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

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

IPHREHAB : CERVICAL TRACTION & POSITIONING

IPHREHAB

Traction

Goal

Reduction of signs or symptoms of C or L spinal compression

Utilize maximal traction with minimal force

PARAMETERS

• Body position:prone, supine,hip position, bilateral, or unilateral direction of pull
• Force used
• Intermittent traction:traction time and rest time
• Sustained traction
• Duration of treatment
• Progressive steps
• Regressive steps

Patient instruction

Explain to patient

Position Pt.

C spine can be done in sitting or supine.Supine provides increased relaxation, vertebral separation and easier countertraction

L traction can be done supine or prone

Angle of Pull

C spine Occiput ( C1-C2) 0-5 degrees flexion

• Mid. Cervical (C2-C5) 10-20 flexion
• Low cervical (C5-C7) 25-30 flexion

Effects on Cervical Flexion

Rope Angle

– To effect 25-30 degrees of flexion on the neck the rope angle will need to approach 45 degrees due to the flexibility of the rope resulting in a sagging with the weight of the head

– The angle is 0, or flat for atlanto-occipital and atlanto-axial traction

Inter vertebral Encroachment

Flex, and SB toward unaffected side and rotation toward affected side

Disc- C spine neutral.  Want ligaments to be lax and allow better distraction

Cervical Traction

Application of a longitudinal force to the C-spine & structures

Tension applied can be expressed in pounds or % of patient’s body weight.

At 7% of patient’s body weight, vertebral separation begins 

Human head accounts for 8.1% of body weight (8-14 lbs.)

Greater amount of force is needed widen areas

You want force to be about 20% of body weight

Cervical Traction Positioning

Seated – a greater force is needed to apply the same pressure (due to gravity) than if supine

Supine – support lumbar region (bend knees, use knee elevator, or hang lower legs over end of table & place feet on chair); allows musculature to relax 

Effects of Cervical Traction :

• Reduces pain & paresthesia associated w/ n. root impingement & m. spasm
• Reduces amount of pressure on n. roots & allows separation of vertebrae to result in decompression of disks.

Effectiveness of Cervical Traction:

Cervical traction has been linked to 5 mechanical factors

• Position of the neck
• Force of applied traction
• Duration of traction
• Angle of pull
• Position of patient