Spinal traction 1

Spinal traction used in physiotherapy

1. Spinal Traction
Dr Subash Srivastav
Asst Prof

2. Traction
Process of drawing, or pulling apart, of a
body segment
Mechanical Traction -using a traction
machine or ropes/ pulleys to apply a traction
force
Manual Traction -clinician positions patient
and applies traction force to joints of the
spine or extremities

3. Effects of Traction: Spine
Encourages movement between
each individual spinal segment
Amount of movement varies
according to…
Position of spine,
Amount of force, and
Length of time the
force is applied
Transient effect

4. Effects of Traction: Spine
pain, paresthesia, or tingling
Due to physical separation of vertebral
segments thus decreasing pressure on
sensitive structures
As long as positive physiologic
effects occur,
traction should
be continued

5. Effects ofTraction: Bone
No immediate effects due to traction
May result in increased spinal movement that
reverses bone weakness associated with
immobilization
May assist with increasing or maintaining
bone density

6. Effects ofTraction: Ligaments
Stretching effect
Structural changes occur slowly due to
viscoelastic properties
Ligaments resist shear forces and return to
original form following removal of a deforming
load
Sensitivity to rate of loading
Ligament deformation results in lengthening
of a ligament caused by traction loading
Slow loading rates allow for more deformation

7. Effects ofTraction: Disks
Normal disk in non-compressed position
Internal pressure (indicated by arrows) is
exerted equally in all directions
Internal annular fibers contain nuclear
materials

8. Effects ofTraction: Disks
In an injured disk, sitting or standing
compresses the disk causing the nucleus to
become flatter
Pressure in this instance still remains
relatively equal in all directions

9. Effects ofTraction: Disks
In an injured disk, movement in weight-
bearing causes a horizontal shift in nuclear
material
If this was forward bending, the bulge would
occur in the posterior annular fibers
Anterior annular fibers would be slackened and narrow

10. Effects ofTraction: Disks
Herniation of the nuclear material occurs if
the annular wall becomes weak
Herniation may possibly put pressure on
sensitive structures in the area

11. Effects ofTraction: Disks
When placed under traction, intervertebral space
expands thereby decreasing pressure on the disk
Taut annular fibers create a centripetally directed
force
Decreases herniation and pressure on sensitive
structures in the area

12. Effects ofTraction: Articular Facet
Joints
Facet joints are separated releasing impinged
structures
Dramatic reduction in symptoms
Joint separation decompresses articular
cartilage allowing synovial fluid exchange to
nourish cartilage
Decreases rate of degenerative changes
Increased proprioception from facet joint
structures provide sensation of pain relief

13. Effects ofTraction: Muscles
Vertebral muscles can be stretched
Initial stretch should come from body
positioning
Stretch lengthens tight muscle
Allows for better muscular blood flow
Activates muscle proprioceptors providing
sensation of pain relief
Gate Control Theory

14. Effects ofTraction: Nerves
Focus of most traction treatments
Pressure on nerves or nerve roots often
associated with spinal pain
Unrelieved pressure on a nerve will cause
Slowing, eventual loss of impulse conduction
Motor weakness, numbness, and loss of reflex
Pain, tenderness, and muscular spasm

15. Traction Treatment Techniques
Lumbar Positional Traction
Inversion traction
Manual Lumbar Traction
Level-specific
Unilateral leg pull
Mechanical Lumbar Traction
Manual Cervical Traction
Mechanical Cervical Traction

16. Lumbar Positional Traction
Patient typically on restricted activity program
“Trial and error” process to determine position
that offers maximum comfort

17. Side-lying Position: Unilateral
Foramen Opening
Lateral Herniation
Patient leaning away
from painful side
Lie painful side up
Lie on right side over
blanket roll

18. Side-lying Position: Unilateral
Foramen Opening
Lateral Herniation
Patient leaning away
from painful side
Lie painful side up
Lie on right side over
blanket roll
Medial Herniation
Patient leaning toward
painful side
Lie painful side down
Lie on right side over
blanket roll

19. Side-lying Position: Unilateral
Foramen Opening
Side-lying with a
blanket roll between
iliac crest and rib cage
Increases
intervertebral foramen
size of superior side of
lumbar spine

20. Side-lying Position: Unilateral
Foramen Opening
Maximum opening of
intervertebral
foramen
Achieved by flexing
upper hip and knee
and rotating
shoulders in
opposite directions
Maximum opening of left side

21. Supine Position: Bilateral Foramen
Opening
Knees to chest
position
increases size of
lumbar intervertebral
foramen bilaterally
Separation of
spinous processes

22. Inversion Traction
Hang upside down
Lengthens spinal
column due to
stretch provided by
weight of trunk
Repeat inversion
2-3 times
Observe for signs of
vertigo, dizziness, or
nausea

23. Manual Lumbar Traction
Used prior to mechanical traction
Helps determine degree of lumbar flexion,
extension, or side-bending that is most
comfortable
Most comfortable position is usually best
therapeutic position

24. Level-Specific Manual Traction
Position patient for
maximum effect at a
specific spinal level
Lumbar spine flexed
using upper leg as
lever
Palpate interspinous
space
Upper spinous
process is where
maximum effect is
desired

