Traction Flashcards
Term: Pulling or drawing
Traction
Term: Separation of jiont surfaces moving perpendicular to one another
Distraction
Term: Used to describe manual traction
Longitduinal mobilization
6 Effects of Spinal Traction
- Distraction/separation of vertebral bodies
- Distraction and gliding of facet joints
- Widening of the intervertebral foramen
- Tensing of ligamentous structures
- Straightening of spinal curves
- Stretching of spinal musculature
Describe the purpose of unilateral long axis traction
Can be used for protective scoliosis or to open the foramen on one side
Type of Traction: Special table composed of two sections that can be individually angled and rotated allowing the pt. to progress tx
Autotraction (no longer used)
Describe the force placed on the pelvis with Cotrell 90/90 Traction
Creates flexion at the pelvis
Describe 3 positions that unload the spine
- Supine in 90/90
- Use of UE to unload the spine in sitting
- Propping one leg on a step in standing
Type of Traction: Over the door unit that can put to much pressure on TMJ
Head Halter (for c-spine, no longer use)
Describe how the angle of pull is adjusted with using the Saunder’s Cervical Traction Device
By adjusted the height of the table
Describe what you can accomplish with manual traction that can’t be achieved with mechanical traction
Manual traction allows traction at a single segment, this can’t be accomplished with mechanical traction, instead the entire C/T/L-spine is on traction
Describe how traction is generated with portable traction units
With the use of a pressure pump that creates the longitudinal pull
6 General Traction Guidelines
- The pt. MUST RELAX
- Continually monitory sx
- DO NOT leave the pt. unattended for the 1st tx
- ALWAYS give the pt. the safety button (shut off button)
- ALWAYS consider SINS
- Establish before/after subjective asterisks
5 Indications for Spinal Traction
- Herniated nucleus pulposus
- DDD/DJD
- Joint hypomobility
- Facet impingement
- Muscle spasms
T/F: Traction alone is effective
FALSE: likely unsuccessful when used alone
Describe the effect on traction on HNP and the appropriate dosage
Effect: Can separate vertebra and lead to decrease pressure on the nucleus with a resulting suction force
Dosage: Sustained traction OR Longer hold-rest periods (60 sec hold, 20 rest) of intermittent traction, Tx time of 5-10 min
Describe the effect on traction on DDD/DJD and the appropriate dosage
Effect: Lowers intradiscal pressure which affects the nurtitional state of the nucleus pulposus
Dosage: SHorter hold-rest of intermittent traction
Describe the effect on traction on Joint Hypomobility and the appropriate dosage
Effect: Can be seen as a form of mobilization that involves the passive movements of joint
Dosage: Short hold-rest periods of intermittent traction
Describe the effect on traction on Facet Impingement
Can release restriction on the facets
Describe the effect on traction on Muscle Spasm
Traction can decompress/separate the painful joint structures. If the pain is relieved by traction, muscle spasm will be relieved as a result of relazation or nociceptive reflexes
Provide a Summary of the EBP for (Lumbar) Traction
- Poor evidence for mechanical traction along for acute/subacute/chronic LBP
- Improvement has been documented when traction is used in combination with exercise and modalities
- Mechanical effects are effective in the short term (<5 wks), but not in the long term (>12 wk)
- There is no dose-response relationship for traction but low doses are probably sufficient to achieve benefit
There is more evidence in support of traction for the C-spine
4 Predictors of Successful response to Mechanical LUMBAR traction
- Low level fear-avoidance behavior
- No neurological deficit involvement
- > 30 yo
- Non-onvoles of manual work
Describe a corssed SLR and what it indicates
A SLR on the right reproduces back pain on the left
Indicative of a disc herniation
4 Predictors of Effective Mechanical Traction (Fritz)
- Presence of leg sx
- Signs of nerve root compression
- Peripheralization with extension movements
- Crossed SLR +
6 Contraindications for Traction
- Structural disease secondary to tumor or infection
- Patients with vascular compromise.
- Any condition for which movement is contraindicated.
- Osteoporosis: precaution
- RA
- TMD
7 Cautions for Traction
- Acute strains and sprains
- Inflammatory conditions that might be aggravated
- Joint instability
- Pregnancy
- Osteoporosis
- Hiatal hernia
- Claustrophobia
4 Things to determine before beginning traction
- Traction force
- Duration
- Static vs. Intermittent
- Patient position
Describe how to determine/apply traction force in the L-spine
Start with lighter force. You want to end up in a force range of 25-50% of the pt.’s BW
The first 25% of force over comes friction, while the second 25% of force causes separation
Below 20% of force is considered low dose or placebo traction
Describe how you determine the duration of traction
Typically start with 3-5 minutes of traction, based on the SINS slowly progress to 10-15 minutes of traction
Describe when you would use static vs. intermittent traction
Static:Sustained pull – Used for moderately severe and irritable conditions
Intermittent:Hold/Rest – Used with less severe and irritable conditions
Describe what movements are created in the spine with anterior and posterior pull
Anterior pull = extension
Posterior pull = flexion
Describe what traction forces can be achieved with the pieces of the traction belt close together
- Supine position with posterior pull
- Prong position with anterior pull
Describe what traction forces can be achieved with the pieces of the traction belt farther apart
- Supine with anterior pull
- Prone with posterior pull
Describe the importance of a stable harness
A stable pevlic belt provides the necessary traction while a stable thoracic belt provides counter traction and prevents the pt. from sliding down the table
Describe the placement of the pelvic belt
Should be secured first
Top should be above iliac crests and across the umbilical line
Describe the placement of the thoracic belt
Should be placed second
Top below xiphoid process with the bottom overlaping the pelvic belt
Describe the effect of rope angle on lumbar traction
Higher angle = posterior pull
Straighter angle = anterior pull
List the 5 D’s and why they are important to consider before beginning traction
5 D’s: Drop attack, Dizziness, Diplopia, Dysarthria, Dysphagia
They rule in/out of the possibility of vertebral artery involvement
Describe how you determine the amount of traction force for the C-spine
Typically 5-20 lbs
Upper cervical traction can be achieved with 5-15 lb
Lower cervicla traction can be achieved with 20-40 lb
Describe the rope angle needed to target upper vs. lower C-sine with traction
Upper = 10-15 degrees
Lower = 20-30 degrees
