Part 26

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