Spinal Traction

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Spinal Traction

• Jennifer Doherty-Restrepo, ATC, LAT
• Entry-Level Athletic Training Education Program
• PET 4995 Therapeutic Modalities

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Traction

• Process of drawing, or pulling apart, of a body
  segment
• Mechanical Traction - using a traction machine or
  ropes/ pulleys to apply a traction force
• Manual Traction - clinician positions patient
  and applies traction force to joints of the spine
  or extremities

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Effects of Traction Spine

• Encourages movement between each individual
  spinal segment
• Amount of movement varies according to
• Position of spine,
• Amount of force, and
• Length of time the
  force is applied
• Transient effect

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Effects of Traction Spine

• ? pain, paresthesia, or tingling
• Due to physical separation of vertebral segments
  thus decreasing pressure on sensitive structures
• As long as positive physiologic effects occur,
  traction should
  be continued

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Effects of Traction Bone

• No immediate effects due to traction
• May result in increased spinal movement that
  reverses bone weakness associated with
  immobilization
• May assist with increasing or maintaining bone
  density

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Effects of Traction Ligaments

• Stretching effect
• Structural changes occur slowly due to
  viscoelastic properties
• Ligaments resist shear forces and return to
  original form following removal of a deforming
  load
• Sensitivity to rate of loading
• Ligament deformation results in lengthening of a
  ligament caused by traction loading
• Slow loading rates allow for more deformation

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Effects of Traction Disks

• Normal disk in non-compressed position
• Internal pressure (indicated by arrows) is
  exerted equally in all directions
• Internal annular fibers contain nuclear materials

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Effects of Traction Disks

• In an injured disk, sitting or standing
  compresses the disk causing the nucleus to become
  flatter
• Pressure in this instance still remains
  relatively equal in all directions

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Effects of Traction Disks

• In an injured disk, movement in weight-bearing
  causes a horizontal shift in nuclear material
• If this was forward bending, the bulge would
  occur in the posterior annular fibers
• Anterior annular fibers would be slackened and
  narrow

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Effects of Traction Disks

• Herniation of the nuclear material occurs if the
  annular wall becomes weak
• Herniation may possibly put pressure on sensitive
  structures in the area

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Effects of Traction Disks

• When placed under traction, intervertebral space
  expands thereby decreasing pressure on the disk
• Taut annular fibers create a centripetally
  directed force
• Decreases herniation and pressure on sensitive
  structures in the area

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Effects of Traction Articular Facet Joints

• Facet joints are separated releasing impinged
  structures
• Dramatic reduction in symptoms
• Joint separation decompresses articular cartilage
  allowing synovial fluid exchange to nourish
  cartilage
• Decreases rate of degenerative changes
• Increased proprioception from facet joint
  structures provide sensation of pain relief

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Effects of Traction Muscles

• Vertebral muscles can be stretched
• Initial stretch should come from body positioning
• Stretch lengthens tight muscle
• Allows for better muscular blood flow
• Activates muscle proprioceptors providing
  sensation of pain relief
• Gate Control Theory

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Effects of Traction Nerves

• Focus of most traction treatments
• Pressure on nerves or nerve roots often
  associated with spinal pain
• Unrelieved pressure on a nerve will cause
• Slowing, eventual loss of impulse conduction
• Motor weakness, numbness, and loss of reflex
• Pain, tenderness, and muscular spasm

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Traction Treatment Techniques

• Lumbar Positional Traction
• Inversion traction
• Manual Lumbar Traction
• Level-specific
• Unilateral leg pull
• Mechanical Lumbar Traction
• Manual Cervical Traction
• Mechanical Cervical Traction

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Lumbar Positional Traction

• Patient typically on restricted activity program
• Trial and error process to determine position
  that offers maximum comfort

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Side-lying Position Unilateral Foramen Opening

• Lateral Herniation
• Patient leaning away from painful side
• Lie painful side up
• Lie on right side over blanket roll

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Side-lying Position Unilateral Foramen Opening

• Lateral Herniation
• Patient leaning away from painful side
• Lie painful side up
• Lie on right side over blanket roll
• Medial Herniation
• Patient leaning toward painful side
• Lie painful side down
• Lie on right side over blanket roll

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Side-lying Position Unilateral Foramen Opening

• Side-lying with a blanket roll between iliac
  crest and rib cage
• Increases intervertebral foramen size of superior
  side of lumbar spine

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Side-lying Position Unilateral Foramen Opening

• Maximum opening of intervertebral foramen
• Achieved by flexing upper hip and knee and
  rotating shoulders in opposite directions

Maximum opening of left side
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Supine Position Bilateral Foramen Opening

• Knees to chest position
• increases size of lumbar intervertebral foramen
  bilaterally
• Separation of spinous processes

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Inversion Traction

• Hang upside down
• Lengthens spinal column due to stretch provided
  by weight of trunk
• Repeat inversion 2-3 times
• Observe for signs of vertigo, dizziness, or
  nausea

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Manual Lumbar Traction

• Used prior to mechanical traction
• Helps determine degree of lumbar flexion,
  extension, or side-bending that is most
  comfortable
• Most comfortable position is usually best
  therapeutic position

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Level-Specific Manual Traction

• Position patient for maximum effect at a specific
  spinal level
• Lumbar spine flexed using upper leg as lever
• Palpate interspinous space
• Upper spinous process is where maximum effect is
  desired

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Level-Specific Manual Traction

