2. TRACTION
• Drawing apart; pulling
• Separation of bones and/or bony segments utilizing a distraction force
• A traction is a treatment option that is based on the application of a longitudinal
force to the axis of the spinal column.
• In other words, parts of the spinal column are pulled in opposite directions to
stabilize or change the position of damaged aspects of the spine.
• The force is usually applied to the spine through a series of weights or a fixation
device and requires that the patient is kept in bed.
• Traction is a manual ‘stretching’ of the spine which reduces pressure on the discs
and therefore reduces the individual’s pain.
3. TYPES OF TRACTION
1. Manual Traction: In manual spinal traction, a physical therapist uses their
hands to put people in a state of traction. Then they use manual force on the
joints and muscles to widen the spaces between vertebrae. The period of
traction generally doesn’t last very long.
2. MECHANICAL TRACTION: The specialized treatment technique of mechanical
traction uses devices that work by stretching the spinal vertebrae and muscle.
Mechanical traction allows for continuous or intermittent stretching on a
traction table while combining heat, vibration, and/or massage. These tables
can use computer-based systems to apply exact amounts and/or variations of
pressure.
3. Gravitational traction: distraction force is provided by gravity
4. SPINAL TRACTION CATEGORIES
1. Continuous traction: Continuous spinal traction is applied for several hours
requiring only small amounts of weight. It’s an uncomfortable mode of
traction wherein patient cannot tolerate poundage enough to cause
separation of the vertebrae for an extended length of time.
2. Sustained/STATIC TRACTION: Steady amount of traction is applied for few
minutes and equally coupled with stronger poundage.
3. INTERMITTENT MECHANICAL TRACTION: Traction is applied alternatively
and withdrawn through a mechanical device.
4. POSITIONAL TRACTION: Traction is applied by the use of pillows, blocks, or
sandbags to affect a longitudinal pull on the spinal structures.
5. CONTRAINDICATIONS OF SPINAL
TRACTION
• Diseases affecting vertebra or spinal cord, including cancer & meningitis
• Vertebral fractures
• Extruded disc fragmentation
• Spinal cord compression
• Osteoporosis
• Spinal infection
• RA or other acute inflammatory joint disorder
6. PRECAUTIONS FOR SPINAL
TRACTION
• Joint hypermobility
• Acute inflammation
• Pregnancy (increased ligamentous laxity and risk for abdominal compression)
• TMJ dysfunction (cervical) if using chin strap
• Close monitoring of patient should be performed throughout treatment
• Can cause thrombosis of internal jugular vein if excessive duration or traction
weight is used
7. CALCULATING TRACTION FRACTION
• Traction pulls are opposed by friction forces.
• for traction forces to effect spinal segments, traction force must exceed friction
force.
• There is a mathematical relationship between body weight and the amount of
friction force from the treatment surface. this is called the "coefficient of static
friction".
8. GOALS OF TRACTION
• reduce radicular signs - reducing nerve impingement
• reduce muscle guarding via prolonged stretch
• reduce joint pain
• increase range of motion
• promote fracture healing
9. THEORY OF THERAPEUTIC EFFECTS
1. Herniation of disc material - Pressure on intradiscal components of the
involved disc(s) are reduced. Negative pressure pulls disc material back into
the disc, decreasing the size of herniated disc material.
2. Degenerative joint disease - Pressure on facet and foraminal space is
temporarily decreased, resulting in nerve compression and decreased nerve
root irritation and/or secondary swelling from progressive joint changes.
3. Muscle spasm or guarding - Benefit is due to low load prolonged stretch of
surrounding soft tissues of the cervical and lumbar spine.
