Part 8

On the hand the contact may be said to vary, according to the direction of subluxation and position of adjuster, so as to describe a circle around the pisiform in the course of the various changes of position necessary to the use of this movement. No error could be greater than to attempt to use always the same face of the pisiform and to adapt the position of hands and arms to this end, when any face or aspect of the little bone is equally good with any other.

Which Hand Used

When standing on patient’s right use left hand for palpating hand and right hand for contact with the vertebra, using left hand again to grip and reinforce the contact hand. Exception to this is made by introducing an extra change of hands with C 6, or 7, D 1, L 4 or 5, and Sacrum. The change is necessitated by the insecurity of the usual position or the fact that it cramps the wrist of contact hand. To make the change: palpate as usual, hold subluxation with second finger of palpating hand, substitute second finger of other hand and withdraw palpating hand, which is then free to make the contact.

When standing on left side exactly reverse the use of hands. Palpate with the same hand which would be used if patient were sitting. Introduce no unnecessary move into the placing of the hands. This will be found to produce better results than any other technic for this portion of the move.

Delivery of Force

In using this movement it is perhaps best to deliver nearly equal force with both hands; certainly whatever forces are released by the arms should be simultaneous. It is possible, however, to allow one arm to preponderate in the movement without marring its efficiency, but the amateur adjuster will do well to balance his forces at first.

Speed and Concentration

Speed is a prime essential. By its employment a very ordinary amount of muscular strength can be made to accomplish a large amount of work and very difficult adjustments may be accomplished.

Concentration of mind at the instant of adjustment, so as to secure muscular control and perfect co-ordination of the two arms as well as to direct and concentrate the forces used at a given and strictly limited area, is also essential.

Uses

For ordinary adjustments of Dorsal or Lumbar subluxations, excepting the middle four Dorsals, for breaking ankyloses by repeated applications of force, and for overcoming muscular resistance in patients who are unable to relax at all, this form or style of adjusting is probably the best. It is most useful in the Dorsals. In many instances Lumbar vertebrae will move better by application of a slightly slower force, especially if a roll is used. The Recoil may be used with the roll.

While it is easily possible to move any Cervical in this way, making no change in the technic except to use the ulnar side of the fifth metacarpal bone for the contact instead of the pisiform, it is inadvisable in most cases above the sixth, and in some instances absolutely unpardonable. The shock to the nervous system and the danger of moving two or more vertebrae or of subluxating a normal one are too great. In at least one instance hemiplegia instantly followed the use of this move on the Axis, and headaches and nerve exhaustion are frequent sequelae.

For these reasons it is probably best never to use “The Recoil” above the sixth Cervical. For every form of subluxation there is an easier and safer mode of correction.

Name

This has been called “The Recoil” because of a belief that if force be applied to a vertebra in the form of a very rapidly transmitted shock the vertebra will rebound to the shock and settle in its normal position, the intelligence within the body utilizing the force thus blindly applied to bring about this result.

This belief is erroneous. First the vertebra and all surrounding tissues are misshapen to fit their _abnormal_ position and relation and this shape gives them a tendency, if rapidly loosened, to settle into the old abnormal position. Second, there is no such conscious intelligence which has power to replace a subluxated vertebra. If this supposition were correct, then the Innate Intelligence would do well to utilize those jars and shocks which ordinarily _produce_ subluxation to bring about normality and keep the spine perfectly aligned.

There is no such internal rebound or recoil as stated above. The chief value of the movement lies in its speed, according to principles equally applicable to other moves, and in accord with the Law of Momentum.

Sources of Information

This movement as described above contains many essential principles which follow Parker and Palmer, developers of “The Recoil,” but the technic is considerably modified to suit the author’s own views. It cannot be claimed, therefore, that this is “The Recoil” as now taught by Palmer, since the chief stress is here laid upon the movement of the vertebra in a predetermined direction and not upon the withdrawal of the hands to let “Innate” do the work. The name “Recoil” is really inappropriate for the move as described.

