Spinal Traction

Question 1

What is spinal traction?

Answer 1

A mechanical force applied to the body that separates the joint surfaces and elongates surrounding soft tissues.

Question 2

Different Types of Spinal Traction = ?

Answer 2

Different Types of Spinal Traction - Lumbar Traction:

1) Mechanical

• Static
• Intermittent

2) Inversion

3) Self-Traction/Positional

4) Manual

Question 3

Mechanical Traction

Advantages & Disadvantages = ?

Answer 3

Mechanical Traction:

- Advantages:

• Force & time well controlled
• Readily graded
• Replicable
• Does not require constant clinician attention
• Static or intermittent traction

- Disadvantages:

• Expensive
• Time-consuming to set up
• Lack of patient control or participation
• Restriction by belts poorly tolerated by some patients
• Mobilizes broad region rather than specific spinal segments

Question 4

Manual Traction

Advantages & Disadvantages = ?

Answer 4

Manual Traction:

- Advantages:

• Minimal equipment required
• Short set-up time
• Force can be finely graded
• The clinician is present throughout the treatment
• Trial: Can be applied briefly, before mechanical traction, to determine if mechanical traction will be tolerated
• It can be used with patients who do not tolerate tight belts

- Disadvantages:

• Limited maximum traction force
• Amount of traction force cannot be easily replicated or specifically recorded
• Cannot be applied for a prolonged period of time
• Required a skilled clinician to apply
• Can be labor intensive for PT

Question 5

Traction - Precations = ?

Answer 5

Traction - Precations:

i) Structural diseases affecting the spine

• Tumor, Infection, Osteoporosis,
• Prolonged systemic steroid use

ii) When pressure from belts may be hazardous

• Pregnancy, Hiatal hernia, Vascular compromise, Osteoporosis

iii) Displacement of annular fragment

• Traction will not change the position of the fragment

iv) Medial disc protrusion (see next slide for details)

v) When severe pain fully resolves with traction

• Increased compression on nerve root can cause complete nerve block

vi) Claustrophobia or psychological aversion

vii) Inability to tolerate prone or supine positions

viii) Disorientation

ix) TMJ problems or dentures (for cervical traction)

Question 6

What are the physiological effects of spinal traction?

Answer 6

• Distracts joint surfaces
• Stretches soft tissues,
• Reduces disc protrusions,
• Relaxes muscles.

Question 7

What are the clinical indications for using spinal traction?

Answer 7

Back or neck pain with or without radicular symptoms, caused by disc bulge or herniation, and nerve root impingement.

Question 8

What are the contraindications for spinal traction?

Answer 8

• Unstable fractures
• Cord compression
• Fused vertebrae
• Acute injury or inflammation
• Joint hypermobility or instability
• Uncontrolled hypertension

Question 9

How does mechanical traction differ from manual traction?

Answer 9

Mechanical traction allows for controlled force and timing, whereas manual traction requires a skilled clinician and cannot be easily replicated or prolonged.

Question 10

What are the benefits of inversion traction?

Answer 10

Minimal equipment needed, easy for the patient to perform, and can be done in various environments.

Question 11

Types of Cervical Traction = ?

Answer 11

• Mechanical
• Manual
• Wall mounted or “over the door” traction units
• Other home units (Saunders)

Question 12

What is the primary mechanism proposed for traction reducing herniated nucleus pulposus (HNP)?

Answer 12

Reduction of disc protrusion, thus relieving compression on spinal nerves.

Question 13

What specific settings are recommended for lumbar spine traction to address disc problems?

Answer 13

• 25% of body weight
• 60 seconds hold / 20 seconds relax
• 20-30 minutes

Question 14

What parameters are advised for cervical spine traction during the acute phase?

Answer 14

• 7-9 lbs force
• Static
• 5-10 minutes

Question 15

What should be assessed before applying spinal traction?

Answer 15

• Type of traction
• Patient position
• Traction force
• Duration and frequency of treatment
• Patient’s response.

Question 16

Prone mechanical traction signs of nerve root compression = ?

Answer 16

(1) Peripheralization with repeated lumbar extension

(2) Positive crossed SLR

Question 17

What are the adverse effects of spinal traction?

Answer 17

Increased symptoms with high-force treatments, rebound pain increases, and potential lumbar radiculopathy from cervical traction.

Question 18

How should traction force be adjusted for initial treatments?

Answer 18

Start with low force and monitor the patient’s response.

Question 19

What are some examples of when traction might be contraindicated due to joint-related issues?

Answer 19

In cases of Down’s syndrome and rheumatoid arthritis due to joint instability.

