Traction

Question 1

3 things to do BEFORE putting someone on traction for the first time:

Answer 1

1. Ask about contraindications
   - -> VA for CS (5 D’s)
   - -> CE for LS
2. Perform manual traction & assess response
3. Check integrity of the ligaments
   - -> anterior shear test (LS)

Question 2

Contraindications to Traction

Answer 2

1. VA
2. CE
3. RA
4. structural disease secondary to tumor or infection
5. TMJ dysfunction
6. any condition where movement is contraindicated (fusion, cord compression)

Question 3

Intensity/Traction force

Answer 3

Lumbar spine

• 25-50% of BW (25% on first trtmt)
• increase wt if no response, decrease wt if symptoms are worse, and stop if no response after 2-3 visits

Cervical spine

• Upper: 10-15lbs
• Lower: 20-40lbs

Question 4

Duration

Answer 4

first treatment = 3-5 minutes

Build up tolerance to 10-15 minutes

Consider SINS

Question 5

Static vs. Intermittent

Answer 5

Same for LS and CS

Static - acute, moderate severe/highly irritable conditions

Intermittent - chronic, low irritability conditions

Question 6

Patient & Cable Position

Answer 6

Lumbar spine - supine or prone

• posterior pull –> flexion; cable higher, w/ legs on pillow or bulster
• anterior pull –> extension; cable straight, w/ legs on pillow

Cervical spine - always supine

• Upper: lower angle
• Lower: higher angle

Question 7

Effects of spinal traction

Answer 7

1. distraction of vertebral bodies
2. combination of distraction & gliding of facet joints
3. widening of IV foramen
4. Tensioning of ligaments
5. straightening of spinal curves
6. stretching of spinal musculature

Question 8

Herniated Discs

• why
• ideal position & settings

Answer 8

traction seperates vertebra allowing the NP to migrate back towards the center of the disc w/n boundaries

best treated w/ static or long hold-rest periods (60sec hold, 20 sec rest) of intermittent

• 5-10 min treatment time
• posterior best for unloading the spine in 90/90

Question 9

DDD

• why
• ideal settings

Answer 9

traction lowers interdiscal pressure & increases nutrition to the disc

optimal stimulus for disc = intermittent comp/decomp

• respond best to short hold-rest periods

Question 10

Joint hypomobility

• why
• ideal settings

Answer 10

traction passively moves the joints, increasing mobility

best to use short hold-rest periods of intermittent

Question 11

Facet impingement

• why
• ideal settings

Answer 11

traction releases restriction of facet joints

MANUAL traction ideal b/c it can be applied segmentally

Question 12

Muscle Spasm

• why
• ideal settings

Answer 12

Traction decompresses or separates painful joint structures

–> if pain is relieved the muscle spasm will be relieved as a result of relaxation of nociceptive reflexes