Case Report

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Journal of Acupuncture Research 2025; 42:73-79

Published online February 5, 2025

https://doi.org/10.13045/jar.24.0065

© Korean Acupuncture & Moxibustion Medicine Society

Abnormal Cervical Spine Curvature Improved by Korean Medicine Treatment with Chuna Therapy: A Case Report

Sun Jin Bae , Yeon Soo Kang , Pil Je Park , So Jeong Kim , Hyun Jin Jang , Jeong Kyo Jeong , Kwang Sik Yoon , Ju Hyun Jeon , Young Il Kim

Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea

Correspondence to : Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75 Daedeok-daero 176 beon-gil, Seo-gu, Daejeon 35235, Korea
E-mail: omdkim01@dju.kr

Received: November 21, 2024; Revised: December 2, 2024; Accepted: December 9, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

This study discussed significant improvements in the cervical spine curvature and decreased pain levels after receiving combined Korean medicine treatments, including Chuna therapy, in a patient diagnosed with abnormal cervical spine curvature accompanied with neck, shoulder, and upper back pain. In addition to Chuna therapy, the patient received both inpatient and outpatient treatments between January 11, 2022, and February 26, 2022, including acupuncture, pharmacopuncture, electroacupuncture, herbal medicine, and physiotherapy. The patient’s condition was assessed by measuring the range of motion (ROM) to determine joint mobility, the numerical rating scale (NRS) was used to assess pain levels, and Jackson’s angle on radiography was utilized to assess cervical spine curvature. After treatment, the patient’s pain level decreased from NRS 5 to 1–2, with significant improvements in cervical ROM and Jackson’s angle.

Keywords Abnormal cervical curvature; Chuna therapy; Combined Korean medicine; Jackson’s angle; Numerical rating scale; Range of motion, articular

The normal cervical spine curvature is formed by the height difference between the anterior and posterior parts of the cervical intervertebral discs [1]. The spinal curvature enhances shock absorption and helps maintain stability and equilibrium [2]. Jackson’s angle, which is used to assess cervical lordosis, is measured by drawing an extension line along the posterior vertebral bodies of the 2nd and 7th cervical vertebrae and measuring the angles of the tangent lines. On average, 21–44° is considered normal, < 21° is categorized as hypolordosis, and > 44° is classified as hyperlordosis [3]. Each centimeter in the anterior deviation adds 2–3 kg of load on cervical spine. Improper posture can increase pressure on the cervical spine and cause musculoskeletal disorders and structural deformities [4].

Treatments for cervical spine curvature abnormalities include surgical and conservative treatments such as exercise and physical therapy. Surgery for severe neurological disorders is recommended only after conservative treatment owing to the risk of postoperative complications [5].

Korean medicinal treatments for cervical spine curvature include Chuna therapy [6-9], herbal medicine [10], and acupuncture [11]. Park et al. [7] reported cervical spine kyphosis and lordosis reversal using the Nakcha correction technique in patients with chronic cervical pain. Ryu et al. [8] compared an experimental group using the cervical spine extension correction method with a control group that received only acupuncture, and pain improved in the former group. However, they did not confirm curvature recovery. Han et al. [9] confirmed the recovery of cervical lordosis with cervical extensor traction exercise; however, there were not enough cases to confirm the change in pain and cervical curvature after using the supine cervical extension and cervical muscle energy technique (MET). Therefore, improvements in cervical lordosis restoration and neck pain were confirmed using a combination of Chuna therapy and Korean medicine for cervical spine curvature abnormalities.

A 19-year-old female visited the ○○ University ○○ Korean Medicine Hospital 11 times between January 11, 2022, and February 26, 2022.

1. Chief complaints

The patient complained of neck pain and restricted range of motion (ROM) of the cervical spine.

2. Onset

Symptoms occurred following a traffic accident on January 11, 2022.

3. Past history and present illness

None.

4. Physical examination findings

No limitation in the cervical ROM flexion, bilateral rotation, or lateral bending; however, pain was accompanied by an ROM at 50° during extension.

5. Radiology findings

During admission, whole-spine in anterior–posterior and lateral views revealed straightening of the cervical lordosis.

