The Practice and Applied
Therapeutics of Osteopathy
Charles Hazzard, D. O.
TREATMENT OF THE SPINE
In this chapter it is proposed to outline the general
method of procedure in spinal treatment. As no specific case or disease
is now under consideration the student must bear in mind that the treatments
described are general methods and that in any given case he would find
it necessary to select and combine these different modes in a manner best
calculated to enable him individually to reach the case.
As far as practicable the specific lesions mentioned
in Chapter I will be considered, and treatments appropriate to their reduction
will be given.
These treatments are all manipulative. They
have as their object the righting of what is mechanically wrong.
They are therefore mechanical of necessity, and are founded upon the necessities
of the human mechanism when deranged.
In treatment, the practitioner may have in view
either or both of two objects. He works to right the spine itself,
and to affect it alone, or he works upon the spine to affect some other
part of the body pathologically connected with the part of the spine in
I. The patient lies upon the ventral
aspect of the body in as comfortable a position as possible. The
head turns easily to one side, and the arms hang down loosely at the sides
of the table. The practitioner must see that the patient thoroughly
relaxes the muscles of the whole body. He now, standing at the side
of the patient, uses the palm of the hands or the cushions of the fingers
to thoroughly manipulate and relax all the spinal muscles. In treating
the muscles upon the side toward him, he works from one side of the spinal
column to the other, in a direction at right angles to the general direction
of the muscular fibres. He treats the muscles of the opposite side
by spreading them away from the spinous processes.
In this way all contractures of the muscles are
released, flabby muscles are toned, blood and nerve mechanisms are freed
and upbuilt. This removing of contractures is sometimes a necessary
step to the diagnosis of deeper lesions which may have been masked by them.
II. The patient lies upon his side,
the practitioner stands at the side of the table, in front of the patient;
with one hand he grasps the uppermost arm of the patient just above the
elbow; with the other hand he holds under the spinous processes of any
portion of the spine under treatment. Now, using the arm as a lever,
he pushes it downward and forward, at the same time springing the spine
This treatment releases tension in all deep structures,
restores free-play between bony parts, and removes pressure from blood-vessels
and nerves. It may be applied in all cases of curvature, sagging,
or swerving of a portion of the spine, lateral deviations of vertebrae,
in separating or approximating vertebrae, etc.
III. Practically the same effect may
be obtained upon the lower portion of the spine as follows: with the patient
still upon the side, his thighs and legs are flexed, and fixed by pressure
of the abdomen of the practitioner against them. Both hands are now
free and spring the spine strongly upward toward him, or to manipulate
the muscles; or,
IV. With the patient still lying
upon his side, the practitioner leans over him, placing his forearms, one
against the iliac crest and the other against the shoulder. He now
with his forearms pushes these two points further apart, while with both
hands he springs the middle portions of the spine toward him, or manipulates
It will be observed that the treatment described
under II, III, and IV above all may be used to thoroughly stretch any portion
of the, spine by laterally directed force. In this way deeper stretching
of all spinal structures may be accomplished within the limits of safety
than by stretching the spine as a whole by longitudinal traction.
V. The latter is applied with the patient
lying upon his back; the practitioner, standing at the head of the table,
passes one hand beneath the occiput, the other beneath the chin, and draws
toward him. The required degree of resistance is afforded by the
weight of the patient or by an assistant holding the ankles.
The neck must not be rotated during this forcible
tension, and jerking must be avoided.
VI. The principle of exaggeration
of the lesion is one that may be applied to the treatment of many bony
luxations. It consists in so manipulating the parts as to tend to
further increase their malposition, and in then applying pressure to them
in such a direction as to force them back toward normal position at the
same time as the part in question is released from its condition of exaggeration.
This motion releases tension, loosens adhesions, and gains the benefit
of the natural recoil of the structures from their exaggerated position.
VII. With the patient prone and the
practitioner kneeling upon the table at one side of the patient, or with
a knee upon either side, direct pressure may be applied, from above downward,
to all spinal parts. This position of relaxation is favorable for
forcing vertebrae, or the heads of ribs into place and for the stretching
of the deep and anterior spinal ligaments.
VIII. The patient lies across the
table with the abdomen and anterior chest resting upon it, the arms and
head hanging loosely down upon one side and the legs upon the other.
The practitioner may stand at either side of the table (or kneel upon it,)
and work for results as in VII, with the additional advantage that the
arms, neck, or limbs may be manipulated at will in the course of the treatment.
