Mechanical Agents:Traction & Intermittent Compression Flashcards
(140 cards)
1
Q
Traction =
A
Tension applied to a body segment to cause vertebral separation, relieve pain, and reduce neural compression
2
Q
Spinal Effects of Traction: Cervical
A
⬆ Fluid exchange and nutrient transport in discs
⬆ Intervertebral foramina dimensions
💬 Limited evidence of reduced disc herniation extension
⚠️ Conflicting evidence on muscle activity effects
❓ Duration of effect is unknown
3
Q
Spinal Effects of Traction: Lumbar
A
⬆ Fluid exchange and nutrient movement
↓ Intradiscal pressure during passive traction (may become negative)
❗ Traction by the patient (e.g., inversion) may increase pressure
Temporary reduction of disc herniation may occur
Possible cumulative effect with repeated sessions – but not well supported
❓ Duration of effect is unknown
4
Q
Whether cervical or lumbar — any biomechanical or physiological effects are likely ___, and clinical impact varies by patient.
A
temporary
5
Q
Treatment Variables:
A
Positioning
Force
Mode
Cycle timing
Duration
6
Q
Positioning:
A
Supine vs. Prone:
Depends on comfort, diagnosis, and effect on muscle tension.
Lower Extremity Positioning:
Affects pelvic tilt, lumbar spine alignment, and patient comfort.
7
Q
Angle of Application =
A
Affects the direction of pull and targeted spinal level
(e.g., 15–25° cervical flexion to target C5–C6)
8
Q
Force:
A
Lumbar ~50% BW, Cervical start at ~10–30 lbs
9
Q
Mode:
A
Sustained Traction (ST): Best for disc herniation (centralization) = static = constant pull
Intermittent Traction (IT): Better for comfort, MS/ligament effects = rhythmic push-pull cycles (joint stiffness
10
Q
Cycle timing:
A
Short hold (≤10 sec) = pain gating
Long hold (≥10 sec) = stretch tissues
11
Q
Duration:
A
Disc: 8–10 min (start low and increase if needed)
12
Q
Dosage Components:
A
Tension (force applied, typically % body weight)
Duration of traction
Cycle (on/off times)
Total cycle duration
Ratio of max vs. min tension (e.g., 3:1 or 1:1)
Ramp time: Gradual build-up or release at start/end for comfort
13
Q
Manual vs. Mechanical
A
Manual: More adaptable (esp. cervical)
Mechanical: More consistent; lumbar needs split table
Inversion: ~40% BW force; not as common in PT
14
Q
Traction Contraindications
A
Acute injury
Ligament laxity
Fractures
Pregnancy (lumbar)
RA (cervical instability risk)
15
Q
Pair traction with___ immediately after to maintain space and neuromuscular improvements!
A
therapeutic exercise
16
Q
Intermittent Pneumatic Compression (IPC) =
A
⬆ Interstitial pressure → moves fluid into venous & lymph circulation
⬆ Venous return → ↓ edema, ↓ DVT risk
⬆ Peak venous flow velocity → helps clear valve sinuses
17
Q
Indications:
A
Edema (non-acute)
Lymphedema
Venous stasis ulcers
PAD (with exercise)
DVT prevention (esp. post-op)
18
Q
Contraindications:
A
DVT or suspected DVT
Acute trauma/injury edema
Infection
Open wounds (unless dressing allows)
Heart failure or fluid overload
19
Q
Precautions
Monitor for:
A
SOB → pulmonary issues
Numbness/tingling → DVT or nerve irritation
Joint stiffness → reposition or shorten treatment
20
Q
Parameters:
A
pressure (LE)
pressure (UE)
cycle
time (general)
time (lymph)
21
Q
Recommendation:
Pressure (LE)
A
40–80 mmHg
22
Q
Recommendation:
Pressure (UE)
A
30–60 mmHg
23
Q
Recommendation:
Cycle
A
30 sec on / 30 sec off (typical)
24
Q
Recommendation:
Time (general)
A
30 min (1–3x/day)
25
Recommendation:
Time (lymph)
3–4 hours
26
Cochrane Review (2022):
IPC + meds = ↓ DVT & PE risk
27
Maia et al. (2024):
Small benefit for sports recovery; best protocols = 20–30 min @ 80 mmHg
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Traction =
Tension applied to a body segment (e.g., spine)
29
Support =
Traction produces increased spinal length and intersegmental separation
✅ Well-supported in the literature
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Effects on Multiple Tissues:
🔹 Spinal motion
🦴 Bone
🦠 Ligaments
💿 Discs
⚙️ Facet joints
💪 Muscles
⚡ Nerves
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Spinal Motion / Movement =
Motion varies by spinal segment and amount of force used
Actual movement is typically small (1–2 mm) and transient
Acute pain relief may occur even with minimal movement
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Mechanism of Pain Relief =
Vertebral separation → decrease compression & surface contact
→ ✅ Decreased pain
May relieve foraminal compression on nerve roots or structures
33
Lasting Effects =
Come from structural adaptations around the vertebrae
→ Not from the traction itself, but from what the body does in response over time
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Traction isn’t magic—it creates a window for:
temporary relief and potential healing if followed up with exercise and postural correction
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Tension Loading =
Rapid loading → ❌ Injury risk
Ligaments become stiffer under quick force
Slow loading → ✅ Length changes possible
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In shortened/scarred ligaments:
traction may help restore normal length — but avoid overstretching!
