ANKLE TRACTION -HOW I SEE IT
Joseph A. Muccio, P.T., Cert. MDT
The ankle traction technique, described in this book, utilized for ankle sprains, has been a highly controversial approach in rehabilitation. Questions as to when it is appropriate to begin traction after an injury and what is occurring physiologically have generated a good deal of discussion from many perspectives. While the majority of my work experience has dealt with spinal dysfunction I have re.cently enjoyed the unique
experience of observing, first hand, the successful outcomes of ankle traction with uncomplicated sprains within one to three days of injury .The patients I have observed demonstrated significant benefit from early traction, mobilization, passive and active range of motion, through ankle traction, followed by progressive weight bearing and proprioceptive activities.
An interesting parallel I have observed is the relationship of spinal stability to ankle stability.
Dr. Panjabi describes a concept of spinal stabilization system as
consisting of three subsystems: Passive musculoskeletal subsystem
including vertebrae, spinal ligaments, joint capsules and passive
mechanical properties of the muscles. Active musculoskeletal
subsystem consisting of muscles and tendons about the spinal column.
The neural -feedback subsYstem consisting of various force and
motion transducers located in ligaments, tendons and muscles and the
neural control centers. Panjabi states these subsystems although
conceptually separate are functionally interdependent. According to
Panjabi these subsystems must work together to provide normal
function and stability to the spine (1).
How I see it the ankle must also possess similar subsystems to employ proper function and stability. When an individual suffers an injury such as an ankle sprain, these subsystems must either shut down or reduce significantly when the ankle is immobilized.
It appears logical that the sooner these subsystems become activated the sooner the healing process begins. Analyzing all the components of the ankle traction technique it becomes quite obvious that these are the exact components needed to activate and challenge these subsystems. A closer analysis of these components is appropriate at this time.
Traction activates the passive musculoskeletal subsystem including the ankle ligaments, joint capsule and the ankle mortise itself. The traction engages only the physiological barrier, not the anatomic barrier, thus damage to any supporting structures is virtually non -existent. Dorsi / plantar flexion with traction activates the musculoskeletal subsystem of the surrounding muscles and tendons. The neural -feedback subsystem is challenged throughout the technique due to the traction and resistive movements used simultaneously. Incorporating weight bearing and
proprioceptive activities with the ankle traction technique is an excellent progression following the early and aggressive activation of these subsystems. Ankle traction is a method of activating and challenging these subsystems at an early stage of rehabilitation but in a safe and effective manner. This is the key to the whole approach. Only when these subsystems have been properly activated and challenged does the weight bearing and proprioceptive activities become more beneficial. This is the real value of the ankle traction technique and this is what sets it apart from the traditional approach to ankle rehabilitation. That is how I see it.
I. Panjabi, MM: The Stabilizing System of the Spine. Part I. Function,
Dysfunction, Adaptation and Enhancement. JOURNAL OF SPINAL DISORDERS. Vol.
5, No.4, pp 383 -389 @ 1992 Raven Press, Ltd., New York.
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