Early American Manual Therapy

A Manual of Osteopathy Eduard W. Goetz, D.O. 1909 SPECIAL MOVEMENTS WITH ILLUSTRATIONS

The succeeding pages give some of the special movements with illustrations and are given in this manner to avoid repetition in the text and duplication of the cuts, as will frequently be referred to in the text.

5. PRESSURE ON THE GREAT OCCIPITAL NERVES
WITH the patient sitting on a chair, place your left hand on his forehead, and with the right hand place the thumb on one side and the fingers on the other, of the spine, over the site of great occipital nerves which leave the skull at a point shown in cut No. 1 K. K., page 24; press these two points hard, and at the same time push the head backward with the left hand and hold same for two or three minutes. This treatment will usually stop any headache, but for more severe attacks see treatment for same, page 77.

6. PRESSURE ON THE FOREHEAD
WITH the patient on his back, place your hands upon the forehead, press downwards with considerable force and hold for a few seconds. Has the effect of the had in catarrhal conditions.

7. MANIPULATION OF THE CERVICAL REGION IN THE BACK OF THE NECK
    WITH the patient lying on his back, place the left hand on his forehead, and the right hand on the muscles in the back of the neck near the spine, in the region of the upper cervical vertebrae, and, while rolling the head away from you with the left hand, pull the muscles of the neck towards you, but not allowing the fingers to slip on the skin, the idea being to stretch the muscles. Now move the hand down the neck a little and repeat the above movement, and so on down as far as the 7th cervical vertebra, location of which may be seen in cut No. 1, A, page 24.

8. MANIPULATION OF THE MUSCLES IN THE SIDE OF THE NECK
    WITH the patient on his back, place the left hand on his forehead, and with the other manipulate the muscles of the side of the neck from the angle of the jaw to the collar bone. While turning the head away from you, draw on the muscles, pulling them towards you without letting your
fingers slip on the skin.
    This treatment and No. 7 should be given to both sides of the neck and should be given about three minutes.

9. STRETCHING THE NECK
WITH the patient lying on his back, place one hand under the chin and the other at the base of the skull and pull on the head until the body moves; next, while pulling, turn the head slightly from side to side two to three times. This treatment frees the circulation in the neck and especially between the vertebrae of the entire spine.

10. TREATMENT OF THE SUPRA-ORBITAL NOTCHES
HAVE the patient sitting on a chair or stool; with one finger of each hand press against the notches which may be felt in the bony arches above the eyes, the location of which may be seen in cut No. 4 A A, page 27. If used in connection with the treatment for headache, inhibit the nerves that leave the skull at this point, by holding same for about a minute. If for eye trouble, stimulate the nerves by a vibrating motion.

11. TREATMENT OF THE NASAL DUCT
WITH the patient sitting on a stool or chair, place thumb of each hand in inner corner of each eye, press hard and hold for a few seconds. Now move the thumbs down either side of the nose about half way, and in a circular motion, with out allowing the thumbs to slip on the skin, work the muscles in this region for a few seconds. This treatment is used in connection with the others for all affections of the nose and eyes, especially for catarrh, cold in the head, and obstructions to the nasal duct which runs from the eyes to the nose.

12. SPRINGING SPINE IN THE UPPER DORSAL REGION
WITH the patient sitting on a chair, grasp his wrist and raise the arms high above the head; at the same time place your knee in the middle of the back, high between the shoulder blades, and with the pressure there, bring the arms outward and downward to the side; this should be repeated several times, each time lowering the knee about two inches, until you get as low as the twelfth dorsal vertebra, the location of which is shown in cut No. 1, B, page 24. This treatment is used in all affections of the throat, lungs, and heart.

13. TO INHIBIT PHRENIC NERVE (IN ATTACK OF HICCOUGH)
WITH the patient sitting on a chair, stand behind him; place the first finger on each side of the neck just above the collar bone at a point, shown In cut No. 4 C C, page -27. Press in deeply and hold for a minute or until the hiccough has ceased. The other treatment for hiccough is shown on page 37.

14. TO INHIBIT PHRENIC NERVE
WITH the patient sitting on a chair, with the fingers of each hand press against the front part of the transverse processes of the third, fourth, and fifth cervical vertebra and inhibit same for about a minute holding them firmly with considerable pressure. (See location of transverse processes in cut No. 3 C, page 26, and which may he felt through the skin at the side of the neck.) This treatment should be given in connection with treatment No. 13, page 36.

