Traction
Dr. Kanwal Arshad
Assistant Professor
LEARNING OBJECTIVES
Introduction
Types of traction
Physiological effects of traction
Indications of traction
Traction
Definition
Process of drawing, or pulling
apart, of a body segment
TYPES OF TRACTION
Mechanical
Manual
Types of Traction
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 Spinal Traction
Distraction of vertebral bodies
Distraction and gliding of facet joints
Tensing of the ligamentous structures
Widening of intervertebral foramen
Straightening of spinal curves
Stretching of spinal musculature
Effects of Spinal Traction
1. Mechanical
elongation of spine
→ widens the
intervertebral
foramina.
Effects of Spinal Traction
1. Zygapophyseal (facet) joint
mobilization.
2. Muscle relaxation
a. relaxation →↓ pain from m. spasm
or guarding
b. → greater vertebral separation.
3. Reduction of pain.
Mechanical Elongation of The Spine
Factors influencing amount of vertebral separation
1. Spinal position.
- Flex → post aspect separation of vertebrae.
2. Amount of force.
- 7% body wt for cervical traction.
- 50% body wt for lumbar traction.
If less no inefficient, if more lead to trauma.
1. Comfort & relaxation.
→ greatest vertebral separation.
2. Angle of pull.
- In cervical flex 35°→ greatest post
separation. -
In lumbar, harness pull from the post aspect
pelvis rather than from the sides → spine
flexion
Angle of pull.
Zygapophyseal (facet) Joint Mobilization
Traction →
1.Compress, or
2.Approximate,
3.Slide, or
4.Translate facet surfaces.
Factors influencing direction of facet
surfaces movement
1.Flexion & longitudinal traction
2.Side bending of spine
3.Rotation of spine
Muscle Relaxation
Relaxation
→↓ pain from m. spasm → greater vertebral separation.
→↓ pain from m. guard → greater vertebral separation.
Factors influencing amount of
relaxation:
a. Pt. position:
To feel secure & well supported, many pts reported
feeling more relaxed in supine than sitting for cervical
traction.
b. Duration of traction:
After 20-25 mins traction is necessary for m. relaxation.
c. Force:
M. relaxation can be achieved at levels < those needed for
mechanical separation
(only 4.5 : 6.5 kg max.) for cervical spine.
d. Spinal position:
A lesser angle of pull → greater relaxation
Reduction of Pain
A. Mechanical effects:
• Movement →↑ circulation. &
→↓ concentration of noxious chemical irritants.
• Vertebral separation
→ temporary ↑ intervertebral foramina size, which
→↓ pressure on impinged n. root.
B. Neurophysiologic effects:
1. Mechanoreceptor stimulation
→ block nociceptive transmission at spinal cord or
brain stem level.
2. Inhibition of reflex m. guarding
→↓ discomfort from contracting muscles.
Factors Influencing Amount of Pain Reduction
1. Patient position.
The pt should be positioned for comfort & ease of application.
2. Spinal position.
A. Acute stage:
Usually the involved spinal segment is positioned in a (slack)
pain free position.
B. Subacute & chronic stage:
Usually the involved spinal segment is positioned in a
stretched position.
. Force & duration.
A. Acute stage:
Only use low intensity oscillations, for a short period.
B. Subacute & chronic stage:
Progressively↑ amount o force & duration depending on
patient tolerance.
Indications for traction
Cervical
Pain
Muscle spasm
Hypomobile facet
Disc herniation
Indications for traction
Lumbar
◦Pain
◦Muscle spasm
◦Disc herniation
◦Hypomobile facet
◦Nerve root impingement
Contraindications for traction
Cervical
◦ Acute neck injury
◦ RA
◦ Bone cancer
◦ Increased pain or radicular symptoms
◦ Osteoporosis
◦ Cervical instability
◦ (+) Vertebral Artery Test
Contraindications for traction
Lumbar
◦ Pregnancy
◦ Fractures
◦ Joint instability
◦ Bone cancer
◦ Increased pain or radicular symptoms
◦ Osteoporosis
Poundage
◦ start at 25% BW progress up to 50 % BW -- looking for relief of symptoms
Duration
◦ Intermittent: 30 on / 15 off // 5 – 10 min
◦ Static: 10 – 30 minutes
Remember that
Traction should never increase symptoms; if it does, discontinue use and use a
different tool