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❗ Contraindicated for ___ injuries
acute
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⚠️ Ligament ___ is a risk
overload
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Traction may trigger gating effects via ___
proprioceptor afferents (modulating pain)
40
In later rehab stages, ___ traction can promote ___
gradual
adaptive remodeling (length & strength)
41
Traction is not appropriate early post-injury. It's most useful for:
chronic tightness, scarring, or restricted mobility — and only when applied slowly and progressively.
42
Lumbar Traction
Primary Indication:
Nerve root impingement due to:
Disc herniation
Spondylolytic lesions
43
Effect of Lumbar Flexion:
Flexion → increase separation of spinous processes
Expands foramina = more room for nerve roots
⚠️ But may exacerbate symptoms in flexion-intolerant patients (e.g., disc pain worsened in flexion)
44
Types of Lumbar Traction:
Positional
Mechanical
Manual
Inversion
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Lumbar Traction:
Positional =
Foramen UP side lies uppermost
→ Add rotation toward superior shoulder to maximize opening
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Lumbar Traction:
Mechanical =
Most effective for lumbar traction
allows larger, consistent forces
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Lumbar Traction:
Manual =
💬 Challenging for lumbar due to large force requirements
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Lumbar Traction:
Inversion =
Applies traction via body weight
→ ~40% of body weight force
49
For left-sided nerve root compression, lie patient ___ sidelying with ___ side up and rotate to the left.
right
left
50
Mechanical Traction
Variables:
Position
Force Used
Intermittent vs continuous
Duration of treatment
Progress/regress criteria
51
Position =
Prone: Often better tolerated for patients with disc herniations as it reduces flexion. May allow for muscle relaxation.
Supine: Commonly used; more comfortable for patients with facet joint or foraminal issues.
Choose based on patient comfort and diagnosis.
52
Force Used =
Should be individualized. Start conservatively (e.g., ~30 lbs trial), then titrate up.
Research supports needing at least 25% of body weight to affect the lumbar spine.
Clinical range: 65–200 lbs, but 50% body weight is a good rule of thumb.
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Intermittent vs Continuous =
Intermittent (IT): Used for joint mobilization, comfort with higher forces.
Sustained (ST): More effective for disc herniation and nerve root impingement (promotes centralization of symptoms).
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Duration of Treatment (TX) =
Depends on the pathology.
Shorter (8–10 min) for acute disc issues.
May need to extend gradually if symptoms persist.
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Progress/Regress Criteria =
Set objective signs (e.g., decreased pain, increased ROM, improved function).
Stop or reduce force if symptoms worsen.
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Practical Considerations:
Split Table: Reduces friction during traction, allowing more effective segmental distraction.
Harness Application:
Must be in direct contact with skin for accurate and effective force transmission.
Loose or over clothing = less effective.
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Strong evidence for:
discogenic lesions and nerve root impingements
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Mechanical Traction
Particularly helpful for patients with:
Herniated nucleus pulposus (HNP)
Radiculopathy
Foraminal stenosis
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Positioning - Neutral to Slight Flexion:
Increases intervertebral space and foraminal opening.
Most supported in literature for reducing nerve root compression.
Avoid excessive flexion—may worsen symptoms in certain disc pathologies.
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Force Required =
25% Body Weight (BW)
Research shows that forces below 25% BW are ineffective in producing mechanical separation in the lumbar spine.
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___ is the general therapeutic range.
65–200 lbs
Lower forces may not provide benefit, while higher forces may be needed for larger patients or more severe pathologies.
