Spinal Traction Overview Chapter 17

Purpose Force that separates the vertebrae, opening the intervertebral space Effects:  Decreased pressure on intervertebral disks  Decreased pressure spinal nerve rots  Opens facet joints  Elongates tissue Body areas:  Cervical  Lumbar/pelvis

Types of Traction Sustained  Continuous, small force for an extended period (appx. 45 min) Intermittent  Alternately applied and withdrawn traction Manual  Administered by the clinician Positional  Body positioning to elongate the involved tissue

General Principles Angle of pull  Neutral: Transverse plane  Flexion/Extension: Frontal plane  Unilateral: Sagittal plane  Multiaxial: Two or more planes Anatomical differences  Cervical inferior facet joints angle anteriorly Flexion opens facet joints  Lumbar facets angled posteriorly Extension opens facet joints

General Principles Tension  No clear formula  The traction must overcome the resistance exerted by the soft tissue  Use the least amount of tension needed to relieve symptoms  Duration is inversely related to tension

Physiological Effects Encourages movement of spine between each vertebra Improves circulation Increases metabolism Enhances nutrition ROM increases dependent on:  Patient position  Amount of force applied  Type of traction  Treatment time

Indications Disk protrusions Degenerative disk disease Nerve root compression Facet joint pathology Muscle spasm

Contraindications Acute injury Unstable spinal segments Cancer, meningitis, or other spinal cord/ vertebrae disease Vertebral fracture Extruded disk fragments

Intervertebral Disks and Disk Lesions Anatomy  Annulus fibrosus  Nucleus pulposus Dehydration  Decrease range of motion narrowing intervertebral foramen  Weakens annulus fibrosis  Day vs. night  Age

Disk protrusion Body weight and muscle tone compress the disk and force the nucleus pulposus posteriorly Traction  Decreases the pressure  Increases disk hydration Imbibe  Traction applied for too long can absorb too much fluid

Anatomy:  Intervertebral foramen:  Opening for 31 pairs of spinal nerve roots Disk degeneration  Narrowing of intervertebral space Osteophytes  Decrease opening  Inflammation of nerve sheath’s Intervertebral Foramen Stenosis

Facet Joint Pathology Healthy facets transmit approximately 20% of the body weight Inflamed facets transmit approximately 47% of body weight (lumbar spine) Traction can open the facet joints

Muscle Spasm Long, slow stretching can reduce tonic muscle contraction by elongating the involved fibers Intermittent traction promotes relaxation during the OFF phase Increased diameter of the intervertebral foramen decreases muscle spasm  Reduced pressure on spinal nerve roots

Maintenance Cleaning  Follow manufacturer’s instructions for unit and harness  Avoid liquids from entering unit Check cords and traction cable Recalibrate unit Unit must be inspected and serveced by a technician annually