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THE SPINE-TRACTION PROCEDURES

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THE SPINE-TRACTION PROCEDURES Objectives of the Lecture At the end of the lecture the students will be able to: Define spinal traction procedure. – PowerPoint PPT presentation

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Title: THE SPINE-TRACTION PROCEDURES


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THE SPINE-TRACTION PROCEDURES
  • Objectives of the Lecture
  • At the end of the lecture the students
    will be able to
  • Define spinal traction procedure.
  • Know the ultimate goals and effects of spinal
    traction.
  • Be oriented to the indications for spinal
    traction.
  • Recognize and define the different types of
    traction procedures.
  • Detail the modes of application of spinal
    traction.
  • Identify the limitations, precautions and
    contra-indications to spinal traction
    application.
  • Understand cervical and lumbar traction
    techniques.
  • Know the general procedure for application of
    spinal traction.

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Contents of the Lecture
  • Introduction to spinal traction.
  • Effects of spinal traction
  • Indications for spinal traction
  • Definitions and description of traction


    types, modes
    of application (mechanical, manual, positional),
    jt. pain, m. spasm or m. guarding.
  • Limitations of spinal traction.
  • Contraindications of spinal traction.
  • Precautions to spinal traction application.
  • Cervical traction techniques Positional,
    mechanical, home traction, self-traction.
  • Lumbar traction techniques Positional,
    mechanical, home traction, self-traction.
  • Summary on general application procedures.

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Definition
  • Spinal traction means drawing or pulling on the
    spinal column (vertebral column).

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Effects of Spinal Traction
  • Mechanical elongation of spine ? widens the
    intervertebral foramina.
  • Zygopophyseal (facet) joint mobilization.
  • Muscle relaxation
    a. relaxation ?? pain
    from m. spasm or guarding

    b. ? greater vertebral separation.
  • 4. Reduction of pain.

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1.Mechanical Elongation of The Spine
  • Factors influencing amount of vertebral
    separation
  • 1. Spinal position.

    - Flex ? post aspect separation of
    vertebrae.
  • 2. Amount of force.

    - 7 body wt for cervical traction.

    - 50 body wt for lumbar traction.

    If less no inefficient, if more lead to trauma.
  • 3. Comfort relaxation.

    - ? greatest vertebral separation.
  • 4. Angle of pull.

    - In cervical flex 35? greatest post
    separation.
    - In lumbar, harness pull
    from the post aspect pelvis
    rather than from the sides ? spine flexion.

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2. Zygapophyseal (facet) Joint Mobilization
  • Traction ?
  • Compress, or
  • Approximate,
  • Slide, or
  • Translate facet surfaces.
  • Factors influencing direction of facet surfaces
    mov.
  • Flexion longitudinal traction
  • Side bending of spine
  • Rotation of spine

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3. Muscle Relaxation
  • Relaxation
  • ?? pain from m. spasm ? greater
    vertebral separation.
  • ?? pain from m. guard ? greater
    vertebral separation.
  • Factors influencing amount of relaxation
  • Pt. position

  • To feel secure well supported, many pts
    reported feeling more relaxed in supine than
    sitting for cervical traction.
  • Duration of traction
  • After 7 20-25 mins traction is necessary
    for m. relaxation.
  • Force

  • M. relaxation can be achieved at levels lt
    those needed for mechanical separation
  • (only 4.5 6.5 kg max.) for cervical
    spine.
  • Spinal position

  • A lesser angle of pull ? greater
    relaxation.

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4. Reduction of Pain
  • A. Mechanical effects
  • Movement ?? circulation.

    ?? concentration of noxious
    chemical irritants.
  • Vertebral separation

    ? temporary ? intervertebral foramina
    size, which ??
    pressure on impinged n. root.
  • B. Neurophysiologic effects
  • Mechanoreceptor stimulation

    ? block nociceptive
    transmission at spinal cord or brain stem level.
  • Inhibition of reflex m. guarding
    ??
    discomfort from contracting muscles.

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Factors Influencing Amount of Pain Reduction
  • Patient position.
  • The pt should be positioned for comfort
    ease of application.
  • Spinal position.
  • A. Acute stage
  • Usually the involved spinal
    segment is positioned in a (slack)
  • pain free position.
  • B. Subacute chronic stage
  • Usually the involved spinal
    segment is positioned in a stretched position.
  • 3. Force duration.

  • A. Acute stage
  • Only use low intensity
    oscillations, for a short period.
  • B. Subacute chronic stage
  • Progressively? amount o force
    duration depending on patient tolerance.

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Types of Application of Traction
  • Constant

  • A steady force is applied
    maintained for an extended time.

