spinal traction cervical & lumbar 1. traction traction is the process of drawing or pulling the...
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Spinal Traction
Cervical & Lumbar
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Traction Traction is the process of drawing or pulling the
spinal column to apply a longitudinal force to the spine & associated structure, this force separates the vertebrae, opening the intervertebral space
It is therapeutic tools that falls in the area of exercise because of its effect on the musculoskeletal system and use in stretching and mobilizing techniques.
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How Does Traction Relieve Pain? Increasing the space
between vertebrae Separating the
apophyseal joints Widening the
intervertebral foramina Removing pressure on
injured tissue Reducing muscle spasm Increasing peripheral
circulation
Relaxing muscles Changing intervertebral
disk pressures Tensing the posterior
longitudinal ligament Creating suction to draw
protruded disks toward their center
Flattening an abnormal lumbar curvature
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Physiological effects on Bone Increases spinal movement, overall and between
each vertebrae Reverses immobilization-related bone weakness by
increasing or maintaining bone density
Physiological Effects on Ligament Creates ligament deformation, thereby increasing
movement and decreasing impingement problems Long-term effects
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Physiological Effects on Articular Facet Joints
Increases the separation between joint surfaces
Decompresses articular cartilage, allowing synovial fluid exchange to nourish the cartilage
May decrease degenerative changes May decrease pain perception
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Physiological Effects on Muscles Lengthens tight muscles and allows
better muscular blood flow. Activates muscle proprioceptors, further
decreasing painPhysiological Effects on Nerves- Decreases compression forces on nerves
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General Principles Angle of pull
Neutral: Transverse plane Flexion/Extension: Frontal plane Unilateral: Sagittal plane Multiaxial: Two or more planes
Anatomical differences Cervical inferior facet joints angle anteriorly
• Flexion opens facet joints Lumbar facets angled posteriorly
• Extension opens facet joints
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General Principles Tension
No clear formula The traction must overcome the resistance exerted
by the soft tissue Use the least amount of tension needed to relieve
symptoms Duration is inversely related to tension
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Factors that influence the amount of vertebral separation
Spinal Position: the greater the amount of flexion that the spine is placed before traction, the greater the vertebral separation.
Amount of force applied:- In cervical spine: a force of approximately 7% of the body weight separate the vertebrae.
A minimum force of 11.25 to 13.5 Kg is necessary to lift the weight of the head when sitting to counteract the resistance of muscle tension.
- In lumbar spine: a minimum force of half of the body weight is necessary for mechanical separation.
Angle of pull: - In cervical spine: the angle of pull creating the greatest posterior elongation is 35 degree.- In lumbar spine: pulling from the posterior aspect of the pelvis rather than from the sides
is necessary to cause flexion of the spine.
Position of patient: the patient should be in comfortable and relaxed position. Many patients report feeling more relaxed supine than sitting for cervical traction.
Duration of application: 20 to 25 minutes is applicable time.
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Types of Traction1- Static or Constant Traction, which may be:- Continuous or prolonged: static traction in which the force is
maintained for several hours. - Sustained: a static traction in which the force is maintained
from few minutes up to one-half hour.2- Intermittent Traction
Alternately applied and withdrawn traction at frequent interval.
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Mode of application:
Mechanical: using various types of equipment.
Manual: Administered by the therapist
Positional: through positioning to elongate the involved tissue
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Indications Muscle spasm Hypomobility of the joints from joint
dysfunction or degenerative disk changes Herniated or protruding disks Nerve root compression Facet joint pathology Capsulitis of vertebral joints Anterior/posterior longitudinal ligament
pathology
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Lumbar Disc Herniation
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Contraindications Absolute Spinal infections Spinal Cancer Spinal Cord pressure Rheumatoid Arthritis Osteoporosis Relative Ligamentous strains and hypermobility Acute stage of injury Traction anxiety Cardiac or respiratory insufficiency Pregnancy
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Limitations of Traction The effect of vertebral separation is temporary No consistent protocol exist, rational is hypothetical
with inconsistent clinical results.Precautions Complete patient’s evaluation should be done before
traction. Close monitoring of patient should be performed
throughout treatment. Can cause thrombosis of internal jugular vein if
excessive duration or traction weight is used.
