Technic and Practice of Chiropractic

Palpation

Same as for Recoil or Heel Contact, q. v.

Contact

Using the same adjusting hand as for the Heel Contact, place the middle of the ulnar edge of the fifth metacarpal bone in contact with the spinous process. If the vertebra be superior, place the edge of hand above, if inferior, place the hand below. This contact is especially good for S or I vertebrae.

Position of Hands and Arms

The fingers of adjusting hand cross the spine at a right angle to its long axis. The back of hand will be toward patient’s head except in adjusting the last two Lumbars, with which a change of hands is made necessary by the upward slant of the lower half of the Lumbar curve.

The palpating hand now grips the adjusting hand so that the fingers of the upper hand, held close together, press against and reinforce the lower on its dorsum and just above the contact point. The thumbs are hooked together as shown in Fig. 27, so that the hands may be stiffened and their tendency to roll avoided.

The elbows are outrotated and locked as in the Pisiform Double Transverse Move and both shoulders are loosened.

Movement

This is chiefly delivered with the upper arm, using upper hand to drive the lower. Force should be quickly delivered when patient is relaxed. The direction of force should be determined by the direction of subluxation and by the slant of the spinous process. Thus, when patient lies prone upon a bifid bench and sways downward against a lax abdominal support, the spinous processes of the lower dorsal make an acute angle with the plane of the floor. If one be superior, contact above it and force driven straight toward the floor will tend to correct the subluxation. There is a slightly different force angle for every subluxation correctable by this move.

This move is less painful than the pisiform contact and may often be used to advantage, especially in the Lumbar region.

LUMBAR SINGLE TRANSVERSE

For the correction of a rotated Lumbar. Best used on second and third. This movement should never be attempted unless the transverse process can be palpated. Lumbar transverses are sometimes short or fragile, and unless they can be distinctly felt no force should be applied where they are believed to lie.

Contact

Pisiform bone with posterior transverse.

Palpation and Placing of Hands

Palpating as if for other movements, pause with the second finger of palpating hand indicating the spinous process of the vertebra to be moved. Note that if the spinous process be to the right of the median line the left transverse will be posterior, if to the left, the right transverse.

The transverse may then be found as in the Dorsals; it should lie even with the interspace above the spinous process, deeply overlaid with strong muscles. When the transverse has been located by a deep, probing movement of the fingers, place adjusting hand, pisiform on transverse, close to the spinous process for greater solidity and fingers extending downward and outward from the midspinal line parallel with the lower rib curve.

If the adjuster stands on the side of the patient opposite to the transverse to be moved the hand opposite the palpating hand becomes the contact hand, as in other moves. But if the posterior transverse is on the same side with the adjuster, a change of hands is made and the palpating hand becomes contact hand. To accomplish this the adjuster must turn and face away from the patient with arm extended straight downward to the contact. After contact is made the remaining hand reinforces the adjusting hand by gripping the wrist.

Movement

In making the contact press downward, deeply and firmly, so as to crowd the muscles aside and place the pisiform directly upon the transverse. Movement is given after the patient’s body has been swung downward for a considerable distance, and is sharp and decisive, directed straight toward the floor.

LUMBAR DOUBLE TRANSVERSE MOVE

A movement sometimes applied to posterior or postero-rotary Lumbars.

Palpation and Contact

From the spinous, find first the more posterior transverse and make contact with it, since most force must be directed there. Stand facing patient’s head and place right hand on right transverse and left hand on left.

Contact point in this move is the tuberosity of the scaphoid with the posterior surface of the transverse. Fingers curve away from median line so as to avoid the rib curve.

Movement

After heavy, steady pressure downward, force is delivered with a quick, throwing movement, most force on the posterior side.

THE “SPREAD” MOVE

Upon the theory that when two forces are simultaneously applied, the one to drive some vertebra cephalad (by its spinous process) and the other to drive some lower vertebra caudad, the intervening vertebrae tend, if anterior, to be drawn outward or toward a more posterior position, this move is predicated.

The author does not believe that it accomplishes its purpose, but will briefly describe it for the benefit of those who do.

