The Spine: Traction Pissecure, Taction is the “process of drawing or Pulling.’ * When traction is used to draw or pull on te spinal column, TC 1s called spi ction, Traction is a therapeutic tool that falls in the jain of exercise because of its effects on the musculoskeletal system and use in srechny ‘ai mobilizing techniques.” Its mode of application is often through machines although benipist ply traction to the joints of the spinal column through carefully applied man taland positional techniques. Its uses and applications are varied and subject to the patients dinkal response more than objective scientific argument for its success in decreasing symp- fons To date there are no randomized clinical studies strongly supporting or disproving the dicacy of traction for therapeutic intervention.”> Goals and plans of care for various posture and spinal problems are described in Chap- ves 14 and 15, In many instances, traction is a recommended procedure in the plan of care; therefore, the information in this chapter should be studied concurrently with the information inthe previous two chapters for completeness. OBJECTIVES Mer studying this chapter, the reader will be able to: 1 Identify the effects of spinal traction. 2 Define the types of traction and how they are applied. 3 Identify the indications, limitations, contraindications, and precautions for the use of spinal traction. " 4 cate traction techniques for use within a total therapeutic exercise program. 5 Describe safety rules and procedures for mechanical and manual traction techniques. Aoply basic mechanical, positional, and manual traction techniques to the spineApplication of Therapeutic Exercise Techniques to Regions of the Body IL. Effects of Spinal Traction’® A. Mechanical Elongation of the Spine 1. The effect of elongation is mechanical separation of the vertebrae, which: Aa Stretches the spinal muscles beTenses the ligaments and facet joint capsules ¢ Widens the intervertebral foramina d- Straightens the spinal curves __€& Slides the facet joints A Flattens a nuclear disk protrusion 2, Factors that influence the amount of vertebral separation 3,9,19,14,21,23 ne x Spinal position ‘The greater the angle of flexion. that the spine is placed in prior to the admin. istration of traction, the greater the vertebral separation, espec ally the poste- rior aspect of the vertebral body.*” _b“Angle of pull ‘The angle of pull of the traction-force affects the amount of flexion of the spine, . @ In the cervical spine, the angle of pull creating the greatest posterior elongation is 35 degrees. ) (2) In the lumbar spine, a harness that pulls from the posterior aspect of the pelvis rather than primarily from the sides is necessafy to cause flexion of the spine.” . . Amount of force. The effective force is influenced by the body position, weight of the par, friction of the treatment table, method of traction used, amount of pa- tient relaxation, and the equipment itself, Generally, for vertebral separa- tion: ) An the cervical spine, under friction-free circumstances, a force of appro imately 7 percent of the total body weight separates the vertebrae’ A minimum force of 11.25 to 13.5 kg (25 to 30 Ib) is necessary to lift the weight of the head when sitting and to counteract the resistance of mus de tension. The greatest amount of separation occurs during the frst few minutes of treatment at a given force.* (2) In the lumbar spine, a minimum friction-free force of half the body weight is necessary for mechanical separation.6"" d, Comfort and relaxation These are necessary for greatest benefit of vertebral separation. ° B. Zygapophyseal (Facet) Joint Mobilization a ce noamenrenectntrec pent parting Eee or translation of the facet surfaces eee or a separation of the facet surfaces Compression or an approximation of the facet surfaces 2. Factors that influence the direction the facet surfaces move a. Flexion of the spine Positioning the person in flexion (causes a sliding of the articular surfacestween the facet joints) A lon, fect and increases the amour side bending of the spine Positioning the Person in a side-bent po, the articular facets on the convex sige nO CAUSES a slidin traction force increases the amount of aut, UNS) the convex side etching that a Rotation of the spine Positioning the person in rotation side toward which the body of the sion on the opposite side, 182123 Ce reinforces th e the sliding ef aN be accomplished. 8 force between Adding a longitudinal in be accomplished on c. Muscle Relaxation 1. Effects that occur with relaxation a/ Décreased pain from muscle guarding or spasm b, Greater vertebral separation 2, Factors that influence the amount of relaxation a. Position of patient There is greater cervical muscle activity when sitting than when supine." Subjectively, many patients report feeling more relaxed supine than sitting for cervical traction, and they have less tendency to deviate from the set posi- tion.®? The patient needs to feel secure and well supported.”