Transcript Spinal traction

Spinal Traction
Salman Farooqi
Lecturer
IPM&R, KMU
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
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

Effects of Traction: Spine


pain, paresthesia, or tingling
Due to physical separation of vertebral
segments thus decreasing pressure on
sensitive structures
Effects of Traction: Spine

As long as positive physiological
effects occur, traction should
be continued
Effects of Traction: 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

Effects of Traction: Discs
Normal disc in non-compressed position
 Internal pressure (indicated by arrows) is
exerted equally in all directions
 Internal annular fibers contain nuclear
materials

Effects of Traction: Discs
In an injured disc, sitting or standing
compresses the disc causing the nucleus
to become flatter
 Pressure in this instance still remains
relatively equal in all directions

Effects of Traction: Discs

In an injured disk, movement in weightbearing causes a horizontal shift in nuclear
material
Effects of Traction: Discs
Herniation of the nuclear material occurs if
the annular wall becomes weak
 Herniation may possibly put pressure on
sensitive structures in the area

Effects of Traction: Discs


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
Effects of Traction: 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
Effects of Traction: Articular
Facet Joints

Increased proprioception from facet
joint structures provide sensation of
pain relief
Effects of Traction: Muscles

Vertebral muscles can be stretched

Initial stretch should come from body
positioning
Stretch lengthens tight muscle
 Allows for better muscular blood flow

Effects of Traction: Muscles

Activates muscle proprioceptors
providing sensation of pain relief

Gate Control Theory
Effects of Traction: Nerves

Focus of most traction treatments

Pressure on nerves or nerve roots often
associated with spinal pain
Effects of Traction: Nerves

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

Traction Treatment
Techniques

Lumbar Positional Traction


Inversion traction
Manual Lumbar Traction
Level-specific
 Unilateral leg pull

Traction Treatment
Techniques
Mechanical Lumbar Traction
 Manual Cervical Traction
 Mechanical Cervical Traction

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
Side-lying Position: Unilateral
Foramen Opening

Lateral Herniation




Patient leaning away
from painful side
Lie painful side up
Lie on over blanket roll
Medial Herniation



Patient leaning toward
painful side
Lie painful side down
Lie over blanket roll
Side-lying Position: Unilateral
Foramen Opening
Side-lying with a
blanket roll between
iliac crest and rib
cage
 Increases
intervertebral
foramen size

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
Supine Position: Bilateral
Foramen Opening
Knees to chest
position
 increases size of
lumbar
intervertebral
foramen bilaterally
 Separation of
spinous processes

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

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

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

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

Unilateral Leg Pull Manual
Traction




Sacroiliac problems
strap is placed through
groin and secured to
table
Hold ankle and move
hip into 30o flexion and
15o abduction
Apply steady traction
force
Mechanical Lumbar Traction:
Equipment


Use split table to eliminate friction between body
segments
Non-slip traction harness stabilizes trunk
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
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

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

Mechanical Lumbar Traction:
Body Positioning
Extension
 Closes foramen
because bony
arches come
closer together

Mechanical Lumbar Traction:
Body Positioning




Prone position
Used with normal to
slightly flattened lumbar
lordosis
Best for disk protrusions
Place pillows under
abdomen
Mechanical Lumbar Traction:
Body Positioning



Supine position
Produces posterior intervertebral separation
Optimal at 90o hip flexion



Scoliosis,
Unilateral joint
dysfunction, or
Unilateral lumbar
muscle spasm
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
Intermittent vs. Sustained
Traction

Intermittent Traction


Effective for posterior intervertebral
separation
Sustained Traction

Recommended for disk protrusion and
rupture
Progressive and Regressive
Steps

Progressive mode
Increases traction force in a pre-selected
number of steps
 Allows slow accommodation to traction


Regressive mode


Decreases traction force in a pre-selected
number of steps
Patient comfort is primary consideration!
Manual Cervical Traction
Stretches muscles and joint structures
 Enlarges intervertebral spaces and
foramen
 Creates centripetally directed forces on
disk and surrounding soft tissue

Manual Cervical Traction
Mobilizes vertebral joints
 Increases joint proprioception
 Relieves compressive effects of
normal posture
 Improves arterial, venous, and
lymphatic flow

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
Mechanical Cervical Traction




Supine
Neck flexed 20 - 30o
Traction harness pulls on
occiput
Intermittent pull



.

> 20 pounds
Minimum of 7 seconds
Adequate rest time for
recovery
Treatment time, 20 - 25 min
Mechanical Cervical Traction

Wall-mounted device


Static traction most easily
employed




Inexpensive
Use weight plates, sand bags, or
water bags
Sitting or prone
Gentle pull, 10 - 20 pounds
Treatment time, 20 - 25 min
Indications for Spinal Traction






Nerve root
impingement
Disk herniation
Spondylolisthesis
Narrowing within
intervertebral foramen
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
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