THE HEEL CONTACT

A movement for the adjustment of posterior, postero-superior, or postero-inferior subluxations in the Dorsal region (except middle four) and in the Lumbar. May also be used for postero-laterals when laterality is very slight. Given with patient in position B. Contact point, heel of hand with spinous process.

Heel Contact

By the “heel of the hand” is here meant the depression between the scaphoid and pisiform bones. This hollow forms a natural receiver for a spinous process and thus avoids lateral slipping.

The four fingers of adjusting hand are spread out and anchored upon the patient’s body. The wrist is held at a right angle to hand and the arm straightened, the elbow being outrotated until it “locks,” that is until it will move no farther. The other hand grasps the wrist of the adjusting hand.

Adjusting Hand

The rule is to use the right hand for adjusting hand if standing on patient’s right and palpating with left, or to use left hand if on left side and palpating with right. The fingers are to be directed toward the patient’s feet. Exception to this rule is made with the last two Lumbars, where it is more convenient to change hands and direct the fingers toward the head.

Movement

This is given almost entirely with adjusting arm; that is, with the arm whose hand is in contact with the vertebra. The supporting hand serves merely to guide the force to a definite point as if a straight rod were working through a fixed circlet. Indeed, the force in this movement is delivered almost straight down from the shoulder. Shoulder should be dropped well out of its socket so as to secure play for a sudden downward movement without raising the hand from its contact. If the shoulder is stiff or the head of the humerus remains in the glenoid cavity the movement cannot be properly given without raising the hand. Movement is quick, sharp, and _deep_, i. e., directed to the center of mass of the vertebra.

It may be directed straight toward floor to correct a posterior, inclined slightly toward the head or feet to correct approximation, or--as some aver--slightly sidewise to correct a mild degree of rotation.

PISIFORM DOUBLE TRANSVERSE No. 1

An adjustment to be used only in the Dorsals from fourth to ninth inclusive, for posterior or postero-rotary subluxations. It is probably best to use this movement only for straight posterior subluxations and to apply either the Pisiform Single Transverse or the Two Finger Double Transverse to the rotary displacements in this region.

Contact

Both pisiform bones, each _upon_ a transverse process and both upon the _same_ vertebra.

With patient in position B and the adjuster standing upon his left the contact should be made by the following exact method. Palpate with right hand, which comes to rest upon the spinous process of the subluxated vertebra. Note if it be P. R. or P. L., because this fact will govern the next movement. Let the first finger of palpating hand reach outward about one inch and upward to a point opposite the tip of the next superior spinous process, which point will approximate the position of the transverse. This first upon the side of the _posterior_ transverse, which will be the right with a left subluxation or the left with a right one. Let second and third fingers, now abandoning the spinous, follow the first and rest over the assumed position of the transverse.

Now palpate with a deep, limited, massage movement until the club-shaped extremity of the transverse is felt under the middle finger. Hold this point with the middle finger, drawing away the other two, and guide the free hand to an exact contact _upon_ the transverse. Thus if standing on the left, as predicated, the _left_ hand will be first to make contact and with the most posterior transverse, with which most _exact_ contact is necessary.

With pisiform placed, let the fingers extend away from your body; if on the side of the spine opposite you, let them extend downward so as to follow the curve of the rib and to be anchored upon the rib connected with the transverse of contact; if on the same side, let fingers extend downward parallel with the column.

Now--still using the original palpating hand--palpate on the other side from the first contact until the other transverse is discovered. Mark its tip with a quick, deep pressure and a sharp withdrawal of the fingers, so that a spot of anaemia appears momentarily. Carefully place the pisiform of the palpating hand in contact, guided by the anaemic spot. If this second contact is on the side on which you stand the fingers will be toward the head; if on the opposite side, they will follow the rib curve outward and downward.

Re-read the above directions carefully. It will be seen that the technic is quite free from unnecessary movements.

The two hands are now placed almost exactly at right angles to each other, arched fingers anchored to prevent slipping.

