The joint manipulation technique is a therapeutic method that applies techniques such as flexion and extension, and shaking to the joints, allowing them to perform flexion, extension, and rotation within their physiological limits. This technique has the effects of relaxing muscles and promoting circulation, and is suitable for all joints. It is applicable to common orthopedic conditions such as joint adhesion, misalignment, and muscle spasms.
I. Basic Operational Methods
1. Shaking Method
This method involves using the joint as a pivot to perform passive circular movements of the limb.
1. Neck Shaking
The patient sits with the neck relaxed, while the practitioner stands behind or to the side. One hand supports the back of the head, while the other hand supports the chin, coordinating the movement to perform circular shaking.
2. Waist Shaking
(1) Supine Waist Shaking
The patient lies supine with legs together, flexing the hips and knees. The practitioner places both hands on the knees; or one hand on the knee and the other on the ankle, coordinating the arms to perform circular shaking.
(2) Prone Waist Shaking
The patient lies prone with legs extended. The practitioner presses on the waist with one hand and supports the knees slightly above with the other hand, coordinating the arms to perform circular shaking.
3. Shoulder Shaking
(1) Elbow Support Shoulder Shaking
The patient sits while the practitioner stands to the side. One hand presses above the shoulder joint to stabilize it, while the other hand supports the elbow, allowing the forearm to rest on the practitioner’s forearm, coordinating the force to perform medium amplitude circular shaking of the shoulder joint.
(2) Wrist Grip Shoulder Shaking
The patient sits while the practitioner stands opposite. One hand stabilizes the shoulder, while the other grips the wrist, allowing the upper limb to abduct. The hands coordinate to perform medium amplitude circular shaking of the shoulder joint.
(3) Large Amplitude Shoulder Shaking
The patient sits or stands with both arms relaxed. The practitioner stands in front with feet in a forward stance. The practitioner raises one side of the upper limb forward and upward, using one hand to support the wrist and the other to stabilize the upper arm. The upper limb is slowly lifted forward and upward, with the supporting hand gradually turning palm up. When raised to about 160°, the wrist is grasped with the palm down. The other hand slides from the wrist along the outer side of the forearm and upper arm to above the shoulder joint. After a slight pause, the hands coordinate to apply force, pressing down slightly on the shoulder joint while lifting the wrist, allowing for shoulder joint extension. The wrist is then shaken backward and downward, moving through a 45° position in front and slightly pausing. At this point, the hand stabilizing the shoulder slides down to the wrist, holding both wrists. The arm is then raised and rotated back to the starting position, with the wrist hand gradually changing to support the wrist, while the other hand crosses back to above the wrist joint. This constitutes a full large amplitude rotation of the shoulder joint, which can be repeated several times. During large amplitude shaking of the shoulder joint, the practitioner should coordinate foot movements to adjust body weight, stepping forward slightly when shaking upward and backward, and stepping back slightly when shaking downward.
4. Elbow Shaking
The patient sits with the elbow flexed at about 45°. The practitioner supports the back of the elbow with one hand and grips the wrist with the other, coordinating the force to perform circular shaking of the elbow joint.
5. Wrist Shaking
The patient sits with palms facing down. The practitioner grips the patient’s palm with both hands, with thumbs pressing on the back of the wrist and fingers on the sides of the palm. The arms coordinate to perform circular shaking of the wrist joint under slight traction. Alternatively, one hand can grip above the wrist while the other grips the fingers, performing shaking of the wrist joint under slight traction.
6. Hip Shaking
The patient lies supine with one leg flexed at the hip and knee. The practitioner supports the knee with one hand and grips the ankle or heel with the other. The angles of flexion at the hip and knee joints are adjusted to about 90°, then the arms coordinate to perform circular shaking of the hip joint.
7. Knee Shaking
The patient lies prone with one leg flexed at the knee. The practitioner stabilizes the thigh with one hand and grips the ankle with the other, performing circular shaking of the knee joint. This method can also be performed in the supine position, with the operated leg flexed at the hip and knee, supporting the popliteal area with one hand and gripping the ankle with the other to perform circular shaking.
8. Ankle Shaking
The patient lies supine with legs extended. The practitioner sits at the foot end, using one hand to support the heel for stabilization and the other to grip the toes, performing circular shaking of the ankle joint under slight traction. This method can also be performed in the prone position, with the operated leg flexed at about 90°, one hand supporting the heel and the other gripping the toes, coordinating the force to perform circular shaking of the ankle joint.
2. Flexion and Extension Method
This method involves flexing and extending the joints.
1. Shoulder Extension Method
The practitioner squats in a horse-riding stance beside the patient, placing the affected limb behind their neck so that the elbow rests on the practitioner’s shoulder. The practitioner wraps both hands around the patient’s shoulder, applying slight downward pressure on the shoulder joint while slowly standing up, maintaining a certain height based on the patient’s ability to abduct and flex the shoulder joint, holding for 2-3 minutes, then relaxing, gradually increasing the amplitude, and repeating 3-5 times.
2. Elbow Extension Method
The patient sits facing the practitioner. The practitioner supports the affected limb’s elbow with one hand, placing the hand under the practitioner’s armpit, while the other hand stabilizes the patient’s shoulder, performing shoulder pushing and elbow lifting to straighten the elbow joint.
3. Knee Extension Method
The patient lies supine with both legs extended and relaxed. The practitioner stands on the affected side, supporting the affected leg’s calf on the practitioner’s forearm with one hand, while the other hand stabilizes above the knee joint, performing flexion of the knee and hip, then coordinating both hands to lift the elbow to perform knee extension, pushing the knee joint straight while simultaneously raising the affected limb. The height of the limb’s elevation is based on the condition and the patient’s tolerance.