  • A. Continuous
  • - A static force is maintained for
    several hours days.
  • Often it is applied in bed, small
    amount of wt. is tolerated .
  • - Usually for immobilization.
  • B. Sustained

  • - A static traction in which the
    force is maintained from a few minutes up
  • to one-half hour.
  • - Is useful as a prolonged stretch
    to spinal structures.
  • Intermittent

  • The force is alternately applied
    released at frequent intervals, with
  • greater forces than sustained
    traction.

  • - Usually in a rhythmic pattern

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Modes of Application
  1. Mechanical
    Various types of equipments are
    available for hospital, clinic or home use.
  2. Manual
    Through positioning handling, the
    PT applies traction force to the desired spinal
    segment.
  3. Positional
    Through positioning, a
    sustained force on specific segment of spinal
    column can be obtained.

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Indications
  • Spinal nerve root impingement from
  • A. herniated nucleous pulposus.

  • B. spinal or foraminal stenosis
    caused by spondylosis, edema
  • spondylolisthesis.
  • 2. Joint hypomobility due to



    A. dysfunction
  • B. degenerative changes.
  • 3. Symptomatic facet joints pain.
  • 4. Muscle spasm.
  • 5. Diskogenic pain Post-compression .

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Contraindications
  • Acute back strains, sprains inflammations
    aggravated by initial traction treatment.
  • Rheumatoid arthritis of cervical spine where
    necrosis of supporting ligaments ? instability
    subluxation or dislocation of a vertebra with
    spinal cord damage.
  • Any spinal condition or disease in which movement
    is contra-indicated.
    (TB, severe osteoporosis, malignancy, )

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Precautions
  • Osteoporosis.
  • 2. Patients using dentures shouldnt remove it
    as ?TMJ is forced into an abnormal resting pos.
    can be
    traumatized with pressure from the chinstrap.
  • 3. Patients with respiratory problems.
  • 4. TMJ pain may be provoked with using cervical
    halter, especially when the chinstrap places
    a lot of force on the mandible, so manual
    traction can be applied in this case.

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General Procedures
  • Determine appropriateness for choice of traction
  • by testing with manual traction at first.
  • - If the traction test relieved or
    reduced the symptoms, an initial
    treatment is given.
  • - If the traction test aggravates the
    symptoms, traction ttt should probably
    not
  • applied.
  • 2. Determine if manual, positional or mechanical
    traction will be used.

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  • 3. Position the pt for maxemum. comfort
    relaxation.
  • 4. Determine duration of traction.
  • 5. Apply safety roles for mechanical traction.


  • Use ropes that are
    in good repair.


    Secure the equipment to not to move when the
    traction
  • force is applied.
  • - Check the traction dial is turned to zero
    before after
  • treatment.
  • - Periodically check the traction
    calibration.
  • - Use disposable tissues, gauze halters.


    Never leave the patient
    alone while receiving traction unless
  • he/she has some means to signal for help.

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Cervical Traction Techniques
  • Manual Traction
  • Position of pt

    supine, relaxed as possible on treatment table.
  • Position of PT

    stand at the head of ttt table support wt of pt
    head in his hands.
  • PT hand placement

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  • Mechanical Traction
  • .
  • Position of patient head is determined by

  • Evaluation as well as the condition being
    treated.
  • To obtain maxemum posterior separation of the
    vertebrae,
    the head should be
    positioned in flexion up to 35.
  • - To obtain greater muscle relaxation position
    the head closer to neutral.
  • 4. Apply the head halter.
  • First, line the head halter with gauze or
    tissue.
  • Adjust the halter to fit the chin
    of the pt comfortably.
  • - The major traction force must be
    against the occiput,
    not the chin to ? compression of TMJ.
  • - Gauze may be placed between the teeth or
    padding under the chin to absorb pressure.
  • - Dont remove dentures if the pt. wears them as
    stress may be placed on TMJs.
  • - Eye glasses should be safely set aside.

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  • 5. Attach the halter to the spreader bar of the
    unit

    check that the pt. is aligned for
    proper pull.
  • 6. Set controls

    - The traction dial should be
    set at zero before activating the
  • unit.

    - If the unit has off-on
    timer for intermittent traction, suggested
  • starting intervals are 30 seconds on, 30
    secs off,or 1 min on,
  • 30 secs off.
  • 7. Activate the unit gradually ? traction
    force
    - To avoid ttt soreness the 1st ttt
    poundage shouldnt exceed
    10-15 pounds.
  • - Progression of dosage at succeeding ttts
    will depend on the goals pts reaction.
  • 8. Treatment duration

    - May be from 10-30 mins for sustained
    or intermittent traction, depending on the pts
    condition ttt goals.

