Part 9

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.

First Cervical

_Subluxation._ _Adjustment._

Right--R. Break, or straight lateral. Right, posterior--R. P. Rotary lateral. Right, anterior--R. A. Morikubo. Right, superior--R. S. Break. Right, inferior--R. I. Break. Right, posterior, superior--R. P. S. Rotary lateral. Right, posterior, inferior--R. P. I. Rotary lateral. Right, anterior, superior--R. A. S. Morikubo. Right, anterior, inferior--R. A. I. Morikubo. Left--L. Break. Left, posterior--L. P. Rotary lateral. Left, anterior--L. A. Morikubo. Left, superior--L. S. Break. Left, inferior--L. I. Break. Left, posterior, superior--L. P. S. Rotary lateral. Left, posterior, inferior--L. P. I. Rotary lateral. Left, anterior, superior--L. A. S. Morikubo. Left, anterior, inferior--L. A. I. Morikubo. Anterior (entire Atlas)--A. Morikubo (both sides). Posterior (entire Atlas)--P. Rotary lateral (both sides).

NOTE.--All right subluxations adjusted from right side, all left from left side.

Second Cervical

Posterior--P. Posterior Cervical move. Posterior, right--P. R. Double contact on right side. Posterior, left--P. L. Double contact on left side. Posterior, right, inferior--P. R. L. Double contact on right. Posterior, right, superior--P. R. S. Double contact on right. Posterior, left, inferior--P. L. I. Double contact on left side. Posterior, left, superior--P. L. S. Double contact on left side. Right (lateral)--R. Break (Same if R. I. or R. S.) Right (rotary)--R. Rotary (Same if R. I. or R. S.) Left (lateral)--L. Break (Same if L. I. or L. S.) Left (rotary)--L. Rotary (Same if L. I. or L. S.) Superior--S. Posterior Cervical move. Inferior--I. Posterior Cervical move. Anterior (entire Vertebra)--A. Ventral transverse contact on most anterior side. Anterior, right (lateral)--A. R. Second metacarpal contact from right. Anterior, right (rotary)--A. R. Pisiform Ant. Cerv. contact on right. Anterior, left (lateral)--A. L. Second metacarpal contact from left. Anterior, left (rotary)--A. L. Pisiform Ant. Cerv. contact on left.

Third Cervical

Same as second.

Fourth Cervical

Same as second.

Fifth Cervical

Same as second.

Sixth Cervical

Posterior--P. The Recoil, hands reversed. Posterior, right--P. R. Recoil, hands reversed. Posterior, left--P. L. Recoil, hands reversed. Posterior, right, superior--P. R. S. Recoil, hands reversed. Posterior, right, inferior--P. R. I. Recoil, hands reversed. Posterior, left, superior--P. L. S. Recoil, hands reversed. Posterior, left, inferior--P. L. I. Recoil, hands reversed. Right (lateral)--R. Break (Same if R. I. or R. S.) Right (rotary)--R. Rotary (Same if R. I. or R. S.) Left (lateral)--L. Break, from left (Same if L. I. or L. S.) Left (rotary)--L. Rotary (Same if L. I. or L. S.) Superior--S. Edge contact move. Inferior--I. Edge contact move. Anterior (entire vertebra)--A. Pisiform Ant. Cerv. contact on most anterior side. Anterior, right (lateral)--A. R. Second metacarpal contact from right. Anterior, right (rotary)--A. R. Pisiform Ant. Cerv. contact on right. Anterior, left (lateral)--A. L. Second metacarpal contact from left. Anterior, left (rotary)--A. L. Pisiform Ant. Cerv. contact on left.

Seventh Cervical

Same as sixth Cervical, except that T. M. may be used on right or left rotary subluxations.

First Dorsal

Posterior--P. Recoil, hands reversed. Posterior, right--P. R. Recoil, hands reversed. Posterior, right, superior--P. R. S. Recoil, hands reversed. Posterior, right, inferior--P. R. I. Recoil, hands reversed. Posterior, left--P. L. Recoil, hands reversed. Posterior, left, superior--P. L. S. Recoil, hands reversed. Posterior, left, inferior--P. L. I. Recoil, hands reversed. Posterior, superior--P. S. Heel contact. Posterior, inferior--P. I. Edge contact. Superior--S. Heel contact. Inferior--I. Edge contact. Right--R. T. M. (Same if R. S. or R. I.) Left--L. T. M. (Same if L. S. or L. I.) Anterior--A. No correction.

