June 2008

Extension traction -- can we improve outcomes AND patient safety?

Extension traction devices that can be used in the chiropractic office and by patients in their homes are among the most powerful tools used by many doctors of chiropractic. Admittedly "low tech," these devices can improve corrective care outcomes by restoring normal lordotic curves of cervical and lumbar spines.

Yet, in spite of their efficacy, we still see some patients who simply won't respond. Is it possible we could be overlooking something simple?

According to current theory, extension traction devices are safe and effective only when used by patients suffering a loss or reduction of the normal lordotic curves and whose abnormal posture is associated with contracted anterior paraspinal tissues (and, of course, where there are no known contraindications).

After caring for hundreds of patients who are helped by extension traction, we often tend to think that all hypolordotic conditions are associated with contracture of the anterior paraspinal soft tissues. The two go together so frequently that when we see one, we assume the presence of the other. But that's not the case and using extension traction devices in the absence of such association can mean not only a lack of positive outcome, but could also pose greater health risks for the patient.

If your practice includes any kind of extension traction therapy, it's crucial that you carefully screen every patient before recommending or beginning a traction protocol.

Naturally, the first step would be to establish whether there is a loss of normal lordosis. A number of tests are available to make this determination, the most common being a measurement of Jackson's angle. Once this is done, you need to determine if the hypolordotic posture is associated with shortening or contracture of the anterior soft tissues. Although a number of protocols can be followed to make this determination, they all include looking for specific signs such as restricted range of motion, strutting of anterior soft tissues during extension, presence of myofascial trigger points, etc.

Finally, you need to make sure there are no contraindications to the use of extension traction. These can include history of stroke or aneurysm and/or history of neurological symptoms.

In short, before you recommend any kind of extension traction therapy, you need to take a complete patient history to rule out contraindications, perform an accurate screening procedure such as George's Test, and perform a short "trial" extension and a short trial traction with minimal force.

Only then should you consider the use of extension traction devices, in order to optimize outcomes and safeguard patient safety.

The topic of patient safety when using traction is far more extensive than can covered in this short article. To learn more, request the free Report on Patient Safety by calling 334-448-1210 or visiting matlinmfg.com.