Fan Zhiyong, Cha He Ping
Department of Rehabilitation, Guangdong Hospital of Integrative Medicine
Abstract: Cervical spine traction therapy is an effective treatment method, especially for neurogenic cervical spondylosis. In cervical spondylosis traction therapy, traction posture, force, time, speed, angle, equipment selection, and operation are closely related to clinical efficacy. The operation should be tailored to the individual situation, and traction alone can be used, or a variety of treatment methods can be used in combination. The author puts forward a few thoughts on the current problems in the process of traction for cervical spondylosis. Fan Zhiyong, Department of Tui-Na, Guangdong Provincial Hospital of Traditional Chinese Medicine
Keywords: cervical traction; cervical spondylosis; clinical thinking
Cervical spondylosis, also known as cervical spine syndrome, is mainly due to a series of symptoms such as headache, neck and shoulder pain, dizziness, and numbness caused by the imbalance of tissue structure inside and outside the spine caused by cervical disc degeneration, cervical spine osteophytes, cervical trauma and strain, and congenital developmental abnormalities, which stimulate or compress the nerves, blood vessels, spinal cord, and sympathetic nerves in the neck [1]. With the accelerated pace of life, especially the development of office media such as the Internet in recent years, cervical spondylosis tends to be more youthful, and in today’s fierce competition, even some secondary school students have implied initial cervical spondylosis, and according to Pei Renhe statistics, patients with cervical spondylosis under 30 years of age account for about 11.1 % of the total number of patients, and the trend is increasing [2]. Cervical spondylosis can also cause a variety of other diseases, such as cervicogastric syndrome, cervicocardial syndrome, and neck and shoulder syndrome.
Reflection 1: Is it applicable to all types of cervical spondylosis
Among them, the effectiveness of traction method for cervical spondylosis has been confirmed in a large number of studies, and it is especially the treatment of choice for neurogenic cervical spondylosis. It has different degrees of therapeutic effects for some vertebral artery type, spinal cord type cervical spondylosis, sympathetic nerve type and mixed type cervical spondylosis. It has the following effects on the treatment of cervical spondylosis [3]: the posterior longitudinal ligament is stretched to facilitate cervical disc herniation can be reset; the synovial membrane of the posterior cervical joint embedded is reset; the adherent nerve roots can be relaxed after traction; the intervertebral foramen is enlarged to improve the radiating pain due to compression of nerve roots; the cervical position is corrected to relax the cervical muscles, and the blood flow to the neck is improved at the same time. It has been reported that spinal cord and vertebral artery types cannot be used, but it has also been reported that the use of cervical traction under suitable conditions can have unexpected effects. In my clinical opinion, the reasonable use of cervical traction is equally effective in the treatment of other types of cervical spondylosis, but the use of traction therapy in the treatment of patients with spinal and vertebral artery types cannot be generalized. We have clinically found that traction under small weight in the supine position and for a long time has a significant therapeutic effect on patients with spinal and vertebral artery types of cervical spondylosis.
Thinking 2: Several factors that affect the efficacy of traction
In clinical practice, traction angle, weight, and time are the three main factors that affect the therapeutic efficacy. To date, there are different approaches to the selection of these three parameters at home and abroad, and there is a lack of experimental studies on their biomechanics. There is always a problem of how to optimize the combination of the appropriate choice of traction angle with weight and time for cervical spondylosis. At the same time, traction treatment also lacks a selection scheme for individual differences, that is to say, there are great individual differences in people, including the degree of development of individual cervical muscles, the degree of muscle spasm, the location of the lesion, and the change in the physiological curvature of the cervical spine, etc. There are large individual differences in traction force and traction angle. People often do not have a deep understanding of traction, and some people think that the pain disappears or is reduced after a few minutes of traction, and that it is only to bring back and adjust as much of the protruding nucleus pulposus as possible, but what is the direction of traction, through what action points and lines, and how much traction force is needed to meet the real demand of traction and achieve real treatment [4]?
