Week 4- Spinal Traction, Compression Therapy Flashcards
SPINAL TRACTION
SPINAL TRACTION
What is spinal traction?
Applying distraction forces to the spine to separate articular surfaces between vertebral bodies and elongate the spine.
What are the 6 spinal traction methods?
- Manual
- Mechanical
- Pneumatic
- Positional
- Gravity assisted
- Inversion
The Goals and Indications of Spinal Traction are to Decrease:
- ______ stiffness (hypomobility)
- __________ blocking
- Muscle spasm
- Disc __________
- Discogenic pain
- Joint pain
- Nerve ______ impingement
- Joint
- Meniscoid
- protrusion
- root
The indications for traction generally may be indicated for:
- ________ or ________ spine pain with radiculopathy
- Patients who have a reduction of symptoms with ________ traction
- cervical or lumbar
- manual
Contraindications for Traction include:
- Acute ________, ________, and inflammation
- Spondylolisthesis
- Fracture
- Increased ___________ with traction
- Increased nerve root ________ with traction
- Joint ______mobility or instability
- Pregnancy (lumbar traction)
- Patients who have received surgical stabilization or decompression, spine implants, or prosthetic discs
- strains, sprains
- peripherilization
- symptoms
- hypermobility
Precautions for Traction include:
- Claustrophobia
- Hiatal ______
- Impaired _______
- Any disease or condition that can compromise the structure of the spine (RA, steroid use, tumor, osteoporosis)
- hernia
- cognition
Spinal traction is a joint distraction that separates the facet joints and opens up the __________ foramen to relieve pressure on the __________ foramen and decrease compressive forces on __________.
- intervertebral
- nerve root
- facets
For spinal traction to cause joint distraction, the lumbar region requires a minimum of __% of the patient’s body weight to cause separation while the cervical region needs __% of the body weight to result in separation.
- 50%
- 7% or 20-30lbs
Spinal traction also causes a reduction of disc protrusion in what 2 ways?
- ) Separating the vertebral bodies leads to decreased intradiscal pressure creating a suction like effect on the nucleus pulposus.
- ) Surrounding ligamentous structures are taut which also helps to push disc centrally.
For spinal traction to reduce disc protrusion, the lumbar region requires up to __% (__-__lbs) of the patient’s body weight to reduce disc protrusion while the cervical region requires __-__lbs.
- 50% (60-120lbs)
- 12-15lbs
Spinal traction can also cause ____-tissue stretching on the surrounding spinal muscles, ligaments, tendons, and discs. In order to get soft-tissue stretching, do we need to achieve joint seperation?
- soft-tissue stretching
- No
For spinal traction to stretch soft-tissue, the lumbar region requires __% of the patient’s body weight while the cervical region requires __-__lbs.
- 25%
- 12-15lbs
Spinal traction can also cause _______ relaxation by interrupting the pain-muscle spasm cycle by stimulating ___________ through the motion of intermittent traction and by inhibiting neuron firing with static traction.
- muscle
- mechanoreceptors
For spinal traction to stretch muscle relaxation, the lumbar region requires __% of the patient’s body weight while the cervical region requires __-__lbs.
- 25%
- 12-15lbs
What are the 3 variables for cervical traction?
- ) Static or intermittent
- ) Angle of traction (greater flexion= lower C spine)
- ) Dosage (amount of tension, duration of traction, cycle duration)
- Cervical traction force should not exceed __-__ lbs and we should start light.
- The force is also determined by the goals and patient tolerance. In the acute phase; disc protrusion, elongation of soft-tissue, and muscle spasm is done with __-__lbs of force while joint distraction is done with __-__lbs of force.
- 30-40lbs
- 10-15lbs
- 20-30lbs
Cervical traction treatment time is between __-__min for acute conditions and disc protrusions and __-__min for other conditions.
- 5-10min
- 15-30min
Cervical traction duty cycle:
- Static traction is done with disc ___________ or when symptoms are aggravated by motion.
- Intermittent traction is done with disc protrusion at a : ratio (hold:rest); or for joint distraction/mobility at a : ratio (hold:rest).
-protrusion
- 3:1
- 1:1
What should we watch out for post-traction?
