Effects of Traction
types of disc herniation
stage 1: protrusion
stage 2: prolapse
stage 3: extrusion (nucleus pulpous breaks through annulus fibrosis)
stage 4: sequestered
Traction will provide pain relief for which types of disc herniation
protrusion
minor prolapse
Indications
Benefits of traction for HNP
Facet Impingement
Facet Hypomobility
argument against mechanical traction:
it is NON-SPECIFIC
DDD/DJD
Central Stenosis
Contraindications
Types of traction
Should r/o vertebral aretery issues – no dizziness or blurry vision by extension and sidebend to test circle of willis
Lumbar Facet motion
FLEXION: bilateral facets upglide = OPEN
SB: ipsilateral facets downglide (CLOSE), contralateral upglide (OPEN)
ROTATION: ipsilateral facet joints gap (OPEN), contralateral facet joints approximate (CLOSE)
static or intermittent?
Cyriax: static
Maitland: static
Saunders: intermittent or static
GENERAL RECOMMENDATIONS:
Lumbar Traction Position
Lumbar Traction Force
Lumbar Traction Belts
Lumbar Traction Duration/Frequency
Cervical traction Types
Cervical Traction Considerations
- may actually get joint compression if excessive muscle guarding
Cervical Traction Position
upper c-spine: neutral 0-5 deg mid cerv (c2-5): 10-20 deg * max separation at ~24 deg lower cerv (c5-7): 25-35 degrees --> flattens lordosis --> opens posterior articulations ---> widens intervertebral foramen, stretches posterior soft tissue
Cervical Traction Force
Cervical Traction Dosage
**Be aware of TMJ – best to use Saunders cervical traction device
Documentation of Tx
Type of traction: Int or static Treatment time Patient position Treatment parameters Patient response