Spinal Mechanical Traction - Lecture 3 (modalities)

Question 2

Application of tensile forces to the long axis of the spine

Answer 2

Traction

Question 3

What 4 things that traction can be

Answer 3

1) Mechanical
2) Manual (w/ hands)
3) Gravity (think inversion table)
4) Active (pt does it themselves)

Question 4

KNOW: traction was initally done for disc herniations (get the herniated materal to go back in)

KNOW: Traction can be intermittent or continuous

Continuous = inversion table (until you flip yourself back over)

Intermittent = better / more tolerance by pts

Question 5

KNOW: In cardver subjects its been shown to
* Increase intervertebral space
* INcrease intervertebral forman space
* more room for nerve root

Adding flexion w/ traction showed inconsistent findings (not very beneficial)

In animal models fluid exchange and nutrient transport MAY be enhanced

All in cervical spine

Question 6

What does traction do to disc herniation size in live subjects? (cervical)

Answer 6

Reduces it immeditly - however - we dont know how long those effects last
* ~30 pounds of traction was used

Question 7

What does traction do to muscular changes? (cervical)

Answer 7

nothing

Question 8

What happens to muscle activation w/ lumbar spine traction

Answer 8

Increases it but stop immediately after traction

Question 9

KNOW: Young people w/ traction get increased disc height in lumbar spine - middle age get enhancted water diffusion

Question 10

Volume of disc hernaition is reduced w/ lumbar spine traction on average

Question 11

How long did the effects last w/ lumbar traction on volume of disc herniation (it running out)

Answer 11

Only a few minutes

however - it can take someone a while to get set up so might not be worth doing

Question 12

KNOW: traction is slowly done (little tension –> more tension)
* Known as intermittent traction

Question 13

Occipital harness = cervical traction
* wedges
* Pad
* Strap

Question 14

Where do the harnesses go for lumbar traction

Answer 14

One above the iliac crest
One below the iliac crest

NOTE: Can also have a stool or bolster for LE support

can also have a thoracic harness

Question 15

Question 16

Question 18

Some therapist still want to add some kind of flexion - even though there isnt much evidence for it
* dont to pt confomert

Question 19

observe for how long after leaving pt on traction

Answer 19

2-3 mins

Question 20

what should traction feel like

Answer 20

gentle puling

Question 21

KNOW: We dont want traction to be painful

Question 22

Allow pt to lay in supine for a few minutes after removing the traction to let everything calm down
* may be dizzy

Question 23

Whats used more static or intermittent traction

Answer 23

intermittent
100% tension –> 50% –> 100

Question 24

How much tension should tension be?

Answer 24

10-25 pounds

Question 25

Ho long should cervical traction last

Answer 25

10-20 minutes

Question 26

For intermittent traction we have a cycle minimum = 30sec max = 10sec back and forth

Question 27

Can have ascending or descending steps for tension where we work our way up then back down

Question 28

What is a rebound effect for tension

Answer 28

Traction helping at first then after its stopped it getting really painful * should go away really quickly If these symptoms last a long time we wont do traction in the future

Question 29

Question 30

MAKE SURE TABLE IS LOCKED BEFORE PT IS ON Once were ready to go unlock the table

Question 31

Question 32

KNOW: Lumbar traction only varies from cervical is that the pt can be in prone and supine *** and the tension will be a max of 50% body weight**

Question 33

Entering parameters

Question 34

Best traction home ones are the ones w/ a pneumatic pump so they can pup up the tension themselves

Question 35

What is pneumatic traction

Answer 35

where you pump it up

Question 36

Contraindications to traction * Acute cervical trauma (especially whiplash because theres typically injury to m tissue - dont want to pull on messed up tissue) * Osteoproris - dont pull on briddle bones * Use of steriods or other mediations that can ecompromise bone integrity * RA ankylosis som=ndylitits (things that alter joint mechancis) * Joint hypermobility / instability * Pregnancy * Prior surgical stabilization or decompression * Spinal implants/prosthetic discs * Non mechanican pain

Question 37

Pre-cautions w/ traction * Claustrophobia * COPD - watch for difficulty breathing - amount of pressure w/ harness * Pt positioning (comfertable?) * Robound efects (is this really worth it) Always start w/ more conservative settings

Question 38

Indications for traction Lumbar: * Treatment based = certain presentation equate to you treat people this way - if you treat poeple this way they tend to get better * Impairment based = group them based on impairments and you treat them this way * No specifc group of patients to use this on Cervical * Group of pts that tend to do better are radiating UE symptoms (radiculopthy) * Weaker support of mobility deficits (stiffer) Proposed cervical traction prediction rule (if they present w/ these they will do better w/ traction) * Peripheralization of pain with lower cervical mobility testing * Positive shoulder abduction test * ≥55 yrs old * Reduction in symptoms with distraction Positive ULTT NOTE: Not a stand alone treatment - goal is to get pts off of traction ASAP