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___ is commonly cited as a good therapeutic force starting point
50% BW
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Always begin with a trial dose:
30 lbs for the first session, especially in acute conditions or with new patients, to assess tolerance.
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Gradual Increase:
Important to progressively build up force over time for safety and comfort.
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Sustained Traction (ST):
Preferred for disc herniations, especially for centralization of nucleus pulposus (NP).
Helps reduce nerve root compression.
Best evidence for use in acute discogenic pain.
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Intermittent Traction (IT):
More comfortable for patients, especially with higher forces.
Mimics joint mobilization and is useful for facet joint or muscle conditions.
Used when prolonged tension would cause discomfort.
67
Short Hold Times (≤10 seconds):
Activates the gate control theory (via mechanoreceptors).
Influences muscle spasm and pain modulation.
68
Long Hold Times (≥10 seconds):
Targets ligamentous and muscular stretch.
Used when goal is structural elongation or postural correction.
69
Match force and mode (IT vs ST) to ___ and ___
diagnosis
patient tolerance.
70
Start conservatively and ramp up ___ as tolerated.
both force and duration
71
Document patient ___ to adjust future treatment appropriately.
response to trial
72
For disc protrusions, studies recommend ____ treatment durations, typically ____
shorter
8–10 minutes
**This avoids prolonged stress on surrounding structures while still promoting centralization and decompression
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When to Increase Duration:
If there's no improvement or only partial relief, you can gradually increase the treatment time.
Progressively extending sessions helps assess tolerance and potential benefit, especially in chronic or complex cases.
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Progressive Traction:
Gradual ramp-up of force over time during the session.
Helpful for comfort and tissue accommodation, especially in sensitive or acute cases.
Can reduce risk of muscle guarding or sudden discomfort.
75
Regressive Traction:
Slowly decreases force before ending the treatment.
May reduce post-treatment soreness or rebound symptoms.
Allows time for tissues to adapt back from stretch, similar to a cooldown.
76
TherEx to Pair Before Getting Off Table:
(To reinforce traction benefits and prevent regression)
Core stabilization exercises
Neural glides if radiculopathy present
Pelvic tilts or bridges for lumbar traction
Scapular retraction and chin tucks for cervical traction
Postural education/movement retraining
77
Synergistic Modalities:
(To enhance or complement traction)
Moist heat or hot pack – relaxes muscles pre-traction
E-stim (TENS or IFC) – pain modulation post-traction
Ultrasound – local tissue effects (less commonly used adjunct)
Manual therapy (e.g., joint mobilization) – before or after to support mechanical gains
78
Manual Cervical Traction
Reasons for Use (Similar to Lumbar):
Nerve root compression (e.g., due to disc herniation or foraminal narrowing)
Joint dysfunction or hypomobility
Muscle guarding and pain relief
79
Why Manual > Mechanical in Some Cases:
Allows fine-tuned adjustments to position, angle, and tension
Enables immediate patient feedback to guide changes
Great for short-duration testing to determine if traction is appropriate before using mechanical
80
Real-Time Positional Adjustments =
You can adjust for optimal comfort or relief on the fly (e.g., change angle of flexion or rotation based on symptom relief)
Ideal for patients with unpredictable or acute presentations
81
Sprains & Strains:
Rhythmic longitudinal traction helps:
Reduce muscle spasms
Decrease compressive pain
Promote relaxation and pain relief
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Cervical Traction
Force Parameters:
Use gentle forces (<20 lbs) due to the smaller size and sensitivity of cervical structures.
83
Cervical Traction
Modality Preference:
Intermittent Traction (IT) is commonly used for cervical spine because it:
Promotes better comfort
May reduce guarding and enhance circulation
84
Cervical Traction
Post-Treatment:
Consider a cervical collar post-treatment (especially early on) to:
Maintain traction-induced separation or alignment
Prevent re-compression as the patient resumes upright posture
85
Cervical Traction Parameters:
Positioning
Target 5–10° of cervical flexion:
Flexion opens posterior structures (e.g., intervertebral foramen)
Optimizes stretch and unloading of nerve roots
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Cervical Traction Parameters:
Force
typical range: 10–60 lbs
depending on:
Patient tolerance
Body size/musculature (↑ force for larger individuals)
Begin low and increase gradually—start with a trial force
87
Cervical Traction Parameters:
Duration
Pull time: 3–10 seconds
Rest time: Brief pauses between pulls
Total session time: 3–10 minutes (shorter for initial treatments or acute cases)
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___ cervical musculature may need slightly higher forces for effective results
Larger
89
Mechanincal Cervical Traction
support:
Mechanical devices provide decent, consistent traction at the cervical spine.
