Part 7

The great safety of the movement lies in the fact that it is impossible with any reasonable amount of force to move the transverse process too far. If the vertebra is not subluxated so as to indicate this movement, gentle attempts to use it will fail. The deceptive bent spinous process may sometimes be detected in this way.

The chief objection to Rotary Nos. 1 and 2 is that the Dorsals and Lumbars cannot be adjusted in this position and the patient must rise from the bench and lie down again to have his Cervicals adjusted. This is obviated if No. 3 is used but the latter position fails to secure the perfect relaxation of muscles of Nos. 1 and 2, and is therefore recommended as an alternative only.

The commonest obstacle to the use of this move is the voluntary or involuntary contraction of the neck muscles. The Hook Support, q. v., will limit this resistance by affording a sense of perfect security to the patient. If muscles are _contractured_ a slight “check” will be felt as the head reaches a certain degree of rotation, and beyond this point it will refuse to move though easily movable within the radius limited by the “check.” It is as if the head were held by an inelastic cord. It is best when contracture is present not to attempt moving the head too far but to deliver the movement with the muscles as much relaxed as possible.

Position and Palpation

Place patient in position C as described under Technic of Palpation. Stand at head of bench with patient’s head supported by one knee and perhaps also by one hand. Palpate chiefly to discover the numbers of vertebrae, following a record previously made. Finish palpation with the tip of the first finger of either hand resting upon the spinous process of the vertebra to be adjusted.

Placing Contact

Consider here which way the vertebra is to be moved; if toward the right use right hand and if toward the left use left hand for adjusting. Draw the adjusting hand straight around until the first finger, about the middle of the proximal phalanx, rests against and _behind_ the transverse process.

It is important that the finger be drawn _straight_ around, and not upward or downward, except with the second Cervical with which the finger may pass slightly upward to the transverse. To insure correct placing of finger let patient’s head be absolutely at rest, supported by the Hook Support with face turned slightly away from the adjusting hand. Reinforce contact finger with the other three fingers held close together behind it. The thumb may or may not be placed against patient’s jaw as desired, but one must be careful not to lose exact contact by drawing adjusting hand upward from a lower Cervical in an attempt to reach the jaw.

Use of Second Hand

Meanwhile the other hand supports the head and holds its weight as described under the Hook Support, q. v.

Turning Head

Next, holding the first finger gently but firmly pressed against the transverse process, turn the head in the direction of the subluxation and away from the adjusting hand. That is, if the vertebra be subluxated to the right turn the face toward the right, the use of the terms “right” or “left” referring to the spinous process.

Movement

When the head is drawn around so that the vertebrae are thoroughly separated on the side toward which movement is to be directed, and the patient’s muscles are thoroughly relaxed though it is felt that further rotation of the head would put them upon a tension, give the movement. It consists in a quick throw of the adjusting hand, force transmitted from shoulder through an outward fling of the elbow, directed upward and inward against the transverse process. It replaces the articular process against its fellow, moving one vertebra, smoothly and easily.

_All_ force should be delivered with contact hand. The hand moves through very little space. The principle of the movement is transmitted shock.

THE ROTARY No. 2

A transition in technic between No. 1 and No. 3.

Position

Patient lies face upward on closed table, head resting upon forward section. Adjuster stands at side of patient, choosing the side according to the subluxation so as to face across the table in the direction toward which spinous process is to move. Palpation is difficult in this position on account of the increase in the curve of the Cervicals, so that it is best to follow a record previously made.

Having found the subluxation make contact as follows.

Contact

Reach across patient’s neck with right hand for a right subluxation or left hand for a left, and find spinous process. Then draw the middle finger straight around until the palmar surface of the middle finger just below the second joint fits snugly behind the transverse process. Place the other hand under the head and with both hands working together turn the head toward you, chin upraised, and draw the neck into a greater flexion until it is felt that contact is firm and close.

Movement

The movement is a quick drawing toward the adjuster of the second, or contact, finger, which has been, as it were, hooked over the transverse. The transverse is thus drawn sharply forward and the vertebra rotates around its vertical axis so that the spinous follows, or tends to follow, the transverse in the same arc of movement.

ROTARY No. 3

Position

Patient sitting erect, both feet evenly on floor and hands not braced. Stand in front of the patient but to one side or the other as for Rotary No. 2. Use right hand for adjusting right subluxations and left hand for lefts.

Contact

As for No. 2, contact is with palmar surface of second finger but may be shifted to third finger for the lower vertebrae if desired. The thumb is usually placed on the mandible and aids the opposite hand, placed on the other side of the head, in turning and otherwise controlling the head.

