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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