force for initial session
10 lb max
force to stretch soft tissue, treat mm spasm, or disk protrusion
7-10% of BW
(11-15 lb)
force to separate vertebrae
13-20% of BW
(20-30)
duration range
5-30 min
duration for disk related sxs
10 min or less
duration for other spinal conditions
up to 30 min
cervical traction is most often in
supine
cervical traction can be done in
supine or sitting
cervical traction in a flexed position
greater separation of posterior structures including the facet joints & intervertebral foramen
cervical traction in an extended position
greater separation of anterior structures including the disk spaces
upper cervical spine
0-5 degrees of flexion
midcervical spine
10-20 degrees of flexion
lower cervical spine
25-35 degrees of flexion
cervical traction is mostly static or intermittent?
intermittent
What is the best position if the goal is to pull into
flexion
?
Supine Primary
What is the best position if goal is to pull into
extension
, but pt. cannot tolerate prone position?
Supine Secondary
What is the best position if goal is to pull into
extension
?
Prone Primary position
What is the best position if goal is to pull into
flexion
, but pt. is receiving other modalities and repositioning is not desired.
Prone secondary
How must the pelvic pad be secured?
Over Bare Skin
Secured First
1-2" above iliac crest
How must the Thoracic pads be secured?
Arms in loops
Pads lateral over ribs
Pads must overlap pelvic harnass
What is the purpose of the split in the table?
To reduce friction and increase pull
How do you position the pt. on the table?
So the iliac crest is 1"-2" above the split.
How much force do you need for lumbar traction?
At least 1/4 of person's bodyweight. Should begin at 1/4 and can be progressed to a max of 1/2 of body weight.
In which position is the rope angled?
Primary Prone
Primary Supine
Flexion
Supine with legs on stool
Pelvic pads posterior
Rope straight
Secondary Supine
Extension
Supine with leg straight (towell roll)
Pelvic pads Lateral
Rope Straight
Primary Prone
Extension
Prone with small pillow under ankle
Pelvic pads Anterior
Rope - Slightly angled
Secondary Prone
Flexion
Prone with large pillow under stomach
Small pillow under ankle
Pelvic Lateral
Rope Straight
force for initial session
10 lb max
force to stretch soft tissue, treat mm spasm, or disk protrusion
7-10% of BW
(11-15 lb)
force to separate vertebrae
13-20% of BW
(20-30)
duration range
5-30 min
duration for disk related sxs
10 min or less
duration for other spinal conditions
up to 30 min
cervical traction is most often in
supine
cervical traction can be done in
supine or sitting
cervical traction in a flexed position
greater separation of posterior structures including the facet joints & intervertebral foramen
cervical traction in an extended position
greater separation of anterior structures including the disk spaces
upper cervical spine
0-5 degrees of flexion
midcervical spine
10-20 degrees of flexion
lower cervical spine
25-35 degrees of flexion
cervical traction is mostly static or intermittent?
intermittent
Why is Low Back Pain so important?
Many have reported that LBP is self-limited1
90% of LBP episodes resolve without physician intervention
40-50% improve in 1 week
75% of patients with sciatica will resolve in 6 months with conservative care
Recurrence rates are 79-90%1
While there may be
Why is LBP so important to DO's?
Why counterstrain?
Describe Strain Counter Strain for Lumbar's.
Describe the Anterior elements, middle elements and posterior elements of the lumbar spine.
What are the tissues that generate pain in the lumbars?
What is the action, origin and insertion of the quadratus lumborum?
Describe the iliolumbar ligament.
What are some symptoms and pain referral for problems with quadratus lumborum?
Explain the difference between discogenic vs facetogenic pain.
Describe the Degenerative Cascade model.
What are some assessment tools in the taking the history and doing the exam.
The history and examination remain the mainstay in evaluation of LBP, despite new and expensive technology1
History:
Initial goal: distinguish the serious causes of LBP, i.e. recognizing red flags
What are initial goals of the physical exam. What is particularly important?
Remember:
Allopathic sources:
Most common cause of LBP in every age group soft tissue strain2 AND
Most lumbar injuries due to segmental dysfunction1
Can we see how DO's have a distinct advantage in diagnosing (and treating) LBP!
Discuss Host + Disease =Illness model treatment options.
When is surgery indicated?
What are the 5 steps of strain/counter strain?
Where are the Anterior Lumbar Tender Points?
What type of somatic dysfunction does the Anterior Lumbar Tender Points correspond with?
What are the posterior lumbar tender points?
What somatic dysfunction does the posterior lumbar tender points?
Where are the iliolumbar ligament tender point?
What is the corrective procedure of the iliolumbar posterior tender point?
Where is the quadratus lumborum posterior tender point?
What is the corrective procedure of the quadratus lumborum?
Spondylitis
Spondylosis
Spondylolysis
SPondylolisthesis
Facet tropism
spina bifida
What are some important congenital dysfunctions.