Movement

Turn the head away from the adjusting hand until the neck muscles feel taut as a result of position and not of contraction. The movement then is given as a sharp jerk of the contact hand forward.

ANCHOR MOVE No. 1

Theory

It is held that a vertebra often loses its proper relation with the vertebra below, and consequently with _all_ the vertebrae, or the entire column of the spine below, without being disturbed in its relation to the one, or ones, above; that, in other words, the column may be divided into two sections by subluxation, the upper section set askew upon the lower. With this reasoning it would clearly be desirable to so adjust the spine as to move a given vertebra, and with it all vertebra above, so to speak, upon the vertebra below. To do this all vertebrae above the one to which force is applied must needs be firmly _anchored_ to prevent strain between them.

Such a move has been devised by Bunn for Cervical use and is here described from the author’s few observations only. Further study may modify the technic somewhat.

Position

Patient is placed as for Dorsal and Lumbar adjustments in position B. Move is applied to rotated, postero-rotary, and antero-rotary subluxations and face turned toward side from which move is to be made. Adjuster, after palpation which discovers the vertebra to be moved and the direction of movement, stands at the head of table facing patient’s feet.

Contact

With the palms of both hands resting against the side of the neck and thumbs extended at right angles to hands, make contact with both thumbs on one vertebra as follows:

If vertebra is to be rotated toward patient’s left, place right thumb against spinous process on its left side and left thumb upon right transverse process from behind it. Press firmly with the palm and fingers of each hand against the vertebrae above, gripping around neck and base of skull so as to hold all parts together.

Movement

The move is delivered simultaneously with the two hands, forcing spinous process toward the right and transverse in an anterior direction. The head must be raised from the bench and wholly supported by the hands and the head turns with the vertebra.

Uses

A powerful comparatively easy move which has the advantage of wide applicability and of avoiding the change of posture of the patient which mars many Cervical moves.

ANCHOR MOVE No. 2

Position

Same as for No. 1.

Contact

For a left subluxation to be moved toward the right, place the left thumb upon the right side of the spinous process so that it hooks over the spinous in position to draw or pull the spinous. Place right thumb against the end of the left transverse as much on the anterior side as possible so that it may exert a _prying_ force in a posterior direction.

Movement

Simultaneous application of force with the thumbs tends to rotate the vertebra as does No. 1, but unlike No. 1 the tendency is to bring the vertebra out in a posterior direction instead of driving it more anteriorly.

Uses

This move is applied to rotated Cervicals which are anterior, more on one side than on the other.

POSTERIOR CERVICAL MOVE

Uses

For a posterior Cervical below the Atlas. The common and careless practice of moving such a vertebra with the Rotary, or the dangerous practice of using the Recoil may be avoided by this move and much better results obtained.

Position

Patient in position C, head projecting well beyond bench so as to allow for a dropping backward of the head. Palpate as for the Rotary and hold palpating finger on tip of spinous process of posterior vertebra while contact is made.

Contact

Contact point is middle of radial surface of first phalanx of first finger and is placed against the tip of the spinous process, directly between it and the floor, as the patient lies. Hand is held rigid and edgewise, fingers together so that the contact finger is well supported.

Completing Position

Use the free hand to hold the head with the Hook Support, q. v. Turn the patient’s chin slightly away from the adjusting hand and drop the elbow of adjusting arm down until a straight line could pass through elbow, spinous process, and patient’s chin. It may be well to crouch and rest the elbow against one knee for solidity. Then allow the head to drop backward until chin is elevated and further backward flexion would strain the muscles. You are ready for the movement.

Movement

A quick throwing movement upward and inward, or toward patient’s chin. As nearly as may be the force should tend to pass along the spinous process in a direction exactly anterior to the (then) plane of the vertebra.

NOTE: Either hand may be used with this movement.

DOUBLE CONTACT MOVE

Uses

This is indicated for postero-rotary or postero-lateral subluxations. Its line of force is a bisector of the angle between the straight anterior and the straight lateral movement.

Contact

There are two points of contact, both on the first finger, one (first secured) on the radial side of the second phalanx and the other on the radial side of the proximal phalanx. The first contact point is placed against the tip of the spinous, the other behind the transverse process.

Press slightly against the two processes with the finger so as to feel them plainly.