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  • 9. Demonstrate to the pt. how to turn off the
    unit - if
    his symptoms get worse.
  • 10. At the end of the ttt
    -
    Turn all controls off turn dial indicators to
    zero. - Remove the halter
    from the spreader bar.
  • - Then remove the head halter.
  • 11. Re-evaluate the pts condition
    - Be sure he
    doesnt feel dizzy or nauseated before
    leaving the ttt area.
  • 12. If the pt complains of headache, nausea,
    fainting or ? symptoms during or following ttt
  • -a. Reduce the wt. ,or,
  • b. ? length of ttt time at
    the next visit, or
  • c. discontinue ttt.

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Lumbar traction techniques
  • Manual Traction
  • It isnt easy as in cervical region because at
    least
    ½ body wt. must be moved the

    coefficient of friction of the part to
    be moved must be overcomed.
  • Pt. position supine on treatment table.
  • PT position varies with position of patients
    hips LL
  • With the LL extended lumbar in extension,
    the PT can exert a
    pull at the ankles.
  • With the hips flexed 9o lumbar
    spine flexed, the pts
    legs are draped over PTs shoulders.


    The PT then exerts the force with his/her arms
    wrapped across the pts thighs

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  • When manual traction is used for evaluation
  • - Vary the amount of flex, ext side bending

    note the pts response.
  • 5. During ttt
  • - Use spinal position that best ? the SS.
  • 6. PT must use his entire body wt to ? effect of
    traction force
  • - Place the patint on a split traction table
    to ? friction.
  • - When applying a high-dosage traction force,
    the thorax is
  • stabilized.
  • Put a counter-traction belt around pts rib
    cage secure it to the head end of the table,
    or have a second person to stabilize the pt by
    standing at the head end of the table holding
    onto pts arms.

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  • II. Mechanical Traction
  • Be familiar with the unit available by reviewing
    the manufacturers
    operating instructions.


    The most effective
    traction is applied via a split-traction table,
    as eliminating the need to overcome the
    coefficient of friction of half of the bodys
    wt.
  • Apply traction counter-traction harness (belt)
  • - traction harness is applied over the
    skin above pelvis ? upper part
    is secured above the iliac crest.
  • - counter traction harness is attached
    around lower rib cage ? keep pt. from slipping

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  • 3. Position the pt either supine or prone
  • - Thorax should be on the stationary part of
    the table pelvis on
    the movable one so
    lumbar spine is
    positioned over the split of the table.
  • - Whether the spine in flex ,or ext. is
    determined by evaluation,
    pts comfort the condition as well as ttt
    goal.
  • - To obtain posterior separation of the
    vertebrae,
    the lumbar spine should be flexed
    (flattened)

  • a. when supine, hips are flexed thighs
    rest on a padded stool.
  • b. when prone, several pillows are placed
    under the pts abdomen.

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  • 4. Attach the anchor straps
  • a. The counter-traction or stabilizing harness is
    secured
    to the end of the traction table.
  • b. The straps from traction harness may attach to
    a spreader bar attached to the traction rope.
  • If unilateral traction, one anchor onlyll be
    attached to traction rope.
  • c. Check that the pt. is aligned for proper pull
    then take all the slack out of the straps.
  • 5. Set the controls
  • Be familiar with the type of unit.
  • If the unit has off-on timers for intermittent
    traction,
    set them for the desired time intervals.
  • Set ttt duration. It may be up to 30 mins for
    most units. It
    depends on the goals, pts condition reaction
    to traction.

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  • 6. Unlock the split traction table

    - so it will separate when the unit is activated.
  • 7. Activate the unit gradually ? the force
    (if the unit
    hasnt been pre-programmed to do so
    automatically).
  • 8. Demonstrate to the pt how to turn off the unit

    - if his symptoms
    worsen while the unit is on. Make sure he has a
    signaling device to call for help if necessary.
  • 9. At the end of the ttt
  • Turn all controls off turn indicators back to
    zero.
  • Lock the split of the table before the pt.
    attempts to get off.
  • Re-evaluate the pt note any changes in S, S
    ROM.

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  • 9. Demonstrate to the pt. how to turn off the
    unit - if
    his symptoms get worse.
  • 10. At the end of the ttt
    -
    Turn all controls off turn dial indicators to
    zero. - Remove the halter
    from the spreader bar.
  • - Then remove the head halter.
  • 11. Re-evaluate the pts condition
    - Be sure he
    doesnt feel dizzy or nauseated before
    leaving the ttt area.
  • 12. If the pt complains of headache, nausea,
    fainting or ? symptoms during
    or following ttt
    -a. Reduce the wt. ,or, -b. ?
    length of ttt time at the next visit, or
  • -c. discontinue ttt.

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