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Spinal traction lecture

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Joint distraction=
separation of two articular surfaces perpendicular to the plane of the articulation
Reduction of disc protrusion(Mechanisms of action)=
clicking back of disc fragment, Suction due to decreased intradiscal pressure, tensing of posterior longitudinal ligament at posterior aspect of disc pushing displaced material back into positon , Not shown to be effective with large discal herniations or calcified protrusions, Sufficent force required (at least 60#'s) to produce effects on lumbar spine
Clinical indications for spinal traction=Disc bulge or herniation(symptoms)=
may cause back or neck pain, with or without radiation (dermatomal pattern)
Soft tissue stretch can be=
Continuous, sustained, intermittent, manual, and positional
Joint hypomobility (not enough movement) what happens=
Simultaneious glide and distraction of joint while stretching soft tissues around joint
disc bulge or herniation indications=
reduction of disc bulge/protrusion--> decreased compression of spinal nerve roots, best when applied shortly after injury, while tissue is fairly soft, traction may reduce current injury and prevent further disc herniations
methods of administering Postitional traction=
(by the pt), use gravity and bw to relieve pressure on entrapped nerves, relax muscles in spasm, usually lasts 5-30 min, inversion traction would be characterized as positional traction
Joint mobilization=
high force traction stretches surrounding soft tissue structures--> increased joint mobility, lower force and stimulation of mechanoreceptors gates afferent transmission of pain stimuli, allowing greater joint mobility
Joint mobilization can be
Intermittent, Manual and positional
Absoulte contraindications common in C1-C2 artticulations for pt with=
RA, down's syndrome, and Marfan's syndrome
Paraspinal muscle spasm results in=
inhibition of the pain spasm pain cycle, inhibition of alpha motor neuron firing from stimulation of GTO, High load traction may also reduce spasm caused by underlying pathologies that would respond to traction, Static, high load or intermittent, low load
Subacute joint inflammation indications=
reduction of pressure on inflamed joint surfaces, gating of pain transmission with intermittent tractiosn, help maintain normal fluid movement and prevent edema formation at joint
what happens in peripheralization of symptoms with tractiosn=
continuing with peripheralization can lead to aggravation of injury or prolonged symptoms from injury, dont have to discontinue traction, but modification must be made, decrease load, change pt's positon
Joint distraction reduces=
compression on joint surfaces and widen intervertebral foramina, by decreasing pressure on articular surfaces, intraarticular structures, or spinal nerve root, may decrease pain originating from joint injury, inflammation or nerve root compression
Two types of spinal traction=
Cervical, lumbar, (thoracic spine dosen't have much movement so we don't apply traction there
Absoulte contraindications for peripheralizations of symptoms with traction=
progression of spinal symptoms to peripheral area indicates worsening nerve function and increasing compression
Muscle reladation may result of pain reduction due to =
reduced pressure on pain sensitive structures, gating of pain transmission by stimulation of mechanoreceptors, any reduction of pain facilitates muscle relaxation and a reduction of spasms by interrupting the pain spasm cycle
Helathy spine has
greater distraction than degenerated spine with same amount of force
Disc bulge or herniation in conjunction with pt. education to reduce risk or recurrence=
correction of faulty posture or body mechanics, lumbar stabilization through exercise or corset, self traction, cautious, gradual return to activity
Absolute contraindications for traction=
when motion is contraindicated, unstable fracture, cord compression, soon after spinal surgery, with
Application of a mechanical force to =
seperate or attempt to separate joint surfaces, elongate the surrounding soft tissue structures
Nerve root impingemnet result from=
herniated discal material, ligament encroachment, narrowing of interveteral foramen, Osteophyte encroachment (stenosis), spinal nerve root swelling, Spondylolisthesis, decreasing spinal loading helps decrease impingement
joint hypomobility indicated for=
best for use when multiple sites affected, not a localized area of hypomobility
Sustained method of administering traction=
Similar to continuous but no longer than 45 min at a time, shorter duration=higher forces can be used, results in muscle relaxation, soft tissue stretching and sparation of bony surfaces
Distraction can be=
Sustained, intermittent, manual and positional
absolute contraindications for traction with an acute injury or inflammation (within last 72 hrs) unless Dr. implements continuous=
may aggravate acute inflammation or interfere with healing of acute injury, onset/injury in last 72 hrs is considered in acute phase, once initiated, begin static traction and move toward intermittent traction
absolute contraindications for joint hypermobility or instabiliy may be the result of=
recent fx, joint dislocation, surgery, high relaxin levels in pregnancy, poor posture, congenital ligament laxity
Muscle relaxation=
facilitates relaxation of paraspinal muscles,
Methods of administering MANUAL traction=
may be performed by the therapist or pt (self traction,), high forces for 15-60 seconds to treat or determine indiction for mechanical traction, provided in various positions to determine most comfortable and beneficial positioning
Immobilization can be=
Continuous
Intermittent method of administering traction=
Alternate application and release of tration for rief intervals (15-60 seconds) for a 10-30 minute treatment, utilizes high forces, used to separate bony surfaces, mobilize joints, stretch soft tissues and relax muscles
Pt. Immobilization=
very low load, 10-20#'s, prolonged static traction for hours to days, effects of traction are not theraputic goal, bed rest and immobilization cause pain reduction, generally used at home and not in therapy/hospital setting
Soft tissue strethcin may contribute to=
spinal joint distraction, reduction of disc protursion, increased spinal ROM and decreased pressure on facet joint surfaces, decreased pressure on intervetebral nerve roots
Distraction of the spinal apophyseal joints(facet joints)=
amount of force applies must allow the soft tissue surrounding the joint to elongate in order to cause separation of the joint surfacaes, location and health of joints dictates force required
Cervical joints =
7% force of bw to distract
Lumbar joints=
50% force of bw to distract
Nerve root impingement symptoms=
neurological deficits form imingement (sharp, stabbing pain)
Soft tissue stretching=
increases th distance between vetebral bodies and facet joint surfaces , utilizes moderate load, prolonged length of time
Compression relief (temporary) can be=
sustained, intermittent, manual, positional
Muscle relaxation can be=
Continuous, sustained, inermittent, manual and positional
joint hypomobility contraindicated for=
pt.'s with combined hypomobility and hypermobility within the spine, Applying distraction forces to all joints eill cause increased laxity in hypermobile areas (better to utilize manual techniques to localize forces)
Mechanical method of administering traction Continuous=
constant force applied for several hours a day, usually last 10-14 days, only utilizes small amounts of force, reduces pressure on spinal muscles and soft tissues during complete bed rest

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