Spinal Traction
Traction
Process of drawing, or pulling apart, of a body segment
Mechanical Traction – using a traction machine or ropes/ pulleys to apply a traction force
Manual Traction – clinician positions patient and applies traction force to joints of the spine or extremities
Spinal Traction
It is a form of decompression therapy that relieves pressure on the spine. It can be performed manually or mechanically.
It is used to treat
herniated discs,
sciatica,
degenerative disc disease,
pinched nerves,and many other back conditions
It stretches the spine to take pressure off compressed discs. This straightens the spine and improves the body’s ability to heal itself.
Manual Spinal
In This, a physical therapist uses his hands to put a patient in a state of traction. Then he or she uses manual force on the joints and muscles to widen the spaces between vertebrae.
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Mechanical Spinal
In mechanical spinal traction, a patient lies on a table that has special tools to stretch the spine. A physical therapist will attach a series of ropes, slings, and pulleys to the patient to mechanically relieve pressure.
Spinal traction is a non-surgical way to relieve pain and correct problems in the spine. While it does have some potential side effects, spinal traction offers consistent relief for most patients
There are no long-term risks of spinal traction. Some side effects may occur during or after treatment. Many patients experience muscle spasms after traction. Some have pain in the treated areas.
Spinal traction is not for everyone. A physician can determine if the risks are worth the potential rewards.
Effects : Spine
Encourages movement between each individual spinal segment
Amount of movement varies according to…
Position of spine,
Amount of force, and
Length of time force is applied
Transient effect
Effects : Spine
¯ pain, paresthesia, or tingling
Due to physical separation of vertebral segments thus decreasing pressure on sensitive structures
As long as positive physiologic effects occur, traction should be continued
Effects : Bone
No immediate effects due to traction
May result in increased spinal movement that reverses bone weakness associated with immobilization
May assist with increasing or maintaining bone density
Effects : Ligaments
Stretching effect
Structural changes occur slowly due to viscoelastic properties
Ligaments resist shear forces and return to original form following removal of a deforming load
Sensitivity to rate of loading
Ligament deformation results in lengthening of a ligament caused by traction loading.
Effects : Discs
Normal disc in non-compressed position
Internal pressure (indicated by arrows) is exerted equally in all directions
Internal annular fibers contain nuclear materials
Effects : Discs
In an injured disc, sitting or standing compresses the disk causing the nucleus to become flatter
Pressure in this instance still remains relatively equal in all directions
Effects : Discs
In an injured disk, movement in weight-bearing causes a horizontal shift in nuclear material
If this was forward bending, the bulge would occur in the posterior annular fibers
Anterior annular fibers would be slackened and narrow
Effects of Traction: Discs
Herniation of the nuclear material occurs if the annular wall becomes weak
Herniation may possibly put pressure on sensitive structures in the area
Effects : Discs
When placed under traction, intervertebral space expands thereby decreasing pressure on the disk
Taut annular fibers create a centripetally directed force
Decreases herniation and pressure on sensitive structures in the area
Effects : Articular Facet Joints
Facet joints are separated releasing impinged structures
Dramatic reduction in symptoms
Joint separation decompresses articular cartilage allowing synovial fluid exchange to nourish cartilage
Decreases rate of degenerative changes
Increased proprioception from facet joint structures provide sensation of pain relief
Effects : Muscles
Vertebral muscles can be stretched
Initial stretch should come from body positioning
Stretch lengthens tight muscle
Allows for better muscular blood flow
Activates muscle proprioceptors providing sensation of pain relief.
Effects : Nerves
Focus of most traction treatments
Pressure on nerves or nerve roots often associated with spinal pain
Unrelieved pressure on a nerve will cause
Slowing, eventual loss of impulse conduction
Motor weakness, numbness, and loss of reflex
Pain, tenderness, and muscular spasm
Traction Treatment Techniques
Lumbar Positional
Inversion traction
Manual Lumbar Traction
Level-specific
Unilateral leg pull
Mechanical Lumbar Traction
Manual Cervical Traction
Mechanical Cervical Traction
Lumbar Positional
Patient typically on restricted activity program
“Trial and error” process to determine position that offers maximum comfort
Side-lying Position: Unilateral Foramen Opening
Lateral Herniation
Patient leaning away from painful side
Lie painful side up
Lie on right side over blanket roll
Side-lying Position: Unilateral Foramen Opening
Lateral Herniation
Patient leaning away from painful side
Lie painful side up
Lie on right side over blanket roll
Medial Herniation
Patient leaning toward painful side
Lie painful side down
Lie on right side over blanket roll
Side-lying Position: Unilateral Foramen Opening
Side-lying with a blanket roll between iliac crest and rib cage
Increases intervertebral foramen size of superior side of lumbar spine
Side-lying Position: Unilateral Foramen Opening
Maximum opening of intervertebral foramen
Achieved by flexing upper hip and knee and rotating shoulders in opposite directions
Supine Position: Bilateral Foramen Opening
Knees to chest position
