Spinal TractionSpinal Traction

Jennifer Doherty-Restrepo, ATC, LAT

Entry-Level Athletic Training Education Program

PET 4995: Therapeutic Modalities

TractionTraction

Process of drawing, or pulling apart, of a body segment

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

Manual Traction - clinician positions patient and applies traction force to joints of the spine or extremities

Effects of Traction: Effects of Traction: SpineSpine

Encourages movement between Encourages movement between each individual spinal segment each individual spinal segment

Amount of movement varies Amount of movement varies according to…according to… Position of spine, Position of spine, Amount of force, and Amount of force, and Length of time the Length of time the

force is applied force is applied

Transient effectTransient effect

Effects of Traction: Effects of Traction: SpineSpine

pain, paresthesia, or tingling pain, paresthesia, or tingling Due to physical separation of vertebral Due to physical separation of vertebral

segments thus decreasing pressure on segments thus decreasing pressure on sensitive structuressensitive structures

As long as positive physiologic As long as positive physiologic effects occur, effects occur, traction should traction should be continued be continued

Effects ofof 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

Effects ofof Traction: Ligaments

Stretching effect Structural changes occur slowly due to

viscoelastic properties Ligaments resist shear forces and return to

original form following removal of a deforming load

Sensitivity to rate of loading Ligament deformation results in

lengthening of a ligament caused by traction loading Slow loading rates allow for more

deformation

Effects ofof Traction: Disks

Normal disk in non-compressed position Internal pressure (indicated by arrows)

is exerted equally in all directions Internal annular fibers contain nuclear

materials

Effects ofof Traction: Disks

In an injured disk, sitting or standing compresses the disk causing the nucleus to become flatter

Pressure in this instance still remains relatively equal in all directions

Effects ofof Traction: Disks

In an injured disk, movement in weight-bearing causes a horizontal shift in nuclear material

If this was forward bending, the bulge would occur in the posterior annular fibers Anterior annular fibers would be slackened and

narrow

Effects ofof Traction: Disks

Herniation of the nuclear material occurs if the annular wall becomes weak

Herniation may possibly put pressure on sensitive structures in the area

Effects ofof Traction: Disks

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

Effects ofof 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

Increased proprioception from facet joint structures provide sensation of pain relief

Effects ofof Traction: Muscles

Vertebral muscles can be stretched Initial stretch should come from body

positioning Stretch lengthens tight muscle Allows for better muscular blood flow Activates muscle proprioceptors

providing sensation of pain relief Gate Control Theory

Effects ofof Traction: Nerves

Focus of most traction treatments Pressure on nerves or nerve roots often

associated with spinal pain 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

Traction Treatment Techniques

Lumbar Positional Traction Inversion traction

Manual Lumbar Traction Level-specific Unilateral leg pull

Mechanical Lumbar Traction Manual Cervical Traction Mechanical Cervical Traction

Lumbar Positional Traction

Patient typically on restricted activity program

“Trial and error” process to determine position that offers maximum comfort

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

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 Medial Herniation

Patient leaning toward painful side

Lie painful side down

Lie on right side over blanket roll

Side-lying Position: Unilateral Foramen Opening

Side-lying with a blanket roll between iliac crest and rib cage

Increases intervertebral foramen size of superior side of lumbar spine

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

Supine Position: Bilateral Foramen Opening

Knees to chest position

increases size of lumbar intervertebral foramen bilaterally

Separation of spinous processes

Inversion Traction

Hang upside down Lengthens spinal

column due to stretch provided by weight of trunk

Repeat inversion 2-3 times

Observe for signs of vertigo, dizziness, or nausea

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

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

Upper spinous process is where maximum effect is desired

Level-Specific Manual Traction

When motion of lower spinous process can be palpated, place foot against opposite leg to prevent further flexion

Trunk is then rotated toward the upper shoulder until motion of upper spinous process can be palpated

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

Unilateral Leg Pull Manual Traction

Hip joint problems or difficult lateral shift corrections

Thoracic counter-traction harness is used

Hold ankle and move hip into 30o flexion, 30o abduction, and full external rotation

Apply steady traction force until noticeable distraction occurs

Unilateral Leg Pull Manual Traction

Sacroiliac problems In addition to

thoracic counter-traction harness, strap is placed through groin and secured to table

Hold ankle and move hip into 30o flexion and 15o abduction

Apply steady traction force

Mechanical Lumbar Traction: Equipment Use split table to eliminate friction

between body segments Non-slip traction harness stabilizes trunk

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

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

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

Mechanical Lumbar Traction: Body Positioning

Extension Closes foramen

because bony arches come closer together

Mechanical Lumbar Traction: Body Positioning Prone position Used with normal to

slightly flattened lumbar lordosis

Best for disk protrusions Place pillows under

abdomen Other modalities may be

applied Allows for assessment of

spinous process separation

Mechanical Lumbar Traction: Body Positioning

Supine position Produces posterior intervertebral

separation Optimal at 90o hip flexion Unilateral pelvic traction recommended if

stronger force is desired Scoliosis, Unilateral joint

dysfunction, or Unilateral lumbar

muscle spasm

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 Must use progressive steps to

comfortably reach therapeutic loads

Intermittent vs. Sustained Traction

Intermittent Traction Effective for posterior intervertebral

separation No firm recommendations for on/off times

Sustained Traction Recommended for disk protrusion and

rupture

Treatment Duration

With suspected disk protrusions, total treatment time should be relatively short

10 minutes or less

If treatment reduces symptoms, treatment time should remain at 10 min or less

If the treatment is partially successful or unsuccessful in relieving symptoms, gradually increase time over several treatments up to 30 min

Progressive and Regressive Steps

Traction equipment may be built with progressive and regressive modes

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!

Manual Cervical Traction

Stretches muscles and joint structures Enlarges intervertebral spaces and foramen Creates centripetally directed forces on

disk and surrounding soft tissue Mobilizes vertebral joints Increases joint proprioception Relieves compressive effects of normal

posture Improves arterial, venous, and lymphatic

flow

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, 3 - 10

sec Treatment time, 3 - 10

min

Mechanical Cervical Traction

Supine Neck flexed 20 - 30o

Traction harness pulls on occiput

Intermittent pull > 20 pounds Minimum of 7 seconds Adequate rest time for

recovery

Treatment time, 20 - 25 min

Forces up to 50 pounds may produce increased intervertebral separation.

Mechanical Cervical Traction

Wall-mounted device Inexpensive

Static traction most easily employed Use weight plates, sand bags, or

water bags

Intermittent traction may be used

Sitting or prone Gentle pull, 10 - 20 pounds Treatment time, 20 - 25 min

Indications for Spinal Traction

Nerve root impingement

Disk herniation Spondylolisthesis Narrowing within

intervertebral foramen

Osteophyte formation

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

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