CMTN311. Session 05. Lumbar, Sacrum and Pelvis Region Disorders: Chinese Medicine Department.

Transcription

1 CMTN311 Session 05 Lumbar, Sacrum and Pelvis Region Disorders: Chinese Medicine Department

2 Session 05 Content Lumbar, Sacrum & Pelvis Disorders: o Foundation routine o Chinese medicine diagnosis o Treatment principle o Techniques of benefit o Rationale for each application o Clinical usage and outcomes o Mechanics of technique o Cautions and contraindications o Specific work, health and safety considerations o Demonstration and supervised practice of techniques to a variety of different Jing luo channels Endeavour College of Natural Health 2

3 Revision of 24 basic Tui Na Techniques Facial & Jaw Disorders Disorders of Cervical & Thoracic region Disorders of Upper Extremities Disorders of Lumber, Sacrum and Pelvis region Disorders of Lower Extremities Disorders of Chest, Hypochondrium and Abdomen Headache, Insomnia, Common cold and Asthma Epigastric pain, Constipation and diarrhoea Menstruation Disorders Pregnancy and Postpartum Disorders Endometriosis and Polycystic ovary Syndrome Review of Musculoskeletal, Internal and Gynaecological Disorders STUDENT NAME: ATTENDANCE (min. 80%) Continuous skill development SESSION ROUTINE Health & safety* Clean hands Tidy work area Patient management* Communication with patient comfort/pain Appropriate positioning/pillows Technique* Location Duration Variation Speed Rhythm Pressure Accuracy of technique Practitioner posture Comments: *Active participation required in each class. Mark each box with a tick as appropriate to indicate active participation in this activity. This is a pass/fail assessment. Sessions 1-6 were assessed on the mid-semester review. Endeavour College of Natural Health 3

4 Foundation Routine: Back and Waist Push the back along GV & BL meridians with one or both hands from GV14 to Eight Liao (BL31-34). Continued by pinching and grasping repeatedly along these meridians. This serves as the Adaptive level. Perform Analgesic techniques such as Kneading, Revolving, Pressing & Supressing. Focus on the area of disorder (lumbar/sacral in this case) on both sides of the spine along the meridians from top to bottom with fingers, palms, forearm and /or elbow. Strengthen the waist by revolving with forearm and rolling with hand on the waist until a warm sensation is achieved. Use beneficial techniques such as Plucking and Scrubbing on beneficial points or Ashi points for specific disorders according to pattern and diagnosis. Chop, Dotting, Patting & Hammer to dissipate. Endeavour College of Natural Health 4

5 Foundation Routine: Back and Waist back Where to use waist Sacral area Endeavour College of Natural Health 5

6 Mechanics & rationale of routine/techniques Relax tendons, active blood, dredge meridians, relieve pain, expel wind, disperse cold Relax the patient and acts as both the adaptive and beginning analgesic segment of treatment for disorders of the entire back area It is most effective when combined with other techniques for specific disorders. Often combined with simple mobilizations such as Stretching and Rotating to help realign the back. It is effective since it works on the entire back but also allows the practitioner to be able to focus on the area of injury Endeavour College of Natural Health 6

7 Techniques of benefit and clinical usage Indications: Common spine disorders caused by trauma, wind-cold-dampness or deficiency of kidney. Endeavour College of Natural Health 7

8 Chinese medicine diagnosis: Myofibrositis of the Back & Waist Qi Stagnation & Tendon Adhesion Blood Stasis & Tendon Adhesion Adhesion of tendon due to Cold- Damp Lumbar Pain & Stiffness due to Kidney Deficiency Endeavour College of Natural Health 8

9 Myofibrositis of the Back & Waist: Qi Stagnation & Tendon Adhesion S/S Stiffness, aching, weakness in the back & waist, worse with walking, alleviated by activities of the day but overexertion brings serious pain. Treatment principle Dredge the flow of qi, relax tendino-muscular meridians/sinew meridians Treatment Foundation Back and Waist Routine. Focus upon the area with the most stagnation, use Hua Tou & both Bladder lines to stimulate and ease the pain. Roll, Press & Knead into the legs; repeat on opposite side. Dissipative conclusion of the Foundation Back & Waist Routine. Stretch & Rotate the legs. Endeavour College of Natural Health 9

10 Myofibrositis of the Back & Waist: Blood Stasis & Tendon Adhesion S/S Spasm, pain & stiffness in the back & waist, inability to bend forward or look up; pain is localized & increased when turning. Palpation reveals stringy spasm of tendons & muscles. Treatment principle Resolve stasis, dredge collaterals, relax tendons and muscles Treatment Foundation Back and Waist Routine. Focus upon the area with the most stagnation, use Hua Tou & both Bladder lines to stimulate and ease the pain. Knead, Dot, Pinch or Press DU4, LR8, GB34, BL40, BL60, LR1-3. Dissipative conclusion of the Foundation Back and Waist Routine. Stretch & Rotate the legs. Endeavour College of Natural Health 10

