Part 15

Any vertebra may be posterior: the Atlas is rarely so as a whole, and never unless the Axis is also displaced backward; the Cervical and Dorsal regions present frequent variations of this sort, which must not, however, be confused with long, prominent, or overdeveloped spinous processes; the Sacrum may be posterior to the ilium on one side, or to both ilia.

Occipital Subluxations

Mention should be made here of a form of subluxation not strictly vertebral--displacement between the condyles of the occipital bone and the lateral masses of the Atlas. This occurs when the head has been moved too violently upon the Atlas so as to cause an immediate nerve irritation and muscle tension sufficient to hold it in its abnormal position. The Cervicals may be quite normal below the Atlas though this, of course, is not the rule. Correction of occipital subluxations is made by applying force to the Atlas and to the skull, sometimes by holding Atlas and rotating the skull.

Age of Subluxations

The relative age of subluxations may be determined, within rather wide limits, it is true, by a study of the form of the spinous process. Newly acquired subluxations are sharply defined, having noticeable edges on the spinous process. In time they tend to become rounded and blunt and appear to cover more surface, just as the mountain range which, when first upheaved, is sharp and rugged, gradually rounds into regular curves through the work of the elements.

In this way Nature protects the subluxated vertebra from further contact with the environment surrounding man, the rounded process offering less opportunity for a blow or shock to affect it.

Changes in Shape

Bone diseases such as rachitis osteomalacia, etc., and especially Potts’ Disease, or spinal caries, make marked changes in the shape of vertebrae. Also a subluxated vertebra may gradually assume a shape suited to the abnormal position it occupies, the commonest change being the assumption of a wedge shape by the centrum. This is a great obstacle to adjustment, as the abnormal shape of the vertebra makes it tend to settle after each movement into the old abnormal position.

There are few spines without some more or less misshapen vertebrae.

Ankylosis also makes great changes in the shape of vertebrae. There are two kinds of ankylosis--true and false. The first is a deposit of bone cells upon bone, often the formation of a bridgelike structure to hold contiguous vertebrae together. This may bind any portions of the vertebrae but most commonly holds the bodies, in which case it can only be appreciated by detecting the lack of movement between normally separable vertebrae. False ankylosis occurs with fever in bone and consists in an exudation of bone substance which sometimes produces remarkable distortions of shape.

TECHNIC OF ADJUSTING

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.