that less force will be required if his muscles are passive. Remind
him frequently of this and assume that he desires to relax. A word
immediately before the adjustment often induces a temporary relaxation
during which the adjustment is given. Anything which detracts the
attention from the coming shock is an aid. Sometimes asking the
patient to inhale and exhale slowly and deeply will sufficiently take
his attention from the adjustment. Experience will teach him that he
suffers less pain when relaxed and presently relaxation becomes a
habit. Instructing patients to think of sleep, turning the eyeballs
upward, has been effective with some.
Muscular Suggestion
This can only be given by maintaining a state of relaxation in one’s
own muscles, which in itself is desirable in most cases, for reasons
to be presently explained. In handling Cervical vertebrae move the
head gently from side to side with your own hands relaxed as much as
possible. The lazy motion suggests relaxation. Then when it is felt
that the neck is thoroughly relaxed, vary the motion with a quick
adjusting movement.
In Dorsal and Lumbar regions after the hands are in correct position
the adjuster should pause a moment both to be sure that the direction
of movement and his purpose to move are clearly fixed in his mind
and to be certain that both himself and the patient are relaxed. The
adjustment is given instantly and from a perfectly lax muscle, as a
boxer strikes.
An added advantage is the greater amount of speed and control which
may be commanded in this way. The lax arm, being in a neutral state as
regards motion, can be contracted in any desired direction without
loss of force or of time, whereas a taut muscle cannot further effect
motion of the arm without relaxation of its antagonistic muscles, which
takes time.
Muscular Control
Considerable contral over one’s own muscles is necessary in order
perfectly to relax arm and shoulder muscles just before the adjustment
and then to utilize a measured and determined quantity of force in a
desired direction. To acquire this much practice is necessary--practice
on the living subject. The desired end may be hastened, however, by
acquiring the abstract property of muscular control or by developing
control already gained.
Many different forms of exercise will aid in the acquisition of
muscular control and the ability to relax and then to follow the
relaxation with an instantaneous whiplike contraction in a given
direction. The best of these is without doubt _bag-punching_. The
movements employed with a punching-bag, especially the lateral
quadruple movement with both elbows and both hands, tend to develop
precisely the sort of control needed for correct adjusting. The
beginner can do no better than to practice in this way, by which, it
must be remembered, only a necessary _property_, and not by any means
the exact movement, may be acquired.
Amount of Force
The amount of force used in an adjustment varies so much in different
spines and in different parts of the same spine that it is quite
impossible to state any correct estimate of it in terms of physical
units. In general the Cervicals move with least resistance, then the
Dorsals, then the Lumbars, and finally the Sacrum and Ilia as hardest
of all to displace or replace.
In developing additional force when it is found that the force first
used on any vertebra has been insufficient to move it, remember this
law: _Work equals one-half Mass times the square of the Velocity_.
In other words, doubling the speed of the movement increases its
effectiveness four-fold; tripling it, nine-fold.
The increase in force should never be effected by increasing the
_weight_ or _pressure_ upon the patient’s body, for reasons which
should be clear from a study of previous pages, but always by
increasing the _speed_ of the movement.
Names Used to Describe Movements
The names herein employed to indicate certain movements, each a
well-defined method of procedure for the accomplishment of some special
end, are the names or descriptive terms which seem to be in the most
general use at this time. Few of these movements have arrived suddenly;
most of them are the result of gradual growth and evolution: so with
the terms by which they are known; they have gradually become a part
of the common language of the profession. Usage sanctions them, though
some of them are cumbersome, unwieldy, or entirely inappropriate.
[Illustration:
Fig. 7. Morikubo Move. For correction of a lateral and rotated
Atlas (L. A.). Pisiform contact with anterior transverse.
]
SPECIAL TECHNIC
MORIKUBO MOVE
A movement for the correction of a lateral and rotated Atlas, indicated
for use only when the Atlas is recorded as R. A. or L. A. The position
of the patient’s head renders the transverse process inaccessible
unless it be anterior on the side from which adjustment is to be given.
Position of Patient
Place two sections of the bifid bench together so as to secure the
effect of a solid bench with an upward sloping front. Have patient
lying on back with back of head resting firmly on bench, chin slightly
uptilted. Then turn patient’s head so that it faces sidewise and rests
flatly on the side of the least prominent transverse. This exposes
the anterior transverse in front of the tendons of the sterno-mastoid
muscle.
