VCU DPT - Agents (Traction)

what is traction

a mechanical force that is applied to the body, in order to seperate joint surfaces and elongate tissue

what are three ways to apply traction

manually

mechanically

self traction

t/f: traction can be used on both traction or peripheral joints

true

what are 5 big effects of traction

joint distraction

reducing nucleus pulposus protrusion

soft tissue stretch

muscle relax

fluid exhcnage/nutrient transport

when we apply traction to two surfaces perpipdunalr to their surfaces, we create

joint distraction

LUMBAR if we want distraction of less than 3 mm, what % Bw are we using?

what is truly happening here

25%

soft tissue stretch

LUMBAR if we want distraction of more than 3 mm, what % BW are we using?

what is happening her

50%

joint distraction

what is the maximum amount of BW% we can use for lumbar traction

50%

with cervical distraction, what is the maximum % BW we can use

7-10%

maximum BW% for tracton for

a) lumbar

b) cervical

a) 50%

b) 10%

what is the theroy behind disc protrusion and lumbar traction

the space created allows the disc to withdraw back in

- more space for canal, formina widended, disc height increased

what are indications for traction, related to disc protrusion

nerve related symptoms that go down the leg, matching specific dermatome/myotomes

what is goal for traction due to disc protrusion?

what would be. a red flag?

centralize

peripherlize

when traction applies stretch to soft tissue and ligaments, is it specific or general

general

________ traction wokrs via the gate theory to help decrease pain

________ traction works via decreasing stretch response of GTOs to inhibit alpha motor neurons

intermittment

static

how can (at least in theory) traction help fluid exchange and nutrient transport

because the motion it causes helps the fluid move, like when you compress joints through motion

what are the 2 most common indications for traction

nerve root impingement (radic)

disc bulge/hernia

name 5 indications for traction

nerve root impingement

disc bulge

joint hypomobility

subactue joint inflammation

paraspinal muscle spasm

for impingement associated with:

- disc bulge

- ligament enroachment

- stenosis

- osteophyte

- nerve root swelling

what can be used to help

traction

when is traction best applied w/ nerve root impingement

shortly after onset of sx

in patients whose sx improve w/ decreased spinal loading

lumbar traction may improve _______ sx and ______ size of hernia

when it is best applied?

radic

decrease

soon after sx onset, in combo w/ other treatment

what type of other treatments is traction best in combo w/ for impingement

posture improvement

stability strengthening

flexibility

the location of the hernia can dictate the response to traction. Which would likely...

a) get better

b) may get better may get worse

c) get worse

1) nerve compression offloaded by traction

2) hernatied nucleus pulposus w/ nerve compression

3) nerve compression made worse by traction

1) b

2) a

3) c

what benefit might you have with joint hypomboility, making it an inidcation for traction

spinal facet joints can distract and help mobility

- non specific

to address joint hypomobility, traction is best applied:

a)

b)

a) slow and rhythmic

b) intermittently

for joint hypo mobility traction, is it specific or general

non specific

why might traction benefit subacute joint inflammation

the pressure on inflamed joint surfaces is decreeased

if small motion is applied, gate theory might come into play

subacute joint inflammation is best applied....

- grades _______, _______

- __(static/intermittent)___

1 and 2, gentle

intermittently

with paraspinal muscel spasm, how may traction help?

static or low load intermittent is best for ______________

higher load is best for __________

can calm the muscles

pain spasm cycle

underlying cause

what does literature say about traction for cervical spine

- long term effects

- pain

- ROM

- med use

may have no long term effects

may have less pain

better ROM

lowered med use

with cervical traction, patient will likely benefit if they have 3/5 of the following syomptoms:

peripherlaization with lower c-spine testing

+ shoulder abduction test

older than 55

positiove upper limb tension

postive neck distraction test

with cervical traction, patient will likely beneift if they have _____/5 of the following symptoms:

peripherlaization with lower c-spine testing

+ shoulder abduction test

older than 55

positiove upper limb tension

postive neck distraction test

3

what does literature review for lumbar spine look like

back pain long term will heal on its own, but traction might help lower the pain earlier

however, evidence is mixed

what is a major (bolded on the slides) contraindication for traction

sx are peripheralized with traction

why is pregnancy a contraindication for traction

what about uncontrolled HTN

there is extra hypermobility that could be an issue

traction increases BP, so it can pose a real issue

name some contraindications for traction (11)

acute cervical truama

- whiplash

osteoporosis/penia

RA/CT issue

hypermobility

steroid use

ankylosing spondy

pregnancy

motion contraindicated

malignancy

peripheralization of sx

uncootrlled HTN

name some precautions for traction

claustrophobia

COPD (and other resp conditions)

decreased congitonin

hiatal hernia/GERD (bc need to be supine!)

