Technic and Practice of Chiropractic. Joy Maxwell Loban
considered curvatures.
Visual Examination
The general inspection of the spine which precedes the count should bring to light, in addition to prominent subluxations, and general symptoms observable by inspection of the back, any marked curvatures. Their general locality and direction will be noted by this observation and their details left to be discovered by closer examination.
During palpation with a long and rapid glide one may also note these general points with respect to any curvature.
Do not mistake the four normal curves, the anterior Cervical and Lumbar and the posterior Dorsal and Sacral, for curvatures. The normal Lumbar curve is so unusual in practice that a novice has been known to name it a lordosis.
Description of Curvatures
Four varieties of curvature are commonly described. Kyphosis is a curvature with its convexity directed backward, usually, but not always, found in the Dorsal region. Lordosis, the opposite of Kyphosis, is an anterior curvature, usually in the Lumbar in which case it is an accentuation of the normal curve. Scoliosis has its convexity directed laterally either to the right or the left. It is commonly also Rotatory, having its vertebrae rotated around their vertical axes so as to make the outer or the inner transverses more prominent than those on the other side.
In a Scoliosis the rotation may swing either the bodies or the spinous processes toward the convex side of the curvature; the latter is much the easier of adjustment while the former furnishes one of the most intricate problems of adjustment.
Cause of Curvatures
Without entering here into a discussion of those disturbed metabolic processes—themselves the result of subluxation—which result in curvature by general softening of the bone, as in rachitis or spondylitis deformans, we will simply state the general proposition that almost all curvatures which are in any degree angular result from a single subluxation to be found at the point of the angle. It has been demonstrated in such cases that adjustment at that point will correct the curvature in time but it is usually wiser to hasten matters by selecting other points of attack by a method to be presently suggested.
Long, regular, but not pronounced, Scoliosis, usually in the Dorsal, may be an example of occupation curvature, following the continued use of muscles in a fixed position and not due to subluxation. Another example is the mailman’s Lordosis. These in themselves are not detrimental to health and are negligible unless some special point of impingement through individual subluxation exists within them.
The sharp, angular kyphosis of Pott’s Disease, tubercular caries of the vertebrae, the curvature involving three or four vertebrae which are extremely tender to palpation, should warn against adjustment unless one can be very certain that the vertebrae are sufficiently intact. Fracture of a decayed vertebra is easily possible under adjustment. The cause of Pott’s Disease is usually at the angle point, most frequently the tenth Dorsal but possibly any Dorsal from fifth to twelfth.
Record on Curvatures
If it is the purpose of the examiner to straighten the curvature he should choose for adjustment a series of non-adjacent vertebrae which are most prominent in the direction of the curvature; thus in a right scoliosis he should choose only those vertebrae most prominently out to the right, and in a kyphosis only posterior ones. A lordosis as such cannot be properly adjusted except in the Cervicals, but lordosis is usually a compensating curvature (see below) and can be otherwise corrected.
If the patient suffers from some disease which assumes more importance than the curvature and demands attention, select the one vertebra which is causing the disease, without reference to its position in the curvature, and adjust that vertebra into a proper relation with the adjacent ones, even though you adjust directly toward the convexity of the curvature. Disease may often be relieved by making a curvature regular more quickly than by eliminating the entire curvature. Sometimes both considerations may influence the selection of vertebrae.
In a curvature there is not necessarily pressure on nerves at every foramen. In fact, such pressure is the exception rather than the rule in curvature and a careful study of the spine must be made in order that adjustments may be accomplished without causing temporary impingement here and there.
A foot-note describing curvature may be appended to the record of palpation. It should contain the special name of the curvature, whether simple or compound, and the numbers of the first and last vertebrae in it. For instance, note may read: “Right rotary scoliosis from D 3 to L 1 inclusive.”
Compensatory Curvatures
When a primary curvature is present one or two secondary curvatures usually appear to preserve the equilibrium of the body. With a Dorsal kyphosis there is often a Lumbar lordosis and sometimes less marked lordosis in both Cervical and Lumbar. With a primary right scoliosis in the Lumbar there will be a secondary left scoliosis above. The secondary curvature is called compensatory. In selecting vertebrae for adjustment it is well to neglect the compensatory curvature as much as possible, leaving it to right itself as the primary one is corrected. If, however, the primary curvature be a lordosis, and not adjustable, work on the secondary curvature may gradually aid in reducing the primary, to a certain extent at least.
Ankylosis
This topic is discussed here partly because it is so often associated with curvature.
Ankylosis can be appreciated only by detecting the lack of normal movement between adjacent vertebrae. Place a finger in the interspace between suspected vertebrae and ask the patient to perform the movement calculated to separate the spinous processes in a normally movable spine. If in the Dorsals, ask him to drop the head and shoulders as far forward as possible without bending at the hips. Alternate repetitions of this movement with straightening and the spinous processes should alternately separate and approach each other. Test several successive vertebrae so as to note that all change their position except two.
In the Lumbars have the patient repeatedly bend the body forward from the hips striving to make his spine convex backward. In the Cervicals forward flexion of the head will serve. Occasionally general ankylosis is found with curvature, as in Spondylitis Deformans.
Many Chiropractors mistake failure to move a vertebra with an attempted adjustment for evidence of ankylosis. In nine cases out of ten such failure is due to other reasons, ankylosis being very infrequent. It is a much abused excuse for incapability. Free movement between spinous processes is absolute proof that the vertebrae are not ankylosed.
DIFFICULTIES IN PALPATION
The chief difficulty arises from failure to observe some of the rules herein laid down.
Carelessness or inattention precludes accuracy.
Pain may cause the patient to assume an unnatural or cramped attitude simulating curvature, especially of the Cervicals. More errors occur from this cause in judging the laterality of C 2 than with any other vertebra.
The occasional bent spinous process in Cervical or Dorsal regions may deceive the palpater unless transverse palpation is employed. But the frequency of slightly bent processes in dry spines and a superficiality of reasoning upon the subject have led to great overestimation of their importance. As a matter of fact only a very few maladjustments arise from deception of the palpater in this way, though the profession contains few practitioners who make a routine method of verifying by the transverses. The reason is simple. Bent processes are caused by direct violence applied before the union of shaft and epiphysis is complete. Sufficient force to produce a change of direction usually produces subluxation in the same direction. Adjustment continued until the offending process was quite aligned