Friday, April 11, 2014

Biomechanics and Physio Therapeutic Efficacy of Intersegmental Traction Tables


Intersegmental traction is not "traction" in the colloquial sense. Standard spinal traction known to most doctors and patients offers a longitudinal force applied to either the cervical or lumbar spine via attachment of a pulling apparatus from either the head or pelvis.  On the contrary, intersegmental traction may more appropriately be termed "passive spinal mobilization".  In practice, this therapy is applied by taking advantage of the user's bodyweight while lying in a supine position and having their spine lifted segmentally, in a linear sequence. This creates extension at the intervertebral junction by virtue of bilateral, paravertebral, mechanical rollers that massage and move longitudinally up and down the spine on a track.

Roller motion follows a path that is elliptical in nature, lifting (forcing into extension) 2-4 contiguous vertebral segments at a time as rollers rotate and apply a dorsal to ventral force. This is valued because most of us endure daily work routines and tasks involving purely spinal flexion, without  counter-balancing such repetitive action with movements in the antagonist direction (i.e. extension). Activities like dance, yoga and gymnastics are the exception to such. The forces of intersegmental traction serve to counter the prevalent, repetitive daily spinal movements or postural stresses experienced by most of us - even the fit and active folks.

Some advanced Chiropractic Intersegmental Tables like the Quantum 400 offer reversible direction roller massage and will exert dorsal to ventral  force with either a cephalad or caudad component.  Cephalad-directed roller rotation offers the greatest traction benefit for the cervical spine and top half of the thoracic spine, while caudad-directed roller rotation offers the greatest traction benefit for the lower thoracic and all of the lumbar spine.

Therapeutic Effects and Benefits of Intersegmental Massage

1) Centripedal forces or negative pressure inside spinal discs - by nature's design, the anterior placement of the spinal disc benefits from vertebral extension because negative pressure resulting from such, applied in combination with concurrent stretching of the anterior longitudinal ligament, creates suction that may encourage reduction of a disk herniation.
2) Researcher resources like Cyriax demonstrate muscle relaxation, recognized in EMG activity during and after application of intersegmental traction. This relaxation is not only noted in paraspinal muscles,  but perhaps more importantly in the deep spinal muscles known as rotatores and multifidi.
3) Passive mobilization of posterior facet joints of the spine is facilitated with intersegmental traction therapy.

Indications for Use of Intersegmental Tables

  • Lumbar facet (posterior joint) syndrome
  • Scoliosis, Hyperkyphosis and/or anterior posture syndromes
  • Stress and tension
  • General joint stiffness or hypomobility
  • Resolving nerve root compression syndromes
  • Herniated or protruded discs (not when recommended when severely acute or with trouble lying supine)
  • Anklosing Spondylitis (Marie Strumpell Syndrome)
  • Retrolisthesis
  • Osteoarthritis or degenerative spondylosis
  • Muscular spasm
  • General spinal maintenance
Suggested Alternatives For Very Acute Cases

For acute back syndromes with antalgic postures, nerve root compression, foot drop and or signs of disk rupture, this author would recommend substituting either: 1) prone  Cox flexion-distraction table techniques, or 2) the use of conventional longitudinal traction with knees bent in lieu of the intersegmental variety.  It may however be appropriate to engage intersegmental traction for the non-acute healing phase of such conditions.

Contraindications for Use of Intersegmental Spinal Traction

  • Infection or malignancies affecting the spinal vertebrae or contiguous tissues
  • Anterior spondylolisthesis
  • Acute Lumbar Disc Syndrome with disk rupture, extrusion and/or severe nerve root compression
  • Severe Lower back pain concommitant with antalgic anterior postures
  • Acute spinal fractures or known severe spinal instability/hypermobility
  • Acute rib fractures or dislocations
  • Chemical radiculopathy or radiculitis
  • Severe osteoporosis

The material and essays of clinical experience contained above are copyrighted (2014) on behalf of Dr. Brad R. Lustick dba: BackBeNimble.com

10 comments :

  1. Would this Chiropractic table help with neck pain at all? I often find that my neck bothers me a lot. I pop it a lot, which may not help at all, but I pop it because it hurts so much. I'm not sure if it's muscle pain or something else. Would this table be able to massage muscles that cause neck pain?
    Claudia Rosenburg | http://www.akpt.net/contact

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    1. Although the typical positioning on the Quantum intersegmental traction table focuses the therapy on the thoraco-lumbar spine, the body position and roller height could be adjusted to provide direct therapy to the cervical spine as well. However, even without doing such, the health of the cervical spine is so highly integrated with the fluidity of movement in the thoracic and lumbar spine that simply using it normally, greatly reduces stress in the neck as well. Some of the muscles in the neck reach well down into the thoracic spine.

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  2. In your therapeutic effects and benefits under number 1, is their a posterior longitudinal ligament as well? Would you need to keep them relatively the same amount of stretched as well to reduce the chances of herniation in either direction? I've been experiencing back pain from a herniated disc for about 10 years now, and I'm just wondering if there is any ways to use strengthening and stretching like that to reduce pain by using the ligaments already in place to pull my back in a more natural direction. http://www.myofascialphysicaltherapy.com

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    1. Hi Tim, Certainly there is a posterior longitudinal ligament as well, but, in short it has very little usefulness with regard to using therapeutic traction for reduction of a disc herniation. It actually is so narrow in span from side to side that applying stretch to that ligament likely has very little impact on creating a therapeutic negative pressure internal to the lumbar disc. In theory, it is the internal negative pressure that may encourage reduction of herniation. In fact, the lack of a wide span of that ligament surrounding more of the disc is what makes a posterior/lateral disc protrusion the most common type. That being said, you also ask if strengthening/stretching has therapeutic value for restoring the natural position or posture of the back and the answer is certainly - yes! Progressive, functional strengthening and stretching of the core is crucial to a favorable outcome with disc related problems.

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  3. I myself experience the chronic neck pain. In my opinion chiropractic care is the best way to deal with neck pain. Chiropractor doctor ensures the gentle and safe neck treatment.

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  4. This sounds wonderful! I often find myself having pain in the back as I am keen in using a thicker pillow. Then I would later resort to having a swedish/shiatsu combination massage which I know would only make it worse or it is really not recommended. Thanks for sharing this.

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  5. Its wonderful technology indeed .Most of the lower back pain can be resolved by this technique.Thanks

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  6. Learn the health benefits and understand the science behind Stretch Zone™ Miami's unique method has revolutionized the fitness industry. Here are options for Joint Pain Treatment, Back Pain Relief, Reduce Stress & Stiffness & Soreness, Increase Range of Motion and Alternative Treatment Physician. f you spend most of your day sitting, this stretch is for you. The reclining pose from LA-based yoga instructor Vytas Baskauskas can help to work out the kinks from a long day spent in a chair, relieving the strain in your lower body.
    This particular yoga pose provides a deep stretch, but is easily modifiable for beginners or those who are just starting to work on their flexibility. Follow along with Baskauskas' calming directives in the video above from Udaya, and feel the tension melt away.

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  7. My chiropractor only allows 2 minutes on the intersegmental traction bed...after the adjustment. I would like 10 minutes before the adjustment. Would 2 minutes be of any benefit at all?

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    1. Well yes, 2 minutes would be a benefit, but it is a very short duration for the therapy. Perhaps the doctor's practice is busy enough that 10 minutes is not a logical alternative. Also, because of biased of the insurance companies, chiropractors cannot not charge much for this type of therapy, so perhaps 10 minutes would not be possible for the clinic.

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