Traction Flashcards
Traction from what language?
Latin- tracio> drawing or pulling apart
Traction in papyri
Egyptian 3,000 BC axial traction for spinal fractures
Hippocrates Peri arthron
776 BC- described traction for treatment of back pain
Galen (201 BC), Avicenna (1037) Pare (1690)
treated LBP with hippocrates traction
W. Gayle Crutchfield (1933)
used cranial tongs for treatment of cervical spine injuries
James cyriax (1950s)
Traction treatment of choice for small nuclear protrusions
Joint distraction
The separation of two joint surfaces perpendicular to the plane of articulation
-force applied must be great enough to cause soft tissue elongation around the joint to allow for joint surfaces to distract
Lumbar spine physiological effects of traction
- 25% of BW will increase length of spine however;
- 50% of BW needed to distract zygapophyseal joints
Cervical spine physiological effects of traction
- 7% of BW will increase length of spine however;
- 25 pounds of traction separates 2-20 mm
Reduction of Disc protrusion
Cyriax traction is treatment of choice for small nuclear protrusions
- krause et al: lumbar traction force of 60-120lbs can reduce disc prolapse and cause retraction of herniated disc material
- HNP retracted during traction in: 78.5% median, 66.6% posterolateral, and 57.1% of lateral protrusions
Herniation index
AB=maximum AP disc length
CD= width of herniated disc @ mid AB distance
EF=Maximal canal length
GH= width of spinal canal at mid AB distance
Herniation index= (AB x CD)/ (EF x GH) x 1,000
Physiological effects of traction
- Soft tissue stretching
- Muscle relaxation ( dec. spasm)
- Joint mobilization
Physiological effects of traction: soft tissue stretching
Spinal traction will result in elongation of the spine and increase distance between vertebral bodies and facet joints
- process is the same as for stretching any soft tissue
Physiological effects of traction: Muscle relaxation
- Muscle relaxation due to reduction in pressure on pain sensitive structures
- static traction: depression of monosynaptic response due to prolonged stretch
- intermittent traction: stim of GTOs to inhibit alpha motor neurons
Physiological effects of traction: Joint mobilization
- Due to high-force traction due to stretching of surrounding soft tissue
- forces up to 50% of body wt required to move joints in the spine
- lower forces may reduce pain by stimulation of mechanoreceptors> spinal gate
Physiological effects of traction:patient immobilization pain relief by
- increased space between vertebrae
- separating apophyseal joints
- widening of IV foramina
- stretching muscles and ligaments
- reducing muscle spasm
- changing IV disc pressure
- creating suction force on disc
- flattening abnormal lumbar lordosis
Physiological adaptations from traction
- Bone: increases movement between vertebrae
- ligaments: tensile load ligaments
- articular facet joints: increase separation, decreases compression loading, allows synovial fluid exchange
- muscles: lengths tight muscles, activates proprioceptors
- Nerves: decompress
Disc bulge or herniation
- Cyriax: indicated for small disc protrusion
- most effective if used early on
- can aide in reducing risk of further disc protrusion
DRX90000 spinal decompression
- Claims 86% success rate with patients with LBP
- DRX9000
Clinical indications current research
Philadelphia panel evidence based clinical practice guidelines on selected rehab interventions for LBP
- no benefit seen during acute, subacute, or chronic state of healing
- sample sizes, population choosen, force of traction used???
