Mechanical Spinal Traction

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Mechanical Spinal Traction

• Veronica Southard PT MS GCS

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Spinal Traction

• Electronic units
• Pulling forces
• Longitudinal separation and gliding C or L
  segments or lengthening of soft tissues
• There are several types of traction including
  cont bed traction, manual traction, Auto
  traction, Positional traction and Mechanical
  traction

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Goal

• Reduction of signs or symptoms of C or L spinal
  compression
• Utilize maximal traction with minimal force

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Physical Effects of Traction

• Gentle stretch to joint capsule
• Dependent upon the angle of pull and position of
  the spinal segments

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Effects Cont

• Increased inferior-superior dimensions of the
  intervertebral foramina
• Elongation of posterior muscular tissues
• Improved blood supply to posterior soft tissue
  and intervertebral discs
• Altered intradiscal pressure

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Indications

• Musculoskeletal signs
• Decreased sensation, motor function or reflexes,
  that are temporarily reduced with manual traction
• General hypomobility of spine
• Local spinal hypomobility and associated
  increased muscle tone that reduces with manual or
  positional traction

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Indications cont

• Musculoskeletal symptoms
• Numbness of extremity, pain, tingling that is
  temporarily relieved by manual or positional
  traction.
• Central, unilateral or bilateral spinal pain
  reduced by manual or positional traction

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Common Indications

• Spinal nerve root impingement due to DDD
• Intradiscal pressure if treatment is 10 minutes
  or less.
• Spinal nerve root impingement due to stenosis.
  Vertebral body separation, typically in a flexed
  direction
• Generalized of hypomobility of L C spine
• M spasm resulting in nerve root impingement

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Contraindications

• Absolute
• 1. Spinal infections
• 2. Spinal Ca
• 3. Spinal Cord pressure
• 4. RA
• 5. Osteoporosis

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Contraindications Relative

• Ligamentous strains and hypermobility
• Acute stage of injury
• Traction anxiety
• Cardiac or respiratory insufficiency
• Pregnancy

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Patient instruction

• Explain to patient
• Position Pt.
• C spine can be done in sitting or supine.Supine
  provides increased relaxation, vertebral
  separation and easier countertraction
• L traction can be done supine or prone

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Angle of Pull

• Angle of Pull
• C spine Occiput ( C1-C2) 0-5 degrees flexion
• Mid. Cervical (C2-C5) 10-20 flexion
• Low cervical (C5-C7) 25-30 flexion

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Intervertebral Encroachment

• Flex, and SB toward unaffected side and rotation
  toward affected side
• Disc- C spine neutral. Want ligaments to be lax
  and allow better distraction

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Lumbar spine

• Positioning for intervertebral encroachment is
  neutral for bilateral involvement. Unilateral SB
  toward good side with trunk rotated toward the
  affected side.
• Facets are treated in flexion
• Position L5-S1 45 hip flexion
• L4-L5 60-75 HIP FLEXION
• L3-l4 75-90 HIP FLEXION

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Traction Technique

• Angle of pull
• C spine supine better. 25 flexion
• L spine Flex hip and knees, symmetrical or prone
  or unilateral technique

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Force

• C spine start with 15, Increase to 25, Never
  exceed 50
• L spine 25 body weight, up to 50 body weight.
  Never exceed body weight. Nerve root problems
  may require only 25-60. Start with low force

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Mode of treatment

• Intermittent Most comfortable
• On times generally between 7-20 sec
• Off times 7 to 60 sec
• On/Off ratio may be 11 or 31

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Static traction

• Used less frequently.
• Treatment times 8-25 minutes
• Brief continuous for disc problems 10 minutes
• Facet problems 15-20 minutes

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Other duration considerations

• HNP Decrease time 5-8 minutes
• DJD, Spondylolithesis up to 20
• Frequency from 2-3 times per week up to daily
• Allow the patient to rest a few minutes upon
  completion. Ask the patient f they have any
  dizziness or headache post treatment

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Document

• A. Position
• B. Angle of pull
• C. Amount of force., hold and rest cycles
• D. Static or intermittent
• E. Duration
• F. Pt. Response
• Pain / changes
• Functional changes