Chapter V: Introduction (4)

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.

There is no such internal rebound or recoil as stated above. The chief 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.

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.

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.

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.

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.

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.

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.

ILIAC ADJUSTMENTS

Palpation

With patient sitting erect on flat surface, feet on floor, stand behind and examine both sacroiliac articulations at once with the palmar surfaces of the fingers of both hands. If the two articulations are similar in every line neither ilium is subluxated, though the _sacrum_ may be rotated on its transverse axis between the ilia, so as to be posterior or anterior at base or apex.

But no examination of the ilia is complete without investigating also the lumbosacral articulation. It sometimes happens that though the first sacral spinous process naturally completes the lumbar curve and there is no lumbosacral subluxation the crests of both ilia appear much posterior to their normal relation to the upper part of sacrum: this is a double iliac displacement.

Usually the ilia are both normally articulated; this is one of the most difficult joints to weaken and is seldom affected except by the most extreme force. When iliac subluxation exists one side is affected alone nine times out of ten. The tenth case may show double subluxation.

Movement

Nine-tenths of the so-called “iliac adjustments” are quite amusingly ineffective. The force required really to _move_ an ileum (save in joint disease or in children) is tremendous and not to be commanded by the ordinary adjuster. The light jars applied as a routine procedure by so many Chiropractors are in reality nothing more than single percussion strokes which stimulate the sacral nerves.

Place patient in position B and apply the hands to a posterior ilium as to a posterior sacrum, making contact with the most prominent portion of crest or posterior border and driving in a direction which would represent a part of the circumference of a circle of which the transverse sacral axis of rotation touches the center, or the center of fixation in the sacroiliac joint.

COCCYGEAL ADJUSTMENTS

Examination

Place patient on an angle table, i. e., one which rises in the center and slopes away toward either end. Separate the thighs slightly, patient lying face down, and insert the rubber-covered second finger, palmar surface upward, very carefully into the rectum. The tip of the coccyx may then be felt and its movability and position determined. Unless it is immovably fixed in an abnormal position it should not be molested; the movable coccyx responds to mere muscle tension by changes of position and cannot act as a primary cause of nerve impingement.

Usually this examination will be rendered unnecessary by the external palpation which may disclose the movability of the coccyx and at once render further exploration superfluous.

When the coccyx is anteriorly subluxated and ankylosed in that position it may be a factor in producing constipation, hemorrhoids, etc., but its influence in other diseases, especially of the nervous system, has been greatly overrated by those who have not yet fully accepted the doctrine that nerve impingement is the primary cause of all disease.

Movement

When it has been decided that the coccyx must be moved, the position and use of hand is the same as for the palpation. The finger hooks under the tip of the coccyx, draws upon it until a tight contact is secured and then jerks sharply backward upon it with a view to its abrupt fracture. No mitigation of the jerk in the hope of previously loosening or gradually replacing the bone is of value for _osseous tissue_ must be broken before any movement may take place.

This movement is painful and the region of the newly fractured coccyx may remain sore for a period ranging from a few days to several weeks. It is wise to warn the patient of the facts before proceeding.

The fractured coccyx may be absorbed, or may be reankylosed in a proper position or in a new abnormal position, or may remain loose and movable.

ADJUSTMENT OF CURVATURES

We have previously discussed in detail the nature and discovery of curvatures. A few words should be said here about their correction.

If the sole object of the adjustment is to correct the curvature it is best to select for adjustment those vertebrae which are most subluxated in the direction of the curvature. According to the length of the curvature a series of from two to six, separated by some distance, are chosen. These are adjusted until they cease to be the most prominent ones in the curvature and then others, then most prominent, are chosen and adjusted until they in turn cease to be most prominent. In this way the curvature may eventually be straightened, or nearly so. It is doubtful if any curvature can be absolutely eradicated, although it may be straightened until unnoticeable except by the expert.

To overcome a curvature it may be necessary to break every rule which governs ordinary adjusting and to invent new ways of placing the hands or of delivering force. No two require exactly the same measures and he is most successful with curvatures who is most adaptable to changing conditions.

One rule may be safely laid down. Do not alternate from day to day, loosening at the same time many vertebrae, but choose the ones most in need of adjustment and _follow your choice_ as long as it is indicated. The chief vertebra is nearly always the one at the _angle_ or _point_ of the curvature.

The sharp, angular curve of Potts’ Disease, involving two or three vertebrae, should warn against adjustment, usually, since in this disease the vertebrae are fragile and easily fractured. If a case has not progressed too far a cure may be effected, but great caution in taking such cases must be exercised. Every Chiropractor should be well informed on the diagnosis of Potts’ Disease, or spinal caries.