Use of Hands
Stand leaning over head of bench and carefully place the pisiform bone
of adjusting hand upon the tip of the transverse process, being careful
to push aside the sterno-mastoid tendons if they interpose themselves
between the pisiform and the process. The fingers of the adjusting hand
extend downward toward the clavicle and rest lightly, very lightly,
upon the patient’s neck. With the other hand firmly grip the wrist of
the adjusting hand, fitting the pisiform of the upper hand into the
hollow below the styloid process of the radius.
Movement
This is delivered straight downward toward the bench. It should be
light and quick and the hand should not follow the process in its
movement.
This movement is painful and should not be used if avoidable. When
used it requires the utmost care and a careful measuring of force.
Err, if at all, on the side of overcaution. The technic will be better
understood after study of the more detailed description of “The
Recoil”, since the position and use of hands, arms, and shoulders is
much the same for both.
PISIFORM ANTERIOR CERVICAL MOVE
Indicated for rotation of a Cervical vertebra in which one transverse
process is anterior to its normal position or more anterior than its
fellow which may also be somewhat, though less, anterior.
Placing Patient
As for the Morikubo Move place the patient in the dorsal recumbent
posture with head resting on bench and chin uptilted. Turn patient’s
face slightly away from the side of the selected anterior transverse
and steady the head with the free hand while palpating.
[Illustration: Fig. 8. Pisiform anterior Cervical move.]
Making Contact
Palpate downward from the Atlas transverse along the posterior margin
of the sterno-mastoid, dipping deeply into the neck and exploring with
the tips of the first three fingers until the offending process is felt
as a nodule of bone plainer to the touch than those above and below.
Always reach _across_ the neck to the selected transverse; if it be the
right, stand on the patient’s left and use left hand for palpating and
for contact hand as well.
Having found the process, gently move aside any tissues which tend to
interpose between the finger and the bone, change hands so that the
palpating hand is free and the other holds the contact spot clear of
interposed tissue and plainly points it out, then place pisiform bone
of contact hand gently but firmly against the _front_ of the process
so that a mass of bone is felt between the pisiform and the bench when
downward pressure is made.
Completing Position
It will be noted here that the head is unstable and tends to rock
with slight pressure or movement of the contact hand. Steady the head
by placing the knee upon head of bench and against side of patient’s
head, not roughly but so that the head cannot move further toward the
adjuster.
Now reinforce the contact hand by gripping the wrist with the other,
press slightly downward to tighten the contact and avoid slipping, and
you are ready for
The Movement
which is directed sharply _downward_ toward the bench. This move
rotates the vertebra around its vertical axis and puts a strain in a
backward direction on the whole column at this point.
Care must be used, because the move at best is painful. It is easy to
slip across the end of the transverse. Take every precaution to avoid
imprisoning a muscle, nerve, or blood-vessel between the contact hand
and the vertebra. Rightly used this move is valuable, perhaps most
valuable of all anterior Cervical moves, but it requires nice judgment.
LAST FINGER CONTACT
This movement differs from the preceding one in two important
particulars; the contact hand must be so selected with relation to the
side of vertebra adjusted that the fingers will extend upward toward
the patient’s head, and the opposing hand supports the head instead of
reinforcing the contact hand.
Placing Patient
As for preceding move. The head will remain in this position only until
the contact is made, after which it will be raised by the supporting
hand until a tight contact is felt and the neck muscles drawn fairly
taut.
[Illustration: Fig. 9. Last finger contact for anterior Cervical.]
Making Contact
Palpate with left hand if standing on patient’s left to adjust a right,
anterior subluxation. Find the offending anterior transverse, draw
tissues away with middle finger of palpating hand, change to middle
finger of free hand which marks and holds the point of contact. Now
place (with care) the base of the little finger of the hand which was
used for palpating, at a point just below the condyle of the last
metacarpal and a little to the palmar side, in direct contact with the
front of the transverse. The last finger will be flexed toward the
radial side and a shallow depression thus left for the contact.
Completing Position
Hold contact lightly and slip the free hand under the patient’s head,
which faces slightly toward the adjuster. Raise the head, bending the
neck away from the adjusting hand and toward patient’s chest until it
is felt that the contact is secure and that further movement would put
the neck upon a strain. You are ready for
The Movement
which is delivered entirely with contact hand, downward and toward the
back of the neck. The delivery is difficult because the force arm is
flexed at the elbow and the position awkward. Practice, however, will
soon render one adept.