displanced annular fragment

medial disc protrusion

can not be supine

TMJ/dentures for cervical strap

why might GERD or hiatal hernias be a precaution for traction

bc of the inability to lie supine those are asscaited with

why might TMJ issues or dentures be a precuation for traction

the cervical strap

why do we start light and slowly increase

excessive force may increase sx

there can be a rebounding increase in pain

advantages to mechanical traction

reproducible force, graded

static or intermittent

some units available for home use

not clinician dependent

disadvantages to mechnaical traction

can be expensive

set up time

it is a passive treatment

belts can be a problem

mobilizies generally, not specifically

where do you place the lumbar area you want to treat

over the physical split in the table

how many layers of clothing can you use for mechanical traction

1 layer of clothing max

lumbar procedure steps (12)

screen patient

table locked and put area over split

secure the harness and straps

position in comfrt, 90-90

take up slack, check pull through strap

unlock the table

set parameters

give patient button

monitor 2-3 cycles

after tx, lock table and remove harness

assist patient to sit slowly

reasses pain/sx

where do you put the straps for lumbar harnesses/straps

pelvic straps: secured to ASIS, above trochanters

thoracic straps: inferior to widest part of rib cage

what is the lumbar paramters for

FORCE

start gentle and do not increase more than 5-15 pounds

facet/disc/joint problem should start w/ 30-45# and increase to 50% BW

with lumbar parameters, start with _____# of froce and increase over time to _________

30-45

50% BW

if treating muscle spasm with lumbar spine, what % BW do we get to

25%

duration of lumbar parameters

- on/off time

a) disc issue

b) joint distraction

a) 60 sec on, 20 sec off

b) 15 sec on, 15 sec off

what is total duration of lumbar paramters

20-30 minutes

- begin 5-10 min tho

the "off" time is ____% force of "on" time

50%

what positioning is best for lumbar traction

90-90 bolster

with cervical parameters....

what force do you start with

what force do you increase to

what increments do you increase froce by

8-10#

7-10% BW

3-5 pounds (go no more than 30#)

which is the best form of traction for cervical

intermittetent

on/off time for cervical traction:

a) disc issue

B) joint distraction

c) muscle spasm

a) 60 sec on, 20 sec off

b) 15 sec on, 15 sec off

c) static, 5 sec on, 5 sec off

what is default on/off time for cervical traction

60 sec on, 20 sec off

with cervical traction, the "off" time is ____% the force of "on" time

50

what is most common time for intermittent cervical traction

15 minutes

for positoning cervical psine traction, the degrees of flexion should be:

a) upper c-spine

b) mid c-spine

c) low c-spine

a) 0-5 deg flexion

b) 10-20 deg flexion

c) 25-35 deg flexion

what is important about cervical traction positioning

lowest level of periph sx

advtanges to mechanical traction (4)

static/intermittetent

more affordable than electronic

no set up time

no belt or claustrophiba

disadvatnages to mechanical traction (2)

not as reproducible or graded

clinician dependent

with manual cervical traction, how do we progress patient psioiton

start with neutral

then flexion

then side bend

then rotation

t/f: combine treatment with other modalities to increase tissue extensibility

true

relief is often ________ with manual cervical traction

temporary

describe self positional traction

use body weight to exert distraction on spine

can be for lumbar, not cervical

no literature support

we ca use self/positoinal traction for ___(lumbar/cervical)_____ issues but not for ___(lumbar/cervical)_____

lumbar

cervical

t/f: there is a lot of support in literature for self/positional traction

FALSE

there is NOT a lot of support