THE SPINE-TRACTION PROCEDURES
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Objectives of the Lecture
At the end of the lecture the students will be able to:
Define spinal traction procedure.
Know the ultimate goals and effects of spinal traction.
Be oriented to the indications for spinal traction.
Recognize and define the different types of traction procedures.
Detail the modes of application of spinal traction.
Identify the limitations, precautions and contra-indications to spinal
traction application.
Understand cervical and lumbar traction techniques.
Know the general procedure for application of spinal traction.
Contents of the Lecture
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Introduction to spinal traction.
Effects of spinal traction:
Indications for spinal traction:
Definitions and description of traction:
types, modes of application (mechanical, manual, positional), jt. pain, m. spasm or m.
guarding.
Limitations of spinal traction.
Contraindications of spinal traction.
Precautions to spinal traction application.
Cervical traction techniques: Positional, mechanical, home traction, self-traction.
Lumbar traction techniques: Positional, mechanical, home traction, self-traction.
Summary on general application procedures.
Definition
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Spinal traction means drawing or pulling
on the spinal column (vertebral column).
Effects of Spinal Traction
1.
Mechanical elongation of spine → widens the
intervertebral foramina.
2.
Zygopophyseal (facet) joint mobilization.
3.
Muscle relaxation
a. relaxation →↓ pain from m. spasm or guarding
b. → greater vertebral separation.
4.
Reduction of pain.
1.Mechanical Elongation of The Spine
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Factors influencing amount of vertebral separation
1. Spinal position.
- Flex → post aspect separation of vertebrae.
2. Amount of force.
- 7% body wt for cervical traction.
- 50% body wt for lumbar traction.
If less no inefficient, if more lead to trauma.
3. Comfort & relaxation.
- → greatest vertebral separation.
4. 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.
2. Zygapophyseal (facet) Joint
Mobilization
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Traction →
Compress, or
2. Approximate,
3. Slide, or
4. Translate facet surfaces.
1.
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Factors influencing direction of facet surfaces mov.:
1.
Flexion & longitudinal traction
2.
Side bending of spine
3.
Rotation of spine
3. Muscle Relaxation
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Relaxation
→↓ pain from m. spasm → greater vertebral separation.
→↓ pain from m. guard
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→ greater vertebral separation.
Factors influencing amount of relaxation:
a.
Pt. position:
To feel secure & well supported, many pts reported feeling more relaxed in supine than
sitting for cervical traction.
b.
Duration of traction:
After 7: 20-25 mins traction is necessary for m. relaxation.
b.
Force:
M. relaxation can be achieved at levels < those needed for mechanical separation
(only 4.5 : 6.5 kg max.) for cervical spine.
b.
Spinal position:
A lesser angle of pull → greater relaxation.
4. Reduction of Pain
A. Mechanical effects:
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Movement →↑ circulation. &
→↓ concentration of noxious chemical irritants.
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Vertebral separation
→ temporary ↑ intervertebral foramina size, which
→↓ pressure on impinged n. root.
B. Neurophysiologic effects:
1.
Mechanoreceptor stimulation
→ block nociceptive transmission at spinal cord or brain stem
level.
2.
Inhibition of reflex m. guarding
→↓ discomfort from contracting muscles.
Factors Influencing Amount of Pain
Reduction
1.
Patient position.
The pt should be positioned for comfort & ease of application.
1.
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.
3.
Force & duration.
A. Acute stage:
Only use low intensity oscillations, for a short period.
B. Subacute & chronic stage:
Progressively↑ amount o force & duration depending on patient tolerance.
Types of Application of Traction
Constant:
A steady force is applied & maintained for an extended time.
A. Continuous
- A static force is maintained for several hours : days.
Often it is applied in bed, small amount of wt. is tolerated .
- Usually for immobilization.
B. Sustained:
- A static traction in which the force is maintained from a few minutes up
to one-half hour.
- 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
Modes of Application
1.
Mechanical
Various types of equipments are available for
hospital, clinic or home use.
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.
Indications
1.
Spinal nerve root impingement from:
A. herniated nucleous pulposus.
B. spinal or foraminal stenosis caused by spondylosis, edema &
spondylolisthesis.
2.
Joint hypomobility due to:
A. dysfunction
B. degenerative changes.
3.
Symptomatic facet joints pain.
4.
Muscle spasm.
5.
Diskogenic pain & Post-compression #.
Contraindications
1.
