Traction

• Traction

  Tensional mechanical force applied to the body in a way that separates joint surfaces and elongates surround soft tissues
• Ways traction can be applied

  • Manually - clinician
  • Mechanically - machine
  • Patient - body weight
• Traction

  • Distracts joint surfaces
  • Decreases pressure on articular surfaces, intra-articular structures, spinal nerve roots
• Spinal decompression

  • Aids in pulling nutrients, oxygen, and moisture back into the disc
  • Facilitates healing
• Traction

  • Mobilizes joints
  • Increased by high-force traction stretching the soft tissue structures
  • Low-force = oscillatory motion (intermittent) stimulates mechanoreceptors
  • Decreases joint related pain (gate pain transmission)
• Traction

  • Reduces protrusions of nuclear discal material
  • Suction of displaced parts back toward the center
  • Tension of PLL pushes posteriorly displaced discal material anterior towards original position
• Lumbar disc protrusions reduced with force at least 60 lbs
• Cervical disc protrusions reduced with force at least 15-30 lbs
• Traction

  • Stretches soft tissue
  • Elongates the spine
  • Increases distance between vertebral bodies and facet joint surfaces due to increased length of soft tissues
• Clinical benefit of traction

  • Increases spinal ROM
  • Decreases pressure on facet joints, discs, and IV discs
• Traction

  • Relaxes muscles
  • Static traction causes muscle relaxation due to depression of monosynaptic response from stretching muscles for several seconds
  • Intermittent traction causes muscle relaxation by stimulating GTOs to inhibit alpha motor neuron firing
• Indications for traction

  • Disc herniation
  • Nerve root entrapment
  • Subacute joint inflammation
  • Muscle spasm
  • Stenosis
• Precautions for traction

  • Structural diseases/conditions that adversely affect tissues making them hypermobile or weak
  • When pressure of belts may be hazardous
  • Displaced annular ligament
  • Medial disc protrusion
  • When severe pain resolves with traction
  • Claustrophobia or other psychological aversion to traction
  • Inability to tolerate supine or prone
  • Disorientation
• Contraindications for traction

  • Where motion is contraindicated
  • Acute injury/inflammation
  • Joint hypermobility
  • Peripheralization of symptoms with traction
  • Uncontrolled HTN
• Structural diseases causing hypermobility or weakness

  • Tumor
  • Infection
  • RA
  • Osteoporosis
  • Prolonged systemic steroid use
  • Local radiation
• When pressure of belts may be hazardous: Pressure on inguinal vessels, constrict respiration, vertebral artery (cervical)
• Displaced annular ligament - traction is unlikely to change patient signs/symptoms
• Medial disc protrusion - movement of nerve root from traction may increase the impingement of the disc on the nerve root
• Severe pain resolves with traction can indicate complete compression of nerve root
• Claustrophobia - use manual or positional traction
• Inability to tolerate supine or prone - cervical traction in sitting, lumbar shelf traction
• Disorientation - patient needs to be able to provide feedback or know when to stop machine
• Choosing appropriate patient positioning for traction

  1. If targeting upper portion of spinal area = increase flexion

  2. Upper lumbar/lower thoracic = hips flexed to 90/90

  3. Lower cervical/upper thoracic = put patient in cervical flexion

  4. DISCS = ALWAYS TREAT IN NEUTRAL POSITION
• Parameters for acute phase/initial traction treatment

  • force: 30-45 lbs
  • On/Off: static
  • total time: severe sx = 5 min, mod sx = 10 min
• Parameters for muscle spasms

  • 25% of BW
  • On/Off: 5 on, 5 off
  • total time: 20-30 min
• Parameters for joint distraction

  • Force: begin with 25% of BW, work up to 60%
  • On/Off: on 15 sec, off 15 sec
  • total time: 20-30 min
• Parameters for disc (radiculopathy)

  • Force: begin with 25% of BW, work up to 60%
  • On/Off: on 60 sec, off 20 sec
  • total time: 20-30 min