15. TO RAISE THE CLAVICLE
WITH the patient lying on his back, bend the arm at the elbow, taking hold at that point with the right hand; at the same time push the shoulder upwards and with the fingers of the left hand, placed deep behind the clavicle or collar bone in the supra-clavicular fossa (shown in cut No. 3 E, page 26, or 4 B B page 27), bring the patient's arm upward, outward, and then downward, slowly and not too strongly; hold in this position for a few seconds, while drawing upward with the left hand, and repeat the same operation on the other side. This releases the blood vessels to and from the head and frees the circulation to the head and neck.

16. TO LOWER THE FIRST RIB
HAVE the patient lie on his back, with your left hand draw the patient's left arm above his head, and place the thumb of the right hand in the supra-clavicular fossa (see cut No. 3 E, page 26, for same). Close to the neck, and while pulling on the out-stretched arm, press in the opposite direction with the thumb on the first rib, which may be plainly felt close to the neck, and now return the arm to the patient's side, with a forward and downward movement. As the first rib is frequently drawn upwards by contraction of the muscles in the side of the neck, thus interfering with free circulation to the head and neck, this treatment will have the effect of removing the obstruction. Use same treatment on opposite side if necessary.

17. TO STIMULATE THE CIRCULATION TO THE HEAD
WITH the patient sitting on a chair, draw one arm well above the head, at the same time with the thumb of the disengaged hand press on the angle of the ribs between the shoulder blade and the spinal column, beginning at the second dorsal vertebra on the side corresponding to the arm that is raised; now lower the arm with a backward and downward movement to the side; next lower the thumb an inch to the next rib and repeat the movement with the outstretched arm; lower the thumb again to the next rib and repeat the movement; and so on down the back to the tenth rib, which is about an inch below the lower edge of the shoulder blade. Now treat the other side in a similar manner. Will require about three minutes to make these movements.
(See cut No. 1 B, page 24, for location of the ribs from second to tenth.)

18. MANIPULATION OF THE MUSCLES IN THE BACK, IN GENERAL TREATMENT OF THE SPINE
HAVE the patient lie on his side, with his arm loosely thrown over yours as shown; begin at the second dorsal vertebra and work all the way down the back to the end of the spine, working the muscles on the side of the spine towards you. With considerable pressure, draw the muscles upward and outward away from the spine; now move your hands down the back a few inches and repeat the movement and so on down, releasing the patient's arm after you have reached the tenth dorsal vertebra. (The location of the vertebrae may be seen in cut No. 1, page 24.) Now turn the patient to his other side and work the muscles away from the spine in an endeavor to stretch them. This treatment may be made more effectual and complete by placing your fingers on the opposite side of the spine and drawing it upwards towards you; work so all the way down the spinal column.

19. MANIPULATING THE MUSCLES AND SPRINGING THE SPINE LATERALLY IN
THE LUMBAR REGION
WITH the patient on his right side, draw up his legs, and place your left hip against his knees and your right hand under his legs, and with the fingers of the other hand work the muscles in the lumbar region, drawing the muscles toward you and not allowing the fingers to slip. Work from the twelfth dorsal to the fifth lumbar vertebrae. While drawing on the muscles push the legs against the abdomen. To spring the spine reach over to the opposite side of the vertebrae and draw them towards you. Both these treatments should be given on the other side also, having the patient turn over to the left side. Treat about three minutes. These movements are valuable in cases of lumbago, lame back, rheumatism, and suppressed menstruation.

20. MANIPULATION OF THE SPLANCHNIC REGION
WITH the patient lying on his right side, let the left arm hand loosely over your left, and with considerable pressure with the fingers work the muscles in the back between the sixth and twelfth dorsal vertebrae, on the side of the spine nearest you, drawing the muscles upward and outward. Now have the patient turn over to the left side and give the same treatment.
The work on the splanchnics is very important in all diseases of the liver, stomach, kidneys, spleen, small intestines, and the pancreas.

21. FLEXING THE LEG ON THE ABDOMEN
FOR stretching and loosening the ligaments and muscles of the leg and hip, and increasing the circulation.
With the patient on his back, take his leg by the knee with your right hand and flex it strongly several times against the abdomen as shown in the cut. (See treatment No. 22 for completion of this movement.)

22. MANIPULATION OF THE LEGS (COMPLETION OF TREATMENT NO. 21)
TAKE hold of the patient's ankle with the one hand and the knee with the other, as shown in cut, and turn the foot inward and the knee outward, then straighten the leg, bringing it down with a slight jerk; this should be repeated several times with each leg and every other time turn the
knee inward and the foot outward.