6. Evaluation criteria

1) Numerical rating scale

This scale was used to objectively evaluate the subjective levels of pain. Patients rated their pain from 0 (no pain) to 10 (worst imaginable pain). Numerical rating scale (NRS) assessments were performed daily at 7 A.M. during hospitalization and during each outpatient visit.

2) Cervical range of motion

For objective measurement of the cervical ROM, flexion, extension, bilateral lateral bending, and rotation were assessed. ROM was documented for each movement, and if pain was felt during movement, the result was marked positive (+). Measurements were recorded daily at 7 AM during hospitalization and each outpatient visit.

3) Cervical Jackson’s angle

For comparison of the cervical spine curvature before and after treatment, lateral radiographs were recorded, and Jackson’s angles of the cervical spine were measured.

7. Treatment methods

1) Acupuncture

Acupuncture was performed twice daily, once in the morning and once in the afternoon, during hospitalization and once during each outpatient visit. Needling was performed using a single arc needle (0.25 × 30 mm, sterilized stainless steel; Dongbang Medical). Acupuncture points, including BL10, BL11, BL12, GB20, GB21, EX-HN15, and EX-B2, were needled bilaterally at a depth of 5–10 mm, and needles were retained for 15 minutes. Transcutaneous infrared irradiation therapy (IR-880, 220 V, 60 Hz; ITC Co., Ltd.) was used on the affected area.

2) Electroacupuncture

Electroacupuncture was performed for 15 minutes at a frequency of 3 Hz using an electroacupuncture device (STN-111; StraTek) on bilateral BL10 and GB20, areas where the patient experienced tenderness.

3) Pharmacopuncture

Pharmacopuncture was performed once daily during hospitalization and once weekly during each outpatient visit using the same method. So-yeom pharmacopuncture (2 cc, Association of Korean Pharmacopuncture Institute) was extracted into a 1-mL syringe (26 G × 13 mm syringe; Jeonglim Medical Industry Co.) and injected into bilateral BL10 and GB20 using a sterile needle (30 G × 38 mm; Sungshim Medical Co., Ltd.), with 0.5 mL administered at each of the four points for a total of 2 mL.

4) Herbal medicine

From January 11, 2022, to February 26, 2022, the patient took 10 packs of Hoesusan-gagam, consuming one pack (120 mL per pack) twice daily after meals (Table 1).

Table 1 . Herbal composition of Hoesusan-gagam and daily dosage

Botanical name (herbal name)Dose (g) per day
Cyperi Rhizma8
Perillae Herba8
Linderae Radix6
Aurantii Nobilis Pericarpium6
Atractyodis Rhizoma6
Cnidium officinale Makino4
Angelicae Dahuricae Radix4
Platycodi Radix4
Aurantii Fructus4
Angelicae Koreanae Radix4
Araliae Cordatae Radix4
Chaenomelis Fructus4
Bombycis Corpus4
Glycyrrhizae Radix2
Zingiberis Rhizoma12
Zizyphi Fructus8


5) Physical therapy

During hospitalization, interferential current therapy (ICT), deep heat therapy (M/W), and transcutaneous electrical nerve stimulation were applied to the patient’s cervical region once daily for 15 minutes. During each outpatient visit, ICT and M/W were applied once for 15 minutes.

6) Chuna therapy

Supine cervical extension and MET were performed by an experienced practitioner using a Chuna table. From January 11, 2022, to January 15, 2022, seven Chuna treatments were administered: one during the inpatient period (January 14, 2022) and six during outpatient visits (January 18, 2022, to February 26, 2022).

First, supine cervical extension is performed with the patient lying in the supine position. The practitioner uses the middle fingers to apply pressure to the cervical facet joints, moving them left and right. To elevate one segment at a time, the articular surface is palpated and pushed laterally. The practitioner then touches the patient’s articular processes with their fingertips and massages the back to stretch and correct both sides simultaneously. These steps are repeated 2–3 times, starting from the 6th to the 2nd cervical vertebra [12].