Uses
For rotated vertebrae which have one transverse anterior to the other,
Cervicals only. This move gives a slightly less advantageous force
angle than the preceding, but is less likely to be painful.
SECOND METACARPAL CONTACT
Position of Patient
Place patient supine on bench so that his head extends beyond the end
of bench and is supported by the upraised knee of the palpater. Stand
at head of bench so as to face patient’s feet.
Use of Hands
Differing from their use in the preceding moves the hands are so placed
that the adjusting hand for a right, anterior subluxation will be right
hand, for a left anterior the left hand. The opposite hand supports the
head after contact is made.
Making Contact
Contact point on hand is second metacarpal at the end of the condyle,
or second metacarpo-phalangeal joint. This is placed in front of the
offending transverse, the head having been rotated away from that side
and other tissues drawn carefully aside from the bone. The back of the
hand is downward toward the clavicle, fingers semi-flexed on palm,
thumb resting on jaw.
Supporting Head
The following position is the correct one for supporting the head in
all Cervical adjustments delivered in the above position of patient and
adjuster.
Cup the supporting hand slightly and fit the patient’s ear into the
cupped palm. Let fingers extend toward the base and back of the neck,
the finger position varying according to the amount of rotation of the
head so that the fingers are in all cases directly _under_ the head
weight. The wrist then flexes on the hand, and wrist and forearm are
brought up across the patient’s forehead so that a force delivered
from the opposite side cannot cause the head to roll or move upon the
supporting hand. After placing both hands draw the head so that the
chin is tilted upward until it is felt that contact is snug and tight.
This supporting position is invaluable and much neglected by adjusters,
who might save themselves much annoyance and many failures by its
constant use. In the study of succeeding Cervical moves refer to this
description frequently. We shall call it the Hook Support, because the
arm and hand resemble a hook which grasps the under side of the head
and curves over the upper.
Movement
This is delivered entirely with contact hand and in a direction as
much posterior as can be achieved without slipping past the end of the
process. If the head is sufficiently rotated away from the contact side
the angle of force is better than with a straight lateral adjustment,
which it somewhat resembles, but not so good for anteriors as either of
the two preceding moves. It is chiefly useful when the other two fail.
OCCIPITO--ATLANTAL MOVE
To move an Atlas so disposed that its one side is posterior while the
whole vertebra is laterally displaced in the same direction; to move,
for instance, an Atlas R. P.
Have patient lying on back in position C with head projecting beyond
bench and supported by adjuster’s knee.
Placing of Hands
Place the first three fingers of one hand under the most laterally
prominent transverse so as to hold it firm, first placing the first
finger carefully just behind and against the end of that transverse and
then reinforcing it with the second and third fingers, slightly tensed,
and resting their tips on the lamina close underneath the occipital
bone.
Next place the other hand so that the thumb rests firmly upon the
patient’s jaw and the first finger extends backward along the lower
margin of the occipital bone.
To complete the position rotate the head gently toward the side of the
laterally prominent Atlas, until it rests, face toward the side, and is
supported by the three fingers of the one hand and the heel and wrist
of the same hand. It will be noted that when the head is rotated the
first finger of supporting hand slips to a position directly upon the
tip of the transverse process and the other two take its place against
the posterior aspect of the tip of the transverse. The Atlas now rests
with its intertransverse line almost vertically upward from supporting
fingers, which hold it against further rotation.
Movement
When the neck muscles have been thoroughly relaxed by slight and gentle
movement, throw the upper elbow sharply away from your body, which
has the effect of transmitting force through the thumb to the jaw and
sharply rotating the head still further, loosening its articulation
with the now firmly held Atlas. The condyloid joints thus loosened tend
to settle into their proper relations, the weight of the head causing
it to slip downward--laterally upon the Atlas.
Uses
This is really a movement of the head rather than of the Atlas and is
an easy movement when practicable. It requires complete relaxation and
will often fail. It is probable that many apparent Atlas subluxations
are really subluxations of the head upon that bone which leave Atlas
and Axis in normal relation. This move is most used to loosen the Atlas
when it resists ordinary adjustments.