23. TO SPRING THE LEGS APART
WITH the patient on his back and the legs drawn up, take hold of each knee and force the legs apart with considerable force. This stretches the muscles on the inner side of the legs.

24. TO INHIBIT THE ACTION OF THE LOWER BOWELS
PLACE the patient on his back, with his legs drawn up, and with the flat of the fingers of both hands paced as shown in the cut, near the pubic bone, and with a moderate pressure draw the hands toward the head, not allowing them to slip; now hold for a few seconds; this will quiet the movement of the intestines and is a valuable treatment in cases of griping pains in the lower intestines.

25. MANIPULATION OF THE LIVER
HAVE the patient lie on his back, with his legs drawn up, and, standing on his left side, place your right hand underneath the short ribs, and with the left hand press, with a moderate degree of force, well up underneath the floating ribs in front, as shown in above cut, and while pulling upwards and toward you with the right hand, press on the liver with your left hand, and draw same towards you, not allowing your hand to slip on the flesh. Work from the side to the middle line of the body in front. Manipulate these parts about one minute.

26. MANIPULATION OF THE STOMACH AND SPLEEN
THE work on the stomach is practically the same as that for the liver, as shown in Treatment No. 25, but on the opposite side of the body. Manipulate about one minute.

27. DEEP PRESSURE ON EITHER SIDE OF THE NAVEL
WITH the patient on his back and his legs drawn up, place the flat of the hands, with the fingers slightly bent, at the side of the navel towards you and press gently but deeply, and, without allowing the fingers to slip, draw them towards the side of the body on which you stand; repeat several times and then treat the other side in a similar way.

28. MANIPULATION OF THE SIGMOID FLEXURE
WITH the patient on his back and the legs drawn up, work the abdomen with the flat of the hand and the fingers slightly bent, beginning at the sigmoid flexure, where the hand rests as shown in the above cut, and with a deep and firm pressure draw the hand upward towards the head, not allowing the hands to slip; now move the hand upwards a few inches, and press and draw again, and so on around the abdomen, following the course of the large intestine.
This treatment should take about three minutes.

29. MANIPULATION OF THE SMALL INTESTINES
WITH the patient on his back and his legs drawn up, place the hands near the outer side of the abdomen as shown in the cut, and with the fingers draw the abdomen toward you and push it back again in the opposite direction with the "heel" of the hand, a motion very similar to that of kneading bread, using a moderate degree of pressure, but not enough to make it painful to the patient. Work here should be done about two minutes.

30. GENERAL TREATMENT OF THE BODY. THIS IS A COMBINATION OF TREATMENTS GIVEN BELOW.

1. Treatment No. 7.
2. Treatment No. 8.
3. Treatment No. 9
4. Treatment No. 19
5. Treatment No. 20.
6. Treatment No. 21.
7. Treatment No. 22.
8. Treatment No. 23.
9. Treatment No. 25.
10. Treatment No. 26.
11. Treatment No. 27.
12. Treatment No. 28.
13. Treatment No. 29.

The full treatment is considered a tonic to the general system, stimulating the nervous and circulatory systems. It requires about twenty minutes.

31. TO STRETCH THE SCIATIC NERVE AND THE FLEXOR MUSCLES OF THE LEG
WITH the patient on his back raise the leg at the right angles to the body, drawing down the toes with one hand, and with the other pushing against the knee, as shown in cut, and with your knee hold down the patient's other leg; now push the upright leg towards the patient’s head as far as possible; do this several times. Perform the same movement with the other leg.
This is largely used in cases of rheumatism, cramp in the legs, cold feet, etc.

32. MANIPULATION OF THE MUSCLES OF THE LEG
WITH the patient on his back, beginning at the upper part of the thigh near the body, and spanning the limb, as shown in above cut, work the muscles with a circular movement around the leg, first turning them to one side and then to the other, and so work on down the leg. This treatment has the effect of stimulating the circulation and is, therefore, valuable in cases of rheumatism, swelling of the legs, cold feet, etc.

33. MANIPULATION OF THE SHOULDER JOINT
WITH the patient on his back, work all the muscles around the shoulder joint, on the chest in the region of the joint, and the muscles that cover the shoulder blade. Then take hold of the patient's arm with one hand, and with the other grasp the shoulder as shown in the above cut, and while holding the joint firmly, raise the arm forward and upward, bringing it above the head, and lower it again backwards and downwards; repeat this several times. This treatment may be painful at first if the joint is affected, and therefore the arm should only be raised as high as the patient can bear. After a few treatments, which should be given every other day, the soreness will have disappeared sufficiently so that lie will be able to stand the full treatment.

