IPHREHAB : Lumbar Traction AND TREATMENT

IPHREHAB


Lumbar Traction

• To be effective, lumbar traction must overcome lower extremity weight (¼-½ of body weight)
• Friction is a strong counter force against lumbar traction
• Split table is used to reduce friction

General Technique for Applying Lumbar Tx

• Traction harness use

– Clip buckle versus velcro

– Vinyl versus cotton

– Adjustable lengths, pads

– Placement of lumbar belts 

• skin versus clothes – dissipate traction force)

– Use of thoracic belts on lower, lateral ribs

• Not in axilla

– The thoracic belt is placed on after the pelvic belt

Mechanical Traction Application

• Motorized lumbar traction
• Assess body weight
• Remove material that may interfere with halter
• Adjust halter accordingly

1. Traction halter = Pelvis
2. Stabilization harness = 8th-10th Ribs

• Unlock split table and align target spinal segment over the opening in the table
• Secure and connect halter
• Align angle of pull to correspond with specific pathology
• Explain treatment to patient and give safety switch

Effects on Lordosis (prone)

• Patients with sever pain and muscle spasms may tolerate prone traction better

• Pillows and harness to control lordosis

• Rope angle

– Always low

– Pillows can decrease or increase lordosis

• Pelvic harness

– May be placed to effect lordosis, as with supine

– Harness is never placed posteriorly in prone

– Rarely anterior

– As a rule, it is placed laterally to maintain other positional effects

• Treatment in prone 

– Allows performance of other modalities without position changes 

– Allows for easy palpation of the interspinous spaces to determine the level and degree of spinal motion 

General Technique for Applying Lumbar Tx

• Patient position

– Prone versus supine (comfort, goals)

– Prone 

• Disc

• Pillows under abdomen to flatten lordosis, under thighs or chest to increase extension

– Supine

• Mobilization

• pillows under knees to decrease lordosis

– Initial soft tissue stretch on soft tissue should come from positioning 

Effects of Lordosis (supine)

• Leg Position

– Up on a stool, decreases lordosis

– Flat, normal lordosis is maintained

– 90/90 position should flatten back, less than that decreases in increments

• Rope Angle

– Flat low pull maintains

– With increased (elevated) rope angle, lordosis decreases

• Pelvic Harness

– Greatest effect on lordosis

– Posterior pull decreases lordosis

– Lateral pull maintains lordosis

– Anterior pull increases lordosis

– Positions between these will result in incremental changes 

Patient Positioning

Supine

Increases flexion

• Supine + Flexion

Further increasing flexion

46-60 = L5-S1

60-75 = L4-L5

75-90 = L3-L4

90 = Posterior inter vertebral space

• Extension

Opens facet joints and increases distraction in upper lumbar

Initiation of Treatment

• Set controls to zero and turn on unit
• Adjust ratio
• Tension

1. Approximately 25% of body weight
2. Radicular pain caused by disk herniation: 30 to 60% of body weight

• Duration

1. Corresponding to pathology

• Instruct patient to remain relaxed

Termination of Treatment

• Tension
• Gradually reduce over 3 or 4 cycles
• Gain slack and turn unit OFF
• Many units have an auto OFF sequence
• Remove halter from unit and patient
• Patient remains in position for 5 minutes after the treatment

Patient Positioning

Prone

• Used when excessive flexion or lying supine causes pain
• Beneficial

1. Allows other modalities to be used during traction
2. Effects the lower disk protrusions

• Optimal Position
• Experience
• Trial and error

Traction Technique

• Angle of pull
• C spine supine better.  25* flexion
• L spine Flex hip and knees, symmetrical or prone or unilateral technique