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Cervical Traction Generally applied with the patient supine or sitting
Supine preferred because it eliminates gravity Three main types
Manual Positional Mechanical
Application of a longitudinal force to the C-spine & structures Tension applied can be expressed in pounds or % of patient’s
body weight. At 7% of patient’s body weight, vertebral separation begins
Human head accounts for 8.1% of body weight (8-14 lbs.) Greater amount of force is needed widen areas You want force to be about 20% of body weight
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Cervical Traction Set-up Neck – placed in 25-30° flexion
Straightens normal lordosis of C-spine Must have at least 15° flexion to separate facet joint
surfaces Body must be in straight alignment Duration – 10-20 minutes most common Remove any jewelry, glasses, or clothing that may
interfere Lay supine, place pillows under knees Secure halter to cervical region placing pressure on
occipital process & chin (minor amount)
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Cervical Treatment Set-up
Align unit for 25-30° of neck flexion Remove any slack in pulley cable On:Off sequence 3:1 or 4:1 ratio Following treatment, gradually reduce tension & gain
slack Have patient remain in position for a few minutes
after treatment
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Manual Cervical Traction To perform manual cervical traction
Clinician sits at head of table facing patient
Head is cradled to allow distraction of cervical vertebrae without hurting patient
Traction is applied• Head is slowly moved to
maximize relaxation and comfort How to slowly move head into
relaxation and comfort Neutral position pain: affecting upper
cervical vertebrae Flexed 30° pain: affecting lower
cervical vertebrae Lateral flexion pain: pressure on
spinal nerves with radiating pain into arms or hands
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Cervical Traction Positioning Supine – support lumbar region (bend knees, or hang
lower legs over end of table & place feet on chair); allows musculature to relax
Therapist standing at the head of the treatment table, supporting the weight of the patient’s head in his hands.
Flex the head until motion of the spinous process just begins at the determined level. Support the head with folded towels at the level of flexion, then side bend the head away from the side to be distracted until movement of the spinous process begins.
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Mechanical Cervical Traction
Harness traction Harness traction
device hung over a doorway
Amount of tension adjusted by patient
As patient pulls one click on the pulley, 1 lb of pressure is applied, separating the vertebrae.
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Mechanical Cervical Traction
Table traction Mechanical intermittent or sustained table traction Involves use of head harness attached to mechanical
device at end of table Device can pull sustained or intermittent traction
• Usually 30 sec on, 10 sec off
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Initiation of Treatment Set controls to zero and turn on unit Remove slack Adjust Ratio
Normally 3:1 or 4:1 Tension
Approximately 10 pounds or 7% of body weight First exposure use lower tension
Duration Corresponding to pathology
Termination of Treatment
- TensionGradually reduce over 3 or 4 cyclesGain slack and turn unit OFF
- Remove halter from unit and patient- Patient remains in position for 5 minutes after the treatment
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Lumbar Traction There are more types of lumbar traction than cervical
traction. Some of the most commonly used techniques are
presented. To be effective, lumbar traction must overcome lower
extremity weight (½ of body weight) Friction is a strong counterforce against lumbar traction
Split table is used to reduce friction
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Manual Lumbar Traction Allows the clinician to feel patient’s reaction to
treatment Can be used as examination technique Clinician uses her hands or a belt to pull on
patient’s legs, separating vertebrae
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Manual Lumbar Traction Single-leg traction
Manual traction Requires two clinicians Patient is prone or supine. One clinician supports patient’s torso, while other
puts traction on leg exhibiting radicular pain. After a series of five, 30 sec bouts, patient lies
supine at edge of table and stretches affected hip flexors (which are usually tight)
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Manual Lumbar Traction (L3-4, L4-5, L5-S1)
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Manual Lumbar Traction (T12, L1, L1-2, L2-3)
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Unilateral Leg Pull Manual Traction Counter-traction harness needed From ankle flex hip 30, ABD hip 30 and ER
fully Apply steady traction along long axis of LE
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Mechanical Lumbar Traction
Uses a specialized table that separates when adequate forces are applied
• Patient’s head and trunk are on one half; hips and legs are on other half.
One end of belt or strap is attached to patient; other end is attached to mechanical device that separates table
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Mechanical Lumbar Traction
Traction Force No separation < ¼ BW Can be delivered in either sustained or intermittent mode
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Lumbar Positional Traction Bilateral Foramen Opening
Athlete in supine Hip/knees flexed
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Lumbar Positional Traction
Unilateral Foramen Opening Sidelying position Pillow between iliac crest and
lower border of ribs Flex hip/knees until LS is
forward Trunk rotation toward superior
shoulder
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Lumbar Positional Traction Supine Knees to chest
Forward bend of lumbar spine Separation of Spinous
processes Increased size of
intervertebral foramen
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Unilateral Lumbar Positional Traction
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Unilateral Lumbar Positional Traction
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