TuiNa Orthopedics & Soft Tissue Therapies

TuiNa literally means manipulation and mobilization of soft tissue, and orthopedics is a medical specialty treating functional impairments and deformities of the skeletal system, including soft tissues such as joint capsules, cartilage, ligaments, tendons and muscles. TuiNa has a history of use and development in Traditional Chinese Medicine (TCM) as old as acupuncture and herbalism, and is combined with these treatment protocols. It is a medical specialty that is part of hospital care in China and is quickly being recognized throughout the world. TuiNa has been called ‘Asian Massage’ and ‘Acupressure’ for want of a better term in the United States.

TuiNa incorporates Shiatsu (which literally means finger pressing or manual point release), myofascial release, joint mobilization, soft tissue manipulation, and other manual techniques, and traditionally may be used with topical herbal medicines, as well as patient instruction in therapeutic techniques and correction of body mechanics. The Chinese term for physiotherapy is Li Liao, and TuiNa, needle stimulation, cupping, and other modalities are all physiotherapies included under the legal scope of practice of the California Licensed Acupuncturist. The science and practice of TuiNa is part of TCM and is distinctly different from the specialties of Physical Therapy, Chiropractry, and Osteopathy, but integrates well with these other medical specialties. The Licensed Acupuncturist may receive extensive training in TuiNa as part of the medical school curriculum, or may choose not to study this specialty, but more and more TCM physicians are opting to study this involved science. The patient needs to inquire whether the acupuncturist has received training in TuiNa.

Research in recent years has shown that deep tissue physiotherapies, such as Tui Na, also have many beneficial effects on the whole health (see the article entitled Deep Tissue Massage and it's many benefits on this website). Studies at UCLA Medical School and Cedars-Sinai have confirmed that deep tissue phsiotherapies benefit hormonal balance, immune function, and neurohormonal health. The rewards of a thorough and professional holistic approach to treatment, as practiced by this physician, are many, and each year the benefits are being confirmed by sound scientific study.

Since Tui Na is a very developed science, the techniques used may vary considerably from one practitioner to another. Much is dependant upon the level of study and background of the particular physician. You want to make sure that the Tui Na therapist has received extensive medical training and education. Almost always, TuiNa involves focus upon the deep tissues, and a thorough knowledge of anatomy and physiology is important insure positive effects. It is distinguished from massage of superficial tissues, which is called AnMo in China. Since it works directly on injured and inflamed tissues, this therapy can be uncomfortable, but as the tissues heal and become healthy, the discomfort is replaced by a good feeling of restoration. Here are some descriptions of pertinent aspects of TuiNa.

Myofascial Release, Neuromuscular Reeducation, Trigger Point Needling, and Active Release Technique

Myofascial release is a technique used to treat a chronic contracture and/or dysfunction of the muscle caused by strain. Myo- refers to muscle and fascia is the connective tissue that joins the muscle with surrounding tissues. When a muscle suffers a strain injury, either due to trauma or overuse, it may develop a chronic syndrome of constant contracture and dysfunction. Instead of the nerves firing and then relaxing, the muscle is constantly firing. When this occurs, the chemicals that recycle in the contract and relax phases, mostly calcium and magnesium, but also ATP (adenosine triphosphate) instead build up in the tissues surrounding the point of innervation of the muscle, causing irritation and pain, usually felt as a referred pain pattern. A chronic inflammatory condition may result, as well as a pathology of the nerves, now termed a denervation supersensitivity. This condition may persist indefinitely without treatment, and stress imbalances of deep stabilizing muscles may lead to joint irritation. A chronic myofascial syndrome may spread to surrounding neurons and even cause autonomic dysfunction over time.

Release of the myofascial trigger point and resolution of biomechanical dysfunction may be accomplished by a number of therapeutic techniques. Direct manual release involves application of pressure at the trigger point, or point of innervation of the muscle, until the muscle lacks the nerve flow to maintain the constant firing and contracture, forcing the normal contract and release mechanism. Repeated release should restore normal function, as long as the patient stops the repetitive strain, which is accomplished by correction of postural mechanics and targeted stretch and strengthening of the muscle or muscles. Other techniques of myofascial release include trigger point needling stimulation, and neuromuscular reeducation, such as learned techniques of reciprocal inhibition and contract-release. Postfacilitation stretch, positional release, and movement training are also types of neuromuscular retraining (NMR) that are now grouped under “mind-body” techniques. These techniques have a long history in both Chinese TuiNa and Japanese Shiatsu practice. Electrical stimulation and muscle defeat has also long been utilized, but may not have the impact of direct trigger point therapeutics.

Satellite trigger points may also need to be released, especially at the myotendinous junction, near the joint attachment, usually accomplished by an active release technique (ART). These techniques, like acupuncture, are somewhat subtle and require some expertise and skill, with active participation of the patient. The patient needs to be instructed sufficiently in postural correction (ergonomics) and targeted stretch and exercise as well to accomplish the goals of myofascial release and sustained neuromuscular reeducation. This holistic approach is vitally important to a positive outcome.

Myofascial syndromes may be the most prevalent cause of chronic pain as well as neuropathies. These neuropathies may be caused by mechanical impingement on the nerve as well as chronic inflammatory irritation. Myofascial release is most effective when all contributing factors are addressed in therapy. For this reason, a practice that emphasizes a proactive involvement in care is most successful. Correcting the causes of chronic injury, such as posture and ergonomics, or body mechanics, and addressing the underlying health problems that may be perpetuating your condition by inhibiting proper tissue repair, are important aspects of this care. By addressing myofascial pain with direct care as well as Systemic Medicine, a greater chance of complete success is possible.

Chronic pain syndromes often involve cognitive and behavioral perpetuators. Hypersensitivity to pain triggers (hyperalgesia), painful sensitivity to light pressure (allodynia), emotional pain associations, and dysfunction in the modulation of pain sensation (hypothalamic -limbic), are all hallmarks of chronic pain. Studies have shown that when the actual tissue triggers in referred pain are directly treated, that patients cognitively are able to objectify the pain triggers and causes more effectively, and with this comes a decrease in the difficult and confusing aspects of chronic pain syndromes. Patient instruction and education are also part of traditional TCM therapy and provide the means to help the patient improve both cognitively and behaviorally. Instruction in therapeutic activities helps the patient adopt a more proactive approach to their chronic pain syndromes that often provide great benefit within the holistic protocol. The behavioral aspect to treatment has also long been a hallmark of treatment in TCM, and is becoming highly touted in standard medicine again as a mind-body medicine. While the physiotherapies in Tui Na are time consuming, the benefits of this time spent in therapy can be very important. Standard medicine provides very limited time spent with the physician, and often the cognitive and behavioral aspects are not addressed. TCM thus integrates with standard medicine in an important manner.

Above: In Traditional Chinese Medicine, star anise is sometimes utilized for clearing phlegm, as a digestive aid, to improve appetite, and assist with digestion. Interestingly, natural chemicals found in chinese star anise were used in the development of Tamiflu, a commercial anti-viral drug.

— Photo: Michele Clement