Unit 7 - Mechanical Traction & Motion Devices (CPM)

Biomechanical and Physiological Effects of Traction
cervical spine

• Increase in intervertebral foramina (CT scan)

• Increase in intervertebral disc spaces (neutral and flexion)

• Separation of facet joint (extension)

• Reduction in disc herniation area

• Improve fluid exchange and nutrient transport through annulus fibrosus

• Variable results in terms of muscle activity (increase, decrease, no
  changes)

positioning for cervical traction

• neck is positioned between two padded wedges at the level of the
  mastoid processes.

• wedges should not compress the patient's neck, and the
  patient should feel a slight pressure, but be comfortable

• Different angulations are achieved by raising or lowering the
  table

• patient's positioning of the upper and lower extremities. Notice a roll of sheet or towel supports the arms, and the legs rest on a bolster with about 45 degrees of hip and 60 degrees of knee flexion

• This position helps keep the spinal muscles relaxed and the patient comfortable

Biomechanical and Physiological Effects of Traction

lumbar spine

• Muscle activity increased initially and then subsides.

• Increase blood flow in the musculature

• 'Decrease pain

• Create a negative pressure draws in a protrude disc

• Reduction in disc herniation area (CT scan)

• Decrease in sciatic radiating pain (Straight leg raise measurement)

Lateral Flexion Angle

• Greater distractive effect on ONE side of the cervical spine when the symptoms.

• This is not a common application, and there is no scientific evidence for the benefits of these application

General Parameters

cervical traction

• Patient Position: Supine

• Static or Intermittent- 3:1 (Stretch) or 1:1 (Pain)

  • Ex: 30 seconds at the greater tension to 10 seconds at the lower tension (lower is half than greater tension)

• Force of pull: 10 to 25 lbs

• Treatment time: 10 to 20 minutes

• Cervical Unit Angle:

  • C1 C2: 0 to 5-degrees

  • C3-C4:10 to 20-degrees

  • C5 C7:-25 to 30-degrees

General Considerations

cervical traction

• Intermittent (3:1) is most common.

• If Static is chosen: less tension and total duration (5-8 mins)

• After cervical traction, allow the patient to rest for approximately 5 minutes before rising. Ask for dizziness of feeling faint.

• Rebound - reduction of symptoms during traction followed by an increase and persistence of symptoms for minutes or hours after the session ends. Communication

• Expected effects: Symptoms relief such as peripheral pain or paresthesia, improved ROM, functional activities, and upper- extremity strength

Lumbar Traction Preparation

Harness is placed superior to the patient’s iliac crests and to the widest lateral dimension of the rib cage

General Parameters

lumbar traction

• Patient Position: Supine or Prone

• Static or Intermittent- 3:1 (Stretch) or 1:1 (Pain)

• Ex: 30 seconds at the greater tension to 10 seconds at the lower tension

• Force of pull: 1/3 to 50% of Patient’s weight

• Treatment time: 10 to 20 minutes

General Considerations

lumbar traction

• Intermittent (3:1) is most common

• If Static is chosen, less tension and total duration

• Communication regarding expectations and responses to treatment.

• Expected effects:

  • Improvement of the hip flexion during straight leg raising

  • Improvement in reflexes or sensation

• Adverse effects are rare, but some patients have been reported
  headaches, nausea, and fainting

Traction Indications
Cervical or Lumbar mechanical pain syndromes

• Lumbosacral muscle strain,

• Disk herniation,

• Muscle spasms

• Chronic traumatic pain

• Chronic mechanical low back pain from overuse

• Radiculopathies

Precautions for Mechanical Traction

• Claustrophobia

• Chronic obstructive pulmonary disease (COPD)

• Cervical traction during pregnancy

• Worsening of symptoms

• Disoriented patients

Contraindications for Mechanical Traction

• Acute cervical trauma, including whiplash injury

• Osteoporosis or osteopenia

• Compromise bone integrity (steroids use)

• Connective tissue diseases due to rheumatologic disorders such as ankylosing spondylitis’Joint hypermobility/instability

• Lumbar traction during pregnancy

• Prior surgical stabilization or decompression

• Spinal implants/prosthetic discs

• Nonmechanical pain (tumors, infections, spondyloarthritis)

Continuous Passive Motion

• Motion devices are mechanical devices that are used to generate continuous passive motion (CPM).

• CPM consists of moving a joint slowly and continuously within a controlled range of movement.

• CPM has healing benefits for joint diseases, injury, and damaged soft tissues

when is cpm used

after surgeries; the patient can still be under anesthesia, and the continuous passive movement produced by motion devices will move the joint as soon as possible if the bulky dressing, that is a dressing used to control the bleeding, prevent the early motion

Guidelines and Parameters

motion devices

• Motion devices are applied to the involved extremity immediately after surgery while the patient is still under anesthesia or as soon as possible if bulky dressings prevent early motion.

• The physician and PT must determine the degree of joint motion. Usually, a low arc of 20° to 30° is often used initially and progresses 10° to 15° per day as tolerated.

• The available range of motion and patient tolerance determines the portion of the range to
  initiate the treatment.

• The rate of motion is usually 1cycle/45 sec or 2 min

• Time is variable, but the most effective was from
  4 to 8 hours.

• Treatment duration: less than a week or when the ROM was obtained.

• Physical Therapy is performed when the patient is not in the machine - motor control gain.

• The longer periods of time per day have shown a shorter hospital stay, fewer postoperative complications, and greater ROM at discharge

Effects of CPM

• Preventing the development of adhesions and contractures and, thus, joint stiffness

• Providing a stimulating effect on the healing of tendons and ligaments

• Enhancing the healing of incisions over the moving joint

• Increasing synovial fluid lubrication of the joint and thus increasing the rate of intra-articular cartilage healing and regeneration

• Preventing the degrading effects of immobilization

• Providing a quicker return of ROM

• Decreasing postoperative pain

cpm contraindications

• Insufficient soft tissue constraints (ligaments)

• Unstable joints

• Fractures are not rigid fixed

cpm precautions

• Increase joint bleeding

• Wound healing complications

• Swelling of the joints (avoid end range)

• Nerve compression on the device

• Risk of thromboembolism