Day 16 – Sports Therapy and Rehabilitation Clinic
Duration: 5 hours Cumulative hours: 150.15
Reflection in Action (as it happens)
I knew that I was seeing a patient first thing in the morning and that she was coming in for her first traction treatment. In preparation for the appointment I went through the patient’s previous notes to gain an idea of her injury history. She had received a confirmed S1 herniation diagnosis and had been treated by the NHS and an Osteopath since last December. She had also had an online appointment last week and it was agreed that she would come in for traction treatment.
I did some reading on the use of traction and its effectiveness for treating thoracic and lumbar herniations. I had never used mechanical traction to treat a patient before, so it was a good learning opportunity for me and very interesting. There is currently a lack of evidence-based research on the long-term benefits of traction for disc herniation. There is no consensus among researchers regarding whether traction is beneficial in separating vertebrae, reducing the size of herniated disks and reducing radiculopathy. A review by Gay & Brault, (2008) only found 10 RCTs investigating the use of traction with patients with chronic LBP. The studies contained more evidence against the use of traction.
I went through a subjective assessment with the patient to establish if there had been any changes in the patient’s symptoms. She was experiencing numbness in her posterior thigh, calf and heel in the right leg but there was no pain. The discomfort was continuous but did not affect her sleep. She is currently doing a program of exercise prescribed by the NHS which involves building strength in the hip and improving proprioception in the right leg. The patient finds lumbar flexion more difficult and it causes neurological stimulus in the heel. She is now doing higher impact exercise such as jogging. She experiences pins and needles afterwards but it hasn’t been too bad.
I went through active ROM for the thoracic and lumbar spine. ROM of the thoracic spine was not restricted. ROM of the lumbar spine was limited in lateral flexion and rotation on the left side of the body. The straight leg raise was negative but flexibility was limited with 40-450 for the left leg and 500 for the right leg. I also palpated the posterior thigh and noted high tone in the left thigh. There was also restricted ROM in external rotation of the hip.
My clinical supervisor showed me how to set up the mechanical traction machine, the settings to use and how to position the patient on the bed. The first traction treatment was scheduled for 30% of the patient’s weight. Patient’s weight was 65Kg – 30% of her weight was 19.5 – we set the weight of the traction machine at 19 Kg, and selected the static options. The total time of treatment was 40 minutes.
After the patient’s treatment I discussed foam rolling exercises to desensitise the biceps femoris and soleus, which the patient found beneficial.
The patient will be returning the following week for her second traction treatment.
Reflection on Action (afterwards)
I had never conducted mechanical traction treatment with patients before. I discussed my thoughts about the literature that I had read on the use of mechanical traction for patients with LBP. Much of the literature found more evidence against the use of traction, however mechanical traction is used in the clinic to help patients with compressed cervical and lumbar intervertebral discs, despite the fact that it is no longer used in the local hospital (Clarke et al., 2006; Graham et al., 2006; Thackeray, Fritz, Childs, & Brennan, 2016).
After the appointment I finalised my notes which my supervisor checked and signed off. She also checked my notes from the previous Wednesday, for my patient who had chronic insertional tendinopathy. We talked about developing a plan for progressing plyometric exercises. It is important to start with double-leg plyometric exercises that decelerate or put the brakes on before we think about plyometric exercises that involve jumping.
References
Clarke, J., Van Tulder, M., Blomberg, S., De Vet, H., Van Der Heijden, G., & Bronfort, G. (2006). Traction for low back pain with or without sciatica: An updated systematic review within the framework of the Cochrane Collaboration. Spine, 31(14), 1591–1599. https://doi.org/10.1097/01.brs.0000222043.09835.72
Gay, R. E., & Brault, J. S. (2008, January 1). Evidence-informed management of chronic low back pain with traction therapy. Spine Journal. Elsevier. https://doi.org/10.1016/j.spinee.2007.10.025
Graham, N., Gross, A. R., Goldsmith, C., Haines, A. T., Kay, T., Peloso, P., … Bronfort, G. (2006). Mechanical traction for mechanical neck disorders: A systematic review. Journal of Rehabilitation Medicine, 38(3), 145–152. https://doi.org/10.1080/16501970600583029
Thackeray, A., Fritz, J. M., Childs, J. D., & Brennan, G. P. (2016). The Effectiveness of mechanical traction among subgroups of patients with low back pain and leg pain: A randomized trial. Journal of Orthopaedic and Sports Physical Therapy, 46(3), 144–154. https://doi.org/10.2519/jospt.2016.6238