Traction -- Lecture notes

Before applying cervical and lumbar traction:

1) Assess skin integrity & sensation 2) Review contraindications & precautions 3) Explain the procedure to the patient including rationale for use, what the patient should expect during treatment, and what feedback the patient should provide 4) Inspect the equipment. Make sure the unit is plugged in

Name three advantages of mechanical traction:

1) Force applied and time are well controlled, readily graded, and easily replicable 2) Once applied correctly, it does not require the clinician to be with the patient throughout the treatment 3) Allows for the application of static or intermittent traction

What to do when lumbar traction treatment is complete?

1) Have the patient just relax for ~ 1 minute before removing the harnesses and the traction stool. 2) Assist the patient in lifting their legs to remove the traction stool as needed if using supine traction. Assist the patient back to a seated position as needed 3) Reassess the skin in the area that the treatment was applied and assess the patient's response to the treatment. Assess any changes in both neck pain and change in any radicular symptoms that the patient may have been experiencing. Also assess for any changes in mobility and/or strength post treatment if indicated 4) Clean the treatment area and equipment

Name three disadvantages of mechanical traction:

1) Mechanical traction units are expensive 2) Set up is time consuming 3) Lack of patient control or participation in the treatment 4) Poorly tolerated by some patients 5) Mobilizes broad areas of the spine rather than individual spinal segments

How to set up for cervical traction:

1) Position the patient appropriately while considering patient comfort and goals of the treatment to be applied. The patient should be positioned in supine with their head resting on the cervical sled with their neck between the halters. The patient should be positioned so that the halters fall just below the mandible. Use a bolster or wedge underneath the patient's lower extremities for comfort as needed. 2) Tighten the halter. It should be tightened enough so that it is snug, yet comfortable for the patient. 3) Tighten the forehead strap to help stabilize the head and neck during the treatment 4) Set the appropriate parameters based on the goals of the treatment Mode (static or intermittent)Hold / relax times (on / off times)Treatment timeTraction force 5) Provide the patient with the Safety Switch and explain to the patient what it is for and how to activate it if necessary

How to apply manual cervical traction:

1) Position the patient in supine in a relaxed position 2) Sit at the end of the table with the patients head resting comfortably in your hands 3) Apply a traction force through the occiput by leaning your body weight backward

What to do when cervical traction is done:

1) Turn off the machine, remove the forehead strap and loosen the halter. Have the patient just relax for ~ 1 minute before having them sit up. Assist them back to a seated position as needed 2) Reassess the skin in the area that the treatment and applied and assess the patient's response to the treatment. Assess any changes in both neck pain and change in any radicular symptoms that the patient may have been experiencing. Also assess for any changes in mobility and/or strength post treatment if indicated 3) Clean the treatment area and equipment

How does traction reduce disc protrusion?

1) licking back of a disc fragment 2) suction force caused by decreased intradiscal pressure 3) tensing of the posterior longitudinal ligament pushing the disc material anteriorly

What is the force required to increase the length of the lumbar spine?

25 percent of the patient's body weight

What is the force required to distract lumbar apophyseal joints?

50 percent (or 60 percent) of the patient's body weight

What is the force required to distract the cervical vertebrae?

7 percent of the patient's body weight -- This is enough to decrease compression on a spinal nerve or facet joint (about 20 to 30 lbs)

What are the results of positioning a patient in prone for lumbar traction?

A neutral to extended position results in greater separation of the anterior structures, including the disc spaces

What are the contraindications for spinal traction?

Acute injury or inflammation Joint hypermobility or instability Peripheralization of symptoms during traction treatment Uncontrolled Hypertension Impaired sensation

When to unlock the table for lumbar traction?

After fully set up (straps tightened, mode selected) & after the patient has the safety switch

How tight should the straps be for lumbar traction?

As tight as possible to prevent slippage during the treatment. Make sure that the patient can still breathe normally, especially when tightening the thoracic harness. Fully tighten the straps connecting the thoracic harness to the traction table.

What is the force required to address cervical disc protrusions?

At least 15 to 30 lbs.

What is the force required to address lumbar disc protrusions?

At least 60 lbs.

What are some indications for spinal traction?

Disc bulge or herniation Nerve root impingement Joint hypomobility Muscle Spasms Adhesions Disc degeneration Foraminal stenosis Contracted connective tissue Facet joint impingement Radiating pain

Intervertebral disc pressures

Highest = bent, seated & holding a weight

Where to attach the straps of the thoracic harness for lumbar traction?

Hooks at the head of the traction table. The patient's arms should be between these straps and the front part of the strap should be directly over the patient's anterior shoulders.

When might prone position for traction be advantageous?

If the patient does not tolerate the supine position (flexion) or if symptoms are reduced by extension clinically. Forces using prone traction may be more localized to the lower lumbar spine.

Why keep the force low when initially applying lumbar traction?

Initial traction force should be approximately 30-45 pounds (13-20 kg). This is to reduce the risk of reactive muscle guarding and spasm and determine whether traction may aggravate the patient's symptoms.

What are effects of spinal traction?

Joint distraction Reduction of spinal disc protrusion Soft tissue stretching Muscle relaxation Joint mobilization

Do you need more or less force to decrease the force of a muscle spasm compared with decompressing a spinal nerve?

Less. To decrease muscle spasm and stretch soft tissues, 12-15 pounds of force is generally effective.

Intermittent lumbar traction

Longer hold times --related to a disc protrusion. Shorter hold times is recommended for symptoms related to joint dysfunction

Parameters for traction

Mode (static or intermittent) Hold / relax times (on / off times) Treatment time Traction force

How to apply manual lumbar traction:

Position the patient comfortably. This techniques can be performed in supine with the knees bent with the traction force applied just below the knees, or long leg traction can be applied with the legs extended and the traction force applied just above the ankles Apply a traction force by leaning your body weight backward

What is the proper force progression for introducing cervical traction for the first time?

Start ay 8-10 pounds (3-4 kg) and gradually increased to ~ 7% of the patients body weight.

What are the precautions for spinal traction?

Structural diseases affecting the tissues in the area of treatmentTumorInfectionRAOsteoporosis When the pressure of the belts may be hazardous to the patient Pregnancy OsteoporosisHerniaVascular compromise Displaced annular fragment (disc fragment) Claustrophobia Inability to tolerate prone or supine positions Disorientation TMJ dysfunctions (cervical traction) Dentures (cervical traction) When severe pain resolves fully during traction treatment

What is the most commonly used position for lumbar traction?

Supine

Positional traction

Targeted opening a specific segment(s) of the spine can be achieved through positioning the patient in certain ways. This techniques may be able to create opening at the targeted segment and be a way to provide the patient with a degree of symptom relief

Guidelines for monitoring cervical and lumbar traction:

The patient should be monitored for the first few cycles to make sure it is set up and working correctly and the patient is comfortable. (if not, stop the treatment and make any adjustments that are needed) Continue to monitor the patient periodically throughout the treatment. Get feedback on patient comfort, amount of force, change in symptoms. etc.

How to attach the spreader bar for lumbar traction?

To the straps of the pelvic harness and to the rope from the traction machine. Make sure the the rope is pulled out all the way from the traction machine (so there is no slack in the rope) before connecting it to the spreader bar

Can traction help with spinal disc protrusion?

Yes, but only small to moderate bulges

Can traction be applied at home?

Yes, there are numerous home units available.

Traction

a tensional mechanical force applied to the body in a way that separates the joint surfaces and elongates the surrounding soft tissues

Where should the opening for the table be during supine and prone lumbar traction?

approximately the level of the pelvic harness

How can traction relax muscles?

decreased pain caused by reduced pressure on pain sensitive structures or gating of pain transmission through the stimulation of mechanoreceptors by oscillatory movements produced by intermittent traction

What to do with legs during supine lumbar traction?

elevated using a traction stool in approximately a 90/90 position

The pelvic harness for lumbar traction should be applied with the top ...

just above the iliac crests

How can you apply traction?

manually by a clinician, mechanically by a traction machine, or by the patient using body weight and gravity

Static lumbar traction

recommended when the treatment area is inflamed, symptoms are easily aggravated by motion, or the symptoms are related to a disc protrusion

What disorders benefit from cervical traction?

reducing pain and increasing cervical ROM and studies indicate that it may be particularly helpful in reducing symptoms associated with mechanical neck disorders

Flexed position for supine lumbar traction

results in greater separation of posterior structures, including the facet joints and intervertebral foramina

The thoracic harness should be applied over the patients chest with the lower edge of the harness at approximately ...

the level of the xiphoid process

Where might lumbar traction forces in the supine position may be more localized?

upper lumbar and lower thoracic spine