Chapter 12 PET 4995 by 3Ibl7oF


									    Spinal Traction

     Jennifer Doherty-Restrepo, ATC, LAT
Entry-Level Athletic Training Education Program
       PET 4995: Therapeutic Modalities
 Process of drawing, or pulling apart, of a
  body segment
 Mechanical Traction - using a traction
  machine or ropes/ pulleys to apply a traction
 Manual Traction - clinician positions patient
  and applies traction force to joints of the
  spine or extremities
Effects of Traction: Spine
 Encourages movement between
  each individual spinal segment
 Amount of movement varies
  according to…
     Position of spine,
     Amount of force, and
     Length of time the
      force is applied
 Transient effect
Effects of Traction: Spine
  pain, paresthesia, or tingling
     Due to physical separation of vertebral
      segments thus decreasing pressure on
      sensitive structures
 As long as positive physiologic
 effects occur,
 traction should
 be continued
Effects of Traction: Bone
 No immediate effects due to traction
 May result in increased spinal movement that
  reverses bone weakness associated with
 May assist with increasing or maintaining
  bone density
Effects of Traction: Ligaments
 Stretching effect
 Structural changes occur slowly due to
  viscoelastic properties
     Ligaments resist shear forces and return to
      original form following removal of a deforming
     Sensitivity to rate of loading
 Ligament deformation results in lengthening
  of a ligament caused by traction loading
     Slow loading rates allow for more deformation
Effects of Traction: Disks

 Normal disk in non-compressed position
 Internal pressure (indicated by arrows) is
  exerted equally in all directions
 Internal annular fibers contain nuclear
Effects of Traction: Disks

 In an injured disk, sitting or standing
  compresses the disk causing the nucleus to
  become flatter
 Pressure in this instance still remains
  relatively equal in all directions
Effects of Traction: Disks

 In an injured disk, movement in weight-
  bearing causes a horizontal shift in nuclear
 If this was forward bending, the bulge would
  occur in the posterior annular fibers
     Anterior annular fibers would be slackened and narrow
Effects of Traction: Disks

 Herniation of the nuclear material occurs if
  the annular wall becomes weak
 Herniation may possibly put pressure on
  sensitive structures in the area
Effects of Traction: Disks

 When placed under traction, intervertebral space
  expands thereby decreasing pressure on the disk
 Taut annular fibers create a centripetally directed
      Decreases herniation and pressure on sensitive
       structures in the area
Effects of Traction: Articular Facet
 Facet joints are separated releasing impinged
     Dramatic reduction in symptoms
 Joint separation decompresses articular
  cartilage allowing synovial fluid exchange to
  nourish cartilage
     Decreases rate of degenerative changes
 Increased proprioception from facet joint
  structures provide sensation of pain relief
Effects of Traction: Muscles

 Vertebral muscles can be stretched
     Initial stretch should come from body
 Stretch lengthens tight muscle
 Allows for better muscular blood flow
 Activates muscle proprioceptors providing
  sensation of pain relief
     Gate Control Theory
Effects of Traction: Nerves
 Focus of most traction treatments
 Pressure on nerves or nerve roots often
  associated with spinal pain
 Unrelieved pressure on a nerve will cause
     Slowing, eventual loss of impulse conduction
     Motor weakness, numbness, and loss of reflex
     Pain, tenderness, and muscular spasm
Traction Treatment Techniques
 Lumbar Positional Traction
     Inversion traction
 Manual Lumbar Traction
     Level-specific
     Unilateral leg pull
 Mechanical Lumbar Traction
 Manual Cervical Traction
 Mechanical Cervical Traction
Lumbar Positional Traction
 Patient typically on restricted activity program
 “Trial and error” process to determine position
  that offers maximum comfort
Side-lying Position: Unilateral
Foramen Opening
 Lateral Herniation
    Patient leaning away
     from painful side
    Lie painful side up
    Lie on right side over
     blanket roll
Side-lying Position: Unilateral
Foramen Opening
 Lateral Herniation
    Patient leaning away
     from painful side
    Lie painful side up
    Lie on right side over
     blanket roll
 Medial Herniation
   Patient leaning toward
    painful side
   Lie painful side down
   Lie on right side over
    blanket roll
Side-lying Position: Unilateral
Foramen Opening

 Side-lying with a
  blanket roll between
  iliac crest and rib cage
 Increases
  intervertebral foramen
  size of superior side of
  lumbar spine
Side-lying Position: Unilateral
Foramen Opening

 Maximum opening of
 Achieved by flexing
  upper hip and knee
  and rotating
  shoulders in
  opposite directions   Maximum opening of left side
Supine Position: Bilateral Foramen

 Knees to chest
 increases size of
  lumbar intervertebral
  foramen bilaterally
 Separation of
  spinous processes
Inversion Traction
 Hang upside down
 Lengthens spinal
  column due to
  stretch provided by
  weight of trunk
 Repeat inversion
  2-3 times
 Observe for signs of
  vertigo, dizziness, or
Manual Lumbar Traction
 Used prior to mechanical traction
 Helps determine degree of lumbar flexion,
  extension, or side-bending that is most
 Most comfortable position is usually best
  therapeutic position
Level-Specific Manual Traction

                  Position patient for
                   maximum effect at a
                   specific spinal level
                  Lumbar spine flexed
                   using upper leg as
                  Palpate interspinous
                  Upper spinous
                   process is where
                   maximum effect is
Level-Specific Manual Traction

