1, the methodological defects of spinal long lever manipulation From the mechanical point of view to analyze the manipulation, the orthopedic manipulation of the manipulation of force from the force point to the target joint bone, ligament connection as the simplest mechanical – lever. As early as in Ancient Greece, Hippocrates (Hippocratic) introduced spinal manipulation under the title of “Joint Rehabilitation by Leverage”. Therefore, in terms of classification, according to the distance between the point of application of force and the target joints of osteopathic manipulation, it can be divided into two categories: long leverage manipulation and short leverage manipulation. According to this classification standard, spinal manipulation such as cervical rotation trigger, lumbar spine oblique trigger is a long lever manipulation, while spinal compression reset is a short lever manipulation. Due to the long force distance between the position of force application and the target segment of the spinal manipulation, it can be amplified by the mechanical force of the lever to complete the manipulation under the condition of less force. However, there is an advantage and a disadvantage of the long lever maneuver. During the operation of the long lever maneuver, the force of the maneuver has to pass through the stress transfer of multiple links before it can be applied to the target segment, thus completing the reset movement. Such as the application of cervical spine rotary wrench to restore cervical vertebral subluxation, the rotational torque from the skull, first of all, the atlanto-occipital joint to overcome the frictional resistance to rotation, causing the atlanto-occipital ligament tensions; tense atlanto-occipital ligament further drive the atlanto-atlantoaxial joint to overcome the frictional resistance and rotate, so that atlanto-atlantoaxial joint joints of the joint capsule, ligament tensions; drive the cervical 2,3 segments of the rotational… …In this way, the torsion force is transmitted through the osteoarticular-ligamentous chain link by link to reach the target acting segments of the lower cervical spine. As long lever spinal manipulation requires multiple stress transfer links to realize joint realignment, these stress transfer links are more or less anatomically and pathologically different, which makes it difficult to adjust and control the transfer links, and thus it is often difficult to accurately locate the target segments in the clinic. This is especially true when the patient’s muscle spasm is difficult to release and the misaligned segments are in a protective interlocking state. Secondly, due to the viscoelastic properties of the collagenous tissue and the unavoidable passive motion of the joints, there is a loss of energy in the stress transfer process in each link, which creates an uneven distribution of manipulative stress in each link. The rotational torque from the skull has to be constantly consumed in each segmental movement, and high torsional stresses occur in the upper cervical segments where supraphysiologic movement is not required, while only small torsional stresses are present in the lower cervical segments where supraphysiologic movement is required, which is insufficient to satisfy the need for joint reset. The result is either too light of a torque to achieve the goal of realignment, or too much torque in the upper cervical spine, resulting in accidental injury. Furthermore, in long lever spinal manipulation, all segments of the spine are in passive motion, and the passive motion of the spine cannot be selectively focused or restricted to the diseased segments. For example, if the cervical spine is rotated to correct the subluxation of the middle and lower cervical segments, the whole cervical spine must be rotated by more than 60° in order to realize the possibility of correction. According to cervical spine kinematics and clinical research, such a large cervical rotation has the potential to cause distortion and compression of the vertebral artery on one side of the upper cervical spine. The so-called short-lever maneuver refers to the direct application of force to the diseased segment, usually using the spinous processes or transverse processes of the upper and lower vertebrae of the segment as the bone levers. Compared to the long lever maneuver, it is more accurate in terms of controllability than the long lever maneuver. Since the short lever maneuver applies force directly on the spinous processes, transverse processes or articular processes of the diseased segment, as long as the operator is familiar with the bony landmarks of the human body, it is easy to accurately control the position of the segment to be restored. If the force is applied to the diagonal transverse processes of C5 and C6, the cross-pressure fine-tuning maneuver can only cause passive rotation of the C5 and 6 segments, and will never cause rotation of other segments. Secondly, the short lever maneuver avoids the multi-link transmission of the stress of the maneuver, and the segment with the highest stress is the target segment, so that the non-lesioned segments do not need to bear additional loads, and will not hurt the innocent tissues. In addition, the passive motion of the segments of short lever manipulation is concentrated or limited to the target segment and its neighborhood, so the overall passive motion of the spine is generally controlled within 5-15°, which is within the range of the patient’s daily physiological motion, and basically avoids the stress injury of the internal and external spinal nerves and vascular tissues. Even if manipulation is applied to patients with spinal cord cervical spondylosis, ideal spinal cord decompression effect can be achieved on the basis of ensuring the safety of the manipulation. 