traction
DESCRIPTION
TRACTION. OUTCOMES. Must be familiar with the types of mechanical traction. Must be familiar with the mechanical effects of traction. Must be familiar with the indications for mechanical traction . Must be familiar with the contra-indications for mechanical traction. - PowerPoint PPT PresentationTRANSCRIPT
TRACTION
OUTCOMES• Must be familiar with the types of mechanical traction.• Must be familiar with the mechanical effects of traction.• Must be familiar with the indications for mechanical traction. • Must be familiar with the contra-indications for mechanical traction.
OUTCOMES• Must be familiar with the application and technique for mechanical cervical traction.• Must be familiar with the dosage and progression of mechanical cervical traction.• Must be familiar with the application and technique for mechanical lumbar traction.• Must be familiar with the application and technique for mechanical lumbar traction.
DEFINITION
• Traction is derived from the Latin word “tractico” which means a process of drawing or pulling.• It is used in the same way as ordinary passive mobilisation techniques
TYPES OF TRACTION
• Continuous traction• Sustained traction• Intermittent traction• Manual traction• Auto-traction• Positional traction• 90/90 traction
TYPES OF LUMBAR TRACTION
• Inversion traction• Gravity traction• Pool traction
MECHANICAL EFFECTS• Delordosis of the spine• Separation of the vertebrae• Widening of intervertebral foramen• Combination of distraction and gliding of
the facet joints• Stretching of spinal musculature and
ligaments• Distraction
MECHANICAL EFFECTS
• Tensing of posterior longitudinal ligament• Suction• Relaxation of spinal muscles• Joint mobilisation• Reduction of herniated nuclear material• Increase of interspinous distances• Epidural fatty tissue become prominent
MECHANICAL EFFECTS
• Small pressure changes• Normalisation of conduction• Pain relief
MECHANICAL EFFECT (SUCTION)
• Onel (1989) - negative intradiscal pressure “sucks back” the herniated nucleus material and widening of IV disc space causes a stretch on the ant and post longitudinal ligaments
MECHANICAL EFFECT (SUCTION)
• Krause (2000) negates this statement
CLINICAL EFFECTS OF TRACTION
• Remains controversial• Produced from combination of mechanical
and physiological effects
INDICATIONS
• Severe nerve root pain• Recent neurological changes• Degenerative conditions• Widely distributed areas of thoracic and
lumbar pain• Pathological
• Trauma to ligaments• Spondilolisthesis and spondilolysis• No further improvement with mobilisation• Lumbar conditions where movements are
painless during objective evaluation
CONTRA-INDICATIONS
• Resent onset of severe lumbar pain• Hypermobility or instability• Undiagnosed pain• Persistent cough• Cardio-vascular conditions• Spinal malignancy
• Cord compression• Spinal infection• Hiatal hernia• Uncontrolled hypertension• Aortic aneurysm• Abdominal hernia• Severe haemorrhoids
CONTRA-INDICATIONS
• Inadequate investigation• Acute traumatic lesions• Large central disc• Ileofemoral incompetency• Uncooperative patient• Marked ligamentous insufficiency and
segmental instability
CONTRA-INDICATIONS
• Dizzy, nauseated and sick after first careful attempt - cervical
• Vertebrobasilar insufficiency• Patient unable to relax - cervical• Appreciable involuntary head or neck
movements - cervical
TRACTION FORCE NEEDEDResearcher Weight
(traction force)
Maitland < 13 kg for first timeAverage weight between 30 kg and 45 kg
Cyriax 40 kg to 85 kg
Grieve 13 kg to 34 kg
Hicklings 32 kg to 68 kg
APPLICATION OF TRACTION
PRONE
SUPINE
PRONE INTO FLEXION
UNILATERAL
TREATMENT DURATION
Researcher Weight Time
Saunders (1995:286) Few min to 40 min
Onel, et al. (1987:82) 45 kg 40 min
Maitland (2001:376) Determine by dummy-trial
Not exceeding 10 for 1st time, duration not exceed 15 min
Cyriax (Harte, et al. 2003:1543)
30 – 45 min
Hicklings (Harte, et al. 2003:1543)
20 – 40 min with average 30 min
Grieve (Harte, et al. 2003:1543)
10 min initial treatment; 15 min thereafter
UPPER CERVICAL TRACTION
• Upper cervical area • C1-C4• Neutral position
UPPER CERVICAL TRACTION
LOWER CERVICAL TRACTION
• Lower cervical area• C4-T1• Neck in flexion using pillows or towel roll
METHOD
• Patient lies with two pillows under his knees
• Apply gentle traction via spreader bar• Know the area and severity of patient’s pain• Trial-run for 10 seconds• Re-assess the symptoms
PROGRESSION
• Applied daily• Test neck movements directly after traction
except with severe nerve root pain• Time should be increased first• Strength can be increased in small stages• Treatment usually 15 minutes• Severe nerve root: 30 minutes
PROGRESSION
• Stop traction if no improvement after 4-5 treatments
• Severe nerve root pain sometimes at least 7-8 treatments, but
• Movement test must improve by 4th to 5th session
• NB: Carefully assess signs and symptoms before, during and after treatment
UPPER LUMBAR TRACTION
• L1-L4• Neutral position
UPPER LUMBAR TRACTION
LOWER LUMBAR TRACTION
• L4-S1• Patient positioned in Fowler’s position
(Thomas-curl position)
LOWER LUMBAR TRACTION
LUMBAR TRACTION
• Attach the thoracic harness in standing and re-adjust in supine
• Assess area and degree of pain before pull• Knees flexed over pillows to put joint in
mid-position• Trial run
LUMBAR TRACTION
• 12,5 kg to 13 kg for 10 seconds• Arms by side• Reduce if patient experiences low back pain• Re-assess back and leg symptoms after 10-
20 seconds
DURING RELEASE
• Rolling pelvis side to side• Rest for a few minutes• NB: Do not test patients comparable sign
immediately only re-assess following day• Warn patient
PROGRESSION
• Pain less or gone = improvement• Signs and symptoms worse• Signs and symptoms ISQ• Over 3-4 sessions improvement will be
small• If signs improve - increase time first• With no exacerbation - increase kg
REMEMBER
• There is often a postural component involved with disorders of the lumbar spine
RULE OF PROCEDURE (Grieve, 1989)
• Bear in mind contra-indications• Examine thoroughly • Try and localise the problem• Keep treatment under control by frequent
reassessment and precise recording• Each step should be reasoned• Modify techniques which are unproductive
RULE OF PROCEDURE (Grieve, 1989)
• Warn patient about treatment soreness• Do not over treat• Never push through spasm• Treat joint irritability with respect
TREATMENT PROTOCOL
• Teach spinal stabilisation• Dynamic maintenance of postural control• Patient reassurance• Ergonomic advice• Mechanical principles involved• Restoration of maximal patient function• Pain control
TREATMENT PROTOCOL
• To educate patient• To maintain lumbar muscles• Combination of treatments• Back school• Strengthening exercises
TREATMENT PROTOCOL
• Flexibility exercises• Fitness• Total bedrest• Encouragement to function despite
symptoms• Corset• Lumbar intervertebral traction