General Traction Treatment Considerations
Static vs. intermittent
- again, research is variable when it comes to best practices. In general:
- muscle relaxation: low load long duration stretch (static stretch)
- facet mobilization approach: short and equal on-off time (10 sec/10 sec)
- herniated disc diagnosis/dysfunction: longer on:off ratio (3:1)
Treatment time
- for acute disc herniation < = 8 minutes (increased treatment time may cause fluid to enter disc space, thus increasing intradiscal pressure
- for chronic conditions, generally 20-25 minutes: treatment time will vary depending on patient response
Frequency
- proportional to acuity: More acute ---> more frequent
Positional traction
- allows patients to position themselves with guidance and then independently in positions to decrease compression to affected foraminal or facet structures.
- for cervical traction: patient is instructed on how to position their head and neck to provide maximal decompression of involved structures
- for lumbar traction: patient is instructed on how to position their legs and trunk to provide maximal decompression of involved structures
- Position to maximally open facets
- forward flexion - contralateral side flexion - ipsilateral rotation
- Position to maximally open foramen:
- forward flexion - contralateral side flexion - contralateral rotation
- monitor for signs and symptoms of pain due to facet compression by prolonged positioning on the contralateral side
Manual traction
- applied using a three-dimensional pulls by a therapist; joint specific traction is considered a more advanced technique
- in the cervical spine, therapist applies a manual pulling force at the occiput for decreasing muscle guarding
- in the lumbar spine, therapist applies a manual pulling force at the pelvis and/or LEs depending on symptoms and target tissue response
Warning: DO NOT attempt these techniques without direct instructor supervision
Demonstration of cervical manual traction (Approximately 1 minute)
Demonstration of lumbar manual traction (Approximately 3 minutes)
Positioning and Draping
Always position for patient comfort and drape as needed to assure only areas that need to be exposed to perform the techniques are out in the open.
