ZHU Guo-miao, et al. Mechanisms of Spinal Micro-adjustment Manipulations in Treating Cervical Spondylotic Radiculopathy
DOI: 10.1007/s11726-007-0068-7

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Copyright © 2007 Shanghai Research Institute of Acupuncture and Meridian

Critical Review

Mechanisms of Spinal Micro-adjustment Manipulations in

Treating Cervical Spondylotic Radiculopathy

ZHU Guo-miao(朱国苗), SUN Wu-quan(孙武权), SHEN Guo-quan(沈国权), FANG Min(房 敏)
Department of Massage, Yueyang Hospital of Integrative Chinese & Western Medicine Affiliated to Shanghai University
of Traditional Chinese Medicine, Shanghai 200437, P. R. China

提要

: 在探讨神经根型颈椎病发病机制的基础上，从生物力学角度阐释脊柱微调手法治疗

神经根型颈椎病的机理，即脊柱微调手法是通过恢复和改善颈椎动静力平衡来达到其较
好的临床疗效的。

关键词

: 颈椎病；推拿；按摩；综述文献

Summary: On the basis of the investigation of the pathogenesis of cervical spondylotic
radiculopathy, this paper studies the mechanisms of spinal micro-adjustment manipulations in
recovering and improving cervical dynamic and stationary balance from the perspective of
biomechanics.

Key Words: Cervical Spondylosis; Tuina; Massage; Review Literature
CLC Number: R246.9
Document Code: A

Cervical spondylotic radiculopathy (CSR), chiefly

based upon the degenerative cervical discs, refers to
the condition that the spinal nerve roots are stimulated
or compressed by the secondary changes of muscles
and joints around the neck and the degeneration and
hyperplasia of vertebral bodies nearby, manifesting
pain in the neck and upper limb and the sensation loss,
motor deficit and reflex alteration in the areas
innervated by the spinal nerves

[1]

. Cervical

spondylotic radiculopathy is the most common type
of cervical spondylosis, with the morbidity of up to
3.5‰ in common population and accounting for
about 60％of cervical spondylosis

[2]

. It most happens

in the people at the ages of 50-54

[3]

.

The stability of cervical vertebrae in normal people

consists of endogenous stability and exogenous
stability. Endogenous stability is a stationary balance
maintained by vertebral bodies, appendixes,
intervertebral discs and connecting ligaments;
exogenous stability, the primitive drive of spinal
movement, is a dynamic balance regulated and
controlled by cervical muscles. Under the regulation

Foundation Item: Supported by Shanghai Leading Academic
Discipline Project, Project Number: T0302

of nervous system, the balance of the structures of
endogenous stability and those of exogenous stability
are as between mast and cable. The physiological
movement and stability of the neck, based upon the
stationary balance, is regulated by muscular
contraction and relaxation, hence to make dynamic
balance

[4]

. The breakdown of the normal cervical

biomechanics balance is the vital cause of cervical
spondylosis, and any impairment of the structures of
endogenous and exogenous stability may lead to or
trigger the imbalance of the cervical structures

[5]

.

Chronic strain of cervical muscles due to long-term
abnormal postures is the leading cause. Impaired
muscle fibers and diminished muscle strength can
directly give rise to the breakdown of cervical
dynamic balance and imbalance between cervical
stationary and dynamic balance. Breakdown of
stationary balance can make the intervertebral discs,
ligaments and bony structures degenerate, aggravate
muscular injury and convulsion, further break
dynamic balance and produce vicious cycle, and bring
about systemic biomechanics dysfunction of the
whole neck and loss of cervical stability. Therefore, it
is argued that cervical spondylotic radiculopathy is
caused first by loss of dynamic balance and mainly by

Journal of Acupuncture and Tuina Science, Volume 5, Number 2, 2007 April

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loss of stationary balance

[6]

. In the advanced stage, the

intervertebral spaces become narrow and small joints
hyperplastic and the intervertebral foramens of
anteroposterior diameter and superoinferior diameter
shrink, stimulating nerve roots and sinu-vertebral
nerve of the recurrent branch of meningeal nerve, and
presenting clinical symptoms and signs. Some
researches revealed that loss of cervical stability,
including reduced height of intervertebral discs and
degenerative changes of anterior luschka joints and
posterior zygapophyseal joints, might narrow nerve
root canals and thus compress spinal nerve roots. This
is the most common cause of cervical spondylotic
radiculopathy, accounting for 70%-75%; in
comparison with lumbar disturbance, the cause of
nucleus pulposus herniation only accounts for
20%-25%

[5]

. Thereby, reestablishing the dynamic and

stationary balance and restoring cervical endogenous
and exogenous stability are the key solution to
effective treatment of cervical spondylotic
radiculopathy.

At present, the treatment method of cervical

spondylotic radiculopathy is classified as surgical and
no-surgical. Non-operative therapy, an effective
treatment means based on scientific analysis of
cervical spondylotic radiculopathy, can relieve or cure
cervical spondylosis, especially in the early and
intermediate stages. Non-operative therapy can hence
be thought of the main treatment method of cervical
spondylotic radiculopathy

[7]

. Among the non-

operative therapy, manual operation has become one
of the routine modalities of cervical spondylosis.
Clinical randomized controlled trials have showed
that manual operation has remarkable effects and
fewer side effects

[8]

.

