March 2009

Extension traction in the professional office

by Dr. Mark Payne

Last time, I discussed the use of Dakota Traction, a simple home device for use in restoring the cervical lordosis. In this month's column, I'll be covering a simple extension traction procedure for use within the professional office.

In-office traction has two key advantages over home traction. It assures some measure of compliance and provides a safe supervised environment in which patients become accustomed to a regimen of extension traction care and proficient at using the equipment. Let's take a look at a simple and affordable method you can use in your office known as compression-counterstressing traction (AKA the "Stynchula Method").

The method actually requires two simple devices.

First, the patient is placed in a seated position, facing the wall, with a weighted traction harness placed to pull or "compress" the head downward and back into full extension (See Fig.1).

A second device (the "counterstressing strap") is placed behind the patient's neck and attached to the wall pulling forward into the lordosis while the head is being extended backward. The combined forces create stretching of the anterior soft tissues in such a way as to reinforce the cervical lordosis. This method is often more comfortable than many other methods because the counterstressing strap provides support to injured or inflamed posterior facet joints.

Compression-counterstressing traction has been around for well over a decade and was recently evaluated in a non-randomized clinical control trial (Harrison DE, Harrison DD, et al: "Increasing the Cervical Lordosis with Chiropractic Biophysics Seated Combined Extension-Compression and Transverse Load Cervical Traction with Cervical Manipulation: Nonrandomized Clinical Control Trial." J. Manipulative Physiol Ther. 2003, Volume 28, Issue 3).

Thirty patients were treated with compression-counterstressing traction and typical chiropractic manipulative therapy. Patients in the treatment group were matched against a control group receiving no treatment. The treatment group saw improvements of approximately 13.6 degrees in their overall cervical lordosis (Jackson's Angle) and an improvement in forward head posture of approximately 11 mm. The control group showed no improvement at all. One year later, 21 of the original 30 in the treatment group were maintaining their corrections!

Patient safety

Essentially, every therapeutic procedure carries some degree of risk and extension traction is no different. As a general rule of thumb, you should not consider applying cervical extension traction to any patient for whom spinal adjustment/ manipulation of the neck would be contraindicated. In addition to a complete history for any possible contraindications, all patients should undergo a physical screening procedure to help detect patients for whom the procedure might carry an unacceptable degree of risk (a complete description of our patient screening procedure is available free upon request).

Treatment

Assuming there are no contraindications, adult patients generally start with three pounds of weight on the traction harness. The head is allowed to relax into full extension and the counterstressing strap is then angled and tensioned so as to properly reinforce the cervical lordosis and maximize patient comfort. Treatment time generally starts at three minutes and is increased about a minute or so each visit according to patient tolerance. Optimum treatment time for soft tissue stretch is probably in the 20-30 minute range but I prefer to reserve such longer sessions for home treatment. I generally keep in-office traction sessions to a more manageable 10-12 minute range and only increase the weight slightly once the target time has been reached. It's not unusual for patients to work up to five or six lbs. of weight after only a few weeks of traction in the office.

Compression-counterstressing traction should be your number one choice for in-office traction for several reasons. The method is easily learned by doctors and staff, only costs about $100 to set up, is well tolerated by most patients, and so simple your patients will quickly learn how to transition themselves in and out of traction with minimal assistance. Finally, offering in-office traction will help boost your bottom line while helping your patients achieve real and meaningful structural change.

(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 a more complete discussion of potential risk factors, patient screening procedures, and treatment protocols, call 334-448-1210 for a FREE report on "Patient Safety." Visit www.matlinmfg.com  for a free product catalog.)