At 08:08 2/19/1999 GMT, you wrote:
>Dear colleagues,
>I wonder if cervical traction could aggravate the neural tissues of someone
with underlying ANT/AMT? Do you have any thoughts on this matter.
>Currently I get pts with ANT/AMT to do gentle neural stretches in a range
that is only at the beginning of their symptoms. I tell them to hold the
stretch for 10 secs and do 3 reps twice daily. This regime has had fairly
good results, but I heard that this has now changed. Anyone know the latest
ideas and any references to back it up?
>Thanks
>Vanessa Ayres MCSP
Dear Vanessa
I think the application of mechanical cervical traction is, ideally, as
specific as any other movement treatment. Unfortunately it is not so easy to
get the tactile feedback of the patient's response during the application of
mechanical traction. The position, force, movement and duration can each
change the traction between an effective and an aggravating treatment. The
same principles apply whether ANT is present or not. There is a clinical
means that may be useful to guage whether traction in a particular position
at a particular strength at a particular time or stage in the patients
recovery is useful(subject, of course to usual considerations of
irritablitiy, etc). When the patient is positioned prior to applying the
traction assess a movement (cervical rotation, ULTT, SLR, or whatever is
appropriate) When the traction is applied, reassess it. It will either be
worse, the same, or better. If worse, the traction is likely to aggravate,
if the same, it can be reassessed after a short time, if better, chances are
it will be effective.This also can provide a means of optomising positioning
and strength of traction.
Secondly, I agree with David that movement seems to generally work better
for neural tissues than sustained positions. However where the movement is
performed(moving the hand, the wrist, the elbow, the shoulder...), as well
as the frequency, amplitude, position in range,duration,etc all influence
the effectiveness. These can be determined intellectually with a 'clinical
reasoning' approach as David Butler describes in his writings or through a
direct interaction with the patient's response (what changes as the movement
is repeated- similiar to how McKenzie suggests to guage response to active
movmements). This usually only takes a few seconds before P1 or resistance
starts to alter. The treating movement can then be continually altered as
guided by the patient's response.
I'll get off my horse now.
Regards
Neil Tuttle
>
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