Chapter IV: Introduction (3)

Let us illustrate with a common experiment in physics. Suspend a number of ivory balls by cords of equal length in such a manner that each is in contact with its fellow and all are in a straight line. When the balls are properly adjusted a straight line should connect their centers. Hold one end ball firmly in the hand or with an instrument which renders it absolutely fixed. Then strike sharply with a light hammer. The balls will all remain stationary except the one on the opposite end which will fly off to a distance exactly measurable according to the force of the blow. How does this occur?

A shock is transmitted through the molecules of the ivory until it reaches the end ball, which is not held back by another. Here the transmitted force is expended in molar motion, the ball leaping away from its fellows as if it had been hung alone and had been struck with the same force.

It is well known that by placing an elbow firmly against a man’s jaw and then sharply striking the closed fist with the other hand, open, a very heavy blow can be given; yet the forearm, through which the shock is transmitted, does not move.

Now ivory is very like human bone. Further, it has been demonstrated that the law illustrated by the above experiment is equally applicable to the movement of vertebrae. The pushing or thrusting movement _may_ move a specific vertebra, but it is probable that the chief factor in so doing is the element of transmitted shock contained in the movement and delivered at the instant of release of the hand from the spine at the end of the movement.

On the other hand it is obvious that a pushing or thrusting movement may move several vertebrae in addition to the one directly in contact with the adjusting hand, in consequence of the way in which the spinal segments are closely bound together. If a steady strain is used, in which muscles and ligaments have time to act, one of three results may occur: (a) the specific adjustment; (b) the movement of several vertebrae at one time, which does not constitute an adjustment; (c) the giving way of the spine at its weakest point, which may be some distance from the point of contact with the adjusting hand, the ligaments and muscles having communicated and diffused the strain throughout a large area. In the latter contingency the result is usually a new subluxation or the increase of an old one, instead of an adjustment.

The Rapid Movement

Thus _Speed_ becomes an important factor in correct adjustment.

A good illustration of the value of speed may be taken from a pile of stakes bound together by a cord. If a man with a hammer desires to remove the center stake of the group, and attempts to do so with a slow pushing movement, the result is a change of position of many stakes, which adhere to the center stake and to each other. If, on the contrary, he strikes a sharp, quick blow with his hammer, meeting squarely the center of balance of the one stake, it will fly straight from its position leaving the others unmoved. This is exactly what we desire to accomplish with an adjustment. By the speed of the movement we expect to move _one_ vertebra before adhesion or the contraction of muscles or inelasticity of ligaments can diffuse the force.

Close Contact

In order to accomplish the transmitted shock it would seem wisest, at first thought, to draw back the hand and strike the vertebra sharply. On the contrary, it has been found advisable to place the hand carefully in _close_ and _immediate contact_ with the vertebra to be adjusted. Nature herself shows us the way in the delicate shock-transmitting mechanism of the tympanum.

Also the hand of the adjuster will cover much more than merely the spinous or transverse process which is used as a lever and to which it is desired to transmit the shock, unless carefully placed so that only a _small portion_ is in contact; by such a contact diffusion of the shock is prevented and its efficiency within a limited area is increased. A carpenter wishing to countersink a nail places in contact with the nail head a small instrument called a countersink, which he then strikes sharply with a hammer. The contact hand of the adjuster represents the countersink and is used by the two arms as a passive instrument for transmitting shock.

The close contact of the hand, which remains passive, renders the adjustment much less painful to the patient than it would otherwise be, and one of the prime objects in the mind of the adjuster should be the minimizing of pain inflicted, by any means which does not lessen the resulting benefit. Also any drawing back of the hand before the movement warns the patient and tends to induce involuntary muscular contraction which interferes with adjustment.

Relaxation

In an adjustment it is necessary to overcome two kinds of resistance--the passive resistance of inertia, of ligaments, or of superincumbent weight, and the active resistance of muscular contraction. It is important that both forms be minimized.

The first may be lessened through the position of the patient’s body; he is placed so that the vertebra to be adjusted is in the freest possible position. The second is reduced to the least possible quantity, amounting to no more than muscle tonus, by using two methods: (a) Oral Suggestion, and (b) Muscular Suggestion.

Oral Suggestion

Explain to the patient the need for relaxation. Make it clear to him 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.

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.

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.

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.

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.

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.

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

When the head is drawn around so that the vertebrae are thoroughly 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.

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.

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.

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.

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.

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.

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.

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.

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.)

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.

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.