Spinal Traction

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Spinal traction
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Definition

• Spinal traction means drawing or pulling on the
  spinal column
• (vertebral column).

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Effects of Spinal Traction

• Mechanical elongation of spine
  (mechanical separation of
  vertebrae ?
• widens the intervertebral foramina).
• 2. Zygopophyseal (facet) joint mobilization.
• 3. Muscle relaxation
  greater vertebral
  separation ? relaxation
• ?? pain from m. spasm or guarding
• 4. Reduction of pain.

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1.Mechnical elongation of the spine

• Factors influencing amount of vertebral
  separation
• a) Spinal position.
  
  - Flex ? post aspect separation of
  vertebrae.
• b) Amount of force.
  
  - 7 body wt for cervical traction.
  - 50 body
  wt for lumbar traction.
• c) Comfort relaxation.
  - ? greatest
  vertebral separation.
• D) Angle of pull.
  
  - In cervical flex 35? greatest post.
  separation. - In lumbar,
  harness pull from the post aspect pelvis rather
  than from the sides ? spine flexion.

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2. Zygapophyseal (facet) joint mobilization

• Traction ?
• Compress, or
• Approximate,
• Slide, or
• Translate facet surfaces.
• Factors influencing direction of facet surfaces
  mov.
• Flexion longitudinal traction? slide facet
  surfaces.
• Side bending of spine ? slide facet surfaces on
  convex side. Adding longitudinal traction ?
  stretch facet surfaces on concave side.
• Rotation of spine ? distract facet surfaces on
  the side toward which the body of the superior
  vertebra is rotating compress on the opposite
  side.

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3. Muscle relaxation

• Factors influencing amount of relaxation
• Pt. position
  
  To feel secure well
  supported, many pts reported feeling more relaxed
  in supine than sitting for cervical traction.
• Duration of traction
  
  20-25 mins traction is necessary for m.
  relaxation.
• Force
  
  M. relaxation can be achieved for
  cervical spine.
• by mechanical separation (only 4.5 6.5
  kg max.).
• Spinal position
  
  A lesser angle of pull ? greater
  relaxation.

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4. Reduction of pain

• A. Mechanical effects
• Movement ?? circulation
  
  ?? concentration of noxious chemical
  irritants.
• Vertebral separation
  
  ? temporary ? intervertebral foramina
  size, which ??
  pressure on impinged nerve root.
• B. Neurophysiologic effects
• Mechanoreceptor stimulation
  
  ? block nociceptive stimuli
  transmission at spinal
  cord or brain stem level.
• Inhibition of reflex m. guarding
  ??
  discomfort from contracting ms.

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Factors Influencing Amount of Pain Reduction

• Patient position.
  The patient
  should be positioned for comfort ease of
  application.
• Spinal position.
  A.
  Acute stage Usually the involved spinal segment
  is positioned in a (slack) pain free
  position.
  
• B. Subacute chronic stage Usually
  the involved
• spinal segment is
  positioned in a stretched
• position.
• Force duration.
  A.
  Acute stage Only use low intensity oscillations
  
  (no stretch) for a short period.
  B.
  Subacute chronic stage Progressively
  
  ? amount o force
  duration depending on
• patient tolerance.

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Types of application of traction

• Constant (static)
  
  A steady force is applied maintained
  for an
• extended time.
• A. Continuous (prolonged)
  - A static
  force is maintained for several hours or days
• Often it is applied in bed, small
  amount of wt. is
• tolerated .Usually for
  immobilization. (mechanical)
• 
  
  B. Sustained
  
  - A static traction
  in which the force is maintained
• from a few minutes up to one-half
  hour. (manua or mech.)
  - It
  is useful as a prolonged stretch to spinal
  structures.
• Intermittent
  
  - The force is alternately
  applied released at frequent
• intervals, with greater forces
  than sustained traction.
  
  - Usually in a rhythmic pattern.
  (preferred mech.)

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Modes of application

1. Mechanical
   Various types of equipments are
   available for hospital, clinic or home use.
   (objective way)
2. Manual
   Through positioning handling, the
   PT applies traction force to the desired spinal
   segment.
3. Positional
   Through positioning, a
   sustained force on specific segment of spinal
   column can be obtained.

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Indications

• Spinal nerve root impingement from
  
  
  A. herniated
  nucleous pulposus.
  B. spinal or foraminal stenosis caused
  by spondylosis, edema
  spondylolisthesis.
• Joint hypomobility due to
  
  
  A.
  dysfunction
  B.
  degenerative changes.
• Symptomatic facet joints pain.
• M. spasm.
• Diskogenic pain Post-compression .

