04/12/2017
I. Orthopedic Lower Back Pain (LBP)
A. Pain comes from the muscles:
Strain, acute inflammation (sprain, attacked by cold)/myofibrositis
B. Pain comes from the joints (include ligaments, cartilage and bones):
Sprain (twisted/displaced), arthritis (rheumatoid or osteoarthritis/”Bi” syndrome), lumbar spondylolisthesis
C. Pain comes from the bones:
Osteoporosis, bone tumor
D. Pain comes from the nerves:
Protrusion of lumbar intervertebral disc (PLID), spinal canal stenosis
II. Key Points of TCM Massage therapy:
A. Chronic muscle pain:
Strains, myofibrositis and myofascitis
Key symptoms and signs: stiff muscles, lower or no elasticity of the muscles, pressing pain on the surface or inside the muscles, nodes or tight strips may be found.
Pathomechanism: chronic inflammations of muscular fibers and fascia. Blongs to “muscle Bi” or Flaccidity syndrome (Wei). There is stagnations of Qi and Blood or no enough nourishment of the muscles.
Goal of the treatment: restore the elasticity of the muscles.
Key points of the manipulations: gentle manipulations are major; drawing and point pressing could be chosen when necessary in the spasm case. Drawing and point pressing may cause side effects.
B. Acute muscle pain:
Sprain, contusion, acute occurring of the chronic pain
Key symptoms and signs: sharp pain, tender spot, swelling feeling, the pain may radiate to the hip, but no shooting pain on the leg and foot, limited motion due to pain and spasm.
Pathomechanism: spasm, swelling or hematoma
Blood stasis, wind-cold-dampness
Goal of the treatment: release spasm, reduce swelling
Key points of the manipulations: combine the gentleness and toughness, local and distal. Special manipulations may be used: pressing, drawing, point pressing.
Common questions: Displaced joint or small muscle spasm;
Deep and thorough of the manipulation;
Instant cure.
C. Displacement of the joint:
Key symptoms and signs: Limited motion on certain way; blocked feeling; fixed pressing pain spot nearby the joint.
Pathomechanism: disorder of the relationship of the joint.
Goal of the treatment: adjust the joint, restore the motion.
Key points of the manipulations: Ban (turning).
The conditions of using turning method;
The functions of the turning method;
The limits and the side effects.
D. Arthritis:
Osteoarthritis and Ankylosing spondylitis.
Key symptoms and signs: chronic pain related to overuse, weather change and rest, deep pressing pain on the lumbar spine; limited motion on all directions.
Pathomechanism: damaged structure of the joints, inflammation
Combined excess and deficiency in TCM. Kidney, Liver, Blood stasis and Wind-Cold-Dampness
Goal of the treatment: stop pain, prevent the further damage on the joints
Key points of the manipulations: relax the soft tissues; drawing and vibrating; be careful on pressing and moving joints methods.
E. Protrusion of lumbar intervertebral disc (PLID):
Key symptoms and signs: shooting pain on the lower leg or foot; abnormal sense on the certain dermal segmentation; reduced strength on certain muscles; approved by CT scan or MRI.
Pathomechanism: mechanical and chemical stimulations on the nerve root; Bladder channel and Gallbladder channel; Blood stasis.
Goal of the treatment: stop pain by removing the stimulations on the nerve root; restore the nerve functions as much as we can; strengthen the lower back.
Key points of the manipulations:
Urgent stage: sharp shooting pain, not reduced during the night or lying down, SLR < 45°. Rest is the major treatment, be careful to do any TuiNa or acupuncture on the lower back area, it may make the pain worse;
Moderate stage: after sharp shooting pain reduced, limited ROM, SLR between 45° ~ 70°. TuiNa is the major method in this period, and Ban (turning) has to be used here to adjust joints and loose the conglutination around the nerve root;
Recovering stage: alternating soreness and pain, usually on the lower back or leg only, reduced sensations, weakness of the muscles, and limited time of actions. TuiNa is used to help the patient to exercise and rebuild muscles. The goal is to restore the strength and flexibility.