Reduction Techniques for Dislocation and Fracture Correction

Repositioning manipulation techniques have the efficacy of correcting dislocations and realigning broken bones. They can not only make the fractured ends and dislocated joints fit properly, restore slipped or displaced joints, muscles, tendons, ligaments, etc., and reconnect the disordered meridians, but also separate adhered tissues. These techniques are mainly used for the reduction of fractures, joint dislocations, contusions, displacements, misalignments, displacement of muscles, tendons, and ligaments, cervical and lumbar disc herniation, and spondylolisthesis.

Manipulation techniques for reduction can be classified into three types: rotational reduction manipulation, levering reduction manipulation, and traction reduction manipulation:

1.Rotatory reduction manipulation

Rotation reduction manipulation, also known as rotary rocking reduction manipulation, is one of the reduction techniques and falls within the scope of passive movement. It can be divided into two types: rotation reduction manipulation for limb joints and rotation reduction manipulation for cervical and lumbar joints:

(1) Rotatory reduction manipulation for limb joints: The operating method involves the masseur holding the proximal limb of the rotated joint with one hand and the distal limb of the rotated joint with the other hand, performing gentle and slow circular rotations. In cases of mild joint subluxation, when resistance is encountered during rotation, the masseur uses the hand holding the proximal part of the rotated limb to push the slightly dislocated or displaced articular head into the joint socket to achieve reduction.

The rotation method has the effects of relaxing tendons and promoting blood circulation, smoothing joints, separating adhesions, and improving joint mobility. It is mainly used for joint pain, restricted joint flexion and extension, mild joint subluxation, and joint movement dysfunction.

(2) Cervical and lumbar joint rotation reduction technique The cervical and lumbar joint rotation reduction technique is primarily used for mild subluxation of cervical and lumbar joints and cervical and lumbar motion dysfunction.

The operational method is as follows: The patient sits in a seated position. The masseur stands behind the patient, supports the patient’s head or the opposite shoulder with one hand, and presses the thumb of the other hand on the affected vertebra. The masseur uses the hand pressing on the patient’s head or opposite shoulder to assist the patient in performing a rotational movement. When rotated to a certain arc, the masseur suddenly exerts inward pressure with the thumb pressing on the dislocated cervical or lumbar vertebra, and a “click” sound can be heard, indicating that the dislocated vertebra has been repositioned.

2. Pull-manipulate reduction method

Pulling manipulation for reduction is also one of the reduction-type techniques and falls within the scope of passive movement. Pulling manipulation has the function of rectifying wellness and correcting dislocations, and is mainly used for functional impairments of joints throughout the body, such as disarrangement or subluxation of the small joints in the cervical and lumbar spine.

The operating method of the pulling manipulation is as follows: Use both hands to exert force together in the same or opposite directions to extend or rotate the joint, enabling a dislocated or subluxated joint to be repositioned through a bouncing or sliding motion. Since the cervical and lumbar spine accommodate vital tissues and organs such as the spinal cord, nerves, and blood vessels, and their physiological structure is highly complex, extreme caution must be exercised when applying the pulling manipulation. It is essential to strictly grasp the indications and techniques of the manipulation. First, ensure stability; second, ensure accuracy; third, ensure dexterity, striving for success in one attempt. At the same time, it is important to follow the natural trend and not exceed the range of physiological traction, and never use brute force.

Pulling manipulation can be divided into:

Cervical spine rotation manipulation, also known as “cervical spine rotational reduction method”. When performing cervical spine rotation manipulation, it is essential to be steady and composed to avoid damaging the cervical spinal cord, nerves, and blood vessels due to the manipulation.

Lumbar vertebrae rotation-manipulation methods: They can be further divided into three types: oblique lumbar rotation-manipulation, lumbar rotational reduction manipulation, and lumbar posterior extension rotation-manipulation.

Shoulder joint manipulation techniques: These mainly include four types of movement methods for the shoulder joint, namely elevation, abduction, extension backward, and adduction.

Elbow joint pulling manipulation: It mainly refers to the flexion and extension movements of the elbow joint.

Wrist joint rotation-traction manipulation: It includes traction movement, flexion-extension movement, rotational movement, and left-right lateral flexion movement of the wrist joint.

It should be noted that the pulling manipulation is an enhanced technique of the rocking manipulation. The differences between them are as follows: the rocking manipulation can be performed by oneself within the physiological traction range or with the assistance of a masseur; the range of motion of the pulling manipulation is larger than that of the rocking manipulation and must be completed with the help of a masseur.

3.Traction reduction method

Traction reduction method is also known as “traction and pulling reduction method”, or referred to as extension method, leading-extension method, or pulling method, etc. Traction reduction method can widen the intervertebral space, promote the reduction of the dislocated (protruded) material, or helps with occasional the compressed tissues. It includes three types: “traction-compression reduction method”, “traction-lifting reduction method”, and “traction-pushing reduction method”. It is mainly used for the supports of fractures in various parts of the body, joint dislocations, malpositions, misalignments, joint synovial membrane incarceration, nerve root compression, tendon dislocation, cervical and lumbar intervertebral disc herniation, spondylolisthesis, and other conditions.

Traction reduction method can be further divided into manual traction, cloth strap traction, and mechanical traction, etc., based on the different traction appliances used.

(1) Traction and Pressure Reduction Method is mainly used for the supports of cervical and lumbar disc herniation, as well as the reduction of spondylolisthesis and deviated spinous processes.

Operational method: While using the traction method to widen the intervertebral space, apply pressure manipulation at the lesion site of the affected area, that is, the site of intervertebral disc bulging or herniation, or vertebral body slippage, protrusion, or spinous process deviation. This helps promote the return of the herniated intervertebral disc, slipped, protruded, or deviated vertebral body to its original position.

(2) Traction, elevation, and reduction method is primarily used for the reduction of anterolisthesis.

The operational method is as follows: The patient lies prone. Under the condition of applying strong traction, the masseur places both hands respectively under the patient’s left and right abdomen, holds their breath, and forcefully lifts the slipped part of the patient upwards to promote the reduction of the slipped vertebra.

Traction-pushing reduction method is mainly used for diaphyseal fractures and dislocation of the joints of the extremities.

Operative method: Depending on the different injured parts of the patient, the patient can assume a lying or sitting position. While traction is being applied, the massage therapist uses their hands to push the broken ends of the fracture or the dislocated joint head back to their original positions for reduction.

However, it should be noted that when performing manipulation techniques on the neck and waist, the traction force should not be too strong, the traction time should not be too long, and the intensity of massage techniques should not be too heavy to avoid causing other injuries. The duration of each traction and massage session should not exceed 30 minutes.

It is widely known that traction therapy aims to widen the intervertebral spaces, facilitating the reduction of herniated intervertebral discs, spondylolisthesis, protruding or deviated spinous processes, and dislocated articular heads, as well as relieving compression on tissues such as entrapped synovial membranes and compressed nerve roots. Currently, the “traction followed by massage and reduction” method is predominantly employed, yet its clinical outcomes are not entirely satisfactory. Based on the aforementioned principles, through repeated experimentation, we have developed a successful approach of “simultaneous traction, massage, and reduction.” Years of clinical practice have confirmed that this method yields excellent results in supports fractures, joint dislocations and subluxations, deviated or protruding spinous processes of the spine, altered spinal curvature, intervertebral disc herniation, and spondylolisthesis. This represents a major achievement in my decades-long career in massage therapy.