Traction AndTraction Of Different Body Parts

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
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—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,
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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.
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—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
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—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
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—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
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—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
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—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
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—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
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—Lumbar Positional 
—Patient typically on restricted activity program
—“Trial and error” process to determine position that offers maximum comfort
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—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
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—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
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—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
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—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
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—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
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—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
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—Mechanical Lumbar Traction: Equipment
—Use split table to eliminate friction between body segments
—Non-slip traction harness stabilizes trunk
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—Mechanical Lumbar :
Setup
—Pelvic harness
—Applied while standing
—Contact pads and upper belt placed at, or just above, iliac crest
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—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
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—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
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—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
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—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
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—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
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—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
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—Indications for Spinal Traction
—Nerve root impingement
—Disk herniation
—Spondylolisthesis
—Narrowing within intervertebral foramen
—Osteophyte formation
—Degenerative joint diseases
—Subacute pain
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—Joint hypomobility
—Discogenic pain
—Muscle spasm or guarding
—Muscle strain
—Spinal ligament or capsular contractures
—Improvement in arterial, venous, and lymphatic flow
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—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.
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—Spinal traction is known to cause muscle spasms. Most doctors are prepared for this to happen during or after therapy.
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—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
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