- [Singer] Bob and Brad
the two most famous physical therapists on the internet.
- Howdy folks, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- Together we are the most famous
physical therapists on internet.
- In our opinion, of course Bob.
- And in our opinion today, Brad, we're gonna talk about one
of the good treatments that you can do when
you have neck and arm pain.
- Right.
- And so we're gonna talk
about two different forms of traction that you might try.
- Exactly.
There's a number of different forms.
These are two forms that we've used and are familiar with.
So that's why we're gonna talk about 'em
so we can give you that information.
- Now we're not going to talk about
whether or not you need traction,
that needs to be determined by someone else.
- Right. - These are just showing you
two options and one's kind of a little more expensive
and one's less expensive.
- Right.
They have their pros and cons
and we'll go over that in detail.
So, and typically with this, if someone has neck pain,
it might be pain in the shoulder
and often time goes down to the arm, to the fingers.
- Yep.
And by the way, I, speaking of fingers,
I see somebody waving at us.
- Oh, sure enough.
That we got four new people out there today.
- Yeah, four new people.
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- Excellent.
- Let's get started. We wanna start with this one Brad?
- Cervical traction.
Okay, have a seat right here for
- So this is a unit that just fits over the door, right?
- Right. Exactly. - We can see that, Brad.
- We have it mounted here 'cause it's not
- We don't have a door.
- Yeah, exactly, we're doorless, so.
But anyways, the concept you'll see in the pictures,
it mounts on the door, you close the door
and it's hanging alongside the door.
- You probably wanna make sure it's a door that
nobody's gonna be coming in while you're on the traction,
'cause that probably wouldn't be good, would it?
- Yeah, well usually it bumps into the door and you're okay,
it just kinda makes some noise.
There is one little thing,
I don't know if I should do this, but I am going to,
before I'll do this,
I'll go under someone like this and have 'em relax,
close your teeth gently together
so you're bit not biting your tongue
and look straight up and I just, gentle pressure
and if that person responds as, "Oh, that feels good",
then I'm gonna do this traction.
If they say it hurts,
I'm not gonna do it for sure.
- There's a good point Brad.
I mean, that's, that's a good indicator right there.
- It's a good way to screen.
Right. - Right.
- Okay. Why don't you move your chair back, Bob,
because we need to get lined up underneath the unit.
Okay.
We're not gonna go through all the details
how to put it up,
you can look at your instructions for that.
Go ahead, Bob.
This, now this is one of the advantage of this,
you do it in a seated position.
So if you can't lay down and you wanna do this
in a seated position, that's what you're gonna,
this is a nice device with this.
Other big advantage of this is the cost,
- Yeah. - $25,
you got something and it works well.
- Yeah, it's a little bit more
of a hassle to set this one up.
- Yeah.
- But once it's set up
it's actually very comfortable.
- Right. Yes, the other person that's having it,
you feel good with it and if you have a good chair
you can relax on, but it does take two people.
You might be able to do it by yourself, however,
- After you've set it up, maybe a few times
with another person that I think you might be able to do it.
- Right.
But it's always easier with two people.
- Right. - So here we got,
the harness, so to speak, around Bob's chin
in the back of his head,
goes up through a pulley here, here
- So I'm getting pressure here and pressure here.
- Right - Kinda equal pulling up.
- It's pulling up there
because we have a nice variable weighted water bag
to adjust the weight of the traction going down.
And the big question is,
is how much weight do you put in here
So the force applied to the neck is appropriate?
I've got four pounds in there which is pretty light
and that's a good place to start
and as long as Bob says, "Oh, that feels good"
and if he says his arm and hand pain is feeling better,
big plus.
If he says, "Oh, it feels alright, but nothing's happening",
you might want to add some more weight.
- And I think it's good, Brad,
to actually, we were just talking about this,
chair with arms is nice
or maybe putting the arm on a pillow.
- Sure. Yep.
- The one that's giving you pain
so that you're not putting stress on that.
- Yep. - You know, so,
- Exactly.
Now, what I do is I just take some wristbands
or ankle weights, 'cause it's a lot easier to put weight
on than trying to put water in this bag,
'cause otherwise you gotta take it off, go to the sink,
- Yes. - Put more in.
- So to determine the initial weight.
- Exactly.
- Right.
You might use weights so you can then, later on
you can put the amount of weight you want.
- Right. So I'm gonna put one and a half pounds
on there now, Bob, how does that feel?
Could we use a little more or does that feel
like it's doing the job?
- Well, it's up to you, Brad.
If you wanna do a little more, you can try a little more.
- Okay. So it feels good yet?
There's no pain?
- That feels good.
- Okay. Anything happen in the arm?
Fingers feeling better?
- Yep. The fingers are feeling better.
I still feel a little bit right in here.
- Okay. I'm gonna add some weight.
There we go.
