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Spinal Traction

Spinal Traction. Salman Farooqi Lecturer IPM&R, KMU. Traction. Process of drawing, or pulling apart, of a body segment. Mechanical Traction. using a traction machine or ropes/ pulleys to apply a traction force. Manual Traction.

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Spinal Traction

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  1. Spinal Traction Salman Farooqi Lecturer IPM&R, KMU

  2. Traction • Process of drawing, or pulling apart, of a body segment

  3. Mechanical Traction • using a traction machine or ropes/ pulleys to apply a traction force

  4. Manual Traction • Clinician positions patient and applies traction force to joints of the spine or extremities

  5. 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

  6. Effects of Traction: Spine •  pain, paresthesia, or tingling • Due to physical separation of vertebral segments thus decreasing pressure on sensitive structures

  7. Effects of Traction: Spine • As long as positive physiological effects occur, traction should be continued

  8. Effects of Traction: Bone • No immediate effects due to traction • May result in increased spinal movement that reverses bone weakness associated with immobilization • May assist with increasing or maintaining bone density

  9. Effects of Traction: Discs • Normal disc in non-compressed position • Internal pressure (indicated by arrows) is exerted equally in all directions • Internal annular fibers contain nuclear materials

  10. Effects of Traction: Discs • In an injured disc, sitting or standing compresses the disc causing the nucleus to become flatter • Pressure in this instance still remains relatively equal in all directions

  11. Effects of Traction: Discs • In an injured disk, movement in weight-bearing causes a horizontal shift in nuclear material

  12. Effects of Traction: Discs • Herniation of the nuclear material occurs if the annular wall becomes weak • Herniation may possibly put pressure on sensitive structures in the area

  13. Effects of Traction: Discs • When placed under traction, intervertebral space expands thereby decreasing pressure on the disk • Taut annular fibers create a centripetally directed force • Decreases herniation and pressure on sensitive structures in the area

  14. Effects of Traction: Articular Facet Joints • Facet joints are separated releasing impinged structures • Dramatic reduction in symptoms • Joint separation decompresses articular cartilage allowing synovial fluid exchange to nourish cartilage • Decreases rate of degenerative changes

  15. Effects of Traction: Articular Facet Joints • Increased proprioception from facet joint structures provide sensation of pain relief

  16. Effects of Traction: Muscles • Vertebral muscles can be stretched • Initial stretch should come from body positioning • Stretch lengthens tight muscle • Allows for better muscular blood flow

  17. Effects of Traction: Muscles • Activates muscle proprioceptors providing sensation of pain relief • Gate Control Theory

  18. Effects of Traction: Nerves • Focus of most traction treatments • Pressure on nerves or nerve roots often associated with spinal pain

  19. Effects of Traction: Nerves • 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

  20. Traction Treatment Techniques • Lumbar Positional Traction • Inversion traction • Manual Lumbar Traction • Level-specific • Unilateral leg pull

  21. Traction Treatment Techniques • Mechanical Lumbar Traction • Manual Cervical Traction • Mechanical Cervical Traction

  22. 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

  23. Side-lying Position: Unilateral Foramen Opening • Lateral Herniation • Patient leaning away from painful side • Lie painful side up • Lie on over blanket roll • Medial Herniation • Patient leaning toward painful side • Lie painful side down • Lie over blanket roll

  24. Side-lying Position: Unilateral Foramen Opening • Side-lying with a blanket roll between iliac crest and rib cage • Increases intervertebral foramen size

  25. Side-lying Position: Unilateral Foramen Opening • Maximum opening of intervertebral foramen • Achieved by flexing upper hip and knee and rotating shoulders in opposite directions Maximum opening of left side

  26. Supine Position: Bilateral Foramen Opening • Knees to chest position • increases size of lumbar intervertebral foramen bilaterally • Separation of spinous processes

  27. 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 nausea

  28. Manual Lumbar Traction • Used prior to mechanical traction • Helps determine degree of lumbar flexion, extension, or side-bending that is most comfortable • Most comfortable position is usually best therapeutic position

  29. Level-Specific Manual Traction • Position patient for maximum effect at a specific spinal level • Lumbar spine flexed using upper leg as lever • Palpate interspinous space

  30. 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

  31. Unilateral Leg Pull Manual Traction • Sacroiliac problems • strap is placed through groin and secured to table • Hold ankle and move hip into 30o flexion and 15o abduction • Apply steady traction force

  32. Mechanical Lumbar Traction: Equipment • Use split table to eliminate friction between body segments • Non-slip traction harness stabilizes trunk

  33. Mechanical Lumbar Traction: Setup • Pelvic harness • Applied while standing • Contact pads and upper belt placed at, or just above, iliac crest • Rib pads • Positioned over lower rib cage

  34. Mechanical Lumbar Traction: Body Positioning • Neutral spinal position • Allows for largest intervertebral foramen opening before traction is applied • Usually position of choice whether prone or supine

  35. Mechanical Lumbar Traction: Body Positioning • Flexion • Increases posterior opening • Puts pressure on disk nucleus to move posterior • Other soft tissue may also close foramen opening

  36. Mechanical Lumbar Traction: Body Positioning • Extension • Closes foramen because bony arches come closer together

  37. Mechanical Lumbar Traction: Body Positioning • Prone position • Used with normal to slightly flattened lumbar lordosis • Best for disk protrusions • Place pillows under abdomen

  38. Mechanical Lumbar Traction: Body Positioning • Supine position • Produces posterior intervertebral separation • Optimal at 90o hip flexion • Scoliosis, • Unilateral joint dysfunction, or • Unilateral lumbar muscle spasm

  39. 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 weight

  40. Intermittent vs. Sustained Traction • Intermittent Traction • Effective for posterior intervertebral separation • Sustained Traction • Recommended for disk protrusion and rupture

  41. Progressive and Regressive Steps • 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!

  42. Manual Cervical Traction • Stretches muscles and joint structures • Enlarges intervertebral spaces and foramen • Creates centripetally directed forces on disk and surrounding soft tissue

  43. Manual Cervical Traction • Mobilizes vertebral joints • Increases joint proprioception • Relieves compressive effects of normal posture • Improves arterial, venous, and lymphatic flow

  44. Manual Cervical Traction • Variety of head and neck positions • Hand should cradle neck contacting one mastoid process • Other hand on chin • Gentle pull, < 20 pounds • Intermittent pull, 3 - 10 sec • Treatment time, 3 - 10 min

  45. Mechanical Cervical Traction • Supine • Neck flexed 20 - 30o • Traction harness pulls on occiput • Intermittent pull • > 20 pounds • Minimum of 7 seconds • Adequate rest time for recovery • Treatment time, 20 - 25 min .

  46. Mechanical Cervical Traction • Wall-mounted device • Inexpensive • Static traction most easily employed • Use weight plates, sand bags, or water bags • Sitting or prone • Gentle pull, 10 - 20 pounds • Treatment time, 20 - 25 min

  47. Indications for Spinal Traction • Nerve root impingement • Disk herniation • Spondylolisthesis • Narrowing within intervertebral foramen • Degenerative joint diseases • Subacute pain • Joint hypomobility • Discogenic pain • Muscle spasm or guarding • Muscle strain • Spinal ligament or capsular contractures • Improvement in arterial, venous, and lymphatic flow

  48. Contraindications for Spinal Traction • Acute sprains or strains • Acute inflammation • Fractures • Vertebral joint instability • Any condition in which movement exacerbates existing problem • Bone diseases • Osteoporosis • Infections in bones or joints • Vascular conditions • Pregnant females • Cardiac or pulmonary problems

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