THE INDIVIDUAL SUBLUXATION
Having prepared our patient, surveyed the entire spine, carefully counted the vertebrae to secure a proper orientation, and specially examined the Atlas, then divided the spine into groups and selected the vertebrae to be adjusted with regard to their degree of malposition, let us confine our attention definitely for the first time to the single vertebra below the Atlas.
Reread “[Direction of Subluxation]” under “[The Record],” [p. 25]. Also read article on “[Subluxations],” [p. 76].
Bear in mind that each subluxation recorded is intended for adjustment and indicate nothing impossible on your record. For instance, an anterior subluxation in the Dorsal region cannot be corrected and should not be recorded for correction.
Remember the six capital letters used in describing a subluxation.
Use only the downward gliding movement of the three palpating fingers.
Keep in mind the count as you have established it for that particular spine, recalling one or two very prominent and noticeable vertebrae whose numbers you have noted.
Use a light touch. If necessary, change the patient’s position to make the vertebra more accessible instead of pressing with more force.
When in doubt as to direction, change sides and use the other hand. If still in doubt, take a longer glide, covering six vertebrae instead of three or four.
Keep your mind on your work, forgetful of everything else.
And picture to yourself the entire vertebra and its surroundings; its body, pedicles, and laminae, its transverse processes and all articulations; above all, mentally visualize the foramina and nerves. Estimate from the position of each vertebra the pressure at each foramen. Decide whether the vertebra is rotated, tipped, laterally displaced, anterior or posterior, or whether the subluxation partakes of several of these directions.
Decide in what direction movement of the vertebra would release most pressure and list accordingly.
Never hesitate to change your opinion if you discover evidence that you have made a mistake. Keep at all times an open mind in palpation.
Cervical Palpation
The third Cervical, lying under the projecting spinous process of the larger second, may be hard to find, and therefore the full count is always required before listing any vertebra. By requiring the patient, who is in position A, to drop his head forward and rest its weight in the hand which is not palpating, the Cervicals may be more easily palpated. Remember that this posture widens the interspaces and also makes the spinous processes appear more posterior than they really are, this difference being most noticeable at the fourth.
One bifurcation of a Cervical spinous process may be longer than the other and prove confusing unless care be taken always to palpate both bifurcations and note their form. This can almost always be successfully accomplished.
Sometimes the posterior neck muscles and ligaments will be rigid so that they interfere with palpation and at the same time make it impossible for the patient to flex his head forward. Having found that this is due to real contracture and is therefore not susceptible of voluntary relaxation by the patient, support the head in front and push aside the muscles with the fingers, gliding underneath the muscle layers as much as possible and close to the spinous processes.
Transverse palpation in the Cervicals is used to verify findings from the spinous processes or to differentiate between rotated and laterally displaced vertebrae and bent spinous processes when the spinous swerves to right or left.
Dorsal Palpation
The Dorsals are usually considered in three groups. It must be remembered that the form and obliquity of spinous processes vary considerably in this region. The upper processes are very slightly oblique, slanting downward, the middle Dorsals very oblique, and the inferior ones again only slightly so. There is a form change, most commonly at the eighth Dorsal, which may be mistaken for a posterior subluxation. The process here becomes more horizontal and more blunt.
Among the first four Dorsals a bad lateral or rotated vertebra may be listed as well as a posterior one, since we can readily adjust it. In the middle group either the posterior or rotated vertebra is chosen according to the estimate as to which causes greatest nerve impingement, either being adjustable. In the lower group, however, preference is usually given the posterior vertebra when possible, because rotary subluxations indicate transverse adjustments and it is somewhat dangerous in this region to use the transverses as levers.
Lumbar Palpation
The Lumbars and Sacrum are considered in one group. The Lumbars, with patient erect, should curve anteriorly and the first Sacral spinous process should complete the regular curve. This is rarely found, however; the normal is the exception in any part of the spine.
In the Lumbars we usually choose the rotated rather than the posterior vertebra, but solely because rotation here produces the greatest degree of impingement. The laterality of spinous processes, indicating rotation of the whole vertebra around an axis lying in the transverse line between the articular processes, can best be perceived, as a rule, with patient sitting quite erect. If in doubt, have patient lean forward and rest elbows on knees, which posture separates the Lumbars, rendering the individual spinous process easier to discover but the relative position more difficult of determination.
The fifth Lumbar, if anterior, may be so listed, forming an exception to the general rule.
Sacral Palpation—Pelvis
First palpate Sacrum as if part of Lumbar region. Note whether the base (upper portion) is posterior or not. Then stand behind the patient and use both hands to examine the sacroiliac articulations. Use palmar surfaces with the flat hand toward patient’s body, and carefully compare the two sides to detect inequalities, which indicate iliac subluxation, or rotation of Sacrum between the ilia on a transversely disposed axis passing through the two articulations, in which case the Sacrum is to be adjusted. Do not mistake a dislocated hip with compensatory tilting of the whole pelvis, or faulty sitting posture with only one tuber ischii supporting the body, for pelvic subluxation.
Be not in undue haste to record pelvic subluxations lest your haste bring its immediate reward in the difficulty of adjustment.
The Coccyx
The Coccyx may be detached from the Sacrum by various accidents and later re-ankylosed thereto in an abnormal position so as to impinge upon the rectum or other structures. Impingement of the coccygeal nerves is usually unimportant. Chronic and intractable rectal constipation, with its attendant train of evils, may result from coccygeal displacement with ankylosis. In spite of numerous treatises to the contrary, the writer avers that other symptoms are extremely rare.
To examine the Coccyx use a rubber covering on the second finger. Place patient face down and insert second finger per rectum with the palmar surface upward. If subluxated Coccyx be found, it must usually be fractured with a sharp jerk, in order to relieve the condition. After fracture, it may be absorbed or may re-ankylose to the Sacrum in a better position, or it may remain freely movable.