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RE: spinal fusion and decompressive traction
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RE: spinal fusion and decompressive traction - August 30, 2008 11:00:11 AM
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TexasOrtho
Posts: 540
Joined: December 22, 2007
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John...you obviously haven't been paying attention. It's scrip club according to Pacman (excuse me) Adam Jones these days. Bas what is your approach to a patient who presents with signs of DRG sensitization or nerve root compression? You are keen to take pot shots but I rarely see you put your approach out there for scrutiny. Take us through a session with Bas.
Incidentally, I also use cervical traction when indicated. Both manual and mechanical.
< Message edited by TexasOrtho -- August 30, 2008 12:09:13 PM >
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Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: spinal fusion and decompressive traction - August 30, 2008 11:29:11 AM
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Kaden
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I would agree with Duffy. I would use traction if warranted in a case with complete fusion healing. My personsal preference might be to do some manual versus mechanical traction and that way I could continually monitor and alter my treatment appropriately.
I do think there is literature to support the use of traction in some mild myelopathy cases - don't have time to find now but will look later.
But for me it is not rocket science. Patient presents with neurological pain/deficits and I apply distraction and symptoms improve, then it will become apart of my treatment plan. It may not be a part of treatment for that long but if it can reduce pain and improve my ability to progress a treatment session then why not do it.
I think a lot of the literature claiming traction is not effective looks at its ability to create vertebral separation. I think we can agree that without massive forces this does not happen. But that does not mean traction is not effective, it just means the old theory of vertebral separation is not supported.
I think if we took patients with LE or UE radiculopathy a certian sub group would respond to traction with consistent pain relief. Are we decompressing discs - no, simply providing some symptom relief.
If I can compress the cervical spine and create symptoms and can distract and symptoms improve then traction it is...I don't need a RCT to tell me if I should be performing that technique.
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RE: spinal fusion and decompressive traction - August 30, 2008 12:50:44 PM
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PTupdate.com
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Joined: October 8, 2001
From: Pittsburgh, PA USA
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Great points Kaden. And, I just did this article in the past few weeks on my site:
QUANTITATIVE CHANGES IN THE CERVICAL NEURAL FORAMEN RESULTING FROM AXIAL TRACTION: AN IN VIVO IMAGING STUDY The Spine Journal, Vol. 8, No. 4, July/August 2008
And, true foramenal separation does indeed occur. Not that this occurrence means it's a beneficial one for the patient. But if I can do something that buys someone relief of pain (and therefore the physical effects that are causing that pain), I am all for it.
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: spinal fusion and decompressive traction - August 30, 2008 1:54:35 PM
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Sebastian Asselbergs
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From: Barrie, Canada
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Duffy, I never said traction wasn't good. I should have made my question more clear:
"What is the clinical reasoning for someone to apply traction the first time with a patient."
BTW, I was on my way to bed....Good reason though: golf at 7:15 the next morning.
I have tried in the past to play with a few previous-night-drinks in my system. And I thought my golf couldn't get any uglier.....
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Mundi vult decipi
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RE: spinal fusion and decompressive traction - August 30, 2008 4:28:43 PM
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PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
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Bas: First, I believe I answered your question, even before re-phrasing
And, the idea is to NOT STOP drinking the night before an early golf match, that way you will be relaxed....you'll be surprised how much better your game will be. You can sleep when you get home from all those festivities.
_____________________________
John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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RE: spinal fusion and decompressive traction - August 30, 2008 9:45:14 PM
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Sebastian Asselbergs
Posts: 1191
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From: Barrie, Canada
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Rod, when in the hell did I take a pot-shot in this thread?
All I wanted was some insight into others' process of choosing traction for patients. WAS it because the doctor ordered? I did not think so - certainly not in Duffy's case (I know him well enough by now to know he does not kow-tow to what is prescribed)
quote:
the real question is why would you do traction?
just because the doctor wants it? This was the question that started that.
Man.
Of course I use manual decompression/traction ..... As I have said in previous threads.
And Rod, taking you through a session with Bas could take a looooong time. But I will shorten it - you see, each one is different - especially the teaching parts, but also the manual parts. I use my hands, some paper with patient-specific drawings or illustrations; but I use mostly my educational skills (and most of the time) for teaching the patient about their problem and what THEY can do about it. Traction can play a role here - to let them feel what the body is really like when it lengthens and relaxes (a novelty for many).
Feel better now that you have seen a mini-description of a session with Bas?
_____________________________
Mundi vult decipi
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RE: spinal fusion and decompressive traction - August 30, 2008 10:31:40 PM
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TexasOrtho
Posts: 540
Joined: December 22, 2007
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Bas. College football season has started and the things that make me feel better come in the form of Longhorn wins and any combination of Sooner or Aggie losses. So far I'm on my way to being 2-1 on that front.
That being said your description really did make me feel a lot better. I could be worrying about Hurricane Gustav barreling into my backyard Tuesday morning, but knowing you consider traction as an alternative is really keeping my head up. Thanks for having my back Bas.
_____________________________
Rod Henderson, PT
Board Certified Orthopedic Specialist (or Super-Freak)
Certified Strength and Conditioning Specialist
www.texasorthopedics.blogspot.com
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RE: spinal fusion and decompressive traction - September 1, 2008 6:56:46 AM
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Mr Baecker
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Joined: February 6, 2006
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quote:
ORIGINAL: bobmfrptx
One guy had 30 treatments costing him $4500.00 dollars out of his pocket because the chiro said insurance doesnt cover the DRX 9000.. He had a tight piriformis, hyperlordotic (secondary to short hip flexors) c.c of sciatica to the foot on the right. 4 treatments of MFR techniques to "decompress the pelvis", lengthen the shortened tissue and return him to a more physiological state of rest posture eliminated his sciatica, improved his ROM and he was able to walk 2 miles without pain.
Insurance paid me 56.00 per visit. ( Very cost effective therapy IMO) He performs a home flexibility program consisting of "elongation stretches" 2 times daily, walks and performs squats with no weights to strengthen lower extremities and keep the pelvis "open". (not quite Farni postures yet).
Just curious about your results with the '"mechanical decompression unit".
bob
I am curious how do you identify a compressed pelvis and what do you do to decompress it?
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RE: spinal fusion and decompressive traction - September 2, 2008 1:05:34 PM
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bobmfrptx
Posts: 51
Joined: December 12, 2006
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increased lumbosacral angle and a Thomas test for hip flexors..
decompression technique explained previously in SI thread...
< Message edited by bobmfrptx -- September 2, 2008 1:11:29 PM >
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