Patient Position and Angle of Pull

Patient position has more influence on the angle of pull during lumbar traction
than cervical traction. Lumbar traction can be applied with the patient prone or
supine. Patient comfort, the pathology being treated, and the spinal segments and
structures being treated also help determine the patient position. Positioning the
patient supine increases lumbar flexion of the lumbar spine. Flexing the hip and
knees further increases flexion of the lumbar spine and pelvis, flattening the
lumbar spine. Flexing the hips from 45 to 60 degrees of flexion increases the
laxity in the L5–S1 segment, 60 to 75 degrees in the L4–L5 segment, and 75 to
90 degrees in the L3–L4 segment.
Flexing the hips to 90 degrees also increases the posterior intervertebral space.
In the lumbar spine, extension opens the facet joint and increases distraction in
the upper lumbar and, possibly, the lower thoracic segments.
The prone position is used when excessive flexion of the lumbar spine and pelvis
or lying supine causes pain or increases peripheral symptoms. An increased
amount of distraction occurs in the lower lumbar segments when the patient is
prone, a beneficial effect with lower disk protrusions.
This position has the advantage of allowing other modalities to be applied
concurrently with the traction. The patient’s position and angle of pull should
maximize the separation and elongation of the target tissues.
Determining the optimal position and angle of pull is often derived by trial and
error and depends on the patient and the pathology. For example, a posterior disk
protrusion may respond best with the patient prone and the spine placed in
extension or neutral. However, if no pain relief is obtained in either of these
positions, positioning the patient supine with the lumbar spine placed in flexion
may produce beneficial resul Relief of symptoms caused by nerve root
impingement should be obtained with the patient supine and the spine flexed.

Contraindications to the Use of Lumbar Traction

The contraindications to the use of lumbar traction are similar to those described
for cervical traction. Vertebral body fractures or unstable spinal segments are an
absolute contraindication to lumbar traction unless the treatment is specifically
approved by the patient’s physician.

• Spondylolisthesis Spondylolisthesis can lead to hypermobility of the

vertebral segment, a contraindication to sustained and intermittent traction.
 Do not use lumbar traction for patients with pain of unknown origin or pain
caused by diseases, infections, or.
• Traction applied to severely herniated disks may increase the rate of
degeneration.
• Discontinue use if the treatment increases the severity of the patient’s
symptoms Rheumatoid arthritis and osteoarthritis are contraindicated because
necrosis can cause ligamentous weakness. The force of the applied traction
could result in vertebral subluxation or dislocation and further weaken the soft
tissue structures.

Clinical Application of Intermittent Lumbar Traction

Traction harness: Sometimes referred to as the pelvic “corset.” Fits around the
patient’s pelvis and attaches to the traction unit’s pulley cable.
Stabilization harness: Fits around the patient’s torso and attaches to the
treatment table.
Split table: The lower half of the table glides on rollers, thus eliminating friction
and allowing vertebral separation to occur at a lower applied force.
Mode: This setting allows the traction to be applied intermittently or
continuously.
Type: For multipurpose units that treat both the lumbar and cervical spine.
Hold time: This control adjusts the duration of the traction phase (in seconds).
Rest time: This control adjusts the duration of the relaxation phase (in seconds).
Applicable only to intermittent traction.
Tension: Controls the amount of tension, in pounds, applied to the halter.
Cable release: Eliminates the tension on the traction cable.
Low tension: Sets the minimum amount of tension to be applied during the OFF
cycle.
Duration: Selects the total treatment time.
Safety switch: Allows the patient to interrupt the treatment and immediately
decrease the tension if pain or other discomfort is experienced.
Alarm: Sounds when the patient triggers the safety switch or a malfunction in
the unit is detected.

Setup and Application

The following protocol describes the setup and application of motorized
intermittent lumbar traction with the patient supine and the knees and hip flexed
(e.g., for treatment of nerve root impingement) on a split traction table.
Digital units can display force in pounds (lb) or kilograms (kg). Motorized
traction devices should not be used in the presence of flammable gases such as
oxygen, nitrous oxide and many anesthetic gases. The unit may interfere with
sensitive electrical equipment.

