TuiNa Orthopedics & Soft Tissue Therapies

TuiNa literally means manipulation and mobilization of soft tissue. It has a history of use and development as old as acupuncture and herbalism. It is a medical specialty that is part of hospital care in China and is quickly being recognized throughout the world. It has been called ‘Asian Massage’ and ‘Acupressure’ for want of a better term in the United States, but incorporates Shiatsu (which literally means finger pressing or manual point release), myofascial release, joint mobilization, soft tissue manipulation, and is traditionally used with topical herbal medicines and patient instruction in therapeutic techniques and correction of body mechanics. The Chinese term for physiotherapy is Li Liao.

Since it 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. Almost always, TuiNa involves focus upon the deep tissues. 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, Trigger Point Needling, and Active Release Technique

Myofascial release is a technique used to treat a chronic contracture 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. Instead of the nerves firing and than relaxing, the muscle is constantly firing. When this occurs, the chemicals that recycle in the contract and relax phases, mostly calcium and magnesium, instead build up in the tissues surrounding the point of innervation of the muscle, causing irritation and pain. A chronic inflammatory condition results. This condition may persist indefinitely.

Release of the myofascial dysfunction may be accomplished by a number of means. 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. 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. Other techniques of myofascial release include trigger point needling stimulation, and neuromuscular reeducation, such as learned techniques of reciprocal inhibition and contract-release.

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. These techniques, like acupuncture, are somewhat subtle and require some expertise and skill, and the patient needs to be instructed sufficiently in postural correction (ergonomics) and targeted stretch and exercise. 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.

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