Completing Position

Hold the head with the Hook Support and turn the face away from the adjusting hand (right hand for a P. R., left hand for a P. L.). Drop elbow low and hold it well away from your body so that there appears an obtuse angle between wrist and forearm with the point of the angle toward you. Be careful of this point as the tendency is to make an angle with the point away from you--a weak position.

Drop head backward until firm resistance is felt.

Movement

Force is delivered in an antero-lateral direction as above described, _entirely_ with adjusting hand.

THE “T. M.” No. 1

Uses

For subluxations listed R or L but not Posterior and upon C 6, C 7, D 1, and D 2 only. This movement applies a lateral force to the spinous process so as to correct _rotation_ of the vertebra, but I repeat that it is inappropriate for posterior or postero-lateral subluxations.

Position

Patient lying in position B as for Dorsal adjustment. Find the subluxation by following the record and perceiving that the count assumed to be correct permits the subluxations to correspond to those recorded and that a vertebra in this region is R or L, R. A. or L. A., R. S. or L. S., R. I. or L. I. The laterality of the spinous process determines the next step.

For a right subluxation turn the face toward the _left_ and use _right_ hand for contact hand. For a left subluxation turn the face to the right and use left hand for contact hand.

Contact

Thumb of contact hand is placed upon and against the side of the spinous process so that it presses firmly. The thumb is extended almost at right angles to the hand which rests upon the patient’s shoulder with fingers extending, and gripping, over the clavicle. Be sure of the solidity of the position.

Next place the other hand upon the patient’s forehead and press the head backward, or toward the side of the contact hand, until the neck is well flexed and the tissues tightened between the now opposing hands.

Movement

When this tightened condition is reached a quick decisive movement of _both_ hands in opposite directions, but chiefly of the hand applied to the head, will secure an easy movement of the vertebra.

This move is a very valuable adaptation of the old crude and other dangerous “T. M.,” of which No. 2, below, is another, more like the original move but possessing several “safety” features.

“T. M.” No. 2

Position of Patient

The patient sits erect on a flat seat with both feet resting upon the floor as during palpation.

Placing Hands

After careful palpation and selection of a vertebra to be adjusted in this way, stand directly behind the patient. If the vertebra is subluxated to the right use right hand for adjusting (or contact) hand, if to the left use left hand. Hold the hand so that the thumb is at right angles to the hand and tense and firm. Place the palmar surface of the end of the thumb against and upon the tip of the spinous process and grasp the neck firmly with the fingers, which extend over the base of the neck and toward the clavicle. The other hand is placed easily on the top of the head.

Position of Head

The completing of position after contact has been made is governed by two considerations; the need for relaxing the neck muscles and for so supporting the vertebrae above the contact that movement will take place only at the point of contact. If the neck muscles are contracted the movement is almost always defeated and should always be abandoned to avoid strain.

To secure the desired position ask the patient to relax his muscles and allow you to place his head as desired. If he seeks to place it himself the necessary muscular contraction on his part will defeat the movement. The movements of the head must be passive.

With thumb and remainder of adjusting hand properly placed, use the other hand upon the head as follows: First flex the head forward on the chest as far as possible, then rotate it slightly so that the face is turned a little toward adjusting hand. Then flex the head sidewise until a resisting pull of muscles indicates that they have been stretched taut. It is well during the third movement described to let the forearm swing down at right angles to the hand so that it presses firmly against the ends of all the Cervical transverses, distributing the force among them.

Or, after placing contact hand rest the elbow in the angle at the base of the neck and let the forearm extend upward along the side of the neck. Then flex the wrist until the hand will rest upon the patient’s head and perform the movements of the head as described above.

Movement

A quick, simultaneous movement of both hands in opposite directions, _two-thirds_ of which is given with the hand which holds the head. The thumb in contact with the spinous process moves slightly inward toward the median line but its chief use is to hold the vertebra very firmly. To this end part of its force is directed forward against the shoulder and through the ball of the thumb.

Failure to place the head properly or in securing sufficient flexion of the neck before move is attempted are the chief causes of failure. Force must be delivered quickly and sharply and the best adjustment of this kind is usually the one in which the head and hands move through the least space.

Uses

This movement is obviously useful only for the correction of _rotation_, since the force is directed sidewise against the spinous process.

The “T. M.” was originally intended as a Cervical adjustment, but its greatest use is now from C 6 to D 2 inclusive. Above the sixth its use is questionable because of the possibility of moving more than one vertebra or some other than the one desired.

