1. Oblique Wrenching Lumbar Vertebrae

The oblique wrenching is the most frequently used manipulation of wrenching lumbar in the clinical practice．A lot of variations have been developed on the basis of the oblique wrenching．The most common manipulating manner is the following one. The patient is in lateral lying position with the suffered side upward. Standing in front of the patient, the practitioner adjusts the patient’s shoulder and buttock location to a suitable position, at which the rotation center of the spine is just on the suffered segment; then puts one hand on the patient’s shoulder and the other flexed elbow and forearm on the buttock．After that, the practitioner pushes the shoulder forward while wrenches the buttock backward. When the spine is rotated to its elastic barrier position, the practitioner makes a sudden and controlled thrusting-wrenching to expand rotation range 3 to 5 degrees. A spring sound that indicates the articular facet is shifted relatively can be heard. Commonly, this is the successful sign of restoration (Fig 248). Click to read Chinese medicine Treatment for Polyarteritis Nodosa.

The touch site may also be changed to the patient’s flexed knee so as to increase twisting distance and save labor (Fig 249)．Or to the lower thigh with the hand which is inserted through theflexed knee (Fig 250). Manipulating behind the patient is also allowed, but the manner is changed to wrenching the pelvis backward and thrusting the shoulder forward(Fig 251). The oblique wrenching is applicable to the treatment of the posterior articulator disturbance of the lumbar vertebrae, the acute sprain of the lumbar and theprotrusion of the lumbar intervertebral disc．

2. Improved Oblique Wrenching Lumbar Vertebme

The application of the oblique wrenching is relatively aimless for the manipulator usually is unable to accurately estimate the twisting center of the spine. Therefore, the improved oblique wrenching is just aimed at this problem. The patient is in the lateral lying position with the suffered side upward. Standing in front of the patient, the practitioner puts the index and middle fingers at the interval of spinous processes that is above the suffered vertebra and the other below the suffered spinous processes. Then the practitioner grasps the shoulder to move forward and makes the spine be flexed step bystep. If the practitioner feels the upper spinous processes moving while lower spinous process keeping in still by the fingers, he should stop moving the shoulder and keep the upper trunk in this posture. Click to read Coronary Arteriosclerotic Cardiopathy in TCM.

After that, the practitioner guides the patient to cross his arnls and grasp the opposite shoulders. Fixing the upper shoulder with one hand, the practitioner touches the intervald of the suffered segment with the index and the middle fingers, and flexes the patient’s hip joint of the other side and the lumbar vertebrae so as to expand the intervals between facet joints as well as spinous processes gradually. If the lower interval is expanded while the upper interval is kept in still, the practitioner flexes the patient’s above hip and knee and puts the ankle on the other knee. With the index finger proping the projected process, the practitioner pushs the patient’s shoulder forward with one hand and pulls the buttock backward with the other elbow to rotate the spine step by step to its limited Dositlon In this way, the twisting center of the spinal column is iust located in the suffered segment, and the increased twisting force delivered on both the upper and lower lever of the spine (the shoulder and the pelvis)may break the balance of the spine and get restoratmn?Then the practitioner makes a sudden and controlled wrenching at the suitable time to expand the rotation range 3 to 5 degrees, in the meanwhile the finger thrusts the spinous process downward. Thus the subluxation may be restored (Fig 252). Click to read TCM Diagnosis for Coronary Arteriosclerotic Cardiopathy.

