Terminology - What is traction?

[WolfmanHarris]

So I was studying spinal trauma tonight and was using the ITLS text when one of their pearls caught my eye on manual in line stabilization.

ITLS Page 168

"Traction: Do not apply traction to the head and neck. Maintain in-line stabilization of the head, neck and spine."

This threw me for a small loop as I'd always been told to apply gentle traction to relieve some of the weight of the head. So I dove into Bledsoe's "Essentials of Paramedic Care" and found my problem.

Bledsoe Page 263

"Gentle pressure inward engages the head and prevents it from moving. A gentle lifting force of a few kilograms helps take some of the weight of the head off of the cervical spine, but care should be take not to left the head or apply any traction to this critical region."

It seems the wrong term has been injected into my education somewhere along the way and has stuck. But I knew I hadn't just heard it in one place. I've heard "gentle traction" used over and over by different instructors and providers and to prove I didn't imagine it I grabbed the Red Cross EMR text "Emergency Care Manual" and found on Page 225:

"1. Place your hands on both sides of the person's head.

2. Apply gentle traction to the head away from the body.

3. Slowly rotate the head until the chin is in line with the middle of the chest."

So after this I'm left with one key question: what does traction mean? Does it have different meanings in different circles? Where might this problem of terminology have come from?

- Matt

Edit: Scratch that. I'm even more confused now. I reread ITLS and they don't mention any sort of force applied superiorly during manual stabilization. Anyone got any insight on which one to go with. My protocols are non-specific so I'd be looking for reasons for or against based on patho. I'm at a loss myself.

[ERDoc]

Traction is basically force that is applied on a part of the body that pulls it away from the central part of the body. Thus, if you are applying traction when holding cspine, you are pulling the head away from the body. Ideally you want to provide stabilization/immobilization, which means that he head and cspine are not allowed to move.

[Canadian Caesar]

Yup, I can see where your confusion comes from Harris.

I just think of it as Traction being the opposite of Compression, if that helps.

Think of it like this:

- Person walking with a cane on an injured leg is reducing the compressive forces on the leg.

- A person with a femur fracture and a traction splint is not merely reducing the weight on the leg. Genuine traction is being achieved here. (Hopefully.)

As for you question of appropriate treatment, I see supporting some of the weight of the head on a sitting or standing patient as reducing compressive forces, not true traction. To me true traction would mean that the stresses on the spine are in the opposite direction of compression.

So would I relieve some stress on a standing pt? If I could slightly, I think yes.

But would I continue this if they were laying down and the weight of the head was no longer applying compressive force to the spine? I think not.

Mind you, this is just the way I keep stuff straight in my head. and it isn't exactly straight out of a textbook. :wink:

[Dustdevil]

Definitely confusing.

I believe that Dr. Bledsoe was not referring to true "traction", as we generally think of it, as he specifically clarifies that he is talking only of relieving the head from a bit of gravity, and not actually moving it away from the body. He also was referring only to upright patients, and not supinated patients. His statement does not seem to contradict the ITLS advice technically, only semantically.

I do, however, wonder if ITLS is a little more careful with their words than Dr. Bledsoe because they are more concerned with dumbing their programme down to the lowest common denominator than with actually educating competent providers. Sounds probable to me.