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.