2, the lighter the force, the smaller the amplitude of the more secure Osteopathic manipulation should be light and avoid brute force is the common understanding of most Chinese osteopathic and massage experts, such as the “Medical Zong Jinjian, the bones of the heart of the law of the so-called”: “the machine touched on the outside, the trick was born in the inside,” Mr. Fan Chunzhou believes that: “the hand to be light and soft sex do not bother! Mr. Fan Chunzhou believed that “the hand should be gentle and the nature should not be disturbed”. However, the traditional manipulative theory only puts forward this idealized requirement of osteopathic manipulation in a general way, and does not further put forward the specific ideas and methodological research to realize “substituting force with dexterity”, which is the regret of the osteopathic theory. According to the analysis of domestic and foreign literature, there are two reasons for spinal manipulation accidents, one is the improper selection of indications for manipulation, and the implementation of spinal manipulation for patients with certain contraindications to massage, such as spinal tumors, which causes medical injuries and belongs to the scope of clinical research on massage; the other is the problem of spinal manipulation itself, which is due to the improper operation of manipulation, and the overuse of manipulative force and/or spinal passive movement, which causes medical injuries, that is, the methodological problems of spinal manipulation. The methodology of spinal manipulation belongs to the category of Tui Na manual research. At the methodological level of spinal manipulation, the process of spinal manipulation is examined. When spinal passive motion is caused by manipulation, it not only produces spatial displacement and internal stress changes in the intervertebral discs and posterior joints that make up the active segments, but also produces spatial displacement and internal stress changes in the spinal cord, nerve roots and neighboring blood vessels. Thus, regardless of the passive motion, the greater the amplitude of the motion, the greater the potential for injury to nerves, blood vessels, and other tissues due to excessive spatial displacement and stress increase in the bone structure. Considering that spinal manipulation is often performed on patients with various pathological changes such as intervertebral disc degeneration, intervertebral space narrowing, vertebral osteophytes, osteoporosis, etc., the safe space for spinal movement in these patients is much smaller than the normal value for healthy people, and even during physiological spinal movement, there is the possibility of neural and vascular compression, such as spinal postural neuralgia and head and neck positional vertigo. To reduce the risk of manipulation, the amplitude of passive spinal motion must be reduced, and the force of manipulation must be reduced. For the same object, the smaller the amplitude of passive motion caused by the manipulation, and the lighter the force of the manipulation, the smaller the spatial displacement of the spine and its ancillary structures and the increase in internal stress, the less likely to cause medical injuries, and the safer the manipulation will be. Of course, the idealized spinal manipulation described above does not exist in practice, or can only be a long-term goal. In order for a spinal segment to appear to be in restorative motion, it must overcome all kinds of resistance and must be made to move beyond its physiologic limitations, requiring a certain intensity of manipulative power. Clinically, why some doctors can complete spinal adjustment with relatively light force, while most doctors can only use brute force to realize spinal adjustment? Prof. Shen Guoquan believes that the reason lies in the ability to reduce the resistance during manipulation. According to Mr. Fan, manipulation is a kind of inspiration, which must be made on the basis of the opportunity and the situation. However, if this kind of inspiration can not rise to rational understanding, so that it can be used by the majority of clinicians, can not be said to be the gizzard of heaven. In order to theoretically explore the osteopathic manipulation of such “inspiration” regularity, more importantly, in order to solve the “skill instead of force” to achieve the idea and methodology, Professor Shen Guoquan in the new “Tui Na manual law” put forward the theory of resistance of the joint movement techniques. The resistance of joint reset mainly comes from three aspects, namely, the elastic tension of joint capsule and ligament, the friction resistance of joint surface and muscle tension. Among the factors of joint passive movement resistance ① the frictional resistance of articular surface is determined by the friction coefficient of articular cartilage and the pressure of articular surface, i.e., F= μN. Since the friction coefficient of the same joint of the same body in a specific period of time is a constant, the frictional resistance is mainly determined by the variable size of the articular surface load N. The frictional resistance is mainly determined by the variable size of the articular surface load N. Factors affecting the magnitude of the articular surface load are body position, elastic tension of the transarticular colloid tissue, and contractile force of the transarticular muscles. ② The elastic tension of the joint capsule and ligaments is the passive force, which transmits the manipulative force from the place of application to the target-acting segment in the process of manipulative repositioning, thus driving the articular surfaces to slide against each other and restoring the normal anatomical relationship, and it is the necessary stress-transferring link in the process of manipulative repositioning. It is the necessary stress transfer link in the process of manipulation and restoration. And the pulling stress will be transferred to the articular surface after the target action segment, which will open the intervertebral space and joint space, reduce the load of the articular surface, and reduce the friction resistance of the joint. Muscle tension is one of the most active change factors, muscle tension increases the load of joint surface, and even causes interlocking of the posterior joint surface of the spine, thus causing difficulties in joint reset and directly opposing the operation of the manipulation, affecting the smooth operation of the manipulation. Therefore, to reduce the resistance of spinal manipulation, the following ways can be used: ① Reduce muscle tension ② Appropriate separation of joint surfaces ③ Appropriate tension of ligaments, joint capsules and other collagenous tissues ④ Correct direction of movement and application of force 3, the difference between fine-tuning and restoration The theory of misalignment and restoration