Traction

Traction

1. SPINAL TRACTION Presented By: ASHISH KUMAR SHARMA BPT 4 th Year NOIDA INTERNATIONAL UNIVERSITY

2. TRACTION Drawing apart; pulling Separation of bones and/or bony segments utilizing a distraction force A traction is a treatment option that is based on the application of a longitudinal force to the axis of the spinal column. In other words, parts of the spinal column are pulled in opposite directions to stabilize or change the position of damaged aspects of the spine. The force is usually applied to the spine through a series of weights or a fixation device and requires that the patient is kept in bed. Traction is a manual ‘stretching’ of the spine which reduces pressure on the discs and therefore reduces the individual’s pain.

3. TYPES OF TRACTION Manual Traction: In manual spinal traction, a physical therapist uses their hands to put people in a state of traction. Then they use manual force on the joints and muscles to widen the spaces between vertebrae. The period of traction generally doesn’t last very long. MECHANICAL TRACTION: The specialized treatment technique of mechanical traction uses devices that work by stretching the spinal vertebrae and muscle. Mechanical traction allows for continuous or intermittent stretching on a traction table while combining heat, vibration, and/or massage. These tables can use computer-based systems to apply exact amounts and/or variations of pressure. Gravitational traction: distraction force is provided by gravity

4. SPINAL TRACTION CATEGORIES Continuous traction: Continuous spinal traction is applied for several hours requiring only small amounts of weight. It’s an uncomfortable mode of traction wherein patient cannot tolerate poundage enough to cause separation of the vertebrae for an extended length of time. Sustained/STATIC TRACTION: Steady amount of traction is applied for few minutes and equally coupled with stronger poundage. INTERMITTENT MECHANICAL TRACTION: Traction is applied alternatively and withdrawn through a mechanical device. POSITIONAL TRACTION: Traction is applied by the use of pillows, blocks, or sandbags to affect a longitudinal pull on the spinal structures.

5. CONTRAINDICATIONS OF SPINAL TRACTION Diseases affecting vertebra or spinal cord, including cancer & meningitis Vertebral fractures Extruded disc fragmentation Spinal cord compression Osteoporosis Spinal infection RA or other acute inflammatory joint disorder

6. PRECAUTIONS FOR SPINAL TRACTION Joint hypermobility Acute inflammation Pregnancy (increased ligamentous laxity and risk for abdominal compression) TMJ dysfunction (cervical) if using chin strap Close monitoring of patient should be performed throughout treatment Can cause thrombosis of internal jugular vein if excessive duration or traction weight is used

7. CALCULATING TRACTION FRACTION Traction pulls are opposed by friction forces. for traction forces to effect spinal segments, traction force must exceed friction force. There is a mathematical relationship between body weight and the amount of friction force from the treatment surface. this is called the "coefficient of static friction".

8. GOALS OF TRACTION reduce radicular signs - reducing nerve impingement reduce muscle guarding via prolonged stretch reduce joint pain increase range of motion promote fracture healing

9. THEORY OF THERAPEUTIC EFFECTS Herniation of disc material - Pressure on intradiscal components of the involved disc(s) are reduced. Negative pressure pulls disc material back into the disc, decreasing the size of herniated disc material. Degenerative joint disease - Pressure on facet and foraminal space is temporarily decreased, resulting in nerve compression and decreased nerve root irritation and/or secondary swelling from progressive joint changes. Muscle spasm or guarding - Benefit is due to low load prolonged stretch of surrounding soft tissues of the cervical and lumbar spine.

10. Joint hypomobility - Benefit is due to: moving articular structures on each other distracting articular structures to free up motion increase synovial fluid production and nutrition to cartilaginous structures increase activation of mechanoreceptors to inhibit the pain response Facet Impingement – Benefit is due to decompression of facet capsular structure which can become impinged with compression

11. CERVICAL TRACTION

12. INTRODUCTION Application of a longitudinal force to the C-spine & structures Strongest evidence for the benefits of traction is in cervical applications Benefits of the use of cervical traction is supported in cases of osteoarthritis, cervical radiculopathy, disc herniation, and tension headaches T he force applied for cervical traction is 20% or ¼ of body weight

13. PHYSIOLOGICAL EFFECTS increasing vertebral separation reducing cervical muscle activation reducing nerve conduction disturbances increases reflex arc strength increasing blood flow restoring cervical lordosis

14. EFFECTIVENESS OF CERVICAL TRACTION Cervical traction has been linked to 5 mechanical factors - Position of the neck Force of applied traction Duration of traction Angle of pull Position of patient

