Traction

ESAT 3640Therapeutic Modalities

Traction

Process of drawing or pulling apart of a body segment

Mostly used on spine, but can be used on other body parts Encourages movement of the spine

both overall and between individual spinal segments

Traction

Amount of movement depends on Position of spine Amount of force applied Duration Angle of pull Position of patient

Types of Traction

Manual Mechanical

Why use Traction

Decrease pain Decrease Parasthesia

Relief due to physical separation of structures resulting in decreased pressure on sensitive structures (nerves)

Lasting therapeutic changes occur from adjustments or adaptations of the structures around the vertebrae in response to traction

Effects on Bone

Wolff’s Law Bone remodels itself and provides

increased strength along the lines of the mechanical forces placed on it

Traction Reverses immobilization related bone

weakness by increasing or maintaining bone density

Effect on Disks

Reduces disk protrusion Traction increases separation of

vertebral bodies leading to decrease in central pressure in the disk space

Encourages disk nucleus to return to central position

Mechanical tension of the annulus fibrosis and ligaments surrounding the disk also nuclear material and cartilage fragments toward the center

Effect on Disks

Movement of materials relieves pain and symptoms associated with compression of nerves and vascular structures

Decreased compressive forces allows for better fluid exchange within the disk and spinal canal

Effect on Disks

Herniation reduction tends to be transitory Return of compressive forces

Effect on Ligaments

Restores normal length to ligaments shortened by: Injury Long term postural problems

Traction force provides stress that encourages ligaments to make adaptive strength and length changes

Effect on Ligaments

Key Point: Relief of pressure on nerves and

vascular system Activation of proprioceptive nerves?

Gate mechanism

Effect on Muscular System

Stretching of vertebral muscles Improved muscular blood flow Proprioceptive nerve activation

Gate mechanism

Muscular System Key Points

Position of spine Optimize stretch of particular muscle

groups Initial stretch provided by body

position Addition of traction provides

additional stretch

Effect on Facet Joints

Release of structures impinged between joint surfaces Meniscoid structures Synovial fringes Osteochondral fragments

Reduction of symptoms Pain Numbness

Effect on Facet Joints

Decompression of articular cartilage Increased synovial fluid exchange Increased nourishment of cartilage Proprioceptive discharge

Gate mechanism

Effect on Nerves Main reason traction use 1st Clinical sign of nerve pressure

Tingling Signs of nerve degeneration:

Motor weakness Numbness Loss of reflex Pain Tenderness Muscle spasm

Effect on Nerves Unrelieved pressure will cause slowing and

eventual loss of impulse conduction Some degenerative changes are reversible

depends on amount of degeneration and amount of fibrosis

Decrease pressure on nerves leads to Increased blood flow to nerve Decreased edema Return to normal function

Contraindications Acute sprains or

strains Acute inflammation Fractures Vertebral joint

instability Any condition in which

movement makes condition worse

Tumors Bone disease Osteoporosis Infections in bones

and joints Vascular conditions Pregnant females Cardiac or

pulmonary problems

Lumbar Positional Traction

Supine Knees to chest

Forward bend of lumbar spine Separation of spinous processes Increased size of intervertebral

foramen

Lumbar Positional Traction

Unilateral Lumbar Positional Traction Side lying Pillow or blanket roll between iliac

crest and lower border of rib cage Roll is placed close to the level of the

spine you want separation to occur Increased opening of foreamen on side up

Hip and knee flexed until lumbar spine is in forward bent position Accentuates opening of foreamen

Unilateral Lumbar Positional Traction

Unilateral Lumbar Positional Traction

Trunk rotation Maximal opening

What side up?? Lean away from painful side

Painful side up Lean towards painful side

Painful side down

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Manual Lumbar Traction (L3-4, L4-5, L5-S1)

Side lying Use leg as lever to flex spine

Feel for motion of the spinous process below desired level

Rotate trunk Feel for motion of the spinous process

above desired level

Manual Lumbar Traction (L3-4, L4-5, L5-S1)

Manual Lumbar Traction (T12, L1, L1-2, L2-3)

Side lying Trunk rotation Lumbar flexion

Manual Lumbar Traction (T12, L1, L1-2, L2-3)

Manual Lumbar Traction

Both techniques usually done on a split table

Rotation and flexion tighten and lock joint structures in which motion takes place leaving the desired segment with more available movement

Unilateral Leg Pull

Hip joint problems; Lateral shift 30 hip flexion 30 Hip abduction Full external rotation

SI joint 30 hip flexion 15 hip abduction

Unilateral Leg Pull

Manual Cervical Traction Thenar eminence placed at mastoid

process Fingers cradle neck reaching over to

other mastoid process Cephalic pull Add in rotations and glides depending on

condition Evaluation and knowledge of C-spine

mechanics are key

Manual Cervical Traction