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.
[Illustration: Fig. 13. The Rotary, No. 2.]
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.
[Illustration: Fig. 14. The Rotary, No. 3.]
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.
[Illustration: Fig. 15. “Anchor Move,” No. 1. For a P. L. subluxation.]
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.
[Illustration: Fig. 16. Posterior Cervical move.]
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.
[Illustration: Fig. 17. Movement for correction of a lateral Atlas
whose prominent transverse is posterior.]
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.
[Illustration:
Fig. 18. A movement for Atlas when laterally displaced. Contact:
metacarpo-phalangeal joint with end of prominent transverse.
]
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.
[Illustration: Fig. 19. The “T. M.,” No. 1.]
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.
[Illustration: Fig. 20. The “T. M.,” No. 2. Note position of right arm
and hand of adjuster.]
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.)
[Illustration: Fig. 21. After palpation. Finger ready to guide contact
hand to a spinous process.]
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.
[Illustration: Fig. 22. “The Recoil.” Ready for the movement.]
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.
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.