Traction with SCS

[clubdeac]

Was asked by a PT today if she could do traction in a patient with an SCS. Obviously you want to prevent lead migration and this may theoretically pose a small risk but I doubt it would really cause any harm. Would you agree? Any reason to believe differently if cervical traction with cervical SCS?

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[bedrock]

Bad idea.

Besides if they have SCS implant, the patient already clearly failed all conservative care (including PT), so your PT is risking lead migration for nothing, as traction won't somehow suddenly cure an end stage patient that required SCS.

 

[freddydpt]

Traction will have the same effect on a stimulator as the patient performing sit to stand.

 

[nvrsumr]

1+ on why would need traction at this point.

Otherwise, wouldnt loose sleep over it.

 

[freddydpt]

1+ on why would need traction at this point.

1. re-herniated disc at same or different level
2. pt reports improved radicular pain with traction
3. treatment of facet arthropathy
4. stim may have been put in for another reason (i.e neuropathy)

 

[emd123]

An old stim, scarred in and stable? Okay, they're allowed to move their head and neck however they want, and PT is not different. At the same time, I don't know that I'd put that theory to the test with traction.

But I also agree, you're not likely to hit a home run (or even a bunt for that matter) with PT in a chronic stimmer. Likely to be of very limited value, like it is in most patients by the time they get to us.

 

[freddydpt]

I would respectfully disagree re: PT and the chronic stimmer. I had a pt just last month who had a stim placed. Previous pain physician placed it for "radicular" pain (someone from out of state). Pt presented to me as a strain but he said this was the reason/same pain he had the stim placed. Showed him a brief stretch and soft tissue mobilization and pt is now pain free and not using his stim, completely off of opioids. Don't give up on PT. I also realize this is not a typical result.