Second, the primary targets of the MET are the sternocleidomastoid, levator scapulae, and upper trapezius muscles, which were tender to palpation. The patient is guided to perform isometric contractions while the practitioner applies a counteracting force for 6–7 seconds. Following this, the patient releases the force, allowing the muscle to extend to the limiting barrier in a relaxed state [12].

8. Results

At the initial visit on January 11, 2022, the patient had neck pain of NRS 5, which decreased to 3–4 after treatment. On January 15, 2022, day 5 of treatment, the pain decreased to NRS 2. Upon admission, cervical ROM was limited to 50° because of pain during extension. On discharge, all end-angle pain resolved without cervical ROM limitations. Her pain remained at NRS 1–2 without ROM limitations during outpatient care (Table 2, Fig. 1).

Fig. 1. Changes in the NRS score during the treatment period. NRS, numerical rating scale.

Table 2 . Changes in cervical ROM during the treatment period

Cervical ROMJanuary 11, 2022 (before treatment)February 26, 2022 (after treatment)
Flexion (°)4545
Extension (°)50 (+)55
Lateral bending (°)45/4545/45
Rotation (°)60/6060/60

(+): the angle that the patient expressed pain.

ROM, range of motion.



Furthermore, whole-spine anterior–posterior and lateral radiographs taken on January 11, 2022, showed a Jackson’s angle of 11.10°, indicated hypolordosis. After treatment, including 7 Chuna sessions, radiograph on February 26, 2022, showed an angle of 39.67°, and Jackson’s angle was restored within the normal range (Table 3, Figs. 2, 3).

Fig. 2. Lateral view of the cervical curvature. (A) Before treatment. (B) After treatment.

Fig. 3. Treatment timeline during the period. NRS, numerical rating scale.

Table 3 . Changes in Jackson’s angle during the treatment period

January 11, 2022 (before treatment)February 26, 2022 (after treatment)
Jackson’s angle (°)11.1039.67

The human body uses the posterior cervical muscles to stabilize the head and cervical spine [13]. An abnormal cervical curvature results in persistent strain on the posterior cervical muscles, such as the cervical erector spinae, suboccipitalis, subscapularis, semi-polaris, and trapezius, leading to headaches, cervical pain, and decreased cervical ROM [14].

The mechanical stress of a traffic accident can increase fatigue in the cervical muscles, reducing the muscular support needed to maintain a balanced posture. This situation can lead to increased tension in the cervical extensor muscles, which can contribute to the forward displacement of the head. Maintained posture can lead to the hyperextension of the ligaments and deformation of the spinal joint discs [15].

In this study, acupuncture was performed on BL10, BL11, BL12, GB20, GB21, EX-HN15, and EX-B2. These points were selected based on a study showing that needling the cervical Jiaji points can reduce posterior cervical muscle tension and that acupuncture in the cervical region can improve local blood circulation and alleviate nerve irritation symptoms [16].

In electroacupuncture, the low-frequency electroacupuncture stimulation of 3 Hz has a lasting analgesic effect [17] and helps control pain. So-yeom pharmacopuncture was used, which can significantly alleviate pain in patients with acute inflammation [18]. In a previous study [19], So-yeom pharmacopuncture demonstrated anti-inflammatory effects by inhibiting the production of inflammatory cytokines and free radicals.

Hoesusan-gagam was used as herbal medicine. It is classified as a Qi-regulating and harmonizing formula [20] to regulate Qi, invigorate blood circulation, and alleviate neck pain and ROM limitations.

Chuna therapy addresses structural or functional problems by inducing effective stimulation to human skeletal structure and soft tissues using the hands or parts of the limbs for muscle communication and blood circulation [12]. Cervical Chuna therapy is used to alleviate pain and movement restriction caused by cervical spine curvature abnormalities [20]. According to Kim and Jeong [6] patients with acute cervical pain who received Chuna therapy exhibited changes in the cervical spine curvature.

A combination of seven Chuna sessions and 11 acupuncture sessions improved cervical pain (NRS 1–2) and restored the ROM. Jackson’s angle improved from 11.10° to 39.67°, which is within the normal range. The combined treatment with the supine cervical extension technique and MET shows potential for the management of abnormal cervical spine curvature.

