Spinal Traction, Knight & Draper 2008


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  • Too tight or Frozen -> ideal or just right or within normal limits-> too loose or laxity
  • Spinal Traction, Knight & Draper 2008

    1. 1. Chapter 18. Spinal Traction
    2. 2. The Intervertebral Disk <ul><li>Outer layer: annulus fibrosus </li></ul><ul><ul><li>Series of interlacing cross-fibers that are attached to adjacent vertebral bodies </li></ul></ul><ul><li>Inner layer: nucleus pulposus </li></ul><ul><ul><li>A protein gel between the cartilaginous end plates of the vertebrae and the annulus fibrosus </li></ul></ul>
    3. 3. The Intervertebral Disk (cont.) <ul><li>Functions </li></ul><ul><ul><li>Shock absorption </li></ul></ul><ul><ul><li>Provide flexibility and movement </li></ul></ul><ul><ul><li>Provide adequate space between the vertebrae for exiting nerves </li></ul></ul>
    4. 4. The Intervertebral Disk (cont.) <ul><li>As we age, or because of injury, the disk may lose its normal shape </li></ul><ul><ul><li>For example, a bulging disk with weakened annulus fibers might look like the inner tube of a bicycle tire with a weak spot. </li></ul></ul>
    5. 5. The Intervertebral Disk (cont.) <ul><li>This is an MRI of a herniated disk at the L3 – L4 level; the patient is one of the authors of your text. </li></ul><ul><li>He found some relief from lumbar traction. </li></ul>
    6. 6. The Intervertebral Disk (cont.) <ul><li>If a disk is damaged and you move in weight bearing position, the nucleus pulposus will shift according to fluid-dynamic principles. </li></ul>
    7. 7. The Intervertebral Disk (cont.) <ul><li>For example, if you bend to the right side, the vertebrae squeeze the nucleus to the left. </li></ul><ul><li>If tears develop in the annular fibers, the nucleus will tend to take the path of least resistance and move in this direction. </li></ul>
    8. 8. Traction <ul><li>Increases the separation of the vertebrae </li></ul><ul><li>Decreases the central pressure in the disk space </li></ul><ul><li>Encourages the nucleus pulposus to return to a central position </li></ul><ul><li>The mechanical tension of the annulus fibrosis and ligaments surrounding the disk (especially the posterior longitudinal ligament) help push the nucleus pulposus back into its proper place. </li></ul>
    9. 9. Why Use Traction? <ul><li>Principal reason is pain relief </li></ul>
    10. 10. How Does Traction Relieve Pain? <ul><li>Increasing the space between vertebrae </li></ul><ul><li>Separating the apophyseal joints </li></ul><ul><li>Widening the intervertebral foramina </li></ul><ul><li>Removing pressure on injured tissue </li></ul><ul><li>Reducing muscle spasm </li></ul><ul><li>Increasing peripheral circulation </li></ul><ul><li>Relaxing muscles </li></ul><ul><li>Changing intervertebral disk pressures </li></ul><ul><li>Tensing the posterior longitudinal ligament </li></ul><ul><li>Creating suction to draw protruded disks toward their center </li></ul><ul><li>Flattening an abnormal lumbar curvature </li></ul>
    11. 11. Physiological Effects on Bone <ul><li>Increases spinal movement, overall and between each vertebrae </li></ul><ul><li>Reverses immobilization-related bone weakness by increasing or maintaining bone density </li></ul>
    12. 12. Physiological Effects on Ligament <ul><li>Creates ligament deformation, thereby increasing movement and decreasing impingement problems </li></ul><ul><ul><li>Long-term effects </li></ul></ul>
    13. 13. Physiological Effects on Articular Facet Joints <ul><li>Increases the separation between joint surfaces </li></ul><ul><li>Decompresses articular cartilage, allowing synovial fluid exchange to nourish the cartilage </li></ul><ul><li>May decrease degenerative changes </li></ul><ul><li>May decrease pain perception </li></ul>