Many months are usually required for the straightening of a curvature--how many can scarcely be estimated in advance of the experiment with any case. Often the case which seems simplest requires the longer time, while a very pronounced curvature, as in some cases of rachitis, may yield in a few months.

PREFERABLE ADJUSTMENTS

The selection of the move with which to correct each subluxation depends upon the adjuster’s concept of the _kind_ and _direction_ of the subluxation and of the mechanics of the different corrective moves in his repertoire. The move used should be one in which the application of force is exactly along opposite lines to the lines of force which originally produced the subluxation.

Omitting involved explanations as to the elements of each displacement and the manner of change in bone, muscle, ligament, cartilage, etc., and presupposing a comprehension of the principles of each adjustment named, there follows here a list of possible subluxations of each vertebra in turn, from Atlas down, with a simple statement of the RIGHT MOVE for that subluxation.

In each instance there are other moves than the one listed which would _move_ the vertebra and some which would partially correct it, but none which would quite so definitely tend to _correct the displacement_. Unfortunately it is not a fact that every movement of a vertebra is an adjustment. If this were true subluxations would not exist, because they could never have been produced. Too often the adjuster uses a move because it is easy, because its use has become habitual with him, rather than because it is indicated by the conditions of the case--then blames Chiropractic because his results are negative or bad.

The move which is suited to a certain kind of subluxation of one vertebra may be quite out of place with another, in a different part of the spine. Thus the Recoil is quite proper for a posterior Lumbar and is contraindicated with a posterior middle Dorsal.

If all vertebrae were shaped exactly alike, if all were equal in size, if subluxation were possible only in one direction, then one method of adjustment would be quite sufficient. Diversity of technic is demanded, but a discriminating diversity, with a good reason for every move used.

First Cervical

_Subluxation._ _Adjustment._

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

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

Second Cervical

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

Third Cervical

Same as second.

Fourth Cervical

Same as second.

Fifth Cervical

Same as second.

Sixth Cervical

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

Seventh Cervical

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

First Dorsal

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

Second Dorsal

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

Third Dorsal

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

Fourth Dorsal

Same as third Dorsal.

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

Fifth Dorsal

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

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

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

Sixth Dorsal

Same as Fifth Dorsal.

Seventh Dorsal

Same as Fifth Dorsal.

Eighth Dorsal

Same as Fifth Dorsal.

Ninth Dorsal

Same as Fifth Dorsal.

Tenth Dorsal

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

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

Eleventh Dorsal

Same as Tenth Dorsal.

Twelfth Dorsal

Same as Tenth Dorsal.

First Lumbar

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

Second Lumbar

Same as First Lumbar.

Third Lumbar

Same as First Lumbar.

Fourth Lumbar

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

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

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

Fifth Lumbar

Posterior--P. Heel contact.
Posterior, superior--P. S. Edge contact.
Posterior, inferior--P. I. Edge contact.
Posterior, right--P. R. Recoil.
Posterior, right, superior--P. R. S. Recoil.
Posterior, right, inferior--P. R. I. Recoil.
Posterior, left--P. L. Recoil.
Posterior, left, superior--P. L. S. Recoil.
Posterior, left, inferior--P. L. I. Recoil.
Right--R. Recoil (Same if R. S. or
R. I.)
Left--L. Recoil (Same if L. S. or
L. I.)
Anterior--A. “Bohemian” anterior fifth
Lumbar move. (Not always
advisable.)

Sacrum

Posterior base--B. of S.--P. Heel contact on base.
Posterior apex--A. of S.--P. Heel contact on apex.
Entire Sacrum posterior Sac. P. Heel contact between
sacroiliac articulations.

Coccyx

To be adjusted only when ankylosed in an abnormal position and then
by leverage of finger through rectum.

A FINAL WORD

Some useful information pertaining to adjustment will be found in section entitled, “Practice,” q. v.

After a careful and painstaking study of the foregoing pages it will still be found that the student is not by any means equipped for the work. He must _practice_ these things to learn them. We learn to do by _doing_. The chief use of this section will be as a reference and guide during the practice of adjusting.

THE CAUSE OF DISEASE

Disease a Morbid Process

Disease has been variously regarded as an entity, a process, a condition. It has been mentioned in terms which would almost personalize it, such as, “attacked by pneumonia,” “seized with cramps,” “in the clutches of tuberculosis.” Men have endeavored constantly to discriminate between diseases and to learn the appearance and peculiarity of each, and have resolved each into its peculiar elements only to learn that the merging lines between two diseases or between cases of the same disease are imperceptible. It is no more possible to define any one disease within exact limits and to distinguish it from all others than to consider one function of the human body without studying its interdependence with others.

