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Spinal Traction
Cervical & Lumbar

2. Traction
Traction is the process of drawing or pulling the spinal column to apply a longitudinal force to the spine & associated structure, this force separates the vertebrae, opening the intervertebral space
It is therapeutic tools that falls in the area of exercise because of its effect on the musculoskeletal system and use in stretching and mobilizing techniques.

3. How Does Traction Relieve Pain?
Increasing the space between vertebrae
Separating the apophyseal joints
Widening the intervertebral foramina
Removing pressure on injured tissue
Reducing muscle spasm
Increasing peripheral circulation
Relaxing muscles
Changing intervertebral disk pressures
Tensing the posterior longitudinal ligament
Creating suction to draw protruded disks toward their center
Flattening an abnormal lumbar curvature

4. 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
Long-term effects

5. Physiological Effects on Articular Facet Joints
Increases the separation between joint surfaces
Decompresses articular cartilage, allowing synovial fluid exchange to nourish the cartilage
May decrease degenerative changes
May decrease pain perception

6. Physiological Effects on Muscles
Lengthens tight muscles and allows better muscular blood flow.
Activates muscle proprioceptors, further decreasing pain
Physiological Effects on Nerves
- Decreases compression forces on nerves

7. General Principles Angle of pull Anatomical differences
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

8. 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

9. Factors that influence the amount of vertebral separation
Spinal Position: the greater the amount of flexion that the spine is placed before traction, the greater the vertebral separation.
Amount of force applied:
In cervical spine: a force of approximately 7% of the body weight separate the vertebrae. A minimum force of to 13.5 Kg is necessary to lift the weight of the head when sitting to counteract the resistance of muscle tension.
In lumbar spine: a minimum force of half of the body weight is necessary for mechanical separation.
Angle of pull:
In cervical spine: the angle of pull creating the greatest posterior elongation is 35 degree.
In lumbar spine: pulling from the posterior aspect of the pelvis rather than from the sides is necessary to cause flexion of the spine.
Position of patient: the patient should be in comfortable and relaxed position. Many patients report feeling more relaxed supine than sitting for cervical traction.
Duration of application: 20 to 25 minutes is applicable time.

10. Types of Traction 1- Static or Constant Traction, which may be:
- Continuous or prolonged: static traction in which the force is maintained for several hours.
- Sustained: a static traction in which the force is maintained from few minutes up to one-half hour.
2- Intermittent Traction
Alternately applied and withdrawn traction at frequent interval.

11. Mode of application: Mechanical: using various types of equipment.
Manual: Administered by the therapist
Positional: through positioning to elongate the involved tissue

12. Indications Muscle spasm
Hypomobility of the joints from joint dysfunction or degenerative disk changes
Herniated or protruding disks
Nerve root compression
Facet joint pathology
Capsulitis of vertebral joints
Anterior/posterior longitudinal ligament pathology

13. Cervical Disc Herniation

14. Lumbar Disc Herniation

15. Contraindications Absolute Spinal infections Spinal Cancer
24/07/1438
Contraindications
Absolute
Spinal infections
Spinal Cancer
Spinal Cord pressure
Rheumatoid Arthritis
Osteoporosis
Relative
Ligamentous strains and hypermobility
Acute stage of injury
Traction anxiety
Cardiac or respiratory insufficiency
Pregnancy
May aggravate symptoms in the case of severe serious pathology, such as a large disc prolapse, tumor or severe osteophytes
Jt. Capsules, ligs, bones are fragile. Pt’s are subject to atlanto-axial sublux or to developing instability next to areas of hypomobility
Bones are fragiliie and subject to fracture

16. Limitations of Traction
The effect of vertebral separation is temporary
No consistent protocol exist, rational is hypothetical with inconsistent clinical results.
Precautions
Complete patient’s evaluation should be done before traction.
Close monitoring of patient should be performed throughout treatment.
Can cause thrombosis of internal jugular vein if excessive duration or traction weight is used.