Position

Patient is placed over a roll which rests under the thighs so as to flex thighs and pelvis on the Lumbar spine, or an adjustable table is so tilted, both sections sloping downward from the middle, as to accomplish the same result.

Contact

The usual method, if only a single vertebra is anterior, is to make contact with the vertebrae immediately adjacent, crossing the hands and having fingers of upper hand pointing toward head and of lower hand toward Sacrum. But some adjusters use this move differently, making contact with Sacrum and with the mid-dorsal region in general and applying a slow force with both hands. Contact is with heel of hand upon spinous process.

SACRAL ADJUSTMENTS

The adjustment of the comparatively fixed sacrum is difficult at best and requires a very considerable force, violently applied. It is probable that nine-tenths of all attempts to move sacra fail. In children, when sacrum does not articulate properly with the ilia, and in adults in whom the sacrum has been loosened by trauma and remains in an abnormal relation to surrounding structures, it can be moved.

The sacrum is described as being posterior at the base or at the apex, and its axis for rotation is believed to be a transverse line through the sacroiliac articulations. Force for its adjustment is applied at right angles to the curve of the sacrum at the point of contact. The best contact is with the heel of the hand against a part of the sacrum, the wrist of the adjusting hand being gripped and reinforced by the other hand. If standing on patient’s left, the right hand becomes adjusting hand for sacrum as for the last two Lumbars, if on the right, the left hand.

Another contact is with the pisiform and adjacent soft part of hand upon the sacral base, the pisiform hooking against the first sacral spinous process.

Do not mistake an anterior fifth Lumbar for a posterior sacral base. Discriminate between iliac and sacral subluxations by noting that with the latter both sacroiliac articulations, and with the former only one seems abnormal.

ILIAC ADJUSTMENTS

Palpation

With patient sitting erect on flat surface, feet on floor, stand behind and examine both sacroiliac articulations at once with the palmar surfaces of the fingers of both hands. If the two articulations are similar in every line neither ilium is subluxated, though the sacrum may be rotated on its transverse axis between the ilia, so as to be posterior or anterior at base or apex.

But no examination of the ilia is complete without investigating also the lumbosacral articulation. It sometimes happens that though the first sacral spinous process naturally completes the lumbar curve and there is no lumbosacral subluxation the crests of both ilia appear much posterior to their normal relation to the upper part of sacrum: this is a double iliac displacement.

Usually the ilia are both normally articulated; this is one of the most difficult joints to weaken and is seldom affected except by the most extreme force. When iliac subluxation exists one side is affected alone nine times out of ten. The tenth case may show double subluxation.

Movement

Nine-tenths of the so-called “iliac adjustments” are quite amusingly ineffective. The force required really to move an ileum (save in joint disease or in children) is tremendous and not to be commanded by the ordinary adjuster. The light jars applied as a routine procedure by so many Chiropractors are in reality nothing more than single percussion strokes which stimulate the sacral nerves.

Place patient in position B and apply the hands to a posterior ilium as to a posterior sacrum, making contact with the most prominent portion of crest or posterior border and driving in a direction which would represent a part of the circumference of a circle of which the transverse sacral axis of rotation touches the center, or the center of fixation in the sacroiliac joint.

COCCYGEAL ADJUSTMENTS

Examination

Place patient on an angle table, i. e., one which rises in the center and slopes away toward either end. Separate the thighs slightly, patient lying face down, and insert the rubber-covered second finger, palmar surface upward, very carefully into the rectum. The tip of the coccyx may then be felt and its movability and position determined. Unless it is immovably fixed in an abnormal position it should not be molested; the movable coccyx responds to mere muscle tension by changes of position and cannot act as a primary cause of nerve impingement.

Usually this examination will be rendered unnecessary by the external palpation which may disclose the movability of the coccyx and at once render further exploration superfluous.

When the coccyx is anteriorly subluxated and ankylosed in that position it may be a factor in producing constipation, hemorrhoids, etc., but its influence in other diseases, especially of the nervous system, has been greatly overrated by those who have not yet fully accepted the doctrine that nerve impingement is the primary cause of all disease.