It just went down.
I could actually feel the rope tighten up more.
Bob. How's that feel?
- And now it seems like that's even disappearing now.
- Okay. Now, I'm gonna keep doing that, adding weight
but you're gonna be conservative the first time.
I've already got positive things going on,
I'm not gonna put any more weight on,
especially the first time,
I'm gonna hit my timer, you know?
And we're gonna go for five minutes maximum
on the first time, that's the way I do it.
We take it off and then we see how he responds to it
over the next 24 hours to make sure something
funny doesn't happen.
It might feel good now,
but later tonight it flares up and we have a problem.
Usually that doesn't happen.
I've never had it happen.
- It really shouldn't happen.
There's no reason it should.
- Right.
- And if it feels good while you're doing it
there's no reason it should hurt later.
- Right.
I'm conservative.
That's the way I do it.
Do it the way you want.
But I think then the next time they come in
then I get more aggressive.
I'll put more weight on
I'll go from five minutes to ten minutes
and at that point, we'll see how they respond
over the next day
and then I'll go up to 15 pounds
and usually, I've never gone over 15 pounds.
If you're getting good results
I don't see any reason to keep adding weight.
- And Brad, you had, we had the discussion
whether or not to face away or face towards,
you tend to like to face away, to start off with.
- Right, right.
- I agree with you.
I think to have the neck maybe really kind
of going straight up and down instead of flexion
I think is a good way to start.
- Sure.
- But you've said, a lot of times
if it doesn't work this way, you might try the other way.
- Yep, turn the person around,
facing the door and then see what the response is.
The nice thing about this is this way I like to
treat is, I let the symptoms be my guide.
- Right.
- If we get improvement, centralization,
the arm pain, moving up towards the shoulder,
the shoulder pain, going to the neck,
that's a positive result.
Things are going good.
One thing's for sure, is if you put weight on here
and the person starts feeling uncomfortable, you're done.
- Yeah.
- You just take it off and it's not an option.
- It's an experiment really.
- Yeah. - What we're doing.
We're trying to figure out which one's gonna work
and we don't know, sometimes we're surprised.
- There's the theory
about distraction on the neck,
taking the pressure off the nerve in the neck,
therefore releasing the pain and symptoms in the arm
and then there's what really happens.
And you have to go by what really happens.
So I might go, if they're sitting like this
and we don't have any success or it hurts,
I might turn the person around right away, facing the door
and see it happens that direction.
It may get better, it may not
but you go by how the person responds.
- And how many times a day Brad?
I would say they could do this
a couple times a day if it helps, right?
- If they've got good response, yeah,
once in the morning, once in the evening
or whenever it fits your schedule.
I don't know if I'd do it more than that.
- I wouldn't start off that way.
- No.
- I would start again with the one time.
- Exactly.
So again now to take this unit off,
you can take it off by yourself, not too hard.
- Well, one thing you could just kind of
grab on couldn't you?
- Yep, you can go on there
but you gotta get the Velcro things off here.
- Here I can grab here.
- Yep. So you get it off your neck.
There you go.
Off of the shoulder.
Watch the glasses and let go Bob, you're clear.
- I'm clear?
- Yep. Let go.
Don't worry about it, Bob.
The worst that could happen is nothing.
Okay, good.
Now the other option is traction laying down.
- So that's about 25 bucks.
- Yep. And this one here is a Chattanooga device.
There's other manufacturers and they're all about the same.
They probably come from the same factory, different name.
I don't know about that, but.
All right now why don't you lay down Bob.
If this doesn't work, you don't have it available
or the person will respond much better laying down,
the first thing I do is I have the person lay
down like this and I put my fingers like this
right under the occipital bones, right behind the ears,
you can feel 'em and have the person really relax
and I just start pulling towards me.
Do you feel that pull Bob?
- Mmhm.
- Okay. Does that make your neck
and arm and shoulder feel better?
- Yeah, it's better.
It's not gone, but it's better.
- Okay. If that feels good, I may even do just
a little bit more,
teeth together, gently Bob
so you're not biting your tongue and I'm gonna pull gently
with my hands and just my fingers, not my arms.
And I'll pull a little bit harder.
- Mmhm.
- And if the response is positive, I'm thinking, okay
let's get the Saunders cervical traction device.
Now that's the one we've been using,
they're made very well.
So let's get right to it.
All right.
Can you sit up Bob?
So you'll see how this fits in.
It's actuated with pneumatic pumps.
So we got an air cylinder in there.
- See how it's spreading apart.
- Here we go.
- That would add six inches to my height.
- Yeah. Yeah.
Six and a half foot's not tall enough,
we're gonna get him to seven today.
Hang on Bob.
- We should be putting you on here.
- Yeah.
I don't know.
Actually, this is a comfortable device.
So it's got a head strap for your forearm.
- You're not ready for me yet.