17. Cervical Traction Generally applied with the patient supine or sitting
Supine preferred because it eliminates gravity
Three main types
Manual
Positional
Mechanical
Application of a longitudinal force to the C-spine & structures
Tension applied can be expressed in pounds or % of patient’s body weight.
At 7% of patient’s body weight, vertebral separation begins
Human head accounts for 8.1% of body weight (8-14 lbs.)
Greater amount of force is needed widen areas
You want force to be about 20% of body weight

18. Cervical Traction Set-up
Neck – placed in 25-30° flexion
Straightens normal lordosis of C-spine
Must have at least 15° flexion to separate facet joint surfaces
Body must be in straight alignment
Duration – minutes most common
Remove any jewelry, glasses, or clothing that may interfere
Lay supine, place pillows under knees
Secure halter to cervical region placing pressure on occipital process & chin (minor amount)

19. Cervical Treatment Set-up
Align unit for 25-30° of neck flexion
Remove any slack in pulley cable
On:Off sequence 3:1 or 4:1 ratio
Following treatment, gradually reduce tension & gain slack
Have patient remain in position for a few minutes after treatment

20. Manual Cervical Traction
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 pain: affecting upper cervical vertebrae
Flexed 30° pain: affecting lower cervical vertebrae
Lateral flexion pain: pressure on spinal nerves with radiating pain into arms or hands

21. Cervical Traction Positioning
Supine – support lumbar region (bend knees, or hang lower legs over end of table & place feet on chair); allows musculature to relax
Therapist standing at the head of the treatment table, supporting the weight of the patient’s head in his hands.
Flex the head until motion of the spinous process just begins at the determined level. Support the head with folded towels at the level of flexion, then side bend the head away from the side to be distracted until movement of the spinous process begins.

22. Mechanical Cervical Traction
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.

23. Mechanical Cervical Traction
Table traction
Mechanical intermittent or sustained table traction
Involves use of head harness attached to mechanical device at end of table
Device can pull sustained or intermittent traction
Usually 30 sec on, 10 sec off

24. Initiation of Treatment
Set controls to zero and turn on unit
Remove slack
Adjust Ratio
Normally 3:1 or 4:1
Tension
Approximately 10 pounds or 7% of body weight
First exposure use lower tension
Duration
Corresponding to pathology
Termination of Treatment
- Tension
Gradually reduce over 3 or 4 cycles
Gain slack and turn unit OFF
- Remove halter from unit and patient
- Patient remains in position for 5 minutes after the treatment

25. Lumbar Traction
There are more types of lumbar traction than cervical traction.
Some of the most commonly used techniques are presented.
To be effective, lumbar traction must overcome lower extremity weight (½ of body weight)
Friction is a strong counterforce against lumbar traction
Split table is used to reduce friction

26. Manual Lumbar Traction
Allows the clinician to feel patient’s reaction to treatment
Can be used as examination technique
Clinician uses her hands or a belt to pull on patient’s legs, separating vertebrae

27. Manual Lumbar Traction
Single-leg traction
Manual 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, 30 sec bouts, patient lies supine at edge of table and stretches affected hip flexors (which are usually tight)

28. Manual Lumbar Traction (L3-4, L4-5, L5-S1)

29. Manual Lumbar Traction (T12, L1, L1-2, L2-3)

30. Unilateral Leg Pull Manual Traction
Counter-traction harness needed
From ankle flex hip 30, ABD hip 30 and ER fully
Apply steady traction along long axis of LE

31. Mechanical Lumbar Traction
Uses a specialized table that separates when adequate forces are applied
Patient’s head and trunk 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

32. Mechanical Lumbar Traction
Traction Force
No separation < ¼ BW
Can be delivered in either sustained or intermittent mode

33. Lumbar Positional Traction
Bilateral Foramen Opening
Athlete in supine
Hip/knees flexed

34. Lumbar Positional Traction
Unilateral Foramen Opening
Sidelying position
Pillow between iliac crest and lower border of ribs
Flex hip/knees until LS is forward
Trunk rotation toward superior shoulder

35. Lumbar Positional Traction
Supine
Knees to chest
Forward bend of lumbar spine
Separation of Spinous processes
Increased size of intervertebral foramen

36. Unilateral Lumbar Positional Traction

37. Unilateral Lumbar Positional Traction