SPINAL TRACTION Traction can draw or pull on an object. Distraction (a more accurate term for clinical use) is the separation of surfaces of a joint by pulling. Distraction can be applied to peripheral limbs or spinal segments

SPINAL TRACTION The force that provides distraction can be generated manually by a therapist, by a machine, or by weight. Friction is the counterforce that opposes motion or attempted motion

FRICTION Friction is always parallel to the surface in contact and opposite in direction. For instance if a pt. Is lying on a table and the pull is in the direction towards the head then friction will work in the opposite direction towards the feet.

FRICTION Friction must be considered when applying traction. You must overcome friction in order to achieve separation of joints. When using a split table for lumbar traction friction is eliminated.

Effects of Tx Joint Distraction Reduction of HNP/bulge ST stretching MM relaxation Joint mobes Pt. immobilization

CLINICAL INDICATION Reduce radicular sx related to DDD, HNP, stenosis and subluxations. Distraction can  joint space to possibly centralize sx.

Decrease compression of nerve root thru distraction Decrease compression of nerve root thru distraction. Distraction decreases compression and increases intervertebral foramina space.

CLINICAL INDICATION Decrease MM spasm and allow soft tissue stretching via a prolonged stretch Decrease pain with intermittent traction via gating mechanism Increase ROM via distraction/mobes of joint surface

Contraindications and Precautions Page 292-296

Application Technique

Positioning Lumbar Tx – can be prone or supine depending on goal If placed supine, hip positioning is significant to target level 45  - 60 laxity L5-S1 60  -75  laxity L4-L5 75 -90  laxity L3-L4 If treating HNP place prone to increase ext

Positioning Cervical Traction can be done supine or sitting Supine is preferred to decrease cervical and UT/levator MM activity Neck is in a neutral position to address upper C-spine and flexed ~ 25  to address lower C - spine

Static vs Intermittent Mode Static – used when sx are easily aggravated by motion, acutely inflammed, related to an HNP or to decrease a MM spasm. Intermittent – On time (pull) and Off time (release) HNP – longer hold time and shorter relax time, use a 3:1 ratio (On 60 secs, OFF 20 secs.

Intermittent Mode To treat a facet problem or joint dysfunction use a 1:1 ratio ( On 15 sec/Off 15sec) Table 10-2 and 10-3

Determining Force of Pull Force of pull depends on your Rx goal. For an initial Rx use a lower force and gradually increase force Initial Rx: Lumbar 25-50#, Cervical 8-10#

Determining Force of Pull GOAL: separate jt surfaces or reduce HNP Lumbar – need at least 50% of body weight I.e if pt. Weighs 200# you will need at least 100# Cervical – range is variable depending on comfort can go as high as 25#

Determining Force of Pull GOAL: decrease spasm and/or stretch soft tissue Lumbar = 25% of body weight I.e if pt. Weighs 200# you will need at least 50# Cervical = low sustained weight, 12-15#

Determining Force of Pull Force needs to be increased for lumbar traction if split table not used. Caution Lumbar force should not exceed 50% of body weight Cervical force should not exceed wt of head (30#) When using Intermittent Tx the force during the relax phase should not be more than 50% of max force. Do not fully release to prevent rebound effect

Treatment Time Table 10-2 and 10-3

Advantages/Disadvantages

This Week’s SOAP Note, Case study 10-1, page 309