11 Myofibrositis of the Back & Waist: Adhesion of tendon due to Cold-Damp S/S Heavy stiffness & pain in the lumbar region with difficulty bending forward or looking up, stiffness of tendons & muscles in the back & waist; worse with overwork & wet weather; desire for warmth, aversion to cold. Inability to sit or lie down for extended periods of time or to walk extended distance. Treatment principle relax tendons & muscles, regulate and promote the flow of qi & blood, dispel cold, eliminate dampness, dissipate stasis and relieve pain. Treatment Foundation Back and Waist Routine. Focus on the waist, stimulating BL23 & BL52. Knead/Roll/Revolve/Grasp/Pluck BL37, BL39, BL59, BL57, BL58, GB38 & BL60. Dissipative conclusion of the Foundation Back and Waist Routine. Stretch & Rotate the legs. Endeavour College of Natural Health 11

12 Myofibrositis of the Back & Waist: Pain & Stiffness due to Kidney Deficiency S/S Soreness of the back & waist with muscular atrophy & feebleness, serious weighty pain when bending forward or looking up; better with pressure; cold limbs, lassitude, clear urine, loose stool. Treatment principle Regulate and promote the flow of qi & blood, warm the middle jiao, invigorate kidney, soft tendons, rectify joints Treatment Foundation Back and Waist Routine. Focus on the waist, stimulating BL23 & BL52 first then using warming palm & vibrating. Press & One Finger Meditate on BL40, BL56, BL57, KID3, BL60. Dissipative conclusion of the Foundation Back and Waist Routine. Stretch & Rotate the legs. Endeavour College of Natural Health 12

13 Chinese medicine diagnosis: Prolapse of the Lumbar Intervertebral Disk Lumbar pain and stiffness and neuralgia of the hip are produced by this disorder. Often seen in yang and strong males Pathogenesis is overexertion of external trauma. TCM pattern according to Bi syndrome Endeavour College of Natural Health 13

14 Prolapse of the Lumbar Intervertebral Disk S/S Inability to stand up straight due to crushing pain, waist bends to unaffected side, standing is impossible without help. Can involve leg pain that comes gradually on one side and is aggravated by waist movement moves down the buttock, thigh and possibly ankle. Treatment principle Divide tendons, rectify joints, dredge obstruction, promote flow of qi and blood, resolve stasis, relive pain Treatment Work on the Healthy side first. Foundation Back and Waist Routine. Press & Revolve on BL40, BL57, ST36, GB30, GB34, GB39, BL60. Dissipative conclusion of the Foundation Back and Waist Routine. Stretch & Rotate the legs. Endeavour College of Natural Health 14

15 Most commonly occurring in middle aged patients, especially females. Result of repeated injury to the area. TCM pattern according to Bi syndrome. Chinese medicine diagnosis: Lumbosacral Strain S/S Vague heavy pain in lumbosacral region, tender around DU3, BL26, BL31; stiffness in waist, restricted motion of the hip & inability to carry weight on the back. Serious cases walking is difficult; symptoms are aggravated with weather change, menstruation or bending the waist for extended periods of time. Treatment principle divide tendons, rectify joints, dredge meridians, active collaterals resolve stasis, relieve pain, soften tendons, ease joints Treatment Foundation Back and Waist Routine. Focus on stimulating Ba Liao points (BL31-34) both sides, revolve/suppress GB30 &BL54. Press & Pluck on BL40, BL57, KID3, BL60, SP6. Stretch & Rotate the legs. Endeavour College of Natural Health 15

16 Cautions and contraindications with specific work, health and safety considerations Endeavour College of Natural Health 16

17 Foundation Routine: Back and Waist (Modified) Push & Roll the back, Press along the Hua Tou Jia Ji & Bladder Channels this serves as the Adaptive level. Focus on the area of disorder. Kneading & Plucking, Scrubbing on beneficial points or Ashi points. Knead & Roll around the hip to stimulate blood flow. Suppress GB30 & BL54 then repeat on opposite side. Chop, Dot, Pat, Hammer to dissipate. Endeavour College of Natural Health 17

18 Chinese medicine diagnosis: Sacroiliac Joint Injury The various tendons located around the sacroiliac joint become relaxed & flaccid in women who have had multiple births; it also occurs in physically active young men. TCM pattern according to Bi syndrome S/SL: Swelling and pain at the sacroiliac, attempts to stand up bring squeezing localized pain, hip ROM is restricted and walking is difficult; tenderness is felt from BL27-BL29. Treatment principle: reposition, soften tendons, ease joints, resolve stasis, relieve pain Treatment: modified Foundation Back & Waist Routine. Forearm Knead Ba Liao (BL31-34). Press & Knead BL27-30, BL40, SP6. Dissipative conclusion of the modified Foundation Back &waist Routine. Stretch & Shake the legs. Endeavour College of Natural Health 18

19 Chinese medicine diagnosis: Traumatic Arthritis of the Hip Joint The hip joint is a type of void aperture in TCM and is rich in qi & blood. It is easily injured by falling, sudden movement or impact. Resulting in swelling, localized pain and restricted of movement. Often seen in teenage. TCM pattern according to Bi syndrome S/S: Stringy spasm of muscles in the buttocks; tenderness at GB30, swelling & protrusion at LIV10-11 that is resistant to pressing. If the tendons & muscles are twisted the feet are misaligned and the patient may hobble. If the tendon is in spasm, the patient will walk on tiptop. Patients with joint stickiness walk sideways with protruding buttocks. Serious cases will see the hip remaining flexed and it cannot be straightened; there is also a reluctance to move due to sharp pain. Endeavour College of Natural Health 19