15. ANGLE OF PULL research is variable regarding the ideal angle of pull general guidelines suggest 25 degrees of cervical flexion during traction application Must have at least 15° flexion to separate facet joint surfaces Body must be in straight alignment

16. CERVICAL TRACTION POSITIONING Seated – a greater force is needed to apply the same pressure (due to gravity) than if supine Supine – support lumbar region (bend knees, use knee elevator, or hang lower legs over end of table & place feet on chair); allows musculature to relax

17. CERVICAL TREATMENT SET-UP Remove any jewelry, glasses, or clothing that may interfere Lay supine, place pillows, etc. under knees Secure halter to cervical region placing pressure on occipital process & chin (minor amount) Align unit for 25-30° of neck flexion Remove any slack in pulley cable On: Off sequence 3:1 or 4:1 ratio

18. VIDEO

19. LUMBAR TRACTION

20. INTRODUCTION Lumbar traction is the process of applying a stretching force to the  lumbar vertebrae through body weight, weights, and/or pulleys to distract individual joints of the lumbar spine.  It remains a core component of PT curriculum, including understanding of its theoretical basis for application as well as the practical skill of safely applying manual and mechanical traction. T he force applied for lumbar traction is 40-60% or ½ of body weight.

21. PHYSIOLOGICAL EFFECTS increase vertebral separation decrease intradiscal pressure reduction of disc protrusion increase lateral foraminal opening distract apophyseal joints temporary reduction of scoliosis temporary increase in lordosis decrease lumbar paraspinal activity

22. ANGLE OF PULL generally perpendicular to table for L1-L5 line of pull needs to change at L5-S1 to accommodate for the lumbosacral angle (30 degrees) in supine, 90/90 position facilitates traction force at L5-S1 in prone, angle of pull should be at 30 degrees from table to reach L5-S1 disc space

23. LUMBAR TRACTION POSITIONING Supine positioning - Tends to increase lumbar flexion Flexing hips from 45 – 60 DEGREE - increases laxity in L5-S1 segments Flexing hips from 60 – 75 DEGREE - increases laxity in L4-L5 segments Flexing hips from 75 – 90 DEGREE - increases laxity in L3-L4 segments Flexing hips to 90 DEGREE - increases posterior intervertebral space Prone Position - Used when excessive flexion of lumbar spine & pelvis or lying supine causes pain or increases peripheral symptoms

24. LUMBAR TRACTION SET-UP Calculate body weight Apply traction & stabilization harness Position on table, drape for modesty Set mode – intermittent or continuous Set ON:OFF ratio time Set duration Give patient Alarm/Safety switch Explain everything to patient prior to beginning treatment!

25. VIDEO

26. GENERAL TRACTION TREATMENT CONSIDERATIONS

27. Static vs. intermittent again, research is variable when it comes to best practices. In general: muscle relaxation: low load long duration stretch (static stretch) facet mobilization approach: short and equal on-off time (10 sec/10 sec) herniated disc diagnosis/dysfunction: longer on: off ratio (3:1)

28. TREATMENT TIME For acute disc herniation < = 8 minutes (increased treatment time may cause fluid to enter disc space, thus increasing intradiscal pressure. for chronic conditions, generally 20-25 minutes: treatment time will vary depending on patient response.

29. FREQUENCY proportional to acuity: More acute ---> more frequent

30. POSITIONAL TRACTION allows patients to position themselves with guidance and then independently in positions to decrease compression to affected foraminal or facet structures. for cervical traction: patient is instructed on how to position their head and neck to provide maximal decompression of involved structures for lumbar traction: patient is instructed on how to position their legs and trunk to provide maximal decompression of involved structures Position to maximally open facets forward flexion - contralateral side flexion - ipsilateral rotation Position to maximally open foramen: forward flexion - contralateral side flexion - contralateral rotation monitor for signs and symptoms of pain due to facet compression by prolonged positioning on the contralateral side

31. MANUAL TRACTION applied using a three-dimensional pulls by a therapist; joint specific traction is considered a more advanced technique in the cervical spine, therapist applies a manual pulling force at the occiput for decreasing muscle guarding in the lumbar spine, therapist applies a manual pulling force at the pelvis and/or lower extremities depending on symptoms and target tissue response. Warning: DO NOT attempt these techniques without direct instructor supervision

32. Positioning and draping Always position for patient comfort and drape as needed to assure only areas that need to be exposed to perform the techniques are out in the open.