Define static traction.
a constant pull exerted throughout treatment with no release phase
When is static traction used?
- Discs
- muscle spasms- low load, long duration stretch indicated
- capsular tightness- low load, long duration stretch indicated
- decreased treatment time and decreased amount of force should be used for static
- static pull may be uncomfortable during treatment, may cause irritation, evidence conflicting as to whether it is more effective
Define intermittent traction.
the alternating application and release of the traction force
When is intermittent traction used?
- Facet joint problems: short equal periods of pull and release (10 pull, 10 sec off)
- Discs: pull and release periods longer and unequal (60 sec pull, 20 sec off)
- Used more frequently than static
- generally more comfortable for patients
- allows more pounds of force to be used
Define hypermobility.
from internet:
-increased ROM at joints, and joint laxity
Define hypomobility.
from internet
-decrease in the normal movement of a joint or body part -may result from an articular surface dysfunction or from disease or injury that affects a bone, muscle, or joint
Define distraction
from internet:
-separation of joint surfaces without rupture of the binding ligaments and without displacement
Define herniated nucleus pulposus (HNP).
disc material is protruding into the intervertebral foramen and putting pressure on spinal nerve roots. (notes)
from internet:
a condition in which part or all of the soft, gelatinous central portion of an intervertebral disk (nucleus pulposus) is forced through a weakened part of the disk, resulting in back pain and nerve root irritation
Define osteoporosis.
low bone density susceptible to fractures (notes)
internet:
a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D
Define stenosis.
space between the bones in the intervertebral foramen decreases causing bony pressure on the nerve root, can be from degenerate disc or osteophytes
Define osteophytes.
from internet:
a bony outgrowth associated with the degeneration of cartilage at joints
- aka bone spurs
What are the effects of spinal traction?
Physiological effects:
- increase in vertebral separation and lateral foramen opening
- Decrease in intradiscal pressure
- Disc protrusion reduced
- Distraction of facet joints
- Decrease in muscle activity
* Research studies are conflicting about the efficacy of traction and whether or not these effects consistently occur
What are the signs and symptoms of nerve root impingement?
- When comparing right and left sides, a significant difference in muscle strength of muscles that are innervated by a particular level of spinal nerve.
- A significant difference in DTRs when comparing right and left.
- loss of sensations along dermatomes
- Radicular symptoms. ex: pain radiating down the back of the leg (sciatica)
What is a sign?
can be measured by a therapist using an objective test
What is symptom?
something a patient can describe. ex: pain
A weak hip flexor on the right would suggest impingement of what spinal nerve?
Right L1 or L2
Weak quadriceps on the right would suggest impingement of what spinal nerve?
Right L3 or L4 nerve root
Weaker dorsiflexors and big toe extensors would suggest impingement of what spinal nerve?
L5 or S1
Weaker plantar flexors or hamstrings would suggest impingement of what spinal nerve?
S2
A weaker right patellar tendon reflex suggests impingement of what spinal nerve?
Right L3/L4
A weaker Achilles tendon reflex suggests impingement of what spinal nerve?
S2
Loss of sensation from the big toe, up the front of the calf, over the knee, to the lateral thigh suggests problems at what spinal nerve?
L4
What are the indications for spinal traction?
- Disc Herniation
- Degenerative Joint Disease
- Muscle spasm
- Generalized hypomobility of the cervical or lumbar spine
- Facet impingement
- Tension headache
- Radiculopathy
What are contraindications for spinal traction?
- Spinal infections such as meningitis
- Spinal cancer
- traction could cause metastasis or fractures - Spinal cord pressure as evidenced by bilateral neural signs.
- This could indicate cancer, serious disc problems or severe osteophytes. Traction might worsen an already severe situation - Rheumatoid Arthritis (RA) or other acute inflammatory joint disorders
- RA can cause ligamentous laxity, most significantly at the atlantoaxial joint; traction could cause subluxation and spinal cord injury. - Osteoporosis
- low bone density with susceptibility to fractures; bones are compromised and traction could cause fractures. - Unhealed fracture
- traction could misalign the fracture - For lumbar traction this, any conditions that prohibit increased abdominal pressure caused by application of the harness.
- Ex: pregnancy, hernias, severe hypertension, aortic aneurism, and severe hemorrhoids - Joint hypermobility
- traction may aggravate or worsen the condition