Can be performed in supine or seated (over-the-door units) — but seated setups are more awkward and patient-dependent.
90
Mechanincal Cervical Traction
positioning:
Recommended cervical flexion: 20–30° to maximize intervertebral space and reduce nerve root compression.
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Mechanincal Cervical Traction
dosage:
Initial force: ~20 lbs (intermittent or continuous)
Duration: 20–25 minutes is typical for initial sessions
92
Space gains from traction are temporary:
Anterior separation: ~0.4 mm
Posterior separation: ~1.0–1.5 mm
These effects return to baseline within 20–30 minutes, unless reinforced with therapeutic exercise.
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You MUST prescribe ____ to lock in the biomechanical benefits.
post-traction TherEx (e.g., deep neck flexor training, posture correction, or nerve glides)
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Kaltenborn Traction Grading system =
classify the amount of traction applied to a joint during manual therapy
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Grade I – Loosen
Purpose: Pain relief.
Effect: Minimal traction to neutralize joint pressure, without actual joint surface separation.
Mechanism: May activate the gating mechanism to reduce pain.
Clinical use: Often used early to assess pain response and patient tolerance.
96
Grade II – Tighten or Take Up Slack
Purpose: Initial joint mobility and sensitivity assessment.
Effect: Separates joint surfaces by taking up the slack in the capsule, eliminating “joint play.”
Clinical use: Helps determine joint reactivity before progressing to higher grades.
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Grade III – Stretch
Purpose: Increase joint mobility in hypomobile joints.
Effect: Applies enough force to stretch the joint capsule and surrounding tissues.
Clinical use: Used when the goal is to improve ROM or break adhesions.
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Each grade has a distinct therapeutic goal—so choose based on whether you're prioritizing ___ (Grade I), ___ (Grade II), or ___ (Grade III).
pain relief
assessment
mobility gains
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Traction for LBP - Level D Evidence
Conflicting evidence on effectiveness of intermittent lumbar traction for general LBP.
Level D = weak support, low confidence in benefit across broader patient populations.
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Traction for LBP may help:
Subgroup with nerve root compression and either:
Peripheralization of symptoms (i.e., symptoms move away from the spine).
Positive crossed straight leg raise test.
These patients may benefit from intermittent traction in the prone position.
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Moderate evidence (stronger than Level D) suggests:
PTs should not use intermittent or static lumbar traction for:
Acute or subacute nonradicular LBP
Chronic LBP
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In other words: If there's no ___ component or ___ involvement, traction likely won't help.
radicular
neural
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What is IPC?
IPC = Intermittent Pneumatic Compression
Uses a mechanical pump and sleeve to deliver cyclical external pressure to limbs.
Also called vasopneumatic compression.
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Physiological Effects of IPC:
Prevents Deep Vein Thrombosis (DVT) by promoting venous return.
Reduces edema by facilitating lymphatic and venous drainage.
Improves sensory function post-stroke (CVA)—likely by enhancing circulation and proprioceptive input.
Promotes wound healing in cases of venous stasis ulcers.
Increases blood flow in Peripheral Artery Disease (PAD).
Reduces limb volume in lymphedema—especially useful when paired with manual lymphatic drainage.
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IPC Mechanism & Theory
Main goal: Mobilize fluid (edema) and enhance venous/lymphatic return.
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IPC raises ___, which helps push excess fluid back into veins and lymph vessels for clearance.
interstitial pressure
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When the tissue pressure exceeds that of blood/lymph vessels, fluid moves out of ___ and back into ___.
the interstitial space
circulation
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Increases forward blood propulsion, prevents ____, promotes ___, and reduces ___.
venous stasis and clot formation
ulcer healing
lymphedema
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Hemodynamic Benefits (Mechanism Theory):
Compression can double blood flow velocity.
Helps clear venous valve sinuses, minimizing clot risk.
Reduces distention in venous structures, which is a common cause of stasis.
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Primary Indications for IPC:
Edema
Venous Thromboembolism (VTE) Prevention
Peripheral Artery Disease (PAD)
Venous Stasis Ulcers
Lymphedema
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Edema (Swelling):
Must first determine the cause—not all edema is appropriate for IPC.
A detailed history and exam are critical before applying IPC.
Examples: post-surgical swelling, lymphedema, venous insufficiency (not systemic causes like CHF).
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Venous Thromboembolism (VTE) Prevention:
IPC helps prevent blood clots by promoting venous return.
Especially important in patients with limited mobility or post-op status.
