Traction Flashcards
What is the history of traction in Egypt 3000 BC
Axial traction for the reduction of spinal fractures
What is the history of traction by hippocrates 776 BC
Treatment of back pain
Who used hippocrates traction for low back pain treatment (3)
- Galen
- Avicenna
- Pare
What did W. Gayle Crutchfield do for traction in 1933
Cranial tongs for treatment of cervical spine injuries
What did James Cyriax use traction for in the 1950s
Small nuclear protrusions
What is the definition of joint distraction
Separation of two joint surfaces perpendicular to the plane of the articulation
True or False:
For joint distraction to occur the force applied must be great enough to cause soft tissue elongation around the joint to allow for joint surfaces to distract
True
What percent of the body weight is needed to increase the length of the L-spine
25%
What percent of the body weight is needed to distract zygapophyseal joints in the L-spine
50%
What percent of the body weight is needed to increase the length of the C-spine
7%
How much separation occurs in the C-spine due to 25 lbs of traction
2-20 mm
Is the separation long lasting or short lived
Short lived
What did Krause et al determine about the effects of 60-120 lbs of lumbar traction
It can reduce disc prolapse and cause retraction of herniated disc material
What did Onel et al determine about the percent of herniated nucleus pulposus that retracted during traction for median, posterolateral, and lateral protrusions
Median: 78.5%
Posterolateral: 66.6%
Lateral: 57.1%
What does AB equal in the disc herniation index
Maximum AP disc length
What does CD equal in the disc herniation index
Width of the herniated disc at mid AB distance
What does EF equal in the disc herniation index
Maximum canal length
What does GH equal in the disc herniation index
Width of the spinal canal at mid AB distance
What is the equation for herniation index
(ABxCD)/(EFxGH)x1000
What did Worden et al determine about the process of stretching soft tissue with traction
It is the same as stretching and soft tissue
What did Mathews determine about traction causing muscle relaxation
Muscles relaxed due to reduction in the pressure on pain sensitive structures
What type of traction is the depression of monosynaptic response due to prolonged stretch
Static traction
What type of traction is the stimulation of GTOs to inhibit alpha motor neurons
Intermittent traction
What did Saunders determine about the percent of the body weight required to move joints in the spine
50%
True or False:
Lower forces of traction may reduce pain by stimulation of mechanoreceptor (spinal gate)
True
How does the patient get relief from traction (9)
- Increasing space between vertebrae
- Separating apophyseal joints
- Widening of intervertebral foramina
- Stretching muscles and ligaments
- Reducing muscle spasm
- Changing intervertebral disc pressure
- Tensing PLL to exert force on disc
- Creating suction force on disc
- Flattening abnormal lumbar lordosis
How does traction effect bone
Increase the movement between vertebrae
How does traction effect ligaments
Tensile loads ligaments
How does traction effect articular facet joints (3)
- Increases separation
- Decreases compression loading
- Allows synovial fluid exchange
How does traction effect muscles (2)
- Lengthens tight muscles
2. Activates proprioceptors
How does traction effect nerves
Decompression
What are the indications for traction (12)
- Reduce disc herniation
- Nerve root impingement
- Joint hypomobility
- Subacute inflammation
- Paraspinal muscle spasm
- Adhesions
- Muscle spasm
- Foraminal stenosis
- Contracted CT
- Apophyseal joint impingement
- Radiating pain that doesn’t respon to repeated movements
- Reduce low back pain
The DRX9000 spinal decompression machine claims to have a success rate of what for patients with LBP
86%
What are possible causes of nerve root impingement (6)
- Disc
- Ligament encroachment
- Narrowing of intervertebral forament
- Osteophyte encroachment
- Nerve root swelling
- Spondylolisthesis
What does traction of a hypomobile joint allow for
The ability to glide and distract spinal joints
What are the contraindications of traction (17)
- Places that motion is contraindicated
- With acute injury or inflammation
- Joint hypermobility or instability
- Peripheralization of symptoms with traction
- Uncontrolled hypertension
- Malignancy
- Infectious spinal diseases
- RA
- Spinal cord compression
- Osteoporosis
- Cardiovascular disease
- Aortic aneurysm
- Severe respiratory disease
- Pregnancy
- Hiatal hernia
- Abdominal hernia
- Active peptic ulcers
What are the precautions of traction (10)
- Structural diseases
- When pressure from belts may be hazardous
- Displacement of annular fragment
- Medial disc protrusion
- Severe pain fully relieved by traction
- Claustrophobia
- Patient can’t tolerate prone or supine position
- Disorientation
- TMJ problems
- Dentures
What is inversion traction
Using the body weight to provide distraction force
When was inversion traction popular
10-20 years ago
Why did inversion traction lose popularity
Potential increase in systolic and diastolic BP and ophthalamic artery pressure
What are the 2 types of mechanical traction
- Static
2. Intermittent
What is static mechanical traction used for (3)
- Irritable conditions
- Inflammation
- Disc protrusions
What is intermittent mechanical traction used for (2)
- Joint dysfunctions
2. Mobilization effect
What are the application techniques of traction (10)
- Inversion traction
- Auto traction
- Mechanical traction
- Electric traction
- Weighted traction
- Hydraulic traction
- Self traction
- Unilateral lumbar traction
- Positional traction
- Manual traction
When is supine hook lying position of the patient during mechanical spinal traction the most optimal position (2)
- General joint hypomobility
2. Spinal stenosis
When is prone position of the patient during mechanical spinal traction the most optimal position (1)
- Disc conditions
When is unilateral lumbar traction done
For unilateral symptoms
What is the definition of positional traction
Placing a patient in a position for a prolonged period of time so as to decompress target tissue
What is the definition of manual traction
The application of force by the therapist so as to distract the target tissue
How much flexion should the C-spine be placed in during mechanical traction while supine
20-30
How much flexion should the C-spine be placed in during mechanical traction while supine if you are treating the AO or AA joint
0 degrees of flexion
What are the 2 types of manual traction
- Towel traction
2. Conventional manual traction
What is the definition of self traction
The use of gravity or the weight of the body to exert a distraction force on the spine
What were the clinical prediction rule variables that Raney et al determined for cervical traction for mechanical neck pain (5)
- 55 years old and up
- Positive shoulder abduction test
- Positive ULNT A (Elvy’s test)
- Symptoms peripheralize with PACVP of C4-C7
- Positive neck distraction test
What is considered a quality score for Raney et al’s clinical prediction rule
67%
How many of the clinical prediction rules are required for cervical traction to be indicated
3 or more
What does the clinical prediction rule yield for a LR
+ 4.8
What does a + 4.8 LR yield
A small to moderate shift in probability
