Joint manipulation techniques

Joint mobility can be maintained using joint manipulation techniques. These are safe for the treatment of stiff and aching joints, but always consider the physical limitations of the joint you are treating. The elbows and knees are mainly hinge joints, allowing movement in one plane, athough it’s possible to get a little lateral movement in them. Only five joints in the body can rotate: two shoulders, two hips and the neck. Of these, only the shoulder joint can rotate in a full circle. The wrist and ankle are sliding joints. Always remember that manipulation involves leverage, which requires sensitivity. An effective stretch will just exceed what your partner would be normally capable of. Damage can easily result if the joint is overstretched.

To assess a joint problem, first ask your partner to move the joint as far as possible and tell you where there is stiffness or pain. Manipulate slowly and smoothly, and stop if you feel resistance. Before using any joint manipulation techniques, use soft tissue massage on the qi-points around the joint. This stimulates qi and blood flow and relaxes muscles, tendons and ligaments, enabling you to work on the joint effectively.

These techniques relieve pain and obstruction in the joint capsule and the surrounding muscles. Contracted, tight muscles hold tension, which can be released by manipulation, allowing the muscles to lengthen and improve tone.

BENEFITS

• Stretches and manipulates the connective tissues of the joint capsule to aid joint mobility.
• Stretches the muscles that control the joint to improve muscle tone.
• Improves the distribution of qi and blood through the meridians into the joints.
• Removes qi and blood blockages from the meridians.

Shaking

The shake is used to treat the arms and legs. First loosen the muscles with a full soft tissue massage of the limbs. Shake only one arm at a time; the legs can be shaken individually or together.

SINGLE LEG AND HIP SHAKE Lift the foot with one hand under the heel, grasping the top of the foot with your other hand, and pull gently.

Shake firmly ten times with small, rapid, up and down movements. Repeat five times.

The shake transmits through the hip and the spine for hip mobility. It eases pressure on the spinal nerves to relieve sciatica and hip pain.

DOUBLE LEG AND BACK SHAKE Place one hand under each heel and shake exactly as for the single leg and hip shake (see here ).

Shaking both legs stretches the spine to release pressure on the lumbar discs, which relieves back pain and sciatica.

ARM SHAKE Hold your partner’s hand firmly in both of your hands, with your thumbs together on the top of the wrist.

Raise your partner’s arm to about shoulder height, palm facing downwards. Pull gently to stretch the arm and then shake the arm rapidly up and down ten times with small movements.

Extension and flexion

These techniques are used on hinge joints – the elbow and the knee.

ELBOW EXTENSION AND FLEXION Flex your partner’s arm, resting the elbow on your left hand, and press your thumb into LI 11 (see here ) and your middle finger into H 3 (see here ).

Holding your partner’s wrist with your other hand, firmly flex and extend the arm, keeping your thumb and finger pressure on LI 11 and H 3.

To increase the stimulation of the joint, rotate the forearm in both directions.

SUPINE KNEE EXTENSION AND FLEXION Stand facing your partner’s leg. Cupping one hand under the heel and resting the other over the kneecap, lift the leg into the position shown on the right.

Push the leg towards the body until you feel slight resistance. Now firmly extend the leg by pressing down on the knee while pulling the heel in the direction shown by the arrow. This manipulation improves flexibility in the knee and hip.

PRONE KNEE FLEXION Place your left hand over BL 25 and BL 26 and slide your other hand under the toes of both feet. Apply pressure on the lower back as you raise the feet to the buttocks.

Where there is extreme stiffness of the knee joint, flex one leg at a time. The lumbar press manipulates the back as well as the knees and hips for improved flexibility.

For a different effect, repeat with the lower legs crossed, each way in turn.

Rotation

In everyday life we don’t use the full rotatory potential of our joints. Tui Na rotations help to compensate for this by improving joint mobility. Rotation techniques are used on the shoulders, hip joints, ankles and wrists. Neck rotations can cause serious injury and are not described in this book.

Always massage the soft tissues in the chosen area before attempting a rotation, to aid the flow of blood and qi and release muscle tension. With regular Tui Na, frozen shoulders and even joints affected by severe osteoarthritis can have their mobility improved.

SHOULDER ROTATION WITH ELBOW FLEXED Stand behind your partner, supporting the right forearm on yours with a light grip under the wrist. With your other hand, grip the shoulder joint, pressing into LI 15 (see here ) and SJ 14 (see here ). Rotate the arm forwards and backwards. This gentle rotation releases shoulder pain and restriction. Each circular movement should be as large as the mobility of the joint will allow.

