Traction

By

Traction !
Process of drawing or pulling apart of a body segment used in
treating painful spinal conditions.
Mechanical traction

Manual traction

Using a traction machine or

ropes/pulleys to apply a
traction force.

By clinician who positioned

patient and applies traction
force to joint of the spine or
extremities.

Physical/therapeutic effects of traction

Bone

Spine movement
Encourages movement both overall
and between each individual spinal
segment.
Amount of movement varies
according to
position of spine
amount of force
Duration of time
Pain, paresthesia or tingling
Due to physical separation of vertical
and resultant decrease in pressure on
sensitive structures.

Wolfs Law! Bone remodels itself and

provide strength in response to

compressive and distractive loads.
No immediate effects on bone occur due
to traction that causes symptom changes.
Intermittent traction with rhythmic
on/off load cycles promote movement.
Major effects on bone may result in
increased spinal movement that
reverses bone weakness associated with
immobilization.
May assist with inc or maintaining bone
density.

Ligaments
Stretching effect
Structural changes occur slowly due
to
Viscoelastic properties
Ligaments resist shear forces and
return to original form following
removal of a deforming load
Sensitivity to rate of loading
Rapid loading ! Ligament become
stiffer and resistant to change in
length
Slow loading ! Allow lig. to lengthen
as it absorb force of load thus treating
shortened or contracted ligaments to
restore their normal length.

Loading should be applied slowly

and comfortably
Ligament deformation ! Results in
lengthening of a ligament caused by
traction loading.
Slow loading rates allow for more
ligament deformation.
Ligament deformation causes the
spinal vertebrae to move apart.
When ligaments stretched it put
pressure on or move external
ligamentous structures thus relieve
pain i.e.
Proprioceptive nerves, synovial
fringes.

Disks
Normal disk in non-compressed position.
In an injured disk, sitting or standing compresses the disk
causing the nucleus to become flatter.
Herniation of the nuclear material occurs if the annular
wall becomes weak.
When placed under traction, intervertebral space expands
thereby decreasing pressure on the disk.

Articular facet joints

Facet joints are separated releasing
impinged structures like synovial
fringes, meniscoid structures etc.
Dramatic reduction in symptoms.
Inc joint separation decompresses
articular cartilage allowing synovial
fluid exchange to nourish cartilage.
Decrease rate of degenerative
changes.

Synovial fringes! Folds of synovial

tissue that move in or out of the

joint space.
Disc protrusion ! Abnormal
projection of nucleus through some
or all of annular ring.
Disc herniation ! Protrusion of the
nucleus pulposes through defect in
annulus fibrosis.
Meniscoid structure ! A cartilage tip
found on the synovial fringe of
some facet joints.

Muscles
Vertebral muscles can be stretched
Stretch lengthens tight muscle thus
promote muscle relaxation
Allows for better muscular blood
flow.
Activates muscle proprioceptive
providing sensation of pain relief.
Dec in muscular irritation.

Nerves
Pressure on nerves or nerve roots
from bone spur, disc bulge, reduced
foramen space often associated with
spinal pain.
Unrelieved pressure on a nerve will
cause
Traction Dec. pressure on nerves will

Traction treatment
techniques

Lumber positional traction

Inversion traction
Manual lumber traction
Level-specific
Unilateral leg pull
Mechanical lumber traction
Manual cervical traction
Mechanical cervical traction

Lumber positional traction

Patient typically on restricted activity program.
Trial and error, process to determine position that offers maximum
comfort and relieve pressure on nerve roots.
To treat nerve root impingement and low back pain.

Side-lying position ! Unilateral foramen

opening (max. opening)
*maximum opening of intervertebral foramen.
*achieved by flexing upper hip and knee and
rotating shoulders in opposite direction.

Supine position ! Bilateral

foramen opening
Knees to chest position
Increase size of lumber
intervertebral foramen
bilaterally.
Separation of spinous processes.
To treat low back ache.

