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: