MPM 1- Exam 3 Questions And
Correct Answers
What effect does traction have on the following pathologies?
1) disc
2) IVF/nerve root
3) joint
4) muscle - Answer 1) Distraction or separation of vertebral bodies; Negative intradiscal
pressure
2) Widening of the intervertebral foramen; Decrease compressive forces and circulatory
compromise of neural structures
3) Combination of distraction and gliding of facet joints (lubrication, nutrition); Tensing
ligamentous structures of spinal segment
4) Stretching spinal musculature; Straightening of spinal curves (Hippocrates)
1) In order to achieve vertebral separation in the cervical spine, what is the minimum
pull you should use and how long do the effects usually last? 2) What about vertebral
separation in the lumbar spine? 3) What force should you use for reduced intradiscal
pressure in the lumbar spine? - Answer 1) minimum 25 # pull; temporary-returns by the
next morning
2) 70-300 # pull; temporary-returns after 30 minutes
3) 50-100 # pull on a split table is required to get a change
1) When using traction to widen the IVF, what degree of flexion in the c-spine should the
pt be positioned in in order to achieve an 18-21% increase in the anterior IVF? 2) About
how much of a gain can be achieved in the lumbar IVF with traction? 3) What effect does
traction have on joint spacing? 4) What effect does it have when treating myofascial
issues? - Answer 1) 30 degrees of flexion
2) 3 mm on average
3) no significant effect
4) may actually tighten the muscles instead of stretching them
1) What is the goal of decompression therapy?
,2) About what amount of force does this use?
3) What is a benefit of manual traction? 4) What patient's is this a useful treatment in? 5)
About how much force occurs with gravity lumbar traction? 6) What are the
contraindications for this? - Answer 1) to create negative pressure in the disc
2) 65-90 # of force; uses a grab bar or axillary blocks instead of a thoracic restraint
3) Allows for continuous feedback/modification of traction force
4) useful in pts with guarding, apprehension, or spasms
5) about 50% of body weight
6) Contraindicated in patients with cardiovascular disorders or retinal problems
1) When using harness supported treadmill ambulation for a stenotic patient, how fast
should they be walking? 2) And for a disc patient? 3) How long should these pts be
walking for? 4) According to a study, which one of these pts had significant
improvements with unweighted ambulation when combined with manual therapy? -
Answer 1) 0.8-2 mph
2) 0.1-0.5 mph
3) 30-50 minutes
4) stenotics
What are the proposed pathology indications for traction? (5) - Answer 1-Prolapsed
Intervertebral disc
2-Nerve root impingement (Herniated disc, Narrowing intervertebral foramen)
**these two are the main ones that we should be doing traction on**
3-Joint dysfunction (stiffness/impingement)
4-Degenerative disc disease (Spondylosis)
5-Para-spinal muscle spasm
1) What symptoms will the pt have if they have a nerve pathology in their lumbar spine
and would be indicated for traction treatment? 2) What if they have a disc pathology in
the lumbar spine? - Answer 1) Signs of nerve root compression, Unable to achieve
centralization with specific movements, Positive crossed SLR, and Improved status with
traction test(s)
2) Standing extension pain, prone extension relief; Sit to stand painful (disc and SI
symptom); Pain during first 1/3 of sagittal ROM; Improved status with traction test(s);
Increased pain with form/force closure
, What are the form/force closure tests that you would expect to cause an increase in pain
for a patient with a disc pathology in their lumbar spine? (5) - Answer Increased pain
with:
-External manual pressure of pelvis into wall during trunk movement
-Lumbosacral belting during trunk movement
-ASLR with manual external compression or active muscle contraction
-Prone Instability Test (PIT)
-Core contraction during trunk movement
What is the CPR for traction on patients with neck pain? - Answer -Peripheralization with
C4-7 mobility testing
-Positive shoulder abduction test (Bakody's sign)
-Age ≥ 55
-Positive ULTT A
-Positive neck distraction test
4/5 criteria (LR+=23.1)
What are the indications for cervical traction in a pt with disc pathology? - Answer -Pain
increased with ipsilateral rotation
-Pain increased with scapular retraction during neck ROM(flexion)
-Pain increased with pushing contralateral ASIS/ipsilateral shoulder into wall during
neck ROM
-Neck rotation during DNF contraction in supine increases pain
1) What are the absolute contraindications for traction? 2) What are the relative
contraindications? - Answer 1) Structural disease (tumor, infection, fracture); also if
they have rods in their back
2) Acute inflammation from disc sprain/tear (Valsalva negative, Sharp pain episodes
during transitions, Very intense, diffuse pain, Increased AM pain, No directional
preference); Joint instability, Pregnancy (+3mos or regional), Rheumatoid arthritis,
Osteoporosis (more absolute with >45% DEXA loss), Abdominal Aortic aneurysm,
Surgical hardware
1) What are 6 variables that affect traction setup?
2) What is the default position to perform cervical traction in? 3) What is the default
position to perform lumbar traction in? 4) When should you move to a supine hooklying
Correct Answers
What effect does traction have on the following pathologies?
1) disc
2) IVF/nerve root
3) joint
4) muscle - Answer 1) Distraction or separation of vertebral bodies; Negative intradiscal
pressure
2) Widening of the intervertebral foramen; Decrease compressive forces and circulatory
compromise of neural structures
3) Combination of distraction and gliding of facet joints (lubrication, nutrition); Tensing
ligamentous structures of spinal segment
4) Stretching spinal musculature; Straightening of spinal curves (Hippocrates)
1) In order to achieve vertebral separation in the cervical spine, what is the minimum
pull you should use and how long do the effects usually last? 2) What about vertebral
separation in the lumbar spine? 3) What force should you use for reduced intradiscal
pressure in the lumbar spine? - Answer 1) minimum 25 # pull; temporary-returns by the
next morning
2) 70-300 # pull; temporary-returns after 30 minutes
3) 50-100 # pull on a split table is required to get a change
1) When using traction to widen the IVF, what degree of flexion in the c-spine should the
pt be positioned in in order to achieve an 18-21% increase in the anterior IVF? 2) About
how much of a gain can be achieved in the lumbar IVF with traction? 3) What effect does
traction have on joint spacing? 4) What effect does it have when treating myofascial
issues? - Answer 1) 30 degrees of flexion
2) 3 mm on average
3) no significant effect
4) may actually tighten the muscles instead of stretching them
1) What is the goal of decompression therapy?
,2) About what amount of force does this use?
3) What is a benefit of manual traction? 4) What patient's is this a useful treatment in? 5)
About how much force occurs with gravity lumbar traction? 6) What are the
contraindications for this? - Answer 1) to create negative pressure in the disc
2) 65-90 # of force; uses a grab bar or axillary blocks instead of a thoracic restraint
3) Allows for continuous feedback/modification of traction force
4) useful in pts with guarding, apprehension, or spasms
5) about 50% of body weight
6) Contraindicated in patients with cardiovascular disorders or retinal problems
1) When using harness supported treadmill ambulation for a stenotic patient, how fast
should they be walking? 2) And for a disc patient? 3) How long should these pts be
walking for? 4) According to a study, which one of these pts had significant
improvements with unweighted ambulation when combined with manual therapy? -
Answer 1) 0.8-2 mph
2) 0.1-0.5 mph
3) 30-50 minutes
4) stenotics
What are the proposed pathology indications for traction? (5) - Answer 1-Prolapsed
Intervertebral disc
2-Nerve root impingement (Herniated disc, Narrowing intervertebral foramen)
**these two are the main ones that we should be doing traction on**
3-Joint dysfunction (stiffness/impingement)
4-Degenerative disc disease (Spondylosis)
5-Para-spinal muscle spasm
1) What symptoms will the pt have if they have a nerve pathology in their lumbar spine
and would be indicated for traction treatment? 2) What if they have a disc pathology in
the lumbar spine? - Answer 1) Signs of nerve root compression, Unable to achieve
centralization with specific movements, Positive crossed SLR, and Improved status with
traction test(s)
2) Standing extension pain, prone extension relief; Sit to stand painful (disc and SI
symptom); Pain during first 1/3 of sagittal ROM; Improved status with traction test(s);
Increased pain with form/force closure
, What are the form/force closure tests that you would expect to cause an increase in pain
for a patient with a disc pathology in their lumbar spine? (5) - Answer Increased pain
with:
-External manual pressure of pelvis into wall during trunk movement
-Lumbosacral belting during trunk movement
-ASLR with manual external compression or active muscle contraction
-Prone Instability Test (PIT)
-Core contraction during trunk movement
What is the CPR for traction on patients with neck pain? - Answer -Peripheralization with
C4-7 mobility testing
-Positive shoulder abduction test (Bakody's sign)
-Age ≥ 55
-Positive ULTT A
-Positive neck distraction test
4/5 criteria (LR+=23.1)
What are the indications for cervical traction in a pt with disc pathology? - Answer -Pain
increased with ipsilateral rotation
-Pain increased with scapular retraction during neck ROM(flexion)
-Pain increased with pushing contralateral ASIS/ipsilateral shoulder into wall during
neck ROM
-Neck rotation during DNF contraction in supine increases pain
1) What are the absolute contraindications for traction? 2) What are the relative
contraindications? - Answer 1) Structural disease (tumor, infection, fracture); also if
they have rods in their back
2) Acute inflammation from disc sprain/tear (Valsalva negative, Sharp pain episodes
during transitions, Very intense, diffuse pain, Increased AM pain, No directional
preference); Joint instability, Pregnancy (+3mos or regional), Rheumatoid arthritis,
Osteoporosis (more absolute with >45% DEXA loss), Abdominal Aortic aneurysm,
Surgical hardware
1) What are 6 variables that affect traction setup?
2) What is the default position to perform cervical traction in? 3) What is the default
position to perform lumbar traction in? 4) When should you move to a supine hooklying