Side-lying position ! Unilateral

foramen opening
Side-lying with a blanket roll
between iliac crest and lower
rib cage.
Increase intervertebral foramen
size of superior side of lumber
spine.

Inversion traction
*hang upside down
*lengthens spinal column due to stretch provided by weight of trunk.
*Force of trunk in this position is approx. 40% body wt.
*EMG activity dec. after 70sec in this position.

Treatment protocol
Repeat inversion 2-3 times
with a rest of 2-3 min b/w
bouts.
Treatment time range from
10-30 min.
Observe for signs of vertigo,
dizziness, or nausea.

Contraindication

Recent surgery
Hypertensive
Diabetes
Asthma
Diabetes
Thyroid disease
Migraines

Manual lumber traction!

*used prior to mechanical traction for lumber problems.
*helps determine degree of lumber flexion, extension, or side-bending that is most comfortable.
*most comfortable position is usually best therapeutic position.
*patient comfort bigger impact on tractions results

Level specific manual traction

Position patient for max effect at a
specific spinal level.
Having both hip and knees flex at
90 degree.
Apply enough pressure under
calves to lift buttocks off the table.
90 to 90 degree traction achieved.

Disadvantage ! Is to maintain large

traction force for a period of time and
energy consumption of therapist.
Split table can be used for this purpose
to decrease frictional forces and energy
consumption of therapist.

 When traction of upper lumber spine is

required then position is in reverse
order.
Trunk is rotated first and then lumber
spine is flex.
Both rotation and flexion lock and
tighten joint structure in which motion
has to take place.

Place chest against ASIS and upper

hip.
Lean toward patientss feet.
Use enough force to cause a
palpable separation of the spinous
processes at desired level.

Unilateral leg pull manual traction

Hip joint problems or difficult
lateral shift corrections.
Thoracic counter-traction harness
is used.
Hold ankle and move hip into 30
degree flex and 30 degree abd and
till ext rotation.
Apply steady traction force until
noticeable distraction occurs.

To treat SI joint problems.

A banana strap is placed across
the groin on side to be stretched to
secure patient position.
Therapist brings patient hip into
30 degree flexion, 15 degree
abduction and then apply
sustained or intermittent traction
force to leg.

Manual cervical traction !!objectives

Stretches muscles and joints structures
of vertebral column.
Enlarges intervertebral spaces and
foramen.
Creates centripetally directed forces on
disk and surrounding soft tissue.
Mobilize vertebral joints.
Increases joint proprioception.
Relieves compressive effects of normal
posture.

One hand placed under neck

with thenar eminence in contact
with one mastoid and fingers
cradling the neck reaching
across towards the other
mastoid process.
Other hand on chin.
Gentle longitudinal cephalic
pull <20pounds.
Intermittent pull 3-19 sec on
and off /
Treatment time ! 3 -10 min.

Mechanical cervical traction

Supine lying
Neck flexed 20 to 30 degree.
Traction harness exerts pull on
occiput rather than chin.
Intermittent pull of 20 pounds,
minimum of 7 sec ,adequate rest time
for recovery.
Treatment time for 20 to 25min.

Wall mounted device, inexpenditure.

Static traction most easily employed,
use weight plates, sand bags, or water
bags.
Average separation at post vertebral
area 1 to 1.5 mm per space while at
anterior vertebral area is 0.4 mm per
space.

Indications for spinal traction

Nerve root impingement .
Disk herniation
Spondylolisthesis
Narrowing within intervertebral
foramen.
Ostrophyte formation.
Degenerative joint disease.
Subacute pain.
Joint hypomobility
Discogenic pain.
Muscle spasm or guarding.
Muscle strain.

Contraindication for spinal

traction

Acute sprains or strains.

Acute inflammation
Fractures
Vertebral joint instability
Any condition in which movement
exacerbates existing problem.
Spinal cord compression.
Bone disease
Osteoporosis
Infection in bones or joints.

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