4. Hip Extension Method
The patient lies on their side with the affected side up, while the practitioner stands behind. One hand grips the affected ankle, and the other presses on the waist, coordinating the force to pull the affected limb backward, while the hand on the waist pushes forward, resembling a bow shape, repeating the operation several times.
5. Single Hip Flexion Method
The patient lies supine, and the practitioner stands on the side of the affected limb, gripping the lower end of the affected limb (above the ankle) with one hand and holding the heel with the other, flexing the knee and hip, then coordinating both hands to flex the hip, knee, and ankle joints simultaneously, bringing the thigh as close to the abdomen as possible.
6. Double Hip Flexion Method
The patient lies supine, with the practitioner supporting both heels with one hand and stabilizing the front of the knee joint with the other, performing flexion and extension of both knee and hip joints. After reaching a certain limit, the practitioner can apply small repeated pressure on the knees, gradually increasing the angle of hip flexion to bring the thighs closer to the abdomen.
7. Knee Flexion Method
The patient lies prone, and the practitioner stands beside the affected limb, gripping the lower end of the calf with one hand and the toes with the other, gradually flexing the knee joint to increase the bending angle. Alternatively, one hand can be placed under the knee joint (popliteal area) while the other grips above the ankle, performing flexion of the knee and hip, pushing the knee joint forward while applying downward pressure on the calf to flex the knee joint.
In clinical practice, these basic operational methods are often used after the skin and muscle manipulation techniques, and can be applied individually or in combination, depending on the specific situation. The amplitude should start small and gradually increase, but not exceed the physiological limits of movement.
II. Common Diseases Treated with Joint Manipulation Techniques
1. Ankle Joint Strain (Ankle Sprain)
There is a clear history of trauma to the ankle. After the injury, the ankle joint exhibits pain, local swelling, and bruising, accompanied by limping. Local tenderness is significant; in cases of inversion sprain, there is severe pain below the outer ankle when performing inversion; in cases of eversion sprain, there is severe pain below the inner ankle when performing eversion.X-ray examination shows no fractures. Early treatment focuses on symptomatic management to reduce swelling and relieve pain. Later, appropriate treatment is needed to improve joint function, generally using joint manipulation techniques.
[Treatment Principle] Regulate muscles and meridians, promote joint mobility.
[Operational Steps]
The patient lies supine with legs extended. The practitioner sits at the foot end, using one hand to support the heel for stabilization and the other to grip the toes, performing circular shaking of the ankle joint under slight traction.
2. Rehabilitation after Distal Radius Fracture
There is a history of trauma, often caused by indirect violence. After the injury, there is swelling and pain around the wrist joint, deformity at the distal end of the forearm, significant tenderness, and impaired wrist and forearm function.X-ray examination can confirm the diagnosis. Distal radius fractures include Colles fractures with dorsal displacement, Barton fractures with dorsal displacement, Smith fractures with palmar displacement, and palmar Barton fractures and Chauffeur fractures. After removing the fixation, joint manipulation techniques are needed to promote the recovery of wrist joint function alongside orthopedic treatment.
[Treatment Principle] Regulate muscles and meridians, promote joint mobility.
[Operational Steps]
1. Wrist Shaking. The patient sits with palms facing down. The practitioner grips the patient’s palm with both hands, with thumbs pressing on the back of the wrist and fingers on the sides of the palm. The arms coordinate to perform circular shaking of the wrist joint under slight traction.
2. Flexion and Extension of the Wrist Joint. The patient sits with palms facing down. The practitioner grips the patient’s palm with both hands, with thumbs pressing on the back of the wrist and fingers on the sides of the palm. The arms coordinate to perform flexion and extension of the wrist joint under slight traction.
III. Contraindications
1. Joint dislocation or fracture.
2. Joint inflammation, tumors, or tuberculosis.
3. Soft tissue tears or ruptures.
IV. Precautions
1. Pay attention to controlling the range of joint movement, avoiding movements beyond physiological limits.
2. For joints with limited range of motion, gradually increase the range of joint movement during treatment.
3. Skin and muscle manipulation techniques are often used before joint manipulation techniques to enhance safety and effectiveness.
Previous Articles:
[Traditional Chinese Medicine Feature 01] Acupuncture Techniques – Filiform Needle
[Traditional Chinese Medicine Feature 02] Acupuncture Techniques – Scalp Acupuncture
[Traditional Chinese Medicine Feature 03] Acupuncture Techniques – Auricular Acupuncture
[Traditional Chinese Medicine Feature 04] Acupuncture Techniques – Wrist and Ankle Acupuncture
[Traditional Chinese Medicine Feature 05] Acupuncture Techniques – Fire Needle
[Traditional Chinese Medicine Feature 06] Acupuncture Techniques – Skin Needle
[Traditional Chinese Medicine Feature 07] Acupuncture Techniques – Acupoint Injection
[Traditional Chinese Medicine Feature 08] Acupuncture Techniques – Thread Embedding Technique
[Traditional Chinese Medicine Feature 09] Acupuncture Techniques – Electroacupuncture Technique
[Traditional Chinese Medicine Feature 10] Manipulation Techniques – Skin and Muscle Manipulation Techniques
[Traditional Chinese Medicine Feature 11] Manipulation Techniques – Visceral Manipulation Techniques