Definitions

Vertebral Adjusting is the art of correcting by hand the malpositions of subluxated vertebrae.

A Vertebral Adjustment, strictly speaking, should mean the complete restoration of normal relation between previously subluxated vertebrae. As used in Chiropractic, it means either a partial or complete restoration of such normal relation.

Maladjustment, as used in the profession, designates any movement of vertebrae by hand which produces or increases subluxation.

GENERAL PRINCIPLES OF ADJUSTING

It will be well for the student to master first the general rules and principles which govern vertebral adjustment and then to proceed to a detailed investigation of each movement, in turn, before practicing it. The art of adjusting can only be acquired by practice, and a high degree of excellence in it only by long-continued practice. However, the rapidity with which it can be mastered depends largely upon the formation of a clear pre-conception of the work to be done and the manner of its doing.

As the student progresses in the art he finds himself occasionally guilty of errors which mar, in some degree, the efficiency of his work. These may arise from unconscious modification of the technic first learned or from unconscious repetition of some necessary modification demanded by a special peculiarity in one or more cases.

This section is intended to furnish the proper pre-conception and also to serve as a monitor to adjusters who, by reference to the precepts herein set down, may discover and remedy their own errors. It is not intended to furnish sufficient education to warrant practice without clinical instruction, which is unwarrantable, but rather to accelerate the education which practice alone can furnish.

Object of Adjustment

The vertebral subluxation being an abnormality of relation between vertebrae, it is obvious that its correction must be a return of normal relation. This can only be accomplished by bringing about a change of relative position. Movement of a section of the spine composed of several vertebrae is not, in the true sense, an Adjustment. It is the single vertebra which must be moved.

The movement should be one calculated to bring the vertebra to its normal position in the most direct manner possible. Such a movement should be used as will reverse the direction of the forces which subluxated the vertebra. It should be applied to the transverse or spinous processes, or to the lamina, as is sometimes done in the case of the Atlas, according to the kind of subluxation. Different subluxations require different handling. Cases vary. Select the move best suited to the case. This can be determined most properly by correct palpation which fixes in the mind of the adjuster the position of every part of the vertebra, its relation to its fellows, the points of greatest nerve impingement, etc., all of which should suggest the best method for correction.

The prime object of adjustment is the removal of impingement from nerves.

Transmitted Shock vs. Thrust

The movement used in adjusting has been variously described. Many writers and teachers have used the term “thrust” to describe the movement of the hands, and the term is correctly applied to the movement used by many Chiropractors. But a careful study of the methods of applying force in use among the most successful adjusters, those who have attained the greatest results with the slightest percentage of failures and a minimum of pain to the patient, discloses the fact that the chief element of their adjustment is transmitted shock.

The hand is held in close contact with the vertebra to be adjusted and the arms and shoulders describe such movements as to deliver the required amount of force with the slightest possible change in the position of the hands. The vertebra bounds away from the contact hand. In the delivery of a thrust the hand would follow the vertebra, forcing each portion of the movement. The real effect of a thrusting motion, since the hand cannot enter the body as a sharp instrument would, is that of pushing. Pushing neither subluxates nor adjusts vertebrae so readily as does a rapidly applied shock.

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.

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.

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.

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.

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.
ANote.—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.

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