“Rebound Effect”
-Have patient relax for 5 minutes after treatment
Post-traction we should also record outcomes:
- _______ symptoms
- __________ of symptoms
- ______ ROM/strength
- improved ability to perform ___s
- Improved reflexes/sensation
- decrease
- centralization
- increase
- ADLs
Research shows that cervical traction:
- ________ pressure within the intervertebral foramen and ______ in dimensions of the intervertebral foramen.
- _______ in intervertebral disc space w/ almost 30lbs while C spine was in neutral of in flexion.
- Area of disc herniation ______ and disc space increased.
- decrease, increase
- increase
- reduced
What are the 5 variables for lumbar traction?
- ) Supine or Prone Positioning
- ) Positioning of LE
- ) Static or intermittent
- ) Angle of traction
- ) Dosage (amount of tension, duration of traction, cycle duration)
Clinical considerations for lumbar traction:
- limited evidence
- lack of agreement of _________
- ______ vs. _____ position during traction
- legs extended or in hip flexion if in supine
- parameters
- supine vs prone
In regards to lumbar traction, when the hips are flexed to 45-60 degrees we are increasing the space of __/__. When the hips are flexed to 75-90 degrees we are increasing the space of the _____ lumbar region.
- L5/S1
- upper
For lumbar traction, where is the thoracic harness and the lower harness placed?
- Thoracic- Placed inferior to the widest lateral dimension of the rib cage. 2 straps attached to end of table
- Lower- Placed at or just below the iliac crests but superior to the greater trochanters. 2 straps attached to metal V shaped rod attaching to mechanical unit.
Lumbar traction force for:
- Acute phase-__-__lbs
- Disc protrusion, spasm, elongation of soft tissues-__% of BW
- Joint distraction- __% of BW
- 30-40lbs
- 25%
- 50%
Lumbar traction treatment time is between __-__min for herniated disc and __-__min for other conditions.
- 5-10min
- 10-30min
What should we watch out for post-traction?
“Rebound Effect”
-Have patient relax for 5 minutes after treatment
Post-traction we should also record outcomes:
- _______ symptoms
- __________ of symptoms
- ______ ROM/strength
- improved ability to perform ___s
- Improved reflexes/sensation
- decrease
- centralization
- increase
- ADLs
Research shows that lumbar traction:
- _____ difference in muscle activity with continuous vs. intermittent traction.
- Substantially greater reduction of the total area of herniated disc material vs. use of “_____________”.
- Improvement with straight leg raise when lumbar traction was used with __ and __% of body weight.
- No
- other modalities
- 30% and 60%
Home Traction (Cervical):
- Pneumatic pump with gauge quantifying ______
- Adjustable head rest, similar positioning
- Sustained traction
Home Traction (Lumbar):
- Pneumatic pump, harness to stabilize
- Less tension produced than clinical unit
- Positioning of floor required
-tension
How do we know if cervical or lumbar traction worked?
Test re-test
COMPRESSION
COMPRESSION
- Homeostasis is maintained through ________ and ________ pressure inside and outside the vessels.
- In normal circumstances, hydrostatic is greater than osmotic, forcing small amounts of fluid into ___________. Normal leakage is returned via the _________ system.
- hydrostatic and osmotic
- interstitium
- lymphatic
- In the case of edema, excess fluid is in the __________ tissue spaces of the body.
- What can cause a fluid overload?
- extra-cellular
- venous insufficiency or lymphatic abnormalities
Abnormalities = Interstitial Edema:
- Unregulated ____
- Plasma ________ imbalance
- __________ flow obstruction
- _________ insufficiency
- BP
- protein
- lymphatic
- venous
Localized edema is associated with conditions such as ________ insufficiency, _________ blockage, prolonged dependency, localized _________. It tends to occur in ________ areas of the body.
- venous
- lymphatic
- inflammation
- discrete
Systemic or general edema is associated with __________ conditions such as CHF, hypoalbuminemia, kidney dysfunction. It is typically more _____ and non-discerning edematous pattern.
- systemic
- broad
Consequences of Edema:
- Decreased ______
- __________ limitations
- Decreased ___________ input
- Pain
- Increased collagen leading to ________
- Ultimately may lead to contracture, increased risk of infection, amputation
- ROM
- functional
- somatosensory
- fibrosis
What are 3 ways to assess edema?
