What is spinal traction?
Applying a series of longitudinal forces to seperate vertebral segments
-used to treat mechanical spinal pain
traction is far less physically demanding and time consuming for doctor.
Traction vs Distraction
Traction = machine distraction = dr controlled traction force applied to specific level of spine w or w/o spinal adjustments
What are the 4 basic effects of traction?
- seperation of vertebral bodies
- stretching MM and A.L.L= centripetal affect on annulus fibrosis
- seperation of facets
- enlargement of IVF
Suggested benefits of traction
Distract joint surfaces
- reduces disc protrusion of nuclear material
- stretch soft tissues
- relax mm
- mobilise joints
Tell me a bit about mechanical traction
-applied to lumbar or C spine
-can be static or intermittent
static- same amount of force through treatment session
-intermittent- traction force alternated between 2 set points every few seconds throughout tx session. Usually reduced by 50%
Advantages of mechanical traction?
Force and time well controlled, easily graded and repeatable.
- once applied clinician can be absent
- can be static/ intermittent.
Disadvantages of mechanical traction:
- expensive
- time consuming to set up
- lack of patient participation
- poorly tolerated by some patients.
- mobilized broad regions rather than specifci –> potentially causing hypermobility.
Relative indications for traction
- spinal n root impingement
- herniated or buldging disc
- narrowing of disc space or vertebral foramen
- osteophyte encroachment
- scoliosis and spondylolithesis for pain relief
- joint hypomobility
- DJD
- muscle spasm and muscle guarding
- discogenic pain
- cervicogenic headache
- mild compression fx
- +SLR, if +WLR probs not a good candidate
- Osteophyte inferior to nerve root= not good candidate.
Contraindications
a
Specific intermittent traction Contra-indicatoions
- Severe mm spasms e.g. acute torticollis
- Inflammatory Spondyloarthropathies (neck)
- Acute intervertebral disc syndrome with antalgia
- Acute inflammations of the msk tissues
(myofascitis, bursitis, tendonitis)
Mechanical lumbar traction- Parameters
Static vs Intermittent
Static vs. Intermittent:
- Generally static traction used if:
o Area being treated = inflamed
o Pts sx aggravated by motion
o Pts sx related to disc protrusion
- Intermittent traction with long hold times = may be used for disc protrusion
- Intermittent traction with short hold times = if pts sx related to joint dysfunction
Lumbar:
Hold/ relax times?
Force:
Hold/Relax Times:
- In intermittent traction
- Hold time = maximum force
- Relax time = lower force
- Ratio of hold:relax = depending on pts condition/sx
- Disc prolapse = longer hold time (60secs), shorter relax time (20secs)
- Spinal joint dysfunction = 15secs each
- More severe conditions may require longer hold and relax times
Force:
- Initial consult = low to reduce likelihood of reactive mm spasm
- Initial L/S = 13-20kg + gradually increase as condition improves
- To decrease spinal nn root compression, force = 60% pts body weight
- To stretch soft tissues + have centripetal effect on disc = 25% pts body weight
- Intermittent traction → relaxed force should be 50% of hold force
Lumbar:
Treatment duration and frequency
Treatment Duration:
- Initial tx =
Mechanical cervical traction- parameters
- Similar to those of L/S traction with a few exceptions
- Intermittent traction more effective for reducing pain/increasing ROM in C/S
- Force starts at 3-4kg → if goal is to reduce compressed nn roots 9-13kg/7% body weight