Second Dorsal

Posterior--P. Heel contact. Posterior, superior--P. S. Heel contact. Posterior, inferior--P. I. Edge contact. Posterior, right--P. R. Recoil. Posterior, right, superior--P. R. S. Recoil. Posterior, right, inferior--P. R. I. Recoil. Posterior, left--P. L. Recoil. Posterior, left, superior--P. L. S. Recoil. Posterior, left, inferior--P. L. I. Recoil. Left--L. T. M. (Same if L. S. or L. I.) Right--R. T. M. (Same if R. S. or R. I.) Anterior--A. No correction.

Third Dorsal

Posterior--P. Heel contact. Posterior, superior--P. S. Heel contact. Posterior, inferior--P. I. Edge contact. Posterior, right--P. R. Recoil. Posterior, right, superior--P. R. S. Recoil. Posterior, right, inferior--P. R. I. Recoil. Posterior, left--P. L. Recoil. Posterior, left, superior--P. L. S. Recoil. Posterior, left, inferior--P. L. I. Recoil. Right--R. Pisiform single transverse (on left) (Same if R. S. or R. I.) Left--L. Pisiform single transverse (on right) (Same if L. S. or L. I.) Anterior--A. No correction.

Fourth Dorsal

Same as third Dorsal.

NOTE.--While the Recoil is here, the preferred move for posterior and postero-lateral subluxations, the pisiform double transverse or the two finger double transverse may be used if both transverses are palpable.

Fifth Dorsal

Posterior--P. Double transverse move. Posterior, superior--P. S. Heel contact. Posterior, inferior--P. I. Double transverse. Posterior, right--P. R. Double transverse. Posterior, right, superior--P. R. S. Double transverse. Posterior, right, inferior--P. R. I. Double transverse. Posterior, left--P. L. Double transverse.

NOTE.--The pisiform double transverse and the two-finger double transverse, apply force in exactly similar directions and may therefore be used interchangeably. The latter is preferable for children.

Posterior, left, superior--P. L. S. Double transverse. Posterior, left, inferior--P. L. I. Double transverse. Right--R. Pisiform single transverse (Same if R. S. or R. I.) Left--L. Pisiform single transverse. (Same if L. S. or L. I.) Anterior--A. No correction.

Sixth Dorsal

Same as Fifth Dorsal.

Seventh Dorsal

Same as Fifth Dorsal.

Eighth Dorsal

Same as Fifth Dorsal.

Ninth Dorsal

Same as Fifth Dorsal.

Tenth Dorsal

Posterior--P. Heel contact. Posterior, superior--P. S. Edge contact. Posterior, inferior--P. I. Edge contact. Posterior, right--P. R. Recoil. Posterior, right, superior--P. R. S. Recoil. Posterior, right, inferior--P. R. I. Recoil. Posterior, left--P. L. Recoil. Posterior, left, superior--P. L. S. Recoil. Posterior, left, inferior--P. L. I. Recoil. Right--R. Recoil (Same if R. S. or R. I.)[A] Left--L. Recoil (Same if L. S. or L. I.)[A] Anterior--A. No correction.

[A] Note.--The use of this move is not quite mechanically correct, but it is advised because of the possible danger of using the transverse processes as levers.

Eleventh Dorsal

Same as Tenth Dorsal.

Twelfth Dorsal

Same as Tenth Dorsal.

First Lumbar

Posterior--P. Heel contact. Posterior, superior--P. S. Heel contact. Posterior, inferior--P. I. Heel contact. Posterior, right, superior--P. R. S. Recoil. Posterior, right, inferior--P. R. I. Recoil. Posterior, left--P. L. Recoil. Posterior, left, superior--P. L. S. Recoil. Posterior, left, inferior--P. L. I. Recoil. Right--R. Lumbar single transverse move, if transverse is palpable, otherwise Recoil. (Same if R. S. or R. I.) Left--L. Lumbar single transverse move, if transverse is palpable, otherwise Recoil. (Same if L. S. or L. I.) Anterior--A. No correction.

Second Lumbar

Same as First Lumbar.

Third Lumbar

Same as First Lumbar.

Fourth Lumbar

Posterior--P. Heel contact. Posterior, superior--P. S. Heel contact. Posterior, inferior--P. I. Heel contact. Posterior, right--P. R. Recoil, hands reversed. Posterior, right, superior--P. R. S. Recoil, hands reversed.

NOTE.--The Heel contact may be substituted for the Recoil above if force be carefully directed in the proper direction in delivery.

Posterior, right, inferior--P. R. I. Recoil, hands reversed. Posterior, left--P. L. Recoil, hands reversed. Posterior, left, superior--P. L. S. Recoil, hands reversed. Posterior, left, inferior--P. L. I. Recoil, hands reversed. Right--R. Lumbar single transverse move, if transverse is palpable, otherwise Recoil. (Same if R. S. or R. I.) Left--L. Lumbar single transverse, if transverse is palpable, otherwise Recoil. (Same if L. S. or L. I.) Anterior--A. No correction.

Fifth Lumbar