Early mobilization is key and should be combined with IPC.
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Peripheral Artery Disease (PAD):
IPC is used cautiously and often in conjunction with exercise.
ACSM Exercise Recommendation for PAD:
Aerobic weight-bearing exercise: 3–5 days/week.
Resistance training: 2 days/week.
Goal: improve circulation and reduce ischemic symptoms (e.g., claudication).
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Venous Stasis Ulcers:
IPC can help promote healing by improving venous return and reducing edema.
Other biophysical agents (like electrical stimulation) and compression dressings are also used adjunctively.
115
Lymphedema:
IPC is used with caution.
Key precaution: Avoid trauma to the involved limb.
Do not take BP or perform venipuncture on limbs with or at risk for lymphedema.
Providers must be vigilant to avoid worsening the condition.
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IPC is contraindicated when swelling is due to ____, as compression may worsen the condition or delay healing.
acute inflammation
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Do not use IPC for ____ edema.
acute injury-related
118
Precautions:
Recent Skin Graft
Acute Local Dermatological Infection
Impaired Sensation or Mentation
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Recent Skin Graft =
IPC may disrupt the graft before it fully adheres.
Wait until the graft is stable and well-healed.
120
Acute Local Dermatological Infection =
Risk of spreading infection through contact with the sleeve or moisture (e.g., perspiration).
Treat infection prior to IPC use or use barrier protection.
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Impaired Sensation or Mentation =
The patient may not detect excessive pressure or discomfort, leading to injury.
Constant monitoring or modified protocols are required.
122
Contraindications for IPC:
Acute Pulmonary Edema
Congestive Heart Failure
Recent or Acute DVT
Acute Fracture
Uncontrolled Hypertension
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Acute Pulmonary Edema
IPC increases venous return → worsens fluid overload in lungs and heart.
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Congestive Heart Failure
Similar risk as above—can increase cardiac stress and exacerbate symptoms.
125
Recent or Acute DVT
Risk of dislodging thrombus, which may embolize to lungs or heart → potentially fatal.
126
Acute Fracture
Compression may cause movement of bone fragments and delay healing.
127
Uncontrolled Hypertension
IPC can raise blood pressure further, putting additional strain on the heart.
128
Possible Complications
Swelling (in other areas)
Stiffness of Joints
Shortness of Breath
Numbness or Tingling
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Swelling (in other areas)
Due to redistributed fluid reentering circulation.
Managed with elevation + gentle exercise
130
Stiffness of Joints
From prolonged immobilization.
Typically resolves in 15–30 minutes.
If persistent, modify positioning or support.
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Shortness of Breath
Could signal fluid overload or pulmonary embolism.
Monitor closely and contact MD if it persists.
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Numbness or Tingling
May indicate DVT or nerve compression.
🚨 Stop treatment immediately and assess the patient.
133
Treatment Variables for IPC:
Vital Signs = Taken before, during, and after each session (BP, HR, RR, etc.)
Circumferential Measurements = Taken pre- and post-treatment to track fluid volume changes (edema reduction)
Wound Characteristics (if present) = Document size, location, drainage, tissue quality
Patient Positioning = Supine, seated, or elevated—may affect drainage and tolerance
On:Off Ratio
E.g. 3:1 or 45 sec on / 15 sec off
Total Treatment Time
Typically 20–60 minutes, depending on condition
134
Intermittent Compression Device:
"JOBST Pump" = Common brand name used in clinics for IPC devices.
Portable & Easy to Set Up =
Useful in outpatient, inpatient, and home care settings.
Limitation: Not Easily Combined with Other Modalities
IPC occupies the limb, so it's hard to use simultaneously with things like electrical stimulation or bandaging.
135
Static vs. Sequential Compression
Research shows no significant difference in outcomes between these two settings in terms of edema reduction.
136
Inflation Pressures:
Goal:
Match diastolic blood pressure, not systolic, to avoid arterial occlusion.
137
Recommended Inflation Pressures Ranges:
Upper Extremity (UE): 30–60 mmHg
Lower Extremity (LE): 40–80 mmHg
138
Inflation Cycle:
Research is inconclusive on ideal cycle.
Typical recommendation:
30 seconds on / 30 seconds off
May be adjusted to longer intervals if needed.
139
Treatment Time:
Lymphedema:
3–4 hours per session
Literature shows lymph flow increases after just 10 minutes of treatment
140
Treatment Time:
General Edema:
30 minutes/session
Can be used up to 3–4 times/day for musculoskeletal conditions
