Thursday, January 28, 2010

Cyriax Traction Recommendations

Traction can be used
1. as an adjunct
2. as a independent modality to treat

Traction as an adjunct treatment

Gentle forcing at almost any joint is tolerated well if the move¬ment is carried out during traction. However, traction as an adjuvant therapy can affect in the following ways

1. An attempt to reduce an intra-articular dis¬placement is much more likely to succeed if the bone-ends are brought apart as far as possible. This is because the loose fragment is now given room to move.
2. If the intra-articular dis¬placement projects beyond the articular edge, the tautening of the ligaments joining the bones during the traction exerts beneficial centripetal force on he fragment.
3. Distraction produces a suction which also exerts beneficial centripetal force on the fragment.
4. If the joint is held at mid-range during traction i.e. in a position that ensures that every ligament is lax, the bones are pulled apart and pressure on the displacement ceases. Pain is thus relieved and the muscles cease to guard the joint.
5. Traction protects the spinal cord and the anterior spinal artery especially at cervical and thoracic joints. At cervical and thoracic joints traction is particularly valuable & effective.

Traction as an adjuvant therapy in OM is used n following cases:

1. Cervical and thoracic joints
2. Displaced loose body (LB) at the knee (Even that LB which cannot be shifted during anesthesia by ordinary forced movements can be affected by traction.)
3. Carpal subluxation.

Traction Alone as an independent treatment

This is used at the spinal joints and at the shoulder.

A. Traction at Spinal joints:

At the neck intermittent traction can be given by suspension. It serves to settle a protrusion already reduced more accurately in place. A Zimmer machine can be employed to ease pain in an ambu¬lant patient and to maintain reduction in cases of great instability. Sustained traction in bed is the only effective treatment for the rare small nuclear disc protrusion at a cervical level.

At the thorax, the indication is the uncommon nuclear type of disc protrusion, a disc lesion at a very kyphotic joint or one adjacent to a wedge fracture of a vertebral body.

At the lumbar spine, the position is different. These large joints are so strong that manual traction is no longer effective as an adjuvant. Moreover, nuclear protrusions are quite common at the lumbar joints, in contradistinction to cervical and thoracic levels. It is now a question of manipulation or traction—manipulation for a displaced fragment of cartilaginous annul us, traction for a soft nuclear protrusion. Traction applies continuous suction to a pulpy herniation and, unless it is too large, draws it back into place a little more each day. Hence at least thirty minutes' treatment is required daily, with between 40 and 80 kg distraction force.

B. Traction at shoulder

At the shoulder, many cases of arthritis are unsuited to forcing. They require intra-articular hydrocortisone. If this is unobtainable, the physio¬therapist's best alternative is distraction of the humeral head from the glenoid. This lasts some seconds, then is released, and repeated again many times. During the first few attempts, muscle spasm keeps the bones in contact but, after a few minutes, they are felt to come apart. Relief ensues which continues after each session ceases.

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