Nerve root impingment
- Best results if applied early
- indicated if neuro signs present
- *Causes:
- disc
- ligament encroachment
- narrowing of IV foramen
- osteophyte encroachment
- nerve root swelling
- spondylolithesis
- *consider for compression load intolerance
Clinical indications: joint hypomobility
- can glide and distract spinal jts
- traction is non specific
Clinical indications: subacute joint inflammation
- May help maintain normal fluid exchange in spinal joints
- may control pain via gating mechanism
Clinical indications
- adhesions
- muscle spasm (ex paraspinal muscle spasm)
- foraminal stenosis
- contracted CT
- apophyseal joint impingment
- radiating pain that does not respond to spinal repeated movements
Traction contraindications
- where motion is contraindicated
- with acute injury or inflammation
- joint hypermobility or instability
- peripheralization of symptoms with traction
- uncontrolled hypertension (inversion traction)
- malignancy
- infectious spinal diseases (TB)
- RA
- Spinal cord compression
- osteoporosis
- cardivascular disease
- aortic aneurysm
- severe respiratory disease
- pregnancy (lumbar)
- hiatal hernia (lumbar)
- abdominal hernia (lumbar)
- active peptic ulcers (lumbar)
Precautions
- structural diseases
- when pressure from belts may be hazardous
- displacement of annular fragment
- medial disc protrusion
- severe pain fully relieved by traction
- claustrophobia
- Pts who cannot tolerate prone or supine position
- disorientation
- TMJ problems
- Dentures
4F APTA practice pattern
Impaired joint mobility, motor function, muscle performance, ROM, and reflex integrity associated with spinal disorders
4D APTA practice pattern
impaired joint mobility, motor function, muscle performance, ROM, and reflex integrity associated with CT dysfunction
Inverse traction
- uses BW to provide distraction force
- popular 10-20 yrs ago
- lost favor due to potential for increased systolic and diastolic BP as well as ophthalmic artery pressure
- no longer recommended
Application techniques
- Mechanical
- static> irritable conditions, inflammation, disc protrusion
- intermittent> jt dysfunctions mobilization effect (on/off times)
- Electric
- weighted
- hydraulic
traction belt attachments
- iliac crests
- lower rib cage
Lumbar mechanical traction: pt position
- supine hooklying
- general jt hypomobility
- stenosis (knees and hips flexed)
- Prone : disc conditions
- unilateral lumbar traction: for unilateral symptoms
Positional traction
-placing pt in a position for a prolonged period of time so as to decompress target tissue
Manual traction
application of force by the therapist so as to distract target tissue
Mechanical spinal traction: safe application for cervical spine
- Optimal pt position
- Sitting
- supine (preferred)
- C-spine should be flexed 20-30 degrees
- use 0 degrees if intent is to treat AO or AA joint
- Traction force should be directed toward the occiput rather than the chin
Parameters: inital/ acute phase lumbar
Force: 13-20 kg (28-44lbs)
Hold/relax: static
total time: 5-10 mins
Parameters: joint distraction lumbar
Force: 22.5 kg (50lbs); 50% BW
hold/relax: 15/15
total time: 20-30 mins
Parameters: decrease muscle spasm lumbar
Force: 25% BW
hold/relax: 5/5
total time: 20-30 mins
Parameters: disc problems or stretch soft tissue
Force: 25% BW
hold/relax: 60/20
total time: 20-30
Parameters: inital/ acute phase cervical
force: 3-4 kg (7-9lbs)
hold/relax: static
total time: 5-10 mins
Parameters: joint distraction cervical
force: 9-13 kg (20-29lbs) 7% BW
hold/relax: 15/15
total time: 20-30 mins
Parameters: Decrease muscle spasm cervical
force: 5-7 kg (11-15 lbs)
hold/relax: 5/5
total time:20-30
Parameters: disc problems and stretch soft tissue cervical
force: 5-7 kg (11-15 lbs)
hold/relax: 60/20
total time: 20-30 mins
Self traction
the use of gravity or the weight of body to exert a distraction force on spine
CPR for cervical traction for mechanical neck pain
- Age >/= 55
- positive shoulder abduction test
- positive ULTT A (elvy’s)
- sx peripheralize with PACVP of C4-C7
- positive neck distraction test
- quality score 67%
- cervical traction indicated if 3 or more predictor variables are present
- LR 4.8 yields a small to moderate shift in probability