! Spinal position Electrical activity in the upper trapezius muscle increases as the angle of ap- plication of cervical traction toward flexion increases; a lesser angle of pull results in greater relaxation.” Duration of application Both intermittent and continuous traction initially cause increased activity in the sacrospinalis muscles, but after 7 minutes, there is return of activity to near resting level.!° In concluding a review of the literature, Harris states that 20 to 25 minutes of traction is necessary for muscle relaxation? Force Muscle relaxation can be achieved at levels less than those needed re me- chanical separation (4.5 to 6.75 kg, o 10 to 15 Ib) in the cervical spine. D. Reduction of Pain 1. Effects that may result in inhibition or reduction of pain @, Mechanical : : () Movement of the region assists circulation and may pa roles et from circulatory congestion, thus relieves Pec on Se ee sels, and nerve roots in the intervertebral foramina. Improving tants may also help decrease the concentration of pe es ee (2) Separation of the vertebrae temporarily increaSts 7) pinged nerve r00t tebral foramina, which decreases Pres on. of the facet surfaces (3) Tension on the facet joint capsule or eee ent should release a meniscoid from 2° See dlipcresie the mobility of the (4) Mechanical stretching of tight tissue shou!Appication of herapeutic Exercise Techniques to Regions of the Body segmeni) thus decreasing pain from restricted movement oF strain tight tissues. on b. Neurpphysiologic Gy Stimulation of mechanoreceptors may block the transmission of “hive stimuli at the spinal cord or brain stem level @) Inhibition of reflex muscles guarding will decrease the discomfon fy, the contracting muscles. om, \ a Factors that influence the amount of pain reduction a. Position of the patient The patient is positioned for comfort and ease of application of the desir technique b. Spinal position (2) Acute stage. Usually the involved region of the spine is positioned so tha the injured tissue is on a slack or in 4 pain-free position. (2) Subacute and chronic problems. Usually the spine is positioned with the involved segment, or the soft tissues related to the segment, on a stretch Force and duration @) Acute stage. With injury and inflammation, only low-intensity oscillations (no stretch) for a short period should be used. (2) Subacute and chronic stage. The amount of force and duration of treat ment can be progressively increased, depending on the goal for treat. ment, type of traction, condition being treated, and tolerance of the pa. tient. @G) If a meniscoid is blocking motion, a stretch force is necessary to release the meniscoid tissue. Rocicep, o IL. Definitions and Descriptions of Traction A of Application Defined . Static or constant traction A steady force is applied and maintained for an extended time interval. inuous or prolonged A static traction in which the force is maintained for several hours to several days. Often it is applied in bed. (2) Only small amounts of weight can be tolerated. (2) It is ineffective in separating spinal structures: and. is primarily used for immobilization. . Sustained ore A static traction in which the force is maintained from a few minutes up (0 one-half hour. (D It is useful as a prolonged stretch to spinal structures. (@) Stronger poundage than that used for continuous traction can be tle Intermittent : The force is alternately applied and released at frequent intervals, usually in 2 _thythmic pattern. Greater forces than that used an can be toh erated by the patient. for sustained traction canThe Spine: haction Procedures . modes of Application 1 2, Manual ‘Through positioning and handling, the theta ist applies the traction force to desired spinal segment. An objective measure of the amount oo pees force cannot be 3 Positional Through positioning, a sustained force on specific segme van can be obtained. It may be Sepa ee tesa or ems for Spinal Traction??? A. Spinal Nerve Root Impingement 1, From a herniated nucleus pulposus This condition requires enough traction force to cause verebral body separs tee. The separation may have several effectson the bulging disk, including making the annular fibers and posterior longitudinal ligament taut, thus flatten- ihe the protrusion or decreasing the intradiskal pressure, thus the pressure on Te bulge." Traction time must be short because the pressure soon equalizes and pressure increases when the traction is released. To avoid the adverse effect froer increased intradiskal pressure on release, the treatment times should be ices than 10 minutes for sustained traction and less than 15 minutes (ve Wier tes mation. Often, in the acute phase, intermittent traction is not well tolerated. Progression depends on the patients response. When the symptoms are bess irri table, higher forces applied intermittently are tolerated 2 rom spinal or foraminal stenosis caused by ligament encroachment, edema, or 5] be temporarily relieved by applying .d increase the size of the intervertebral highly irritable and large weights exacerbate the traction may be tolerated initially Cless than that re- quired to separate the vertebrae for no more than 10 minutes), regener de- pends on the patient's response: Change to intermittent traction on rales tient’s symptoms become predictable; greater forces can then be tol allowing for vertebral separation. . Hypomobilty of the Joints From Dystunction or Degenerative Changes —) ‘i Wheney of motion is limited, spinal traction can De a Nhmeyer gs SO cara cars Wace sues Ee fi RF cxpenl spice essen ASE Ta . Itis a nonspecific form of gretching: enough force to sepa foramina. If symptoms are symptoms, gentle sustained —————Appication of Mrerapeutic Exercive 10s the stretch force in the cervical spine! 