The joint adjustment Tui Na technique involves methods such as pressing, pulling, and twisting to act on the joints, adjusting the tension of the surrounding tissues, joint position, and limb alignment, improving or restoring joint function, or returning the joint position to normal. It has the effects of relaxing muscles and opening meridians, lubricating joints, correcting dislocations, and relieving adhesions. It is applicable to joints throughout the body, with conditions including common orthopedic diseases and spinal-related disorders.1. Basic Operation Methods(1) Pulling MethodFix one end of the joint or limb and pull the other end along the longitudinal axis.1.Cervical Spine Pulling Method(1) Cervical Palm Support Pulling MethodPatient sits, and the practitioner stands behind. Using the tips of both thumbs and the textured surface to press against the two sides of the Fengchi (Wind Pool) points below the occipital bone, with both palms placed on either side of the lower jaw to assist, and both forearms positioned on the inner sides of the Jianjing (Shoulder Well) points on the upper shoulders. The arms coordinate to apply force, with thumbs pushing up, palms lifting, while the forearms press down, slowly pulling upwards for 1-2 minutes.(2) Cervical Elbow Support Pulling MethodPatient sits, and the practitioner stands to the side. One hand supports the back of the head for stabilization, while the elbow of the other arm supports the chin, with the palm resting on the opposite side of the head to enhance stabilization. Both hands work together to slowly pull upwards for 1-2 minutes.The cervical spine pulling can also be performed with the patient lying supine. The practitioner sits at the head end on a stool, one hand supporting the back of the head, the other hand supporting the chin, coordinating force to pull horizontally towards the head end.2. Shoulder Joint Pulling Method(1) Shoulder Joint Counter Pulling MethodPatient sits, and the practitioner stands to the side. Both hands grasp the wrist and upper forearm, gradually pulling while the shoulder joint is abducted to 45°-60°, instructing the patient to lean their body to the opposite side or having an assistant stabilize the upper body to counteract the pulling force, continuing for 1-2 minutes.(2) Shoulder Joint Hand-Pulled Foot-Pushed Pulling MethodPatient lies supine, and the practitioner sits on a stool at the side of the shoulder joint being pulled. The heel of the lower limb closest to the practitioner is placed under the armpit, with both hands grasping the wrist and forearm, abducting the upper limb about 20°. The practitioner leans back, coordinating hand and body to apply opposing force to the shoulder joint for counter traction, after a certain time, then adducting and internally rotating the shoulder joint.3. Elbow Joint Pulling MethodPatient sits, and the practitioner stands to the side. The upper limb is placed in an abducted position, with an assistant holding the upper arm to stabilize, while the practitioner holds the wrist with one hand and the lower forearm with the other to perform pulling.4. Wrist Joint Pulling MethodPatient sits, and the practitioner stands to the side. One hand holds the mid-forearm, while the other hand holds the palm, applying opposing force to perform pulling.5. Lumbar Spine Pulling MethodPatient lies prone, holding onto the head of the bed or having an assistant stabilize the shoulders, while the practitioner stands at the foot end. Both hands grasp the ankles of the lower limbs, leaning back, gradually pulling towards the foot end.6. Hip Joint Pulling MethodPatient lies supine, and the practitioner stands to the side, with an assistant pressing down on the anterior superior iliac spines for stabilization. One side lower limb is flexed at the hip and knee, while the practitioner supports the knee with one hand and the other arm flexes at the elbow to support the popliteal fossa, with the chest and side pressing against the lower leg. Coordinating force with hands and body, the hip joint is pulled upwards.7. Knee Joint Pulling MethodPatient lies supine, and the practitioner stands at the foot end, with an assistant holding the mid-thigh of one side lower limb for stabilization. The practitioner holds the ankle and lower leg with both hands, leaning back, pulling towards the foot end.8. Ankle Joint Pulling MethodPatient lies supine, and the practitioner stands at the foot end. One hand holds the lower leg, while the other hand holds the toes, applying opposing force to continue pulling the ankle joint.(2) Twisting MethodThe practitioner uses one hand to stabilize the proximal end of the joint being treated, while the other hand acts on the distal end of the joint, then both hands apply force in opposite or the same direction, allowing the joint to slowly move passively until resistance is felt, then performing a short, slightly increased amplitude, controlled, sudden twist.1. Chest and Back Twisting Method(1) Chest Expansion Traction Twisting MethodPatient sits, with fingers interlocked behind the head, while the practitioner stands behind. One knee presses against the back at the site of the thoracic vertebrae lesion, with both hands holding the elbows. The patient is instructed to perform forward bending and backward arching movements, coordinating with deep breathing. During forward bending, exhale; during backward arching, inhale. After several repetitions, when the body is arched back to the maximum extent, a short pull is made on both elbows while the knee suddenly pushes forward, often resulting in a “crack” sound.