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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