IX. The patient, sits, the practitioner
stands in front, slightly to one side facing backward from the patient.
He passes the arm nearest the patient back of the neck, and slips his hand
under the opposite axilia from in front. This bends the neck and
upper spine forward and swings the opposite side of the thorax backward,
thus rotating the spine. By using the free hand as a fixed point
at various points along the spine, its successive portions may be thoroughly
rotated and all of its structures loosened.
X. The patient sits; the practitioner
stands behind, pushing the head forward and to one side with one hand,
while with the other he makes fixed points along the upper spine, upon
the side from which the head has been forced. The head is now swung
forward and to the side opposite its first position while the hand brings
pressure upon the fixed points, one after the other. This motion
makes use of the neck as a lever of the first class, the fulcrum being
formed by the hand at the fixed point, with the lesion (weight) below,
and the power (hand applied to the head) above. It is a method of
"exaggeration of the lesion," and is especially useful for the reduction
of lateral luxations in the upper part of the spine.
X. (a) A variation from the above
applies the same principles to lesions lower down in the spine. The
patient sits; the practitioner stands at one side and passes one arm in
front of him, grasping his body securely, and rotating his trunk about
fixed points made at any desired place along the spine by the application
of the free hand to it. The cushion of the thumb of this hand is
pressed firmly against one side of the spines of the vertebrae suffering
from lesion, while the bent index finger is pressed against the other.
XI. The patient sits and clasps his
hands behind his neck; the practitioner stands close behind, passes his
arms beneath the axillae and his palms behind the patient's wrists, which
in his hands. As the practitioner straightens his body and draws
the patient back against his abdomen the neck and upper dorsal spine are
bent forward, the scapulae travel back and up, and all of the ribs, except
the first three or four pairs, which are sprung forward and downward, are
drawn strongly backward and upward.
This treatment thoroughly stretches most of the
spinal ligaments, costo-spinal ligaments, muscles of the back of the neck,
scapulae, and of the spine. It also brings tension upon, most of
the intervertebral, the costo-vertebral, the costo-sternal, acromio- clavicular
and claviculo-sternal articulations.
XII. With the patient sitting, the
practitioner, standing behind, may place one knee beneath the patient's
axilla thus raising and fixing the shoulder and the ribs of one side of
the thorax. This relieves the spine of the weight of these structures
and affords the practitioner two free hands with which he may manipulate
the spine or opposite side of the thorax, using the neck and other arm
of the patient as levers, if desired.
XIII. The ligaments of the posterior
lumbar and of the sacroiliac regions may be thoroughly relaxed by bending
the body of the patient, who is sitting, far forward between his well separated
XIV. The same object is accomplished
with the patient supine, while the legs and thighs are both forcibly flexed
to their limit.
XV. To stretch the posterior scapular,
rhomboid, and levator anguli scapulae muscles, the patient lies upon his
back while the practitioner slips one hand beneath the shoulder and grasps
the spinal edge of the scapula, which has been approximated as closely
as possible to the spinal column. The other hand holds the arm of
the patient just above the elbow, and the arm is raised and pushed across
the chest, the patients hand being in this way forced across well into
the opposite axilla.
XVI. With the same position of the
patient, the anterior scapular muscles may be reached by thrusting the
fingers of one hand deeply beneath the spinal edge of the scapula, while
the other hand grasps the point of the shoulder. Now the whole lateral
half of the shoulder-girdle may be rotated, the first hand continually
working deeper beneath the scapula.
XVII. A thorough "breaking up"
of the lower dorsal and lumbar regions of the spine is accomplished as
follows: The patient lies prone; the practitioner stands at the side and
passes one arm beneath the thighs of the patient, just above the knees
which he raises just free of the table, moving them horizontally from side
to side. At the same time his free hand is applied to the part of
the spine in question, the thumb upon one side of the spinous processes,
the fingers upon the other. The thumb and fingers make lateral pressure
upon the spine, alternating with, and in a contrary direction to, the movement
of the limbs.
This treatment loosens and separates the vertebrae,
releases tension of muscles and ligaments, and upbuilds nerve and blood-action.
XVIII. Dr. Still, in case of
lateral spinal lesion, stands in front of the patient, who is sitting.
He passes both arms around the body and clasps his hands over the point
of lesion; "sinks" the spine down upon this point, bends the patient toward
the side of deviation of the vertebra, then with the hand makes pressure
upon the vertebra to force it back to place while lie rotates the body
toward the opposite side.