The limitations of this study include its single-case focus, lack of follow-up, and inability to determine individual treatment effects. In addition, the patient, presented shortly after traffic accident, may have exhibited motor restriction and muscle stiffness caused by neck pain. Future studies should involve more patients, assess treatment components separately, and include long-term follow-up.

In conclusion, combined Korean medicine treatments, including Chuna therapy, lead to improved cervical ROM, pain reduction, and restoration of the cervical spine curvature.

Conceptualization: SJB, YIK. Methodology: SJB. Formal investigation: SJB. Data analysis: SJB. Writing - original draft: SJB. Writing - review & editing: All authors.

This study was exempt from the Public Institutional Review Board Designated by Ministry of Health and Welfare (IRB no.: P01-202411-01-007). Electronic medical records were used to analyze patient data, and written informed consent was obtained.

  1. Song KS. Static and dynamic analysis of sagittal alignment of the cervical spine with sigmoid configurations - preliminary reoport. J Adv Spine Surg 2015;5:8-16.
  2. Kapandji IA. Physiology articular. 5th ed. Yeongmunsa. 2001:14-15.
  3. Yochum TR, Rowe LR. The essentials of skeletal radiology. Williams & Wilkins. 1987:152-153.
  4. Harrison DE, Harrison DD, Betz JJ, Janik TJ, Holland B, Colloca CJ, et al. Increasing the cervical lordosis with chiropractic biophysics seated combined extension-compression and transverse load cervical traction with cervical manipulation: nonrandomized clinical control trial. J Manipulative Physiol Ther 2003;26:139-151. doi: 10.1016/S0161-4754(02)54106-3.
    Pubmed CrossRef
  5. Korean Pain Society. Pain medicine. 3rd ed. Koonja Publishing Inc. 2007:187-214.
  6. Kim YS, Jeong SH. Five case reports on acute neck pain patients with abnormal cervical curvature using Chuna manual therapy. J Chuna Man Med Spine Nerves 2023;18:65-73. doi: 10.30581/jcmm.2023.18.2.65.
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  7. Park JW, Hwang JP, Kim MK, Oh MS, Heo DS. The case report of Chuna treatment using drop table on neck pain patients with kyphotic cervical curvature. J Chuna Man Med Spine Nerves 2006;1:111-123.
  8. Ryu HS, Jeon SH, Park DS, Lee SK. Clinical study for Chuna treatment on neck pain patient with hypolordotic cervical spine. J Chuna Man Med Spine Nerves 2006;1:11-20.
  9. Han H, Lee J, Hyun K, Yang Y. The effects of cervical extension-traction exercise on cervical alignment, pain, and neck disability in patients with mild turtle syndrome. J Korean Orthop Man Phys Ther 2019;25:1-10.
  10. Jeon TS, Chang H, Choi BW. Current concept on the operative treatment for degenerative cervical disc disease. J Korean Med Assoc 2011;54:941-950. doi: 10.5124/jkma.2011.54.9.941.
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  11. Choi J. Case report of abnormal spinal curvature improved by acupotomy and combined Korean medicine treatment. J Korean Med Soc Soft Tissue 2022;6:128-134. doi: 10.54461/JKMST.2022.6.2.128.
    CrossRef
  12. Korean Academy of Rehabilitation Medicine. Rehabilitation medicine. 5th ed. Koonja Publishing Inc. 2020:51, 62, 82-83, 346-347.
  13. Houglum PA. Therapeutic exercise for athletic injuries. Human Kinetics. 2001.
  14. Jeong YG, Kim MY, Kim JS, Ro HR, Choi YI, Choi HS, et al. The domestic trend of Chuna manual therapy on cervical spinal disorders. J Chuna Man Med Spine Nerves 2013;8:1-13.
  15. McKenzie R. McKenzie method. Go DI, translator. Pureunsol. 2003:161.
  16. Ryu YJ, Sun SH, Lee YH, Choi GY, Lee SJ, Lee KH. The clinical study of 29 cases on effects of cervical Hyeopcheok (Jiaji) point treatment for neck pain. J Acupunct Res 2010;27:239-245.
  17. Korean Acupuncture and Moxibustion Medicine Society. Acupuncture and moxibustion medicine. Hanmi Medical Publishing. 2016:142-149.
  18. Kim DY, Hong SH, Han SY, Kim WY, Oh SH, Lee HW, et al. The research trends of pharmacopuncture therapy on cervical pain caused by traffic accidents. J Pharmacopuncture 2020;23:201-211. doi: 10.3831/KPI.2020.23.4.201.
    Pubmed KoreaMed CrossRef
  19. Yoon HS, Youn DH, Kim SH, Lim JS. Inhibitory effects of soyeum pharmacopuncture (SPP) on rheumatoid arthritis in collagen II-induced arthritis (CIA) mice. J Pharmacopunct 2007;10:31-40.
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  20. The Society of Rehabilitation Medicine of Korean Medicine. Neck pain: clinical practice guideline of Korean medicine. National Institute for Korean Medicine Development. 2021:32, 91-92.

