Traction

Question 1

traction definition

Answer 1

mechanical force applied to the body
separates joint surfaces and elongates the soft tissue surrounding a joint

Question 2

what does traction require

Answer 2

2 opposing forces
- traction
- countertraction

Question 3

durations of distraction

Answer 3

continuous
sustained/static
intermittent

Question 4

modes of mechanical traction

Answer 4

electrical and weighted mechanical

Question 5

modes of manual traction

Answer 5

manual traction

Question 6

explain billing for traction to peripheral joints

Answer 6

manual therapy rather than mechanical modality

– always done manually

Question 7

what is self-traction? positional traction?

Answer 7

self - done by self using body weight
positional - positioned to utilize external forces to do the work

Question 8

explain process of static traction

Answer 8

constant amount of traction force is applied throughout the treatment intervention

Question 9

explain the process of intermittent traction

Answer 9

force alternated between 2 set points during treatment intervention

Question 10

what are the specific guidelines for intermittent traction

Answer 10

a higher level of force is maintained for a given period of time then reduced to 50% of that max for a given time

• may be progressive or regressive

Question 11

effects of traction on joint surfaces

Answer 11

reduction of compression on the joint surfaces

reduction of:
articular pressure
pressure on intra-articular structure
pressure on nerve roots

Question 12

in what manner should traction be applied to joint surfaces

Answer 12

perpendicular to the plane of articulation

Question 13

what % force of body weight must be applied to elongate soft tissue? what about joint surfaces?
- lumbar
- cervical

Answer 13

lumbar
25% = elongation of tissue
50% = joint separation

cervical
7% = joint separation

Question 14

physiological effects of traction

Answer 14

decreased pain
increased mobility

Question 15

how does traction reduce pain

Answer 15

mechanoreceptor stimulation
decreased muscle tension
nerve pressure relief (decreased disc material protrustion)

Question 16

how does traction increase mobility

Answer 16

stretch soft tissue
relaxation of muscle
joint mobilization

Question 17

explain the reduction of disc material protrusion? what does this do as a result?

Answer 17

traction creates a suction phenomenon when intradiscal pressure is reduced

• displaced material will be pulled back to center of the disc

-reduction of herniation size / increased spinal canal space

Question 18

traction applied to what structure will cause disc material protrusion to decrease?

Answer 18

traction of the posterior longitudinal
- pushes material anteriorly

Question 19

what forms of traction are indicated for disc material protrusion reduction

Answer 19

higher amounts of force are needed = mechanical

self and manual are not enough for intended benefits

Question 20

explain disc protrusion size and efficacy of posterior longitudinal ligament traction

Answer 20

• minimally effective with large disc protrusion, herniation, or calcification
• moderately effective with small to moderate disc protrusion

Question 21

explain the relationship between degree of force and duration if the goal is soft tissue stretch

Answer 21

lower forces of traction
prolonged durations

• should improve ROM / mobility that would in turn decrease compression force on joint surface

Question 22

explain effect of intermittent traction on relaxation of muscles

Answer 22

will stimulate mechanoreceptors and cause pain gating
- reduction of pain = reduction of spasms

Question 23

explain effect of static traction on relaxation of muscles

Answer 23

stretches golgi tendon organs
- inhibits alpha motor neuron firing
- inhibits muscle tone

Question 24

explain how low loads of traction effect mobilization of joints

Answer 24

pain gaiting allows for mobility increases
- will not be adequate to separate the joint structures

Question 25

explain how high loads of traction effect mobilization of joints

Answer 25

stretch of surrounding tissue separation of joint structure -- both lead to greater amounts of motion

Question 26

explain the role of manual techniques if considering traction

Answer 26

can be more effective to isolate specific joints - with mechanical traction it can be difficult to isolate a specific vertebral segment

Question 27

indications for spinal traction

Answer 27

disc herniation/bulge nerve root impingement joint hypomobility subacute joint inflammation subacute joint pain paraspinal muscle spasm osteophytes degenerative joint disease

Question 28

consideration when using traction for joint hypomobility

Answer 28

hypomobility in one area can result in hypermobility in another area traction could possibly increase mobility in the hypermobile joint

Question 29

how does traction help sub-acute joint issues? any considerations?

