Frequently asked Questions
progressive splinting is the terminology commonly used to describe the
technique of mobilization splinting with inelastic traction.
It is an effective alternative to dynamic (elastic) traction for
lengthening soft tissue with limited pliability and for increasing PROM
of contracted joints.
and maintaining the tissue at the available end-range-under low-load
stress, the structures have time to grow new cells, and a new end-range
is established. After the tissues lengthen, the inelastic mobilization
component is adjusted in small increments to maintain low-load prolonged
stress at the newly established end-range.
When prolonged, low-load
stress is applied, the tissues gradually lengthen to accommodate the
applied tension. This is why tissue expanders work, and it is
also why inelastic traction works to increase PROM!
It is important that the
right amount of tension be applied to the splinted tissue. Too much
tension can tear or damage the tissue. Tension that is of too low
magnitude will not result in tissue lengthening.
demonstrates that low load prolonged stress to PROM limitations
results in permanent tissue lengthening and increased ROM.
It is important to
understand the stages of wound healing when determining the most
appropriate method of treatment. Inelastic (static-progressive)
traction can be applied to any soft tissue that can safely tolerate
elastic (dynamic) traction. Generally, inelastic traction is not
used with acute joint injuries. It is more appropriate to use
inelastic traction with injuries where the inflammatory stage of
healing has run its course.
For the past 7 years the
creator of ClikStrips™ has used various methods of inelastic traction
for mobilization splinting. Clinically, he has found inelastic
traction so effective that he seldom uses dynamic traction to mobilize
Inelastic traction is a
long established method for remodeling stiff joints and increasing
joint range of motion. It can be applied to rest and hold healing
tissue at end-range as early as the start of the proliferative phase
of healing. This may actually be safer than elastic traction
which consistently applies tension to tissue that is attempting to
Inelastic traction can be used prior to the late
maturation phase of healing, as not to pass up chances to provide
tissue growth. "Biological windows of opportunity come and go as
time progresses. If windows are missed, they cannot be regained
easily, since the inevitable sequelae of ever-increasing joint
stiffness and tethered soft-tissue glide become more and more
devastating with the passage of time"
splinting allows for function and exercise, while promoting edema
reduction and cartilage nourishment. When elastic mobilization
splinting is used to increase PROM limitations, the splinted tissues
continue to be stressed even when they have reached their end-range.
This may result in tissue damage.
It can also be
difficult to maintain consistent tension on the dynamic splint, due to
hysteresis and creep of the elastic traction sources (rubber bands,
splinting with inelastic traction maintains a low-load stress at end
range--without stressing beyond that point. This technique results in
tissue lengthening without tissue damage.
There are times
when it is beneficial to use both techniques on the same
splint--alternating between inelastic traction to elongate the
tissues, and elastic traction to allow motion within the confines of
the splint. For an example of this type of splint,
guidelines have not been developed. Various factors influence the
length of time the splint should be worn--including type and extent of
injury, duration of PROM limitation, the patient’s physiological
response to the injury, the time from injury and the duration of the
If you have
never used inelastic traction, you can start by using the length of
time guidelines that you currently utilize with elastic (dynamic)
traction is properly set, it is generally tolerated for longer wearing
time than dynamic splints.
A study by Ken
Flowers and Paul LaStayo on Total End Range Time (TERT) concluded that "...the increase in
PROM of a stiff joint is directly proportional to the length of time
the joint is held at its end range."FLOWERS
Paul Brand, MD wrote "I do
not know how much tension is needed to stimulate growth, but from
experience I judge that when the skin is held gently and
on-the-stretch to the point of early blanching, it is stimulated to
lengthen....growth is a matter of days and the stimulus needs to be
continuous for hours at a time..."BRAND
Learning to apply the correct amount of
tension comes with experience in assessing joint/tissue end feel.
It is important to closely
monitor the response of the patient’s tissue both at the traction site
and the area where the tissue is experiencing stretch (i.e. stretching a
skin graft). The goal of inelastic traction is for the applied
force to be equal to the resistance of the contracted tissue.
Inelastic traction is an isometric force that should match the
restriction, but not exceed it.
As the restricted tissues
rest at end-range, cell proliferation and fiber re-arrangement occur;
tissue lengthening results. As the joint relaxes into its new length,
the inelastic mobilization device is advanced in minimal increments.
Inelastic traction must be
adjusted incrementally to accommodate gains in PROM. It must always
provide low load stress at end-range--not beyond it. It is important
to remember that static-progression is not a force against the
restricted tissue, but a force to equal the restricted tissue.
“It is very important that
the patient understand the concept of incremental increases to
prevent damage to tissues. The inherent feedback from each advancing
visible ridge [on the ClikStrips™], at times “over motivates” the
patient to advance the Strip prior to the tissue’s ability to
tolerate the tension. For this reason it is best that the therapist
perform the advancements, at least initially.” (Vazquez)
Therapist’s have often
complained that the cost of commercially available
static-progressive splints or splinting components puts them out
of the reach of many patients. Therapists have tried many
approaches to overcoming this problem including trying to
“recycle” the splint component from one patient to the next.
In response to this
budgetary concern of therapists, WFR Corporation has teamed with
Nelson Vazquez OTR/L CHT to develop ClikStrips™…the most
cost-effective, easiest way to make static-progressive splints.
the only inelastic traction (static-progressive) splint
components to incorporate distinct, measurable incremental
adjustments--so you can monitor and document progress. |
The unique, very
low-profile, streamlined design minimizes bulk and makes it
practical to use a single unit or multiple ClikStrips™ on one
splint. This is especially important on hand-based splints where
there is not much room to mount splint components. Other
component systems may be too bulky and cumbersome for using
multiple units on one splint. |
ClikStrips™ are priced
right! Now inelastic mobilization splints can be affordable for
all of your patients with PROM limitations…let them benefit from
the advantages of inelastic mobilization with inelastic
Audible click and
visible progress marks provide constant feedback to patient.|
For information on
attending or hosting a static-progressive/inelastic mobilization
splinting workshop, please e-mail
Damon@Reveals.com or call WFR Corporation at 201-891-1042 or
Reveals™ Low Temperature splinting materials manufactured by WFR
Corporation can be found at
regarding the use of ClikStrips™ can be e-mailed to Nelson Vazquez
OTR/L, CHT at