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


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


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


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;


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

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