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The Project Gutenberg eBook of Technic and
Practice of Chiropractic
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Title: Technic and Practice of Chiropractic

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*** START OF THE PROJECT GUTENBERG EBOOK TECHNIC AND

PRACTICE OF CHIROPRACTIC ***
 TECHNIC AND PRACTICE
OF

CHIROPRACTIC
BY
JOY M. LOBAN, D. C., Ph. C.
Professor of Anatomy and of Theory and Practice of Chiropractic at the
Universal Chiropractic College. Formerly
Professor of Chiropractic Analysis at the
Palmer School of Chiropractic

SECOND EDITION
Revised and Enlarged

PUBLISHED BY
UNIVERSAL CHIROPRACTIC COLLEGE
DAVENPORT, IOWA
1915
 Copyright 1915
BY
JOY M. LOBAN

HAMMOND PRESS
W. B. CONKEY COMPANY
CHICAGO

THIS BOOK IS
Dedicated
TO THE GIRL WHO HAS BEEN MY STAFF
AND LANTERN, AIDING AND LIGHTING
ME ON MY WAY IN THIS NEW FIELD
My Wife
 TABLE OF CONTENTS
Page
Preface to First Edition 9
Preface to Second Edition 11
Introduction 13
Vertebral Palpation 15
Definition 15
General Propositions 15
Habits of Palpation 15
Facts Concerning the Spine 16
Preparation of Patient 22
Position of Patient 22
The Record 23
The Count 29
Atlas Palpation 35
The Group Method 37
The Individual Subluxation 40
Palpation in Position B 46
Palpation in Position C 48
Transverse Palpation 49
Curves and Curvatures 53
Difficulties in Palpation 59
Landmarks 61
Mental Attitude 63
Nerve Tracing 64
 Organ Tracing 64
What Nerves are Traceable 64
Suggestion 67
Place in Diagnosis 67
Technic of Nerve Tracing 68
Subluxations 76
Definition—How Produced 76
Law Governing Location of 78
Varieties of Subluxations 80
Technic of Adjusting 89
General Principles of Adjusting 89
Special Technic (Thirty-two Moves) 99
Preferable Adjustments 155
The Cause of Disease 165
Simple Subluxation Disease 184
Secondary Causes 185
Germ Diseases 185
Diet 192
Poisons 194
Exposure 198
Bodily Excesses 201
Inflammation 202
The Process of Cure 208
Adjuncts 215
Spino-Organic Connection 217
General Discussion 217
Special Nerve Connections 235
Table of Diseases and Adjustments 257
Practice 276
Office Equipment 277
Schedule of Examination 292
 Necessity for Correct Diagnosis 298
Frequency of Adjustments 302
Specific vs. General Adjusting 303
Talking Points 306
Promises to Patients 308
Retracing of Disease 309
Limitations of Chiropractic 312
The Use of Adjuncts 315
Personality 319
Chiropractic Prognosis 322
General Discussion 322
Practical Prognosis 323
 Preface to First Edition

T his little work is offered to the profession without apology for its
brevity or its form. It has been prepared because of an
immediate and pressing need for such a guide in our colleges, and is
offered abroad under the impression that many practicing
Chiropractors feel the same need.

It is intended for handy reference and clinical use and is

arranged as systematically as possible, style being everywhere
sacrificed to utility.
The author lays no claim to the origination of any of the subject
matter of this book nor to having invented any of the movements
described under Technic of Adjusting. The arrangement and
phraseology are in the main original. The intention has been merely
to condense into practical and convenient form for students and
practitioners certain knowledge now held and utilized in our
profession.
The author feels himself indebted to the entire profession for the
information embodied in this work, and to scientists of all time upon
the results of whose infinite and painstaking research are based our
present day advancement; to the many friends and co-workers
whose valuable criticisms and suggestions have aided in this labor;
and to his students, past and present, who have furnished the
necessary encouragement and inspiration for the achievement of
this, the author’s first text-book.
The chief merit of this effort—if merit there be—is its honesty.
The author has endeavored to set forth fairly and simply the facts
and hypotheses with which we have to deal. Its chief offense, in the
eyes of many, will lie in its being just what it purports to be—a book
on Chiropractic. Constructive criticism and suggestion are invited
from all sources, for by our interchange of thoughts we grow.
J. M. L.
 Preface to Second Edition

T he republication of this book has been made possible by the

sustained friendship of the profession for it, and the author’s
thanks are due its many buyers and readers who, by their
recommendation, have made it both possible and necessary that this
book should live and grow.