25. Level-Specific Manual Traction
When motion of lower
spinous process can
be palpated, place
foot against opposite
leg to prevent further
flexion
Trunk is then rotated
toward the upper
shoulder until motion
of upper spinous
process can be
palpated

26. Level-Specific Manual Traction
Place chest against
ASIS and upper hip
Lean toward
patient’s feet
Use enough force to
cause a palpable
separation of the
spinous processes
at desired level

27. Unilateral Leg Pull Manual Traction
Hip joint problems or
difficult lateral shift
corrections
Thoracic counter-
traction harness is used
Hold ankle and move
hip into 30
o
flexion, 30
o
abduction, and full
external rotation
Apply steady traction
force until noticeable
distraction occurs

28. Unilateral Leg Pull Manual Traction
Sacroiliac problems
In addition to thoracic
counter-traction
harness, strap is
placed through groin
and secured to table
Hold ankle and move
hip into 30
o
flexion and
15
o
abduction
Apply steady traction
force

29. Mechanical Lumbar Traction:
Equipment
Use split table to eliminate friction between body
segments
Non-slip traction harness stabilizes trunk

30. Mechanical Lumbar Traction:
Setup
Pelvic harness
Applied while standing
Contact pads and
upper belt placed at, or
just above, iliac crest
Rib pads
Positioned over lower
rib cage

31. Mechanical Lumbar Traction:
Body Positioning
Neutral spinal
position
Allows for largest
intervertebral
foramen opening
before traction is
applied
Usually position of
choice whether
prone or supine

32. Mechanical Lumbar Traction:
Body Positioning
Flexion
Increases posterior
opening
Puts pressure on
disk nucleus to
move posterior
Other soft tissue
may also close
foramen opening

33. Mechanical Lumbar Traction:
Body Positioning
Extension
Closes foramen
because bony
arches come closer
together

34. Mechanical Lumbar Traction:
Body Positioning
Prone position
Used with normal to
slightly flattened lumbar
lordosis
Best for disk protrusions
Place pillows under
abdomen
Other modalities may be
applied
Allows for assessment of
spinous process
separation

35. Mechanical Lumbar Traction:
Body Positioning
Supine position
Produces posterior intervertebral separation
Optimal at 90
o
hip flexion
Unilateral pelvic traction recommended if stronger
force is desired
Scoliosis,
Unilateral joint
dysfunction, or
Unilateral lumbar
muscle spasm

36. Traction Force
No lumbar vertebral separation will occur with
traction forces less than 1/4 of body weight
Effective traction force ranges between 65 and
200 pounds
Traction force recommended = 1/2 body
weight
Must use progressive steps to comfortably
reach therapeutic loads

37. Intermittent vs. Sustained Traction
Intermittent Traction
Effective for posterior intervertebral
separation
No firm recommendations for on/off times
Sustained Traction
Recommended for disk protrusion and
rupture

38. Treatment Duration
With suspected disk protrusions, total
treatment time should be relatively short
10 minutes or less
If treatment reduces symptoms, treatment
time should remain at 10 min or less
If the treatment is partially successful or
unsuccessful in relieving symptoms, gradually
increase time over several treatments up to
30min

39. Progressive and Regressive Steps
Traction equipment may be built with
progressive and regressive modes
Progressivemode
Increases traction force in a pre-selected
number of steps
Allows slow accommodation to traction
Regressivemode
Decreases traction force in a pre-selected
number of steps
Patient comfort is primary consideration!

40. Manual Cervical Traction
Stretches muscles and joint structures
Enlarges intervertebral spaces and foramen
Creates centripetally directed forces on disk
and surrounding soft tissue
Mobilizes vertebral joints
Increases joint proprioception
Relieves compressive effects of normal
posture
Improves arterial, venous, and lymphatic flow

41. Manual Cervical Traction
Variety of head and neck
positions
Hand should cradle neck
contacting one mastoid
process
Other hand on chin
Gentle pull, <20 pounds
Intermittent pull, 3 -10 sec
Treatment time, 3 -10 min

42. Mechanical Cervical Traction
Supine
Neck flexed 20 -30
o
Traction harness pulls on
occiput
Intermittent pull
> 20 pounds
Minimum of 7 seconds
Adequate rest time for
recovery
Treatment time, 20 -25 min
Forces up to 50 pounds
may produce increased
intervertebral separation.

43. Mechanical Cervical Traction
Wall-mounted device
Inexpensive
Static traction most easily
employed
Use weight plates, sand bags, or
water bags
Intermittent traction may be used
Sitting or prone
Gentle pull, 10 -20 pounds
Treatment time, 20 -25 min

44. Indications for Spinal Traction
Nerve root
impingement
Disk herniation
Spondylolisthesis
Narrowing within
intervertebral foramen
Osteophyte formation
Degenerative joint
diseases
Subacute pain
Joint hypomobility
Discogenic pain
Muscle spasm or
guarding
Muscle strain
Spinal ligament or
capsular contractures
Improvement in
arterial, venous, and
lymphatic flow

45. Contraindications for
Spinal Traction
Acute sprains or
strains
Acute inflammation
Fractures
Vertebral joint
instability
Any condition in which
movement
exacerbates existing
problem
Bone diseases
Osteoporosis
Infections in bones or
joints
Vascular conditions
Pregnant females
Cardiac or pulmonary
problems