Sei sulla pagina 1di 45

SPINAL TRACTION

TAMILVANAN MANI

Traction
Process of drawing, or pulling apart, of a

body segment
Mechanical Traction - using a traction
machine or ropes/ pulleys to apply a traction
force
Manual Traction - clinician positions patient
and applies traction force to joints of the
spine or extremities

Effects of Traction: Spine


Encourages movement between

each individual spinal segment


Amount of movement varies
according to

Position of spine,
Amount of force, and
Length of time the
force is applied

Transient effect

Effects of Traction: Spine


pain, paresthesia, or tingling

Due to physical separation of vertebral


segments thus decreasing pressure on
sensitive structures

As long as positive physiologic

effects occur,
traction should
be continued

Effects of Traction: Bone


No immediate effects due to traction

May result in increased spinal movement that

reverses bone weakness associated with


immobilization
May assist with increasing or maintaining
bone density

Effects of Traction: Ligaments


Stretching effect
Structural changes occur slowly due to

viscoelastic properties

Ligaments resist shear forces and return to


original form following removal of a deforming
load
Sensitivity to rate of loading

Ligament deformation results in lengthening

of a ligament caused by traction loading

Slow loading rates allow for more deformation

Effects of Traction: Disks

Normal disk in non-compressed position

Internal pressure (indicated by arrows) is

exerted equally in all directions


Internal annular fibers contain nuclear
materials

Effects of Traction: Disks

In an injured disk, sitting or standing

compresses the disk causing the nucleus to


become flatter
Pressure in this instance still remains
relatively equal in all directions

Effects of Traction: Disks

In an injured disk, movement in weight-

bearing causes a horizontal shift in nuclear


material
If this was forward bending, the bulge would
occur in the posterior annular fibers

Anterior annular fibers would be slackened and narrow

Effects of Traction: Disks

Herniation of the nuclear material occurs if

the annular wall becomes weak


Herniation may possibly put pressure on
sensitive structures in the area

Effects of Traction: Disks

When placed under traction, intervertebral space

expands thereby decreasing pressure on the disk


Taut annular fibers create a centripetally directed
force

Decreases herniation and pressure on sensitive


structures in the area

Effects of Traction: Articular Facet


Joints
Facet joints are separated releasing impinged

structures

Dramatic reduction in symptoms

Joint separation decompresses articular

cartilage allowing synovial fluid exchange to


nourish cartilage

Decreases rate of degenerative changes

Increased proprioception from facet joint

structures provide sensation of pain relief

Effects of Traction: Muscles


Vertebral muscles can be stretched

Initial stretch should come from body


positioning

Stretch lengthens tight muscle


Allows for better muscular blood flow
Activates muscle proprioceptors providing

sensation of pain relief

Gate Control Theory

Effects of Traction: Nerves


Focus of most traction treatments
Pressure on nerves or nerve roots often

associated with spinal pain


Unrelieved pressure on a nerve will cause

Slowing, eventual loss of impulse conduction


Motor weakness, numbness, and loss of reflex
Pain, tenderness, and muscular spasm

Traction Treatment Techniques


Lumbar Positional Traction

Inversion traction

Manual Lumbar Traction

Level-specific
Unilateral leg pull

Mechanical Lumbar Traction


Manual Cervical Traction

Mechanical Cervical Traction

Lumbar Positional Traction


Patient typically on restricted activity program
Trial and error process to determine position

that offers maximum comfort

Side-lying Position: Unilateral


Foramen Opening
Lateral Herniation
Patient leaning away
from painful side
Lie painful side up
Lie on right side over
blanket roll

Side-lying Position: Unilateral


Foramen Opening
Lateral Herniation
Patient leaning away
from painful side
Lie painful side up
Lie on right side over
blanket roll
Medial Herniation
Patient leaning toward
painful side
Lie painful side down
Lie on right side over
blanket roll

Side-lying Position: Unilateral


Foramen Opening
Side-lying with a

blanket roll between


iliac crest and rib cage
Increases
intervertebral foramen
size of superior side of
lumbar spine

Side-lying Position: Unilateral


Foramen Opening
Maximum opening of

intervertebral
foramen
Achieved by flexing
upper hip and knee
and rotating
shoulders in
opposite directions

Maximum opening of left side

Supine Position: Bilateral Foramen


Opening
Knees to chest

position
increases size of
lumbar intervertebral
foramen bilaterally
Separation of
spinous processes

Inversion Traction
Hang upside down
Lengthens spinal

column due to
stretch provided by
weight of trunk
Repeat inversion
2-3 times
Observe for signs of
vertigo, dizziness, or
nausea

Manual Lumbar Traction


Used prior to mechanical traction
Helps determine degree of lumbar flexion,

extension, or side-bending that is most


comfortable
Most comfortable position is usually best
therapeutic position

Level-Specific Manual Traction


Position patient for

maximum effect at a
specific spinal level
Lumbar spine flexed
using upper leg as
lever
Palpate interspinous
space
Upper spinous
process is where
maximum effect is
desired

