中医整脊科技术操作规范标准(6)

1.4.2.6 Old fracture dislocation of cervical vertebrae 1.4.2.7 In the time of pulling

1.4.2.8 Being cautious for disappeared or reversed cervical curvature 1.4.3 Cautions

1.4.3.1 Do not rotate the neck beyond the normal rotation range.

1.4.3.2 Stop rotating when the neck is rotated to the right place and do not blindly pursue the bone sound produced by the vertebral rotation.

1.4.3.3 Be cautious to apply rotating manipulation in a neutral position, because the force exerted by this manipulation is often above the 5th cervical vertebra, which is easy to cause fracture dislocation.

1.4.4 Manipulation Methods

Ask the patient to take a sitting position and the practitioner stands behind the patient. Relax the cervical muscles first and then ask the patient to bend the head forward. The practitioner presses the occipital region by four fingers of the left hand and asks the patient to rotate the neck laterally to the extreme. Then the practitioner support the patient?s chin with the right elbow and presses the left side of the affected vertebra by the thumb. Lift the head upwards gently and a successful reduction is indicated when a bone sound is heard from the neck. The operation of the right side is opposite to the left side.

1.5 Chest Lifting to Hyperextension Manipulation 1.5.1 Indications

1.5.1.1 Cervical disorders complicated with scoliosis of the thoracic vertebra 1.5.1.2 Scoliosis of the thoracic vertebrae 1.5.1.3 Epiphyseal osteomalacia of the spine 1.5.1.4 Arrhythmia of spinal origin

1.5.1.5 Gastrointestinal dysfunction of spinal origin 1.5.2 Contraindications Severe osteoporosis

1.5.3 Cautions

Don?t over-exert knee pushing force. 1.5.4 Manipulation Methods

[Method 1] Ask the patient to sit on the chiropractic chair, face the front, put the hands behind the neck with fingers of two hands crossing. The doctor stands behind the patient and pushes the upper thoracic vertebrae by one knee. Meanwhile, put the hands on the rib sides by passing over patient?s shoulders and lift and pull the body up back by holding the ribs.

[Method 2] Ask the patient to sit on the chiropractic chair, face the front, put the hands behind the neck with fingers of two hands crossing. The doctor stands behind the patient and oppositely holds patient?s forearms by crossing under the armpit. Push patient?s chest back by the chest and lift and pull patient?s body up back by two hands.

[Method 3] Ask the patient to sit on the chiropractic chair, face the front, cross the arms in front of the chest and hold the shoulders by the hands. The doctor sits behind the patient and tries to

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broaden the scapulae by pulling patient?s elbow joint of the opposite side from under the armpit. At the same time, lift and pull the patient?s body back and upwards.

1.6 Thoracic and Lumbar Rotating Manipulation 1.6.1 Indications

1.6.1.1 Disorder of thoracic and lumbar small joints 1.6.1.2 Lumbar spondylolisthesis

1.6.1.3 Prolapse of lumbar intervertebral disc 1.6.1.4 Lumbar canal stenosis 1.6.1.5 Scoliosis

1.6.1.6 Irregular menstruation of spinal origin 1.6.1.7 Osteoarthritis of lower limbs of spinal origin 1.6.1.8 Gastrointestinal disorder of spinal origin 1.6.1.9 Ankylosing spondylitis and spinal deformity 1.6.2 Contraindications

1.6.2.1 After surgery on the thoracic and lumbar vertebra 1.6.2.2 Severe osteoporosis of the lumbar vertebra 1.6.2.3 Pregnant women

1.6.2.4 Tumors of the thoracic and lumbar vertebra 1.6.2.5 Tuberculosis of the thoracic and lumbar vertebra 1.6.2.6 Myelitis of the thoracic and lumbar vertebra

1.6.2.7 Being cautious for acute stage of prolapse of lumbar intervertebral disc 1.6.2.8 Being cautious for patients with lumbar stiffness 1.6.3 Cautions

