J. Acupunct. Tuina. Sci.

(2009) 7: 110-112
DOI: 10.1007/s11726-009-0110-z

Clinical Report

Tuina plus Traction for Cervical Distortion in Teenagers:

A Report of 40 Cases
TANG Jian-hua (), LIU Yong (), ZHANG Xian (), ZHANG Xing-guo ()
The Spinal Disease Department, Wuxi TCM Hospital, Jiangsu 214001, P. R. China

40
1 10 1 2
15
20 5

AbstractObjective: To observe the clinical effect of tuina plus traction for cervical
distortion in teenagers. Methods: Tuina plus traction was applied to 40 teenagers with cervical
distortion once every other day, and 10 days make up 1 treatment course. The therapeutic effect
was evaluated after 2 courses. Result: Significant changes occurred after the treatment: 15 cases
got correction, 20 cases got substantial improvement and 5 cases got certain improvement.
Conclusion: Tuina plus traction works effectively for abnormal cervical physiological curve in
teenagers.
Key WordsSpondylosis; Traction; Chiropractic; Tuina; Massage
CLC NumberR244.1
Document CodeA
Because of long-time sitting position or upper
respiratory tract infection, abnormal physiological
curve of the cervical vertebrae, especially cervical
distortion occurs to more and more teenagers.
Teenagers with this condition may present with a
series of symptoms that result from curve changes of
cervical vertebrae affecting normal balance of cervical
muscles and compressing the carotid artery and spinal
nerves. As a result, its particularly important to
restore the physiological curve and the inherent
balance inside the spine in conservative therapies[1, 2].
The author treated 40 cases with hyper-extensive
traction plus short-lever micro-adjustment and
obtained significant effects. The report is now as
follows.

1 Clinical Data
1.1 General material
Among the 40 cases, boys: 12; girls: 28; the
youngest: 10; the oldest: 18; the shortest duration: 6
Author: TANG Jian-hua (1972- ), male, attending physician

110

days; and the longest duration: 6 months. Stiff-neck

type: 22 cases; pattern of cervical radiculopathy: 5
cases; pattern involving vertebral artery: 8 cases; and
a mixed pattern: 5 cases. X-rays showed changes of
physiological curves, deviated spinous processes,
asymmetric uncovertebral joints, and stenosis of
intervertebral space (distortion: 27 cases; and
straightened: 13 cases). Organic diseases are excluded
in all cases.
1.2 Observation of indexes
The physiological curvatures were measured before
and after treatment with Borden method[3]; the
maximal perpendicular depth from the posterior
border of odontoid process of C2 to the posteriorinferior border of C7 in lateral radiographs were
measured: the normal value is (125) mm, >17 mm
indicates an enlarged curve, <7 mm indicates a
straightened one; a negative value indicates distortion.
The values in all cases are less than 7 mm.

Copyright2009 Shanghai Research Institute of Acupuncture and Meridian

J. Acupunct. Tuina. Sci. (2009) 7: 110-112

2 Treatment Methods
2.1 Traction
Elevate by 30 cm of the bed blocks in the side of
headstock and ask the patient to take a flat lying
position with an elevation of 7-10 cm beneath the
shoulder. Put a round pillow 10 cm in diameter
beneath the occiput to make a hyperextension for
traction. The traction weight: 2-4 kg. Duration: 4560 min. The treatment was done twice a day and 10
days made up 1 course.
2.2 Tuina
After traction, the practitioner applies tuina
manipulations[4].
Ask the patient to take a sitting position: apply
Dian-an (digital pressure), Rou-an (kneadingpressing), Na-nie (grasping-pinching), Tan-bo
(plucking), and Gun-rolling manipulations to relax
cervical muscles including sternocleidomastoid,
anterior scalenus muscle, levator scapular muscle,
erector spinae muscle and latissimus dorsi muscle for
about 10 min.
Still in a sitting position: 1) hold the lower
mandible with a flexed elbow joint and contact the
temporal-occipital region with fingers, push-press the
deviated spinous process with another hand; 2) ask
the patient to flex the neck until the sensation in
thumb that the space above the deviated spinous
process start to separate; 3) maintain the amplitude of
neck flexion, pull and stretch the head and neck
longitudinally upward and then rotate toward the
healthy side for about 10; and 4) with a sensation of
the patients cervical muscle relaxed, increase the
rotation of head and neck by 3-5suddenly and at the
same time push the spinous process with the thumb. A
"crack" sound often indicates a successful adjustment
(Fig.1).
Or ask the patient to take a prone position and ask
an assistant to support the patients mandible with one
hand and hold the occiput with another hand for
longitudinal parallel pulling and traction. The
practitioner stands on one side of the patient: press the
contralateral spinous process of the inferior vertebra
with one thumb to stabilize, press the deviated
spinous process with the thumb of another hand; and
then gradually increase force until a sensation of the
patients cervical muscle relaxed or a shifting

sensation between the two adjacent spinous processes.

A sudden increase in force at this time can also cause
a "crack" sound indicating a successful reposition
(Fig.2).