34. WORK ON THE SPLEEN
WITH the patient sitting on a chair or stool, take hold of his left wrist and raise the arm high above the bead, and while pressing on the ninth rib with the thumb of the other hand, at a point about two inches to the left of the spinal column, as shown in cut, draw the arm downward with a backward motion. Now lower the thumb of the right hand to the next rib below and repeat the movement with the left arm. Lower the thumb again to the next rib and repeat the operation.

35. CORRECT APPLICATION OF COMPRESS TO THE THROAT
WET a cloth, preferably old linen, in cold water and fold to several thicknesses and long enough to reach from the angle of the jaw on one side to the angle on the other, and about three inches wide; now cover this with a woolen cloth large enough to cover the wet cloth completely, and to be pinned or tied over the crown of the head. Another cloth may now be tied around the forehead as shown, and pinned to the throat cloth to keep it from slipping during the night. Remove the cloths in the morning, and wash the throat with cold water and rub with alcohol to prevent taking cold. This application should be made nightly until relief is felt. The cloths should be scalded before being applied again, to destroy the poisonous matters that have been thrown off through the skin and taken up by them.

36. SPRINGING LOWER JAW
WITH the patient on his back, place the first finger of each hand behind the angle of the lower jaw on each side. Now have the patient open his mouth; at the same time, with a limited degree of pressure, push the jaw forward and have the patient slowly close the mouth. Repeat this several times. This movement acts on the fifth cranial nerve and is a valuable treatment in all eye and ear troubles.

37. MANIPULATION UNDER THE JAW
WITH the patient on his back, place one hand on his forehead, and with the other work deeply under the jaw, beginning near the ear and gradually working towards the chin, not allowing the fingers to slip on the skin. Go through the same, movement on the other side of the head. This treatment is given in case of catarrh, mumps, diphtheria, and any throat trouble.

38. SPRINGING SPINE IN UPPER LUMBAR REGION
WITH the patient sitting on a chair or stool, stand behind him and place your knee against the back at a point below the last rib, and with the hands take hold of the patient’s shoulders, as shown, and draw them backwards at the same time pressing against the spine with the knee.

39. INHIBITING THE SUPERIOR CERVICAL PLEXUS
WITH the patient on his back, place one hand on either side of the upper part of the neck, close to the spine, in the region of the second, third, and fourth cervical vertebrae, and hold same for two or three minutes. (For location of the superior cervical plexus, see cut No. 1 MM, page 24.)

40. MANIPULATION OF FRONT OF THE NECK
WITH the patient on his back, place one hand on his forehead, and with the finger and thumb of the other placed on either side of the windpipe work the front of the neck from the chin down to the collar bone, moving the structures crosswise to the neck. Work in this region should require about two minutes. An essential movement in the throat diseases.

41. TO RAISE THE RIBS
WITH the patient on his back, stretch his arm out sidewise, and while bearing down and at the same time pushing it upward, press upward on the ribs with the fingers of the other hand, beginning with the third, as shown in above cut, then the fourth, fifth, and so on down to the seventh, the location of which may be seen in cut No. 2 C, page 25, This work should he done on both sides of the body alike, but only on the left side in case of neuralgia of the heart.

42. SPRINGING THE SACRUM
WITH the patient lying face downwards, place your left hand on the sacrum and with the other raise the legs and swing them from side to side several times and then lower same with a circular motion, being careful not to raise the legs any higher than the patient can bear. Should be repeated several times.

43. SPRINGING SPINE IN THE LUMBAR REGION
WITH the patient lying face downwards, place the thumb and first finger, one on each side of the spine, beginning at the first lumbar vertebra (the location of which may be seen in cut No. 1 C, page 24), and with the other hand under the legs as shown, raise them and lower again with a circular motion from left to right. Repeat this several times and then lower the hand on the back an inch and repeat, being careful not to raise the legs any higher than the patient can bear. This treatment is especially valuable in leucorrhea, suppressed menstruation, and incontinence of urine.

44. MANIPULATION OF THE OVARIES
WITH the patient on her black, and legs drawn up, press deeply in the region of the ovaries on the opposite side from which you stand, and draw your hands towards you; repeat several times and do the same on the other side.

45. GENERAL TREATMENT OF THE NERVES ALONG THE SPINE
WITH the patient lying face down and arms hung off at the sides of the table, place your thumbs, one on each side of the spine, and with a moderate pressure work the muscles, pushing them upward and outward; beginning at the second dorsal vertebra work down the entire length of the spine moving the thumbs down one inch each time. This treatment should require about five minutes.