“THE BREAK” No. 1
(Lateral Cervical Move)
The principle involved in this and the three succeeding moves is the
same. The contact is made with the end of the laterally prominent
transverse process of a Cervical vertebra other than the Atlas, and the
movement is directed entirely from side to side. It is to be used only
for lateral and not for rotary or anterior or posterior subluxations, a
point to be remembered as it is just as easy to produce as to correct
subluxation with this move.
Position
Have patient lying on back in position C, with head projecting beyond
bench and supported by adjuster’s knee. Following a record previously
made count downward to a subluxated vertebra and palpate both
transverses with the two hands at once to find if one is prominent
laterally, remembering that the record indicates merely the position of
the spinous process.
Having found the laterally prominent transverse, place the tip of the
finger of the corresponding hand on the spinous of the subluxated
vertebra; that is, if a right subluxation, use right hand and if a
left, use left hand. Then draw the hand around until the middle of
the proximal phalanx of the first finger rests against the end of the
transverse. The tip of the finger will be freed from the spinous by
this movement.
Hold the adjusting hand tense, edgewise to the neck, fingers together
and pointing downward. The thumb may rest against the patient’s jaw
or may be free; the essential thing is the snug contact of the first
finger against the transverse.
[Illustration: Fig. 10. “The Break,” No. 1, from right. Contact; first
phalanx with end of right transverse.]
Movement
With the hand in position and the head supported by the Hook Support,
bend the head laterally, keeping the face upward, until it is felt
that further movement would strain the muscles.
Deliver the movement in a straight lateral direction, quickly and
entirely with the contact hand.
“THE BREAK” No. 2
For the Atlas only, and for straight lateral displacement of that
vertebra.
Position and Contact
Position of patient’s head and of supporting hand exactly as in using
Break No. 1. Contact is made with the end of the Atlas transverse
on the laterally prominent side. Contact point on hand is second
metacarpo-phalangeal joint, or rather, the condyle of the second
metacarpal.
Movement
As for Break No. 1.
“THE BREAK” No. 3
Position
Have patient sitting erect on bench or stool and stand before him. For
a right subluxation use left hand and for a left, right hand. Contact
point is the middle of the proximal phalanx of the first finger and the
fingers reach backward and downward, thumb upward so as to be out of
the way.
Movement
Force _should_ be applied entirely with the contact hand to avoid the
possibility that movement of the head may bring about movement of some
other vertebra than the desired one. But in practice the force is
usually divided between the head and the vertebra. The Hook Support
cannot be used in this position.
Uses
The use of this position for the Break avoids the necessity for the
patient to lie down again in a new position after having Dorsals and
Lumbars adjusted. It is extremely convenient. But on the other hand it
is undeniably harder for the patient to relax his muscles when sitting
up with head flexed sidewise and a sense of lost equilibrium than when
lying down. The Break No. 1 will be found the better for the average
case.
“THE BREAK” No. 4
Position
Same as Break No. 3 except that adjuster stands behind patient and
rests the thumb upon the base of the neck posteriorly while the fingers
extend downward and forward toward the clavicle. As with No. 3, the
supporting hand rests against the opposite side of the head and forces
it sidewise to tighten the contact.
[Illustration: Fig. 11. “The Break,” No. 3.]
Movement
Properly, a quick lateral movement of contact hand while the head is
firmly held by the opposing hand.
NOTE: “The Break” is unfortunately named and it would be well if some
less suggestive term were generally substituted.
THE ROTARY No. 1
For the correction of rotation only, and usable in the Cervicals from 2
to 7 inclusive.
Philosophy of the Rotary
A study of the Cervical articulations will make it clear that if a
force be applied laterally to the spinous process the probable result
will be a _rotation_ of the vertebra, which swings one articular
process back from its fellow but leaves the other in close, but
modified, contact. Thus the spinous process may appear to the left
while the left articular process is fitted firmly against that of the
adjacent vertebra, while those on the right are separated. Similar
rotation, modified only by the difference in shape of the vertebrae,
occurs in the Lumbar region.
A movement applied to the spinous process might correct this condition
or might complicate it according to the manner of application. But the
_most direct line_ of force for correction is along a line which would
pierce the separated articular processes almost in an antero-posterior
direction. The Rotary approaches this very closely. It is a setting
forward of the articular process against its fellow by applying a
movement directly to the transverse process, which lies very close to
the articular process.
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.
[Illustration: Fig. 12. The Rotary, No. 1. Ready for the movement.]
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