Traction: Indications and Methods

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

for mechanical traction. 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. Must be familiar with the application and technique for mechanical lumbar traction. Must be familiar with the application and

technique for mechanical lumbar traction. 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 TYPES OF TRACTION

Continuous traction Sustained traction

Intermittent traction Manual traction Auto-traction Positional traction 90/90 traction TYPES OF LUMBAR TRACTION Inversion traction Gravity traction Pool traction

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

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 MECHANICAL EFFECTS Small pressure changes Normalisation of conduction Pain relief 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 MECHANICAL EFFECT (SUCTION) Krause (2000) negates this statement CLINICAL EFFECTS OF

TRACTION Remains controversial Produced from combination of mechanical and physiological effects INDICATIONS Traumanerve Severe to ligaments root pain

Recent neurological Spondilolisthesis andchanges spondilolysis Degenerative No further improvement conditions with mobilisation Widely distributed Lumbar

conditions areas whereofmovements thoracic and are lumbar pain painless during objective evaluation Pathological

CONTRA-INDICATIONS

Cord compression Resent onset of severe lumbar pain Hypermobility Spinal infectionor instability Undiagnosed Hiatal

hernia pain Persistent cough Uncontrolled hypertension Cardio-vascular Aortic aneurysmconditions Spinal malignancy Abdominal hernia

Severe haemorrhoids CONTRA-INDICATIONS

Inadequate investigation Acute traumatic lesions Large central disc Ileofemoral incompetency Uncooperative patient Marked ligamentous insufficiency and segmental instability 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 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

APPLICATION OF TRACTION PRONE SUPINE PRONE INTO FLEXION UNILATERAL

TREATMENT DURATION Researcher Weight Saunders (1995:286) Time Few min to 40 min

Onel, et al. (1987:82) 45 kg 40 min Maitland (2001:376) Determine by dummytrial

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 UPPER CERVICAL TRACTION Upper cervical area C1-C4 Neutral position UPPER CERVICAL TRACTION LOWER CERVICAL TRACTION

Lower cervical area C4-T1 Neck in flexion using pillows or towel roll METHOD Patient lies with two pillows under his knees Apply gentle traction via spreader bar Know the area and severity of patients pain Trial-run for 10 seconds

Re-assess the symptoms 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

PROGRESSION Stop traction if no improvement after 4-5 treatments Severe nerve root pain sometimes at least 78 treatments, but Movement test must improve by 4th to 5th session NB: Carefully assess signs and symptoms before, during and after treatment

UPPER LUMBAR TRACTION L1-L4 Neutral position UPPER LUMBAR TRACTION LOWER LUMBAR TRACTION L4-S1 Patient positioned in Fowlers position

(Thomas-curl position) LOWER LUMBAR TRACTION 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 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 1020 seconds 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

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

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

RULE OF PROCEDURE (Grieve, 1989) Warn patient about treatment soreness Do not over treat

Never push through spasm Treat joint irritability with respect TREATMENT PROTOCOL

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

TREATMENT PROTOCOL To educate patient To maintain lumbar muscles Combination of treatments

Back school Strengthening exercises TREATMENT PROTOCOL Flexibility exercises Fitness Total bedrest Encouragement to function despite symptoms Corset

Lumbar intervertebral traction

Recently Viewed Presentations

  • DAFT Workshop: 12.30-2.00pm 7th June 2013 Couples Work

    DAFT Workshop: 12.30-2.00pm 7th June 2013 Couples Work

    Tentative explorations, allowing for the consideration of new meanings & possibilities Anti-Discriminatory Practice Sexual Orientation Occupation Class Interests Abilities John Burnham Literacy Gender Race. Religion Age. Attributes. Appearance Class. Colour Ethnicity. Economic Status. Education Sexuality.
  • Schutz &amp; Rettung, Feuerwehr &amp; Rettungsdienst

    Schutz & Rettung, Feuerwehr & Rettungsdienst

    Schutz & Rettung - Berufsfeuerwehr Nord. 15. Oktober 2015. Protection & Rescue - Fire Service North. Captain Dr. Jan Bauke, Head of Department Fire Service North. Schutz & Rettung. 24 hour - "On call round the clock for you" 15....
  • Hinge Point Questions - STEM

    Hinge Point Questions - STEM

    The half life is 22 hours. After 96 hours 0.15625g remains The isotope is administered as the compound potassium iodide, which reduces the radioactivity. The correct name for the functional group of the alkanols is: Carbonyl Alcohol Hydryl hydroxyl Alkanoic...
  • Chapter 3 -- A Guided Tour Through Arena

    Chapter 3 -- A Guided Tour Through Arena

    Rockwell Software\Arena\Examples Model window (usually on right side of Arena window) Where model is built Resize, maximize, minimize, scroll/pan, zoom Can have multiple model windows open at once Cut, Copy, Paste within Arena, and between Arena and other applications (when...
  • Figures, Graphs, and Tables

    Figures, Graphs, and Tables

    Footnotes under tables are okay. Headings and captions should be concise and precise, not long narratives. Don't extend beyond the boundaries of the table or figure itself. Make sure that units are included in columns or rows of tables and...
  • Put the Historical Perspectives Reading Assignment on your

    Put the Historical Perspectives Reading Assignment on your

    Core Notation. Example: Write the electron configuration for Ga using core notation. ... Valence electrons are the ones in the s and p subshells beyond the noble gas core, and any partially filled d and f subshells [Ne] 3s23p1 [Ar]...
  • Cisco Presentation Guide - cfile25.uf.tistory.com

    Cisco Presentation Guide - cfile25.uf.tistory.com

    Icon Library Current as of July 6, 2010
  • The SIX Basic Comma Rules - NWACC

    The SIX Basic Comma Rules - NWACC

    The SIX Basic Comma Rules. Thanks to a great book: The LEAST You Should Know about English