- Pitting Edema Scale
- Volumetric Measurement
- Linear Measurement
What is the scale for Pitting Edema?
- 1+ = Barely detectable depression when finger is depressed into the skin
- 2+ = Slight indentation, 15s to rebound
- 3+ = Deeper indentation, 30s to rebound
- 4+ = >30 seconds to rebound
How is assessing edema via volumetric measurement done?
- Measure water displaced in a container by immersing the extremity to a known anatomical landmark.
- The difference between measurements of the uninvolved vs the involved provides a comparison and a measure for documentation.
What is a big caution when assessing edema via volumetric measurements?
Caution for patients with open wounds!
What is the key when assessing edema via linear measurement?
Keep the way they are measured the same each time and compare involved to uninvolved.
What are the 3 main ways edema can be reduced?
- ) Improved venous and lymphatic circulation
- ) Physical barrier to limit the size and shape of tissue
- ) Increased tissue temperature
Compression Uses:
- Generally utilized to improve fluid balance, increase venous and lymph return, thus reducing ______ or ________ edema
- ____ prevention
- Shaping of residual limb following ________
- Proven to facilitate healing in venous insufficient wound areas
- Manual _______/__________ techniques have supplanted use of mechanical compression in many instances
- Some conditions may require the daily use of compression stockings to counteract effect of _________ on vascular and lymph systems
- venous or lymphatic
- DVT
- amputation
- massage/drainage
- gravity
Goals and Indications for Compression:
- __________ to mold residual limb
- Decrease _______ edema
- ___________ management (often seen in Cancer patients)
- ________ ulcer
- _______ insufficiency
- _______ injuries
- Amputation
- chronic
- lymphedema
- Stasis
- Venous
- Subacute
Contraindications for Compression:
- Trauma/______
- Acute ____
- Completely obstructed lymph or venous return
- Arterial disease/insufficiency
- Arterial _____________
- Acute _________ edema
- Loss of _________
- Edema with cardiac or renal impairment
- Impaired __________
- Infection in treatment area
- _____proteinemia (<2g/dL)
- fracture
- DVT
- revascularization
- pulmonary
- sensation
- cognition
- hypoproteinemia
Precautions for Compression:
- Decreased _________
- Malignancy
- Uncontrolled __________
- Over area of superficial peripheral nerve
- sensation
- hypertension
What are the 2 types of compression and what are they?
Static
-Exerting a continuous or constant force
Intermittent
-Exerting a varying force over time
Intermittent compression is thought to provide improved outcomes through a milking mechanism from _______ to ____________.
distal to proximal
What are 3 compression methods?
- ) Bandages
- ) Garments
- ) Pumps
Despite the method utilized for compression, care must be exercised to provide greater compression forces in the _________ extremity and gradually decreasing _____________, aiding in circulatory return.
- distal
- proximally
In regards to bandages, what is the difference between resting and working pressure?
- Resting pressure is applied when elastic properties of the bandage are stretched in application. This pressure remains whether the patient moves or remains still.
- Working pressure is produced by muscle activity of movement pushing against the restraining bandage.
Highly extensible bandages provide high ______ pressures when stretched with application, but typically provide very low ______ pressure.
- resting
- working
Relatively inelastic bandages provide low ________ pressure, but high _______ pressure.
- resting
- working
What are the pros and cons of highly extensible bandages?
PROS \+inexpensive \+readily available \+easily removed \+patient/care giver can be trained to install
CONS
- Correct and Incorrect Application
- May slide down the extremity
- Difficult to apply even tension
- Quickly loose their elastic properties
- Requires patient to be able to reach area to be wrapped/unwrapped if they do not have a caregiver to help
What are the pros and cons of low stretch bandages?
PROS
+Higher working pressure generated, rather than resting pressure (less likely to impede circulation)
+Still relatively inexpensive
+Easily Removed
+Patient/Care Giver can be trained to install
+More fool-proof for application of compressive forces
CONS
- Not as effective at removing edema as highly elastic bandages
- Less comfortable to wear than highly elastic bandages
- Correct and Incorrect Application
- Requires patient to be able to reach area to be wrapped/unwrapped
- Less readily available than highly elastic
Semi-Rigid Bandages are applied every - days to the extremity after edema has been removed by other means.
