Spinal Traction Lab – Flashcards
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Equipment required for appliation techniques-Mechanical traction
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Electrical mechanical tractionTraction unit, thoracic and pelvic belts or cervical halters, spreader bar, extension rope, split traction tabl
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Equipment needed for application of weighted mechanical traction
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Traction devices (ropes, pulleys, weights), thoracic and pelvic belts or cervical halters, Spreader bar, weight bar for water, wieghts or sand
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Electrical Mechanical traction units=
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apply forces up to 150# , apply static or intermittent traction, lumbar or cervical spine placement, allow accurate control of forces being applied, allow variation in pt position
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Over-the-door cervical traction devices=
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static cervical traaction only, inexpensive and easy to set-up, require a great deal of pateint education on position, amount nd duration of force to be used.
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Other home traction devices=
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usually more expensive and comple than over the door
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Procedue-mechanical lumbar traction
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determine if pt dx is likely to respond to traction and select mechanical traction device, determine optimal pt possition, apply force in direction of movement that produces decrease of symptoms, regardless of side of pain, apply force on side of hypomobility (convex side),
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Determine optimal pt position=
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position for comfort that allows muscle relaxation, must have maximal separation between involved structures being treated, usually apply force along mid-sagittal line of body,may apply unilateral force for pt with symptoms greater on one side
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Flexed position results in greater separation of posterior structures
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facet joints, intervetebral foramina( hypomobility, intermittent, )
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Neutral or extende position has greater effects on anterior structures
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dics spaces (static or intermittent)
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Prone position =
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prome position used for syptoms that are reduced by extension or supine positioning is not tolerated, Prone, neutral position localizes forces to loer lumbar segments
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Supine flexed positon localizes forces to=
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upper lumbar and low thoracie segments
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L3-L4 in supine flexed positon=
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75-90 degrees hip flexion
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L4-L5 supine flexed position=
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60-70 degrees hip flexion
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L5-S1 supine flexed position=
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45-60 hip flexion
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lie on split table, with treatment area over split=
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reduces amount of traction force requred to overcome friction, 1/4 of pt bw is needed, less traction force is required used to provide the same amount of distraction
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Application of blts and/or halter=
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secerely tighten the belts so they do not move when traction force is applied, should be directly in contact with skin, not over clothes, if possible
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Thoracic belt=
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stabilizes upper body while lower body is being pulled, lower border should be just below th ribs
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Pelvic belt=
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superior limit marking aligns superior to iliac crest (supine) or on the superior edge of sacrum (prone)
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Setting traction parameters for Static or Intermittent=
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provides a constant force throughout the treatment, indicated for inflammation, symptoms easily aggravated by motion, stretching soft tissues or symptoms related to disc protrusion
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setting traction parameters for Intermitten t raction= (click, suck, tense)
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force alternates between two set points every few seconds for the duration of the treatment indicataed for with long hold time for disc protrusion or with short hold tmes for joint dysfunctions
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Hold/Relax times (intermittent traction)=
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Max force during hold time and minimum force during relax time, ratio of hold, relax depends on pt's condition, Dsc problems 60"20 sec (3:1 ratio), Spinal joint/facet problem 15:15 sec (1:1 ratio) , Greater severity of symptoms leads to both longer hold and relax times to limit amount of movement
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Force=
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kept low initially and gradually increased with pt. tolerane, ALWAYS use the lowest force necessary to produce benefits. generally don't exceed 50 % of pt. bw, starting lumbar traction force is generally thought to be 25-50 # , increase 5-15 #'s with each treatment, decrease if any peripheralization of symptoms or complete relief of pain occurs
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Treatment of compressed nerve roots or facet joints=
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50#'s to 50% of pt's body weight
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treatment of muscle spasms, disc protrusion or soft tissue stetch=
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25% of pt bw
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For intermittent traction treatment =
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relax force should be 50% of the hold force, total release of force can cause rebound aggravation of symptoms, so this is not recommended.
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Total treatment duration=
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initial treatment should be 5-10 min based on severity of symptoms, 8-40 min treatment times have been used, no benefits seen with longer than 40 min
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treatment of disc protrusions=
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5-10 min
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treatment of other problems=
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10-30 min
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Treatment frequency=
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No published studies to support daily application, IDDT= rage among chiropractors
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starting traction=
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using split table, allow one full cycle before releasing table to take-up slack in belts/rope, table should move up and down as force is applied and released to prevent static pull, assess pt's response and provide a means for pt. to call you if needed
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Release traction and assess response=
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lock table sections, release tension of ropes, allow breif rest period before getting up, which recompresses the joints
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Advantages=
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force and time controlled, graded and replicable, not required to be with pt. throughout treatment, static or intermittent traction allowed, may be used at home with certain weighted devices
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Disadvantages=
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expensive equipment, time-consuming to set-up, lack of pt. participation, some pt.s may not tolerate belts, affect broad areas of spine, not localizing forces to desired areas
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Procedure starts with cervical traction=
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Performing veterbral artery test
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second step of procedure for cervical traction=
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determine optimal pt. position, may be sitting or supine
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In supine postion=
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head is supported and may result in increased relaxation of muscles and greater separation or treated areas, shown to be most effective, cervical flexion, rotation and side bending can be adjusted
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In sitting position=
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flexion, extension can be adjusted to a point
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In neutral or extended position=
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localizes forces to upper cervical segments
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In flexed position=
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localizes forces to lower cervical segments
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C1-C2=
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0-5 degrees
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C2-C5=
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10-20 degrees
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C5-C7=
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25-30 degrees
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Maximum posterior elongation of cervical spine with _____________ degrees of cervical flexion
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20-30
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third step in procedure for cervical traction=
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Apply halter, may apply pressure at the occiput only or at both the occiput and the mandible, depending on the pt, connect belts/halter to traction device
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fourth step in procedure for cervical traction=
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setting traction parameters,
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FORCE=
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starting cervical traction force is generally thought to be 5-10 #'s, increase 3-5 #'s with each treatment,
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Decreasing compression of nerve root or facet joints=
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20-30#'s
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decrease muscle spasms, disc protrusion or stretch soft tissue=
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10-15 #'s, may use in combination with hot pack to increase spinal elongation
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General rule=
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don't exceed 300#'s
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Last step of procedure for cervical traction=
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start traction, observe first few cycles to ensure halter stays in place