The new edition has been somewhat enlarged by the

introduction of additional matter into each section and by the
addition of two entire new chapters on “Preferable Adjustments” and
“Chiropractic Prognosis.” New plates have been added and old errors
corrected. In every way an attempt has been made to express with
conservatism the real advance made by Chiropractic since the first
edition was put on the press.
J. M. L.
 INTRODUCTION

N o two students, approaching for the first time the study of

Chiropractic, approach from the same angle. Their viewpoints
differ. In order that all may gain as nearly as possible the same
viewpoint from which to consider in turn the sections of this book, it
will be well if each student reads the entire book before beginning to
memorize its parts and convert them into practical working
knowledge.

An effort should be made, abandoning all other, to acquire the

Chiropractic viewpoint. This accomplished, the rest of the task
requires time and patience alone, without waste labor. The section
on Vertebral Palpation should be studied step by step, the study of
each step being combined with practice in it. Likewise the section on
Nerve-Tracing, theory preceding practice. The study of the Technic of
Adjusting should occupy those months immediately preceding the
commencement of actual adjusting practice and continue during
such practice. The chapters on Practice are intended for the student
about to enter the field. The table of Spino-Organic Connection can
be best understood by those who have studied or are studying the
anatomy and physiology of the nervous system.
Let every page be studied with a good medical dictionary open
at the elbow of the reader. Pass no word without comprehension, no
detail without mastery. He who would seek to modify the life
processes of the human body must fortify himself against fatal error
with every bit of knowledge he can acquire.
 VERTEBRAL PALPATION
Definition
Vertebral Palpation consists in the use of the tactile sense to
determine the position, relation, size, shape, and as far as possible
the condition, of the segments of the spinal column, in order thus to
discover the primary causes indicative of disease.
Or, Vertebral Palpation is the name given the manual
examination of spinal vertebrae.

General Propositions
Every palpation should be made with the adjustment of the
vertebrae in mind. The record of palpation should be a correct guide
as to direction of adjustment. No subluxation impossible of
adjustment should be recorded.
The two essentials of correct palpation are accurate perception
and correct reasoning. To secure the first, a certain approved
manner of using the hands is herein laid down and a considerable
amount of tactile sense development by practice is required. Correct
reasoning depends upon knowledge of all the important facts
concerning the spine and of the rules governing palpation.
Absolute concentration is required and to this end many of the
following rules are directed.

Habits of Palpation
Every palpater unconsciously forms habits of thought and action.
These habits may be good or bad. We deliberately form a habit of
holding the first three fingers closely together or the habit of using a
downward glide, but we should avoid the habit of finding certain
subluxations because they are usual and expected rather than
because they are actually there. For instance, one may easily form a
habit of listing every other vertebra in the spine, his whole record
thus depending upon his first choice.
Because of this perfectly natural tendency to establish a routine
of thought and action and to follow it precisely, it is best not to
attempt palpation without the aid of an experienced teacher until
after correct habits have been formed. Once formed, a palpation
habit, right or wrong, is very hard to break. Many a teacher has
expended himself uselessly in the effort to undo some technical fault
acquired by the student in a blundering undirected trial.