Very many more treatments might be described, but
enough general treatments have been given to reach all parts of the spine
and to correct the lesions that are likely to be met with in practice.
These treatments may be combined or may be taken as the basis of new ones
which the practitioner may often find necessary to work out in order to
reach some special lesion or to treat some special case.
In this portion of the text, the treatments can of necessity be described,
and their application be given, only in a general way. They are outlines
of methods of procedure, and the application of the principles embodied
in them must be made to the specific lesion met with in a given case by
The lesions described in Chapter I, such as lateral
deviation of a vertebra or lateral swerving of a portion of the column;
vertebrae separated or approximated; anterior or posterior luxation of
vertebrae; the "smooth spine"; the loss of normal curvature; the rigid
or relaxed spine, etc., may all be reduced by various applications of these
Generally speaking, the results attained by the
use of these treatments are, the relaxation of contractured muscles; the
release of tension in nerve, muscle, ligament or other fibrous structure;
the reduction of bony lesion; the removal of obstruction from, and the
renewal of blood and nerve-currents.
XIX. The fifth lumbar vertebra, after
luxation, way be restored in various ways. The posterior displacement
is the most frequent. In this case one may place the patient upon
his side, flex the knees against one's abdomen, fix the fifth lumbar by
holding beneath it with one hand, while the other, slipped beneath the
thighs, rotates the weight of the lower part of the body about the fixed
point. Recent dislocations may be adjusted in this way without difficulty.
In long standing cases, continued treatment is necessary, the work of relaxation
of parts, etc., in preparation for its reduction, being performed in part
by the application of principles already described.
With the patient upon his back and the body below
the fifth lumbar protruding over the foot of the table, the practitioner,
standing between the limbs and holding one under each arm, places both
hands beneath the pelvis, makes a fixed point at the fifth lumbar, and
by the movement of his own body rotates the lower half of the patient's
body about the fixed point.
With the patient upon his back, the practitioner
standing at one side, the clenched hand is placed beneath the body at one
side of the fifth lumbar spine. The leg and thigh are now strongly
flexed by the free hand, external circumduction of the thigh is made, and
the weight of the body is thrown onto the fixed point. In some cases
this treatment is sufficient for replacing the bone.
In case the vertebra be anterior the above treatments
may be applied for the purpose of loosening all the ligaments.
Also the principle of exaggerating the lesion may
be applied by making a fixed point of the practitioner's knee at the fifth
lumbar, the patient sitting. The patient's body is bent backward
against the fixed point and then rotated forward. Also, with the
patient sitting and the fifth lumbar fixed with one hand, the free arm
grasps the body of the patient and rotates it about the fixed point.
The bodies of the vertebrae may be thus warped or slightly moved upon each
other, drawing the bone back to place.
In many long-standing cases of bony lesion, the
strengthening of the surrounding muscles and ligaments must take place
and be depended upon to hold the ground gained as the part is gradually,
during a course of treatment, brought back toward its normal position.
XX. In case the sacrum be found
to be anterior or posterior from its normal position, this is a matter
partly relative to the position of the innominate bones, luxations of which
will be discussed later.
In cases of posterior protrusion, after relaxation
of the sacroiliac ligaments, pressure may be made with the knee directly
upon the sacrum from behind, with the patient either sitting or lying upon
his side. At the same time the pelvis and the upper parts of the
body are drawn strongly backward.
XXI. In restoring the coccyx to normal
position both external and rectal treatment may be necessary. In
some cases external treatment alone will be sufficient. The saccro-coccygeal
articulation is generally quite pliable. In external treatment, attention
must be first given to the relaxation of the muscle and fibrous tissues
concerned. The bone may then be grasped and moved or sprung from
either side toward the median line, may be forced anteriorly, or the finger
may be gently inserted beneath its tip and may draw it back toward its
Rectal treatment should not be given oftener than once a week
or ten days. The patient lies upon his side or bends, face downward, over
a table. The index finger, anointed with vaseline or oil is inserted, palm
down, into the rectum. It is then turned palm up; laid along the hollow
of the coccyx, and swept from side to side, to free the action of blood-vessels
and nerves. With the finger in the rectum and the thumb outside, the bone
may be grasped and moved toward any position necessary. As a rule its restoration
to a normal position is only gradually accomplished.