1. To potentially localize al spine in neutt Spine in flexion to affect the lower segments a. Put the cervic to affect the upper segments, b. Put the cervical 2, To potentially localize the stretch force in the lumbar spine! a. Put the lumbar spine b. Put the lumbar spine and Jower thoracic region. 4. To obtain unilateral effects peaition the spinal segment ina skde-bending position or side beng slight rotation before the traction force is applied. Positional traction jg in neutral to affect the lower segments, { knees into flexion to affect the uppe; i Ne UPPEC seamen, ling wi ts for this purpose. , tr or maximum distraction of the facets on one side of the neck, th fide bent opposite and then rotated toward the side to be affected b. For maximum sliding of the facets on one side, the ne tated opposite the side to be affected. ¢. For maximum sliding and distraction ofthe lumbar spine, the tnink js bent opposite and then rotated toward the side to be affected. * 4. To achieve a stretch force Vertebral separation must occur, Progress treatments depending on the pues response, ki is side bent ang 5. Precaution: Use caution with degenerating joints; to much movement may ‘crease their irritability. If traction causes increased pain or decreased range motion, either too much traction force was used or it is inappropriate to cog tinue as a method of treatment. Traction should not be used with potential ins bilities from ligamentous necrosis in rheumatoid arthritis'® or conditions in which there has been prolonged use of steroids. C. Joint Pain From Symptomatic Facet Joints 1. Acute stage Small movements within the ayailable range of motion are beli to stimulate mechanoreceptors and block pain perception at the spinal as well as} help maintain normal fluid exchange.™' (Gentle forces of int trac may relieve pain; the forces should not cause vertebral separation and set any injured tissues. ) 2. Chronic stage (Pain from hypomobility will fequire dosages that apply @ stretch force 10 H limiting tissues. Patient tolerance will dictate whether to use higher dos # intermittent or lower dosages of sustained or positional traction. D. Muscle Spasm or Guarding “*\\y 1. If the cause of the spasm or guarding i guarding is protrusion of the nucleus pulps related to a facet probl a me ae lem, the cause of the problem should be (real 2. With a soft tissue inju ad iy or torn muscle, the injured area should be shortened position duri : ing the acute phase of healing, then gradually 4s the scar becomes stable (see Chapter 7), ee Pia er er niques to Regions of the Body > \V.CC — 1, Flexion of the spine places a st Te Sene: wacton roceatres eeaponlgt neg laces @ stretch force on the ual o am mI of the spine and increa: ae Posterior soft tissue struc- ion’, therefore, flexion should be a : ref is wuscle contrac- b. The spine is placed in a pain-free poses CoM" HE ACHE stage of beaing " iON. = Usually a gentle intermittent trction is preferred when the extent of soft tissue injury is nev i following any acute injury sen ; now! d. If there is any exacerbation of symptoms, wrslon should ould not be given. fs Meniscold Blocking 4 tapped meniscoid wi position and cannot bloc ats arnt fee the patient is in a forward-bent Osi e the facts and put tension on the joint capsule, postion pe cae i ces vel tional vi joint surfuces as well as pt tension on the joint capsule. Either ore aconag ans one, applied at a high enough dosage (0 effect the desired facet meniscoid. "et motion, should release a trapped F. Diskogenic Pain, Postcompression Fi ofthe Spine ‘racture, and Other Conditions The conditions may respond to spinal traction. Begin with th segment 1 spinal in wutral or pain-free position. The symptoms should be monitored and adapta- tions made in the technique, depending on the patient's response WV, Umitations, Contraindications, and Precautions A, Umitations of Traction 1. The effect of vertebral separation is temporary, although the temporary relief may be enough to help break into a reflex pain cycle 2, No consistent protocols exist; rationale is hypothetical with inconsistent clinical results 22* Personal experience and the patient's response dictate method, force, duration, and frequency of treatment? 