PMOD_TRACTION

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

1. Distract Joint Surfaces

   1. Separation of two articular surfaces _______ to the plane of the articulation (to prevent injury)

   2. To address (reduces) compression of spinal nerve roots:

      1. It widens the IV foramina, potentially reducing pressure on the structures

      2. This may reduce pain from spinal joint injury or inflammation or nerve root compression

% of Body Weight	Purpose
25%	To increase length of ______ spine
50%	To distract the lumbar _______ /______ ___
7%	To distract _______ vertebrae

• perpendicular

• Table:

  % of Body Weight	Purpose
  25%	To increase length of lumbar spine
  50%	To distract the lumbar apophyseal /facet jts
  7%	To distract cervical vertebrae

Effects of Traction

2. 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

Fill the Table: Based on Diagnostic Procedures
Lumbar traction	_- _ Kg; 60-120 lbs
Cervical traction	_-_ Kg; 15-30 lbs

Fill the Table: Based on Diagnostic Procedures
Lumbar traction	27-55 Kg; 60-120 lbs
Cervical traction	7-13 Kg; 15-30 lbs

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

3. Stretch Soft Tissue

   1. INC length of soft tissues & distance between vertebral bodies and facet joint surfaces.

   2. INC length of tendon & mobility using a moderate-load, prolonged force

   3. INC ROM & DEC pressure on facet joints,discs and nerve roots even when complete joint surface separation is not achieved.

Effects of Traction

4. 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

5. 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)

1. Position the Patient

Spine Position	Greater separation of	Including	Additional Info
Flexion (supine)	______ structures	Facet joints and intervertebral foramina	Supine flexed localizes traction to upper lumbar and lower thoracic segment
Neutral or Extension (Prone)	_______ structures	Disc spaces	Greater relaxation and lesser EMG activity of paraspinal muscles were observed in prone  Localizes force to lower lumbar segments

Consider applying force unilaterally (with side-bending) for patients with one-sided symptoms

Spine Position	Greater separation of	Including	Additional Info
Flexion (supine)	Posterior structures	Facet joints and intervertebral foramina	Supine flexed localizes traction to upper lumbar and lower thoracic segment
Neutral or Extension (Prone)	Anterior structures	Disc spaces	Greater relaxation and lesser EMG activity of paraspinal muscles were observed in prone  Localizes force to lower lumbar segments

Intermittent Lumbar Traction (ILT)

2. Apply the appropriate belts and halter.

3. Connect the belts or the halter to the traction device.

4. Set appropriate traction parameters

   Area of Spine and Goals of Treatment	Force	Hold/ Relax Times (s)	Total Traction Time (mins)
   initial/acute phase	_-_kg (29-44 lbs)	Static	___
   Joint distraction	__% of BW	15/__	____
   Dec muscle spasm	__% of BW	__/5	_____
   Disc problems or stretch soft tissues	___% of BW	_/_	____

Area of Spine and Goals of Treatment	Force	Hold/ Relax Times (s)	Total Traction Time (mins)
initial/acute phase	13-20kg (29-44 lbs)	Static	5-10
Joint distraction	50% of BW	15/15	20-30
Dec muscle spasm	25% of BW	5/5	20-30
Disc problems or stretch soft tissues	25% of BW	60/20	20-30

Intermittent Lumbar Traction (ILT)

5. Start the traction and assess the patient’s response.

   1. PT has to observe the traction being applied and the initial reaction of the patient for a few cycles.

   2. Give means to call you and to stop the traction.

   3. Make adjustments when needed.

6. Release traction and re-assess the patient’s response

Know it by heart lmfao 😁

Intermittent Cervical Traction (ICT)

1. Position the patient (same as lumbar)

   Supine	Greater separation of	Including	Additional Info
   Flexion (sitting)	Posterior structures	Facet joints and intervertebral foramina	Maximum posterior elongation of the cervical spine when 25-35o of neck flexion
   Neutral or Extension (supine)	Anterior structures	Disc spaces	In supine, the cervical spine is supported and Non-WB, resulting in more pt comfort and muscle relaxation, and greater separation of cervical segments in sitting

Consider applying force unilaterally (with side-bending) for patients with one-sided symptoms

2. Apply the appropriate halter.

   1. The pull should be comfortably and evenly applied to both the occiput and mandible

   2. If with TMJ dysfunction, pull is more from the occiput.

Intermittent Cervical Traction (ICT)

3. Connect the belts or the halter to the traction device.

4. Set appropriate traction parameters

Area of Spine and Goals of Treatment	Force	Hold/Relax times (s)	Total Traction Time (mins)
initial/acute phase	_-_kg  (7-9 lbs)	Static	5-10
Joint distraction	_% BW	15/15	20-30
Dec muscle spasm	_-_kg (11-15 lbs)	5/5	20-30
Disc problems or stretch soft tissues	_-_ kg (11-15 lbs)	60/20	20-30

Area of Spine and Goals of Treatment	Force	Hold/Relax times (s)	Total Traction Time (mins)
initial/acute phase	3-4 kg  (7-9 lbs)	Static	5-10
Joint distraction	7% BW	15/15	20-30
Dec muscle spasm	5-7 kg (11-15 lbs)	5/5	20-30
Disc problems or stretch soft tissues	5-7 kg (11-15 lbs)	60/20	20-30

Intermittent Cervical Traction (ICT)

5. Start the traction and assess the patient’s response.

   1. PT has to observe the traction being applied and the initial reaction of the patient for a few cycles.

   2. Give means to call you and to stop the traction.

   3. Make adjustments when needed.

6. 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

Indication	Effects of Traction Needed
Spinal Disc Bulge or Herniation	Distract joint surfaces  Reduce protrusion of nuclear discal  material
Spinal Nerve Root Impingement	Distract joint surfaces  Reduce protrusion of nuclear discal material
Joint Hypomobility	Distract joint surfaces  Stretch soft tissue Relax muscles  Mobilize joints

Subacute Joint Inflammation	Decrease pain
Muscle Spasm	Stretch soft tissue  Relax muscle  Decrease pain

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