Danger of injudicious use of tui-na therapy in ankylosing spondylitis
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Tui-na is a very important component of Chinese medicine. It is a well-respected treatment modality known to be helpful and safe for a wide range of conditions. It can be considered as a certain kind of massage which is performed at acupoints, meridians, and collaterals by pushing, finger twisting, grasping thumb waving pressing, patting, palm twisting, and other manipulation techniques. At present, it is extensively used for relieving pain and stiffness associated with ankylosing spondylitis in China, even though there is a lack of evidence to support its validation and feasibility. The patient in this case was treated by tui-na massage at acute flare-up of ankylosing spondylitis and ended up with catastrophic results.
KeywordsAnkylosing spondylitis Cervical dislocation Tui-na therapy
Ankylosing spondylitis (AS) known as rheumatoid spondylitis has a characteristic of not only reduced but also increased bone formation which contributes to joint ankylosis and syndesmophyte formation, especially in advanced stages . Osteoporosis is considered as a common feature of AS even in early period of the disease . Tui-na is an important part of Traditional Chinese Medicine and is alternatively used in combination with acupuncture and other manipulation techniques to treat AS in China [3, 4]. In this case, the patient with AS was injudiciously treated with tui-na therapy for neck pain and stiffness and end up with catastrophic results.
Tui-na, being part of Traditional Chinese Medicine, is an ancient tradition, which is commonly used in China because of its success in treating specific musculoskeletal disorders (neck/back pain, sciatica, and arthritis) and chronic stress-related disorders of multiple systems. It involves various technical manipulations conducted by the practitioner’s finger, hand, elbow, knee, or foot applied to muscle or soft tissue at specific body locations. Tui-na also incorporates many of the principles of acupuncture, including the use of acupoints. For example, tui-na often uses manual techniques such as pushing, rubbing, kneading, or high-intensity, high-frequency patting to clear energy blocks along specific meridians associated with particular conditions . The infinite variations of tui-na application are derived from skilled use of the fundamental application of depth, pressure, drag, direction, speed, rhythm, frequency, and duration for variation in the quality of touch. All manipulations introduce mechanical forces into the soft tissues. These forces, which are set in the soft tissue, stimulate various physiologic responses . The five kinds of force that can affect the tissues of the body are compression, tension, bending, shear, and torsion. Among them, compressive forces occur when two structures are pressed together; the force is applied perpendicularly. It is described as depth of pressure and is used therapeutically to affect circulation, sensory, and autonomic nerve stimulation, nerve chemicals, and connective tissue pliability. Therefore, it is alternatively used in combination with acupuncture and other manipulation techniques to treat AS in China [3, 4].
Though tui-na is an alternative and effective method in treating patients with AS, the practitioner needs to be more cautious to tui-na manipulation choice. Compression above thoracic spine should be avoided in AS patients.
Author contribution statement
All authors contributed to patient care and writing of the report. Written consent to publication was obtained.
Compliance with ethical standards
Conflict of interest
National Natural Science Foundation of China (Project No. 81501651).
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