Week 10 Traction Flashcards
Spinal Traction definition
A force applied to the body in a way that separates or attempts to separate, joint surfaces and elongates soft tissues surrounding a joint
Theory of Traction is
- Increase space between the vertebrae
- Intervertebral separation may help normalize the spinal discs position and morphology
- Increase the dimension of the intervertebral foramen containing the spinal nerve root
Evidence for traction remains….
limited/lacking evidence
3 types of traction
Mechanical
Manual
Positional
Mechanical Traction
- Application of static or intermittent force by an electrical motor through belts or a halter in the direction of distracting the joint of the spine
- Static= continuous low load force
- Intermittent= alternate cycles where traction is applied at a higher force for a period of time followed by a period at a lower dose
- typical ration 3:1
Manual Traction
- Application of force by the therapist in the direction of distracting the joints
Positional Traction
Prolonged specific positioning to place tension or open the intravertebral space on one side of the lumbar spine
Effects of traction on the cervical spine:
- Increased blood flow, fluid exchange and nutrient transport within the disc
- Increased intervertebral foramina space
- Disc herniations may be reduced
- Decrease in pain with some spine conditions
- Conflicting evidence of effect on cervical spine musculature
- Duration of any biomechanical or physiological effect is unknown
Effects of traction on the lumbar spine
- Fluid exchange and nutrient transport within the disc enhanced
- trunk muscle activity may initially increase then return to prior levels : increased blood flow to muscles with decrease in pain
- During passive traction, intradiscal pressure can be reduced or become negative. traction occurring while the patient is actively contracting the abdominal muscle results in increased intradiscal pressure
- Opening the intravertebral foramina may decrease nerve root compression in some radicular disorders
- Expanse of herniated disc material is suggested to reduce in some subjects during traction. Effect seems to be temporary but repeated traction may result in a positive cumulative effect
Contraindications for Spinal Traction
- Acute sprain/trauma
- Connective tissue disorders or rheumatological disorders resulting in tissue laxity or joint hypermobility/ instability
- Rheumatoid arthritis
- Ankylosing spondylitis
- osteoporosis and osteopenia
- History of steroid use or medications that weaken or demineralize bone
- Hypermobility/instability
- Patients post surgical stabilization or decompression of the spine, spine implants or prosthetic discs
- pregnancy
- Peripheralization of symptoms
- Non-mechanical pain
Precautions of spinal traction
- COPD
- Claustrophobia
Clinical Prediction Rule for Deciding to use Cervical traction
- Clinical prediction rule is for identifying patients most like to respond favorably to cervical traction
- Peripheralization of pain with lower cervical mobility testing
- Positive shoulder abduction test
- Age 55 years or older
- Reduction of symptoms with manual distraction
- positive upper limb tension test
Clinical Prediction rule for at home traction : cervical conditions
- pain 7/10
- Score on the fear avoidance belief questionnaire work subscale of <13
- Relief with manually applied traction
- Pain perceived distal to the shoulder
Cervical Spine Traction Application
Total time 10 -20 minutes
- Cycle time= static/intermittent 3:1 or 6:2
- Force max 10-25Ib (max is 30 Ib) Minimal range is 50% max force
- Start low force for 10 minutes and then go up
Lumbar Spine Traction Application
- 10-20 minutes
- Cycle time 3:1 or 6:2 intermittent/static
-force up to 50% of the patients body weight - lower tension off cycle is 50% or less of max force
