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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Cervical Disc Herniation

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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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