3, The longitudinal traction force is nonspecific as to vertebral level. It affects the entire region. B, Contraindications?#"° \ie‘Kny, spinal condition or disease process in which movement is contraindicated. 2) Aéute strains, sprains, and inflammation*or any painful symptoms aggravated by inifial traction treatments. \4, stretch forces to areas of spinal hypermobility. \4. Rheumatoid arthritis of the cervical spine, in which: potential necrosis of sup- porting ligaments could cause instability and subluxation or dislocation of a ver- tebra-and spinal cord damage."® : : \S. Any spinal pale in which srocoal niger is compromised, such as-spinal malignancy, osteoporosis, tumor, OF i filer 2600 pypteanen oie some eee cardiovas¢ular disease, abdominal hernia, and hiatal hernia contraindications for lumbar traction.Application of Therapeutic Exercise Techniques to Regions of Me Body C. Precautions © © (TMS) pain may be provoked with use of 1. Temporomandibular joint ( seu ters, particularly when the chinstrap places a lot of force on the hal occurs more often wien de hea slighty exe” If pain increases ge several alternatives are suggested: 3. Use manval traction, thereby avoiding pressure under the mandible b Place cotton dental rolls between the back teeth; pressure ay from the traction strap will then cause a distraction of the Tay = Use a cervical traction unit that does not require a chinstrap, la from a srap secured across the patient's forehead and disracton from under the occiput. 2. Patients wearing dentures should not remove them, because the TM) is fone, into an abnormal resting position and can be traumatized with pressur foci 3. Some of the conditions listed under Contraindications may benefit from cn, fully applied traction. When mechanical traction is too forceful for the ¢ V. General Procedures A. Determine Appropriateness for Choice of Traction by Testing Win Manual Traction First (See Sections VI and VI for techniques) 3. When evaluating. apply the traction force in various positions of flexion. exe sion, side bending, and rotation to find whach poniion best reduces or relieves the symptoms Use that potion. pomadble. for the initial treatment . dluate the patient immediately afterward as well as the next diy tw dete mine whether traction shouk) be moxtified or continued. B. Determine if Manual, Will Be Used Positional, or Mechanical Traction C. Position the Pattiont for Maximum Comfort and RelaxationP0000 Ee Te Spine: tr he duration will depend on the eh recat type of tr, eer poundage used, the clinical condiinen ¢ eu? Gnterminent or sustained), the ent the patient, and the Shine oa Boals of the treat ., safety Rules for Mechanical Traction 1, Use only cables and ropes that are in ; 300d repai Secure the equipment so it w mere tec 2 I not mov ure WSR love when the tractio 3, Check to see that the poundage dial is tumed dome non lOrce |S applied the patient or turning on the machine. Riaisiekee> betore sening up 4, Periodically check the poundage calibration, cee disposable ussue, OF gauze Wherever the halters touch the patie mouth, of hair, Disposable halters are available but are See tiaa a are not easily adjusted to all 6, Never leave the patient unattended while he or she ‘ is receiving traction unless he or she has some mechanism for deactiva ne ating the unit and some means to si Nese ey some means to sig. vi, Cervical Traction Techniques A. Manual Traction 1. Position of patient: supine on the treatment table. The patient should be as re- iaxed as possible 2. Position of therapist: standing at the head of the treatment table, supporting the weight of the patient's head in the hands. Hand placement depends on comfort Suggestions includes a. Place the fingers of both hands under the occiput (Fig. 16-14). b. Place one hand over the frontal region and the other hand under the occiput (Fig. 16-18). = hands under the oc- Figure 16—1. Manual cervical traction (A) with the eo Tal under the occiput and “ut (B) with ome hand over the frontal region and the of (using a belt to reinforce the hands for the traction fotApplication of Therapeutic Exerc Techniques 10 Regions of the Body und the spinous process above the venety, Jacement provides a specific traction only ® level at which the fingers are placed \ | ips can be used to reinforce the fingers and ip bel action force (Fig. 16-10). d for evaluation, vary the patient's head posits, flexion, extension, side bending, and side bending with rotation and app), tration force in each position; note the piel toes 4, When administering treatment, use the POSiion that most effectively reduces » clieves the symptoms. S| eae anes the force by fixing his or bet arms isometrically, assum; si mable stance, and then leaning backward in controlled manner. If a bei ¢ ised, the force is transmitted through hy po If just the arm muscles are us.) 0 ce, the therapist tires quickly eta vied intermittently, with 4 smooth and gradual building 6. The force is usually app! i re releasing of the traction force. The intensity and duration are usualy lie by the therapist's strength and endurance 7. Value of manual traction. a. The angle of pull and head position can be controlled by the therapis B: By placing the index fingers around specific spinous processes, the level « traction can be controlled to some degree: No stress is placed on the temporomandibular joint, as is frequently done with mechanical traction. fingers aro' c. Place the index fi Place the in ane to be moved. This vertebral segments around the therapist's the ease of applying the © 3, When manual traction is use \tease B. Positional Traction 1. Position of patient: supine on the treatment table. 