4-7 days
What are the pros and cons of semi-rigid bandages?
PROS
+Useful for less compliant patients, as it remains in place for several days
+Eliminates daily dressing changes
CONS
- Must be protected from environment (shower)
- Long term applications allows for pressure areas if not correctly applied
- Patient may be unable to remove easily if discomfort occurs
Contraindications for Bandages:
- Patients with ________ disease (ABI < 0.8)
- Patient inability to remove bandage (physical or mental)
- Allergy to component
- Active wound _________ at bandage site
- Active _________ at bandage site
- arterial
- infection
- cellulitis
Precautions for Bandages:
- Propensity to be discharging to facility unfamiliar with use of multi-layer dressing
- _____ skin / bony prominences
frail
What is the ankle-brachial index?
- Comparing BP at ankle compared to BP measured at arm.
- Low ABI can indicate narrowing or blockage of arteries in legs.
Do patients need to be measured for garments?
Yes, some OTC are available.
What are the pros and cons of garments?
PROS \+OTC and Custom-fit Available \+Last 4-9 months with proper care \+Provide Graded Compression \+Cosmetically Acceptable
CONS
- Can be difficult to don, especially with arthritic hands
- Costly and not universally covered item by 3rd party payers
Contraindications for Garments:
- Patients with ______ disease
- _______ to component
- arterial
- allergy
Precautions to Garments:
- May be difficult to ____
- Not recommended for over open wounds
don
Pumps are done via mechanical compression and decrease interstitial fluids in what ways?
- Increase pressure in the interstitial spaces forcing the fluid to move into the lymphatic and venous systems allowing for circulation.
- Maintain a mechanical limit to the skin or surrounding tissue through a sleeve to limit “leakage” of fluid into interstitial spaces
- Increases local tissue temperature through insulative factors, allowing improved activity of temp dependent enzymes
What are the 2 types of intermittent pneumatic pumps used?
- Non-dynamic (aka static)
- Dynamic
What is the difference between non-dynamic and dynamic pumps?
Non-dynamic
-Same pressure throughout surface being compressed, force applied and released cyclically.
Dynamic
-Varying pressure throughout surface being compressed, force applied and released cyclically.
Non-dynamic pumps:
- Utilized for ______ prophylaxis in sedentary patients
- Should be utilized any time the patient is not __________
- Must be removed for __________
- Available for calf length or thigh length
- Routine care in hospital for non-ambulatory
- DVT
- ambulating
- ambulation
Dynamic pumps:
- Available in multi-chamber sleeve designs
- Peak pressure first develops _______
- Progresses ________ in wave action, decreasing pressure in each subsequent chamber
- Completes wave then holds complete deflation cycle
- Cycles every - secs
- Many “best” protocols/guidelines exist (typically 3:1)
- distally
- proximally
- 7-8secs
Pumps General Guidelines:
- Check patient’s ____
- Set inflation and deflation ratio to ~: (generally for edema reduction, 45-90 seconds on/15-30 seconds off); to shape residual limb : often used
- Patient’s blood pressure determines device settings
- Treatment time varies depending on patient’s _______ and ________.
- BP
- 3:1, 4:1
- tolerance and condition
Should numbness, tingling, pulsating, or pain be felt during treatment?
No
Contraindications for Pumps:
- DVT, thrombophlebitis
- Acute ________ failure
- Obstructed _________ or ______ flow
- __________ disease
- Fracture
- Local _________
- Significant _____proteinemia- protein levels < 2 g/dl
- Suspected underlying syndrome which may be effected by compression (compartment syndrome)
- cardiac
- lymphatic or venous
- arterial
- infection
- hypoproteinemia
Precautions for Pumps:
- CHF patient must be monitored closely for signs of intravascular fluid burden
- Impaired ________ or mentation
- Uncontrolled _____tension
- CA
- CVA
- Valve insufficiency
- Superficial peripheral _______
- Requires barrier for patients with Contact Isolation Precautions
- Never adjust pressure to greater than ______
- sensation
- hypertension
- nerves
- DBP (diastolic)