20 Traumatic Arthritis of the Hip Joint: Treatment Treatment principle: divided tendons, rectify joints, activate blood, resolve stasis, relieve spasm and pain Modified Foundation Back & waist Routine. Forearm Knead the Waist. Press & Knead GB34, ST36, SPL8, SP7, SP4, SP6. Dissipative conclusion of the modified Foundation Back & waist Routine. Stretch & Shake the legs. OR 1) Modified Foundation Back & Waist Routine 2) Forearm Knead the Waist; Squeezing & Tweaking (stronger) afterwards. 3) Press & Knead GB34, ST36, SP8, SP7, SP4, SP6. 4) Roll the three Leg Yin Meridians. 5) Mobilize the knee to stretch & rotate the hip. Endeavour College of Natural Health 20

21 Trauma to the Piriformis Qi Stagnation: Spasm & Pain in buttocks after injury, restricted hip ROM. Eventually extends into thigh; can experience tearing pain & cramping. Useful Points: GB31, LIV8, GB34-35 Blood Stasis: Spasm & Pain in buttocks after injury, swelling, palpable hardness or nodular structures; reluctance to move due to pain felt along the Shao Yang meridian of the foot; symptoms are worse at night. Useful Points: GB31, ST36, GB36 Treatment principle: relax tendons & muscles, dredge and promote the flow of qi and blood, relieve spasm and pain Treatment: 1) Modified Foundation Back & Waist Routine. 2) Suppress-Knead GB30. 3) Roll & Knead down the leg focusing on useful points. 4) Stimulate the three Yin channels of the leg. 5) Dissipate & Stretch/Rotate the legs. This routine is also effective for Sciatica. If treatment is ongoing, focus more on the healthy side for every third massage. Endeavour College of Natural Health 21

22 Bruised Coccyx S/S: Swelling, distension and heavy pain at the space between the coccyx & sacrum; spasm of related muscles/tendons. Palpation reveals an angular dislocation of the coccyx (floating effect) with aggravation of symptoms upon sitting or being supine; waist is bent with inability to straighten and there is pain upon defecation. Treatment principle: reposition, active blood, resolve stasis, relieve spasm and pain Treatment: 1) Modified Foundation Back & Waist Routine remaining above the sacrum. 2) Gentle Dotting of DU2-7, DU9 & DU14. 3) Mobilize the leg within the limits of the pain threshold. Caution: Be wary that this injury is still considered a dislocation and as such you should ensure that the patient has had scans done on the area before you even consider treatment. If it is safe to treat, stay above the sacrum & only use gentle motions; trying to readjust the coccyx is beyond the scope of our medical practice. Endeavour College of Natural Health 22

23 Case Study 1 Male, 31 years old complains of lower back pain. Weight lifter, trains minimum 5x a week. Unable to stand up straight and refers down the leg. Pain registers as 9/10. One week duration, affecting sleep. Tongue has purple spots & Pulse is Wiry. Endeavour College of Natural Health 23

24 Case Study 2 Male, 38 years old complains of lower back pain. Works in a corporate environment; often working overtime. Heat & Pressure alleviate the pain. Pain is more dull ache & also found in the knees. Back feels cold and empty upon palpation. Tongue is pale/flabby & Pulse is deep/weak. Endeavour College of Natural Health 24

25 Case Study 3 Female, 40 years old complains of lower back pain. Works during the day, studies at night, has 3 kids. Has had this type of pain before; worse when menstruating. Aggravates when schedule becomes busier. Cannot bear weight on her back. Tongue has purple spots & Pulse is Deep/Thready. Endeavour College of Natural Health 25

26 Case Study 4 Male, 24 years old complains of lower back pain. Brick layer who works 5x a week. Pain starts at the buttocks and refers down the leg. Has to take time off work as movement aggravates symptoms. One week duration, affecting sleep. Tongue has purple spots & Pulse is Deep/Thready. Endeavour College of Natural Health 26

27 Case Study 5 Female, 28 years old complains of severe lower back pain. Fell over while running as it started to rain heavily. Has had lower back pain previously but never sharp like this. Unable to sit for long periods of time. Extreme discomfort when defecating. Tongue has purple spots with extended hypoglossal veins & Pulse is thready. Endeavour College of Natural Health 27

28 References o Chengnan, S 2000, Chinese bodywork: a complete manual of Chinese therapeutic massage, Pacific View Press, Berkeley, CA. o Legge, D 2011, Close to the Bone (3 rd edition), Sydney College Press, Australia. o Li, FY 1997, Chinese self massage therapy, Blue Poppy Press, USA. o Pritchard, S 2010, Tui na: a manual of Chinese massage therapy, Churchill Livingstone, Edinburgh. Endeavour College of Natural Health 28

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