reduce the bulge while sparing the nerve pain.

Question 13

Continuous Traction

Answer 13

Continuous traction is applied for several hours at a time. because the skin can only withstand low amounts of pressure, continuous traction is limited to weights of 20-30#. This is not enough to cause lumbar vertebral distraction. Many people feel that continuous traction is merely a method of enforcing bed rest.

Question 14

Sustained (Static) Traction

Answer 14

Application of a constant amount of traction for several minutes to half an hour. The less the time, the greater the allowable force. Sustained traction is much more effective if done on a split table which allows the entire force of traction to cause distraction. A regular plinth will have a great deal of friction loss of force.

Question 15

Intermittent Mechanical Traction (IMT)

Answer 15

This form of traction uses a mechanical device to apply and release force every few seconds. IMT is the most type of traction used in the U.S.

Question 16

Manual Traction

Answer 16

Traction applied to the patient by the therapist. Manual traction may be applied slowly or as a sudden thrust. many patients have difficulty relaxing with manual traction because they can’t anticipate (or don’t trust) what the P.T. will do next.

Question 17

Positional Traction

Answer 17

(using things around the house)
The patient is placed in a certain position with the use of pillows, blocks, or sandbags. gravitational forces are used to provide traction.

Question 18

Auto Traction

Answer 18

The patient applies the traction by pulling with their arms. Te patient therefore controls both the magnitude and direction of the pull.

Question 19

Gravity Lumbar Traction

Answer 19

one end of the patient’s body is secured and gravitational force provides the traction. This is most safely performed with the head up, but there is much force placed on the rib cage. In the last decade, there were several devices created which allowed people to hang upside down to create traction. unfortunately, there is a risk of stroke from such a maneuver.

Question 20

Lumbar and Cervical Traction Tecniques

Answer 20

Look in the Packet!