If you stand on the patient’s right the use of hands is, of course, exactly reversed, the left hand being palpating hand, and making the first contact.

Completing Position

When hands are in position and adjuster standing so as to face directly across the spine, the arms are rotated outward until the elbows “lock.” The adjuster leans over so as to have shoulders directly over the spine, draws the body back from the shoulder girdle to secure freest play in the shoulder joints, and drops head loosely between the shoulders so as to relax the trapezius and prevent any checking of the force.

Movement

Directly downward from the shoulders through straight, stiff arms. The force is delivered separately with the two arms and yet simultaneously. If the vertebra is straight posterior, equal force must be applied on the two sides; if it is posterior and slightly rotated (P. R. or P. L.), most force must be applied to the more posterior transverse.

Considerable practice and looseness of shoulder are required to use this movement properly. It is a regrettable fact that few adjusters _do_ use it correctly, most of them giving a _thrust_ instead of a transmitted shock.

PISIFORM DOUBLE TRANSVERSE No. 2

This modification of the pisiform double transverse move is here described because of its popularity rather than because the author wishes to recommend it. The position is the same as for No. 1, and the uses also, except that it tends to correct postero-inferior subluxations and is not at all adapted for use with superiors.

Contact

Both pisiforms below the two transverses (caudad). After palpation which discloses the posterior transverse the hands are placed as follows: Palpating hand rests always on the side of the spine next the operator; opposite hand crosses the spine. Both are slanted upward so that the fingers point toward the head with the axes of the hand slightly diverging above. The wrists are thus crossed in such a way as to force the forearms to be somewhat flexed on the arms and to slant away from the wrists at an obtuse angle. This with the contact _below_ the transverses, renders it impossible not to force the vertebra in an upward (superior) direction when movement is given.

Movement

A comparatively slow thrusting movement, which tends to spring the spine. The merit of this method lies in its comparative painlessness. Its technic is not attractive.

TWO FINGER DOUBLE TRANSVERSE

A movement for posterior or postero-rotary displacements from fourth to ninth Dorsal inclusive. It serves the same purpose as the Pisiform Double Transverse but is less painful and often easier of delivery. The palmar surface of the fingers, with the flesh of the patient’s back, make a compound cushion which acts as a shock-absorber.

Palpation--Contact

The usual downward gliding movement of left hand if standing on right or of right hand if standing on left will serve for the discovery of the vertebra listed for adjustment. The gliding hand stops with the second finger indicating the spinous process. The first finger reaches upward and outward to the assumed location of the transverse on the side nearest the adjuster; then the second finger reaches to a similar point on the other side, both fingers pointing toward patient’s head. Now the fingers are rolled a little to make sure that they are in contact with the ends of the transverse, the palmar surface of the tip of each finger being the proper contact point. The heel of the contact hand rests near, but not on, the surface of the body over the midspinal line.

Supporting Hand

The ulnar edge of the free hand is now placed across the tips of the two contact fingers so that it rests directly above the ends of the transverses but separated from them by the finger tips. The upper arm is then straightened and the elbow outrotated until it locks firmly so that the arm makes a straight line directly above the transverses. The body is drawn away from the shoulder girdle, pulling the head of the humerus out of its socket as far as possible to allow free play, for all force is to be given by this straight arm.

Movement

If the subluxation is a straight posterior the force is driven directly downward so as to be distributed equally to the two contact points. If it be a postero-rotary, most force is directed to the more prominent (posterior) transverse. Force should be delivered quickly, keeping in mind the principle of transmitted shock.

Contrary to the general belief, as much force can be developed with this move as is needful for any ordinary adjustment. The fact that it is often recommended for use with children or with sensitive or frail patients has led to the belief that it is a relatively ineffective move, whereas its value in such cases lies only in the fact that it inflicts less pain than some others.