Disease is a _process_. It is a natural process. It follows certain well-defined laws and consists in the abnormal performance of function in some bodily organ or organs, or in the untimely performance of some function which would be normal in its proper chronological relation with other functions or at another period of the body’s development. The balance of function of the body is destroyed--some function intensified or diminished--that is all. Every disease, properly studied, reveals its functional base.

Disturbances of the functions of _growth_, _nutrition_, and _repair_ produce changes in structure, physical evidences of disease. It is probable that every disease has a certain amount of structural change connected with it; it is hard to conceive of functional derangement without structural change, in a universe in which Nature is eternally building, destroying, or modifying organic peculiarities to meet changing functional demands. But in many instances this structural change is so slight as to be undiscoverable; such diseases are called “functional” to distinguish them from those in which structural pathologic changes are directly discernible, called “organic.”

Beginning of the Process

Recognizing the fact that disease consists in a succession of steps or a series of events, each depending upon the next preceding one and making possible its successor, and desiring to arrest or check this process and correct the damage done, in other words, “to cure disease,” the question arises, “Where does this process begin?”

If we wish merely to check the process or to modify it, as does medicine, the etiology of the disease is less important than the present state. It is then more important that we understand the changes which are taking place in the body at the time of our attempt, the condition of each organ at that time, and the general recuperative or resisting power of the individual.

But if we would correct all the damage done instead of merely preventing further damage or building up internal resistance against a still active destructive process; if we would so eliminate the effects of the earlier steps as to make the resumption of the disease process most improbable, we must know each step from the beginning to the present, understand their sequence and relation, and go back to the beginning with our correction, _removing the cause_.

The Cause of Disease

Since each event in the morbid process depends upon the preceding one and makes possible those which follow, it is possible to stop at any point in the chain of events and declare, “Here lies the Cause of Disease.” This explains the various etiologies adhered to each by a school of intelligent and scientific men, yet each apparently disagreeing most flatly with the others. No matter which step we select as our “ultimate cause” it truly is the cause, or one of the causes, of succeeding steps, which succeeding steps may well stand in our minds as the whole of the disease. Thus the physician, having found a germ, is quite content to look forward from the invasion of the germ and consider that as the primarily necessary requisite for disease production. In retrospect he follows disease back within the body to the time of entrance of the germ and then leaves the body to study the life habits of the germ and its favorite mode of conveyance. He has unwittingly left the direct line of investigation and followed a spur-track.

So with the osteopath who discovers contractured muscles drawing a member, or a bone, from its normal position. He proceeds to a study of the effect of such contracture upon other tissues and strives to relieve it by treatment--of the muscle.

The dietist discovers that certain food combinations cannot be properly cared for by an individual and that if taken they tend to develop toxins deleterious to the system. Whereupon he undertakes to discover food combinations which the body _can_ care for and believes that he has solved the question of etiology.

Now it is _most_ important that we find the _primary_ cause, the one which makes possible the operation of all the rest and without which all would be powerless to harm man. This we shall expect to find at the point of entrance of disease into the human organism. The primary cause must be the first step _which concerns man_, the first change from normal to abnormal, on which all subsequent changes depend. It is useless to pass outside of the consideration of man and those forces which directly affect man, in our search for the cause of disease. We are powerless to affect outside forces or to control or amend the laws of nature through which disease exists.

Let us attempt then to resolve disease into its successive steps and to find the first which concerns man. Correcting that, we shall have corrected, fully and completely, the process which constitutes disease. By striking at the root we may destroy the entire growth.

Vital Energy

_Irritability_ is the property of being susceptible to excitement or stimulation. Stimulation is the process of increasing the functional activity of any organ. Inhibition is the act of checking, restraining, or holding back the functional activity of any organ. These definitions, taken from Gould, are here introduced as a necessary preface to an attempt to set forth, without unnecessary reference to, or discussion of, any other theory as to the etiology of disease, the Chiropractic explanation of its presence.

Chiropractic maintains that all the chemical and physical activities of the human organism are controlled, directly or indirectly, through a third form of energy transmitted through the Nerve System; that while all three forms of energy are interdependent and closely related in their ultimate expression, one of the three is the _primary_ and most essential form, and especially indicative of life. We may call this third form _Vital Energy_.

There are several good reasons for believing that this nerve force is the primary form in which energy is expressed in man and for believing that it controls and directs the others in greater degree than it is controlled and directed by them.

Of the four forms of tissue of which the body is composed--connective, epithelial, muscular, and nervous--the latter is the one damage to which is followed by the greatest and most permanent consequences.