Patient Preparation
1. Determine the presence of any contraindications.
2. Calculate the patient’s body weight if a split table is being used, unlock the
lower section to allow it to slide.
4. The patient’s clothing must not interfere with the fit of the halter and not allow
the traction or stabilization halter to slide during the treatment.
5. Fit the traction halter on the patient’s pelvis. Depending on the type of harness
being used, a towel or other type of padding may need to be placed between the
harness and the patient’s skin.
6. Fit the stabilization harness to the patient’s torso, normally fitting over the 8th
through 10th ribs.
7. If necessary, drape the patient for modesty.
8. If a split table is being used, align the target spinal segment over the opening
between the fixed and mobile portion of the table.
9. Position the patient, the patient’s hip and knee position, and the angle of pull
appropriate for the treatment being treated. If the patient is supine and
lumbar/pelvic flexion is indicated, elevate the lower legs.
10. Align the angle of pull according to the patient’s pathology.
11. Give the patient the SAFETY switch and explain its purpose and use. The
SAFETY switch must be in the patient’s possession throughout the duration
of treatment.
12. Explain to the patient the sensations to be expected during the treatment and
to report pain, discomfort, or worsening of symptoms.

Initiation of the Treatment

1. Reset all controls to zero and turn the unit ON.
2. If applicable, set the TYPE switch to “Lumbar.”
3. Remove any slack in the pulley cable.
4. Adjust the RATIO to the appropriate ON-OFF sequence (refer to Table 16-2).
5. Adjust the tension to approximately 25% of the patient’s body weight.
Radicular pain caused by lumbar disk herniation is often reduced with forces of
30 and 60% of the body weight.
7. Instruct the patient as to what to expect during the treatment and to inform you
if any discomfort is experienced.
8. Set the appropriate treatment DURATION, and initiate the treatment.
9. Allow the unit to go through its first tension cycle. The TENSION may be
gradually increased during subsequent cycles. Increase the amount of tension as
indicated. If pain is experienced at any time during the treatment, decrease the
amount of force or discontinue the treatment.
10. Instruct the patient to remain relaxed during both the on and off cycles.
11. At regular intervals question the patient about abnormal sensations in the
cervical, thoracic, and lumbar spine and the extremities.
Termination of the Treatment
1. If the traction unit does not automatically do so, gradually reduce the
TENSION over a period of three or four cycles.
2. Gain some slack in the cable, and turn the unit off.
3. Remove the traction and stabilization halter.
4. Question the patient regarding any perceived benefit or complications derived
from the treatment.
5. Have the patient remain lying for 5 minutes after the conclusion of the
treatment.
6. Record the pertinent information (tension, duration,
duty cycle) in the patient’s medical file.
Maintenance
After Each Use
1. Clean the unit according to the manufacture’s recommendation.
2. Avoid allowing liquids (including cleaning solutions) from entering the unit.
At Regular Intervals
1. Check the electrical power cord for kinks, frays, or cuts.
2. Check the traction cable for knots, twisting, and if applicable, damage to its
protective (usually nylon) coating.
3. Recalibrate the unit. Follow the manufacturer’s recommended procedures and
timetable for recalibrating the traction device.
Indications
• Nerve root compression
• Radicular pain
• Herniated or protruding intervertebral disk
• Degenerative disk disease
• Lumbar muscle spasm
• Osteoarthritis or facet joint inflammation
• Facet joint pathology including hypomobile facet

Precautions
• Monitor the patient closely during the treatment.
• Discontinue use if symptoms increase.
• Low-tension traction should be used if ligamentous damage is suspected.
• Use only sustained or continuous traction if lumbar motion is
contraindicated.
Time
Treatment Duration
• Facet joint pathology: 25 min
• Degenerative disk disease: 10 min
• Disk protrusion: 10 min
• Muscle spasm: 20 min