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2.8 · Stretch
Knott, Voss, and their colleagues theorized that the therapeutic effects of traction are due to stimulation of receptors in the joints (Knott and Voss 1968; Voss et al. 1985). Traction also acts as a stretch stimulus by elongating the muscles. Apply the traction force gradually until the desired result is achieved. The traction is maintained throughout the movement and combined with appropriate resistance.
Therapeutic Goals Approximation is used to: 5 Promote stabilization 5 Facilitate weight-bearing and the contraction of antigravity muscles 5 Facilitate upright reactions 5 Resist some component of motion. For example, use approximation at the end of shoulder flexion to resist scapula elevation.
Therapeutic Goals Traction is used to: 5 Facilitate motion, especially pulling and antigravity motions. 5 Aid in elongation of muscle tissue when using the stretch reflex. 5 Resist some part of the motion. For example, use traction at the beginning of shoulder flexion to resist scapula elevation.
Traction of the affected part is helpful when treating patients with joint pain. [ Definition Approximation is the compression of the trunk or an extremity.
The muscle contractions following the approximation are thought to be due to stimulation of joint receptors (Knott and Voss 1968; Voss et al. 1985). Another possible reason for the increased muscular response is to counteract the disturbance of position or posture caused by the approximation. Given gradually and gently, approximation may aid in the treatment of painful and unstable joints.
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There are two ways to apply the approximation: 5 Quick approximation: the force is applied quickly to elicit a reflex-type response. 5 Slow approximation: the force is applied gradually up to the patient’s tolerance. The approximation force is always maintained, whether the approximation is done quickly or slowly. The therapist maintains the force and gives resistance to the resulting muscular response. An appropriate command should be coordinated with the application of the approximation, for example “hold it” or “stand tall.” The patient’s joints should be properly aligned and in a weight-bearing position before the approximation is given. When the therapist feels that the active muscle contraction decreases the approximation is repeated and resistance given. While traction usually facilitates motion and approximation facilitates isometric or stabilizing activity, the therapist should use the one which is most effective. For example, using PNF activities in an upright position and combining them with approximation together with concentric and eccentric muscle activity may be the most effective treatment. Using arm activities against gravity can be combined with approximation instead of traction when this promotes a better function.
2.8
Stretch
The response to a stretch of the muscle chain given by the therapist can lead to a stretch reflex or only to stimulation of these muscles. Giving a stretch to