- There's two knobs here, they're connected,
one on this side, one on this side.
- So they spread this apart or put it together, right?
- Right. You can just rotate 'em,
both knobs are literally connected.
They're on the same shaft and that just spreads it.
So we've already had this adjusted for Bob.
Okay.
Oh oops, okay.
So we have it adjusted for Bob.
- Yeah. I even turn it a little bit like this
'cause this feels more comfortable to be.
- The pads rotate,
so you have get it comfortable.
We're gonna get this, not over the eyes
but over the forehead.
Okay. Depending on the person's shape of the forehead,
you may have to get it closer to the eyes
so it stays, it doesn't hold a lot of force, but it helps.
Okay.
On here, you're gonna see it says release pump and hold,
we go to the pump mode.
You just click it easy like myself.
Usually I gotta get my glasses on so I can read it.
But I've worked with this enough I know where it is.
Okay, now.
You start pumping.
Now, I don't have to do this, Bob could pump.
But I'm gonna do it just for demonstration.
And I usually don't go more
than 20 pounds on the first time.
But at the same time, I'm saying Bob,
you have tingling symptoms in your shoulder,
down to your fingers.
When I'm doing this, if it feels better
let me know, if any pain or things get worse,
I need to know that as well.
- And it is starting to improve now.
- Things are improving.
So I'm gonna add some more pressure.
How does it feel on your head?
- I wouldn't go any further.
- Right there's good?
Okay.
So right there, I'm at 17 pounds.
I turn my timer on, on my phone and then I write down
on my notes, 17 pounds and I start timing for five minutes
and then I start talking to Bob, say, how are you feeling?
We'll talk about the weather a little bit,
couple minutes later,
how are things going?
- Good.
- And sometimes, and I've had this happen
it's like at first it feels good,
but three minutes later, all of a sudden the numbness
in their hand and fingers starts getting worse.
Then, immediately I turn it off and we're done
or I'll make some adjustments and see if it can.
On this, you can adjust, you okay, Bob?
- Yep.
- I just raised the amount of flexion on his neck.
On this unit, there's three different levels.
There's this one, highest.
- That actually did feel better.
- The highest one?
- Yeah, it did.
- Okay.
It's easiest to adjust when you're not on the unit.
- Yeah, I imagine.
- There we go.
I thought you gonna play with this
and if the symptoms improve with the head up
and everything feels better, there you go.
- It fits in there better.
- Feels better on the head? Okay, great.
- Feels that way.
It cradles my head better.
- You're gonna pay.
That's really not important if the hand and the arm pain.
- Right.
- Gets better and this doesn't feel good, well,
you respect what's going on with the symptoms.
- Yeah. If your neck pain gets better
and this gets worse, that's terrible.
That's the worst thing you wanna see.
- That's a stop.
- Yeah. This is all gotta go outta here,
- Right. - Up into here, so.
- Okay. So when five minutes is up,
if things are going good,
I guess if things are going really good
and his hand feels good and the pain
is already up to his neck
and the shoulder pain and numbness is gone,
maybe I'll go longer, but I'm still gonna be.
- I tend to be very conservative with these too Brad.
- And then, you let it off.
And on this one, I like to let the pressure off
and then have the person sit up, stand up
and see how the change in position makes the person feel.
I've had people get up from this
and stand up and say, oh, they feel light headed.
- Right.
- And that can be normal when you put this kind
of stress on the body
but it should go away within 30 seconds
so they should feel fine.
- Right.
So a lot easier to use
but the disadvantage is the cost, Brad.
- Right. So, you know, online
the cheapest I've seen is about is right
around $300 and the same unit's amazing, up to $450.
- Wow.
- Do some shopping around, do what you can
but you can use it by yourself.
It is well built.
I just worked with someone.
He was a guy, very healthy, 81 year old
and he was taking a lot of opioids for the last 15 years.
- Wow.
- So we start using this and it made him feel better
but only for about a day.
So he decided to buy one and his goal is to cut down
his pain medication by using this.
- To me that's the perfect instance of a device like this.
- Right, exactly. - When you can start
getting way off the the pain medication.
- Right.
As far as the next time you do it,
you can go up to 20, 30 pounds.
You can look in the instructions.
I've never gone over 25 pounds.
Not that I wouldn't, but I like to be conservative,
you're making progress.
Why go with more pressure?
- This is a great one to start with a therapist.
- Right. It is.
It really is.
And then you're, you can use this for review at home.
- Right.
- So once again, Bob,
we're getting close to that.
We're working on the head, the neck, the shoulders.
But what's one thing we haven't been able to cure yet.
- We can fix this about anything except for,
- That broken heart.
- I thought you were gonna say broken brain.
- Oh yeah, well.
- Question up here.
- Well, we don't do anything from the neck up,
- Obviously not. Thanks for watching.