1.6.3.1 Assistant is needed to fasten the hip.

1.6.3.2 Do not blindly pursue the rotation sound by rotating repeatedly. 1.6.4 Manipulation Methods

Ask the patient to sit on the chiropractic chair, face the front, put the hands behind the occipital region with fingers of two hands crossing, and bend forward slightly with the 12th thoracic vertebra and 1st lumbar vertebra as the supporting point. Take the left side for example. The assistant fastens the patient?s right hip, while the practitioner stands at the left rear side, puts the left hand at the back of neck and chest (below DU 14) by passing the front of left arm, and fastens the left of thoracolumbar joint by the right hand. The practitioner then rotates the patient?s thoracolumbar region by the left hand. After the patient relaxes, exert opposite force of both hands quickly and simultaneously. In other words, rotate to the left by the left hand and push to the right by the right hand. Local bone sound can be heard. Manipulation on the right side is opposite to the left one.

1.7 Lumbar Rotating Manipulation 1.7.1 Indications

1.7.1.1 Dislocation of posterior lumbar joint 1.7.1.2 Disorder of posterior lumbosacral joint 1.7.1.3 Prolapse of lumbar intervertebral disc

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1.7.1.4 Lumbar canal stenosis 1.7.1.5 Lumbar scoliosis 1.7.2 Contraindications

1.7.2.1 Same to contraindications of the thoracic and lumbar rotating manipulation 1.7.2.2 Slipped vertebral disc compressing dural sac for more than a half 1.7.2.3 Being cautious for collapsed vertebral arch and spondylolisthesis 1.7.3 Cautions

Same to the of the thoracic and lumbar rotating manipulation 1.7.4 Manipulation Methods

Ask the patient to sit on the chiropractic chair, face the front, put the hands behind the occipital region with fingers of two hands crossing, and bend forward with the affected spinous process as the supporting point. Take the left deviated spinous process for example. The assistant fastens the right hip, while the practitioner stands at the left rear side of the patient, puts the left hand on the right shoulder of the patient by crossing under the patient?s left armpit, and fastens the left of the deviated spinous process by the right palm. The practitioner then shakes patient?s waist and when the patient relaxes, exert opposite force of both hands quickly and simultaneously. In other words, rotate to the left by the left hand and push to the right by the right hand. Local bone sound can be heard. Manipulation on the right side is opposite to the left one.

1.8 Lumbosacral lateral Pulling Manipulation 1.8.1 Indications

1.8.1.1 Dislocation of posterior lumbar joint 1.8.1.2 Prolapse of lumbar intervertebral disc 1.8.1.3 Disorder of posterior lumbosacral joint 1.8.1.4 Dislocation of iliosacral joint 1.8.2 Contraindications

1.8.2.1 Unclear diagnosis without excluding tuberculosis and tumor of the sacrum and ilium 1.8.2.2 Disconnected vertebral interarticularis, collapsed vertebral arch and spondylolisthesis 1.8.2.3 Osteoporosis 1.8.2.4 Pregnant women

1.8.2.5 After surgery of thoracic and lumbar vertebra 1.8.3 Cautions

1.8.3.1 The patient is required to lie on the side with the body trunk and lower limbs in a line. 1.8.3.2 If the patient is suspected with intervertebral foramen of one side compressing the nerve root, ask the patient to lie on the healthy side and it is inappropriate to apply lateral pulling of both sides.

1.8.3.3 Being cautious for patients with lumbar stiffness 1.8.4 Manipulation Methods

Ask the patient to lie on the side. Take the lying on the left side for example. The practitioner stands facing the patient and puts the right hand or forearm at the front of the patient?s right armpit, the left forearm on the right hip. After the patient relaxes fully, exert opposite force of both hands at

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the lumbosacral joint quickly and simultaneously. Manipulation to the lying on the right side is opposite to this.

1.9 Hyperextension with Pelvic Pressing Manipulation 1.9.1 Indications

1.9.1.1 Dislocation of iliosacral joint 1.9.1.2 Disorder of posterior lumbosacral joint 1.9.1.3 With pelvic list 1.9.2 Contraindications

1.9.2.1 Same to the contraindications of lumbosacral lateral pulling manipulation 1.9.2.2 With hip joint disorders 1.9.3 Cautions

Be careful to protect the hip joint in the time of posteriorly extending the lower limbs so as to avoid femoral neck fracture due to hyperextension.

