Part 23

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