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January 2005, Vol. 15, No. 1
Table of Contents
ACA's New CCGPP Guidelines • An Opinion of Shortcomings CBP® • ASHN: Chiropractic Enemy • CBP® fosters international Research Collaboration • CBP® Research Corner • Contraction/Expansion Mentally • COX Inhibitors and the FDA • Counter Point • Do You Practice CBP®? • Don's Opinion • European Spine Accepts CBP® Clinical Control Trial • Regarding the Use of Body Weighting • SAC Reaffirms Life University's Accreditation • Spine Accepts CBP® Research • The Diminishing Return Triangle • Traction Details • Validity of PosturePrint™
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Traction Details
by Dwight DeGeorge, MS, DC
Dr. DeGeorge graduated from Palmer College of Chiropractic in Davenport, Iowa. He has been in for 13 years. He was past president of the Pettibon Biomechanics Club at Palmer College and he has taught spinal biomechanics/biophysics throughout the country for the last nine years. He is responsible for the first research papers ever published in JMPT by Palmer College students. He practices CBP® technique and is CBP® certified instructor. Presently, Dr. DeGeorge is the inventor of the Compression Extension Traction Table as well as the Spine Aligner adjusting table. Three studies have been published (one at SPINE and two at JMPT) from studies done at his office. Dr. DeGeorge has now implemented program to help other doctors gain more from their own practices.
Many people ask me questions about traction and several of them seem to come up frequently. I would like to thank those who have done the asking because the questions I am faced with challenge me to constantly re-assess my procedures. I believe these provocative inquiries have helped to make me a better chiropractor. I would like to share some of my 19 years of experience stretching the spine in traction and explain why I choose to do things the way I do.
1. Force — The amount of force that we use in our office during traction is always kept to the point of tolerance (and kept as close as possible to the patients’ tolerance threshold). For the first five years or so, I calculated and kept notes on how much force we applied to a patient’s neck throughout their treatment regime. It has been my experience that the data was never used nor did it help the patient in correction of their sagittal curve imbalances. It became an effort that was futile, cumbersome and nonproductive; so I stopped.
If I were conducting this type of research today in my clinical office, I might want to understand a multitude of factors. These include but are not limited to the patient’s gender, neck circumference, bone cross sectional width, age, athletic history, trauma history, weight, height, length of neck etc. I have found I do not need these specific details to make efficient progress with patients. The academic information supporting corrective traction mandates that force, over a period of time, is essential for results.
Over the years, I have instructed the doctors that have worked for me to challenge patients as much as they can handle. This has worked very well. In some ways, force quantifying numbers are actually a deterrent because they can incur fear in the patient and complacency in both staff and patient with regard to how much force the patient is actually able to tolerate on a day to day basis. If we document what a pressure gauge says, people tend to repeat the same stress instead of increasing it. The patient’s ability to experience increasing loads of force both from day to day and from minute to minute during traction is what causes correction to happen. The ability of the office doctors and staff to work with the patient in applying that force during care seems much more important than the specific number viewed on a pressure gage.
2. Time — I suggest to patients and doctors that traction should be conducted between ten and twenty minutes as a therapeutic level. Going past 20 minutes would seem to reach a point of diminishing returns. Time of traction is a practice management tool in addition to a clinical necessity. Empirical data suggests that the traction stretch be conducted a minimum of 10 minutes (Harrison, DD: JMPT Vol 17 num 7, 1994; p.454). Studies on the rheology of ligaments suggest we do not get excess additional benefit after 20 minutes (the deformation curve begins to become more shallow here and change seems to become negligible somewhere between 20-27 minutes).
3. Size — The size of the harness used behind the patients’ neck has been an extreme concern to me in regard to extension/compression traction as well as in two-way and lumbar traction. I have experimented with endless set-ups using various types of straps in the course of development. It has been my experience that thin straps create a number of different challenges for the patient, depending upon the age, size, gender, and tissue rigidity of the patient. I will not explain each and every one of these variables, however, here are some of our conclusions:
• Thin two-way straps posed too much of a problem — When generating enough force to make a change they became excessively painful for the patient. This interfered with patient compliance and caused visible skin bruising as well as superficial soreness.
• Common sense would tell us the most specific way to conduct 2-way traction would be to use straps 1/4 inch or less in diameter; I believe this is impractical and dangerous. Using larger straps to exert force on the spine from 3/4 inch to 2 inches in diameter seems to produce results just as effectively as the smaller straps but without the soft tissue bruising. Using larger straps have not apparently affected x-ray outcomes when patients were x-rayed during active traction. With this said, a thin strap with no force is as useless as an extremely thick strap with extreme force. The clinician must try to find the best therapeutic range for patient compliance and comfort to have the maximum therapeutic effect over a period of time. We believe the logic discussed here allows for most efficient clinical success by implementing a system that does not deter the patient from following through with their care plan. In this way the equipment helps the doctor increase patient care compliance so the patient can achieve the clinical success they desire.
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