cervical spondylosis with radiating pain

at what angle should be traction given in pts. with cervical spondylosis 1.flexion
2.extension or neutral ??

hi,
neck position depends upon, what type of traction you want to give.
if it is manual traction, examine the patients reaction by giving traction in different neck positions, like neutral, flexion or extension. the most comfortable position and in which the symptoms are getting relieved should be used.
for mechanical traction, according to Kisner, to obtain vertebral seperation neck flexion of 35 degrees should be given. the greater the neck flexion, greater is the posterior elongation.
to obtain muscle relaxation position close to neutral should be given.
thanks

It's nice to have rules, but every thing depends upon a patient's /a patient's body's reaction to intervention. Start easy! Easy flexion, easy tension, easy time (easy hands). Judge your patient's body's / your patient's reaction and move on from there. If there is notable adverse neural tension or neural impingent symptoms /signs, that opens up a whole can of worms... there would have to be a darned good reason for me to consider moving into extension techniques in the neck if that were the case. If there is a notable upper thoracic kyphosis, chin poke, etc. the kyphosis has to be treated, otherwise results are likely to be poor. To treat the kyphosis, you will need to treat (elongate) pec. minor and the anterior position of the shoulder girdle (lower fibres of trapezius etc.). Which, in turn, will probably allieviate a significant part of the adverse neural tension symptoms. Of course, none of this will be to any avail if there isn't significant re-education of the postural habit.

Hello!
In my view before giving traction check for the muscle tightness in cervico-dorsal region...tightness here caused lots of stress on the spine and leads to similar symptoms(though there may be disc changes on MRI)nad it respond very well if u address this tightnes. It has helped 10 out of 9 patients of mine,if i m addresing this tightness
Any suggestions!!!!
Regards
Sana

For mechanical traction position of head and cervical spine is determined by evaluation as well as condition being treated.

To obtain separation of vertebrae, the head should be positioned in flexion up to 35 degree; the greater the angle of traction, the greater is the posterior elongation.

To obtain greater muscle relaxation, position the head closer to neutral.

To obtain the unilateral effects, position the head in side bend position or in position of side bending with slight rotation before the traction is applied.

For manual traction, vary patient head position in flexion, extension, side bending and side bending with rotation and apply traction force in each position; note the patient response. When administering the treatment use the position that most effectively reduces or relieves the symptoms.

For Positional traction, determine the segment to receive the majority of traction force and palpate the spinous process at that level. Flex the head until motion of spinous process just begin at that level. Support the head at that with folded towels at that level of flexion. Then side bend the head away from the side to be distracted until movement of head is felt at that desired level. Finally rotate the head a few degrees towards the side to be distracted. Adjust the towel support to maintain this position for a low intensity, sustained traction stretch to that facet joint and surrounding soft tissue.