PISIFORM SINGLE TRANSVERSE MOVE No. 1

Like the movement just described, this adjustment may be used in the Dorsals from fourth to ninth inclusive. It should be limited to those subluxations which are rotated without being posterior. In such an instance the spinous process _appears_ to be laterally displaced without being posterior, or may appear slightly _anterior_ because it is describing an arc about a fixed center of rotation in the body of the vertebra. One transverse process appears anterior and the other posterior to the line of their fellows.

Palpation

Palpate as for the Recoil and use the same adjusting hand as in that movement, i. e., right hand if standing on right side and palpating with left, or left hand if standing on left and palpating with right. When the palpating fingers have discovered the subluxated spinous process, the first finger seeks a point even with the tip of the next superior spinous process and about an inch to the side on which is the _posterior_ (prominent) transverse. The second and third fingers follow and, dipping inward with a rolling or massage motion, discover the end of the transverse.

Contact

Now the adjusting hand is placed with its pisiform resting directly _upon_ the blunt end of the transverse. If the contact is on the same side of the spine with the adjuster the fingers of adjusting hand extend across the spine and are anchored on the other side, the hand arching sharply and fingers extending somewhat downward. If contact is on opposite side of spine the fingers follow the rib curve downward and outward and are similarly anchored. In every case the fingers should extend away from, and never toward, the adjuster’s body. To violate this rule renders one arm almost useless through its position.

At this juncture the palpating hand becomes a reinforcing hand, to grip the wrist of the other and to aid in the movement.

Movement

The force is directed in a straight anterior direction, quickly and decisively, as if a spinous process were the lever used. Remember that contact must always be made with the _posterior_ transverse. To drive this anterior is to rotate the vertebra around its vertical axis and to bring the spinous process toward the median line, while the opposite, and more anterior, transverse becomes more posterior, as it should be.

PISIFORM SINGLE TRANSVERSE No. 2

Uses

For rotated first or second Dorsals with which, for any reason, the “T. M.” fails. This move involves a use of the head as a lever, as does the “T. M.” No. 2. Inadvisable unless the posterior transverse of the rotated vertebra can be palpated--but often used in cheerful disregard of this detail by those sublimely capable adjusters who do not need to find a vertebra before moving it.

Palpation--Contact

Palpate as for No. 1 above. Very deep palpation will be necessary because the spinous process here is nearly horizontal to the body and the transverse is very deeply placed, overlaid with heavy muscles.

When process is found place pisiform bone of free hand upon it, pressing the muscles aside as much as possible to avoid bruising and resting a considerable amount of weight upon the contact hand. Fingers of contact hand may extend across the spine or downward and parallel with the spine. Or, the hands may be changed so that the palpating hand becomes the contact hand and is placed with the fingers gripped over the base of the neck toward the clavicle.

Head Leverage

The free hand is now placed upon the forehead and the head, which faces toward the contact hand, is flexed backward until the muscles seem taut.

Movement

Is a quick, but fairly gentle, movement of both hands together, so that the head is rocked still further backward at the instant an anteriorly directed force is applied to the prominent transverse. The result is rotation of the vertebra--unless there be a loose articulation in the Cervicals which gives way under the force applied to the head.

THE EDGE CONTACT

(“Point 2 Contact”--“Knife Move.”)

Name

This movement has various names. The name “Point 2 Contact” is handed down from the days when Palmer used three contact points and three moves and designated the middle of the ulnar side of the fifth metacarpal bone as “Point 2.” The name “Edge Contact” was applied later, during the improvements in its technic when the hooking of the thumbs stiffened its efficiency and made it very valuable. It has since been rediscovered (though in constant use) and re-named “Knife Move.”

Uses

A movement which uses the spinous process as a lever and is applicable to D 2, 3, or 4, and to any Dorsal or Lumbar from D 8 down, when posterior, postero-superior, or postero-inferior. It does not correct rotation except insofar as the shape of articular processes may aid an anteriorly directed move in rotating the vertebra.

Some Chiropractors have used the Edge Contact in the Cervicals but this is always improper, as it is practically

impossible in some, and difficult in all, cases to cover only one spinous process when the head is resting on its side.

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