Ask male patients to strip to the waist and female patients to remove all clothing down to the waist except a loose gown or kimono, which is worn reversed so that it opens behind and exposes the spine to direct examination. No greater error can be committed than to attempt examination of the vertebral column through clothing or other covering. Examine with patient seated on a bench or stool with feet evenly placed upon the floor. If the patient is for any reason unable to assume this position the examination may be varied somewhat.
While in this position continue observation of points mentioned above and observe also condition of skin, whether abnormal in color, moisture or nutrition, or whether there is flushing, cyanosis, or pallor, roughness, eruption, etc.; the condition of bones and joints other than vertebral; general emaciation or obesity, local malnutrition or hypertrophy; evidences of operation, scars etc.; and action of muscles more in detail than is indicated under position and carriage of parts.
Having observed these things discontinue general observation and all other considerations for the time in favor of Vertebral Palpation.
Vertebral Palpation
The primary object of Vertebral Palpation is the location of subluxations, or partial displacements, and the determination of the relative degree and direction of those found. Next comes the recording of subluxations in such a manner that a perusal of your record will enable you to reconstruct at any time a mental picture of the spine, as far as possible. (See [Record].) With the making of the record the proper form of adjustment for the correction of each subluxation is decided.
Finally, by failing to find subluxation in certain segments you may safely eliminate those segments from consideration and confine your further attention to the remainder. (See [Spino-Organic Connection].) It must be borne in mind that while the finding of a subluxation is not always positive evidence of the necessity for adjustment there, the absence of subluxation of any spinal segment is proof positive that no disease exists in the corresponding somatic segment. Differential diagnosis is thus often greatly aided by palpation.
Nerve Tracing
Having thus narrowed the field of operation, trace from spine to periphery every nerve tender enough to be traced, noting the relation of the tender nerves to the subluxations already found by palpation. Whenever it is possible note the degree of tenderness of the various nerves and keep in mind through the remainder of the examination the fact that greater tenderness in some one segment indicated either greater or more acute disease in that segment.
It is best to use great caution about entirely eliminating any segment from consideration because of negative findings in attempted nerve tracing. The fact that no nerve is traceable is not always proof that no impingement exists, but only that no irritation exists. Only light or acute impingement may irritate a nerve. In forty, and possibly fifty, per cent of all cases no nerves are traceable at any time. (See [Nerve-Tracing].)