Fig. 1. Position of hands in palpation for record.
With patient sitting, the palpater should step from side to side, changing hands frequently and usually palpating each vertebra with each hand before reaching a conclusion. There are three reasons for this. More accurate records may be made by combining two different impressions on each vertebra; with frequent change of hands one may prevent tiring and consequent loss of sensibility of fingers; this practice develops the tactile organs of both hands equally so that if occasion demand the use of either hand alone it is fitted for the task. To be ambidexterous in all departments of Chiropractic is an invaluable attainment, too often neglected.
The Count
Commence at the second Cervical, the first spinous process below the occiput, and let the fingers glide smoothly downward over the tips or along the sides of the spinous processes, without interruption of motion, until they reach the Sacrum. The palpater notes each vertebra passed and its number—mentally—so that when he reaches the Sacrum he knows that he has passed every intervening vertebra and received a touch impression from each. The Sacrum itself may usually be recognized by its peculiar shape and also by its articulations with the ilia.
If the fingers are raised from their contact during the count, the palpater must recommence at the second Cervical. It is impossible to be accurate in replacing the hand, once removed, until the count has been established and the peculiarities of certain vertebrae remembered, together with their numbers.
To determine the location of the fourth Lumbar where, on account of obesity, lipoma, Cervical lordosis, etc., the count of Cervicals or Sacral palpation is difficult, drop on heels behind the patient and place the second finger of each hand on the crest of the ileum. Then let the thumbs meet in the mid-spinal line in the same horizontal plane as the two second fingers, which spot should correspond to the interspace between third and fourth Lumbars. This measurement is accurate in about 98% of all cases, when patient sits erect; when it varies it will vary by about half the width of a Lumbar spinous process.
The count should be repeated until the palpater is certain that he is able to palpate every spinous process distinctly or to locate accurately any impalpable one. In making the count, palpater may note the number of some very prominent and easily recognizable Dorsal or Lumbar vertebra to be referred to as a starting point for a recount if confusion arises later. This recounting from some prominent vertebra is permissible only after the first accurate count has been made, but then will save the full count, especially when the patient is in an unfavorable position, as lying on table during adjustment.
Difficulties in Counting
The commonest difficulties met with in counting are the following:
Inaccessibility of third Cervical, which lies closely beneath the spinous process of the second and, unless unusually large or somewhat out of its proper position, cannot be readily felt.
An occasional anterior fourth or fifth Cervical which may escape notice unless the head is flexed far toward or the transverse processes examined.
Lipoma or other adipose tissue covering part of the spine.
A missing epiphyseal plate resulting from fracture and absorption, which absence may simulate a wide interspace and be overlooked without careful and detailed observation.
Cervical or Lumbar lordosis. This difficulty may be at least partially overcome by having head bent far forward or body leaning forward with elbows resting on knees and a deliberate attempt on the patient’s part to render the dorsolumbar spine convex backward.
An anterior fifth Lumbar.
The occasional extra vertebra which confuses the palpater.
Finally, the greatest of all difficulties is the imperfect touch of the untrained palpater or the imperfect concentration of the trained. And this is always remediable.
ATLAS PALPATION
With patient in position A stand behind him and place the tips of the second fingers on the tips of the transverse processes of the Atlas, or first Cervical. It can be felt on each side just anterior and inferior to the mastoid process of the temporal bone. Let the first and third fingers rest respectively above and below the transverses and determine whether the Atlas is subluxated as a whole to the Right or to the Left.
Another convenient method is:
Place first fingers on mastoid processes, second on Atlas transverses, and third on angle of jaw. The three fingers of each hand then constitute the points of a triangle. Imagine the base line between the first and third fingers and measure the altitude as a line at right angles to this base line and reaching to the tip of the second finger as the apex of the triangle. The relation of the two altitudes determines the laterality of the Atlas. Thus, if the altitude of the right triangle is less than that of the left, the Atlas is laterally displaced to the Right.
The second matter to determine is the rotation of the Atlas. This is done by using the first and third fingers as probes to determine the amount of space between the transverse and the mandible in front or the mastoid behind. The intention is to compare the laterally prominent side with the other so that the letter A or P on the record will indicate the position of the prominent transverse compared with its fellow.
Next decide as to tipping. Still comparing the prominent transverse with the other, decide whether it is above or below the level of the other by the following method. Placing first three fingers one above the other with the second finger on the tip of the process, note which transverse is highest in the space beneath the ear. List the prominent side as S or Superior, I or Inferior.
Atlas palpation is rendered especially difficult by the special technic and by the interposing tendons of the sterno-cleido-mastoid muscle.
Position of Head
There are three head positions for Atlas palpation. Head erect, face forward; head flexed forward on chest; head flexed backward. Sometimes it is necessary to test in all three positions in order to reach a decision, but ordinarily the first is sufficient.
THE GROUP METHOD
In general palpation of the spine the author has had the greatest success and attained the greatest accuracy through which is called the Group Method. This consists in dividing the spine mentally into five groups or sections, each of which overlaps its fellows except the end groups. This is of advantage for several reasons.
It limits somewhat the attention of the palpater so that he may examine thoroughly and in detail the various vertebrae without holding his attention so closely to one that he fails to perceive its relation to its surroundings. It furnishes five or six vertebrae at a time for comparison so that one may determine which is most subluxated, and therefore most in need of adjustment, and then allows one to reason upon the remainder of the group with this major subluxation in mind.
The use of the Group Method may best be understood by the study of certain didactic instructions, which follow:
Never record or adjust two subluxations of contiguous vertebrae except in those unusual cases where they are equally subluxated and in the same direction; even then it is wisest to adjust them on alternate days. Let it be understood that only in exceptional circumstances