Level-Specific Manual Traction


When motion of lower

spinous process can


be palpated, place
foot against opposite
leg to prevent further
flexion
Trunk is then rotated
toward the upper
shoulder until motion
of upper spinous
process can be
palpated

Level-Specific Manual Traction


Place chest against

ASIS and upper hip


Lean toward
patients feet
Use enough force to
cause a palpable
separation of the
spinous processes
at desired level

Unilateral Leg Pull Manual Traction


Hip joint problems or

difficult lateral shift


corrections
Thoracic countertraction harness is used
Hold ankle and move
hip into 30o flexion, 30o
abduction, and full
external rotation
Apply steady traction
force until noticeable
distraction occurs

Unilateral Leg Pull Manual Traction


Sacroiliac problems

In addition to thoracic

counter-traction
harness, strap is
placed through groin
and secured to table
Hold ankle and move
hip into 30o flexion and
15o abduction
Apply steady traction
force

Mechanical Lumbar Traction:


Equipment
Use split table to eliminate friction between body

segments
Non-slip traction harness stabilizes trunk

Mechanical Lumbar Traction:


Setup
Pelvic harness
Applied while standing
Contact pads and
upper belt placed at, or
just above, iliac crest
Rib pads
Positioned over lower
rib cage

Mechanical Lumbar Traction:


Body Positioning
Neutral spinal

position
Allows for largest
intervertebral
foramen opening
before traction is
applied
Usually position of
choice whether
prone or supine

Mechanical Lumbar Traction:


Body Positioning
Flexion
Increases posterior

opening
Puts pressure on
disk nucleus to
move posterior
Other soft tissue
may also close
foramen opening

Mechanical Lumbar Traction:


Body Positioning
Extension
Closes foramen

because bony
arches come closer
together

Mechanical Lumbar Traction:


Body Positioning
Prone position
Used with normal to

slightly flattened lumbar


lordosis
Best for disk protrusions
Place pillows under
abdomen
Other modalities may be
applied
Allows for assessment of
spinous process
separation

Mechanical Lumbar Traction:


Body Positioning
Supine position
Produces posterior intervertebral separation
Optimal at 90o hip flexion
Unilateral pelvic traction recommended if stronger

force is desired

Scoliosis,
Unilateral joint
dysfunction, or
Unilateral lumbar
muscle spasm

Traction Force
No lumbar vertebral separation will occur with

traction forces less than 1/4 of body weight

Effective traction force ranges between 65 and


200 pounds

Traction force recommended = 1/2 body

weight
Must use progressive steps to comfortably
reach therapeutic loads

Intermittent vs. Sustained Traction


Intermittent Traction
Effective for posterior intervertebral
separation
No firm recommendations for on/off times

Sustained Traction
Recommended for disk protrusion and
rupture

Treatment Duration
With suspected disk protrusions, total

treatment time should be relatively short

10 minutes or less

If treatment reduces symptoms, treatment

time should remain at 10 min or less


If the treatment is partially successful or
unsuccessful in relieving symptoms, gradually
increase time over several treatments up to
30 min

Progressive and Regressive Steps


Traction equipment may be built with

progressive and regressive modes


Progressive mode
Increases traction force in a pre-selected
number of steps
Allows slow accommodation to traction

Regressive mode
Decreases traction force in a pre-selected
number of steps
Patient comfort is primary consideration!

Manual Cervical Traction


Stretches muscles and joint structures

Enlarges intervertebral spaces and foramen


Creates centripetally directed forces on disk

and surrounding soft tissue


Mobilizes vertebral joints
Increases joint proprioception
Relieves compressive effects of normal
posture
Improves arterial, venous, and lymphatic flow

Manual Cervical Traction


Variety of head and neck

positions
Hand should cradle neck
contacting one mastoid
process
Other hand on chin
Gentle pull, < 20 pounds
Intermittent pull, 3 - 10 sec
Treatment time, 3 - 10 min

Mechanical Cervical Traction


Supine
Neck flexed 20 - 30

Traction harness pulls on

occiput
Intermittent pull

Forces up to 50 pounds
may produce increased
intervertebral separation.

> 20 pounds
Minimum of 7 seconds
Adequate rest time for
recovery

Treatment time, 20 - 25 min

Mechanical Cervical Traction


Wall-mounted device

Inexpensive

Static traction most easily

employed

Use weight plates, sand bags, or


water bags

Intermittent traction may be used


Sitting or prone
Gentle pull, 10 - 20 pounds
Treatment time, 20 - 25 min

Indications for Spinal Traction


Nerve root

impingement
Disk herniation
Spondylolisthesis
Narrowing within
intervertebral foramen
Osteophyte formation
Degenerative joint
diseases
Subacute pain

Joint hypomobility
Discogenic pain
Muscle spasm or

guarding
Muscle strain
Spinal ligament or
capsular contractures
Improvement in
arterial, venous, and
lymphatic flow

Contraindications for
Spinal Traction
Acute sprains or

strains
Acute inflammation
Fractures
Vertebral joint
instability
Any condition in which
movement
exacerbates existing
problem

Bone diseases
Osteoporosis
Infections in bones or

joints
Vascular conditions
Pregnant females
Cardiac or pulmonary
problems