1. Traction ESAT 3640 Therapeutic Modalities

2. Traction Process of drawing or pulling apart of a body segment Mostly used on spine, but can be used on other body parts Encourages movement of the spine both overall and between individual spinal segments

3. Traction Amount of movement depends on Position of spine Amount of force applied Duration Angle of pull Position of patient

4. Types of Traction Manual Mechanical

5. Why use Traction Decrease pain Decrease Parasthesia Relief due to physical separation of structures resulting in decreased pressure on sensitive structures (nerves) Lasting therapeutic changes occur from adjustments or adaptations of the structures around the vertebrae in response to traction

6. Effects on Bone Wolff’s Law Bone remodels itself and provides increased strength along the lines of the mechanical forces placed on it Traction Reverses immobilization related bone weakness by increasing or maintaining bone density

7. Effect on Disks Reduces disk protrusion Traction increases separation of vertebral bodies leading to decrease in central pressure in the disk space Encourages disk nucleus to return to central position Mechanical tension of the annulus fibrosis and ligaments surrounding the disk also nuclear material and cartilage fragments toward the center

8. Effect on Disks Movement of materials relieves pain and symptoms associated with compression of nerves and vascular structures Decreased compressive forces allows for better fluid exchange within the disk and spinal canal

9. Effect on Disks Herniation reduction tends to be transitory Return of compressive forces

10. Effect on Ligaments Restores normal length to ligaments shortened by: Injury Long term postural problems Traction force provides stress that encourages ligaments to make adaptive strength and length changes

11. Effect on Ligaments Key Point: Relief of pressure on nerves and vascular system Activation of proprioceptive nerves? Gate mechanism

12. Effect on Muscular System Stretching of vertebral muscles Improved muscular blood flow Proprioceptive nerve activation Gate mechanism

13. Muscular System Key Points Position of spine Optimize stretch of particular muscle groups Initial stretch provided by body position Addition of traction provides additional stretch

14. Effect on Facet Joints Release of structures impinged between joint surfaces Meniscoid structures Synovial fringes Osteochondral fragments Reduction of symptoms Pain Numbness

15. Effect on Facet Joints Decompression of articular cartilage Increased synovial fluid exchange Increased nourishment of cartilage Proprioceptive discharge Gate mechanism

16. Effect on Nerves Main reason traction use 1st Clinical sign of nerve pressure Tingling Signs of nerve degeneration: Motor weakness Numbness Loss of reflex Pain Tenderness Muscle spasm

17. Effect on Nerves Unrelieved pressure will cause slowing and eventual loss of impulse conduction Some degenerative changes are reversible depends on amount of degeneration and amount of fibrosis Decrease pressure on nerves leads to Increased blood flow to nerve Decreased edema Return to normal function

18. Contraindications Acute sprains or strains Acute inflammation Fractures Vertebral joint instability Any condition in which movement makes condition worse Tumors Bone disease Osteoporosis Infections in bones and joints Vascular conditions Pregnant females Cardiac or pulmonary problems

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

20. Lumbar Positional Traction

21. Unilateral Lumbar Positional Traction Side lying Pillow or blanket roll between iliac crest and lower border of rib cage Roll is placed close to the level of the spine you want separation to occur Increased opening of foreamen on side up Hip and knee flexed until lumbar spine is in forward bent position Accentuates opening of foreamen

22. Unilateral Lumbar Positional Traction

23. Trunk rotation Maximal opening What side up?? Lean away from painful side Painful side up Lean towards painful side Painful side down

24. Unilateral Lumbar Positional Traction

25. Manual Lumbar Traction (L3- 4, L4-5, L5-S1) Side lying Use leg as lever to flex spine Feel for motion of the spinous process below desired level Rotate trunk Feel for motion of the spinous process above desired level

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

27. Manual Lumbar Traction (T12, L1, L1-2, L2-3) Side lying Trunk rotation Lumbar flexion

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

29. Manual Lumbar Traction Both techniques usually done on a split table Rotation and flexion tighten and lock joint structures in which motion takes place leaving the desired segment with more available movement

30. Unilateral Leg Pull Hip joint problems; Lateral shift 30  hip flexion 30  Hip abduction Full external rotation SI joint 30  hip flexion 15  hip abduction

31. Unilateral Leg Pull

32. Manual Cervical Traction Thenar eminence placed at mastoid process Fingers cradle neck reaching over to other mastoid process Cephalic pull Add in rotations and glides depending on condition Evaluation and knowledge of C-spine mechanics are key

33. Manual Cervical Traction