Dr Manoj Kumar,Dr Manoj Kumar,Junior Resident, Rehab. Dept., PMCH, PatnaJunior Resident, Rehab. Dept., PMCH, Patna

Dr. Ajit kumar Varma Dr. Ajit kumar Varma MS, DNB (Rehabilitation)MS, DNB (Rehabilitation)

Patna Medical College

Traction

Traction

• Traction is act of drawing / pulling a force which is used to stretch soft tissues and to separate joint surfaces or bony fragmentation.

• In medicine, forces are applied to the body generally to stretch a given part or separate two or more parts.

Purpose

• Goal is to obtain pain relieve and functional improvement.

• Involves applying a force of sufficient magnitude and duration in proper direction while simultaneously registering movement by an equal and opposite force with proper positioning of the patient and correct angle of pull traction is to localize to a specific spinal area.

Trial of traction

• The force is generally applied through a mechanical pulley system with weights and establishing either with a chin strap for the cervical spine for or a pelvic belt for the lumber spine.

• Irritation or compression of nerve roots whether related to Trauma the generative process, or compression from the disc can be benefitted from a trial of traction.

Traction Machine

Effects of tractive force

• Most often used for neck / arm pain secondary to cervical nerve root compromise or radiculopathy and low backache from radiculopathy.

• Specific clinical indications for tractions are controversial but the anatomical basis for the use of traction is well established.

Anatomical Basis

• Enlarge intervertebral foramina.• Separate apophyseal joints.• Stretch muscles and ligaments • Tighten the Posterior L Ligament to

exert centripetal force on the adjacent annulus fibrosus.

• Enlarge the intervertebral spaces.

Salient points

• Theoretically traction may be indicated for any condition that could benefit from anatomical changes.

• Traction can be manual, mechanized or motorized. Pull can be continuous sustained, intermittent and can vary, based on magnitude, duration and direction of pool.

Counter traction

• All the types of treatment must over come the body resistance to traction which is equal to half of the weight of the body segment plus resistance of the involve soft tissue.

• Gravity can be used either to assist or

resist the pooling force .

Continuous Traction

• Low force over a long period of time: i.e. 22-40 hours.

• Often used in Spinal traction mostly to assure that the person remains at rest.

• Sustained traction uses force greater than that used in continuous traction but less than intermittent.

• It is common practice to treat In- patients daily / Out patients three time per week.

Intermittent traction

• Allows use of greater forces but a shorter period of time.

• The force is gradually increased during each treatment cycle and best administered by motorized system.

• Pre programm treatment: Time sequence can vary from 7 to 10 seconds of tractive force with 5 second rest, up to 30 - 60 seconds of traction force followed by 10 to 15 seconds of rest. ( Total Duration 15 minutes only )

Intermittent Traction

• On - off cycle is repeated for 15 to 25 minutes. Used in cervical region to allow use of progressively higher forces up to 50 pounds which increases vertebral separation.

Cervical Traction

• Posterior vertebral separation is related to angle of pull with a maximum separation occurring between 20 to 300 cervical flexion.

• The most common reason to fail or to exacerbate symptoms is applying the force in extension.

Cervical Traction

• At least 10 lbs. of force is necessary to counter the effects of gravity of the head, while 25 lbs. of force is necessary to provide strengthening of the cervical lordotic curve and the earliest separation of posterior vertebral segments .

Cervical Traction contd.

• The maximum separation occurs anteriorly at C4 to C5 after 25 minutes and posteriorly at C6 to C7 after 20 minutes.

• The distraction effect is short lived. • When the patient is noted to be

benefitting from the cervical traction, it can be performed with a home over the door unit as long as the correct angle for pool is maintained.

Cervical Traction contd.

• Facing the door. • Patient using traction at

home should never be alone as some one might need to assist them

Cervical traction Sleeping

Cervical Air Track

Limitations

• Discontinue - If Nausea, dizziness, increased pain in soft tissues of neck. • Cervical region: Midline disc herniation is contraindication - since traction could pull the cord in to contact with the disc.

Limitation …. contd.

• Use with caution. • Patients with history suggestive of

Vertebrobasilar Insufficiency • Patients with RA and other connective

tissue disorders: High risk for Atlanto-axial insufficiency. Dislocation and sudden death may occur

Lumbar traction

• Requires significantly larges forces than cervical traction to overcome the body resistance.

• Pelvic belts or use of gravity by tilting are necessary to obtain sufficient tractive force to lumbar spine.

Lumbar Traction

Lumbar Traction

• Due to the large amount of weight necessary to over come the bodies resistance in the area, either a thoracic of chest belt or corset is necessary to hold the upper body in place during the traction of lower body.

Traction table in two pieces

Lumbar traction … contd.

• Split traction tables have a stationery half and a mobile half unit.

• Lower body rests on the mobile half which separates it from the stationery portion.

• This arrangements allows vertebral separation with less force at the level were the table is separating.

• Force necessary to overcome surface resistance is reduced. Treatment can be provided with as little as 80 pounds to 180 pounds