By Lee Jarvis. Based on an interview with Marc Tellez December 21st, 2023. Proofreading and editing by Brooke Ranieri.
I’ve always found that Osteopathic Practitioners are natural innovators or at least “tinkerers”. This tendency seems to stem from the exploratory nature and origins of Osteopathy, but secondarily because we are often busy in practice and looking to save time and reduce physical effort wherever possible. Additionally, as a tertiary point, it’s worth admitting that you are mostly alone with your Osteopathic thoughts in that room all day (despite the presence of your patients), so it’s normal to come up with and test out methods that may (or may not) work.
In December of 2023, Marc Tellez showed me some great examples of innovative Osteopathic methods he regularly utilized on a standard high/low hydraulic table. Although I can imagine others have come up with similar methods, those shown to me were well thought out, utilized secure handholds, generated significant stretch safely, and are very easily replicated with no extra tools. I believe I’m not alone when I say that I appreciate learning new manual applications without expending large sums of money on new contraptions. I have chosen here to explain and illustrate two methods of traction generation with the high/low table as shown to me by Marc.
The modern high/low table has a bar or pedal at foot level that can be pressed on to electrically activate the hydraulic unit that lowers or raises the table (I mention this to differentiate from the non-electric foot pump style of high/low table that is also common). The intended purpose of any high/low table is simply to accommodate different heights of practitioners, angles of the methods employed, as well as the size of the patient. However, in the examples shown, what the foot-activated option also allows is for the practitioner’s hands to be free to set up and secure the patient as needed for the generation of traction as the table height changes. It is well worth mentioning that this particular table had a very smooth and gradual initiation of movement. Many other tables are somewhat quicker to raise or lower and although they are perfectly safe and comfortable to use, by comparison, they are more jarring and not ideal for this type of a method (or perhaps I need to stop stomping on the foot pedal like a gorilla). In both methods I am about to explain and illustrate, the application is largely the same: the patient is positioned on the table, leverage is delivered with a secure hand/arm hold, and the table is moved up or down, all of which together generates traction/stretch to a specific joint area. As this is a relatively straight forward methodology, it can easily be recreated with different positions and parts of the body should the practitioner be so inclined.
As always, the maneuvers described are for trained professionals only and should not be attempted by anyone without the knowledge, skill, and training to do so.
Seated Knee Traction
The patient is seated comfortably on the table with their knees bent, allowing their lower legs to hang just over the edge.
The practitioner sits in front of the patient’s intended knee and ensures that the leg is relaxed and in a position that allows for easy assessment. The practitioner then grasps the superior end of the tibia with both hands, thumbs overlapping in the front and fingers overlapping in the back. The hold is firm but not painful or uncomfortable for the patient.
The table is activated and lifted upward a small amount. The tibia stays in approximately the same place while the rest of the body lifts up.
This generates traction at the knee joint, including the capsule, ligaments, and muscles to some extent. This requires a little more effort on the part of the practitioner than the effort to maintain the handhold, as much of the downward pull from the practitioner is generated from their seated bodyweight.
Supine Hip Traction with a Figure 4 Hold
The patient is placed in the supine position on the table. The hip is flexed to approximately 90 degrees as tolerated by the patient and/or as necessary for the lever’s target.
The knee is flexed so that the practitioner’s inside table arm can be brought underneath and around it. The inside table arm will grasp the outside table arm, which will be placed palm surface on the greater trochanter. This hold, resembling the number “4”, secures the leg so that when the pedal in the table is pressed to make the table lower a small amount, the leg stays in essentially the same place while the body drops away.
This creates traction at the hip joint, including the muscles that cross the hip, but mainly occurs at the capsule and ligaments.
This method can be applied gently for a duration of time to generate a release. With correct setup, this can be performed by the practitioner with only slightly more effort than maintaining a standing position.
In both these examples, only a straight line of traction is being demonstrated. However, like any manual method, it can be modified to suit the tissue (somatic dysfunction) of the patient through the addition of more specific positions (adduction/abduction, rotation, etc). It is also worth noting that both of these methods are ideal for patients who cannot tolerate a fully extended knee. Though simpler, these methods remind me of the type of thinking that generated the famous McManis Osteopathic table long ago.
It’s always a pleasure to work with graduates of the CAO, and this interaction with Marc was no exception.