Technic and Practice of Chiropractic. Joy Maxwell Loban
be listed. The Group Method is chiefly valuable because of this rule, to prevent the overlooking of the most important subluxation by selecting that one first.
Consider the spine as divisible into five groups; in the first group belong the Cervicals below the Atlas; in the second, the seventh Cervical and first five Dorsals; in the third, the vertebrae from the fourth to the eighth Dorsals inclusive; in the fourth, the last five Dorsals and sometimes first Lumbar; and in the last group, all of the Lumbars and the base of the Sacrum. Consider the first Sacral spinous process here rather than the whole Sacrum and remember that this process should seem to complete the regular Lumbar curve. This grouping may be modified somewhat by the exigencies of palpation in any given case, but the group considered should always include from four to seven vertebrae.
In each group proceed in the same manner to select subluxations. Let the fingers glide over the group, first on the tips and then along the sides of the spinous processes, and note that some one vertebra stands out as the sharpest, most abrupt deviation in the group, thus indicating its selection. Remember that neither the one above this nor the one directly below may be adjusted. This narrows your field of observation for this group to two, three, or four remaining vertebrae.
Select then such others in the group as need to be listed yet do not conflict with the rule against adjacent subluxations. Proceed to discover and record the exact direction of each. When this is done examine the next lower group in the same way and continue until the whole spine has been palpated.
The Atlas must be considered alone and not as a part of any of the above mentioned groups and its position is judged rather by its relation to the head than to other vertebrae; the Sacrum also requires individual attention, being compared with the Lumbar curve and with the ilia.
The one most pronounced subluxation in a group is often mentioned as the “key” to the group, since its correction would effectually loosen the entire group and sometimes partially correct the apparent abnormalities of the rest. It has also been called “major subluxation” to distinguish it from “minor subluxations” which are the others of less importance in the group. This term is not a good one because it suggests what is not always true, namely, that the mechanically greatest subluxation is more potent than any other. Occasionally a slighter subluxation irritates nerves so as to produce a disease more serious and immediately alarming than the condition following the greater displacement.
Example of Group Method
If, in the Cervicals, it is noticed upon gliding downward over the spinous processes that the fifth is badly subluxated and must be adjusted, this fact is held in mind for a moment while the palpater remembers that he cannot adjust and must not list the sixth or fourth. This leaves only the second, third and seventh for consideration, the Atlas having been separately examined. The seventh may best be included in the next group when such a selection is made, so that the palpater need only decide between the second and third Cervical, providing Atlas has not been chosen, as to which, if either, most requires attention. If Atlas has been listed, then there remains instead only the question as to whether the third is or is not subluxated.
In using the Group Method no preference is given to subluxation in any particular direction, save only that below the Cervicals we discriminate against the anteriors, because we cannot adjust them. The Group Method has to do with determining the points of greatest pressure on nerves and this depends upon one’s impression as to the interrelations between all the members of the group. (See p. 80 under Subluxations.)
THE INDIVIDUAL SUBLUXATION
Having prepared our patient, surveyed the entire spine, carefully counted the vertebrae to secure a proper orientation, and specially examined the Atlas, then divided the spine into groups and selected the vertebrae to be adjusted with regard to their degree of malposition, let us confine our attention definitely for the first time to the single vertebra below the Atlas.
Reread “Direction of Subluxation” under “The Record,” p. 25. Also read article on “Subluxations,” p. 76.
Bear in mind that each subluxation recorded is intended for adjustment and indicate nothing impossible on your record. For instance, an anterior subluxation in the Dorsal region cannot be corrected and should not be recorded for correction.
Remember the six capital letters used in describing a subluxation.
Use only the downward gliding movement of the three palpating fingers.
Keep in mind the count as you have established it for that particular spine, recalling one or two very prominent and noticeable vertebrae whose numbers you have noted.
Use a light touch. If necessary, change the patient’s position to make the vertebra more accessible instead of pressing with more force.
When in doubt as to direction, change sides and use the other hand. If still in doubt, take a longer glide, covering six vertebrae instead of three or four.
Keep your mind on your work, forgetful of everything else.
And picture to yourself the entire vertebra and its surroundings; its body, pedicles, and laminae, its transverse processes and all articulations; above all, mentally visualize the foramina and nerves. Estimate from the position of each vertebra the pressure at each foramen. Decide whether the vertebra is rotated, tipped, laterally displaced, anterior or posterior, or whether the subluxation partakes of several of these directions.
Decide in what direction movement of the vertebra would release most pressure and list accordingly.
Never hesitate to change your opinion if you discover evidence that you have made a mistake. Keep at all times an open mind in palpation.
Cervical Palpation
The third Cervical, lying under the projecting spinous process of the larger second, may be hard to find, and therefore the full count is always required before listing any vertebra. By requiring the patient, who is in position A, to drop his head forward and rest its weight in the hand which is not palpating, the Cervicals may be more easily palpated. Remember that this posture widens the interspaces and also makes the spinous processes appear more posterior than they really are, this difference being most noticeable at the fourth.
One bifurcation of a Cervical spinous process may be longer than the other and prove confusing unless care be taken always to palpate both bifurcations and note their form. This can almost always be successfully accomplished.
Sometimes the posterior neck muscles and ligaments will be rigid so that they interfere with palpation and at the same time make it impossible for the patient to flex his head forward. Having found that this is due to real contracture and is therefore not susceptible of voluntary relaxation by the patient, support the head in front and push aside the muscles with the fingers, gliding underneath the muscle layers as much as possible and close to the spinous processes.
Transverse palpation in the Cervicals is used to verify findings from the spinous processes or to differentiate between rotated and laterally displaced vertebrae and bent spinous processes when the spinous swerves to right or left.
Dorsal Palpation
The Dorsals are usually considered