Week 10 Traction

Question 1

what is spinal traction?

Answer 1

a force applied to the body in a way that separates, or attempt to separate, joint surfaces and elongates soft tissues surrounding a joint

Question 2

what are the theories behind traction?

Answer 2

-can increase space between the vertebrae
-intervertebral separation may help normalize the spinal disc’s position and morphology
-increase the dimensions of the intervertebral foramen containing the spinal nerve root

Question 3

what is mechanical traction?

Answer 3

application of static or intermittent force by an electrical motor, through belts or a halter, in the direction of distracting the joints of the spine

Question 4

what are the two types of mechanical traction?

Answer 4

-sustained/static: continuous low load force
-intermittent: alternate cycles where traction is applied at a higher force for a period of time followed by a period at a lower dose (off time)

Question 5

what is the typical ratio for on time:off time for mechanical traction?

Answer 5

-3:1
-30 sec on: 10 sec off or 60 sec on: 20 sec off

Question 6

what is manual traction?

Answer 6

application of force by the therapist in the direction of distracting the joints

Question 7

what is positional traction?

Answer 7

prolonged specific positioning to place tension or open the intravertebral space on one side of the lumbar spine

Question 8

what are the effects of traction for the cervical spine?

Answer 8

-increased blood flow, fluid exchange and nutrient transport within the disc
-increased intervertebral foramina space (opens the space)
-disc herniations may be reduced
-decrease in pain with some spine conditions
-conflicting evidence of the effect on cervical spine musculature
(duration of any biomechanical or physiological effect is unknown)

Question 9

what are the effects of traction for the lumbar spine?

Answer 9

-fluid exchange and nutrient transport within the disc enhanced
-trunk muscle activity may initially increase then return to prior levels
-during passive traction, intradiscal pressure can be reduced or become negative
-opening the intravertebral foramina may decrease nerve foot compression in some radicular disorders
-expanse of herniated disc material is suggested to reduce in some subjects during traction

Question 10

what are the indications for traction?

Answer 10

-lack of agreement on indications
-generally, may be indicated for cervical or lumbar spine pain with radiculopathy

Question 11

what are the contraindications for spinal traction?

Answer 11

-acute spine trauma
-connective tissue disorders or rheumatological disorders resulting in tissue laxity or joint hypermobility/instability
-osteoporosis and osteopenia
-history of steroid use or medications that weaken or demineralize bone
-hypermobility or instability
-patients post surgical stabilization or decompression of the spine, spine implants or prosthetic discs
-pregnancy
-peripheralization of symptoms
-non-mechanical pain

Question 12

what are the precautions for spinal traction?

Answer 12

COPD and claustrophobia

Question 13

what objective evidence is there for the impairment based classification for neck pain?

Answer 13

-provocation of UE symptoms with foraminal compression
-reduction of symptoms with manual traction
-possible sensory, motor and reflex deficits (nerve root)

Question 15

The clinical prediction rule for cervical traction identifies patient most likely to respond favorably to cervical traction. What patients fall in this category?

Answer 15

-peripheralization of pain with lower cervical mobility testing
-positive shoulder abduction test
-age 55 years or older
-reduction of symptoms with manual distraction
-positive upper limb tension test

Question 16

The clinical prediction rule for home cervical traction identifies patient most likely to respond favorably to home cervical traction. What patients fall in this category?

Answer 16

-pain 7/10 or higher
-score on the Fear Avoidance Belief Questionnaire Work subscale of <13
-relief with manually applied traction
-pain perceived distal to the shoulder

Question 17

what treatment based classification is there for lumbar traction?

Answer 17

-patient with radicular symptoms below the knee particularly with lumbar extension
-crossed straight leg raise
-neurological deficits

Question 18

what angle should the harness be at for cervical flexion?

Answer 18

20-30 degrees of flexion

Question 19

if a patient has lower cervical spine symptoms what should the angle of the harness be? for upper cervical spine symptoms?

Answer 19

increased flexion; neutral position

Question 20

what should the total duration be for cervical/lumbar spine mechanical traction?

Answer 20

10-20 minutes (may start with less initially)

Question 21

what should the cycle time be for mechanical cervical/lumbar traction? (static and intermittent)

Answer 21

-static: low load constant force (less max force with shorter time)
-intermittent: cycles of maximal and minimal force; 30 sec on:10 sec off or 60 sec on:20 sec off

Question 22

what should the force be for mechanical cervical/lumbar traction?

Answer 22

-Max: 10-25lbs (30lb absolute max)
-Min: approximately 50% of max force

Question 23

what are some clinical considerations for the application of mechanical traction for the lumbar spine?

Answer 23

-limited evidence for effectiveness
-lack of agreement on parameters
-supine vs prone
-legs extended or in 90-90 (if spine)
-secure attachment of thoracic and pelvic harnesses
-table surface releases (split) to allow movement

Question 24

what should you look for post-traction?

Answer 24

-watch for “rebound effect”
-have patient relax for 5 min after treatment

Question 25

what are some positive outcomes of traction?

Answer 25

-decreased symptoms
-centralization of symptoms
-increased ROM/strength
-improved ability to perform activities of daily living
-improved reflexes/sensation
-(lumbar) increase in symptom free SLR

Question 26

what should be included in documentation for traction treatment?

Answer 26

-type of traction
-area of the body where traction is applied
-patient position
-maximum force
-minimum force
-hold time and relax time
-total treatment time
-response to treatment