IPHREHAB : INTERMITTENT & STATIC TRACTION

IPHREHAB
INTERMITTENT & STATIC TRACTION
Mode of treatment

• Intermittent Most comfortable
• On times generally between 7-20 sec
• Off times 7 to 60 sec
• On/Off ratio may be 1:1 or 3:1 

Lumbar spine

• Positioning for inter vertebral encroachment is neutral for bilateral involvement.  Unilateral SB toward good side with trunk rotated toward the affected side.
• Facets are treated in flexion

• Position:  
• L5-S1= 45* hip flexion
• L4-L5 = 60-75* HIP FLEXION
• L3-l4 + 75-90* HIP FLEXION

Lumbar Traction

HARNESS

• Mechanical traction 
• Motorized unit
• Self-administered Autotraction
• Manual traction
• Belt 
• Thoracic stabilization harness
• Pelvic traction harness
• Clinician’s body weight

Lumbar Traction:  Tension

• Approximately ½ of body weight
• Published literature = 10-300% of patient’s body weight

• Patient Position & Angle of Pull
• Should maximize separation & elongation of target tissues
• Prone or Supine – depends on:
• Patient comfort
• Pathology
• Spinal segments & structures being treated

Lumbar Traction - Patient Position

Supine positioning 

Tends to increase lumbar flexion

Flexing hips from 45 to 60 increases laxity in L5-S1 segments

Flexing hips from 60 to 75 increases laxity in L4-L5 segments

Flexing hips from 75 to 90 increases laxity in L3-L4 segments

Flexing hips to 90 increases posterior intervertebral space

Prone Position

Used when excessive flexion of lumbar spine & pelvis or lying supine causes pain or increases peripheral symptoms

Lumbar Traction – Angle of Pull

Anterior angle of pull increases amount of lumbar lordosis

Posterior angle of pull increases lumbar kyphosis

Too much flexion can impinge on the posterior spinal ligaments

Optimal position & angle of pull – 

Often derived by trial & error 

Depends on patient & pathology of injury

Lumbar Treatment Set-up

Calculate body weight

Apply traction & stabilization harness

Position on table, drape for modesty

Set mode – intermittent or continuous

Set ON:OFF ratio time

Set tension

Set duration

Give patient Alarm/Safety switch

Explain everything to patient prior to beginning treatment!

Static traction

Used less frequently.

Treatment times 8-25 minutes

Brief continuous for disc problems 10 minutes

Facet problems 15-20 minutes

Other duration considerations

HNP Decrease time 5-8 minutes

DJD, Spondylolithesis up to 20’

Frequency from 2-3 times per week up to daily

Allow the patient to rest a few minutes upon completion.  Ask the patient f they have any dizziness or headache post treatment

Document

A. Position

B. Angle of pull

C. Amount of force., hold and rest cycles

D. Static or intermittent

E. Duration

F. Pt. Response

Pain / changes

Functional changes