Spinal Traction

Unit 7: Mechanical Traction

Overview

  • Lecture focus: Mechanical traction as discussed in Chapter 7 – Spinal Traction of the textbook.
  • Objectives:
    • Explain biomechanical and physical principles of spinal traction.
    • Discuss clinical applications of lumbar and cervical traction.
    • Describe physiological effects, indications, contraindications, and precautions of spinal traction.

Definition and Historical Context

  • Traction defined as application of tensile forces to the long axis of the spine.
  • Proposed Mechanism:
    • Separate vertebral bodies to offload discs and redistribute surrounding structures.
  • Historical usage:
    • Hippocrates (420 BC): Applied axial traction and trans-abdominal correction for spinal deformities.
    • Galen: Described scoliosis, lordosis, and kyphosis; influenced medical practice for over 1,500 years.
    • Massey Langworthy: Patented traction table in 1908.
    • Clinicians Cyriax and Maitland: Pioneered the use and indication of spinal traction.

Physiological Effects

Cervical Spine
  • Conflicting evidence on traction effects:
    • Some studies show:
    • Increase in foraminal size with neutral cervical alignment.
    • Decrease in pressure with increase in foraminal size in cervical flexion.
    • Evidence of increase in intervertebral disc space with both neutral and flexion cervical alignment.
    • Effects of traction include:
    • Separation of the facet joint with extension.
    • Reduction in disc herniation.
    • Improved fluid exchange and nutrient transport through annulus fibrosus.
    • Variable results in muscle activity.
Lumbar Spine
  • Physiological effects:
    • Initial increase in muscle activity followed by subsidence.
    • Increased blood flow in musculature; decreased pain noted.
    • Creation of negative pressure in a protruding disc:
    • Reduction in herniation area as shown by CT scan.
    • Decrease in sciatic radiating pain.

Mechanical Traction Tables

Equipment for Cervical Traction
  • Components include:
    • Occipital harness.
    • Securing strap for harness.
    • Controlled safety switch (patient holds this during treatment).
  • Occipital harness attachment:
    • Connected to the speed motor and control panel.
    • Cable slack needed for attachment to mobile portion of the harness.
    • Optional: Hot pack for heating cervical spine during treatment.
Patient Positioning for Cervical Traction
  • Neck positioned between padded wedges at mastoid process level:
    • Wedges should not compress neck; slight pressure felt, must be comfortable.
  • Angulation based on targeted cervical levels:
    • C1 and C2: 0 to 5 degrees.
    • C3 and C4: 10 to 20 degrees.
    • C5 to C7: 25 to 30 degrees.
  • Upper and lower extremities positioned:
    • Arms supported with roll of sheet or towel.
    • Legs on a bolster with 45-degree hip and 60-degree knee flexion, promoting relaxation.

Parameters for Cervical Traction

  • Patient position: Supine.
  • Traction pull: Static or intermittent.
    • Intermittent traction ratios:
    • 3 to 1: Used for stretching (e.g., 30 seconds pulling, 10 seconds release).
    • 1 to 1: Used for pain.
  • Pull force range: 10 to 25 pounds.
  • Treatment time: 10 to 20 minutes.
  • Rest for patient post-treatment: 5 minutes, monitoring for dizziness.
  • Expected effects post-cervical traction:
    • Relief of peripheral pain.
    • Improved range of motion, functional activities, and upper extremity strength.
    • Possible initial increase in symptoms (rebound effect).

Lumbar Traction Preparation

Equipment and Setup
  • Lumbar traction preparation involves:
    • Placement of pelvic and thoracic harness on the table.
    • Optionally, apply a hot pack to the patient’s lower back.
  • Harness placement:
    • Pelvic harness above iliac crests and widest lateral dimensions of rib cage.
    • Slack cable connection to the pelvic harness; release table lock for separation during traction.
Patient Positioning for Lumbar Traction
  • Possible positions include:
    • Supine with knees and hips flexed at 90 degrees.
    • Hook-lying with a bolster under the knees.
    • Prone position for patients experiencing pain during lumbar flexion.

Parameters for Lumbar Traction

  • Patient position options: Supine or prone.
  • Traction pull: Static or intermittent.
    • Intermittent traction ratios: 3 to 1 (stretching) or 1 to 1 (pain).
  • Pull force: 1/3 to 50% of body weight.
  • Treatment time: 10 to 20 minutes.
  • Minimal angulation; straight cable pull longitudinally downwards.

General Considerations and Expected Effects

  • Commonly used intermittent 3 to 1 ratio is preferred.
  • Communication with patient expected prior to treatment for setting expectations.
  • After lumbar traction, patients typically report:
    • Increased hip flexion during straight leg raise without pain.
    • Improvements in reflexes or sensation.
  • Rare adverse effects:
    • Headaches, nausea, faintness; treatment should be discontinued if these occur.

Indications for Traction

  • Lumbar and mechanical traction indicated for:
    • Mechanical pain syndromes (e.g., lumbosacral muscle strain, disc herniation, muscle spasms).
    • Chronic traumatic pain and chronic mechanical low back pain from overuse.
    • Symptoms of radiculopathy (e.g., pain distal to the knee), typically worsened with extension movements.
    • Symptoms reduction with manually applied traction as a criterion for mechanical traction.

Manual vs. Mechanical Traction

  • Manual traction examples used to select candidates for lumbar/cervical traction:
    • If symptoms reduce or centralize with manual traction, mechanical traction may be beneficial.

Precautions and Contraindications

Precautions
  • Precautions for mechanical traction include:
    • Claustrophobia.
    • Chronic obstructive pulmonary disease (COPD).
    • Cervical traction during pregnancy.
    • Patients whose symptoms worsen with traction.
    • Disoriented patients.
Contraindications
  • Contraindications include:
    • Acute cervical trauma (e.g., whiplash).
    • Osteoporosis or osteopenia.
    • Compromised bone integrity from steroids or related medications.
    • Rheumatologic disorders affecting connective tissues (e.g., ankylosing spondylitis, joint hypermobility).
    • Surgical stabilization or decompression that has occurred.
    • Spinal implants, prosthetic discs.
    • Non-mechanical pain sources such as tumors, infections, or spondylarthritis.