Article

Case Report

Journal of Acupuncture Research 2025; 42(): 73-79

Published online February 5, 2025 https://doi.org/10.13045/jar.24.0065

Copyright © Korean Acupuncture & Moxibustion Medicine Society.

Abnormal Cervical Spine Curvature Improved by Korean Medicine Treatment with Chuna Therapy: A Case Report

Sun Jin Bae , Yeon Soo Kang , Pil Je Park , So Jeong Kim , Hyun Jin Jang , Jeong Kyo Jeong , Kwang Sik Yoon , Ju Hyun Jeon , Young Il Kim

Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Korea

Correspondence to:Young Il Kim
Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, 75 Daedeok-daero 176 beon-gil, Seo-gu, Daejeon 35235, Korea
E-mail: omdkim01@dju.kr

Received: November 21, 2024; Revised: December 2, 2024; Accepted: December 9, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This study discussed significant improvements in the cervical spine curvature and decreased pain levels after receiving combined Korean medicine treatments, including Chuna therapy, in a patient diagnosed with abnormal cervical spine curvature accompanied with neck, shoulder, and upper back pain. In addition to Chuna therapy, the patient received both inpatient and outpatient treatments between January 11, 2022, and February 26, 2022, including acupuncture, pharmacopuncture, electroacupuncture, herbal medicine, and physiotherapy. The patient’s condition was assessed by measuring the range of motion (ROM) to determine joint mobility, the numerical rating scale (NRS) was used to assess pain levels, and Jackson’s angle on radiography was utilized to assess cervical spine curvature. After treatment, the patient’s pain level decreased from NRS 5 to 1–2, with significant improvements in cervical ROM and Jackson’s angle.

Keywords: Abnormal cervical curvature, Chuna therapy, Combined Korean medicine, Jackson’s angle, Numerical rating scale, Range of motion, articular

INTRODUCTION

The normal cervical spine curvature is formed by the height difference between the anterior and posterior parts of the cervical intervertebral discs [1]. The spinal curvature enhances shock absorption and helps maintain stability and equilibrium [2]. Jackson’s angle, which is used to assess cervical lordosis, is measured by drawing an extension line along the posterior vertebral bodies of the 2nd and 7th cervical vertebrae and measuring the angles of the tangent lines. On average, 21–44° is considered normal, < 21° is categorized as hypolordosis, and > 44° is classified as hyperlordosis [3]. Each centimeter in the anterior deviation adds 2–3 kg of load on cervical spine. Improper posture can increase pressure on the cervical spine and cause musculoskeletal disorders and structural deformities [4].

Treatments for cervical spine curvature abnormalities include surgical and conservative treatments such as exercise and physical therapy. Surgery for severe neurological disorders is recommended only after conservative treatment owing to the risk of postoperative complications [5].