Facts Concerning the Spine

The spinal column is composed of twenty-six segments called
vertebrae, twenty-four movable and two fixed. The movable
vertebrae are divided for convenience in study into three sections.
There are seven Cervical vertebrae, twelve Dorsal, and five Lumbar
in the normal individual. The number of Dorsals or Lumbars may
vary by one in a rare case. These variations occur in about one
spinal column in each five hundred and are usually in the Lumbar
region, which may contain four or six vertebrae. A prominent first
sacral spinous process may be mistaken for an extra Lumbar.
Five vertebrae have special names. The first Cervical is called
Atlas; the second Cervical, Axis; the seventh Cervical is commonly
known as Vertebra Prominens on account of its long and large
spinous process, although this long process belongs to the sixth
Cervical or first Dorsal instead in 35% of all cases; the large,
irregularly fusiform vertebra just below the Lumbars and between
the ilia is called the Sacrum; and the smaller one below it, the
Coccyx. The latter is occasionally missing.
Each vertebra except the Atlas is composed of a body and an
arch; the arch is made up of two pedicles, short, thick plates of bone
extending outward and backward from the postero-lateral surface of
the body nearer its upper than its lower border, two laminae, thin
plates of bone extending backward and inward from their union with
the pedicles and joining behind to form the spinous process, and has
projecting from it seven processes, two transverse, one spinous, and
four articular, two of which are superior and two inferior. The
foramen enclosed by the body, pedicles, and laminae is called the
neural or vertebral foramen and the canal formed by the connection
of these foramina and completed by the ligaments which unite the
arches is called the neural, vertebral, or spinal canal. It contains the
spinal cord with its membranes and the roots of the spinal nerves.
By means of the four articular processes each true vertebra except
the first articulates with its fellows above and below.
The body of the vertebra is its largest portion and is joined to its
fellows by fibrocartilaginous disks which are sufficiently elastic to
permit some torsion and compression. Nine sets of ligaments,
including the intervertebral substance just mentioned, bind the
vertebrae firmly together. Many muscles are attached to the spinal
column.
The intervertebral foramina are openings at the sides of the
vertebrae, formed by the notching of apposed pedicles. These
openings are surrounded by bone, cartilage, and ligaments and vary
in shape in different sections of the spine. They permit the exit of
the spinal nerves and their sheaths, the re-entrance of some nerve
fibres into the neural canal, and the passage of blood-vessels to and
from the cord. The entire philosophy of Chiropractic focuses at the
intervertebral foramen because there we find the primary cause of
all pathological changes in the body.
The spinous and transverse processes merit particular
description since they are the levers by which vertebrae are adjusted
and nerve impingements at the intervertebral foramina corrected.
But it will be found easiest to describe these processes separately in
different sections of the spine and before proceeding to this
description, a brief picture of the peculiar vertebrae will be
presented.
The Atlas is a bony ring composed of two arches, an anterior
and a posterior, separated in the recent state by a transverse
ligament. Its body is detached and appears as a tooth-like projection
upward from the body of the Axis, the odontoid process, which
articulates with the anterior arch of the Atlas and around which the
Atlas rotates, a ring around a pivot. The Atlas supports the head
upon its lateral masses, two wedge shaped bodies between the
anterior and posterior arches, thinner internally than externally. It
has no spinous process but merely a tubercle where the laminae
join, so that it can be palpated only from the sides upon the tips of
its long transverses. The first Cervical, or suboccipital, nerves
emerge by a groove above the pedicles instead of through a
foramen.
The Axis, or second Cervical, is distinguished by its large, strong
spinous process, which is bifid at its tip, by its superior articular
processes which rest upon body, pedicles, and transverses, and by
its odontoid process, upreared from the body.
The Seventh Cervical, or Vertebral Prominens, usually has a
large spinous process, presents no foramina in its transverse
processes, or only one, the left, and shows no facets on body or
transverse for the rib articulation, as do the Dorsals.
The Sacrum is the largest vertebra; is curved with its convexity
backward; is commonly made up of five fused segments; has only
rudimentary spinous and transverse processes except the first; and
shows sixteen openings, eight anterior and eight posterior, or four
on either side of the median line in front and the same number and
arrangement behind. These openings permit the exit of the anterior
and posterior primary divisions of the sacral nerves separately.
The Coccyx, usually composed of four fused segments, is a
triangular bone which articulates with the Sacrum above and is free
at its distal extremity. Its portion of the neural canal is open
posteriorly and contains merely the thread-like termination of the
cord membranes. It is frequently ankylosed to the Sacrum,
sometimes in an abnormal position so as to impinge the single pair
of coccygeal nerves.
The different regions of the spine show decided differences in
structure, though all resemble each other. The Cervicals are smallest,
the Dorsals next in size, and the Lumbars largest and strongest of
the movable vertebrae. The Dorsals have facets and demi-facets for
the articulation of the twelve pairs of ribs with their bodies and
intervertebral substance, as well as oval facets upon the anterior
aspect of their transverses for articulation with the tubercles of the
ribs.
The spinous processes are smallest and usually bifurcated down
to and including the fifth. The sixth may show a plain bifurcation, or
on any Cervical the bifurcation may be so small as to be
imperceptible to touch. The spinous process of the second overlies
that of the third so as to make the latter very difficult of detection.
Indeed, all cervical spinous processes down to the sixth are harder
to palpate than those in other regions, owing to the anterior cervical
curve. The processes lie in a groove between prominent muscle
ridges.
Dorsal spinous processes are usually single, although the last
four, three, two, or one may show plain bifurcation in certain
individuals. They are somewhat pointed and overlap, except the
lower ones, the obliquity being greatest in the mid-dorsal region and
least at the first and last dorsals.
Lumbar vertebrae have broad, flat-tipped spinous processes
much larger than the others. The last Dorsal may sometimes appear
like a Lumbar in shape, so that the change in shape commonly
supposed to mark a division between Dorsals and Lumbars is not
always an infallible guide.
The transverse processes in the cervical region are very short
and lie close in front of the articular processes. They are pierced by
foramina for the vertebral artery and vein, except the seventh, which
may have one foramen or none. They are difficult of access for
palpation because of their shortness and the amount of overlying
muscle, but may be reached from the front and side by drawing
back the sternomastoid. They increase in length from the second to
the seventh.
In the dorsal region the transverses are larger and stronger and
more constant in size, shape, and direction, serving to support rib
articulations. They extend in a curved direction outward, backward,
and slightly upward from the union of laminae and pedicles and
terminate in a large subcutaneous club-shaped extremity which may
be readily palpated. The eleventh and twelfth dorsal transverses do
not articulate with the ribs and must therefore be used with caution
or not at all as levers for adjustment. The dorsal transverses are
located on a higher level than the spinous processes. In the case of
the upper three dorsals the transverse lies in a plane which would
cross the mid-spinal line between its own and the next superior
spinous. In the mid-dorsal region the transverse is even with the
spinous of the vertebra above, though the relation may vary slightly.
The lower dorsals return to the same relation as the upper.
The transverse processes of the Lumbars are relatively light
compared with the general structure of the vertebrae and are found
just even with the interspace between their own and the adjacent
superior spinous process. They vary greatly in size, length and
strength and may be used as levers for adjustment only when they
are large enough to be clearly palpable through the muscle mass
which separates them from the body surface.

