Download Chapter 18

Chapter 18. Spinal Traction
The Intervertebral Disk
•Outer layer:
–Series of interlacing cross-fibers that are attached to adjacent vertebral
bodies
•Inner layer:
–A protein gel between the cartilaginous end plates of the vertebrae and
the annulus fibrosus
•Functions
–
–
–
•As we age, or because of injury, the disk may lose its normal shape
•If a disk is damaged and you move in weight bearing position, the nucleus
pulposus will shift according to
•For example, if you bend to the right side, the vertebrae squeeze the nucleus to
the
•If tears develop in the annular fibers, the nucleus will tend to take the path of
least resistance and move in this direction.
Traction
•Increases the
•Decreases the
•Encourages the nucleus pulposus to return to
•The mechanical tension of the annulus fibrosis and ligaments surrounding the
disk (especially the __________________ ____________________
___________________) help push the nucleus pulposus back into its proper
place.
Why Use Traction?
Principal reason is
1
How Does Traction Relieve Pain?
•Increasing the space between vertebrae
•Separating the
•Widening the
•Removing pressure on injured tissue
•Increasing peripheral circulation
•Reducing muscle spasm
•
•Changing intervertebral disk pressures
•Tensing the
•Creating suction to draw protruded disks toward their center
•Flattening an abnormal lumbar curvature
Physiological Effects on Bone
•Increases spinal movement, overall and between each vertebrae
•Reverses immobilization-related bone weakness by increasing or maintaining
bone density
Physiological Effects on Ligament
•Creates ligament deformation, thereby increasing movement and decreasing
impingement problems
Physiological Effects on Articular Facet Joints
•Increases the separation between
•Decompresses articular cartilage, allowing ______________ ____________
exchange to nourish the cartilage
•May decrease
•May decrease
Physiological Effects on Muscles
•Lengthens tight muscles and allows better muscular blood flow.
•Activates muscle proprioceptors, further decreasing
Physiological Effects on Nerves
•Decreases compression forces on nerves
Indications
•Compression of
•Disk protrusion
•Joint
•
•Muscle spasm
2
•Disk degeneration
•
•Contracted connective tissue
•Apophyseal joint impingement
•Radiating pain that does not improve with trunk or neck movement
Contraindications
•Malignancy
–Primary or metastatic
•Infectious diseases of the spine
–Tuberculosis
•Uncontrolled
•
•Spinal cord compression
•
•Cardiovascular disease
•Aortic aneurysm
•Acute neck or low back pain
•Frail older adults
•Severe respiratory disease
•Hypermobile vertebrae
–
•When traction increases radicular pain
Specific Contraindications for Lumbar Traction
•
•Hiatal hernia
•
•Active peptic ulcers
•Glaucoma (inversion gravity method)
•Do not substitute traction for a more beneficial treatment
–McKenzie
extension exercise for a posterior bulging disk
Commonly Used Traction Devices
•Manual traction
–Tractive force is applied by
•
–Tractive force is applied with a
3
Cervical Traction
•Generally applied with the patient __________________ or ________________
– ______________ preferred because it eliminates gravity
•Three main types
–
–
–
•Application tip
–With cervical traction, always start with manual traction. Why?
–
•To perform manual cervical traction
–Clinician sits at head of table facing patient
–Head is cradled to allow distraction of cervical
vertebrae without hurting patient
–Traction is applied
•Head is slowly moved to maximize relaxation and
comfort
•How to slowly move head into relaxation and comfort
–Neutral position:
–Flexed 30°:
–Lateral flexion:
•Harness traction
–Harness traction device hung over a doorway
–Amount of tension adjusted by patient
– As patient pulls one click on the pulley, 1 lb of
pressure is applied, separating the vertebrae.
•Table traction
–Mechanical
_____________________ or _________________ table
traction
–Involves use of head harness attached to mechanical device at end of
table
–Device can pull sustained or intermittent traction
•Usually ____ sec on, ____ sec off
4
Lumbar Traction
•Manual
–Allows the clinician to feel
–Can be used as examination technique
–Clinician uses hands or a belt to pull on patient’s legs, separating
vertebrae
•Single-leg traction
–
–Requires two clinicians
–Patient is prone or supine.
–One clinician supports patient’s
torso, while
other puts traction on leg exhibiting radicular
pain.
–After a series of five, ____ sec bouts, patient lies supine at edge of table
and stretches affected ________ _____________ (which are usually tight)
•Mechanical
–Uses
a specialized table that separates when adequate forces are
applied
•Patient’s head and torso are on one half; hips and legs are
on other half.
–One end of belt or strap is attached to patient; other end is
attached to mechanical device that separates table
–Can be delivered in either ________________ or
______________________ mode
•Autotraction
–Uses a specialized table divided into two sections that can be
individually _________________ and __________________
–Patients apply traction force by holding onto or pulling on
overhead bars.
5
•Positional traction
–Uses pillows and bolsters to position vertebrae so that there is
less pressure on nerves and surrounding tissues
•Pool traction
–Flotation belt and water cuffs cause drag,
which result in traction on lumbar vertebrae.
•Inversion table traction
–When patient is suspended upside down, weight of _________
________________ acts as a traction force
–Takes a few sessions to get used to, but has great results
•Post–inversion traction tip
–Lying prone and extending somewhat
on a wedge after inversion traction can
be helpful to a patient suffering from a
______________ bulging lumbar disk.
Treatment Parameters
•Patient position
• Cervical Traction
•
•
•Lumbar Traction
•What positions increase and/or decrease pain?
• Pain while sitting, ↓ pain while prone or trunk extension
• Best position =
•Pain while supine or trunk flexion, ↓ pain while sitting
•Best position =
•REMEMBER: muscle relaxation is key
6
•Treatment mode
• Sustained
• Cause muscle fatigue
• Intermittent
• Patient able to tolerate higher traction forces
•Traction force (general disagreement)
• Magnitude
•Cervical traction = 25 lbs.
•Lumbar traction = 25% - 50% of body weight
•Angle of pull
•Duration
• Range from a few minutes to 40 min.
•Frequency
• Every other day (insurance billing)
• Every day
7