TRACTION includes lumbar and cervical traction

traction

1. SPINAL TRACTION - Dr.Dharani Mavuru [MPT Ortho]

2. TRACTION 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. 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 Based on the Methods of Application There are several methods of delivering traction to patients Manual traction Mechanical traction Motorized traction Positional traction

4. 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. MOTORIZED TRACTION: Only the motorized which is powered by electricity and mostly used by the physiotherapists for the treatment of spinal disorders

5. 3. POSITIONAL TRACTION : Positional traction is a type of traction that involves placing the patient in various positions using pillows, blocks, or sandbags to effect a longitudinal pull on the spinal structures

6. BASED ON NATURE OF PULL: Continuous traction: Continuous spinal traction is applied for several hours requiring only small amounts of weight. It’s an uncomfortable mode of traction where in 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 INTERMITTENT MECHANICAL TRACTION: Traction is applied alternatively and withdrawn through a mechanical device.

7. CONTRAINDICATIONS Osteomyelitis or diskitis Bone/spinal cord tumor Unstable fracture Severe osteoporosis Hypertension Cardiovascular disease Cervical traction • Central intervertebral disk herniation • Carotid or vertebral artery disease • Hypermobility • Rheumatoid arthritis. Lumbar traction • Pregnancy • Cauda equina compression • Cord sign.

8. PRECAUTIONS 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

9. 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

10. 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.

11. 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

12. CERVICAL TRACTION

13. INTRODUCTION Application of a longitudinal force to the C-spine & structures 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 1/7 of body weight

14. PHYSIOLOGICAL EFFECTS Increasing vertebral separation Reducing cervical muscle activation Reducing nerve conduction disturbances Increases reflex arc strength Increasing blood flow Restoring cervical lordosis

15. 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

16. ANGLE OF PULL R esearch is variable regarding the ideal angle of pull G eneral 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

17. 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

18. CERVICAL TREATMENT SET-UP Remove any jewelry, glasses, or clothing that may interfere Lie in 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 On: Off sequence 3:1 or 4:1 ratio

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.  T he force applied for lumbar traction is or 1/3 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. 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

23. 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!

24. GENERAL TRACTION TREATMENT CONSIDERATIONS

25. Static vs. intermittent A gain, research is variable when it comes to best practices. In general: M uscle relaxation: low load long duration stretch (static stretch) F acet mobilization approach: short and equal on-off time (10 sec/10 sec) H erniated disc diagnosis/dysfunction: longer on: off ratio (3:1)

26. TREATMENT TIME For acute disc herniation < = 8-10 minutes (increased treatment time may cause fluid to enter disc space, thus increasing intradiscal pressure. F or chronic conditions, generally 20-25 minutes: Tr eatment time will vary depending on patient response.

27. 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.