Preparation of Patient
In all cases where a complete spinal examination is intended the
preparation is essentially the same. Have patient arrange clothing so
that the spine is exposed to the touch throughout. Avoid bands of
cloth across the spine, as these interfere with the necessary
continuous gliding movement of the fingers. Advise the patient, if a
female, to wear waist or dressing sack, reversed, and have skirts
loosened at the waist. If a man, he should strip to the waist and
wear coat or coat shirt reversed.

Position of Patient
This varies widely according to circumstances but for general
purposes use position:
(A) Place patient on stool, feet even on floor and body in an
easy, relaxed position. This may be modified by asking him to lean
forward and rest elbows on knees, evenly, to facilitate Lumbar
palpation. Patient’s head may be erect or flexed forward or backward
but should never be rotated or laterally flexed during Cervical
palpation except for the purpose of locating some particular
transverse process.
(B) In emergency cases, where haste is urgent or patient is
unable to assume a sitting posture, or as a means of re-verifying
previous palpation, place the patient on adjusting table prone, face
down. (See Fig. 2.) Remember that with the head lying upon its side
the upper dorsal vertebrae will assume a curve with its convexity
away from the face. Palpation in position (B) should precede every
adjustment and, to guard against error, should be considered as a
necessary preliminary to the movement of any vertebra.
(C) For palpation preparatory to using the Rotary, the Break, and
other moves, have patient lying on his back with his head projecting
beyond upper end of bench and resting on the hands and wrists of
the palpater, or have the patient’s head rest on the bench, a less
accessible position.

General Observation
Each spinal examination should begin with a general survey by
which curvatures, marked prominences, etc., may be appreciated.
Frequently some very important fact may be noted which would
escape attention upon minute examination.
 THE RECORD
The record of spinal palpation, when completed, should be an
accurate history of the irregularities found in the spine and an
accurate guide to adjustment. It must be brief and concise as well as
readily comprehensible. One should be able to see at a glance any
desired point on the record, so that it may be used during the
adjustment without undue loss of time or attention. Obviously the
introduction of any useless mark or sign, such as the inclusion of a
number and blank space for each vertebra of the spine, or all
possible subluxations with indications as to which do or do not exist
in the given case, is a mistake.
The record should contain three parallel columns. In the first
column place the number of the vertebra chosen for adjustment. In
the second, place the direction of subluxation. In the third, place the
word or sign which stands for the indicated movement for
correction.

Number of Vertebra
The letter C is used to indicate Cervical, D Dorsal, L Lumbar, and
S Sacrum in the record. Immediately following the letter which
designates the region, place the number which shows the position in
that region occupied by the vertebra in question, the relation of that
vertebra to its fellows. For instance, the third Cervical vertebra is C
3, the eleventh Dorsal D 11. To the S for Sacrum append B or A to
indicate that the Base or Apex is described as to position. This
locates the subluxation. For a record of full spine palpation it is
unnecessary to use the letters C, D, or L more than once, as
subluxations are recorded in the order of their occurrence from
above downward. A dash should always follow the number of the
vertebra to separate it from the letters in the second column for
convenience in reading.