It is beneficial to coordinate the wrenching movement with the patient’s breathing rhythm when the improved oblique wrenching is being manipulated．It is advisable to guide the patient to take a deep breath．A sudden wrenching is made as the patient’s body is relaxed at the end of the exhaling period. The patient’s muscles are too well-developed to be restored, one can take the following methods to increase twisting distance and enhance the Success rate of restoration． 

①Having the prepanng steps been accomplished, the practitioner inserts the hand, which pushes the shoulder in the above manipulating manner, through the above armpit to help the fingers of the other hand to thrust the spinous process downward with the index and middle fingers, while the elbow is pushing the shoulder forward (Fig 253)．

②The direction of lateral lying and spine rotation is on the contrary of the above manipulating manner, but the other manipulating manner is similar. The patient’s position is changed to lie on the suffered side and the practitioner’s fingers are also changed to hook the Dro Jected spmous process upward (Fig 254). If the patient feels severe pain due to the heterolateral rotation and is unable to be manipulated, the practitioner may consider rotating the spine to the healthy side to get restoration. The improved oblique wrenching is suitable for the reduction of all articular disturbances of the lumbar vertebrae and the treatment of the protrusion of the lumbar intervertebral disc．Click to read Hyperviscosity Syndrome in TCM.

3. Rotating-Wrenching Lumbar Vertebrae on Selected Site

The patient rides on a clinical bed with two legs on each side of the bed to fix his pelvis and holds his own occiput with crossed fingers of the two hands to make the upper lever of the spine as a whole unit. Standing behind the patient, the practitioner props the projected spinous process with one thumb, and grasps the opposite shoulder with the other hand, which inserts through the armpit of the suffered side and passes in front of the chest. Then the practitioner flexes and rotates the patient’s spine homolaterally. The flexion range is based on the level of the subluxation segment. For the first lumbar vertebra, it is not required to bend the lumbar. While for the 12 and L3, it is required to bend the lumbar slightly, and for the 1-14 and L5 to bend it to a large degree. When the spine is being rotated to its limited position, a sudden wrenching is made to expand the range of rotation at the suitable time, the subluxation can be restored (Fig 255). This manipulation is applicable to the treatment of the subluxation of the lumbar vertebrae and the protrusion of the lumbar intervertebral disc. Click to read Chinese medicine Treatment for Hyperviscosity Syndrome.

4. Wrenching Leg While Pressing Lumbar

The patient is in the prone position. Standing by the suffered side, the practitioner touches against the projected spinous process with one pisiform, and supports the opposite thigh to pull backward to the spring barrier position with the other hand．Then the practitioner makes a sudden and controlled wrenching to expand the extension range of the spine 3 to 5 degrees, and thrusts the spinous process at the same time. Then restoration can be achieved (Fig 256). This manipulation is applicable to the treatment of the vertebral subluxation of the 1.4 and L5 as well as the protrusion of the lumbar intervertebral disc．

5. Extension-Wrenching Lumbar Vertebrae

The patient is in the prone position. After taking off his shoes, the practitioner squats on the two sides of the patient’s lumbar and touches it gently with his buttocks to restrict the movement of the spine．Then the practitioner holds the patient’s thighs with his hands to pull upward to the limited position and makes a sudden and controlled wrenching backward to expand the extensive range 3 to 5 degrees, and loosens it at once. Repeat the movement 3 to 5 times (Fig 257). This manipulation can also be changed to the lollowing manner: the practitioner kneels against the patient’s lumbar with one knee and holds the ankle to pull backward with his hands(Fig．258)．This manipulation is applicable to the treatment of the protrusion of lumbar intervertebral disc. Click to read Rheumatic Heart Disease in TCM.

Appendix: Rolling Coordinated with Wrenching Lumbar Vertebrae by Extending Lower Extremity

The practitioner exerts the rolling to stimulate both sides of the lumbar and buttock fully so as to relieve pain and relax the lumbar muscles. Then, the practitioner continues rolling on the lumbar region with one hand, and supports the lower end of the thigh with the other hand. Then the practitioner extends the thigh step by step to the elastic barrier position and makes a sudden and controlled wrenching to expand the extension range of the lumbar 3 to 5 degrees while rolling, and loosens the thigh immediately (Fig 259). Repeat the above movements 3 to 5 times. The contraside of the lumbar is manipulated in the same way. This manipulation is widely applied to treat pain in the lower back and leg. Click to read Chinese medicine Treatment for Rheumatic Heart Disease.