(2) Thoracic Vertebra Counter-Resetting MethodPatient sits, with hands interlocked behind the head, while the practitioner stands behind. Both arms extend from under the armpits to grasp the lower segments of both forearms, with one knee pressing against the spinous process of the affected thoracic vertebra. The practitioner applies downward pressure on the forearms while the forearms are lifted, causing the cervical spine to flex and the spine to be pulled upwards and backwards, while the knee pressing against the affected thoracic vertebra also applies forward and downward force, creating opposing traction. After a moment of sustained traction, both hands, arms, and knee work together to perform a short twist, often resulting in a “crack” sound.(3) Shoulder Twisting Thoracic Vertebra Twisting MethodPatient lies prone, fully relaxed, while the practitioner stands on the affected side. One hand presses against the spinous process of the affected thoracic vertebra, while the other hand twists the opposite shoulder upwards and backwards, coordinating both hands to apply opposing force, pausing slightly when resistance is felt, then performing a short twist, often resulting in a “crack” sound.2. Lumbar Oblique Twisting MethodPatient lies on the side, with the upper leg flexed at the hip and knee, while the lower leg is straight. The practitioner stands at the bedside facing the side of the patient, using the elbow or hand on the shoulder front and the other elbow or hand on the hip, applying opposing force with both elbows or hands. During the procedure, small amplitude twisting movements of the lumbar region should be performed first, pressing down on the shoulder and hip simultaneously with slight force to create a continuous small amplitude twist to relax the lumbar region. Once the lumbar region is fully relaxed, when a significant resistance is felt, pause slightly, then perform a short twist, often resulting in a “crack” sound.3. Shoulder Joint Twisting Method(1) Shoulder Joint Abduction Twisting MethodPatient sits, and the practitioner squats to the side. The patient’s arm is abducted to about 45°, then the elbow is placed on one shoulder, with both hands locking around the shoulder from both sides. The practitioner slowly stands up, causing the shoulder joint to abduct until resistance is felt, pausing slightly, then performing a controlled twist to increase the abduction.(2) Shoulder Joint Adduction Twisting MethodPatient sits, with one arm flexed at the elbow in front of the chest, resting on the opposite shoulder. The practitioner stands behind the patient. One hand presses on the shoulder for stabilization, while the other hand supports the elbow and slowly lifts it towards the opposite upper chest, performing a twist to increase the amplitude of adduction when resistance is felt.(3) Shoulder Joint Internal Rotation Twisting MethodPatient sits, with one arm flexed at the elbow behind the waist. The practitioner stands to the side and back, stabilizing the shoulder with one hand while the other hand holds the wrist, slowly lifting the forearm along the back to gradually induce internal rotation of the shoulder joint, performing a controlled upward movement when resistance is felt to create internal rotation.(4) Shoulder Joint Elevation Twisting MethodPatient sits, with both arms hanging naturally. The practitioner stands behind, holding the lower segment of one arm and slowly lifting it from a forward flexed or abducted position upwards until reaching 120°-140°, then holding the forearm near the wrist joint. Coordinating force with both hands, gradually pulling upwards until resistance is felt, then performing a controlled upward twist.4. Elbow Joint Twisting MethodPatient lies supine, with one arm resting flat on the bed. The practitioner sits on a stool at the side. One hand supports the upper part of the elbow joint, while the other hand holds the distal forearm, first performing slow flexion and extension movements of the elbow joint, then determining the twisting method based on the specific functional impairment of the elbow joint. If flexion is limited, the elbow is placed in a flexed position, applying slow pressure to further flex it towards the functional position. When significant resistance is felt, a short twist is performed. If extension is limited, the opposite direction is used for twisting.5. Wrist Joint Twisting Method(1) Wrist Flexion Twisting MethodPatient sits, and the practitioner stands opposite. One hand holds the distal forearm for stabilization, while the other hand holds the fingers, first performing repeated flexion and extension movements of the wrist joint, then placing the wrist in a flexed position and applying pressure, performing a short twist when resistance is felt.