Traction Flashcards
Effects of traction
- Distracts joint surfaces
- Decreases disc bulges/protrusion
- Stretches and increases elasticity of soft tissue structures
- Relaxes mm
- Mobilizes joints
- Decreases pain
- Promotes arterial, venous, and lymphatic flow
Planes
- traction force is applied in the frontal and Sagittarius planes
- discs, nerve roots, and vertebrae lie in the transverse plane
Joint distraction
Separation of 2 articular surfaces perpendicular to the plane of articulation
- stretches soft tissue structures: 25% lumbar and 7-10% (11-15lbs) cervical
- distracts joint surfaces 50% lumbar and 13-20% (20-29lbs) cervical
Reduction of disc protrusions
- traction is the tax of choice for small nuclear disc protrusions
- traction suctions protruding disc fragments back towards center of disc by decreasing intradiscal pressure or stretching of the PLL
- traction is NOT effective on large protrusions that fill the spinal canal or when disc protrusions are calcified
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Disc bulge
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Disc protrusion
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Disc herniation
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Disc rupture (annular tear)
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Soft tissue stretching
- traction increases the length of tendons, ligaments, and mm around the joints which will contribute to joint distraction, reduce disc protrusions, and decrease connective tissue contracture = increase ROM
- increasing spinal ROM with ST stretching decreases pressure on joints, discs, and nerve roots
- achieved with moderate force over a longer duration
Relaxation of paraspinal mm
Traction interrupts the pain-spasm cycle
- static: reflex inhibition of mm
- intermittent: creates an ‘oscillatory effect”
Joint mobilization
- traction increases joint ROM and decreases joint related pain by increasing extensibility of surrounding soft tissue structures
- indicated for multisegmental joint stiffness
- destructing the joint takes up slack in all planes which increases ROM in all directions
Indications
Neck or back pain with or without radicals symptoms caused by
- Nerve root impingement
- Fiscal etiology
- Joint hypomobility (generalized)
- Osteophyte formation / foraminal narrowing (stenosis)
- Subacute joint inflammation and pain
- Paraspinal mm spasm and guarding
* *if a pt has bilateral UE or LE, or global symptoms, could indicate a central cord compression and referral back to MD for surgical intervention
Order of nerve compression
- Sharp pain (dermatomes)
- N&T (dermatomes)
- Loss of mm strength (myotome)
- Loss of reflexes (myotome)
Nerve root impingement
Compression of peripheral nerve root by a disc, inflammation, joint space narrowing, bone spurring or compression at the foramen (stenosis)
S&S
- shape shooting pain primarily on the side of nerve is impinged with or without radiation along a dermatomes
- if prolonged onset of N&T, motor weakness, and loos of reflexes
- aggravated with lateral or rotational motions to the involved side, but varies depending on cause
- *presenting symptoms often indicative of cause of compression
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Disco genie etiology and pain
Caused by disc bulge, protrusion, herniation, or rupture
S&S
- pain is typically across the spine with or without radiation
- pain is usually aggravated with flexion based activities and 1st thing upon walking
Joint hypomobility
Usually associated with degenerative changes, OA, bone spurs, DDD, and/or stenosis
- indicated for multi-segmental stiffness and joint restriction
S&S
- pain usually with extension based activities
- stiffness 1st thing upon waking
- symptoms are usually alleviated with activity/mvmt
Subacute joint inflammation
Usually associated with rheumatic conditions or low grade chronic inflammatory conditions such as RA, OA, and residual irritation form a previous injury (chemical)
S&S
- achy, vague diffuse type pain
- with or without radicular symptoms
Paraspinal mm spasm
Usually associated with acute trauma/injury or can be a result of repetitive micro trauma
- inflammatory component related to damage can contribute to nerve impingement
S&S
- pain typically upon movement
Centralization phenomenon
Traction goal!
- bringing nerve symptoms closer to the spine, with eventual resolution
Guidelines for applying traction
- before traction in applied, PT should have evaluated ROM, joint mobility, strength, sensation, nerve tension, ligamentos integrety, vascular integrity, applicable special tests and reflexes
- determine if static or intermittent traction in appropriate
- thing about positioning (alleviate pain)
Pt position chart
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Static
Force stays the same throughout the duration of treatment; typically less force used
- (post) acute conditions after 72 hours
- if symptoms are aggravated by motion
- disc protrusions
- when separation at the jt surface is indicated
