1. Salman Farooqi Lecturer IPM&R, KMU
Spinal Traction
Salman Farooqi
Lecturer
IPM&R, KMU

3. Traction
Process of drawing, or pulling apart, of a body segment

4. Mechanical Traction
using a traction machine or ropes/ pulleys to apply a traction force

5. Manual Traction
Clinician positions patient and applies traction force to joints of the spine or extremities

6. Effects of Traction: Spine
Encourages movement between each individual spinal segment
Amount of movement varies according to…
Position of spine,
Amount of force, and
Length of time the force is applied

7. Effects of Traction: Spine
 pain, paresthesia, or tingling
Due to physical separation of vertebral segments thus decreasing pressure on sensitive structures

8. Effects of Traction: Spine
As long as positive physiological effects occur, traction should be continued

9. Effects of Traction: Bone
No immediate effects due to traction
May result in increased spinal movement that reverses bone weakness associated with immobilization
May assist with increasing or maintaining bone density

10. Effects of Traction: Discs
Normal disc in non-compressed position
Internal pressure (indicated by arrows) is exerted equally in all directions
Internal annular fibers contain nuclear materials

11. Effects of Traction: Discs
In an injured disc, sitting or standing compresses the disc causing the nucleus to become flatter
Pressure in this instance still remains relatively equal in all directions

12. Effects of Traction: Discs
In an injured disk, movement in weight-bearing causes a horizontal shift in nuclear material

13. Effects of Traction: Discs
Herniation of the nuclear material occurs if the annular wall becomes weak
Herniation may possibly put pressure on sensitive structures in the area

14. Effects of Traction: Discs
When placed under traction, intervertebral space expands thereby decreasing pressure on the disk
Taut annular fibers create a centripetally directed force
Decreases herniation and pressure on sensitive structures in the area

15. Effects of Traction: Articular Facet Joints
Facet joints are separated releasing impinged structures
Dramatic reduction in symptoms
Joint separation decompresses articular cartilage allowing synovial fluid exchange to nourish cartilage
Decreases rate of degenerative changes

16. Effects of Traction: Articular Facet Joints
Increased proprioception from facet joint structures provide sensation of pain relief

17. Effects of Traction: Muscles
Vertebral muscles can be stretched
Initial stretch should come from body positioning
Stretch lengthens tight muscle
Allows for better muscular blood flow

18. Effects of Traction: Muscles
Activates muscle proprioceptors providing sensation of pain relief
Gate Control Theory

19. Effects of Traction: Nerves
Focus of most traction treatments
Pressure on nerves or nerve roots often associated with spinal pain

20. Effects of Traction: Nerves
Unrelieved pressure on a nerve will cause
Slowing, eventual loss of impulse conduction
Motor weakness, numbness, and loss of reflex
Pain, tenderness, and muscular spasm

21. Traction Treatment Techniques
Lumbar Positional Traction
Inversion traction
Manual Lumbar Traction
Level-specific
Unilateral leg pull

22. Traction Treatment Techniques
Mechanical Lumbar Traction
Manual Cervical Traction
Mechanical Cervical Traction

23. Side-lying Position: Unilateral Foramen Opening
Lateral Herniation
Patient leaning away from painful side
Lie painful side up
Lie on right side over blanket roll

24. Side-lying Position: Unilateral Foramen Opening
Lateral Herniation
Patient leaning away from painful side
Lie painful side up
Lie on over blanket roll
Medial Herniation
Patient leaning toward painful side
Lie painful side down
Lie over blanket roll

25. Side-lying Position: Unilateral Foramen Opening
Side-lying with a blanket roll between iliac crest and rib cage
Increases intervertebral foramen size

26. Side-lying Position: Unilateral Foramen Opening
Maximum opening of intervertebral foramen
Achieved by flexing upper hip and knee and rotating shoulders in opposite directions
Maximum opening of left side

27. Supine Position: Bilateral Foramen Opening
Knees to chest position
increases size of lumbar intervertebral foramen bilaterally
Separation of spinous processes

29. Inversion Traction Hang upside down
Lengthens spinal column due to stretch provided by weight of trunk
Repeat inversion times
Observe for signs of vertigo, dizziness, or nausea