Korean medicinal treatments for cervical spine curvature include Chuna therapy [6-9], herbal medicine [10], and acupuncture [11]. Park et al. [7] reported cervical spine kyphosis and lordosis reversal using the Nakcha correction technique in patients with chronic cervical pain. Ryu et al. [8] compared an experimental group using the cervical spine extension correction method with a control group that received only acupuncture, and pain improved in the former group. However, they did not confirm curvature recovery. Han et al. [9] confirmed the recovery of cervical lordosis with cervical extensor traction exercise; however, there were not enough cases to confirm the change in pain and cervical curvature after using the supine cervical extension and cervical muscle energy technique (MET). Therefore, improvements in cervical lordosis restoration and neck pain were confirmed using a combination of Chuna therapy and Korean medicine for cervical spine curvature abnormalities.

CASE REPORT

A 19-year-old female visited the ○○ University ○○ Korean Medicine Hospital 11 times between January 11, 2022, and February 26, 2022.

1. Chief complaints

The patient complained of neck pain and restricted range of motion (ROM) of the cervical spine.

2. Onset

Symptoms occurred following a traffic accident on January 11, 2022.

3. Past history and present illness

None.

4. Physical examination findings

No limitation in the cervical ROM flexion, bilateral rotation, or lateral bending; however, pain was accompanied by an ROM at 50° during extension.

5. Radiology findings

During admission, whole-spine in anterior–posterior and lateral views revealed straightening of the cervical lordosis.

6. Evaluation criteria

1) Numerical rating scale

This scale was used to objectively evaluate the subjective levels of pain. Patients rated their pain from 0 (no pain) to 10 (worst imaginable pain). Numerical rating scale (NRS) assessments were performed daily at 7 A.M. during hospitalization and during each outpatient visit.

2) Cervical range of motion

For objective measurement of the cervical ROM, flexion, extension, bilateral lateral bending, and rotation were assessed. ROM was documented for each movement, and if pain was felt during movement, the result was marked positive (+). Measurements were recorded daily at 7 AM during hospitalization and each outpatient visit.

3) Cervical Jackson’s angle

For comparison of the cervical spine curvature before and after treatment, lateral radiographs were recorded, and Jackson’s angles of the cervical spine were measured.

7. Treatment methods

1) Acupuncture

Acupuncture was performed twice daily, once in the morning and once in the afternoon, during hospitalization and once during each outpatient visit. Needling was performed using a single arc needle (0.25 × 30 mm, sterilized stainless steel; Dongbang Medical). Acupuncture points, including BL10, BL11, BL12, GB20, GB21, EX-HN15, and EX-B2, were needled bilaterally at a depth of 5–10 mm, and needles were retained for 15 minutes. Transcutaneous infrared irradiation therapy (IR-880, 220 V, 60 Hz; ITC Co., Ltd.) was used on the affected area.

2) Electroacupuncture

Electroacupuncture was performed for 15 minutes at a frequency of 3 Hz using an electroacupuncture device (STN-111; StraTek) on bilateral BL10 and GB20, areas where the patient experienced tenderness.

3) Pharmacopuncture

Pharmacopuncture was performed once daily during hospitalization and once weekly during each outpatient visit using the same method. So-yeom pharmacopuncture (2 cc, Association of Korean Pharmacopuncture Institute) was extracted into a 1-mL syringe (26 G × 13 mm syringe; Jeonglim Medical Industry Co.) and injected into bilateral BL10 and GB20 using a sterile needle (30 G × 38 mm; Sungshim Medical Co., Ltd.), with 0.5 mL administered at each of the four points for a total of 2 mL.

4) Herbal medicine

From January 11, 2022, to February 26, 2022, the patient took 10 packs of Hoesusan-gagam, consuming one pack (120 mL per pack) twice daily after meals (Table 1).

Table 1 . Herbal composition of Hoesusan-gagam and daily dosage.

Botanical name (herbal name)Dose (g) per day
Cyperi Rhizma8
Perillae Herba8
Linderae Radix6
Aurantii Nobilis Pericarpium6
Atractyodis Rhizoma6
Cnidium officinale Makino4
Angelicae Dahuricae Radix4
Platycodi Radix4
Aurantii Fructus4
Angelicae Koreanae Radix4
Araliae Cordatae Radix4
Chaenomelis Fructus4
Bombycis Corpus4
Glycyrrhizae Radix2
Zingiberis Rhizoma12
Zizyphi Fructus8


5) Physical therapy

During hospitalization, interferential current therapy (ICT), deep heat therapy (M/W), and transcutaneous electrical nerve stimulation were applied to the patient’s cervical region once daily for 15 minutes. During each outpatient visit, ICT and M/W were applied once for 15 minutes.