• When motion of lower spinous process can be
  palpated, place foot against opposite leg to
  prevent further flexion
• Trunk is then rotated toward the upper shoulder
  until motion of upper spinous process can be
  palpated

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Level-Specific Manual Traction

• Place chest against ASIS and upper hip
• Lean toward patients feet
• Use enough force to cause a palpable separation
  of the spinous processes at desired level

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Unilateral Leg Pull Manual Traction

• Hip joint problems or difficult lateral shift
  corrections
• Thoracic counter-traction harness is used
• Hold ankle and move hip into 30o flexion, 30o
  abduction, and full external rotation
• Apply steady traction force until noticeable
  distraction occurs

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Unilateral Leg Pull Manual Traction

• Sacroiliac problems
• In addition to thoracic counter-traction harness,
  strap is placed through groin and secured to
  table
• Hold ankle and move hip into 30o flexion and 15o
  abduction
• Apply steady traction force

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Mechanical Lumbar Traction Equipment

• Use split table to eliminate friction between
  body segments
• Non-slip traction harness stabilizes trunk

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Mechanical Lumbar Traction Setup

• Pelvic harness
• Applied while standing
• Contact pads and upper belt placed at, or just
  above, iliac crest
• Rib pads
• Positioned over lower rib cage

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Mechanical Lumbar Traction Body Positioning

• Neutral spinal position
• Allows for largest intervertebral foramen opening
  before traction is applied
• Usually position of choice whether prone or
  supine

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Mechanical Lumbar Traction Body Positioning

• Flexion
• Increases posterior opening
• Puts pressure on disk nucleus to move posterior
• Other soft tissue may also close foramen opening

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Mechanical Lumbar Traction Body Positioning

• Extension
• Closes foramen because bony arches come closer
  together

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Mechanical Lumbar Traction Body Positioning

• Prone position
• Used with normal to slightly flattened lumbar
  lordosis
• Best for disk protrusions
• Place pillows under abdomen
• Other modalities may be applied
• Allows for assessment of spinous process
  separation

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Mechanical Lumbar Traction Body Positioning

• Supine position
• Produces posterior intervertebral separation
• Optimal at 90o hip flexion
• Unilateral pelvic traction recommended if
  stronger force is desired
• Scoliosis,
• Unilateral joint
  dysfunction, or
• Unilateral lumbar
  muscle spasm

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Traction Force

• No lumbar vertebral separation will occur with
  traction forces less than 1/4 of body weight
• Effective traction force ranges between 65 and
  200 pounds
• Traction force recommended 1/2 body weight
• Must use progressive steps to comfortably reach
  therapeutic loads

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Intermittent vs. Sustained Traction

• Intermittent Traction
• Effective for posterior intervertebral separation
• No firm recommendations for on/off times
• Sustained Traction
• Recommended for disk protrusion and rupture

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Treatment Duration

• With suspected disk protrusions, total treatment
  time should be relatively short
• 10 minutes or less
• If treatment reduces symptoms, treatment time
  should remain at 10 min or less
• If the treatment is partially successful or
  unsuccessful in relieving symptoms, gradually
  increase time over several treatments up to 30 min

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Progressive and Regressive Steps

• Traction equipment may be built with progressive
  and regressive modes
• Progressive mode
• Increases traction force in a pre-selected number
  of steps
• Allows slow accommodation to traction
• Regressive mode
• Decreases traction force in a pre-selected number
  of steps
• Patient comfort is primary consideration!

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Manual Cervical Traction

• Stretches muscles and joint structures
• Enlarges intervertebral spaces and foramen
• Creates centripetally directed forces on disk and
  surrounding soft tissue
• Mobilizes vertebral joints
• Increases joint proprioception
• Relieves compressive effects of normal posture
• Improves arterial, venous, and lymphatic flow

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Manual Cervical Traction

• Variety of head and neck positions
• Hand should cradle neck contacting one mastoid
  process
• Other hand on chin
• Gentle pull, lt 20 pounds
• Intermittent pull, 3 - 10 sec
• Treatment time, 3 - 10 min

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Mechanical Cervical Traction

• Supine
• Neck flexed 20 - 30o
• Traction harness pulls on occiput
• Intermittent pull
• gt 20 pounds
• Minimum of 7 seconds
• Adequate rest time for recovery
• Treatment time, 20 - 25 min

• Forces up to 50 pounds may produce increased
  intervertebral separation.

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Mechanical Cervical Traction

• Wall-mounted device
• Inexpensive
• Static traction most easily employed
• Use weight plates, sand bags, or water bags
• Intermittent traction may be used
• Sitting or prone
• Gentle pull, 10 - 20 pounds
• Treatment time, 20 - 25 min

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Indications for Spinal Traction

• Nerve root impingement
• Disk herniation
• Spondylolisthesis
• Narrowing within intervertebral foramen
• Osteophyte formation
• Degenerative joint diseases
• Subacute pain

• Joint hypomobility
• Discogenic pain
• Muscle spasm or guarding
• Muscle strain
• Spinal ligament or capsular contractures
• Improvement in arterial, venous, and lymphatic
  flow

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Contraindications for Spinal Traction

• Acute sprains or strains
• Acute inflammation
• Fractures
• Vertebral joint instability
• Any condition in which movement exacerbates
  existing problem

• Bone diseases
• Osteoporosis
• Infections in bones or joints
• Vascular conditions
• Pregnant females
• Cardiac or pulmonary problems