CAUSES:

Back and neck pain is related to different causes
     -- Active support system failure (muscle strain/injury)
     -- Structural support system failure (Ligament, disc injury)
     -- Chronic conditions usually have failure of both systems: structural damage
        and muscle imbalance

SOURCES:

Mechanical effects:

• Decrease intradiscal pressure
• Widen intervertebral foramen
• Stretch ligaments, muscles
• Relax musculature

Physiological effects:

• Relief nerve root compression
• Possible disc retraction
• Mobilize joint and muscle
• Improve blood flow
• Decrease pain
  

Traction parameter set depends on:

• Type of injured tissue
• What is Goal of treatment
       - Pain relief, spasm
       - Decompression or spine elongation
       - Stretch protocol
       - Increase circulation
       - Reduce inflammation
• Acuity of lesion
• Phase of Healing cycle

Symptomatic relief

• Decreased back pain
• Increased ROM
• Decreased muscle tone

Functional improvement

• Increased participation in exercise
• Increased work tolerance
• Increased participation in ADLs

Red flags

• Pain increases or starts referring
• Muscle guarding increases
  

• How to position the patient?
• How strong and how long to apply pretension, or trial?
• How fast should the pull force unload?

Description: Position of the patient and setup of the table.

General guidelines:

• Position the patient for maximum comfort and maximum impact
• Supine creates more flexion, flattens back
• Prone less flexion
  

Description:

• A period of mild traction to take up the slack in soft tissue,
  and allow belting to “seat”
• A pre-test for traction tolerance

General guidelines:

• Traction force must be almost imperceptible to patient

Description:

• Speed at which motor increases traction force

General guidelines:

• Fast speed is more aggressive than slow speed

What type of progression?

• Continual slowing pull, or steps
• What is best way approach this?

If steps:

• How many steps toward max traction?
• How long should the motor pause at each step?
• Should steps be Static (pull-hold) or Intermittent (pull-release)?

• Step progression towards traction phase allows musculature to relax
  
  
• Tense musculature (usually protective spasm) takes 15-20 sec to relax at each step
       - Muscle spindle gets “reset” to new length of muscle and reduces its firing rate
         (provided the muscle is not stretched during this time)
       - Independent time for step hold is new function
  
  
• More steps = smaller change in force
  
  
• Usually no more than 10 lbs per step
  
  
• Acute patients need smaller increments of change, therefore more steps
  
  
• As patient progresses, fewer steps can be used
  
  

Description: Phase during which unloading gradually increases to maximum traction force

General guidelines:

• More and shorter steps for acute conditions
• Less and longer steps for chronic conditions
• Static Steps preferred
  

During traction phase:

• Should traction be Static or Intermittent?
• If Static, how long should total hold time be?
• If Intermittent, how long should this phase last?
• During Intermittent traction, how should you determine maximum
  and minimum poundage, and the duration of hold/rest cycle?
• Traction time?

Description:

• Phase during which max traction force is applied, either
  as a constant force (Static) or alternating between a
  max and min (Intermittent)

General guidelines:

• Static traction is useful to assess if patient can tolerate traction, movement is minimized, typically initial treatments
• Intermittent generally better results than static, more movement, more support in literature
  

Description:

• Hold times during phases of Intermittent traction

General guidelines:

• Hold and Rest times become shorter as condition improves, introducing more repetitions

Description:

• Force during the hold and rest phases of Intermittent traction

General guidelines:

• Higher traction force during later stages
  of care Decompression of disc requires higher force*
• Always use least amount of force necessary for condition

Description:

• Minimal or no hold times

General guidelines:

• Not appropriate with increased muscle tone
  Indicated to increase circulation
• Generally appropriate as condition improves:
  the better the patient, the more movement and repetitions
  

Description:

• Release of traction force at conclusion of treatment

General guidelines:

• Steps are approximately 2-3x the duration as progression steps
• Steps allow tissues to adapt to re-loading
• More steps slows re-compression
• If you load too quickly, muscles will go into compressive spasm
• Use as many steps as you see fit, everyone is different