1. TRACTION

2. OUTCOMES Must be familiar with the types of mechanical traction.
Must be familiar with the mechanical effects of
Must be familiar with the indications for
mechanical traction.
Must be familiar with the contra-indications
for mechanical traction.

3. 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.
technique for mechanical lumbar traction.

4. 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

5. TYPES OF TRACTION Continuous traction Sustained traction
Intermittent traction
Manual traction
Auto-traction
Positional traction
90/90 traction

6. TYPES OF LUMBAR TRACTION
Inversion traction
Gravity traction
Pool traction

7. 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

8. 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

9. MECHANICAL EFFECTS Small pressure changes Normalisation of conduction
Pain relief

10. 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

11. MECHANICAL EFFECT (SUCTION)
Krause (2000) negates this statement

12. CLINICAL EFFECTS OF TRACTION
Remains controversial
Produced from combination of mechanical and physiological effects

13. 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

14. 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

15. CONTRA-INDICATIONS Inadequate investigation Acute traumatic lesions
Large central disc
Ileofemoral incompetency
Uncooperative patient
Marked ligamentous insufficiency and segmental instability

16. 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

17. TRACTION FORCE NEEDED Researcher Weight (traction force) Maitland
< 13 kg for first time
Average 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

18. APPLICATION OF TRACTION

19. PRONE

20. SUPINE

21. PRONE INTO FLEXION

22. UNILATERAL

23. 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

24. UPPER CERVICAL TRACTION
Upper cervical area
C1-C4
Neutral position

25. UPPER CERVICAL TRACTION

26. LOWER CERVICAL TRACTION
Lower cervical area
C4-T1
Neck in flexion using pillows or towel roll

27. 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

28. 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

29. 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

30. UPPER LUMBAR TRACTION
L1-L4
Neutral position

31. UPPER LUMBAR TRACTION

32. LOWER LUMBAR TRACTION L4-S1
Patient positioned in Fowler’s position (Thomas-curl position)

33. LOWER LUMBAR TRACTION

34. 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

35. 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 seconds

36. 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

37. 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

38. REMEMBER
There is often a postural component involved with disorders of the lumbar spine

39. 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

40. RULE OF PROCEDURE (Grieve, 1989)
Warn patient about treatment soreness
Do not over treat
Never push through spasm
Treat joint irritability with respect

41. TREATMENT PROTOCOL Teach spinal stabilisation
Dynamic maintenance of postural control
Patient reassurance
Ergonomic advice
Mechanical principles involved
Restoration of maximal patient function
Pain control

42. TREATMENT PROTOCOL To educate patient To maintain lumbar muscles
Combination of treatments
Back school
Strengthening exercises

43. TREATMENT PROTOCOL Flexibility exercises Fitness Total bedrest
Encouragement to function despite symptoms
Corset
Lumbar intervertebral traction