6) Chuna therapy

Supine cervical extension and MET were performed by an experienced practitioner using a Chuna table. From January 11, 2022, to January 15, 2022, seven Chuna treatments were administered: one during the inpatient period (January 14, 2022) and six during outpatient visits (January 18, 2022, to February 26, 2022).

First, supine cervical extension is performed with the patient lying in the supine position. The practitioner uses the middle fingers to apply pressure to the cervical facet joints, moving them left and right. To elevate one segment at a time, the articular surface is palpated and pushed laterally. The practitioner then touches the patient’s articular processes with their fingertips and massages the back to stretch and correct both sides simultaneously. These steps are repeated 2–3 times, starting from the 6th to the 2nd cervical vertebra [12].

Second, the primary targets of the MET are the sternocleidomastoid, levator scapulae, and upper trapezius muscles, which were tender to palpation. The patient is guided to perform isometric contractions while the practitioner applies a counteracting force for 6–7 seconds. Following this, the patient releases the force, allowing the muscle to extend to the limiting barrier in a relaxed state [12].

8. Results

At the initial visit on January 11, 2022, the patient had neck pain of NRS 5, which decreased to 3–4 after treatment. On January 15, 2022, day 5 of treatment, the pain decreased to NRS 2. Upon admission, cervical ROM was limited to 50° because of pain during extension. On discharge, all end-angle pain resolved without cervical ROM limitations. Her pain remained at NRS 1–2 without ROM limitations during outpatient care (Table 2, Fig. 1).

Figure 1. Changes in the NRS score during the treatment period. NRS, numerical rating scale.

Table 2 . Changes in cervical ROM during the treatment period.

Cervical ROMJanuary 11, 2022 (before treatment)February 26, 2022 (after treatment)
Flexion (°)4545
Extension (°)50 (+)55
Lateral bending (°)45/4545/45
Rotation (°)60/6060/60

(+): the angle that the patient expressed pain..

ROM, range of motion..



Furthermore, whole-spine anterior–posterior and lateral radiographs taken on January 11, 2022, showed a Jackson’s angle of 11.10°, indicated hypolordosis. After treatment, including 7 Chuna sessions, radiograph on February 26, 2022, showed an angle of 39.67°, and Jackson’s angle was restored within the normal range (Table 3, Figs. 2, 3).

Figure 2. Lateral view of the cervical curvature. (A) Before treatment. (B) After treatment.

Figure 3. Treatment timeline during the period. NRS, numerical rating scale.

Table 3 . Changes in Jackson’s angle during the treatment period.

January 11, 2022 (before treatment)February 26, 2022 (after treatment)
Jackson’s angle (°)11.1039.67

DISCUSSION

The human body uses the posterior cervical muscles to stabilize the head and cervical spine [13]. An abnormal cervical curvature results in persistent strain on the posterior cervical muscles, such as the cervical erector spinae, suboccipitalis, subscapularis, semi-polaris, and trapezius, leading to headaches, cervical pain, and decreased cervical ROM [14].

The mechanical stress of a traffic accident can increase fatigue in the cervical muscles, reducing the muscular support needed to maintain a balanced posture. This situation can lead to increased tension in the cervical extensor muscles, which can contribute to the forward displacement of the head. Maintained posture can lead to the hyperextension of the ligaments and deformation of the spinal joint discs [15].

In this study, acupuncture was performed on BL10, BL11, BL12, GB20, GB21, EX-HN15, and EX-B2. These points were selected based on a study showing that needling the cervical Jiaji points can reduce posterior cervical muscle tension and that acupuncture in the cervical region can improve local blood circulation and alleviate nerve irritation symptoms [16].

