Manipulative treatment of soft tissue pain in the neck, shoulder and back
Clinical data
1. General data: Among the 286 cases in this group, 171 were male and 115 were female; age ranged from 29 to 68 years; there were 17 cases with history of trauma; 87 cases with causative acute attacks, 199 cases with chronic attacks, 216 cases with aseptic inflammation in the cervical spinal canal with pain as the main cause, 70 cases with chronic aseptic damage in the cervical spinal canal, mechanical compression with numbness as the main cause accompanied by pain, and chronic soft tissue damage outside the cervical spinal canal such as lifting Scapular muscle attachment, scapular spine edge rhomboid muscle starting and ending point, the upper and lower Okami muscle, the size of the round muscle pain 236 cases.
2. Clinical symptoms: Patients initially had mild damage to the back of the neck and shoulder, numbness of the fingers of the upper extremities, and those with chronic onset had stiffness of the back of the neck and shoulder, stiffness of the plate or habitual fall of the pillow, followed by increased pain in the back of the neck and shoulder, and even unbearable severe pain, sleeplessness at night, swelling of the fingers and loss of grip strength. In 53 cases, there was numbness of toes of both lower extremities, weakness of legs, difficulty in walking and unstable gait. 17 of them had different degrees of sinking of both lower extremities and cotton-like sensation when walking, and 8 cases had a feeling of chest girdle between them, and their bowel movements were normal.
3. Physical signs: The patients all had varying degrees of limitation of cervical spine functional activities and soft tissue pressure pain in the neck, shoulder and back. Indirect percussion test of cervical spine was positive in 112 cases, intervertebral foraminal squeeze test in 104 cases, posterior extension test of cervical spine in 83 cases, arm lift endurance test in 173 cases, arm stretch test in 71 cases, and Hoffman’s sign in power position in 21 cases.
4.Imaging: X-ray examination showed that the physiological curvature of the cervical spine disappeared and straightened, or the retroflexion was deformed, the posterior and superior edges of the cervical spine were osteophytic, the intervertebral space was narrowed, the intervertebral foramen was deformed and became smaller, the power film showed segmental slippage of the cervical spine, ossification of the posterior longitudinal ligament, the ratio of the vertebral canal to the sagittal diameter of the vertebral body was less than 75% in 19 cases, and the power cervical spinal canal was narrowed in 42 cases. There were 126 cases of cervical disc protrusion, including 84 cases of single-segment protrusion, 42 cases of multi-segment protrusion, 61 cases of dural sac and spinal cord compression, and 44 cases of secondary cervical spinal stenosis.
Treatment methods
1. Cervical forward flexion and extension of the cervical spine to squeeze manipulation treatment.
①Patients are placed in supine position with a pillow at the back of the neck, and the height is about 10° when the lesion is in the upper cervical segment and 30° in the middle cervical segment and 20 in the lower cervical segment. If the left side is the affected side, slightly lateral flexion and rotation to the left, the physician stands above the patient’s head, the right hand is inserted from the patient’s neck, palm facing upward, the middle finger is pressed against the posterior small joint or transverse process of the diseased segment (both horizontal and anterior-posterior displacement), the large fissure and thumb are clamped together in the neck (transverse process of the diseased segment), the small fissure and the ulnar side of the hand are stuck in the posterior occipital ridge of the patient’s head, the flexed side of the left wrist is aligned with the patient’s jaw, and the patient is asked to The patient’s whole body is relaxed and the assistant stands at the distal end of the patient, holding the patient’s left ankle with both hands and pulling it up and down against each other at the same time, the physician can feel the joint loosening under the fingers and hear the popping sound, then the technique is successful. Five times of this technique is a course of treatment.
The patient is sitting with the torso backward against the back of the chair. First, fix both shoulders with two special cloth straps on the back of the chair, relax the muscles of the neck, shoulders and back, and then adjust the angle of forward flexion of the cervical vertebrae, the lesion is about 10°~15° in the upper cervical segment, 15°~30° in the middle cervical segment and more than 30° in the lower cervical segment. The assistant stands on the patient’s side with one hand holding the jaw and the other hand placed on the posterior occipital ridge, and the hands are used to force the head upward along the adjusted forward flexion angle. The physician stands behind the patient with both hands in the shape of clenched empty fists, placed on each side of the neck.
On the right side, for example, the left thumb is pressed on the small joint behind the diseased segment, and the right thumb is pushed to the left on the end of the spinous process of the next cervical vertebra. The technique is successful when the physician can feel the joint loosen and hear a “creaking” sound under the fingers. This technique is performed once for each lesion segment and is suitable for abnormalities in the horizontal position of the cervical spine 2~7 front and back.
2.Cervical spine traction fixed-point rotating traction rectification and loosening technique
The patient is seated, cervical traction for 20 ~ 30 minutes, the angle is taken according to the upper, middle and lower cervical spine lesion segments: 10°, 20° and 30° of forward flexion respectively, the weight is 8kg~10kg, taking the right side as an example, the assistant stands behind the patient to fix both shoulders, the patient is fully laterally flexed under traction, the physician’s right hand holds up the patient’s jaw, his thumb is placed on the zygomatic arch of the patient’s right face, the remaining four fingers are placed on the patient’s left cheek.
The left thumb presses the lower bulge of the small joint of the right side of the spinous process, and the remaining four fingers are placed on the left shoulder, and the head and neck are rotated to the right to the elastic restraint position, with instantaneous rapid rotation, while the left thumb applies pressure inwardly. When the sound of small joints popping and the feeling of jumping under the fingers are heard, the head is put back to the right and traction is maintained for 5 minutes, and the treatment ends. This method is suitable for cervical spine 2~7 angle position abnormalities.
3.Cervical spine lateral return squeeze rectification and relaxation technique
The patient is in supine position, with the head rotated 45° to the healthy side, the affected side is on top, the head is in horizontal position, the physician bends down and stands in the direction of the patient’s head, the face is facing the patient, the palm of the left hand is placed on the patient’s healthy side cheek, the palm does not press the patient’s ear. The metacarpal joint of the right hand is pushed away from the soft tissue near the diseased C2-5 articular eminence and placed on top of the diseased C2-5 articular eminence on the affected side, with the palm of the hand slightly flexed laterally toward the ring finger and the elbow close to the body.
The physician’s left hand is pulled slightly in the direction of the patient’s head and pulled away from the C2-5 joint on the healthy side. When the patient exhales, the right hand instantly exerts force to complete the whole bone release, and the direction of force is from back to front. This method is suitable for abnormalities at the level of cervical spine 3~7.
The above mentioned manipulation and release treatment depends on the number of lesion stages. The same stage on the same side is usually not more than 2 times. After the manual treatment, symptomatic medication can be used to assist cervical traction to consolidate and maintain the therapeutic effect.
Treatment results
Efficacy assessment standard: according to the diagnostic efficacy standard of Chinese medicine disease issued by the State Administration of Traditional Chinese Medicine. Cured: The main clinical symptoms basically disappeared and the positive signs turned negative. Improvement: The main clinical symptoms improved significantly, and some positive signs turned negative. Ineffective: No significant improvement in the main clinical symptoms.