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Contraindications

1. Acute strains, sprains inflammations aggravated
   by initial traction ttt.
2. Rheumatoid arthritis of cervical spine where
   necrosis of supporting ligs ? instability
   subluxation or dislocation of a vertebra with
   spinal cord damage.
3. Any spinal condition or disease in which movement
   is contra-indicated. (TB)

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Precautions

1. Osteoporosis.
2. Patients using dentures shouldnt remove it as
   ?TMJ is forced into an abnormal resting pos.
   can be traumatized with pressure from the
   chinstrap.
3. Patients with respiratory problems.
4. TMJ pain may be provoked with using cervical
   halter, especially when the chinstrap places a
   lot of force on the mandible, so manual traction
   can be applied in this case.

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General procedures

• 1. Determine appropriateness for choice of
  traction by testing with manual traction at
  first.
  
• - If the traction test relieved or
  reduced the symptoms, an initial ttt is
  given.
  
• - If the traction test aggravates the
  symptoms, traction ttt should probably
  not applied.
• 2. Determine if manual, positional or mechanical
  traction will be used.

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• 3. Position the pt for max comfort
  relaxation.
• 4. Determine duration of traction.
• 5. Apply safety roles for mechanical
  traction.
• 
  
  Use ropes that are in
  good repair.
• 
  
  Secure the
  equipment so it will nt move when the traction
  force is applied.
• - Check the poundage dial is turned to zero
  before after ttt.
• - Periodically check the poundage calibration.
  
• - Use disposable tissues, gauze halters.
• 
  
  Never leave the
  pt. alone while receiving traction unless he/she
  has some means to signal for help.

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Cervical traction techniques

• Manual traction
• Position of pt
  
  supine, relaxed as possible on ttt table.
• Position of PT
  
  stand at head of ttt table, support wt of pt head
  in his hands.
• PT hand placement.

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• Hand placement depends on comfort. Either
• - place both hands fingers under the
  occiput.
• - place one hand over frontal region
  other hand under occiput.
• - place index fingers around spinous
  process above the vertebra to be moved.
• 
  
• This hand placement provides a specific traction
  to the vertebral segments below the level where
  fingers are placed.
• A belt around the PT hips can be used to
  reinforce the fingers ? ease of traction force
  application.

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• 3. When manual traction is used for evaluation,
  - vary the
  pts head pos in flex, ext, side bending
  with rotation apply a
  traction in each pos
  - note the pts
  response.
• 4. When administering ttt,
  
  - use the pos that most effectively ? or relieves
  symptoms.
• 5. The PT applies the force by
  - fixing
  his arms isometrically, assuming a stable
  stance then leaning backwards in a controlled
  manner.
  
  - If a belt is used ? the force is transmitted
  through the belt.

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• 6. The force is usually applied intermittently,
  with a smooth gradual building releasing of the
  traction force.
• The intensity duration are usually
  limited by the PT strength
• endurance
• 7. Value of manual traction
• Angle of pull head pos. can be controlled by
  the PT.
• By placing the index fingers around specific
  spinous processes, the level of traction can be
  controlled to some degree.
• No stress is applied on the TMJ as is frequently
  done in mechanical traction.

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II. Mechanical traction

• Review the manufacturers directions of the
  machine to become familiar with the available
  traction unit.
• Position the pt. for comfort
  
  A. Sitting
  
  - Uses less clinical space
  but requires more force to
  overcome m tension obtain greater separation
  than supine lying.
  
  - Use a
  comfortable chair with arm rests or place a
  pillow on the pts lap for the
  arms to rest on.
  
  - Chair
  height should support the thighs allow the feet
  to rest comfortably on the floor
  or on a foot stool.
• B. Supine
• - Requires less force to overcome m. tension
  than sitting.
• - Tends to ? lordotic curve by the force of
  gravity on vertebrae.
• - Support the pt. with pillows for max.
  comfort.
• c. semi-reclining

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• 3. Position of patient head is determined by
  
• evaluation as well as the condition being
  treated.
• To obtain post. separation of the vertebrae,
  
  the head should be positioned in flexion up to
  35.
• - To obtain greater m relaxation,
  
  position the head closer to neutral.
• 4. Apply the head halter.
• First, line the head halter with gauze or
  tissue.
• Adjust the halter to fit the chin to The
  major fit the pt comfortably.
  
  traction force must be against the occiput
  not the chin, to ? compression of TMJ.
• Gauze may be placed between the teeth or
  padding under the chin to absorb pressure.
• Dont remove dentures if the pt wears them
  as stress may be placed on TMJs.
• Eye glasses should be safely set aside.

