06-13: Lumbar Traction

Question 1

Herniated disc

Answer 1

• Herniated nucleus pulposus (HNP)
• Caused by stiffness/slumped posture, forward bending, leads to weakness/degeneration
• Common in 25-45 yo pts
• Uncommon in ages > 45 due to fibrotic changes in nucleus - less fluid, less migration

Question 2

HNP Signs & Symptoms

Answer 2

• Initial: sharp, local LBP; may be ripping/tearing sound
• Pain increases with sitting/forward bending
• Once settled (2 wks), radiating symptoms
• Loss of skin sensation, motor function, diminished DTRs, neurotension

Question 3

HNP Treatment

Answer 3

• Immediate: LB first-aid/education (cryotherapy)
• Settled: Positional distraction
• Chronic: Manipulation to hypomobile segments (Avoid rotation), stabilization, general conditioning
• Return to function

Question 4

HNP: L3-L4

Answer 4

• L4 Nerve root
• Anteromedial thigh/knee
• Weak knee extension
• Atrophic quads
• Diminished knee jerk DTR

Question 5

HNP: L4-L5

Answer 5

• L5 nerve root
• LAteral leg, first webspace
• Weak dorsiflexion of great toe (EHL)
• Atrophic anterior calf
• No DTR affected

Question 6

HNP: L5-S1

Answer 6

• S-1 nerve root
• BAck of calf, lateral heel, foot, toe
• Weak plantar flexion of foot and great toe
• Atrophic gastroc/soleus
• Diminished achilles/ankle jerk DTR

Question 7

PIVM

Answer 7

• Passive Intervertebral Motion Testing
• Pt sidelying
• Flex, then sidebend hip

Question 8

Positional distraction

Answer 8

• Designed to remove pressure off nerve root by opening foramen
• Temporary relief

Question 9

Positional distraction - Criteria

Answer 9

• Segment must be localized
• Segment must be mobile
• Pt must be comfortable
• No muscle guarding in position
• Monitor treatment

Question 10

Positional distraction - Procedure

Answer 10

• Pt sidelying on non-painful side over bolster or towel
• Hips flexed until motion detected at targeted segment
• Spine rotated to level above targeted segment
• Patient should be balanced

Question 11

Lumbar traction - Body position

Answer 11

• Prone or supine: Maintain neutral position; allows for max intervertebral foramen opening
• Prone: Pillow under abs flattens lumbar lordosis, reduces disk protrusion
• Supine: Increase hip flexion, posterior intervertebral space separation increase; support LE in 90-90 hip/knee flexion
• Unilateral: Stronger force on one side - used for protective scoliosis, unilateral jt dysfunction, unilateral muscle spasm with scoliosis

Question 12

Lumar traction - Harness

Answer 12

• Pelvic aligned just above or in line with iliac crest
• Thoracic aligned with ribs 8-10
• Buckles accessible after pt lies down to tighten harness

Question 13

Lumbar traction - Traction Force

Answer 13

• Between 25%-50% of pt BW for soft tissue stretch, muscle spasm
• 50% of pt BW for vertebral separation

Question 14

Sustained Traction

Answer 14

• Indicated for disk herniation

- Rx time: 10 minutes or less

Question 15

Intermittent Traction

Answer 15

• Indicated for all other traction-appropriate Dx
• More comfortable, with higher forces
• Traction: 10-60 sec, Rest: 10-20 sec, adjust to pt comfort
• Rx time: 20-30 min

Question 16

Lumbar traction - Parameters

Answer 16

• Harness secure
• Lock/Unlock table
• Call bell and shutoff button
• Rx time: 5-30 min
• Position: Supine or prone
• Force: Start with 30 lbs; 50% BW required to separate vertebrae, may be reached gradually over sessions; 25% BW for soft tissue stretch

Question 17

Indications for Lumbar traction

Answer 17

• Supine: Spinal stenosis, DJD, Osteophytes, Spine opens up in flexion
• Prone: Better with extension, disc herniation

Question 18

Documentation of Mechanical Traction

Answer 18

• Position of pt
• Amount of force
• Intermittent or sustained
• Intermittent: how long was force applied, how long was rest between pulls
• Total Rx time
• Progression/regression setting - if yes, how many steps