is the dominant theory of the field of chiropractic, and it has been proved to be effective way to restore the joints and the fascial soft tissues with the manipulation of the anatomical abnormalities of their positions by the long term clinical practice. It has been proven by long-term clinical practice to be an effective way. Therefore, whether it is the orthopedic massage in China or the chiropractic therapy and orthopedic internal medicine in foreign countries, all of them take the correction of the subluxation of the movable segments of the spine as the key method of treating the diseases of spinal origin. As the theory of spinal manipulation has been widely accepted by medical workers engaged in non-surgical treatment of spinal diseases at home and abroad, the irrational components hidden inside this theory have been gradually exposed and have caused frequent medical accidents in clinical work. Prof. Shen Guoquan, from the perspective of safety of spinal manipulation, conducted in-depth rational thinking on the theory of “restoration”, and reached the following understanding. ①Anatomical position abnormality of segment or “misalignment” is not entirely a pathological phenomenon, the nature of most vertebral subluxation is a kind of adaptive phenomenon to spinal movement and degenerative changes of the spine, and only a small number of “subluxation” become pathological due to the compression or pulling of the soft tissues around the vertebrae. The phenomenon of the spinal column is a kind of adaptation to spinal movement and degenerative changes. ② For the “subluxation” caused by spinal degeneration, segmental stability decline, even if the application of manipulation, the position of the correction is difficult to maintain, that is, “subluxation” of anatomical correction is difficult to achieve in the clinical time. (3) Clinical practice has confirmed that, as long as the manipulation is done properly, even if anatomical restoration is not achieved, there will be a significant relief of clinical symptoms and signs of the patient in an instant, and anatomical restoration of the segment is not a necessity for treatment. Since the anatomical repositioning of the spine must produce passive movements beyond the physiological range, there are certain side effects and risks. ⑤The theory of “adjustment” is used instead of the theory of “restoration”, i.e., to minimize the amplitude of segmental passive movement to provide a more relaxed internal environment for the nerves and vascular tissues as the starting point and destination of the implementation of the manipulation. 4, the formation and development of short-lever fine-tuning manipulation According to the above analysis, Professor Shen Guoquan gradually formed this understanding of spinal manipulation, the development of short-lever manipulation to make up for the shortcomings of long-lever manipulation, to improve the selectivity of the clinical manipulation; to the theory of spinal motion physiology and the theory of resistance of joint passive motion manipulation to guide the manipulation, so as to make the “dexterity instead of force The theory of spinal motion physiology and the resistance theory of joint passive motion manipulation are used to guide the manipulation so that “substituting force with dexterity” is feasible in reality; the anatomical adjustment is replaced by segmental fine-tuning to minimize the amplitude of passive motion of the spine or segments; and the change of clinical signs before and after the manipulation is used as an objective basis for the success of manipulation, instead of whether the popping sound is emitted or the sphenoidal protrusion disappears in the course of the manipulation. After synthesizing the views of domestic and foreign scholars on the mechanism of lumbar intervertebral disc herniation treatment, Prof. Shen Guoquan realized that it is the key to the treatment that the manipulation makes the relative position change between the herniated disc material and the compressed nerve root, so as to play the decompression or decompression effect on the nerve root. However, if we cannot control the amplitude of segmental motion and the strength of the manipulative force, the compressed nerve root and the adjacent soft tissues may be mechanically damaged during the implementation of manipulation. This is the reason for the common clinical problem of “post-manipulation reaction”. Therefore, since 1995, we began to conceptualize and apply the lumbar short-lever micro-adjustment manipulation for the treatment of lumbar intervertebral disc herniation. Compared with the traditional long lever manipulation, the biggest advantage of short lever fine-tuning manipulation is the controllability of manipulation, and it simplifies the steps of spinal manipulation, so that the therapeutic effect that can be achieved by the complete set of lumbar oblique wrenching, backward wrenching, and pressing and vibrating lumbar method can be realized by a single lumbar fine-tuning manipulation. From our own clinical data and feedback analysis of the nationwide promotion and application of the short lever force manipulation-based treatment of lumbar intervertebral disc herniation, the patient’s post-manipulation reaction is slight, the patient’s pain is very little, and the course of treatment is significantly shortened advantages. Compared with the traditional long-lever force manipulation, it has the features of high safety, high efficacy and significant social benefits, and has the scientific value and social benefits of popularization and application. Encouraged by this successful experience of spinal manipulation theory and method innovation, Prof. Shen Guoquan, together with his colleagues, developed a series of short lever fine-tuning manipulation of cervical vertebrae, thoracic vertebrae and sacroiliac joints based on the theoretical basis of spinal biomechanics research results, which enriched the content of Chinese medicine massage clinics and opened up the way of spinal manipulation to the development of scientization and refinement, and enabled a large number of patients to have their spinal manipulation treatment in a shorter time and with a smaller medical treatment. It also enables a large number of patients to get rid of their diseases in a shorter period of time and at a smaller medical cost.