Direction of Subluxation
 The directions considered in palpating or recording subluxations
are six in number, namely:

Name Abbreviation Meaning

Posterior P Toward the rear (Dorsad)
Anterior A Toward the front (Ventrad)
Right R Toward the right hand
Left L Toward the left hand
Superior S Toward the head (Cephalad)
Inferior I Toward the feet (Caudad)
As the fingers glide down the spine the posterior vertebra is the
one which interposes itself in the path of the fingers, forcing them to
describe an outward curve. It is the hill on the automobile road
which forces the surmounting of a curved departure from the
evenness of the road. It is relatively posterior to its fellows above
and below.
The anterior vertebra, to the gliding fingers, means a
depression, a valley. It causes the fingers to dip inward from the
level of their course.
The right or the left subluxation is appreciated by running the
tips of the fingers down the sides of the spinous processes. It really
indicates rotation of the whole vertebra more often than any other
malposition.
We say that a vertebra is superior when its spinous process is
nearer the one above than the one below. It requires a measuring of
relative distances. The degree to which a vertebra is superior is
measured, not by its actual closeness to its fellow, but by the
relation between the space above and the space below.
Likewise a vertebra is inferior when it is closer to its fellow below
than to its fellow above.
Anterior subluxations are rarely recorded as such, except of the
Cervicals or the last Lumbar, because no means of properly adjusting
them is known to Chiropractic.
Order of Letters
In the second column, that devoted to direction of subluxation,
the letter P or A should appear, if at all, as this antero-posterior
relation is the first thing to be determined concerning any individual
subluxation chosen except the Atlas. With the Atlas the first letter
will be R or L. Next the laterality or rotation is indicated by R or L in
every case except Atlas subluxation. Finally the S or I indicates the
last point to be determined, the approximation of the vertebra to its
fellows. This last letter usually shows thinning of intervertebral
fibrocartilage, which will be discussed elsewhere.
If you desire to emphasize any direction as being more
important than another, underscore the letter which stands for that
direction with a single line. If two directions are to be emphasized,
one more than another, underscore the one with two lines and the
other with one. For example, if a vertebra is found to be quite
decidedly posterior, more plainly to the right, and slightly superior,
the record will show it thus: P R S.

Movement for Correction

This is indicated in the third column, separated from the second
by a dash, by means of some brief word or words which describe a
certain movement used in adjusting. The descriptive words and
terms used in this work are all given and explained under Technic of
Adjusting. (See p. 89.) Each word or term stands for a definite
method of procedure. The best movement for the correction of any
subluxation of any vertebra may be found by reference to the
section on Preferable Adjustments, p. 155. If other terms are more
familiar to the student, or in time replace those which are now
common usage in the profession, they will be brief and clear and
may be easily substituted for those given.
Palpation, fixing in the mind of the palpater the manner and
direction of the subluxation, should also suggest as the obvious
correction a movement calculated to reverse the procedure by which
the subluxation was first produced. In other words, a certain kind of
subluxation stands as the effect of a certain application of force
along definite lines determinable by examination. Its correction
should be made in a reverse direction along the same lines. By
recording with the record of subluxation the desired correction, the
adjuster may be reminded daily without new palpation of the
movement best fitted to the case. If on trial it is decided that some
other movement than the one first indicated will better overcome the
abnormality, the record should be changed to correspond to the
decision, and thereafter followed.

Complete Record
The completed record in three columns separated by dashes can
be conveniently read. It contains no superfluous mark of any kind. It
conveys all the necessary information leading to adjustment except
diagnosis and case history. This palpation record should be a part of
a more comprehensive record concerning the case in full and is best
kept on a card, the reverse side of which carries case history. If kept
in an indexed card file it may be referred to daily without loss of
time and an accurate handling of each case be assured.
Have card perfectly blank on palpation record side. For
convenience in reading draw a heavy line beneath the last Cervical
subluxation recorded and another beneath the last Dorsal, thus
dividing the record as the spine is divided, into three divisions.
Below follows a sample palpation record. It will be seen that
here in a very small space may be recorded a great deal of
information, for this record contains an accurate list of the primary
causes of every disease, weakness, or tendency to disease with
which the patient is afflicted, together with the methods for their
removal.

