Technic and Practice of Chiropractic. Joy Maxwell Loban
It must be remembered that the form and obliquity of spinous processes vary considerably in this region. The upper processes are very slightly oblique, slanting downward, the middle Dorsals very oblique, and the inferior ones again only slightly so. There is a form change, most commonly at the eighth Dorsal, which may be mistaken for a posterior subluxation. The process here becomes more horizontal and more blunt.
Among the first four Dorsals a bad lateral or rotated vertebra may be listed as well as a posterior one, since we can readily adjust it. In the middle group either the posterior or rotated vertebra is chosen according to the estimate as to which causes greatest nerve impingement, either being adjustable. In the lower group, however, preference is usually given the posterior vertebra when possible, because rotary subluxations indicate transverse adjustments and it is somewhat dangerous in this region to use the transverses as levers.
Lumbar Palpation
The Lumbars and Sacrum are considered in one group. The Lumbars, with patient erect, should curve anteriorly and the first Sacral spinous process should complete the regular curve. This is rarely found, however; the normal is the exception in any part of the spine.
In the Lumbars we usually choose the rotated rather than the posterior vertebra, but solely because rotation here produces the greatest degree of impingement. The laterality of spinous processes, indicating rotation of the whole vertebra around an axis lying in the transverse line between the articular processes, can best be perceived, as a rule, with patient sitting quite erect. If in doubt, have patient lean forward and rest elbows on knees, which posture separates the Lumbars, rendering the individual spinous process easier to discover but the relative position more difficult of determination.
The fifth Lumbar, if anterior, may be so listed, forming an exception to the general rule.
Sacral Palpation—Pelvis
First palpate Sacrum as if part of Lumbar region. Note whether the base (upper portion) is posterior or not. Then stand behind the patient and use both hands to examine the sacroiliac articulations. Use palmar surfaces with the flat hand toward patient’s body, and carefully compare the two sides to detect inequalities, which indicate iliac subluxation, or rotation of Sacrum between the ilia on a transversely disposed axis passing through the two articulations, in which case the Sacrum is to be adjusted. Do not mistake a dislocated hip with compensatory tilting of the whole pelvis, or faulty sitting posture with only one tuber ischii supporting the body, for pelvic subluxation.
Be not in undue haste to record pelvic subluxations lest your haste bring its immediate reward in the difficulty of adjustment.
The Coccyx
The Coccyx may be detached from the Sacrum by various accidents and later re-ankylosed thereto in an abnormal position so as to impinge upon the rectum or other structures. Impingement of the coccygeal nerves is usually unimportant. Chronic and intractable rectal constipation, with its attendant train of evils, may result from coccygeal displacement with ankylosis. In spite of numerous treatises to the contrary, the writer avers that other symptoms are extremely rare.
To examine the Coccyx use a rubber covering on the second finger. Place patient face down and insert second finger per rectum with the palmar surface upward. If subluxated Coccyx be found, it must usually be fractured with a sharp jerk, in order to relieve the condition. After fracture, it may be absorbed or may re-ankylose to the Sacrum in a better position, or it may remain freely movable.
PALPATION IN POSITION B
This is the position for the majority of adjustments, and as the palpation of each vertebra to be adjusted is a necessary preliminary to the adjustment, this method, though not so accurate as the one already described, must also be used.
The use of the first three fingers of each hand and the relation of hands to patient’s body is the same as in Position A, except for palpating Cervicals when the patient’s face is turned away. It will be found very difficult to make a correct full count, especially to count Cervicals, in this position, and is better to use a record already prepared.
Dorsals
Begin at, or near, the first Dorsal to palpate in this position. Find the vertebra which agrees in direction with the first Dorsal subluxation recorded; let the fingers glide downward until they reach the vertebra which, according to the first decision, would correspond in number with the next subluxation on the record. If this also agrees in direction with the record it may safely be assumed that you are accurate in your numbering. Thereafter, during that adjustment, the count can be made or repeated from any prominent vertebra the number and identity of which are easily recognized.
Fig. 2. Palpation in Position B, preparatory to adjustment.
Lumbars
It may be difficult to count or otherwise to palpate the Lumbars in this position because of the increase in the normal anterior curve when patient is suspended between the two sections of the bench. This will be obviated if a roll be placed under the thighs or if the bench has an adjustable rear section.
Cervicals
If a solid front bench is used remember the spiral turn in the Cervicals, which occurs because of the resting of the head on one side. The curve due to this rotation of the head is compounded with the ever present anterior curve to make a spiral. Do not expect the vertebrae in this position to agree in apparent direction with a record made with the head straight. It is better to make all decisions as to direction of Cervicals in position A and merely to count them in other positions.
In position B, if the patient’s face be away from the palpater it will be necessary to stand with back toward patient and body twisted, and to change hands for counting, resting the free hand on patient’s head to insure its steadiness.
Disagreements
If there be any apparent disagreement between findings in positions B and A, re-examine carefully in both positions, whereupon that which seemed a disagreement will probably prove to have been an error in one or the other palpation. If apparent disagreement persists after searching examination, position A furnishes the safest guide to adjustment because the patient is in his most usual attitude as regards the spinal curves, muscle tension, etc. But it is usually wisest when in grave doubt not to adjust the doubtful vertebra at all.
PALPATION IN POSITION C
Since palpation in this position, patient lying on his back with head supported by palpater’s hands, cannot be so reliable as that done in position A, the chief point to be observed is an accurate count. Only the Cervicals below the first can be properly palpated in this position.
Induce the patient to relax the neck muscles as much as may be, and use in palpation the first three fingers of one hand if the count alone is desired or the first three fingers of both hands if you desire to ascertain the direction of any vertebra. In the former case let the fingers press aside the muscles and glide downward from the second Cervical, being careful to lift the head high enough so that the third Cervical is not overlooked beneath the overlapping second. In the latter case let the fingers of both hands glide gently downward while the patient’s head rests upon the palpater’s wrists or knee. Palpate the transverses in much the same manner, paying special attention to their laterality, felt as a prominence on one side lateral to