1 Traction Cervical & Lumbar

2 Traction Application of a longitudinal force to the spine & associated structure Can be applied with continuous or intermittent tension Continuous – small force for extended time (over hours) Sustained - small force for extended time (45 min. or less) Intermittent – alternates periods of traction & relaxation (most common) May be applied manually or with a mechanical device

3 Indications Muscle spasm Certain degenerative disk diseasesHerniated or protruding disks Nerve root compression Facet joint pathology Osteoarthritis Capsulitis of vertebral joints Anterior/posterior longitudinal ligament pathology

4 Cervical Disc Herniation

5 Lumbar Disc Herniation

6 Contraindications Unstable spineDiseases affecting vertebra or spinal cord, including cancer & meningitis Vertebral fractures Extruded disk fragmentation Spinal cord compression Conditions in which flex. &/or ext. are contraindicated Osteoporosis

7 Precautions Condition should have been evaluated by a physicianPhysician’s Orders Close monitoring of patient should be performed throughout treatment Can cause thrombosis of internal jugular vein if excessive duration or traction weight is used

8 Cervical Traction Application of a longitudinal force to the C-spine & structures Tension applied can be expressed in pounds or % of patient’s body weight. At 7% of patient’s body weight, vertebral separation begins Human head accounts for 8.1% of body weight (8-14 lbs.) Greater amount of force is needed widen areas You want force to be about 20% of body weight

9 Cervical Traction PositioningSeated – a greater force is needed to apply the same pressure (due to gravity) than if supine Supine – support lumbar region (bend knees, use knee elevator, or hang lower legs over end of table & place feet on chair); allows musculature to relax

10 Effects of Cervical TractionReduces pain & paresthesia associated w/ n. root impingement & m. spasm Reduces amount of pressure on n. roots & allows separation of vertebrae to result in decompression of disks.

11 Effectiveness of Cervical TractionCervical traction has been linked to 5 mechanical factors Position of the neck Force of applied traction Duration of traction Angle of pull Position of patient

12 Cervical Treatment Set-upNeck – placed in 25-30° flexion Straightens normal lordosis of C-spine Must have at least 15° flexion to separate facet joint surfaces Body must be in straight alignment Be aware that C-spine traction can cause residual lumbar n. root pain if improperly set up. Duration – minutes most common

13 Cervical Treatment Set-upRemove any jewelry, glasses, or clothing that may interfere Lay supine, place pillows, etc. under knees Secure halter to cervical region placing pressure on occipital process & chin (minor amount) Align unit for 25-30° of neck flexion Remove any slack in pulley cable On:Off sequence 3:1 or 4:1 ratio

14 Cervical Treatment Following treatment, gradually reduce tension & gain slack Have patient remain in position for a few minutes after treatment

15 Lumbar Traction To be effective, lumbar traction must overcome lower extremity weight (¼-½ of body weight) Friction is a strong counterforce against lumbar traction Split table is used to reduce friction

16 Lumbar Traction Mechanical traction Self-administered AutotractionMotorized unit Self-administered Autotraction Manual traction Belt Thoracic stabilization harness Pelvic traction harness Clinician’s body weight

17 Lumbar Traction Tension Patient Position & Angle of PullApproximately ½ of body weight Published literature = % of patient’s body weight Patient Position & Angle of Pull Should maximize separation & elongation of target tissues Prone or Supine – depends on: Patient comfort Pathology Spinal segments & structures being treated

18 Lumbar Traction - Patient PositionSupine positioning Tends to increase lumbar flexion Flexing hips from 45 to 60 increases laxity in L5-S1 segments Flexing hips from 60 to 75 increases laxity in L4-L5 segments Flexing hips from 75 to 90 increases laxity in L3-L4 segments Flexing hips to 90 increases posterior intervertebral space Prone Position Used when excessive flexion of lumbar spine & pelvis or lying supine causes pain or increases peripheral symptoms

19 Lumbar Traction – Angle of PullAnterior angle of pull increases amount of lumbar lordosis Posterior angle of pull increases lumbar kyphosis Too much flexion can impinge on the posterior spinal ligaments Optimal position & angle of pull – Often derived by trial & error Depends on patient & pathology of injury

20 Lumbar Treatment Set-upCalculate body weight Apply traction & stabilization harness Position on table, drape for modesty Set mode – intermittent or continuous Set ON:OFF ratio time Set tension Set duration Give patient Alarm/Safety switch Explain everything to patient prior to beginning treatment!

21 References Google Imagesortho/cervical_disc_he... mri.co.nz/ medimgs/Muscu.htm