In electroacupuncture, the low-frequency electroacupuncture stimulation of 3 Hz has a lasting analgesic effect [17] and helps control pain. So-yeom pharmacopuncture was used, which can significantly alleviate pain in patients with acute inflammation [18]. In a previous study [19], So-yeom pharmacopuncture demonstrated anti-inflammatory effects by inhibiting the production of inflammatory cytokines and free radicals.

Hoesusan-gagam was used as herbal medicine. It is classified as a Qi-regulating and harmonizing formula [20] to regulate Qi, invigorate blood circulation, and alleviate neck pain and ROM limitations.

Chuna therapy addresses structural or functional problems by inducing effective stimulation to human skeletal structure and soft tissues using the hands or parts of the limbs for muscle communication and blood circulation [12]. Cervical Chuna therapy is used to alleviate pain and movement restriction caused by cervical spine curvature abnormalities [20]. According to Kim and Jeong [6] patients with acute cervical pain who received Chuna therapy exhibited changes in the cervical spine curvature.

A combination of seven Chuna sessions and 11 acupuncture sessions improved cervical pain (NRS 1–2) and restored the ROM. Jackson’s angle improved from 11.10° to 39.67°, which is within the normal range. The combined treatment with the supine cervical extension technique and MET shows potential for the management of abnormal cervical spine curvature.

The limitations of this study include its single-case focus, lack of follow-up, and inability to determine individual treatment effects. In addition, the patient, presented shortly after traffic accident, may have exhibited motor restriction and muscle stiffness caused by neck pain. Future studies should involve more patients, assess treatment components separately, and include long-term follow-up.

In conclusion, combined Korean medicine treatments, including Chuna therapy, lead to improved cervical ROM, pain reduction, and restoration of the cervical spine curvature.

AUTHOR CONTRIBUTIONS

Conceptualization: SJB, YIK. Methodology: SJB. Formal investigation: SJB. Data analysis: SJB. Writing - original draft: SJB. Writing - review & editing: All authors.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

FUNDING

None.

ETHICAL STATEMENT

This study was exempt from the Public Institutional Review Board Designated by Ministry of Health and Welfare (IRB no.: P01-202411-01-007). Electronic medical records were used to analyze patient data, and written informed consent was obtained.

Fig 1.

Figure 1.Changes in the NRS score during the treatment period. NRS, numerical rating scale.
Journal of Acupuncture Research 2025; 42: 73-79https://doi.org/10.13045/jar.24.0065

Fig 2.

Figure 2.Lateral view of the cervical curvature. (A) Before treatment. (B) After treatment.
Journal of Acupuncture Research 2025; 42: 73-79https://doi.org/10.13045/jar.24.0065

Fig 3.

Figure 3.Treatment timeline during the period. NRS, numerical rating scale.
Journal of Acupuncture Research 2025; 42: 73-79https://doi.org/10.13045/jar.24.0065

Table 1 . Herbal composition of Hoesusan-gagam and daily dosage.

Botanical name (herbal name)Dose (g) per day
Cyperi Rhizma8
Perillae Herba8
Linderae Radix6
Aurantii Nobilis Pericarpium6
Atractyodis Rhizoma6
Cnidium officinale Makino4
Angelicae Dahuricae Radix4
Platycodi Radix4
Aurantii Fructus4
Angelicae Koreanae Radix4
Araliae Cordatae Radix4
Chaenomelis Fructus4
Bombycis Corpus4
Glycyrrhizae Radix2
Zingiberis Rhizoma12
Zizyphi Fructus8

Table 2 . Changes in cervical ROM during the treatment period.

Cervical ROMJanuary 11, 2022 (before treatment)February 26, 2022 (after treatment)
Flexion (°)4545
Extension (°)50 (+)55
Lateral bending (°)45/4545/45
Rotation (°)60/6060/60

(+): the angle that the patient expressed pain..

ROM, range of motion..


Table 3 . Changes in Jackson’s angle during the treatment period.

January 11, 2022 (before treatment)February 26, 2022 (after treatment)
Jackson’s angle (°)11.1039.67

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Jan 07, 2025 Volume 42:1~130

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