Answer 29

reduced pressure on inflamed joint surface pain gaiting fluid exchange induced by motion - want to avoid intermittent traction during acute stage

Question 30

how to target paraspinal muscle spasms with traction

Answer 30

static or intermittent low loads -- will interrupt the pain-spasm pain cycle due to GTO activation

Question 31

contraindications for traction

Answer 31

spinal fusion / fracture / recent surgery progressive neuro deficit acute injury/inflammation VBI ankylosing spondylosis joint hypermobility or instability uncontrolled HTN increased BP with traction if traction is peripheralizing symptoms

Question 32

what conditions may cause an individual to have joint hypermobility or instability

Answer 32

pregnancy RA down syndrome osteoporosis

Question 33

explain traction considerations for TMJ disorders

Answer 33

need to keep dentures in - maintains TMJ position can limit the types of traction applicable

Question 34

precautions when using traction

Answer 34

immature/young patients claustrophobic patients obesity respiratory/CV problems malignancies

Question 35

what special tests would need to be negative before indicating cervical traction

Answer 35

alar ligament transverse ligament sharp pursor VBI testing cluster

Question 36

what are the parameters for traction

Answer 36

patient positioning static vs intermittent hold/relax time force total duration total frequency

Question 37

explain supine positioning and traction relationship

Answer 37

will flex spine - traction will be greater on posterior structures/tissues - good for paraspinal spasms/facet joint manipulation - more flexion will cause greater pull on upper lumbar and lower thoracic segments

Question 38

explain prone positioning and traction relationship

Answer 38

will extend the spine - traction greater on anterior structures/tissues - good for disc problems - pulls on lower lumbar area more

Question 39

explain sitting position and lumbar mechanical traction relationship

Answer 39

will put spine in neutral gravity will provide further pull

Question 40

explain supine position and cervical mechanical traction relationship

Answer 40

more flexion = more posterior / lower vertebra less flexion = more anterior / higher vertebrae

Question 41

explain degree of flexion for: C1-2 C2-5 C6-7

Answer 41

0-5 degrees 10-20 degrees 25-35 degrees maximal posterior pull = 25-35 degrees -- general rule for treatment

Question 42

findings that would indicate static vs intermittent traction

Answer 42

static - inflamed tissues - symptoms increase with motion - disc protrusion causing symptoms intermittent - disc protrusion (will include longer hold time) - joint dysfunction (will include shorter hold time)

Question 43

explain the qualitative ratio associated with hold and relax times

Answer 43

hold - maximal force relax - minimal force

Question 44

hold/relax ratio for - disc protrusion - spinal joint dysfunction/hypomobility

Answer 44

disc = 60:20 dysfunction/hypo = 15:15

Question 45

for those with severe symptoms, what is the proper hold/relax time

Answer 45

longer hold and relax times / less movement as symptoms improve, decrease time so that more movement occurs

Question 46

what determines force of traction

Answer 46

tratment goal patient position treatment area - equal to % body weight of application area

Question 47

what forces are indicated in lumbar traction

Answer 47

facet joint separation = 50-60% BW ST stretch = 25-50% of BW (15-30# typically) - generally do not apply more than 50-60% of BW

Question 48

for initial visit of lumbar spine treatment, what is the recommended load

Answer 48

30-45 lbs increase by 5-15 lbs

Question 49

what forces are indicated in cervical traction

Answer 49

facet jt separation = 7% of BW -- in neutral position: 8-10 lbs (upper) / 25-30 lbs (lower) ST stretch = 12-15 lbs -- generally do not exceed 30 lbs

Question 50

for initial visit of cervical spine treatment, what is the recommended load

Answer 50

8-10 lbs increase by 3-5 lbs

Question 51

explain initial treatment duration and symptom response

Answer 51

if severe = 5 minutes moderate or minimal = 10-15 minutes if symptoms improve = stay same length or slowly increase time if symptoms stay the same = slowly increase time if symptoms worsen = discontinue treatment

Question 52

associated duration for disc protrusions

Answer 52

start at 20 min gradually increase up to 40 if needed