Question 20

Why must traction parameters be carefully selected?

Answer 20

Incorrect parameters can aggravate symptoms, lead to discomfort, or fail to provide therapeutic benefits.

Question 21

What is the significance of the study on traction for low-back pain with or without sciatica?

Answer 21

It showed that traction may have little or no impact on pain intensity, functional status, or global improvement.

Question 22

What are some practical recommendations for patients undergoing traction?

Answer 22

Avoid heavy meals before treatment, empty bladder, and ensure correct positioning.

Question 23

What should be documented after a traction session?

Answer 23

• Type of traction
• Area treated
• Patient position
• Type of halter or belt used
• Maximum force applied
• Total treatment time
• Patient’s response

Question 24

What is the contraindication of spinal traction in cases of structural diseases affecting the spine?

Answer 24

Structural diseases like tumor, infection, osteoporosis, and prolonged systemic steroid use are contraindications.

Question 25

What parameters are recommended for lumbar traction to decrease muscle spasm?

Answer 25

* 5 sec. hold / 5 sec. relax * typically lasting 20-30 minutes

Question 26

For which conditions is spinal traction contraindicated due to potential for increased symptoms?

Answer 26

Unstable fracture, cord compression, recent spinal surgery, or fused vertebrae.

Question 27

What precautions should be taken when applying spinal traction in patients with vascular compromise?

Answer 27

Ensure that pressure from belts is not hazardous, especially in conditions like pregnancy or hiatal hernia.

Question 28

What is a key precaution when using cervical traction to avoid increasing pain?

Answer 28

Avoid using high-force traction as it may cause rebound increase in pain and other complications.

Question 29

What are the recommended settings for intermittent lumbar traction to treat disc problems?

Answer 29

* 25% of BW * 60 sec. hold / 20 sec. relax * 20-30 min.

Question 30

Why is it crucial to monitor a patient's response to traction therapy?

Answer 30

To adjust traction settings based on individual tolerance and prevent adverse effects like increased pain or discomfort.

Question 31

What specific traction setting is recommended for soft tissue stretching in the **cervical** region?

Answer 31

* 11-15 lbs force * 60 sec. hold / 20 sec. relax * 20-30 min.

Question 32

When is traction considered contraindicated due to peripheral symptoms?

Answer 32

When traction causes peripheralization of symptoms, indicating potential worsening or improper force application.

Question 33

What is a precaution for traction usage in patients with joint hypermobility or instability?

Answer 33

Traction is contraindicated in conditions like **Down’s syndrome** and **rheumatoid arthritis** due to joint instability.

Question 34

What clinical signs suggest traction should be reconsidered for a patient?

Answer 34

If symptoms are aggravated by joint loading or relieved by distraction, careful evaluation and adjustment of traction are necessary.

Question 35

What precaution should be taken for patients with disc protrusion during traction?

Answer 35

Traction should not be applied if there is a displacement of an annular fragment as it will not alter the fragment's position.

Question 36

What are the implications of using traction in patients with spondylolisthesis?

Answer 36

Traction is **contraindicated** as it may worsen the condition by further displacing the vertebrae.

Question 37

What is Spondylolisthesis = **?**

Answer 37

**Spondylolisthesis**: * Slippage of one vertebrae on another due to fracture of pars interarticularis * There is a grade 5 = complete dislocation of the spine * Surgery for spinal fusion is indicated for grades 3, 4 and 5

Question 38

How does traction impact patients with acute injury or inflammation?

Answer 38

Traction is **contraindicated** in acute conditions as it may exacerbate pain and inflammation.

Question 39

What are the guidelines for traction force during the treatment of joint hypomobility?

Answer 39

For patients with segmental hypomobility, **manual techniques** are preferred over mechanical traction.

Question 40

What is the best practice for applying traction to patients with cervical issues?

Answer 40

* Increased flexion focuses forces on the lower cervical area * Neutral / Extension focuses on the upper cervical area

Question 41

What guidelines should be followed for patients undergoing traction to minimize risk?

Answer 41

Patients should be instructed to empty the bladder and avoid heavy meals prior to traction to ensure comfort and safety.

Question 42

How should traction be adjusted for patients who experience severe pain resolution during the session?

Answer 42

If severe pain resolves completely with traction, it may indicate an increased compression on nerve roots, requiring adjustment of force.

Question 43

What are the contraindications for traction based on specific spinal conditions?

Answer 43

Conditions such as medial disc protrusion, where traction may increase nerve root impingement.

Question 44

What factors should be documented after applying spinal traction?

Answer 44

* Type of traction * Patient position * Traction force * Duration * Patient's response