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.
[Illustration: Fig. 23. “Heel contact.”]
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.
[Illustration: Fig. 24. Pisiform double transverse adjustment as it
should be given, elbows locked.]
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.
[Illustration: Fig. 25. Two-finger double transverse.]
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.
[Illustration: Fig. 26. Pisiform single transverse move, No. 1.]
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.
[Illustration: Fig. 27. The edge contact in Lumbar region.]
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.
[Illustration: Fig. 28. Lumbar single transverse move.]
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
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.
[Illustration: Fig. 29. “Bohemian Move” for correction of anterior
fifth Lumbar by transmitting shock through spine.]
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