(2) Wrist Extension Twisting MethodPatient sits, and the practitioner stands opposite. Both hands hold the fingers, with thumbs pressing on the dorsal side of the wrist joint, first performing pulling and rotating movements several times, then placing the wrist in an extended position, applying pressure, and performing a short twist when resistance is felt.6. Hip Joint Twisting Method(1) Hip Flexion and Knee Flexion Twisting MethodPatient lies supine, with one leg flexed at the hip and knee, while the other leg is straight. The practitioner stands to the side, pressing down on the knee of the straight leg for stabilization, while the other hand presses down on the knee of the flexed leg, with the chest close to the lower leg for assistance. Coordinating force with both hands and body, pressure is applied to the flexed leg downwards, bringing the front of the thigh closer to the abdomen, pausing slightly at maximum extent, then performing a short twist to increase the amplitude.(2) Hip Joint Extension Twisting MethodPatient lies prone, and the practitioner stands to the side, pressing down on one side of the buttock for stabilization, while the other hand supports the upper part of the same side lower limb, coordinating force to extend the hip joint as much as possible, performing a quick twist when maximum resistance is felt.(3) “4” Shape Twisting MethodPatient lies supine, with one leg flexed at the knee, placing the lower leg above the opposite thigh to form a “4” shape. The practitioner stands to the side, pressing down on the knee of the flexed leg with one hand and pressing down on the anterior superior iliac spine of the opposite side with the other hand, coordinating force to apply downward pressure until significant resistance is felt, then performing a quick twist to increase the amplitude.(4) Hip Joint Abduction Twisting MethodPatient lies supine, and the practitioner stands to the side, pressing down on the knee of the opposite leg for stabilization, while the other hand holds the lower leg or ankle of the leg closest to the practitioner, coordinating force to abduct the leg until significant resistance is felt, then performing a quick twist to increase the amplitude.(5) Straight Leg Raise Twisting MethodPatient lies supine, with both legs straight. The practitioner stands to the side, with an assistant standing on the opposite side, pressing down on one knee for stabilization. The practitioner slowly raises the leg closest to them, when the lower leg is raised to shoulder height, the shoulder presses against the knee, locking the upper part of the knee joint. Coordinating force with the shoulder and arms, the leg is gradually raised, flexing the hip while the knee joint remains straight. When significant resistance is felt, a quick twist is performed. To enhance traction on the lumbar nerve roots, when the leg is raised to maximum resistance, one hand can pull down on the front of the foot, suddenly pulling to extend the ankle as much as possible. For patients with mild limitations in straight leg raises, one hand can pull down on the front of the foot to maintain ankle extension, while the other hand stabilizes the knee to ensure the affected limb is straight, then increasing the amplitude of the raise. Caution is advised for patients with acute sciatica and significant pain.7. Knee Joint Twisting Method(1) Knee Joint Extension Twisting MethodPatient lies supine, and the practitioner stands to the side. One hand presses on one knee, while the other hand is placed on the back of the lower leg, coordinating force until resistance is felt, then performing a quick twist to increase the amplitude of extension.(2) Knee Joint Flexion Twisting MethodPatient lies prone, and the practitioner stands to the side. One hand stabilizes the back of the thigh, while the other hand holds the ankle, flexing the knee until resistance is felt, then performing a quick downward pressure to increase the amplitude. The knee joint twisting method can also involve pressing on the inner or outer side of the knee joint with one hand while pulling the ankle with the other hand to perform twisting.8. Ankle Joint Twisting Method(1) Ankle Joint Dorsiflexion Twisting MethodPatient lies supine, with both legs straight. The practitioner sits at the foot end, supporting the heel with one hand and holding the toes with the other, coordinating force to dorsiflex the ankle joint until significant resistance is felt, then performing a quick twist to increase the amplitude of dorsiflexion.