June 2009

Have you ever tried C.R.A.C.?

by Dr. Mark Payne

Frustrated because your corrective care programs are progressing too slowly? You might want to consider trying a bit of C.R.A.C. No, I haven't started pushing drugs, but I am suggesting you might want to add a little Contract-Relax-Antagonist Contract -- C.R.A.C. -- to your extension traction programs to help speed patient progress.

Here's how it works.

The acronym "C.R.A.C." normally refers to an effective, muscle energy technique for stretching contracted musculature. The method has a simple three-step sequence in which patients are instructed to:

***  Contract the shortened muscle (the agonist) for 8-10 seconds.

***  Relax.

***  Contract the antagonist of the shortened muscle.

Contraction of the antagonist is generally followed by the therapist applying a slight stretch or overpressure to assist stretching of the agonist.

When used in conjunction with extension traction, the assisted stretching efforts of the therapist are replaced by the applied force of the extension traction unit.

The method can be combined with a number of different traction methods. The following is a description of how I have integrated the C.R.A.C. sequence with our popular Dakota traction.

Patients are first positioned properly on the fulcrum with the head free-hanging and the head band in place over the forehead. During the first few minutes of each traction session, patients are instructed to perform the following movements to initiate the C.R.A.C. sequence:

1. Contract: Patient tenses the deep neck flexors by slowly tucking chin upward toward the chest against the resistance of the elastic band. Hold for 8-10 seconds.

Contract

2. Relax: Patient relaxes the neck flexors for a few seconds, allowing the head to fully extend under the slight tension of the headband.

Relax

3. Antagonist Contract: Finally the patient actively pulls the head even further backward by contracting the cervical extensors. Patient holds the extensor contraction for 2-3 seconds, then relaxes totally allowing the traction unit to continue stretching the flexors. Wait 10 seconds or so and repeat the sequence.

Antagonist Contract

I generally ask patients to repeat the entire sequence six to eight times when starting each traction session and then simply relax and let the traction unit apply sustained force for the remainder of the session (usually 20-30 minutes or according to tolerance).

The method works by virtue of Sherrington's Law of reciprocal inhibition in which the taut/contracted flexors are "tricked" into relaxing by contracting the extensors. C.R.A.C. stretching has been around for a long time and appears to be a very efficient way to lengthen taut or shortened musculature.

Years ago, I began experimenting with combining the C.R.A.C. method of inducing muscular relaxation with various types of cervical extension traction. My idea was that if the patient's loss of cervical lordosis was primarily due to contracted musculature on the anterior neck, it might be possible to speed up the process of correcting the lordosis by incorporating more efficient ways of stretching the taut musculature. My results were very encouraging. I found that some (not all) patients, were achieving very rapid corrections, which would have normally taken months to accomplish.

Some of you may recall that I'm always emphasizing the importance of applying sustained corrective forces for 20-30 minutes daily over a period of three or four months in order to stretch contracted ligaments and fascia. But, as it turns out, sustained loading forces aren't necessarily the quickest way to stretch contracted muscle. If you suspect contraction of the anterior neck muscles (think weak deep neck flexors and overactive SCMs here), muscle energy techniques like C.R.A.C. can offer a practical way to speed up the stretching process. Although there's no published research on this particular combination, both methods are safe and effective. Combining them is also safe, logical, and won't cost you a penny extra to try.

My personal experience suggests that 25-30% of patients will show dramatic progress in just 2-3 weeks with C.R.A.C. traction, as opposed to the 10-12 weeks we would normally anticipate. It seems intuitive that these "rapid responders" might well represent a subgroup of patients with a significant muscular component as a perpetuating factor of their abnormal head postures. With this in mind, and because there's really no downside to the method, I often incorporate the C.R.A.C. sequence with my extension traction methods to help reduce muscular resistance as quickly as possible.

If you've been frustrated with slow progress in your corrective care programs, try a little C.R.A.C. to get things moving. I think you just might like it.

(Dr. Mark Payne is the president of Matlin Mfg., a manufacturer and distributor of postural rehab products since 1988. To request more information on postural chiropractic methods please call 334-448-1210 or link to www.MatlinMfg.com.)