Fig.1. Repositioning by pulling, stretching and rotating the neck

Fig.2. Repositioning by pulling and stretching of two people

Ask the patient to take a sitting position: hold the

lower mandible with one palm and press the top of
distorted cervical vertebra with another palm root;
support the cervical vertebra with palm and fingers
and gradually pull and stretch the neck upward; with a
sensation of the patients cervical muscle relaxed,
push upward suddenly with the hand holding the
lower mandible to make a 5-10 of a posterior
extension of the head and neck, and at the same time,
push forward with the palm root of another hand to
adjust the cervical curve (Fig.3).

Fig.3. Repositioning by posterior-extension of cervical vertebrae

After above manipulations, ask the patient to wear

a cervical gear to protect the neck. The treatment was
done once every other day, and 10 times made up 1
course. The therapeutic effect was evaluated after 2
courses.

Copyright2009 Shanghai Research Institute of Acupuncture and Meridian 111

J. Acupunct. Tuina. Sci. (2009) 7: 110-112

3 Therapeutic Effect Observation

3.1 Therapeutic effect criteria
This is based on The Diagnostic and Therapeutic
Effect Criteria for TCM Diseases and Syndromes[5]
issued by the State Administration of Traditional
Chinese Medicine, coupled with X-ray and
measurement of cervical curvatures by Borden
method.
Recovery: Disappearance of symptoms and signs,
normal muscle strength, normal functions of neck and
limbs, ability to manage daily life and work, no
recurrence after a 3-month follow up, a normal value
of cervical curvature, and correction of distortion;
Marked effect: Symptoms such as pain in the neck,
shoulder and neck substantially alleviated, or
disappearance of original symptoms despite a possible
recurrence by some inducing factors, improved
functions in neck and limbs, the cervical curvature is
less than 7 mm and an apparent improvement of
distortion;
Improvement: The symptoms and signs alleviated,
the cervical curvature value is either less than 7 mm
or negative, and a slight improvement or no change of
the distortion;
Failure: The symptoms and signs remained same, a
negative value of cervical curvature and no
improvement of the distortion.
3.2 Treatment result
After the 2 courses, 15 among 40 got recovery, 20
got marked effect and 5 got improvement.

4 Discussion
Clinically, over 80% of the patients with cervical
spondylosis share alterations of cervical vertebrae,
which may affect the normal balance of cervical
muscles and result in fatigue-related spasm of local
muscles and ligaments as well as aseptic
inflammation. In severe conditions, this may affect
the vertebral artery or compress spinal cord or nerves,
leading to varieties of symptoms.
Because of long-time sitting position and lack of
cervical exercises, teenagers are more susceptible to
straightened or distorted cervical curvatures. Cervical

distortion results from structural adjustment

compensation due to disequilibrium and the
remaining of stress can worsen this condition, its
necessary to make an early detection and early
intervention.
Appropriate hyper-extensive traction and tuina
manipulations can relax the adhesion between nerve
root and tissues, widen the intervertebral space,
increase blood circulation, resolve edema, relieve
muscle spasm, regulate the mechanical disorders, and
restore the normal stability[6,7].
We found that despite the disappearance of clinical
symptoms in some cases, they still have cervical
distortions. It needs more studies to confirm whether
further treatment can restore the normal curvature.
For teenagers, its important to protect their necks.
It can be helpful by avoiding one position for long
time plus more cervical exercises.

References
[1] WANG Xin-wei, DENG Ming-gao, CHEN De-yu, et al.
Comparison of Three Methods in Restoring Normal
Cervical Curve and Intervertebral Height. Journal of
Cervicodynia & Lumbodynia, 2004, 25 (1): 10-12
[2] WEI Gui-kang, WEI Jian, HUANG Rong, et al. Clinical
Study on Effect of Manipulations on Cervical Curvature.
Chinese Journal of Traditional Medical Traumatology &
Orthopedics, 1999, 7(5): 13-15
[3] YE Fa-gang, CHEN Bo-hua, ZHOU Bing-wen. X-ray
Findings and Diagnosis for Degenerative Cervical
Instability. Chinese Journal of Surgery, 1993, 31(8): 465.
[4] SHEN Guo-quan, YAN Jun-tao. Illustrated Tuina
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[5] The State Administration of Traditional Chinese Medicine.
The Diagnostic and Therapeutic Effect Criteria for TCM
Diseases and Syndromes.Nanjing: Nanjing University Press,
1994: 186-189.
[6] QIAN Qing-lan, CUI Yun-hua. Treatment of 98 Cases with
Vertebral Artery Cervical Spondylopathy by Electroacupuncture plus Massage. Shanghai Journal of
Acupuncture and Moxibustion, 2006, 25(8): 16-17.
[7] YANG Chong. Therapeutic Effect of Acupuncture plus
Tuina on Cervical Spondylosis. Journal of Acupuncture and
Tuina Science, 2008, 6(6): 344-346.

112 Copyright2009 Shanghai Research Institute of Acupuncture and Meridian

Translator: HAN Chou-ping ()

Received Date: August 31, 2008