    14. 14. Physiological Effects on Muscles <ul><li>Lengthens tight muscles and allows better muscular blood flow. </li></ul><ul><li>Activates muscle proprioceptors, further decreasing pain </li></ul>
    15. 15. Physiological Effects on Nerves <ul><li>Decreases compression forces on nerves </li></ul>
    16. 16. Indications <ul><li>Compression of nerve roots </li></ul><ul><li>Disk protrusion </li></ul><ul><li>Joint hypomobility </li></ul><ul><li>Adhesions </li></ul><ul><li>Muscle spasm </li></ul>
    17. 17. Indications (cont.) <ul><li>Disk degeneration </li></ul><ul><li>Foraminal stenosis </li></ul><ul><li>Contracted connective tissue </li></ul><ul><li>Apophyseal joint impingement </li></ul><ul><li>Radiating pain that does not improve with trunk or neck movement </li></ul>
    18. 18. Contraindications <ul><li>Malignancy </li></ul><ul><ul><li>Primary or metastatic </li></ul></ul><ul><li>Infectious diseases of the spine </li></ul><ul><ul><li>Tuberculosis </li></ul></ul><ul><li>Uncontrolled hypertension </li></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Spinal cord compression </li></ul><ul><li>Osteoporosis </li></ul><ul><li>Cardiovascular disease </li></ul>
    19. 19. Contraindications (cont.) <ul><li>Aortic aneurysm </li></ul><ul><li>Acute neck or low back pain </li></ul><ul><li>Frail older adults </li></ul><ul><li>Severe respiratory disease </li></ul><ul><li>Hypermobile vertebrae </li></ul><ul><ul><li>Spondylolisthesis </li></ul></ul><ul><li>When traction increases radicular pain </li></ul>
    20. 20. Specific Contraindications for Lumbar Traction <ul><li>Pregnancy </li></ul><ul><li>Hiatal hernia </li></ul><ul><li>Abdominal hernia </li></ul><ul><li>Active peptic ulcers </li></ul><ul><li>Glaucoma (inversion gravity method) </li></ul><ul><li>Do not substitute traction for a more beneficial treatment </li></ul><ul><ul><li>McKenzie extension exercise for a posterior bulging disk </li></ul></ul>
    21. 21. Commonly Used Traction Devices <ul><li>Manual traction </li></ul><ul><ul><li>Tractive force is applied by another person </li></ul></ul><ul><li>Mechanical traction </li></ul><ul><ul><li>Tractive force is applied with a machine or other apparatus </li></ul></ul>
    22. 22. Cervical Traction <ul><li>Generally applied with the patient supine or sitting </li></ul><ul><ul><li>Supine preferred because it eliminates gravity </li></ul></ul><ul><li>Three main types </li></ul><ul><ul><li>Manual </li></ul></ul><ul><ul><li>Pneumatic </li></ul></ul><ul><ul><li>Motorized </li></ul></ul>
    23. 23. Cervical Traction (cont.) <ul><li>Application tip </li></ul><ul><ul><li>With cervical traction, always start with manual traction. Why? </li></ul></ul><ul><ul><li>You can rapidly stop a motion that might be troublesome to the patient. </li></ul></ul>
    24. 24. Cervical Traction (cont.) <ul><li>To perform manual cervical traction </li></ul><ul><ul><li>Clinician sits at head of table facing patient </li></ul></ul><ul><ul><li>Head is cradled to allow distraction of cervical vertebrae without hurting patient </li></ul></ul><ul><ul><li>Traction is applied </li></ul></ul><ul><ul><ul><li>Head is slowly moved to maximize relaxation and comfort </li></ul></ul></ul>
    25. 25. Cervical Traction (cont.) <ul><li>How to slowly move head into relaxation and comfort </li></ul><ul><ul><li>Neutral position pain: affecting upper cervical vertebrae </li></ul></ul><ul><ul><li>Flexed 30 ° pain: affecting lower cervical vertebrae </li></ul></ul><ul><ul><li>Lateral flexion pain: pressure on spinal nerves with radiating pain into arms or hands </li></ul></ul>
