1. Spinal TractionOverview Chapter 17

2. Purpose • Force that separates the vertebrae, opening the intervertebral space • Effects: • Decreased pressure on intervertebral disks • Decreased pressure spinal nerve rots • Opens facet joints • Elongates tissue • Body areas: • Cervical • Lumbar/pelvis

3. Types of Traction • Sustained • Continuous, small force for an extended period (appx. 45 min) • Intermittent • Alternately applied and withdrawn traction • Manual • Administered by the clinician • Positional • Body positioning to elongate the involved tissue

4. General Principles • Angle of pull • Neutral: Transverse plane • Flexion/Extension: Frontal plane • Unilateral: Sagittal plane • Multiaxial: Two or more planes • Anatomical differences • Cervical inferior facet joints angle anteriorly • Flexion opens facet joints • Lumbar facets angled posteriorly • Extension opens facet joints

5. General Principles • Tension • No clear formula • The traction must overcome the resistance exerted by the soft tissue • Use the least amount of tension needed to relieve symptoms • Duration is inversely related to tension

6. Physiological Effects • Encourages movement of spine between each vertebra • Improves circulation • Increases metabolism • Enhances nutrition • ROM increases dependent on: • Patient position • Amount of force applied • Type of traction • Treatment time

7. Indications • Disk protrusions • Degenerative disk disease • Nerve root compression • Facet joint pathology • Muscle spasm

8. Contraindications • Acute injury • Unstable spinal segments • Cancer, meningitis, or other spinal cord/ vertebrae disease • Vertebral fracture • Extruded disk fragments

9. Intervertebral Disks and Disk Lesions • Anatomy • Annulus fibrosus • Nucleus pulposus • Dehydration • Decrease range of motion narrowing intervertebral foramen • Weakens annulus fibrosis • Day vs. night • Age

10. Disk protrusion • Body weight and muscle tone compress the disk and force the nucleus pulposus posteriorly • Traction • Decreases the pressure • Increases disk hydration • Imbibe • Traction applied for too long can absorb too much fluid

11. Intervertebral Foramen Stenosis • Anatomy: • Intervertebral foramen: • Opening for 31 pairs of spinal nerve roots • Disk degeneration • Narrowing of intervertebral space • Osteophytes • Decrease opening • Inflammation of nerve sheath’s

12. Facet Joint Pathology • Healthy facets transmit approximately 20% of the body weight • Inflamed facets transmit approximately 47% of body weight (lumbar spine) • Traction can open the facet joints

13. Muscle Spasm • Long, slow stretching can reduce tonic muscle contraction by elongating the involved fibers • Intermittent traction promotes relaxation during the OFF phase • Increased diameter of the intervertebral foramen decreases muscle spasm • Reduced pressure on spinal nerve roots

14. Maintenance • Cleaning • Follow manufacturer’s instructions for unit and harness • Avoid liquids from entering unit • Check cords and traction cable • Recalibrate unit • Unit must be inspected and serveced by a technician annually