Movement

When it has been decided that the coccyx must be moved, the position and use of hand is the same as for the palpation. The finger hooks under the tip of the coccyx, draws upon it until a tight contact is secured and then jerks sharply backward upon it with a view to its abrupt fracture. No mitigation of the jerk in the hope of previously loosening or gradually replacing the bone is of value for osseous tissue must be broken before any movement may take place.

This movement is painful and the region of the newly fractured coccyx may remain sore for a period ranging from a few days to several weeks. It is wise to warn the patient of the facts before proceeding.

The fractured coccyx may be absorbed, or may be reankylosed in a proper position or in a new abnormal position, or may remain loose and movable.

ADJUSTMENT OF CURVATURES

We have previously discussed in detail the nature and discovery of curvatures. A few words should be said here about their correction.

If the sole object of the adjustment is to correct the curvature it is best to select for adjustment those vertebrae which are most subluxated in the direction of the curvature. According to the length of the curvature a series of from two to six, separated by some distance, are chosen. These are adjusted until they cease to be the most prominent ones in the curvature and then others, then most prominent, are chosen and adjusted until they in turn cease to be most prominent. In this way the curvature may eventually be straightened, or nearly so. It is doubtful if any curvature can be absolutely eradicated, although it may be straightened until unnoticeable except by the expert.

To overcome a curvature it may be necessary to break every rule which governs ordinary adjusting and to invent new ways of placing the hands or of delivering force. No two require exactly the same measures and he is most successful with curvatures who is most adaptable to changing conditions.

One rule may be safely laid down. Do not alternate from day to day, loosening at the same time many vertebrae, but choose the ones most in need of adjustment and follow your choice as long as it is indicated. The chief vertebra is nearly always the one at the angle or point of the curvature.

The sharp, angular curve of Potts’ Disease, involving two or three vertebrae, should warn against adjustment, usually, since in this disease the vertebrae are fragile and easily fractured. If a case has not progressed too far a cure may be effected, but great caution in taking such cases must be exercised. Every Chiropractor should be well informed on the diagnosis of Potts’ Disease, or spinal caries.

Many months are usually required for the straightening of a curvature—how many can scarcely be estimated in advance of the experiment with any case. Often the case which seems simplest requires the longer time, while a very pronounced curvature, as in some cases of rachitis, may yield in a few months.

PREFERABLE ADJUSTMENTS

The selection of the move with which to correct each subluxation depends upon the adjuster’s concept of the kind and direction of the subluxation and of the mechanics of the different corrective moves in his repertoire. The move used should be one in which the application of force is exactly along opposite lines to the lines of force which originally produced the subluxation.

Omitting involved explanations as to the elements of each displacement and the manner of change in bone, muscle, ligament, cartilage, etc., and presupposing a comprehension of the principles of each adjustment named, there follows here a list of possible subluxations of each vertebra in turn, from Atlas down, with a simple statement of the RIGHT MOVE for that subluxation.

In each instance there are other moves than the one listed which would move the vertebra and some which would partially correct it, but none which would quite so definitely tend to correct the displacement. Unfortunately it is not a fact that every movement of a vertebra is an adjustment. If this were true subluxations would not exist, because they could never have been produced. Too often the adjuster uses a move because it is easy, because its use has become habitual with him, rather than because it is indicated by the conditions of the case—then blames Chiropractic because his results are negative or bad.

The move which is suited to a certain kind of subluxation of one vertebra may be quite out of place with another, in a different part of the spine. Thus the Recoil is quite proper for a posterior Lumbar and is contraindicated with a posterior middle Dorsal.

If all vertebrae were shaped exactly alike, if all were equal in size, if subluxation were possible only in one direction, then one method of adjustment would be quite sufficient. Diversity of technic is demanded, but a discriminating diversity, with a good reason for every move used.

A FINAL WORD

Some useful information pertaining to adjustment will be found in section entitled, “Practice,” q. v.

After a careful and painstaking study of the foregoing pages it will still be found that the student is not by any means equipped for the work. He must practice these things to learn them. We learn to do by doing. The chief use of this section will be as a reference and guide during the practice of adjusting.