April 2009

Extension traction and patient safety

by Mark Payne, DC

So far, I've discussed a couple of extension traction methods for restoring the cervical lordosis. This is probably a good time to cover patient safety as regards extension traction procedures.

CAUTION: Extension traction procedures aren't for everyone.

There I said it. Of course, I've been saying it constantly for the past 20 years or so. Nevertheless, I continually speak with doctors who have never screened a single patient before starting extension traction treatment. If you're serious about correcting spinal curves, you need to understand the potential risks associated with extension traction procedures and make sure your patients aren't exposed to unnecessary risk of injury.

Essentially, every therapeutic procedure involves some attendant risk and extension traction is no different. It's our duty to weigh potential risks against potential benefits. It's important we do everything in our power to detect potentially "high risk" patients before they undergo any procedure that might carry with it an unacceptable level of danger.

I strongly believe we can minimize risks associated with extension traction procedures with simple, common sense screening procedures. However, no screening procedure is likely to be 100% effective. It's still possible that some high risk patients may slip through our safety net. I understand this whenever I consider using extension traction or any other type of therapy. You need to understand it, too. It's our duty to act according to the current state of knowledge, but unfortunately, extension traction is still a relatively new procedure. The following information is the best I can offer you at this time. It's up to you as the practitioner to determine whether these methods are appropriate for any particular patient.

As a general rule of thumb, you should not consider applying extension traction to any patient for whom spinal adjustment/ manipulation would be contraindicated. By definition, extension traction procedures involve extension (backward bending) of the head and neck. Much has been written in the chiropractic literature about the possible dangers associated with spinal adjustment/manipulation involving extension of the head and neck combined with cervical rotation. Although extension traction DOES NOT involve any rotation of the neck, it is still prudent to screen for any individuals who might be considered as "high risk" for physical treatment of the cervical spine.

Dr. Gordon Stephenson (Columbus, GA) screens
patient for possible contraindications.

During the case history, you ask about any conditions which might contribute to increased risk of complications during extension traction and/or cervical spine manipulation. Such conditions might include: family history or predisposition to stroke, history of high blood pressure, hypertension, diabetes, atherosclerosis, arteriosclerosis, posterior osteophytic spurring, disc protrusion/prolapse, smoking, oral contraceptives, prolonged use of corticosteroids, Down's Syndrome, or spinal stenosis. This list isn't necessarily all inclusive; however, extreme caution is recommended if any of the above are present.

Contraindications

Factors which contraindicate use of extension traction include, but aren't necessarily limited to, patient history of:

***  Stroke or cerebrovascular disease;

***  "Drop attacks," blackouts, loss of consciousness, disturbances of vision and/or equilibrium associated with head positioning;

***  Transient ischemic attacks;

***  Spinal fracture or instability, spinal malignancy, infection or disease of the cord or column including advanced osteoporosis; and

***  Hemophilia or other blood clotting disorders including anticoagulant therapy.

All the above should be considered ABSOLUTE contraindications to any attempts at extension traction. In the case of lumbar extension traction, I believe that pregnancy and/or the presence of aortic aneurysm also present unacceptable risk factors.

Assuming none of the above are present, the patient is put through a simple five-step screening procedure that includes the entire George's Test procedure (bilateral BP, radial pulse, carotid artery auscultation, and vertebrobasilar maneuver) as well as a trial period of extension traction. If significant pain/discomfort, or more notably any neurological symptom, is elicited at any point during the screening, the doctor should discontinue all further attempts at extension traction until the cause can be determined.

Patient rests with head free hanging in full extension to determine tolerance prior to application of any traction force.
A free copy of the entire screening protocol is available upon request.

I encourage all doctors interested in extension traction procedures to request the free report mentioned below. Extension traction has been widely used for well over two decades with a remarkable record of safety. Let's keep it that way by thoroughly screening every patient prior to starting any program of extension traction. The responsibility to "do no harm" rests with each of us.

(A 1979 graduate of Life Chiropractic College, Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehabilitation products since 1988. For more information regarding issues, products or methods discussed in this column, or to receive the FREE 20-page report, "Patient Safety: Screening Procedures and Suggested Treatment Protocols for Extension Traction," call 334-448-1210. Visit www.matlinmfg.com  for a free product catalog.)