1.9.4 Manipulation Methods

Ask the patient to lie on the stomach. The practitioner stands at the side, supports the patient?s affected thigh with one elbow, clasps another hand with the supporting hand and with its elbow pressing the affected iliosacral joint. Then, slowly extend the patient?s affected lower limb to the extreme and exert moderate force to press the pressing elbow. A successful reduction is indicated when a bone sound is heard.

1.10 Hand Pulling and Pelvic Supporting Manipulation 1.10.1 Indications

Same to the Hyperextension with pelvic pressing manipulation

1.10.2 Contraindications 1.10.2.1 Unclear diagnosis

1.10.2.2 Spondyloschisis and spondylolisthesis 1.10.2.3 Pregnant women

1.10.2.4 Being cautious for patients with diseases of the lower limbs 1.10.3 Cautions

Maintain the body and the lower limbs at the same level and exert the force of hands and feet coordinately.

1.10.4 Manipulation Methods

[Method 1] Ask the patient to lie on the side with the affected side above and bend the knee of the healthy side. The practitioner fastens the healthy side calf by one heel and holds the ankle of the affected side by two hands. When the patient relaxes fully, pull the ankle upwards and kick the calf downwards simultaneously with sudden and coordinate force.

[Method 2] Ask the patient to bend the knees and hip. The practitioner presses the knee while rolling the pelvis to and fro.

2 Extraction Methods

2.1 Cervical Cloth-Pocket Traction 2.1.1 Indications

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2.1.1.1 Cervical fracture dislocation

2.1.1.2 Cervical disorders due to abnormal cervical curvature or rotated dislocation of the vertebra

2.1.1.3 Cervical canal stenosis 2.1.2 Contraindications 2.1.2.1 Unclear diagnosis

2.1.2.2 Patients of cervical disorders with dizziness as the chief complaint

2.1.2.3 No sitting cervical traction for disappeared or reversed cervical curvature or aged patients and young children

2.1.2.4 Being cautious to have sitting cervical traction for patients with cervical curvature 2.1.2.5 Acute stage of any cervical disorders 2.1.2.6 Brown-Sequard syndrome 2.1.3 Cautions

2.1.3.1 The cloth pocket must be fastened with longer front and shorter back.

2.1.3.2 During the traction, the patient should lie on the back with eyes looking straight ahead and nose tip and lower jaw at the same level.

2.1.3.3 Do not place the cloth pocket at places that can compress the carotid artery and male laryngeal prominence.

2.1.3.4 The traction weight should be within 3 to 6Kg and depend on patient?s neck muscles. Do not apply excess traction weight.

2.1.3.5 During the traction, pay close attention to patient?s feeling. Remove the traction immediately if the patient has symptoms of dizziness, chest stuffiness and so on.

2.1.3.6 Ask the patient to rest for about 10min after the withdrawal of traction. 2.1.3.7 Do not apply manual bonesetting at the time of traction. 2.2 Supine Pelvic Traction 2.2.1 Indications

2.2.1.1 Injuries of the chest, lumbar and pelvis

2.2.1.2 Dislocation of lumbosacral joint and rotated dislocation of the 4th and 5th lumbar vertebrae 2.2.1.3 Prolapse of lumbar intervertebral disc of young people 2.2.1.4 Dislocation of posterior lumbar joints 2.2.1.5 Disorders of lumbosacral joint 2.2.2 Contraindications

2.2.2.1 Unclear diagnosis of disordered osteoarticular forces by X-ray scan 2.2.2.2 Acute stage of slipped lumbar disc with pain aggravated after traction

2.2.2.3 Complicated with severe hypertension, cardiopathy, asthma and hyperthyroidism 2.2.2.4 Pregnant women and severe osteoporosis 2.2.2.5 After lumbar surgery 2.2.2.6 Spinal tuberculosis 2.2.2.7 Spinal myelitis 2.2.2.8 Spinal tumors

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