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• 5. Attach the halter to the spreader bar of the
  traction unit
  
  
  check that the pt is aligned for proper pull.
• 6. Set controls
  
  - The poundage dial should be
  set at zero before activating the unit.
  
  
  - If the unit has off-on timer for intermittent
  traction, suggested starting intervals are 30
  seconds on,
  30 secs off, or 1 min on, 30 secs off.
• 7. Activate the unit gradually ? traction
  force
  - To avoid ttt soreness the 1st ttt
  poundage shouldnt exceed 10-15
  pounds.
  
  - Progression of dosage at succeeding ttts will
  depend on the goals pts reaction.
• 8. Treatment duration
  
  - May be from 10-30 mins for sustained
  or intermittent traction, depending on the
  pts condition ttt goals.

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• 9. Demonstrate to the pt how to turn off the unit
  
• - if his symptoms get worse.
• 10. At the end of the ttt
  
• - Turn all controls off turn dial indicators to
  zero.
• - Remove the halter from the spreader bar.
• Then remove the head halter.
• 11. Re-evaluate the pts condition
  
• - Be sure he doesnt feel dizzy or before
  leaving the ttt area.
• 12. If the pt complains of headache, nausea,
  fainting or ? symptoms during or following ttt
  
• - Reduce the wt or length of ttt time at the next
  visit or discontinue ttt.

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Lumbar traction techniques

• Manual traction
• It isnt easy as in cervical region because at
  least ½ body wt. must be moved
  coefficient of friction of the part to be moved
  must be overcome.
• Pt. position supine on ttt table.
• PT position varies with pos of pt hips LL
  
• With the LL extended lumbar in
  extension, the
  PT can exert a pull at the ankles.
  With the hips
  flexed 9o lumbar spine flexed,
  the pts legs are draped over PTs
  shoulders.
  
  The PT then exerts
  the force with his/her arms wrapped across the
  pts thighs

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• 4. When manual traction is used for evaluation
• - Vary the amount of flex, ext side bending
  
• note the pts response.
• 5. During ttt
• - Use spinal pos. that best ? the SS.
• 6. PT must use his entire body wt to ? effect of
  traction force
• - Place the pt on a split traction table to ?
  friction.
• - When applying a high-dosage traction force,
  the thorax is stabilized. Put a counter-traction
  belt around pts rib cage secure it to the head
  end of the table, or have a second person to
  stabilize the pt by standing at the head end of
  table holding onto pts arms.

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II. Mechanical traction

• Be familiar with the unit available by reviewing
  the manufacturers
  operating instructions.
  
  
  The most effective traction is applied via
  a split-traction table, as eliminating the need
  to overcome the coefficient of friction of half
  of the bodys wt.
• Apply traction counter-traction harness (belt)
  
• - traction harness is applied over the
  skin above pelvis ? upper part is secured
  above the iliac crest.
• - counter traction harness is attached
  around lower rib cage ? keep pt. from slipping.

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• 3. Position the pt either supine or prone
• 
  
  - Thorax
  should be on the stationary part of the
  table pelvis on the movable
  one so
  lumbar spine is positioned
  over the split of the table.
• - Whether the spine in flex or ext is determined
  by evaluation, pts comfort the condition as
  well as ttt goal.
• - To obtain posterior separation of the
  vertebrae,
  the lumbar spine should be flexed
  (flattened)
• a. when supine, hips are flexed thighs
  rest on a padded stool.
• b. when prone, several pillows are placed
  under the pts abdomen.

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• 4. Attach the anchor straps
• a. The counter-traction or stabilizing harness is
  secured to the
  end of the traction table.
• b. The straps from traction harness may attach to
  a spreader bar attached to the traction rope.
• If unilateral traction, one anchor onlyll
  be attached to traction rope.
• c. Check that the pt. is aligned for proper pull
  then take all the slack out of the straps.
• 5. Set the controls
• Be familiar with the type of unit.
• If the unit has off-on timers for intermittent
  traction,
  set them for the desired time intervals.
• Set ttt duration. It may be up to 30 mins for
  most units. It
  depends on the goals, pts condition reaction
  to traction.

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• 6. Unlock the split traction table
  
  - so it will separate when the unit is activated.
• 7. Activate the unit gradually ? the force
  
• (if the unit hasnt been pre-programmed to do
  so automatically).
• 8. Demonstrate to the pt how to turn off the unit
  
• - if his symptoms worsen while the unit is on.
  Make sure he has a signaling device to call for
  help if necessary.
• 9. At the end of the ttt
• Turn all controls off turn indicators back to
  zero.
• Lock the split on the table before the pt
  attempts to get off.
• Re-evaluate the pt note any changes in S, S
  ROM.

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