February 2009

Home traction: Documented results for cervical curves

by Dr. Mark Payne

Last month, I highlighted a great example of how one case of scoliosis was successfully managed by applying sustained stretching forces into the spine. The purpose, of course, was to gently stretch contracted soft tissues on the concavity of the scoliosis in order to help effect as much correction as possible. Now I want to discuss one application of sustained stretching forces for correction of the cervical lordosis.

I think it's a fair statement that most adults present with less than optimum cervical lordosis. Chronic cases are often associated with adaptation and contraction of the surrounding soft tissues. Once the soft tissues adapt to the hypolordotic posture, it's very difficult to correct the neck with adjustments alone. The visco-plastic mechanical qualities of the contracted tissues sabotage all attempts to adjust the spine back toward normal. Shortened and contracted soft tissues simply won't yield to the rapid on-off forces of traditional adjustments. They require time to stretch and numerous studies have proven the ineffectiveness of adjustments in restoring the normal cervical curve. Sorry to say it, but if you want to correct cervical curves consistently, you're going to need tools other than just your adjustment.

As a rule of thumb, stretching forces should generally be applied for 20-30 minutes daily for effective stretch to occur. Two thoughts should immediately leap to mind. First, this is a task which simply isn't practical to be done "by hand only" and secondly, it's impractical for patients to traction every single day in your office for 30 minutes. If you're really serious about having your patients perform extension traction on a daily basis, much of the work will need to be done at home.

Fig. 1: Extension-compression traction using the Dakota Traction

There are any number of devices on the market which attempt to restore the lordosis. Some are overpriced junk but many will work very well. One well-documented method involves backward extension and caudal compression of the head, commonly termed "extension-compression traction," in order to stretch soft tissues on the anterior neck. There are a number of extension-compression traction products on the market which apply similar forces, but in a shameless act of self promotion, I'll discuss one manufactured by my own company. The point here is to understand the general procedure and why it's effective.

Fig. 2: Extension-Compression methods create
stretch in anterior soft tissues.
 

"Extension-compression" traction methods are so named because the head is extended backward and compressed downward (caudally). In reality, the method only produces compression loading on the posterior motor units. The anterior motor unit (disc) is actually unloaded as the neck extends. The end result is a very effective tensile stretching of the anterior soft tissues (see Fig.2). With this particular device, traction force is provided by a simple, padded elastic band over the forehead. Other devices on the market may use springs, weights, or even the patient's own muscular efforts to create a similar effect. Extension-compression methods are generally well-tolerated, but about one in four patients will generally need to find an alternative method to achieve correction.

Our goal here is to simply apply gentle stretching force for sufficient time to allow soft tissue stretch to take place. Patients generally begin with only a few ounces of force for two or three minutes daily and then gradually increase treatment times until they can comfortably handle 20-30 minutes daily. Only after patients reach the target time is the traction force increased slightly. I am aware some authorities promote the use of much higher amounts of force to vigorously stretch the neck into lordosis, but I urge interested doctors to err on the side of caution. Most of your patients with hypolordotic necks have had their problems for years. It makes no sense to try to hurry the process and may be very counterproductive to do so.

Extension traction procedures have demonstrated a remarkable record of safety for more than two decades but a brief word of caution is appropriate here. Full extension of the head and neck may be contraindicated in certain individuals. We have developed a simple testing protocol to help screen out individuals who may be at higher risk for complications. Although no screening procedure can absolutely guarantee safety for any particular individual, I strongly recommend all patients be thoroughly screened prior to treatment.

Next time, I'll discuss alternatives for patients who simply can't handle extension-compression traction. Meanwhile, call us for your copy of the FREE report, "Patient Safety -- Screening procedures and suggested treatment protocols for extension traction."

(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 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.)