Week 10 Traction Flashcards
what is spinal traction?
a force applied to the body in a way that separates, or attempt to separate, joint surfaces and elongates soft tissues surrounding a joint
what are the theories behind traction?
-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
what is mechanical traction?
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
what are the two types of mechanical traction?
-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)
what is the typical ratio for on time:off time for mechanical traction?
-3:1
-30 sec on: 10 sec off or 60 sec on: 20 sec off
what is manual traction?
application of force by the therapist in the direction of distracting the joints
what is positional traction?
prolonged specific positioning to place tension or open the intravertebral space on one side of the lumbar spine
what are the effects of traction for the cervical spine?
-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)
what are the effects of traction for the lumbar spine?
-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
what are the indications for traction?
-lack of agreement on indications
-generally, may be indicated for cervical or lumbar spine pain with radiculopathy
what are the contraindications for spinal traction?
-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
what are the precautions for spinal traction?
COPD and claustrophobia
what objective evidence is there for the impairment based classification for neck pain?
-provocation of UE symptoms with foraminal compression
-reduction of symptoms with manual traction
-possible sensory, motor and reflex deficits (nerve root)
The clinical prediction rule for cervical traction identifies patient most likely to respond favorably to cervical traction. What patients fall in this category?
-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
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?
-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
what treatment based classification is there for lumbar traction?
-patient with radicular symptoms below the knee particularly with lumbar extension
-crossed straight leg raise
-neurological deficits
what angle should the harness be at for cervical flexion?
20-30 degrees of flexion
if a patient has lower cervical spine symptoms what should the angle of the harness be? for upper cervical spine symptoms?
increased flexion; neutral position
what should the total duration be for cervical/lumbar spine mechanical traction?
10-20 minutes (may start with less initially)
what should the cycle time be for mechanical cervical/lumbar traction? (static and intermittent)
-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
what should the force be for mechanical cervical/lumbar traction?
-Max: 10-25lbs (30lb absolute max)
-Min: approximately 50% of max force
what are some clinical considerations for the application of mechanical traction for the lumbar spine?
-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
what should you look for post-traction?
-watch for “rebound effect”
-have patient relax for 5 min after treatment
