Traction

1. What are the physiological effects of traction?
2. What are contraindications to traction in general? For the cervical spine?
3. What are contraindications to traction for the lumbar spine?
4. How is traction generally prescribed in terms of positioning?
5. How is traction generally prescribed in terms of amount of pull?

Answers:
1. Effects are vertebral joint distraction (elongation of C-spine), reduction of compression and nerve root/disc irritation, reduction in pain, muscle spasm, and inflammation, loosening of adhesions in dural sleeves.
2. General contraindications are spine malignancy, osteopenia, infection, congenital spinal deformity. C-spine contraindications are cervical ligamentous instability (RA, Down's, Marfan, dwarfism), infection, atlanto-axial subluxation, vertebrobasilar insufficiency.
3. L-spine contraindications are pregnancy, cauda equina compression, aortic aneurysm, restrictive lung disease, active PUD, hiatal hernia.
4. 20-30 degrees of flexion optimally opens intervertebral foramina for cervical traction. For lumbar traction, keep patient supine with 90 degrees of hip and knee flexion.
5. For C-spine, use greater than 25 pounds. For L-spine, use 50 pounds for posterior vertebral separation, 100 pounds for anterior separation. Treat for 20 minutes.