It is a fact that there are several organs whose removal leads to certain death because of their importance in the general economy of the body, but it is also true that section of the nerves leading to these organs just as certainly causes death by the cessation of their functions. There is no organ in the body aside from the nerves themselves which does not immediately cease to act upon withdrawal of its nerve force and at once begin a process of degeneration or atrophy.

Pathologic changes in the Nerve System invariably are followed by pathologic changes in the organs controlled by the diseased segment but the converse is not true. Excitation or inhibition of nerve activity produces corresponding and responsive change in the activity of the organs innervated, but excitation of an organ does not necessarily produce similar changes in the Nerve System. That system possesses the power of inhibiting or permitting responsive action, in other words, the power of _choice_.

Research in Comparative Anatomy develops the fact that the differences in power of complex action possessed by different organisms are entirely measurable by differences in the structure and complexity of their nerve mechanisms.

Further, by studying the effects of removal or extirpation, or of pathologic changes in various parts of the nerve system it has been demonstrated that the Brain is the center for those higher forms of activity known as psychic, for the power of accelerating or inhibiting the responses of the lower centers of the nerve system to stimulation from without, and for the conveyance of authority to act to all the lower centers. The Nerve System is the morphologic, physiologic, and dynamic center of the organism and the Brain the center of the Nerve System. We may, then, logically expect to find in the Brain, or in the channels by which power is distributed from the Brain to lower centers or organs, the initial step in the disease process, which is our present quest.

One Nerve System

All nerve tissue in the body is organized and linked together in a complicated aggregation of individual units, communicating by _contact_, and forming one great Nerve System having its directing center in the Brain. It is said by some writers to consist of two distinct systems--cerebro-spinal and sympathetic--but would better be described as consisting of central organs--brain and spinal cord--and peripheral organs--cranial, spinal, and sympathetic peripheral axons connecting with cells in the central axis and linked together in a net-work improperly separable into separate or distinct divisions, the fibres of different parts being bound together in such a way as to establish an intricate intercommunication, closest on the one hand between the cranial and sympathetic and on the other between the spinal and sympathetic. The sympathetic system may be regarded as nothing more than a medium for proper distribution of impulses originating in the cerebro-spinal system, and a series of reflex centers deriving their power to act from the central axis. The proper action of sympathetic ganglia has been demonstrated to depend upon the integrity of the spinal nerve fibres, or rami communicantes, which pass to and terminate in the ganglia with their telodendria (terminal arborizations) in contact with the dendrites (cellulipetal processes) of the ganglion cells.

It will appear that interference with one division or part of the nerve system may be followed by effects partly manifested through a distant part; that excitation or inhibition of a spinal nerve may correspondingly excite or inhibit sympathetic fibres.

Chiropractic Hypothesis

Chiropractic has accepted, as a convenient working hypothesis amply justified by years of clinical experiment and anatomical and physiological research, the proposition that all disease in the human body is primarily made possible by injury to (stimulation or inhibition of) some part of the nervous mechanism.

Injury to other tissues, unless the injury also involves nerve tissue, is quickly repaired and the body goes on without disease. Or the injury is sufficient at once to render the body untenable and death ensues. Few pathological changes follow trauma unless nerve tissue be injured.

This theory to be logical must and does include the entire nerve system. Also, since it is noted that each nerve cell presides over the nutrition of its own processes and possesses its own power of repair, it follows that unless an injury be of fatal nature or of permanent duration, even injuries to nerves tend toward automatic cure. We must seek a permanently operating interference with nerve tissue.

The brain, enclosed within the comparatively solid cranium, is so well protected that nothing except fracture of the skull, violent concussion, or shutting off of its blood supply from without, will produce permanent change there. Also, unless there be pressure by foreign substance against the brain, an injury will be repaired in time and the body resume its normal functional activity. It has been demonstrated that comparatively few diseases occur in this way. Such as do are called traumatic; i. e., caused by wound or injury.

In the broadest sense all disease is caused by trauma, as we shall presently show.

The upper or cephalic peripheral nerves, called cranial, leave the skull by foramina in its base (except the auditory) and are so protected by the immobility of the bones of the skull as to be comparatively free from direct injury. Peripheral injuries occur to cranial nerves but are repairable; even section of the trigeminal for neuralgia is usually followed after an interval by a reunion of the severed parts. As will be shown later, the special end organs of the cranial nerves are not free from the effects of spinal subluxation and their nuclei (deep origins) often share in morbid changes in the brain tissue due to nutritional disturbances.

The sympathetic portion of the nervous system might be classed with the cranial as regards infrequency of permanent interference were it not for the proximity of the great gangliated cord to the transverse processes and bodies of the vertebrae. This proximity renders it liable to sustain permanent impingement in vertebral subluxation.

Trauma Affects Spinal Nerves