This is given almost entirely with adjusting arm; that is, with the arm whose hand is in contact with the vertebra. The supporting hand serves merely to guide the force to a definite point as if a straight rod were working through a fixed circlet. Indeed, the force in this movement is delivered almost straight down from the shoulder. Shoulder should be dropped well out of its socket so as to secure play for a sudden downward movement without raising the hand from its contact. If the shoulder is stiff or the head of the humerus remains in the glenoid cavity the movement cannot be properly given without raising the hand. Movement is quick, sharp, and deep, i. e., directed to the center of mass of the vertebra.

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.