2. Posttion of therapist: standing at the head of the treatment table, supporting the patient's head in his or ber hands, Determine the segment to receive the major ity of traction force and palpate the spinous process at that level. 3, Procedure": Flex the head until motion of the spinous process just begins a the determined level. Support the head with folded towels at that level of flexion. ‘Then side bend the head away from the side to be distracted until movement cf the spinous process is felt at the desired level. Finally, rotate the head a few de grees toward the side to be distracted. Adjust the towel support to maintain ths position for a low-intensity, sustained traction stretch to that facet joint and su rounding soft tissue. 4, Value of positional traction: The primary traction force can be isolated to a spe cific facet. This may be beneficial when selective stretching is necessary, * when the segment above or on the contralateral side is hypermobile and should not be stretched, C. Mechanical Traction 1. Become familiar with the unit available by reviewing the manufacturers di®° tions. Learn the capabilities, limitations, and adjustments possible for the equi: ment. 2. Position the patient for comfort. a. Sitting0 NN The Spine: Traction Procedures (A) This position uses less - clinical sy muscle tension and acco; separa eS More force auc ae ™plish separation of the vertebrae than foarte 2) Use a comforable chair with arm rest L. ap Foreanattoee $ oF place @ pillow on the patient's (3) The height of the chair s rest comfortably on the fl loo b. Supine (Fig. 16-2) inane eae (2) This position requires less fore eto (2) This position tends to reduce the lodotc Gane dx eon, sting 6 curve due to the force of grav- @ supper the patient with pillows for maximum comfort. @ Depending on the angle of pull, friction of the head on the surface of th treatment table must be considered, i ae ¢. Semireclining (1) Use of a reclining cl i a pee hair or tilt table provides alternative positions to sitting (2) Gravity may or may not have an influence, dey , , depending on angle of pull 3, Head position for the patient is determined by the evaluation as well as the con- dition being treated. a, To obtain separation of the vertebrae, the head should be positioned in flex- ion up to 35 degrees; the greater the angle of neck flexion, the greater is the posterior elongation * b. To obtain greater muscle relaxation, position the head closer to neutral.” c. To obtain unilateral effects, position the head in a side-bent position or in a position of side bending with slight rotation (as described in the positional traction section) before the traction is applied, Secure the patient's thorax with a strap so he or she is not realigned with the pull of the rope 4. Apply the bead balter. a. First, line the head halter with gauze or tissue. b. Adjust the halter to fit the patient comfortably, The major traction force must be against the occiput, not the chin, to minimize compression of the tem- poromandibular joint. Gauze may be placed between the teeth or padding under the chin to help absorb pressure. ¢. Do not remove dentures if the patient wears them or stress may be placed on the temporomandibular joints. d. Eyeglasses should be safely set aside, Figure 16-2. Mechanical traction to the cerv- Gl spine, with the patient supine.chniques to Regions of the Body Application of Therapeutic Exercise Techniques to Regions of The Bocy fe. Attach the halter to the spreader bar of the traction unit; che tient is aligned for proper pull. 5. Set controls. a a. The poundage dial should be set at zero before activating the unit . ermittent traction, these shoulq b. If the unit has off-on timers for in © Should be see CK that the i the desired time intervals (1) Only 7 seconds is needed for maximum separation at any one equency tends to be irritating. @ uae aa intervals are 30 seconds on, 30 seconds off o¢ ‘on, 30 seconds off. Duration of treatment may be from 10 to 30 minutes for sustained or inte, tent traction, depending on the patient's condition and goals for treatment, 6. Activate the unit and gradually increase the force of traction 4. To avoid treatment soreness, the first treatment should not exceed 19 15 Ibs b. Progression of dosage at succeeding treatments will depend on the goal an the patient's reaction. . Safety : Demonstrate to the patient