Wrenching Sacroiliac Joint in Chinese Tuina

Thrusting-wrenching Manipulations of Tuina

1. Oblique Wrenching Sacroiliac Joint

The patient is in the ateral lying position with the suffered side upward, straightens the lower limb below and slightly flexes the hip joint below, flexes the knee and hip joint of the above side. The practitioner props the shoulder of the above side to keep it touching the clinical bed with one hand, and the knee of the above side with the other hand. Then the practitioner wrenches the knee postero-inferiorly to restore the spine and the sacroiliac joint to its elastic barrier position, and then makes a sudden wrenching, in which the patient’s knee is moved abductively and rostrally so that the interval of the sacroiliac joint is expanded and its facets are shifted by the effects of the spring force of the periarticular ligaments and the tension of the hamstring muscles．This mallipulationis applicable to the reduction of anterior subluxation of the sacroiliac joint(in which the posterior superior iliac spine moves upward and sinks down) (Fig 260). Click to read Hypotension (Low Blood Pressure) in TCM.

2. Improved Oblique Wrenching Sacroiliac Joint

The patient is in the same position as the above, grasps the bed edge with the hand of the above side. The practitioner holds and pulls the other arm obliquely superiorly to avoid the lumbar vertebrae being over twisted (Fig 261). Then the patient is asked to grasp the opposite shoulders with his two arms, and slightly flex the hip joint of the other side to make the physiological curvature of the lumbar vertebrae flat, and keep the pelvis vertical to the bed surface. With the knee and the hip joint of the above side flexed the heel of above side is put on the knee region of the other side. Later on, the practitioner pushes the upper shoulder to turn forward with one hand, pulls the posterior superior iliac spine to turn backward with the pisiform of the other wrist; then guides the patient to exhale slowly after deep inhalation and rotates the spine during exhaling period．Generally speaking, after 2 to 3 exhaling periods,the spine can be rotated to its elastic barrier position. During the next exhaling period, the hand which props the shoulder keeps the upper trunk steady, in the meanwhile the hand which props the posterior superior iliac spine makes a sudden wrenching directed to the longitudinal axis of the femur. Click to read TCM Treatment Evaluation for Hypotension (Low Blood Pressure).

Thus the subluxation can be restored (Fig 262). This manipulation is applicable to the reduction of the posterior subluxatlon of the sacroiliac joint(in which the posterior superior iliac spine moves downward and bulges posteriorly)．For the anterior subluxation (in which the posterior superior iliac spine moves upward and sinks down), the patient should extend the knee ioint and flex the hip joint to take advantage of the lever force of the hamstring muscles to restore the joint, and the practitioner's touching point should be changed to the ischia tuberosity. Then the practitioner thrusts to the middle point of the line between the patient’s shoulder of the other side and the chin. During the thrusting course, the practitioner may move the patient’s thigh with his leg to tense the hamstring muscles and increase impetus of reduction (Fig 263). Click to read Viral Myocarditis in TCM.

3. Wrenching Sacroiliac Joint by Straightly Lifting Leg

The patient is in the supine position. Holding the heel of the suffered side with one hand, the practitioner presses the knee with the other hand to make the hip and the knee joints flexed and the thigh touch with the chest and the abdomen as possible as it can (Fig 264). Then the patient is asked to cough. When the patient coughs and his muscles are relaxed, the practitioner rapidly stretches the knee in the condition of flexing the hip(Fig 265). This manipulation is applicable to the treatment of the protrusion of the lumbar intervertebral disc as well as the reduction of the subluxation of the sacroiliac joint. For restoring the subluxation of the sacroiliac joint, if the angle of rotating the hip joint is adjusted on the basis of subluxation type, the success rate will be higher．For restoring the anterior subluxation, the hip joint is lateral rotated while knee and hip are being flexed(the knee is rotated to the lateral side and the foot rotated to the medial side) (Fig 266). Then the knee joint is rapidly stretched．For restoring the posterior subluxation, the hip joint is medially rotated while the knee and hip joints are being flexed(the knee is rotated medially and the foot rotated laterally) (Fig 267). Then the knee joint is rapidly stretched. Click to read Chinese medicine Treatment for Viral Myocarditis.

4. Wrenching Sacroiliac Joint by Pulling Flexed Lower Extremity

The patient lies in the supine position and grasps the bed edges with his two hands. Standing by the patient’s foot side, the practitioner holds the ankle with the hands to lift the suffered 1eg about 45 degrees and make the hip and the knee slightly flexed. Then the patient is asked to cough. As the patient coughs and his muscles are relaxed the practitioner makes a sudden and controlled wrenching to draw the leg postero-superiorly．Thus the sacroiliac joint can be restored (Fig．268). This manipulation is applicable to the reduction of the posterior subluxation of the sacroiliac joint. If the patient sufiers from anterior subluxation, the manipulation can also be plied, but the angle of lifting leg is about 10 degrees (Fig 269)．

5. Wrenching Sacroiliac Joint by Flexing Knee and HiD jn SiRing Position

The child sits on the end of the clinical bed, flexing the knee and hip joints of the suffered side. The homolateral foot is put on the bed, whlie the healthy leg hangs naturaly below the bed edge. Sitting behind the child, the practitioner holds the flexed knee of the child to pull backward and upward to the elastic barrier position with his two hands, then makes a sudden and controlled wrenching to restore the sacroiliac articulation (Fig 270). This manipulation is applicable to the reduction of children’s subluxation of the sacroiliac articulatio. Click to read Stroke (Apoplexy) in TCM.

6. Wrenching Leg While Pressing Sacrum

The patient lies in the prone position. Standing by the patient’s heathy side, the practitioner presses the sacrum with one hand and suppons the lower part of the suffered thigh with the other hand to make the knee joint flexed and the leg extended to its elastic barrier position at first．Then the patient is asked to cough．When the patient is coughing and the muscles are relaxed, a sudden and controlled wrenching is done to expand the range of extending the leg 3 to 5 degrees. Thus the sacroiliac joint can be restored. This manipulation is applicable to the reduction of the posterior subluxation (Fig 271). Click to read Chinese medicine Treatment for Stroke (Apoplexy).