30. Manual Lumbar Traction
Used prior to mechanical traction
Helps determine degree of lumbar flexion, extension, or side-bending that is most comfortable
Most comfortable position is usually best therapeutic position

31. Level-Specific Manual Traction
Position patient for maximum effect at a specific spinal level
Lumbar spine flexed using upper leg as lever
Palpate interspinous space

32. Level-Specific Manual Traction
Place chest against ASIS and upper hip
Lean toward patient’s feet
Use enough force to cause a palpable separation of the spinous processes at desired level

33. Unilateral Leg Pull Manual Traction
Sacroiliac problems
strap is placed through groin and secured to table
Hold ankle and move hip into 30o flexion and 15o abduction
Apply steady traction force

34. Mechanical Lumbar Traction: Equipment
Use split table to eliminate friction between body segments
Non-slip traction harness stabilizes trunk

35. Mechanical Lumbar Traction: Setup
Pelvic harness
Applied while standing
Contact pads and upper belt placed at, or just above, iliac crest
Rib pads
Positioned over lower rib cage

36. Mechanical Lumbar Traction: Body Positioning
Neutral spinal position
Allows for largest intervertebral foramen opening before traction is applied
Usually position of choice whether prone or supine

37. Mechanical Lumbar Traction: Body Positioning
Flexion
Increases posterior opening
Puts pressure on disk nucleus to move posterior
Other soft tissue may also close foramen opening

38. Mechanical Lumbar Traction: Body Positioning
Extension
Closes foramen because bony arches come closer together

39. Mechanical Lumbar Traction: Body Positioning
Prone position
Used with normal to slightly flattened lumbar lordosis
Best for disk protrusions
Place pillows under abdomen

40. Mechanical Lumbar Traction: Body Positioning
Supine position
Produces posterior intervertebral separation
Optimal at 90o hip flexion
Scoliosis,
Unilateral joint dysfunction, or
Unilateral lumbar muscle spasm

41. Traction Force
No lumbar vertebral separation will occur with traction forces less than 1/4 of body weight
Effective traction force ranges between 65 and 200 pounds
Traction force recommended = 1/2 body weight

42. Intermittent vs. Sustained Traction
Intermittent Traction
Effective for posterior intervertebral separation
Sustained Traction
Recommended for disk protrusion and rupture

43. Progressive and Regressive Steps
Progressive mode
Increases traction force in a pre-selected number of steps
Allows slow accommodation to traction
Regressive mode
Decreases traction force in a pre-selected number of steps
Patient comfort is primary consideration!

44. Manual Cervical Traction
Stretches muscles and joint structures
Enlarges intervertebral spaces and foramen
Creates centripetally directed forces on disk and surrounding soft tissue

45. Manual Cervical Traction
Mobilizes vertebral joints
Increases joint proprioception
Relieves compressive effects of normal posture
Improves arterial, venous, and lymphatic flow

46. Manual Cervical Traction
Variety of head and neck positions
Hand should cradle neck contacting one mastoid process
Other hand on chin
Gentle pull, < 20 pounds
Intermittent pull, sec
Treatment time, min

47. Mechanical Cervical Traction
Supine
Neck flexed o
Traction harness pulls on occiput
Intermittent pull
> 20 pounds
Minimum of 7 seconds
Adequate rest time for recovery
Treatment time, min .

48. Mechanical Cervical Traction
Wall-mounted device
Inexpensive
Static traction most easily employed
Use weight plates, sand bags, or water bags
Sitting or prone
Gentle pull, pounds
Treatment time, min

49. Indications for Spinal Traction
Nerve root impingement
Disk herniation
Spondylolisthesis
Narrowing within intervertebral foramen
Degenerative joint diseases
Subacute pain
Joint hypomobility
Discogenic pain
Muscle spasm or guarding
Muscle strain
Spinal ligament or capsular contractures
Improvement in arterial, venous, and lymphatic flow

50. Contraindications for Spinal Traction
Acute sprains or strains
Acute inflammation
Fractures
Vertebral joint instability
Any condition in which movement exacerbates existing problem
Bone diseases
Osteoporosis
Infections in bones or joints
Vascular conditions
Pregnant females
Cardiac or pulmonary problems