how to turn the unit off if symptoms become wone 8. At the completion of treatment. a. Turn all controls off and turn dial indicators back to zero. Remove the hale from the spreader bar, then remove the head halter. b, Re-evaluate the patient's condition. Be sure he or she does not feel dizzy or nauseated before leaving the treatment area ¢. If the patient complains of headache, nausea, fainting, or increased symptoms during or following treatment, reduce the weight or length of treatment tine at the next visit or discontinue treatments if the condition warrants. Fele, by 1 min, te « x D. Home Traction: Mechanical 1. Have the patient practice the traction set up under your supervision. Be sure be or she understands: a, What position and neck posture to use (D) With an over-the-door pulley system, sit facing the weight if the flexed position is to be used. (2) Sit facing away from the weight if the neutral or extended position ist be used. For the neutral position, the head should be directly under the pulley; for extension, the chair is moved forward @) Ifa supine position is desired, the head is usually positioned in flexion with the cervical halter attached to the pulley system; the weight of te body provides the counterfor b. How to get comfortable ©. How to apply and release the weights safely 2, Weight application varies, The most common method is with a weight pan ot bag on a pulley system (Fig. 16-3). If the patient uses weights, have them 004 chair or table next to him or her. Have the patient practice applying the wei® $0 itis accomplished smoothly and safely ; 5 oan eo we {0 30 minutes) using small amounts of weight ee eRe erupt fraction requires that the patient lift the wt Ase neck at frequent intervals. Assess both techniques one provides greater relaxation and relief of symptoms.2G flexion. For the neutral or extended Eur te pally and fae aay from te weg E. Self-Traction 1. The patient is sitting or lying down. He or she is taught to place the hands be- hind the neck with the fingers interlocking: the ulnar border of the fingers and hands are under the occiput and mastoid processes. The patient then gives a lift- ing motion to the head. The head may be placed in flexion, extension. side bending, o rotation for more isolated effects He or she may apply the traction intermittently or in a sustained manner. 2. Positional traction can also be used for self-traction. The patient learns to as- sume the position determined by the therapist as described in Section VIB Vil. Lumbar Traction Techniques A. Manual Traction 1 Manual traction in the lumbar region is not as easily applied as in the cervical region because at least half the body weight must be moved and the coefficient of friction of the part to be moved must be overcome 2. Position of patient supine on a treatment table, preferably a split-traction table to minimize the resistance from friction 4 Position of therapist varies with the position of the patient's hips and lower ex- tremities. a With the lower extremities extended and the lumbar spine: in extension, the therapist can exert a pull at the ankles b Wath che hips feed 1 90 degrees and the lumbar spine in flexion. he Tent’ lege ure draped over the therapist's shouldes. The theraps, Then SS: ae ee with his or her arms wrapped across the patente Bhs cA Jvie belt with straps may be used 4 eee ect tieeiiag coelutany arritne sma. of HEED, SIS sion, or side bending and note the patients restos vs sil> oe cnepuetiuen was his Gr er endive body weight to electsay mac Trrer creping a high-dosage traction force, the thorax is stbilzed ton Fr Hoa ere damess around the patient's rib cage and secure i to the hy 2 coup, earactlc, or have a second person stabilize the patient by standing hid ey end of the table and holding the patient’s arms. the hey _B. Positional Traction'*"9 c 5 1. Position of patient side-lying, with the side to be treated uppermos, 4 blanket is placed under the spine at the level where the traction force is gt thu causes side bending away from the side to be treated and therefoy Ces ward gliding of the facets (Fig. 16-40). an yp, Position of the therapist: standing, at the side of the treatment table fag patient, Determine the segment 10 receive the majority of the traction for palpate the spinous processes at that level and the level above. 3, Procedure'®: The patient relaxes in the side-bent position. Rotation is addey isolate a distraction force to the desired level, Rotate the upper trunk by © pulling on the arm the patient is lying on while at the same time palpatn reinows processes with your other hand tO determine when rotation has Pe at the level just above the joint to be distracted. Then flex the patient's u 3 most thigh, again palpating the spinous processes until flexion of the lowers, tion of the spine occurs at the desired level. The segment at which thee opposing forces meet now has a maximum positional distraction force (Fy 16-48). 