(2) Ankle Joint Plantarflexion Twisting MethodPatient lies supine, with both legs straight. The practitioner sits at the foot end, supporting the heel with one hand and holding the toes with the other, coordinating force to plantarflex the ankle joint until significant resistance is felt, then performing a quick twist to increase the amplitude of plantarflexion. The ankle joint twisting method can also involve one hand holding the heel while the other hand holds the tarsus for inversion or eversion twisting.The joint adjustment Tui Na techniques are diverse, and in clinical practice, the above basic operation methods are often used after skin and muscle Tui Na techniques, which can be applied alone or in combination, or other methods belonging to joint adjustment Tui Na techniques can be selected, such as pressing methods (including cross-pressing, impact pressing, etc.), spinal micro-adjustment methods, lifting methods, twisting methods, back methods, and pulling methods, depending on the specific situation.2. Common Diseases Treated with Joint Adjustment Tui Na Techniques(1) Low Back Pain(Lumbar Disc Herniation)History of lumbar injury, chronic strain, or exposure to cold and dampness. Most patients have a history of chronic low back pain before onset. Commonly occurs in young and middle-aged adults. Low back pain radiates to the buttocks and lower limbs, worsening with increased abdominal pressure (such as coughing or sneezing). Spinal curvature may be present, with the physiological curve of the lumbar spine disappearing, tenderness in the paravertebral area, and radiation to the lower limbs, with limited lumbar mobility. Sensory hypersensitivity or dullness may occur in the nerve distribution area of the lower limbs, and long-term cases may show muscle atrophy. Positive straight leg raise or Bragard’s test, with diminished or absent knee and Achilles reflexes, and reduced strength in the extensor hallucis longus.X-ray examination: spinal curvature, loss of lumbar physiological lordosis, possible narrowing of the affected intervertebral disc, and osteophyte formation at the adjacent margins. CT examination can show the location and extent of the disc herniation.[Treatment Principles] Relax muscles and open meridians, regulate muscles and restore function, invigorate blood circulation and remove stasis.[Operation Steps]1. Relieve muscle spasms in the lumbar and gluteal regions. Patient lies prone. The practitioner uses gentle rolling and pressing techniques on the affected lumbar, gluteal, and lower limb areas.2. Lumbar Pulling Method. Patient holds onto the head of the bed or has an assistant stabilize their shoulders, while the practitioner stands at the foot end, holding both ankles with both hands, leaning back, and gradually pulling towards the foot end.3. Lumbar Oblique Twisting Method: Patient lies on the side, and the practitioner applies the lumbar oblique twisting method.4. Promote recovery of the injured nerve function. The practitioner applies rolling, pressing, point pressing, kneading, and grasping techniques along the area supplied by the injured nerve.[Special Note] During treatment, the patient should rest on a hard board bed and keep the lumbar area warm; caution is advised during Tui Na treatment for central-type lumbar disc herniation; the diagnosis of lumbar disc herniation should be clear before treatment.(2) Frozen Shoulder(Periarthritis of the Shoulder Joint)Caused by chronic strain, traumatic injury, and insufficient qi and blood, combined with invasion of wind, cold, and dampness. Commonly occurs around the age of 50, with a higher incidence in females than males, and more frequently in the right shoulder than the left, often seen in manual laborers, typically with a chronic onset. Shoulder pain is worse at night, often triggered by weather changes and fatigue, with functional impairment of the shoulder joint. Muscle atrophy around the shoulder, tenderness in the front, back, and sides of the shoulder, significant limitation of abduction function, and the typical “shoulder shrug” phenomenon. X-ray examinations are often negative, but long-term cases may show osteoporosis.[Treatment Principles] Release adhesions, lubricate joints, invigorate blood circulation and open meridians, and alleviate pain.[Operation Steps]1. Patient sits. First, apply skin and muscle Tui Na techniques.2. Patient sits. Apply the shoulder joint counter pulling method.3. Patient lies supine. Apply the shoulder joint hand-pulled foot-pushed pulling method.4. Patient sits. Apply the shoulder joint abduction twisting method.5. Patient sits. Apply the shoulder joint adduction twisting method.6. Patient sits. Apply the shoulder joint internal rotation twisting method.3. Contraindications1. Joint inflammation, tumors, tuberculosis.2. Joint fractures, dislocations.3. Soft tissue bleeding, edema, ligament or muscle tears or ruptures around the joint.4. Severe osteoporosis.4. Precautions1. Joint adjustment Tui Na techniques have a certain level of difficulty, and safety of the techniques should be prioritized in clinical applications. Diagnosis before the procedure should refer to imaging data.2. Joint adjustments should follow the natural direction, avoiding violent stretching and twisting.3. Patients should also cooperate with functional exercises to maintain joint stability.4. Skin and muscle Tui Na techniques are often used in conjunction with joint adjustment Tui Na techniques.
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] Tui Na Techniques – Skin and Muscle Tui Na Techniques
[Traditional Chinese Medicine Feature 11] Tui Na Techniques – Zang-Fu Tui Na Techniques
[Traditional Chinese Medicine Feature 12] Tui Na Techniques – Joint Movement Tui Na Techniques