Physics
Application of a mechanical distraction force along the long axis of the spine
Physiologic Effects
Physiologic Seperation of tissues
- Facet joint gapping with supine traction application
- Interverterbral foramin size increasses
- Intradiscal pressues reduce
- Increase diffusion of water into the disc and changes in disc height (Important because discs don’t have blood flow but are living tissues; Nutrients, Oxygen in, Waste products out
- Reduction of disc herniation (bulding of disc tissue)
- Increased joint mobility
Disc Injury
- Annulus Fibrosis breaks down, Nucleus pulposus slowly leaves
- Generally breaks down posterior laterally
- 4 Stages: Protrusion, Prolapse (tunneling), Extrusion (Fibrosus disrupted, Sequestration (Free nuclear material)
Radicular Pain
- Goes down limb
- Dermatomal distribution
- Thoracic radicular pain is rare
- Cervical and lumbar radicular are common
Physiologic Effect - Main
Pain modulation (May be secondary to tissue seperation/water diffusion, or secondary stimulus (creates sensation - gives relief))
- Centralization may occur (Goal)
- Should be quick relief
Centralization
Back pain dominant
What we want!! Good Prognosis
Peripheralization
Limb pain dominant
Ex: Leg Pain
After adjustment if occurs, likely spinal surgery required; poor prognosis
Indications for Traction
Specific criteria remain elusive
Most agreed upon indications include:
- Radicular symptoms (arm or leg)
- Positive neural tension and provocation tests (Reproduce radicular response)
- Relief of symptoms with manually applied traction
Not For Chronic Back Pain
Contraindications for Traction
- Acute Trauma
- Osteoporosis or osteopenia
- Chronic Steroid Use
- Rheumatoid Arthritis (Hypermobile in Cervical)
- Ankylosing Syndrome (Vertebrae are fused)
- Down’s Syndrome (Hypermobile, especially cervical)
- Systemic Joint Hypermobility
- Pregnancy (Due to Hormones, very flexible)
- Previous surgical stabilization or decompression
- Previous surgery with spinal implants/prosthetic discs
- Peripheralization with traction
Bone Meds also weaken bones, suggest against traction
Precautions for Traction
- Claustrophobia
- COPD or other respiratory disorders
- Dizziness, fainting and nausea have rarely been reported adverse effects
- Hypertension
Treatment Considerations - Parameters
Traction type: mechanical device (clinic or home), manual, positional
Why does seated traction not work?
- Doesn’t take enough pressure off
- Compresses TMJ (lead to jaw pain)
Why do manual traction? How long?
- 1-2 minutes
- Gives indication if traction gives patient relief
- Short term treatment
Positional traction
- Placing patient in a comfortable position that alleviates radicular symptoms
- Askj patient what does and doesn’t relieve their symptoms
Explain which side is alleviated
Right leg is side of radicular pain. Putting someone in this position allows for relief. Always have effected leg toward the ceiling
Treatment Considerations
Traction mode, Traction cycle, Position and Angle of Application, Traction Force, Traction Duration, Patient Education, Watch Patient, Delegation, Documentation, Home Units
Traction Mode
- Static: Pulls until specific length then holds; More consistent with seperation of facets
- Intermittent: Pulls till specific length, then relaxes, repeats; Tends to be more comfortable
Let patient comfort lead patient treatment
Traction Cycles
If intermittent:
- Tension: Rest Ratios (30s on:10 off common)
- Ascending/Descending steps
- Clinician discretion based on patient comfort
Position and Angle of Application
- 5 to 15 degrees of cervical flexion
- For lumbar (Supine, supine 90/90, prone, or laterally shifted
- Goal is centralization
Traction Force
Cervical
- Begin with 10 lbs initially, gradually work up to 25 lbs
- This may be during one visit or over a couple of visits
Lumbar
- Begin with 30-50% of body weight
- Do not exceed 100% of body weight
Traction Duration
- Generally 10 minutes, working up to 20 minutes
- Allow a few minutes of rest without tension before rising
Patient Education - Traction
- Uncomfortable stretch sensation
- Centralization is desirable, sometimes associated with increased central pain
- Should not be peripherlization, no dizziness
- Sometimes a rebound effect particularly on 1st treatment (Increase symptoms minutes to hours after)
- Consider severity/duration of rebound, distribution of symptoms and modify accordingly
Watch Patient
Patient observation - at 2-3 cycles
Emergency stop button for patients (IN HAND BEFORE YOU PRESS START)
- Call Mechanism
Delegation
Based on assistant experience and need for ongoing assessment