    26. 26. Cervical Traction (cont.) <ul><li>Harness traction </li></ul><ul><ul><li>Harness traction device hung over a doorway </li></ul></ul><ul><ul><li>Amount of tension adjusted by patient </li></ul></ul><ul><ul><li>As patient pulls one click on the pulley, 1 lb of pressure is applied, separating the vertebrae. </li></ul></ul>
    27. 27. Cervical Traction (cont.) <ul><li>Table traction </li></ul><ul><ul><li>Mechanical intermittent or sustained table traction </li></ul></ul><ul><ul><li>Involves use of head harness attached to mechanical device at end of table </li></ul></ul><ul><ul><li>Device can pull sustained or intermittent traction </li></ul></ul><ul><ul><ul><li>Usually 30 sec on, 10 sec off </li></ul></ul></ul>
    28. 28. Lumbar Traction <ul><li>There are more types of lumbar traction than cervical traction. </li></ul><ul><li>Some of the most commonly used techniques are presented. </li></ul>
    29. 29. Lumbar Traction (cont.) <ul><li>Manual </li></ul><ul><ul><li>Allows the clinician to feel patient’s reaction to treatment </li></ul></ul><ul><ul><li>Can be used as examination technique </li></ul></ul><ul><ul><li>Clinician uses her hands or a belt to pull on patient’s legs, separating vertebrae </li></ul></ul>
    30. 30. Lumbar Traction (cont.) <ul><li>Single-leg traction </li></ul><ul><ul><li>Manual traction </li></ul></ul><ul><ul><li>Requires two clinicians </li></ul></ul><ul><ul><li>Patient is prone or supine. </li></ul></ul><ul><ul><li>One clinician supports patient’s torso, while other puts traction on leg exhibiting radicular pain. </li></ul></ul><ul><ul><li>After a series of five, 30 sec bouts, patient lies supine at edge of table and stretches affected hip flexors (which are usually tight) </li></ul></ul>
    31. 31. Lumbar Traction (cont.) <ul><li>Mechanical </li></ul><ul><ul><li>Uses a specialized table that separates when adequate forces are applied </li></ul></ul><ul><ul><ul><li>Patient’s head and torso are on one half; hips and legs are on other half. </li></ul></ul></ul><ul><ul><li>One end of belt or strap is attached to patient; other end is attached to mechanical device that separates table </li></ul></ul><ul><ul><li>Can be delivered in either sustained or intermittent mode </li></ul></ul>
    32. 32. Lumbar Traction (cont.) <ul><li>Autotraction </li></ul><ul><ul><li>Uses a specialized table divided into two sections that can be individually tilted and rotated </li></ul></ul><ul><ul><li>Patients apply traction force by holding onto or pulling on overhead bars. </li></ul></ul>
    33. 33. Lumbar Traction (cont.) <ul><li>Positional traction </li></ul><ul><ul><li>Uses pillows and bolsters to position vertebrae so that there is less pressure on nerves and surrounding tissues </li></ul></ul>
    34. 34. Lumbar Traction (cont.) <ul><li>Pool traction </li></ul><ul><ul><li>Flotation belt and water cuffs cause drag, which result in traction on lumbar vertebrae. </li></ul></ul>
    35. 35. Lumbar Traction (cont.) <ul><li>Inversion table traction </li></ul><ul><ul><li>When patient is suspended upside down, weight of upper body acts as a traction force </li></ul></ul><ul><ul><li>Takes a few sessions to get used to, but has great results </li></ul></ul><ul><ul><ul><li>One of the authors of your book has had positive personal experience. </li></ul></ul></ul>
    36. 36. Lumbar Traction (cont.) <ul><li>Post –inversion traction tip </li></ul><ul><ul><li>Lying prone and extending somewhat on a wedge after inversion traction can be helpful to a patient suffering from a posterior bulging lumbar disk. </li></ul></ul>
    37. 37. Treatment Parameters <ul><li>Patient position </li></ul><ul><li>Treatment mode </li></ul><ul><li>Traction force </li></ul><ul><li>Duration </li></ul><ul><li>Frequency </li></ul>