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All cases should be carefully examined. Of all the methods used in arriving at a diagnosis, palpation or the use of the hand is the most important one. By palpation the Osteopath usually determines a dislocated bone, a contracted muscle or a tightening of a tendon or cartilage. The patient's clothing should be arranged so as to allow free access to the spine and thorax. The patient should be requested to relax all tissues as much as possible and to offer no resistance unless asked to do so. To intelligently examine a spine, the operator should be thoroughly familiar with the outlines of the back. The normal spine is divided into four curves, named from above downward: The cervical curve, concave backward; dorsal curve, concave, forward; lumbar curve, concavity backward; pelvic curve, concave forward. Have the patient sit erect and stand behind him. Note the curves to see if they are normal or not, and also any inequalities on either side of the neck. Examine the glands of the neck for any enlargement. Place the patient on the back and relax all muscles. Place one hand over the forehead and the other over the muscles in the back of the neck. Manipulate the neck muscles while rotating the head. Examine the tissues just beneath the skull, and the vertebrae on both sides of the neck. By allowing the fingers to move down the median line at the back of the neck, the spinous processes, can be felt. By rotating the head and pressing the fingers along the transverse processes, anterior, posterior and lateral deviations may be discovered. Have the patient lean forward, while sitting, and place his hands on his knees. Examine each vertebra carefully to determine any dislocation or subluxation. Examine the chest and abdomen and palpate the various organs to detect any variations from the normal. |