Dr. Arthur Nitz, an associate professor of Physical Therapy at the University of Kentucky also manages Frankfort Physical Therapy Associates in Frankfort , Kentucky . He lectures on neurogenic inflammation, nerve involvement, and the subsequent delays in a normal course of rehabilitation from an orthopedic injury. Dr. Nitz has been in practice for 18 years and his focus is in orthopedic and spinal injuries. Dr. Nitz has been conducting ongoing clinical studies of the benefits of cervical traction since March,1993.

INTRODUCTION

The incidence of disorders affecting the cervical spine is substantial in most general orthopedic clinics (estimated to be 15%).'These disorders may be identified in categories based on the primary soft tissue involvement such as:

• Myofascial syndrome of cervical musculature, muscle pain, greater occipital neuritis
• Facet joint syndrome, degenerative joint disease, cervical spondylosis
• Cervical nerve root compression (disc herniation)

Cervical spine traction, in one form or another, is a major component of conservative management for patients exhibiting soft tissue disorders and is generally successful. The major goals of spinal traction include: Relief of pain, decreased pressure on cervical nerve roots, improved soft tissue extensibility as indicated in pain-free range of motion (ROM), and reduction in painful, protective muscle activity.

Often, home treatment involves use of a portable cervical traction device designed to augment the effects of improvements obtained by in-clinic manual and/or mechanical traction.

Lawson, Ann, P.T. Northern Rockies Therapy Center , Montana

BACKGROUND

Muscular tension in the neck and shoulders has long been a problem for Physical Therapy patients attempting to recover from various forms of cervical dysfunction, both degenerative and trauma induced. As drastic, but necessary changes in our health care system occur, we are further pressed to greater efficiency of care with increased responsibility placed on the patient.

Manual cervical traction devices which a patient controls and also places the patient in a posturally correct supine position with a cervical lordosis can induce greater relaxation without further influence from the stretching action of the device.

It is commonly accepted that a major cause of disease in today's society is related to the effects of stress. Most of us can easily state that our lives contain too much stress. Often, simply the day to day activity required to support a career and family is at times overwhelming. In addition, as our society becomes increasingly technical in its orientation, we find our selves in sedentary patterns of living. Postures of flexion seem to dominate our hour by hour activity with little exception.

The effects of excessive flexion postures in our lifestyle can often lead to postural change, muscular imbalance, and ultimately to adaptive shortening of key muscle groups.

Early signs of these changes on our bodies can be:

• increased onset of headaches
• decreasing mobility of spinal joints
• upper extremity sensory symptoms
• general decreased physical comfort

These early changes are often clear predictors of the process of orthopedic degeneration. Diagnostic testing can often reveal degenerative changes in the spine which are much less reversible in nature. As therapists, our approach is often a postural re-education program, which relies greatly on individual patient motivation, desire to change and the self-discipline needed for follow-through. Unfortunately, many people who have the greatest of intent, make poor patients, in that they are not able to follow through with regular home programs. We all know patients who fit into this category, perhaps even ourselves! Very often, many of us can state that the best motivator that we know is pain. It is unfortunate that a person's physical condition must regress to the point of pain before they choose to respond to their needs.

In home therapy products i.e., cervical traction devices are intended for the patient who is independent, capable of using. good judgement, and who needs "fast" results when their symptoms exacerbate. It is highly portable, easily used and often very effective in almost immediate reduction in muscle tension-related discomfort. Patients are taught to use this device in the clinical setting, with the Physical Therapist/Chiropractor teaching both the postural and intensity levels to the patient.

Similar to the "perceived exertion scale" used in Cardiac Rehabilitation, the manufacturers suggest the use of a "perceived stretch scale" in training patients to use the Pronex.

The levels of perceived stretch being used at this time are as follows:

• mild stretch
• moderate stretch
• high moderate stretch
• maximal stretch

In our experience, use of the patient's subjective sense of the level of stretch is a far better way to provide consistent intensity levels than any gauge device could offer. In other words, the patient will be likely to vary from day to day with their tissue status. In practicality, we have found the perceived stretch to be a more effective way to gauge proper dosage than a numerical value. The responsiVeness of tissue to passive stretch seems to be contingent on the following:

• degree of muscle spasm/tension
• emotional status of patient
• degree of tissue congestion
• chronicity of patient

All of these factors affect how readily the body will respond to the action of the Pronex device.