It is very interesting, however, to see how quickly most people adapt to this very deep and vigorous type of therapy. The secret of success does not depend only on pressure but much more on the combination of points used in the therapy. Expert knowledge is required before the right choices can be made with certainty. These are only attempted when all the soft tissue work on the affected area has been completed. So important is the qi balancing process and the attainment of a good degree of muscle and connective tissue release that the first three stages of a treatment will require at least three quarters of the time allocated to it.
Manipulations are really effective when all the soft tissue and qi-point work has been thorough.
Some Tuina manipulations have a simplicity which belies their effectiveness. The extended arm shake and corresponding leg shake are good examples. In the case of the arm, the practitioner grasps the hand over its dorsum with thumbs just over the top of the wrist to give it mild support. Slight traction is applied and the shake is performed with rapid, small amplitude up and down movements. Apart from stimulating all six arm meridians, this generates a series of rapid, short duration pulls on the shoulder joint - wonderful as part of the treatment to restore mobility to a frozen shoulder.