4, Value of positional traction: The primary traction force can be directed tote side on which symptoms occur or can be isolated to a specific facet and therefore beneficial for selective stretching. n Ng the 8, ang C. Mechanical Traction (Fig. 16-5) 1, Become familiar with the unit available by reviewing the manufacturer’ opent ing mstructions. The most effective traction. is applied. via a splittraction ue thus eliminating the need to overcome the coefficient of friction of half the pe tient’s body weight.The so 5, Mechanical traction to the lumba ps ccm using @ split traction table with pent Supine a 2. Apply the traction and countertractio ‘a. Saunders recommends a heat rial that is attached directly t b. The traction harness is applied over cured above the crest of Re iittit ao ¢. The countertraction harness is used S is used t . tached arGund the lower capes '0 keep the patient from slipping. It is at- 3. Position the patient either supine or prone. a. The thorax should be on the statior i nary part of the table and the pelvis e es ee ae movable Part is kept locked until ready aes is vn a5 bee ic lumbar spine is positioned over the split in the table i ether the spine is in flexion, extension, or side bending is determined bj the evaluation and the patient's comfort and condition as well as the goals of the treatment. ee tes Soran separation of the vertebrae, the lumbar spine should be (2) When supine, the hips are flexed and the thighs rest on a padded stool (2) When prone, several pillows are placed under the patient's abdomen. 4, Attach the anchor straps. a. The countertraction or stabilizing harness is secured to the head end of the traction table. b. The straps from the traction harness may attach to a spreader bar, which is attached to a traction rope. © If unilateral traction is to be applied, attach only one anchor strap from the pelvic harness directly to the traction rope. d. Check that the patient is aligned for proper pull, then take all the slack out of the straps. 5. Set the controls. a. Be familiar with the type of unit. Computer eae have Ca a as a progressive phase that will gradually increase traction pro- pamed ine Other units should be set at zero before activating the n harnesses wvy-duty traction h: armess ma © the Patient’ skin to avoid tignane nT oid slippage. at the upper portion is se. ° unit ae anit has offon timers for Intermitent traction, set them for the desis time intervals. for most ©. Set the duration of treatment. ‘Duration may be up to 30 minutes f Se. the ua Ferg depos onthe pels 40 = PES 0S tion and reaction to the traction. ‘ $ a ar se sales wl epic when ek SSE 2. Activate the unit and gradually Hee the force (if the programmed to do so automatically). nangrine propane oe, og at wer Patient's weight.Application of Therapeutic Exercise Techniques fo Regions of the Body b. Progression of dosage at succeeding treatments will depend on goals and the patient's reaction. 8. Safety turn the unit off if symptoms worsen while Demonstrate to the patient how to the unit is on. Make sure he or she has a signaling device 10 call for help if nec- essary. ‘At the completion of the treatment: 4. Turn all controls off and turn indicators back to er0- B. Lock the split on the table before the patient attempts 10 Bet off © Reevaluate the patient; note any change in symptoms or range ‘of motion D. Home Traction: Mechanical 1. A number of home traction units are best meets the goals for the patient. design of each unit. Have the patient p pervision. Be sure he or she understands: a. Position b. How to get comfortable c. How to apply and release the traction force safely 2, Because mont of the home units use body weight and position within a pulley system for the distraction force, sustained traction is most easily used, Determine ereafe duration for the patient compatible with the goals for treatment. 2 available on the market Choose one that Set-up and instructions are specific to the ractice the traction set-up under your su- E. SelfTraction: Manual L To separate the posterior segment of the lumbar spine, the patient is positioned Supine He or she then draws both knees up to the chest and holds them (grasping around the thighs). This can be undertaken intermittently by releasing the hold and bringing the legs partway down, then pulling them back up again (see Fig. 15-5). Precaution: Flexing the spine in this manner increases the intradiskal pres- sure; therefore, this technique should not be used to treat symptoms of an acute disk protrusion. 2 Positional traction can be used for self-traction. The patient learns to assume position determined by the therapist as described in Section VILB (see 6 Bag Vill, Summary The basic concepts, indications, contraindications, and , . precautions of traction Se a Te coaches iaidebons cl oS for ing cervical and lumbar traction with manual, positional, or mechanical techniques spinal traction is just one technique for managing spinal and back problems, it has been gested that this material be studied concurrently with the material in Chapters 14 and 15,