The spinal micro-adjustment manipulation,

founded by Dr. SHEN Guo-quan, is an important
component of spinal massage. After many years of
clinical practice, it has been proved that this
manipulation plays a vital role in the treatment of
cervical spondylotic radiculopathy, with the
advantages of simple operation, quick action,
remarkable effects, low cost and safety. Spinal
micro-adjustment manipulation is now an extensively
used therapy in clinical practice for cervical
spondylotic radiculopathy. This manipulation is
carried out in three steps: The first step is a
preparation manipulation, also called loosening

manipulation; this step acts to relax the muscles of the
shoulder and ease the patient's mind, making a
preparation for the second step. The second step is
called micro-adjustment manipulation and is the key
manipulation of this spinal micro-adjustment
manipulation; this step functions to directly
manipulate the diseased vertebrae to enlarge
intervertebral spaces, rectify joints disturbance and
restore endogenous and exogenous stability of the
neck, hence to treat cervical spondylotic radiculopathy.
The third step is an ending manipulation and also
called strengthening manipulation; this step lays
emphasis on treating strain muscles and recovering
such soft tissues as muscles to maintain the
physiological balance of the neck. The essentials of
this spinal micro-adjustment manipulation are
presented as follows: a. Relaxation manipulation: The
patient lies on his/her side and naturally relaxes
himself/herself. The practitioner conducts one-thumb
manipulation, grasping manipulation, flicking
manipulation and kneading manipulation on the
muscles of the neck from up to down to relax them;
the shoulders are manipulated alternately, 3-5 min
each. B. Micro-adjustment manipulation: The patient
lies on his/her side. The practitioner places one hand
around the patient's mandible, with the thumb on the
transverse process of the diseased vertebrae and the
palm holding the mandible; the practitioner places his
other hand around the patient's nape, with the thumb
on the upper or lower transverse process of the
diseased vertebra and the palm holding the nape.
Stretch the patient's neck longitudinally for a moment.
When the intervertebral space is widened, deftly press
the processes with the thumbs to rectify the displaced
vertebral bodies. C. Ending manipulation: The patient
lies on his/her back. The practitioner holds the
patient's neck with both hands and gently stretches
and shakes head to relax the neck. Then grasping
manipulation, flicking manipulation and pressing
Quchi (LI 11) and Hegu (LI 4) are performed to
remedy the soreness and numbness, distention and
weakness of the upper limb, for 3-5 min.

Spinal micro-adjustment manipulation is initiated

on the basis of the pathogenesis of cervical
spondylotic radiculopathy, first of dynamic imbalance
and second of stationary imbalance. Spinal
micro-adjustment manipulation can relax the soft
tissues to improve the mechanics of the muscle

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Copyright©2007 Shanghai Research Institute of Acupuncture and Meridian

groups in the neck in the patients with cervical
spondylosis, and eventually relieve or even eliminate
such symptoms as neck pain

[9]

. Especially, this

manipulation can correct the sagittal displacement and
instability of the cervical vertebrae, improve and
restore the cervical physiological radian and spinal
prominence, redistribute the stress of vertebral bodies
front and hind vertebrae of the diseased segment, and
reduce the compression load of the front vertebra,
consequently to diminish the herniated intervertebral
discs and reestablish cervical stationary balance and
restore the endogenous stability of the neck. This
manipulation can also reduce skull gravity moment by
rectifying cervical recurvation, decrease the persistent
contraction of cervical extensor groups and cervical
load, improve the strain of cervical extensor groups
and consolidate cervical exogenous stability.
Reestablishment of cervical dynamic and stationary
balance, increased tension of nerve roots and
improvement of blood supply to nerve and spinal cord
indirectly alleviate the compression on nerve roots,
accelerate local blood circulation, relieve
inflammation and promote the absorption of
inflammatory factors to ease or cure clinical
symptoms and signs

[10]

.

Clinical researches have demonstrated that

conventional manipulations, the rotatory manipulation
in particular, can indeed alter the anatomical
structures inside the cervical canal obviously in the
treatment of cervical spondylotic radiculopathy. In the
presence of serious degeneration, larger osteophyte
happening on the vertebral margins or the larger
nucleus pulposus herniating into the vertebral canal,
rotatory manipulation may easily damage spinal cord
and increase the pressure inside the intervertebral
discs to make the discs protrude more possibly

[11]

. In

contrast with rotatory manipulations, spinal micro-
adjustment manipulation conducts tiny regulation on
vertebral segments instead of anatomical reduction,
not emphasizing the anatomical reduction but
homeopathic operation instead. Based upon the
reestablishment of cervical dynamic balance, spinal
micro-adjustment manipulation works to adjust the
abnormal positions of the diseased vertebral bodies
and joints to restore the cervical endogenous stability,
preventing violent manipulations from injuring the
cervical vertebrae. In spinal micro-adjustment
manipulation, the manipulating force acts on the

diseased segments directly rather than from other
segments, and the normal vertebral bodies are less
affected and the manipulation gets safer

[9]

.

Spinal micro-adjustment manipulation is quite

effective against cervical spondylotic radiculopathy,
but its biomechanics mechanism stays unknown. With
the deepening researches on the clinical efficacy and
biomechanics mechanisms of spinal micro-adjustment
manipulation in treating cervical spondylotic
radiculopathy, this manipulation will enrich the
treatment methods of cervical spondylotic
radiculopathy, and bring out great social and
economic benefits.

References

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Journal of Spinal Injury, 2004, 2(2): 123-126.

[2] Bogduk N. The Anatomy and Pathophysiology of Neck Pain.

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Epidemiology of Cervical Radiculopathy. A
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Biomechanical research on the main structure mechanical
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[9] JIANG Shu-yun, YAN Jun-tao, FANG Min, et al.

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Translator: XIAO Yuan-chun (肖元春)

Received date: October 20, 2006