“THE RECOIL”

(Pisiform Contact)

Position of Patient

This movement is best given on bifid bench of the type commonly known to the profession. Place patient on forward section so that its rear edge rests just below the axilla; this may be ascertained by passing a hand under patient’s arm after he is in position, when the edge of the bench should be felt about an inch below the hanging arm. The thighs should rest on rear section so that the pubic symphysis is free of the bench. The semicircular pubic cut is an advantage in that it avoids injury without making necessary too great a suspension between sections.

Thus the abdomen and the lower part of the thorax are suspended between sections. Under them an abdominal support may be used but it must have the quality of elasticity in a high degree and must lie always below the plane of the other two sections or it will interfere with a perfect adjustment.

For adjustment of the last two Cervicals or any Dorsal down to the sixth, it is best to turn patient’s head toward the direction of the subluxation. This curves that section of the spine into an arc toward the convex side of which movement may be made more easily than toward the concave.

The patient’s hands may lie under the table, loosely, or may reach back and rest upon the buttocks, palm upward. Whichever position secures best relaxation is to be used in any case.

This movement may be used with the roll. (See Fig. 30 and p. 285.)

Position of Adjuster

Stand on either side of patient, feet apart for base and poise. The direction of the feet and position of body will vary according to the direction of the adjustment, by the following two rules:

Rule 1. For movement of a vertebra _away_ from the side on which you stand, place your arms and hands in such a position that the pisiform bone of adjusting hand, both elbows, and both shoulder joints (shoulders being dropped loosely forward) will fall in the same plane and that the plane of direction in which the vertebra is to be moved. In other words, let the force be applied in a line straight from your body _through_ the vertebra. Always shift your feet to a proper position from which to direct the movement.

Rule 2. To move a vertebra _toward_ the side on which you stand, step close to patient’s body and support yourself with one knee against the adjusting table at the most convenient point. Then place arms so that contact point, elbows, shoulders, and the mid-point of the body’s base, between the feet, are all in the same plane. This insures balance during and after the movement and is the attitude from which the greatest and most carefully measured force can be delivered.

It will be seen that the desire is always to deliver all force in one plane and thus avoid conflict of forces and waste or misdirection through the predominance of one force over the other, and to use both arms with equal facility in the move. There are at least a hundred ways to hinder this movement by varying the preliminary positions. And no one can know the real efficiency of the move who has not become instinctively adept at taking position.

Use of Hands and Arms

Use of hands for palpation has been described. (P. 46.)

The palpating hand comes to rest with the middle finger on the spinous process of the vertebra to be adjusted. The heel of the hand is raised, the first and third fingers doubled back, and the heel lowered again. Now the middle finger alone is a slender pointer guiding to the contact point.

Place pisiform bone of other hand snugly _against_ the process to be moved. The hand should rest in a slight arch, pisiform against spinous, fingers rigid and flexed on hand, last finger firmly anchored, or pressed into the flesh, to prevent slipping. (Fig. 22 shows the position.)

The anchoring fingers must always extend away from the adjuster. To turn the fingers back across the spine, in moving a vertebra toward you, is always an error, and the price is partial loss of use of one arm.

With the adjusting hand satisfactorily placed, grasp its wrist firmly with the other hand so that the pisiform of the supporting hand rests in the hollow between the wrist and the metacarpal bone of the extended thumb. By this contact force is driven directly through the chain of bones across the wrist and to the pisiform bone without spreading. In grasping the wrist let the thumb extend around the forearm in one direction and the four fingers in the other. Beware of gripping only with thumb and first finger in which case the edge of the supporting hand will rest on the back of the contact hand and spread the delivered force too widely.

Movement

I have said, but have not sufficiently emphasized the command, that the shoulders must be dropped loosely forward. Let me add that just before the movement is given the head should be allowed to sag downward and the muscles to become relaxed. This movement given with stiff shoulders and upraised head becomes a _push_.

The desired movement is a _throwing_ movement.

Force is released from both shoulders at once, concentrated at the same instant by a slight shifting forward of the elbows, and strikes the spinous process as _one_ force, which is the resultant of the two meeting at the wrist of contact hand and being united there. The two arms use the contact hand as a passive instrument for driving the vertebra.

The objective point, the distance to which the movement is mentally thrown at the instant of delivery, should be the center of mass of the vertebra, varying according to the section of the spine.

Contact Point

The exact contact point of hand with vertebra varies. If the vertebra is to be moved toward the right the pisiform rests _against_ (not _upon_) the left side of the spinous; if toward the left and inferior, against the right side and just above, in the notch between it and the next superior process. The rule is to so place hand that the spinous process is between the pisiform and the direction to which movement is given.