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Tensional mechanical force applied to the body in a way that separates the joint surfaces and elongates surrounding tissues
Manually (by clinician)
Mechanically (using a machine, body weight, or gravity)
TRACTION
Traction became popular in 1950-1960 based on the recommendation of ____________
Proposed the efficacy of traction to treat back and leg pain due to protrusions
James Cyriax
Effects of Traction
Distract Joint Surfaces
Separation of two articular surfaces _______ to the plane of the articulation (to prevent injury)
To address (reduces) compression of spinal nerve roots:
It widens the IV foramina, potentially reducing pressure on the structures
This may reduce pain from spinal joint injury or inflammation or nerve root compression
perpendicular
Table:
Effects of Traction
Reduce Protrusion of Nuclear Discal Material
Clicking back of disc fragment
Suction caused by decreased intradiscal pressure pulling displaced parts of the disc back toward the center
Tension of the posterior longitudinal ligament (PLL) pushing any posteriorly displaced material anteriorly
Spinal traction can reduce spinal discal protrusions which can relief back pain
Reduce lumbar disc prolapse, retraction of herniated disc & reduce its size, INC disc height & space within the space canal & widen the neural foramina
Note: Sx don’t improve if below these values or when traction is applied to patients with LARGE discal herniations that fill the spinal canal or CALCIFICATION of disc protrusion
Effects of Traction
Stretch Soft Tissue
INC length of soft tissues & distance between vertebral bodies and facet joint surfaces.
INC length of tendon & mobility using a moderate-load, prolonged force
INC ROM & DEC pressure on facet joints,discs and nerve roots even when complete joint surface separation is not achieved.
Effects of Traction
Muscle Relaxation
Spinal traction may facilitate relaxation of the paraspinal muscles due to DEC pain caused by reduced pressure on pain sensitive structures or gating of pain transmisssion
Intermittent traction
Oscillatory movements which can dec spasm by interrupting the spasm-pain cycle
Stimulate GTO to inhibit alpha motor neuron firing which results to small changes in muscle tension that produces relaxation of muscles
Static traction
Decreased monosynaptic response with prolonged traction caused by stretching the muscles for several seconds
Effects of Traction
Joint Mobilization
increasing the mobility of the spine/ joints
Dec joint related pain through lower levels of force applied by stimulating the mechanoreceptors through oscillatory movements
Examination Procedures
Pain assessment (SPS)
Palpation for muscle spasm and mobility of the spine
Range of motion assessment
Special tests for radiculopathy
Sensory assessment (dermatomes)
Assessment of postural alignment
Functional assessment
Bed mob and transfers
Impact of condition
Must be done before and after the intervention except special tests because it is provocative
Contraindications
When motion is contraindicated
unstable fx, cord compression and immed. spinal injury
Tractions SHOULD NOT be used in the area contraindicated but PWEDE sa other involved areas where motion is allowed.
Acute injury or inflammation (last 72 hrs)
Can happen right after injury as a result of RA.
Aggravated by traction
Healing of an acute injury is also contraindicated
If onset of pain occured within the last 72 hrs = no traction first
As inflammation resolves, static traction → intermittent traction progression
Joint hypermobility or instability
High Force traction should not be used in areas of joint hypermobility or instability
can be recent fx, joint disloc or surgery, old injury , high relaxin levels due to pregnancy,poor posture
Down & Marfan syndromes
Peripheralization of symptoms with traction
STOP when sx progressed from central → peripheral area = wrosening nerve function and INC compression
mild aggravation of central symptoms alone in a patient with prior central & peripheral symptoms should not be discontinued
Not an immediate CI:
Stop > check traction (fix set up) = if not resolved = CI
Uncontrolled hypertension
Treatment should be discontinued if BP increases >10 mmHg or if HR increases >10 bpm for cervical traction
Avoid CT > 30%
Precautions
Structural disease or conditions affecting the tissue in the area being treated. (CI sabi ni sir D1)
Tumor, RA, infection, osteoporosis, chronic steroid use, local radiation therapy
Tissues may not be strong enough to sustain strong traction force
When Pressure from the belts may be hazardous
Lumbar Traction
Exerts excessive abdominal pressure to pregnant patients or to those with hiatal hernia
Excessive pressure on the inguinal region in patients with compromised femoral artery
This can be avoid by placing pelvic belt at lower edge of the belt superior to the femoral triangle
Caution for patients with cardiac and pulmonary conditions
Cervical Traction
With (+) vertebral artery test or compromised cerebrovascular system
Position halter away from carotid arteries (more distraction over the occiput rather than the mandible
Do manual traction or self-traction instead
MANUAL TRACTION NALANG IF HAZARDOUS
“Displaced” annular ligament
Do not use traction as fragment is no longer connected to the disc since sequestrated cant be returned
Goal can only be for muscle relaxation
“Medial” disc protrusion
INC impingement of the root or disc during traction
Posterolateral bulging is more common
When Severe pain resolves fully with traction
May indicate that traction increased rather than decreased compression a complete “nerve block”
Check sensation, reflexes, muscle strength
Reduce traction force to 50% or change direction of force
Claustrophobia or other psychological aversion to traction
Disorientation
Inability to tolerate prone/supine
TMJD
Dentures
Guidelines
Use small amount of force initially while monitoring patients response to treatment; do manual traction first.
Avoid coughing or sneezing while on traction; increase in intra-abdominal pressure increases intra-discal pressure
Empty bladder; do not have a heavy meal before lumbar traction
Application Techniques
Electrical and weighted mechanical traction
Self-traction
Positional traction
Inversion traction
Manual traction
Intermittent Lumbar Traction (ILT)
Position the Patient
Consider applying force unilaterally (with side-bending) for patients with one-sided symptoms
Intermittent Lumbar Traction (ILT)
Apply the appropriate belts and halter.
Connect the belts or the halter to the traction device.
Set appropriate traction parameters
Intermittent Lumbar Traction (ILT)
Start the traction and assess the patient’s response.
PT has to observe the traction being applied and the initial reaction of the patient for a few cycles.
Give means to call you and to stop the traction.
Make adjustments when needed.
Release traction and re-assess the patient’s response
Know it by heart lmfao 😁
Intermittent Cervical Traction (ICT)
Position the patient (same as lumbar)
Consider applying force unilaterally (with side-bending) for patients with one-sided symptoms
Apply the appropriate halter.
The pull should be comfortably and evenly applied to both the occiput and mandible
If with TMJ dysfunction, pull is more from the occiput.
Intermittent Cervical Traction (ICT)
Connect the belts or the halter to the traction device.
Set appropriate traction parameters
Intermittent Cervical Traction (ICT)
Start the traction and assess the patient’s response.
PT has to observe the traction being applied and the initial reaction of the patient for a few cycles.
Give means to call you and to stop the traction.
Make adjustments when needed.
Release traction and re-assess the patient’s response.
EBIDENSYA
DOCU
Type of Traction
Area of the body where traction
Patient position
Type of halter
Maximum force
Total treatment time
Rationale
ICT in supine with neck flexed 250 X 5kg max force; 2kg min force X 8s pull; 8s release X 20mins to dec muscle spasm.
ILT in supine with hip flexed to 900 , now at 20kg max force; 10kg min force X 8s on-time; 8s off-time X 20mins to decompress lumbar spine.
ACTIVITY: CONNECTISHIZ
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