increases size of lumbar intervertebral foramen bilaterally
Separation of spinous processes
Inversion Traction
Hang upside down
Lengthens spinal column due to stretch provided by weight of trunk
Repeat inversion 2-3 times
Observe for signs of vertigo, dizziness, or nausea
Manual Lumbar Traction
Used prior to mechanical traction
Helps determine degree of lumbar flexion, extension, or side-bending that is most comfortable
Most comfortable position is usually best therapeutic position
Level-Specific Manual Traction
Position patient for maximum effect at a specific spinal level
Lumbar spine flexed using upper leg as lever
Palpate interspinous space
Upper spinous process is where maximum effect is desired
Level-Specific Manual
When motion of lower spinous process can be palpated, place foot against opposite leg to prevent further flexion
Trunk is then rotated toward the upper shoulder until motion of upper spinous process can be palpated
Level-Specific Manual Traction
Place chest against ASIS and upper hip
Lean toward patient’s feet
Use enough force to cause a palpable separation of the spinous processes at desired level
Unilateral Leg Pull Manual Traction
Hip joint problems or difficult lateral shift corrections
Thoracic counter-traction harness is used
Hold ankle and move hip into 30o flexion, 30o abduction, and full external rotation
Apply steady traction force until noticeable distraction occurs
Unilateral Leg Pull Manual
Sacroiliac problems
In addition to thoracic counter-traction harness, strap is placed through groin and secured to table
Hold ankle and move hip into 30o flexion and 15o abduction
Apply steady traction force
Mechanical Lumbar Traction: Equipment
Use split table to eliminate friction between body segments
Non-slip traction harness stabilizes trunk
Mechanical Lumbar :
Setup
Pelvic harness
Applied while standing
Contact pads and upper belt placed at, or just above, iliac crest
Rib pads
Positioned over lower rib cage
Mechanical Lumbar Traction:
Body Positioning
Neutral spinal position
Allows for largest intervertebral foramen opening before traction is applied
Usually position of choice whether prone or supine
Mechanical Lumbar Traction:
Body Positioning
Flexion
Increases posterior opening
Puts pressure on disk nucleus to move posterior
Other soft tissue may also close foramen opening
Mechanical Lumbar :
Body Positioning
Extension
Closes foramen because bony arches come closer together
Mechanical Lumbar Traction:
Body Positioning
Prone position
Used with normal to slightly flattened lumbar lordosis
Best for disk protrusions
Place pillows under abdomen
Other modalities may be applied
Allows for assessment of spinous process separation
Mechanical Lumbar :
Body Positioning
Supine position
Produces posterior intervertebral separation
Optimal at 90o hip flexion
Unilateral pelvic traction recommended if stronger force is desired
Scoliosis,
Unilateral joint dysfunction, or
Unilateral lumbar muscle spasm
Traction Force
No lumbar vertebral separation will occur with traction forces less than 1/4 of body weight
Effective traction force ranges between 65 and 200 pounds
Traction force recommended = 1/2 body weight
Must use progressive steps to comfortably reach therapeutic loads
Intermittent vs. Sustained Traction
Intermittent Traction
Effective for posterior intervertebral separation
No firm recommendations for on/off times
Sustained
Recommended for disk protrusion and rupture
Treatment Duration
With suspected disk protrusions, total treatment time should be relatively short
10 minutes or less
If treatment reduces symptoms, treatment time should remain at 10 min or less
If the treatment is partially successful or unsuccessful in relieving symptoms, gradually increase time over several treatments up to 30 min
Manual Cervical
Stretches muscles and joint structures
Enlarges intervertebral spaces and foramen
Creates centripetally directed forces on disk and surrounding soft tissue
Mobilizes vertebral joints
Increases joint proprioception
Relieves compressive effects of normal posture
Improves arterial, venous, and lymphatic flow
Manual Cervical Traction
Variety of head and neck positions
Hand should cradle neck contacting one mastoid process
Other hand on chin
Gentle pull, < 20 pounds
Intermittent pull, 3 – 10 sec
Treatment time, 3 – 10 min
Mechanical Cervical
Supine
Neck flexed 20 – 30o
Traction harness pulls on occiput
Intermittent pull
> 20 pounds
Minimum of 7 seconds
Adequate rest time for recovery
Treatment time, 20 – 25 min
Mechanical Cervical Traction
Wall-mounted device
Inexpensive
Static traction most easily employed
Use weight plates, sand bags, or water bags
Intermittent traction may be used
Sitting or prone
Gentle pull, 10 – 20 pounds
Treatment time, 20 – 25 min
Indications for Spinal Traction
Nerve root impingement
Disk herniation
Spondylolisthesis
Narrowing within intervertebral foramen
Osteophyte formation
Degenerative joint diseases
Subacute pain
Joint hypomobility
Discogenic pain
Muscle spasm or guarding
Muscle strain
Spinal ligament or capsular contractures
Improvement in arterial, venous, and lymphatic flow
contraindication
Spinal traction can sometimes cause pain that is worse than the original condition. Patients with osteoporosis and certain types of cancer should not use traction therapy.
Spinal traction is known to cause muscle spasms. Most doctors are prepared for this to happen during or after therapy.
Contraindications for
Spinal Traction
Acute sprains or strains
Acute inflammation
Fractures
Vertebral joint instability
Any condition in which movement exacerbates existing problem
Bone diseases
Osteoporosis
Infections in bones or joints
Vascular conditions
Pregnant females
Cardiac or pulmonary problems