Acute back strains, sprains & inflammations
aggravated by initial traction treatment.
2.
Rheumatoid arthritis of cervical spine where
necrosis of supporting ligaments → instability & subluxation
or dislocation of a vertebra with spinal cord damage.
3.
Any spinal condition or disease in which
movement is contra-indicated.
(TB, severe osteoporosis, malignancy, #)
Precautions
Osteoporosis.
2. Patients using dentures shouldn’t remove it as
1.
→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.
General Procedures
Determine appropriateness for choice of traction
by testing with manual traction at first.
- If the traction test relieved or reduced
the symptoms, an initial treatment 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.
3. Position the pt for maxemum. comfort & relaxation.
4. Determine duration of traction.
5. Apply safety roles for mechanical traction.
– Use ropes that are in good repair.
– Secure the equipment to not to move when the traction
force is applied.
- Check the traction dial is turned to zero before & after
treatment.
- Periodically check the traction calibration.
- Use disposable tissues, gauze & halters.
– Never leave the patient alone while receiving traction unless
he/she has some means to signal for help.
Cervical Traction Techniques
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Manual Traction
1.
Position of pt:
supine, relaxed as possible on treatment table.
2.
Position of PT:
stand at the head of ttt table & support wt of pt head in
his hands.
3.
PT hand placement:
Mechanical Traction
.
Position of patient head is determined by:
Evaluation as well as the condition being treated.
– To obtain maxemum posterior separation of the vertebrae,
the head should be positioned in flexion up to 35°.
- To obtain greater muscle 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 of the pt comfortably.
- The major 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.
- Don’t remove dentures if the pt. wears them as stress may be placed on TMJs.
- Eye glasses should be safely set aside.
5. Attach the halter to the spreader bar of the unit;
check that the pt. is aligned for proper pull.
6. Set controls:
- The traction 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 shouldn’t exceed
10-15 pounds.
- Progression of dosage at succeeding ttts will depend on the
goals & pt’s reaction.
8. Treatment duration:
- May be from 10-30 mins for sustained or intermittent traction,
depending on the pt’s condition & ttt goals.
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 pt’s condition:
- Be sure he doesn’t feel dizzy or nauseated before
leaving the ttt area.
12. If the pt complains of headache, nausea, fainting or ↑
symptoms during or following ttt:
-a. Reduce the wt. ,or,
b. ↓ length of ttt time at the next visit, or
c. discontinue ttt.
Lumbar traction techniques
Manual Traction
1.
It isn’t easy as in cervical region because at least
½ body wt. must be moved & the
coefficient of friction of the part to be moved must be
overcomed.
2.
Pt. position: supine on treatment table.
PT position: varies with position of patient‘s hips & LL
– With the LL extended & lumbar in extension,
the PT can exert a pull at the ankles.
3.
– With the hips flexed 9o° & lumbar spine flexed,
the pt’s legs are draped over PT’s shoulders.
The PT then exerts the force with his/her arms wrapped
across the pt’s thighs
When manual traction is used for evaluation:
- Vary the amount of flex, ext & side bending
& note the pt’s response.
5. During ttt:
- Use spinal position that best ↓ the S&S.
6. PT must use his entire body wt to ↑ effect of traction force:
- Place the patint on a split traction table to ↓ friction.
- When applying a high-dosage traction force, the thorax is
stabilized.
Put a counter-traction belt around pt’s 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 the table & holding onto
pt’s arms.
II. Mechanical Traction
1.
Be familiar with the unit available by reviewing
the manufacturer’s 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 body’s wt.
2.
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
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,
pt’s 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 pt’s abdomen.
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 only’ll 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
a. Be familiar with the type of unit.
b. If the unit has off-on timers for intermittent traction,
set them for the desired time intervals.
c. Set ttt duration. It may be up to 30 mins for most units.
It depends on the goals, pt’s condition & reaction to
traction.
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 hasn’t 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:
a.
Turn all controls off & turn indicators back to zero.
b.
Lock the split of the table before the pt. attempts to get
off.
c.
Re-evaluate the pt; note any changes in S, S & ROM.
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 pt’s condition:
- Be sure he doesn’t feel dizzy or nauseated before
leaving the ttt area.
12. If the pt complains of headache, nausea, fainting or
↑ symptoms during or following ttt:
-a. Reduce the wt. ,or,
-b. ↓ length of ttt time at the next
visit, or
-c. discontinue ttt.
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