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Spinal Traction

Spinal Traction. Jennifer Doherty-Restrepo, ATC, LAT Entry-Level Athletic Training Education Program PET 4995: Therapeutic Modalities. Traction. Process of drawing, or pulling apart, of a body segment

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Spinal Traction

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  1. Spinal Traction Jennifer Doherty-Restrepo, ATC, LAT Entry-Level Athletic Training Education Program PET 4995: Therapeutic Modalities

  2. 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 - clinician positions patient and applies traction force to joints of the spine or extremities

  3. 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

  4. 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

  5. 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

  6. 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 load • Sensitivity to rate of loading • Ligament deformation results in lengthening of a ligament caused by traction loading • Slow loading rates allow for more deformation

  7. 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 materials

  8. 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

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

  10. 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

  11. Effects of Traction: Disks • 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

  12. 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 • Increased proprioception from facet joint structures provide sensation of pain relief

  13. 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 • Activates muscle proprioceptors providing sensation of pain relief • Gate Control Theory

  14. 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

  15. 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

  16. Lumbar Positional Traction • Patient typically on restricted activity program • “Trial and error” process to determine position that offers maximum comfort

  17. 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

  18. 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

  19. 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

  20. 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

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

  22. 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

  23. 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

  24. 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 • Upper spinous process is where maximum effect is desired

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

  26. 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

  27. Unilateral Leg Pull Manual Traction • Hip joint problems or difficult lateral shift corrections • 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

  28. Unilateral Leg Pull Manual Traction • Sacroiliac problems • In addition to thoracic counter-traction harness, strap is placed through groin and secured to table • Hold ankle and move hip into 30o flexion and 15o abduction • Apply steady traction force

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

  30. 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

  31. 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

  32. 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

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

  34. Mechanical Lumbar Traction: Body Positioning • Prone position • Used with normal to slightly flattened lumbar lordosis • Best for disk protrusions • Place pillows under abdomen • Other modalities may be applied • Allows for assessment of spinous process separation

  35. 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

  36. 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 • Must use progressive steps to comfortably reach therapeutic loads

  37. Intermittent vs. Sustained Traction • Intermittent Traction • Effective for posterior intervertebral separation • No firm recommendations for on/off times • Sustained Traction • Recommended for disk protrusion and rupture

  38. 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

  39. 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!

  40. 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 posture • Improves arterial, venous, and lymphatic flow

  41. 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

  42. 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 Forces up to 50 pounds may produce increased intervertebral separation.

  43. Mechanical Cervical Traction • Wall-mounted device • Inexpensive • Static traction most easily employed • 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

  44. Nerve root impingement Disk herniation Spondylolisthesis Narrowing within intervertebral foramen Osteophyte formation 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 Indications for Spinal Traction

  45. 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 Contraindications for Spinal Traction

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