Traction and Compression

Traction

force applied along spines axis to separate vertebrae

Methods of traction

mechanical and manuel

How much is spine separated during traction

1-2 mm per intervertebral space

Physical effects of bone

wolff’s law, increased spinal morion, nutrition increase

What does intermittent traction promote?

spinal movement and maintains bone density

Physical effects on ligaments during traction

stretched, slow steady loading recommended, restoration of length, may reduce pain via proprioceptive activation

What does traction do for the IV disc

decreases central pressure on disc, encourages disc to return to central position, enhancing nutrition supply and cellular proliferation

Separation of facet joints causes

impingements to be released and improves cartilage nutrition

Golgi Tendon Organ

senses change in muscle tension

Effects on nerves from traction

relieves nerve compression, restores blood flow and function

Why use a supine position with knees flexed

flattens the lumbar spine (reduces lordosis) for better separation of posterior structures

Why use a prone position?

position is preferred for treated disc protrusions as it encourages extension and can help reduce disc bulge

What position is best for lateral foraminal opening?

sidelying

How is side lying traction set up

Patient lies on non-symptomatic side

Ideal patient position for manual lumbar traction while supine

hips and knees in 90

Hip loose pack

30 flexion, 30 abduction, slight ER

What position of hip would target SIJ with traction?

closed pack

Supine body position for traction best for

stenosis

Duration for intermittent lumbar traction

60 seconds hold, 20 seconds relax

How long should lumbar traction be held for

10-30 minutes

What is the limit of force used for lumbar traction

no more than 50-60% patient body weight

What is a good starting force for traction

25-50% of patients body weight

What force is used as guidance as enough to cause vertebral separation

half the patients body weight

What point is damaged caused with lumbar traction?

440 lbs or greater

How much force should be used on lumbar traction at first visit to determine if modality will have a negative effect?

30lbs

When would sustained lumbar traction be used?

disc injuries, stenosis, nerve entrapment

What is good positioning for manual cervical traction

supine with slight flexion (15-30 degrees)

Total treatment time for cervical traction

10-20 minutes

What is a good force to start with for cervical traction

8-10 lbs

How should force progression happen for cervical traction?

increase 1-2 lbs per session

What is the maximum force used for cervical traction

20-30 lbs

What is the force progression for lumbar traction?

5-15 lbs per session

Positioning for mechanical cervical traction

supine or long sitting

Indications for traction

impingement on nerve root, disc herniation, narrowing of foramen, bone spurs, degenerative joint diseases, joint hypomobility, muscle spasm, contracture, improvement of flow

Contraindications for traction

acute sprains/strains, fractures, tumors, joint instability, uncontrolled hypertension, cancer in spine, pregnancy, osteoporosis, infection, bone diseases, cardiac problems, vascular conditions

Normal response to traction

reduction of symptoms, stretching feeling

Abnormal response to treatment

increase in symptoms, rebound effect

Edema

forms when excess fluid accumulates in tissues that leads to swelling

What can cause edema

increased hydrostatic pressure, decreased oncotic pressure, increased capillary permeability, lymphatic obstruction, sodium and water retention

Grade 1 pitting edema

slight depression with immediate rebound

Grade 2 pitting edema

slight indentation, rebounds within 15 seconds

Grade 3 pitting edema

5-6mm depression that takes 10-30 seconds to rebound

Grade 4 pitting edema

8mm depression that takes over 20 seconds to rebound

Negative effects of edema accumulation

hypoxic cell death, decreased nutrients, pain, decreased ROM, muscle atrophy, infection

Purpose of lymphatic system

return fluids and proteins, safety valve for fluid overload, maintain extracellular balance, filter and protect

Terminal lymphatics

small, one cell thick capillaries with anchoring fibrils, first entry point for excess fluid and proteins

How does lymph flow

muscle contraction, limb elevation, breathing and artery pulses

Lymphedema

overdistention of lymph capillaries, pores become ineffective, constriction of lymph capillaries due to increased pressure

Intermittent pneumatic compression devices

mechanical devices applying cyclic compression to a limb

Objective of intermittent pneumatic compression devices

edema reduction, circulation improvement, lymphatic drainage

Effects of IPCD

increased venous return, reduced edema, improved lymphatic flow, enhanced healing

Mechanism of IPCD

compression cycles create a pressure gradient that moves fluid proximally

What should pressure of IPCD be?

greater then capillary (about 30mmHg) but less than diastolic

Indications for static compression

chronic lymphedema, venous insufficiency, post surgical edema (long term), scar management, DVT prevention

Indications for Intermittent pneumatic compression

DVT prevention in immobile patients, acute lymphedema, short term post surgical edema, peripheral artery disease, chronic venous insufficiency with ulcers

Purpose of static compression

manage swelling, improve venous return, and prevent fluid accumulation

Purpose of IPC

actively reduce swelling, improve circulation, and prevent clots

Contraindications for static compression

arterial insufficiency, skin infections, heart failure, severe hypertension

Contraindications for IPC

active DVT, congestive heart failure, severe peripheral artery disorder, infections or open wounds

Range of on:off sequence for compression

1:1 to 4:1

Pressure for mild conditions

20-30mmHg

Pressures for moderate conditions

30-40mmHg

Pressure for more severe lymphedema

40-50 mmHg

Treatment duration IPC

1-2 hours per sessions, 1-3 times per day

Wraps

used for compression

Tape

for sprain support

Braces

for stabilization

Padding

for protection from impact

Low stretch bandages

high pressure when moving, low at rest (for active patients)

High stretch bandages

low pressure when moving, high at rest (less active patient)

Which way should you wrap

distal to proximal