                  When motion of lower
                   spinous process can
                   be palpated, place
                   foot against opposite
                   leg to prevent further
                  Trunk is then rotated
                   toward the upper
                   shoulder until motion
                   of upper spinous
                   process can be
Level-Specific Manual Traction

                  Place chest against
                   ASIS and upper hip
                  Lean toward
                   patient’s feet
                  Use enough force to
                   cause a palpable
                   separation of the
                   spinous processes
                   at desired level
Unilateral Leg Pull Manual Traction

 Hip joint problems or
  difficult lateral shift
 Thoracic counter-
  traction harness is used
 Hold ankle and move
  hip into 30o flexion, 30o
  abduction, and full
  external rotation
 Apply steady traction
  force until noticeable
  distraction occurs
Unilateral Leg Pull Manual Traction
 Sacroiliac problems
 In addition to thoracic
  harness, strap is
  placed through groin
  and secured to table
 Hold ankle and move
  hip into 30o flexion and
  15o abduction
 Apply steady traction
Mechanical Lumbar Traction:
 Use split table to eliminate friction between body
 Non-slip traction harness stabilizes trunk
Mechanical Lumbar Traction:
 Pelvic harness
    Applied while standing
    Contact pads and
     upper belt placed at, or
     just above, iliac crest

 Rib pads
    Positioned over lower
     rib cage
Mechanical Lumbar Traction:
Body Positioning
                   Neutral spinal
                   Allows for largest
                    foramen opening
                    before traction is
                   Usually position of
                    choice whether
                    prone or supine
Mechanical Lumbar Traction:
Body Positioning
                   Flexion
                   Increases posterior
                   Puts pressure on
                    disk nucleus to
                    move posterior
                   Other soft tissue
                    may also close
                    foramen opening
Mechanical Lumbar Traction:
Body Positioning
                   Extension
                   Closes foramen
                    because bony
                    arches come closer
Mechanical Lumbar Traction:
Body Positioning
 Prone position
 Used with normal to
    slightly flattened lumbar
   Best for disk protrusions
   Place pillows under
   Other modalities may be
   Allows for assessment of
    spinous process
Mechanical Lumbar Traction:
Body Positioning
 Supine position
 Produces posterior intervertebral separation
 Optimal at 90o hip flexion
 Unilateral pelvic traction recommended if stronger
  force is desired
      Scoliosis,
      Unilateral joint
       dysfunction, or
      Unilateral lumbar
       muscle spasm
Traction Force
 No lumbar vertebral separation will occur with
  traction forces less than 1/4 of body weight
     Effective traction force ranges between 65 and
      200 pounds
 Traction force recommended = 1/2 body
 Must use progressive steps to comfortably
  reach therapeutic loads
Intermittent vs. Sustained Traction
 Intermittent Traction
    Effective for posterior intervertebral
    No firm recommendations for on/off times

 Sustained Traction
   Recommended for disk protrusion and
Treatment Duration
 With suspected disk protrusions, total
  treatment time should be relatively short
     10 minutes or less
 If treatment reduces symptoms, treatment
  time should remain at 10 min or less
 If the treatment is partially successful or
  unsuccessful in relieving symptoms, gradually
  increase time over several treatments up to
  30 min
Progressive and Regressive Steps
 Traction equipment may be built with
  progressive and regressive modes
 Progressive mode
    Increases traction force in a pre-selected
     number of steps
    Allows slow accommodation to traction
 Regressive mode
   Decreases traction force in a pre-selected
    number of steps

 Patient comfort is primary consideration!
Manual Cervical Traction
 Stretches muscles and joint structures
 Enlarges intervertebral spaces and foramen
 Creates centripetally directed forces on disk
  and surrounding soft tissue
 Mobilizes vertebral joints
 Increases joint proprioception
 Relieves compressive effects of normal
 Improves arterial, venous, and lymphatic flow
Manual Cervical Traction

 Variety of head and neck
   Hand should cradle neck
    contacting one mastoid
   Other hand on chin
   Gentle pull, < 20 pounds
   Intermittent pull, 3 - 10 sec
   Treatment time, 3 - 10 min
Mechanical Cervical Traction
                              Supine
                              Neck flexed 20 - 30
                              Traction harness pulls on
                              Intermittent pull
                                   > 20 pounds
                                   Minimum of 7 seconds
Forces up to 50 pounds             Adequate rest time for
may produce increased               recovery
intervertebral separation.
                              Treatment time, 20 - 25 min
Mechanical Cervical Traction
 Wall-mounted device
      Inexpensive
 Static traction most easily
      Use weight plates, sand bags, or
       water bags
 Intermittent traction may be used
 Sitting or prone
 Gentle pull, 10 - 20 pounds
 Treatment time, 20 - 25 min
Indications for Spinal Traction

 Nerve root                  Joint hypomobility
    impingement               Discogenic pain
   Disk herniation           Muscle spasm or
   Spondylolisthesis          guarding
   Narrowing within          Muscle strain
    intervertebral foramen    Spinal ligament or
   Osteophyte formation       capsular contractures
   Degenerative joint        Improvement in
    diseases                   arterial, venous, and
   Subacute pain              lymphatic flow
Contraindications for
Spinal Traction
 Acute sprains or            Bone diseases
    strains                   Osteoporosis
   Acute inflammation        Infections in bones or
   Fractures                  joints
   Vertebral joint           Vascular conditions
    instability               Pregnant females
   Any condition in which    Cardiac or pulmonary
    movement                   problems
    exacerbates existing

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