Traction currently takes many forms: simply put, it is the optimal combination of different angles, weights, and times. The power of traction is to make the maximum stress concentrated on the lesion site. Some scholars [5] found that: the location of the maximum stress is related to the traction angle. When the traction angle is small, the location of the maximum stress is close to the upper part of the cervical spine, and as the traction angle increases, the location of the maximum stress gradually shifts downward. When the physiological curvature of the cervical spine changes, the relationship between the traction angle and the position of the maximum stress also changes accordingly. Li Yong et al [6] found that the axial effect of cervical traction on the intervertebral disc was greatest in the neutral position, and the stress was concentrated on the posterior edge of the vertebral body in the anterior flexion position, and shifted to the posterior small joint in the posterior extension position. In the neutral and forward flexion positions, the axial force is concentrated on the disc and the posterior edge of the disc, which can effectively relieve the compression of the disc on the surrounding tissues, while the traction force in the posterior extension position mainly acts on the posterior small joints, which can adjust the small joints and release the synovial imbrication to obtain the ideal treatment effect. Some scholars [7] found that under different traction forces, the cervical spine was displaced to a certain extent, the posterior edge of the intervertebral space was widened, and the anterior edge was mostly narrowed, and the maximum stress location was on the posterior edge of the cervical spine. When the traction angle was constant, the displacement of the cervical vertebrae and the stress at each point increased with the increase of the traction force, and the deformation of the intervertebral space was also more obvious. When the traction force was constant, the displacement of the cervical spine increased with the increase of the traction angle, the location of the maximum stress on the cervical spine shifted downward, and the deformation of the intervertebral spaces increased. Zhou Xiaomin [8] found that the treatment of cervical spondylosis by dynamic angular traction was more effective than single angle angle alone. In posterior extension, the traction force acts directly on the cervical spine without damaging the cervical muscles and ligaments, which is most suitable for maintaining the curvature of the cervical spine and regulating the internal and external balance of the cervical spine. Li Yong et al [9] established a three-dimensional finite element model of the cervical spine C4-6 and applied the same mechanical traction load to the cervical spine in the forward flexion 10 and posterior extension 10 positions to derive the distribution of the intervertebral discs and stresses in the vertebral body, and the analysis found that in the forward flexion position, the force on the vertebral body was mainly at the nerve root exit position on both sides of the vertebral body outside the posterior, and the displacement of the intervertebral disc was mainly at the posterior edge of the vertebral body. The disc displacement is mainly at the anterior edge of the vertebral body. Therefore, the author believes that the treatment should be tailored to the individual, and traction should be performed at different angles according to the foci of the cervical joints and against the X-ray film.
Traction force: It is generally believed that intermittent traction with large force and continuous traction with small force have better effect. Some scholars [10] found that traction at 15° of forward flexion and 4-6 kg of neutral position is more consistent with the biomechanical principle of human cervical spine. The traction weight should not exceed 4 kg for the elderly and frail patients with osteoporosis, or for patients who need surgical treatment or spinal cord type in the future, in order to avoid the decrease of cervical stiffness and instability. According to Wang Shuhua [11], continuous low weight cervical traction is effective for vertebral artery type cervical spondylosis, and the author found that intermittent traction with large force is used for neurogenic cervical spondylosis, while continuous traction with small force is generally more effective for other types of cervical spondylosis. Traction time: there is a close relationship between traction time and traction force, that is, when the traction force is larger, the traction time is slightly shorter, and vice versa, it is slightly longer. Position of traction: Generally speaking, both lying and sitting positions are available. Xia Xinshu [12] found that 64 patients with cervical spondylosis were randomly divided into horizontal intermittent traction group and seated continuous traction group for research: efficacy assessment and comparison between groups were conducted after the course of treatment, and there was no significant difference between groups, and both horizontal intermittent traction and seated continuous traction treatment were effective methods for treating cervical spondylosis. The author found that, in terms of safety, sitting continuous traction is generally better for neurogenic cervical spondylosis, and horizontal traction is better for other types.
Reflection 3: There are problems with the current portable cervical traction devices
Most of the current treatment is focused on the professional traction device based treatment in hospitals, and the hospital traction method mostly has “compression of the mandible”, “high mechanical force”, “cervical muscle easily numb and tense”, etc. At the same time, many cervical spine patients who need traction therapy find it difficult to adhere to it because of the long treatment period, the increased cost of repeated treatment, and the increased time spent. Therefore, many doctors are constantly developing portable cervical traction devices for home use to facilitate the increasing number of patients, but this or that traction device currently on the market often has these or those problems. Such as the most common is the lack of power. There are also problems such as how to achieve the combination of traction factors, traction time, poor angle control, poor dynamic traction, inconvenience to patients in treatment, discomfort to patients during treatment, etc. In response to the above defects, many doctors have developed and designed many cervical traction devices for the rehabilitation of cervical spondylosis, common products: cervical airbag traction device, shoulder traction device, portable air-hydraulic type cervical traction device, force-controlled cervical traction device, supine portable cervical traction device, etc., although in its instructions point out that the product does not need a traction bed and external mechanical device, can be traction by the patient, and can The product can meet several requirements for effective traction of cervical spine disease: fixed stopping of the neck, dynamic traction, controllability of time, controllability of force, controllability of angle traction, effective traction stroke, and make up for the shortage of traditional cervical traction limited by space to achieve the purpose of traction treatment. But the author believes that the current market is full of popular traction device, no matter how to boast the efficacy of portable traction device, is always unable to compare with the hospital traction device.
Thinking four: traction state manipulation
Here to clarify a problem: stretching and traction is 2 concepts, that is, stretching state of manipulation and traction state of manipulation is not the same, traction state of manipulation generally refers to the operation of the tractor traction, and stretching under the operation generally refers to simple manipulation. The role played in traction, for the condition with cervical subluxation, generally the use of manipulative stretching can play a good effect for simple anterior-posterior subluxation, but for the condition with lateral subluxation, mixed subluxation, manipulative stretching at the same time with manipulative correction such as Long’s flash power or Lin’s explosive force, the author believes that for patients who are difficult to rectify in one go, we can often use dynamic Traction is often used to perform manipulation.
Clinically, the rational use of cervical traction can play a synergistic role in the treatment of various types of cervical spondylosis: the cooperation with acupuncture, the cooperation with tui-na, the cooperation with the internal use of traditional Chinese medicine, and the cooperation with various kinds of physical therapy can play a good effect in the treatment.
References
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