1 Lumbar Traction Chapter 17

2 Lumbar Traction Comparison: Cervical and Lumbar Traction  Similar Separating the vertebrae  Difference: Friction, muscle, soft tissue tension, and weight of the lower extremity is a strong counterforce in lumbar traction, requiring more tension to separate the vertebrae  Force is approximately ½ the body weight  Split table reduces friction Patient position has more influences on angle of pull in lumbar traction

3 Indications Spinal nerve impingement Disk herniations Muscle spasm Radicular pain

4 Contraindications Pain of unknown origin Acute injury Unstable spinal segments Cancer, meningitis, or other spinal cord/ vertebrae disease Vertebral fracture Extruded disk fragments

5 Patient Position: Supine Increases flexion Supine and Flexion  Further increases flexion 46-60: L5-S1 60-75: L4-L5 75-90: L3-L4 90: Posterior intervertebral space Extension  Opens facet joints and increases distraction in upper lumbar

6 Patient Position: Prone Used when excessive flexion or lying supine causes pain Benefits:  Allows other modalities to be used during traction  Effects the lower disk protrusions Optimal Position  Experience  Trial and error

7 Types of Lumbar Traction Inversion Gravitational Autotraction Mechanical

8 Inversion Traction Suspended upside down Lengthens spine by the weight of the patient Hazards  Hypertension  Cardiovascular  Glaucoma

9 Gravitational Traction Patient is Upright Can increase posterior disk space between L1-S1 Torso harness may be uncomfortable

10 Autotraction Support body weight by hanging from a bar or arm chair Relaxing spinal muscles can distract vertebrae

11 Mechanical Traction Application Motorized lumbar traction Determine body weight Remove material that may interfere with halter Adjust halter accordingly  Traction halter: Pelvis  Stabilization harness: 8th-10th Ribs

12 Mechanical Traction Application Unlock split table and align target spinal segment over the opening in the table Secure and connect halter Align angle of pull to correspond with specific pathology Explain treatment to patient and give safety switch

13 Initiation of Treatment Set controls to zero and turn on unit Adjust ratio Tension  Approximately 25% of body weight  Radicular pain caused by disk herniation: 30 to 60% of body weight Duration  Corresponding to pathology Instruct patient to remain relaxed

14 Termination of Treatment Tension  Gradually reduce over 3 or 4 cycles  Gain slack and turn unit OFF  Many units have an auto OFF sequence Remove halter from unit and patient Patient remains in position for 5 minutes after the treatment

15 Manual Traction Helps determine the direction and amount of force to apply mechanically In rare instances manual traction can be substituted for mechanical traction Can be applied using a belt that allows the clinician’s body weight to deliver the force