SHOULDER ROTATION WITH ELBOW EXTENDED Extend the arm, holding it loosely by the wrist. With your left hand, grip the shoulder joint, pressing LI 15 (see here ) and SJ 14 (see here ). Then rotate the arm slowly, with large circular movements, forwards ten times and then backwards ten times. Limit the size of the rotation if you feel any resistance.

WRIST ROTATION With one hand, grasp the forearm firmly for support immediately above the wrist. With your other hand holding the fingers, rotate the wrist joint clockwise and anticlockwise, as far as possible. If someone has wrist pain, advise them to vigorously shake both wrists daily.

HIP ROTATION Flex your partner’s right knee so that the lower leg is horizontal and supported across your right forearm, gripping the knee with interlocked hands. Use your hands to rotate the hip carefully, making clockwise and anticlockwise circles. Start gently and gradually increase the size of the rotations as far as the joint allows. Frequent, gentle rotations will improve mobility in arthritic joints.

Another method is to support the heel with one hand and use the other hand on the knee to guide the rotation. This is better for more flexible people, who need larger rotations.

ANKLE ROTATION With your partner lying on their back, raise the foot a little, supporting it with one hand under the lower leg just above the ankle. With your other hand, grip the toes and rotate the foot clockwise and anticlockwise.

Pressing and stretching

These manipulations create two equal forces working in opposite directions: one force ‘stretching’ at a point distant from one force ‘pressing’. The techniques flex and twist the joints to a greater degree than normal, improving their mobility. Carefully control the amount of force you use, feeling for any resistance. When you lift the shoulder or leg, the lumbar presses create a strong manipulation to align the spinal vertebrae.

SHOULDER STRETCH WITH LUMBAR PRESS With your partner lying face down, press your right hand firmly down on the lumbar region, with your heel over BL 25/BL 26 on the left and your fingers resting on the spine.

Lean over and grasp your partner’s right shoulder with your left hand. Now lift the shoulder while applying an equal but opposite force to the back. The result is a well-controlled but potentially vigorous stretch of the front shoulder and upper chest.

This technique gives a twist to the lumbar and lower thoracic spine to align the vertebrae. Repeat, readjusting your hand onto BL 23/BL 24.

LEG LIFT WITH LUMBAR PRESS Standing on your partner’s left, press your left hand onto BL 26 on the side of the spine nearer to you. Slide your right hand under the left leg, holding it just above the knee, and lift the leg as far as is comfortable.

At the same time, press with equal force on the lumbar area. Hold the lift for a few seconds, rotating the leg slightly before lowering it.

Change sides and repeat on the other leg. Lifting the leg with sacrolumbar pressure aligns the sacroiliac joint.

SHOULDER ROTATION STRETCH Standing on your partner’s left, lift the right arm, resting the forearm across the middle of the back. Lean over and slide your right hand under the elbow and up to the shoulder, and grasp it firmly. Your partner’s elbow should lie on top of your forearm. Grasping the top of the shoulder with your left hand, rotate it slowly several times, starting with small movements and gradually making larger rotations, and give it a stretch.

This technique greatly facilitates qi-flow through the shoulders and into the arms, improving shoulder mobility.

SHOULDER STRETCH WITH SCAPULAR PRESS Raise your partner’s shoulder with your right hand, keeping your left hand with your index finger and thumb pressed firmly against the inner edge of the right scapula, and simultaneously lift and press the shoulder against your left hand to give a powerful shoulder stretch.

Lift and press with equal force. Repeat, repositioning your hand along the scapula.

This technique stretches the front of the shoulder and presses the rhomboid muscles between the spine and scapula, easing tension in the upper back.

Stretching

This is a spinal stretch that eases back strain and relieves the pressure on damaged intervertebral discs. Even those who have no back problems find this stretch soothing and relaxing. Spinal stretches are excellent for opening the articular joints of the spinal vertebrae and relieving pressure on intervertebral discs. This improves spinal and sacroiliac flexibility.

STANDING SPINAL STRETCH Stand back to back with your partner, feet slightly apart, and link arms. With their buttocks above yours (flex your legs if necessary), bend forwards at the waist and lift your partner off the floor so the legs hang loosely. Shake your partner gently from side to side and lower slowly to the floor.

Caution: do not attempt this technique if you have back trouble, or with a partner much heavier or taller than yourself.