10. 4. Joint hypomobility - Benefit is due to:
• moving articular structures on each other
• distracting articular structures to free up motion
• increase synovial fluid production and nutrition to cartilaginous structures
• increase activation of mechanoreceptors to inhibit the pain response
5. Facet Impingement – Benefit is due to decompression of facet capsular
structure which can become impinged with compression
12. INTRODUCTION
• Application of a longitudinal force to the C-spine & structures
• Strongest evidence for the benefits of traction is in cervical applications
• Benefits of the use of cervical traction is supported in cases of osteoarthritis,
cervical radiculopathy, disc herniation, and tension headaches
• The force applied for cervical traction is 20% or ¼ of body weight
14. EFFECTIVENESS OF CERVICAL
TRACTION
• Cervical traction has been linked to 5 mechanical factors -
1. Position of the neck
2. Force of applied traction
3. Duration of traction
4. Angle of pull
5. Position of patient
15. ANGLE OF PULL
• research is variable regarding the ideal angle of pull
• general guidelines suggest 25 degrees of cervical flexion during traction
application
• Must have at least 15° flexion to separate facet joint surfaces
• Body must be in straight alignment
16. CERVICAL TRACTION POSITIONING
• Seated – 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
17. CERVICAL TREATMENT SET-UP
• Remove 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
20. INTRODUCTION
• Lumbar traction is the process of applying a stretching force to the lumbar
vertebrae through body weight, weights, and/or pulleys to distract individual
joints of the lumbar spine.
• It remains a core component of PT curriculum, including understanding of its
theoretical basis for application as well as the practical skill of safely applying
manual and mechanical traction.
• The force applied for lumbar traction is 40-60% or ½ of body weight.
22. ANGLE OF PULL
• generally perpendicular to table for L1-L5
• line of pull needs to change at L5-S1 to accommodate for the lumbosacral angle
(30 degrees)
• in supine, 90/90 position facilitates traction force at L5-S1
• in prone, angle of pull should be at 30 degrees from table to reach L5-S1 disc space
23. LUMBAR TRACTION POSITIONING
• Supine positioning -
• Tends to increase lumbar flexion
• Flexing hips from 45 – 60 DEGREE - increases laxity in L5-S1 segments
• Flexing hips from 60 – 75 DEGREE - increases laxity in L4-L5 segments
• Flexing hips from 75 – 90 DEGREE - increases laxity in L3-L4 segments
• Flexing hips to 90 DEGREE - increases posterior intervertebral space
• Prone Position - Used when excessive flexion of lumbar spine & pelvis or lying
supine causes pain or increases peripheral symptoms
24. LUMBAR TRACTION SET-UP
• Calculate body weight
• Apply traction & stabilization harness
• Position on table, drape for modesty
• Set mode – intermittent or continuous
• Set ON:OFF ratio time
• Set duration
• Give patient Alarm/Safety switch
• Explain everything to patient prior to beginning treatment!
27. STATIC VS. INTERMITTENT
• again, research is variable when it comes to best practices. In general:
1. muscle relaxation: low load long duration stretch (static stretch)
2. facet mobilization approach: short and equal on-off time (10 sec/10 sec)
3. herniated disc diagnosis/dysfunction: longer on: off ratio (3:1)
28. TREATMENT TIME
• For acute disc herniation < = 8 minutes (increased treatment time may cause
fluid to enter disc space, thus increasing intradiscal pressure.
• for chronic conditions, generally 20-25 minutes: treatment time will vary
depending on patient response.
30. POSITIONAL TRACTION
• allows patients to position themselves with guidance and then independently in
positions to decrease compression to affected foraminal or facet structures.
• for cervical traction: patient is instructed on how to position their head and neck
to provide maximal decompression of involved structures
• for lumbar traction: patient is instructed on how to position their legs and trunk
to provide maximal decompression of involved structures
• Position to maximally open facets
• forward flexion - contralateral side flexion - ipsilateral rotation
• Position to maximally open foramen:
• forward flexion - contralateral side flexion - contralateral rotation
• monitor for signs and symptoms of pain due to facet compression by prolonged
positioning on the contralateral side
31. MANUAL TRACTION
• applied using a three-dimensional pulls by a therapist; joint specific traction is
considered a more advanced technique
• in the cervical spine, therapist applies a manual pulling force at the occiput for
decreasing muscle guarding
• in the lumbar spine, therapist applies a manual pulling force at the pelvis and/or
lower extremities depending on symptoms and target tissue response.
• Warning: DO NOT attempt these techniques without direct instructor
supervision
32. POSITIONING AND DRAPING
• Always position for patient comfort and drape as needed to assure only areas
that need to be exposed to perform the techniques are out in the open.
