Traction

Question 1

Term: Pulling or drawing

Answer 1

Traction

Question 2

Term: Separation of jiont surfaces moving perpendicular to one another

Answer 2

Distraction

Question 3

Term: Used to describe manual traction

Answer 3

Longitduinal mobilization

Question 4

6 Effects of Spinal Traction

Answer 4

1. Distraction/separation of vertebral bodies
2. Distraction and gliding of facet joints
3. Widening of the intervertebral foramen
4. Tensing of ligamentous structures
5. Straightening of spinal curves
6. Stretching of spinal musculature

Question 5

Describe the purpose of unilateral long axis traction

Answer 5

Can be used for protective scoliosis or to open the foramen on one side

Question 6

Type of Traction: Special table composed of two sections that can be individually angled and rotated allowing the pt. to progress tx

Answer 6

Autotraction (no longer used)

Question 7

Describe the force placed on the pelvis with Cotrell 90/90 Traction

Answer 7

Creates flexion at the pelvis

Question 8

Describe 3 positions that unload the spine

Answer 8

1. Supine in 90/90
2. Use of UE to unload the spine in sitting
3. Propping one leg on a step in standing

Question 9

Type of Traction: Over the door unit that can put to much pressure on TMJ

Answer 9

Head Halter (for c-spine, no longer use)

Question 10

Describe how the angle of pull is adjusted with using the Saunder’s Cervical Traction Device

Answer 10

By adjusted the height of the table

Question 11

Describe what you can accomplish with manual traction that can’t be achieved with mechanical traction

Answer 11

Manual traction allows traction at a single segment, this can’t be accomplished with mechanical traction, instead the entire C/T/L-spine is on traction

Question 12

Describe how traction is generated with portable traction units

Answer 12

With the use of a pressure pump that creates the longitudinal pull

Question 13

6 General Traction Guidelines

Answer 13

1. The pt. MUST RELAX
2. Continually monitory sx
3. DO NOT leave the pt. unattended for the 1st tx
4. ALWAYS give the pt. the safety button (shut off button)
5. ALWAYS consider SINS
6. Establish before/after subjective asterisks

Question 14

5 Indications for Spinal Traction

Answer 14

1. Herniated nucleus pulposus
2. DDD/DJD
3. Joint hypomobility
4. Facet impingement
5. Muscle spasms

Question 15

T/F: Traction alone is effective

Answer 15

FALSE: likely unsuccessful when used alone

Question 16

Describe the effect on traction on HNP and the appropriate dosage

Answer 16

Effect: Can separate vertebra and lead to decrease pressure on the nucleus with a resulting suction force

Dosage: Sustained traction OR Longer hold-rest periods (60 sec hold, 20 rest) of intermittent traction, Tx time of 5-10 min

Question 17

Describe the effect on traction on DDD/DJD and the appropriate dosage

Answer 17

Effect: Lowers intradiscal pressure which affects the nurtitional state of the nucleus pulposus

Dosage: SHorter hold-rest of intermittent traction

Question 18

Describe the effect on traction on Joint Hypomobility and the appropriate dosage

Answer 18

Effect: Can be seen as a form of mobilization that involves the passive movements of joint

Dosage: Short hold-rest periods of intermittent traction

Question 19

Describe the effect on traction on Facet Impingement

Answer 19

Can release restriction on the facets

Question 20

Describe the effect on traction on Muscle Spasm

Answer 20

Traction can decompress/separate the painful joint structures. If the pain is relieved by traction, muscle spasm will be relieved as a result of relazation or nociceptive reflexes

Question 21

Provide a Summary of the EBP for (Lumbar) Traction

Answer 21

1. Poor evidence for mechanical traction along for acute/subacute/chronic LBP
2. Improvement has been documented when traction is used in combination with exercise and modalities
3. Mechanical effects are effective in the short term (<5 wks), but not in the long term (>12 wk)
4. There is no dose-response relationship for traction but low doses are probably sufficient to achieve benefit

There is more evidence in support of traction for the C-spine

Question 22

4 Predictors of Successful response to Mechanical LUMBAR traction

Answer 22

1. Low level fear-avoidance behavior
2. No neurological deficit involvement
3. > 30 yo
4. Non-onvoles of manual work

Question 23

Describe a corssed SLR and what it indicates

Answer 23

A SLR on the right reproduces back pain on the left

Indicative of a disc herniation

Question 24

4 Predictors of Effective Mechanical Traction (Fritz)

Answer 24

1. Presence of leg sx
2. Signs of nerve root compression
3. Peripheralization with extension movements
4. Crossed SLR +

Question 25

6 Contraindications for Traction

Answer 25

1. Structural disease secondary to tumor or infection 2. Patients with vascular compromise. 3. Any condition for which movement is contraindicated. 4. Osteoporosis: precaution 5. RA 6. TMD

Question 26

7 Cautions for Traction

Answer 26

1. Acute strains and sprains 2. Inflammatory conditions that might be aggravated 3. Joint instability 4. Pregnancy 5. Osteoporosis 6. Hiatal hernia 7. Claustrophobia

Question 27

4 Things to determine before beginning traction

Answer 27

1. Traction force 2. Duration 3. Static vs. Intermittent 4. Patient position

Question 28

Describe how to determine/apply traction force in the L-spine

Answer 28

Start with lighter force. You want to end up in a force range of 25-50% of the pt.'s BW The first 25% of force over comes friction, while the second 25% of force causes separation Below 20% of force is considered low dose or placebo traction

Question 29

Describe how you determine the duration of traction

Answer 29

Typically start with 3-5 minutes of traction, based on the SINS slowly progress to 10-15 minutes of traction

Question 30

Describe when you would use static vs. intermittent traction

Answer 30

Static:Sustained pull -- Used for moderately severe and irritable conditions Intermittent:Hold/Rest -- Used with less severe and irritable conditions

Question 31

Describe what movements are created in the spine with anterior and posterior pull

Answer 31

Anterior pull = extension Posterior pull = flexion

Question 32

Describe what traction forces can be achieved with the pieces of the traction belt close together

Answer 32

1. Supine position with posterior pull 2. Prong position with anterior pull

Question 33

Describe what traction forces can be achieved with the pieces of the traction belt farther apart

Answer 33

1. Supine with anterior pull 2. Prone with posterior pull

Question 34

Describe the importance of a stable harness

Answer 34

A stable pevlic belt provides the necessary traction while a stable thoracic belt provides counter traction and prevents the pt. from sliding down the table

Question 35

Describe the placement of the pelvic belt

Answer 35

Should be secured first Top should be above iliac crests and across the umbilical line

Question 36

Describe the placement of the thoracic belt

Answer 36

Should be placed second Top below xiphoid process with the bottom overlaping the pelvic belt

Question 37

Describe the effect of rope angle on lumbar traction

Answer 37

Higher angle = posterior pull Straighter angle = anterior pull

Question 38

List the 5 D's and why they are important to consider before beginning traction

Answer 38

5 D's: Drop attack, Dizziness, Diplopia, Dysarthria, Dysphagia They rule in/out of the possibility of vertebral artery involvement

Question 39

Describe how you determine the amount of traction force for the C-spine

Answer 39

Typically 5-20 lbs Upper cervical traction can be achieved with 5-15 lb Lower cervicla traction can be achieved with 20-40 lb

Question 40

Describe the rope angle needed to target upper vs. lower C-sine with traction

Answer 40

Upper = 10-15 degrees Lower = 20-30 degrees