Sample Record
C 1 R Break
4 PLS Double Contact
 7 LI Rotary
———————————————————
D 3 PR Recoil
7 LS Pisiform Single Transverse
10 P S Heel Contact
———————————————————
L 1 P L I Recoil
4 R Lumbar Single Transverse

Use of Record
The above record is made with patient sitting. It is to be used
while patient is lying upon the adjusting bench. The most convenient
way is to begin palpation in the Dorsal region after patient has been
placed for adjustment, in this way. If first subluxation recorded is D
2—P R I, find the vertebra in the region of D 2 which appears P R I
to the touch. To avoid error, let the fingers then glide downward to
the next recorded subluxation. If this be found to agree in number
and direction with the record, it is safe to assume that the first one
found was correctly numbered in the palpater’s mind; if not, that an
error was made. This can be quickly done. Before each adjustment
the vertebra adjusted should be found to agree with the record; by
doing this constant accuracy may be assured.

THE COUNT
Having described the preparation of the patient and the different
positions in which he may be palpated, noted that all records should
be made in position A, mentioned that general observation which
should immediately precede actual palpation, and interpolated a
description of the record to be made during the palpation, with its
use afterward, we are now ready to consider the technic of the
palpation itself. This should begin with a count of the vertebrae and
continue with Atlas palpation, general examination of a group of
vertebrae, and special examination of individual subluxations in the
group. Each of these tasks will be considered in turn.

Position of Palpater
This depends upon the position of the patient. The letters which
follow correspond to the letters describing the position of the
patient. q. v.
(A) If you desire to palpate with the right hand stand at patient’s
left and face toward him with left hand resting on his shoulder or
supporting his forehead as you palpate Dorsals or Cervicals
respectively. To use left hand stand similarly at patient’s right. Have
palpating arm relaxed and easy, extending as nearly as possible so
that the forearm and hand make a right angle with the patient’s
spine. Let the arm and hand remain close to the patient’s body at all
times. Keep the elbow close to your own body and avoid flexion of
wrist on forearm, or of forearm on arm at more than a right angle,
since such flexion would bring about too great muscular tension for
close appreciation of tactile impressions. If necessary lean sidewise
and elevate shoulder and palpating arm in order to preserve the
proper relation between hand and arm when hand must be elevated
as in palpating upper Cervicals.
(B) As above, if you desire to use right hand stand on left side of
patient and if left hand stand on right. If the patient lies on a bench
so constructed that the head lies on one side, his face must be
toward the palpater in order that the same hand may be used in
Cervical as in other regions. It is inadvisable to change hands except
when absolutely unavoidable. If the patient’s head must be turned
from you palpate the Cervicals by standing with feet pointed away
from patient and turn your body with one hand resting on patient’s
head to hold it steady and the other palpating as if you were
standing on the other side. This is difficult and it is rarely necessary
to count Cervicals in position B if the record be used as advised on
page 29.
 (C) Palpation preparatory to the Cervical adjustment will be
made in this position or in position A, according as you intend
adjusting the Cervicals in the prone or the sitting posture. For the
prone position have the patient’s head supported by either hand,
while the other hand is applied with the tips of the first three fingers
resting on the tips of the spinous processes, from which position
they may glide smoothly down, noting deviations from normal in
position as well as mentally numbering the vertebrae. While this
method of palpation is not so accurate as those given elsewhere,
and should be used only as an additional means after record has
been made, it will always be necessary to make a count before
adjusting any Cervical.

Use of Hands
In general it may be stated that the first three fingers of one
hand are used with an easy downward gliding movement in which
only the tips of the three fingers, evenly placed, are in contact with
the patient’s body. This concentrates the attention upon a very small
tactile surface which may become extremely sensitive by the
concentration. Indeed, it may be said that vertebral palpation only
became an art through the application of the principle of
concentration in practice. The gliding movement is always
downward, because to palpate upward will mass the superficial
tissues under the fingers and confuse the palpater. If there is
uncertainty in the mind of the palpater, as he proceeds, as to the
identity of any vertebra he should go back to the second Cervical, or
to any certainly recognizable vertebra previously fixed in mind, and
recount.
The use of the hands for Atlas palpation differs from their use
elsewhere and will be described under separate head. The use of the
hands with the patient lying face upward is also different. If the
patient be lying prone, the same three fingers are used and the
same downward glide as with patient sitting.
 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
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