Underwater extension

SUBAQUATIC EXTENSIONAL TREATMENT OF THE DISCОGENE ILLNESSES – PRIVATE METHODS, APPLIED SINCE 1968 IN PAVEL BANYA SPA RESORT, BULGARIA

HISTORY OF THE EXTENSIONAL TREATMENT

The implementation of the extension for the setting of dislocated body parts is well-known and dating from far-off antiquity. Hippocrates and Galenus used devices for the correction of a hunchback.

The contemporary extensional therapy is a young branch of the physical medicine and it was introduced in the 1993 from Muchedin, and it was subsequently improved from De Seze and his school, Cyriax (1954). It was introduced in Bulgaria from Professor Georgi Gechev in 1968 in the rehabilitation center in Pavel Banya.

EXTENSION TYPES

Depending on patient position on the traction table:

Horizontal extension
Inclined extension
Vertical extension
Body extension at an angle /PEARL/

II. According to the duration:

Continuous
Temporary continuous
Intermittent
One-moment /manipulation/

III. Other types:

Autotraction
Subaquatic extension

IV. Depending on the treated section of the spinal column

Cervical
Thoracic
Lumbar
Combined

EFFECT OF INFLUENCE  DURING SPINAL COLUMN EXTENSION

Mechanical traction of the spinal column leads to respective reaction of the joint-ligamentar formations and intervertebral disc. It is obtained: a joint mobilization in the extensioned segment, dilation of the intevertebral tracts and foramens, which improves the impaired circulation in these areas, conditions for reponation of a migrated fragment of a disc prolabs are formed according to the force of the aspiration mechanism. Moreover the traction stretches the back longitudinal ligament, as it forms centripetal force, which supports the reponation of the protrusion, proved from De Seze since 1951 by means of X-ray contrasting discographies and in the 1972 it was confirmed in Bulgaria byProfessor G. Gechev.

By the subaquatic extension according to the method of  Professor G. Gechev, a subsidiary effect gives the mineral water, which takes a part with its thermal, mechanical and chemical factor.

THE TRACTION FORCE DURING THE EXTENSION TREATMENT DEPENDS ON:

Friction, which appears between the patient and the traction table, overcome through:
Mоvable fixation boards
By subaquatic extension

Through the distance between the fixed body parts
Through the muscular spasm
Through the previous setting of the lumbar lordosis

EXTENSION TABLE

The extension table for the subaquatic extension has got an original construction, which was  made in the 1968 by Professor G. Gechev and it was recognized as innovation with a Certificate No. X 1787.

The table is a metal-tubular construction, compounded from a base supporting fixed unit and a movable board. The stationary section, which is designed for the seat and the lower limbs, enables a 45°- flexion in the genicular joints.

The movable section of the table is the thoracic board, which begins from the place of the coxofemoral joints and is moving on rollers over the stationary frame through pulleys in a cranio-caudal direction. The thoracic board enables also the movement – setting up and down up to 45° of the torso, i.e. as much as necessary for the setting of the lumbar lordosis.

PATIENT FIXATION

Strap-fixer with a special shaped plane is placed on the surface of the coaxes, by means of which it is provided fixation and stabilization of the lower half of the body. The fixation of the thorax is enabled through a wide belt – tightly fastened to the mobile thoracic platform.

During traction, the body and the platform are in a full cohesion and the sliding is provided only through the rollers. In that way the friction between the body and the board is completely eliminated.

The table has the following dimensions:

Length                       190cm
Width                                    65 cm
Height to the head   70 cm

The whole construction is sunk in a bath-tub with a mineral water.

PRINCIPLES OF THE SUBAQUATIC EXTENSION

Relaxation
Traction
Immobilization

RELAXATION

A complete and effective relaxation of the rigid paravertebral muscularity is achieved in water ambient with a constant temperature: 37-38°C, without a sharp difference from the temperature in the rooms: 22-24°C. In warm mineral water the muscularity is being relaxed completely, usually during a stay for 5-10 minutes. The good effect of the traction in water ambient is due to the fact, that according the Archimedean principle – a part of the body weight is being eliminated.

EXTENSION

The traction of the lumbar spine is made in an antalgic pose with an optimal draught. Most frequently this pose is: lying on the back, with a flexed thorax and with a flexion in the coxofemoral joints up to 45° /embryonic pose, pose in which the space-men fly off. The fixation of the patient is made with a thoracic belt, which embed the lower third of the thorax and in that way it enables a reenacting of the traction of the torso in a cranial direction. The caudal body half is fixated through a board, which is attached to the coaxes and as in that way traction of the sacrum and respectively of the lumbar section of the spinal column is enabled.

The extension itself begins with 15 or 20 kg, and at that the belt status is reported, an eventually occurred discomfort is eliminated. As a criterion for the optimal traction force, most often is used the moment, when the patient informs about the disappearance of the pain. The extension maycontinue until new appearing of pain  аs result of a re-stretching and it follows that the draught (tension) should be decreased until pain disappearance.

The advantage of the extension in a mineral water through pulleys according the method of Professor G. Gechev is that it provides a maximal relaxation and a constant draught during the procedure, which continues 15-30 minutes.

Releasing from the extension happens slowly, gradually, as the weights are being changed one after another. After that fixation of the coaxes is released and then fixation of the thorax.

In cases  when painful symptoms during releasing from the extension appear, it is recommended the patient not to stand up alone, but by means of a mechanical lifting device.

The extension is made one time a day, but the reiterated extension also gives good results, as not to be expected  that the effect will be twice as good as one time a day. The course of treatment is 10-15 extensions and it should not be determined in advance.

IMMOBILIZATION

Providing conditions for full immobilization is achieved by means of an orthopedic bed in the so-called “Williams’ position” (P.C.Williams, 1955), which provides a good opportunity for an antalgic pose. In this pose it is  achieved:

Kyphosis or settling the lumbar lordosis, i.e. dilation of the intervertebral foramens – a circumstance, which is conductive to the decompression and the better perfusion of the nerve elements;
The patient can not turn on his side, as in this way the lumbar section of the spinal column is ruled out from any movement.

The bed regimen should be kept strictly. The brief stay in a vertical position is supported by wearing of a lumbar corset.

Thank you very much for your attention!

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