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
Intermittent
Force alternated between 2 set weights for a set amount of time. Max (based on tx goal) and min (set to 50% of max)
- disc pathology
- mm spasms
- joint distraction
- soft tissue stretch
- subacute joint inflammation
LT: initial acute phase or 1st application of traction
29-44lbs - static - 5-10 min
LT: joint distraction
50%BW - 60:20 - 20-30 min
LT: mm spasms
25%BW - static - 20-30 min (5-10 hernation)
LT: disc protrusions and stretching soft tissue
25%BW - 60:20 - 20-30 min
CT: initial acute phase or 1st application of traction
7-10lbs - static - 5-10 min
CT: joint distraction
20-29lbs (13-20%BW) - 15:15 - 20-30 min
CT: mm spasms
11-15 lbs (7-10%BW) - 5:5 - 20-30 min
CT: disc protrusions and stretching soft tissue
11-15lbs (7-10%BW) - 60:20 - 20-30 min
CT: subacute jt inflammation
11-15lbs (7-10%BW) - 60:20 - 20-30 min
CT: tx progression
1-2 lbs / tx
LT: subacute joint inflammation
25% BW - 60:20 - 20-30 min
LT: tx progression
5-10lbs /tx
Contras ***(ensure correct)
- Motion: unstable or acute fx or immedialty following spinal surgery
- Acute injury or inflammation (sprains/strains)
- Hypermodible or unstable vertebral joints: preganancy, breastfeeding, RA, OA, AA, down’s, spondylolisthesis
- Periperalization of symptoms: characterized by increased pain or radicular symptoms
- HTN (BP > 140/90
- Aortic aneurysms
- Bone disease (osteoporosis, brittle)
- Cardiac, vascular, or pulmonary probs
- Vertebral subluxations, dislocations
- Infections / meningitis
- Cancer
- Trauma w/out diagnostic imaging
Precautions
- Displaced anular fragment
- Medial disc protrusion
- Severe pain fully resolves with traction
- Claustrophobia
- Inability to tolerate prone/supine
- Disorientation
- Hiatal hernia
- Infection
- TMJ
Guidelines
- always start low and monitor
- check pt after 5 min
- D/C if pt’s symptoms worsen or peripheralize
- improvement in 2-3 tx
- pt should feel a moderate change in symptoms during tx, steady progress over time
- no moving (coughing, sneezing)
- pee before you ski
