1 1 Traction

2 2 Effects of Spinal Distraction Joint Distraction – Separation of two articular surfaces – Can treat facet joint & spinal nerve root symptoms – Distraction force - 50% of BW for L- spine & 7% for C- spine

3 3 Effects of Spinal Distraction Reduction of Disc Protrusion – Suction due to decreased intradiscal pressure – Force of 60-120 #’s have been shown to reduce lumbar disc protrusion

4 4 Effects of Spinal Distraction Soft Tissue Stretching – Muscles, tendons, ligaments, discs – Increase soft tissue length & increase joint mobility

5 5 Effects of Spinal Distraction Muscle Relaxation – Can facilitate muscle relaxation May be due to reduction of pain May be due to prolonged stretch (may fire the GTO)

6 6 Effects of Spinal Distraction Joint Mobilization – Stretching of soft tissues with traction can increase joint mobility

7 7 Effects of Spinal Distraction Patient Immobilization – Very low-load traction (10-20 #’s) has been used to immobilization pts with spinal disorders (Bucks Traction) – Presently, not as popular

8 8 Clinical Indications for the Use of Spinal Traction Disc Bulge or Herniation – Traction may be more beneficial for disc bulge than herniation – The greater the damage to the disc, the less effective traction may be.

9 9 Clinical Indications for the Use of Spinal Traction Nerve Root Impingement

10 10 Clinical Indications for the Use of Spinal Traction Joint Hypomobility – Traction cannot isolate a local area of hypomobility – Traction can improve mobility throughout the treated area (c-spine, l-spine)

11 11 Clinical Indications for the Use of Spinal Traction Subacute Joint Inflammation – Traction may reduce strain on injured tissues &/or joints

12 12 Clinical Indications for the Use of Spinal Traction Paraspinal Muscle Spasm – Can reduce muscle spasm by reducing by &/or firing the GTO

13 13 Clinical Indications for the Use of Spinal Traction

14 14 Contraindications for the Use of Traction Where motion is contraindicated – Example – unstable fracture, spinal cord compression, or shortly after spinal surgery

15 15 Contraindications for the Use of Traction With an acute injury or inflammation – Example – shortly after trauma, surgery, RA, OA

16 16 Contraindications for the Use of Traction Joint hypermobility or instability – Example – fractures, dislocation, surgery, pregnancy, lactation, RA, Down’s syndrome

17 17 Contraindications for the Use of Traction Peripheralization of symptoms with traction

18 18 Contraindications for the Use of Traction Uncontrolled hypertension (for inversion traction)

19 19 Precautions for the Use of Traction Structural diseases or conditions affecting the spine(tumor, infection, rheumatoid arthritis, osteoporosis, or prolonged systemic steroid use)

20 20 Precautions for the Use of Traction When pressure of the belts may be hazardous (pregnancy, hernia, vascular compromise, osteoporosis)

21 21 Precautions for the Use of Traction Displacement of annular fragment – Traction is not likely to change the position of the fragment

22 22 Precautions for the Use of Traction Severe pain relieved by traction – May indicate the spinal nerve root becoming more compressed as a result of the traction intervention

23 23 Precautions for the Use of Traction Claustrophobia

24 24 Precautions for the Use of Traction Patients who cannot tolerate the prone or supine position – Pain in prone or supine position or acid reflux

25 25 Precautions for the Use of Traction Disorientation

26 26 Precautions for the Use of Traction Temporomandibular joint (TMJ) problems and dentures

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28 28 Adverse Effects of Spinal Traction Worsening of symptoms New symptoms (radiculopathy due to excessive strain on the spinal cord dura)

29 29 Application Technique: Mechanical Traction Mechanical Lumbar Traction Procedure

30 30 Application Technique: Mechanical Traction Mechanical Cervical Traction Procedure

31 31 Application Techniques: Self- Traction Examples of Self- Traction – Sitting Self-Traction – Self-Traction Between Corner Counters – Self-Traction With Overhead Bar

32 32 Application Techniques: Positional Lumbar Traction

33 33 Application Techniques: Manual Traction

34 34 Traction MRI results before and after cervical traction

35 35 VAX-D

36 36 VAX-D

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40 40 Sari et al. Computed tomographic evaluation of lumbar spinal structures during traction. Physiother Theory Pract. 2005 Jan- Mar;21(1):3-11.

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