Practice of Osteopathy
Charles H. Murray, D.O.
The most important part of osteopathic procedure
is the examination of the patient, the determination of the lesion, the
discovery of what is wrong in the human building. In some cases nature
has taken care of a former abnormality of structure, and then what was
once abnormal has become normal. An attempt to make a forcible correction
of the apparent abnormality would lead to trouble. In some cases
most serious results would ensue.
In other cases, where the real lesion is not discovered,
months of routine treatment would be worse than useless and might be a
detriment rather than a help to the patient. So we say the first
thing and the most important thing to do is to make a careful and painstaking
examination of the patient.
If there are no marked osteopathic lesions, the disease
in question having been brought on by overwork or abuse of function, as
overeating or drinking, there are certain definite areas in which the Osteopath
works, and by securing a better nerve and blood supply hastens the recovery
of the patient. This is especially true in cases of sickness induced
by the various specific microorganisms which are the exciting agents of
a long list of acute diseases, as pneumonia, la grippe, typhoid fever,
scarlet fever, measles, chicken pox, mumps, whooping cough, diphtheria,
erysipelas, tuberculosis, etc., etc. Even in many of these diseases
there are predisposing lesions that weaken certain areas of the body and
permit the entrance and growth of these exciting organisms.
Yet in these very regions in which the Osteopath
works to help recoveries there are, in a majority of cases, lesions of
muscle, ligament, and of the bony structure as well, which have been induced
reflexly. The abused organs or the diseased organs have sent nerve
impulses to the cord, and they have sent them in such large numbers that
they have in turn been sent out to the muscles and other structures lying
in close proximity. A muscle is tense in proportion to the number
of nerve impulses communicated to it. These abnormal nerve impulses,
long continued, have produced contractures; these in turn, by pulling on
the bones to which they are attached, have produced bony lesions.
Some of these bring pressure to bear on the spinal cord and other structures,
and in this manner aggravate the disease.
For the beginner in Osteopathy it will be better
to have the back of the patient bare. If the patient is a
lady, a gown or kimono may be worn which opens in the back.
A suitable kimono for taking the treatment is illustrated in Fig
2. After the operator has had some experience he will readily
examine the spine of patients through the garments, the under clothing
at least. As a general thing we know very little about our
own bodies. Many are more conversant with the normal cow,
horse or hog than with the normal human body. It will be an
excellent thing for the one who expects to make a vocation or even
an avocation of Osteopathy to study carefully the normal body.
Study a number of them. Become thoroughly acquainted with
the normal body, and especially with the normal spine. In
this way you will be all the more readily able to detect the abnormal.
The practitioner should study the various degrees
of motility of spines, joints, necks, backs, etc., of normal individuals.
He should learn the various degrees of tension, tenderness, and pliability
of the various muscles of persons in health. A knowledge of anatomy
and physiology will be very helpful.
Lesions. It is not every vertebra
that is out of line laterally, or deviates anteriorly or posteriorly, that
may be said to be out of position in such a manner as to constitute a lesion.
Before we can say that a deviation of such a character constitutes a lesion
it ought to produce some pathological condition, or ill feeling of some
kind. There should be some change in color and some temperature near
the abnormality. There should be some contraction in the muscles
and ligaments. There should be some inflammation, or a congestion
bordering on inflammation, near the seat of lesion. There will be
pain in nearly all recent lesions. Pain will be present on pressure
in some conditions the muscles in close proximity will be slightly swollen
and have a rigid feeling when worked over with the hand. It will
be always safe and beneficial to manipulate the spine, ribs, ligaments,
muscles, and other tissues, but do not attempt to correct a misplaced bone
until it is known to be out of place in such a manner as to cause pressure,
or is forming an obstruction that is causing some illness. Never
manipulate a tubercular joint or spine. Do not cause pressure on
Since the publication of the second edition of this
book, doctors who are doing research work in Osteopathy are of the opinion
that pressure on nerves resulting from vertebral displacements is not a
cause of disease. This view is in harmony with the author's experience
with one exception, and that is in those cases where a vertebra or vertebrae
are misplaced anteriorly. This allows pressure to be exerted upon
the spinal nerves as shown in Fig. A. In backward displacements the
spinal foramen is made larger, and there can be no pressure exerted on
spinal nerves. This is especially true in those cases where Pott's
disease exists and there is a backward displacement of the vertebrae amounting
to deformity. See Fig. B.
Disease and disturbances of the circulation are not,
as is generally believed by Osteopaths, caused by arterial or venous obstructions
occasioned by misplaced vertebrae. Vertebral displacements and an
obstructed circulation have been the two great points which Osteopaths
have kept before the public. They have believed this, and acting
on this belief, in attempting to adjust vertebrae have done much harm to
suffering humanity. I want to show later how the best results may
be secured from Osteopathy, or mechanical treatment, with no danger of
injury to the patient.
The real lesion, or spinal abnormality, when it exists,
is in a tightened vertebral joint or series of such joints. The ligaments
binding such vertebrae together have become shortened. The intervertebral
substance becomes thinner and is frequently absent. In some cases
it entirely disappears and ankylosis sets in. When a vertebral joint
is not as free in its movements as it should be the adjacent microscopic
tissues are involved and the flow of lymph and circulation in such structures
is impeded. For this reason we claim that the real spinal lesion
is immobility of spinal joints. Other joints may be affected in much
the same manner.
For the above reasons we would be more explicit in
giving caution to avoid harsh and severe treatment and to refrain from
adjusting or attempting to adjust bones of the spine or pelvis unless we
are positively certain that such apparent maladjustments are the cause
of diseased conditions.
It follows that the best treatment will be directed
to loosen the tightened joint or joints and so manipulate the surrounding
tissues that circulation will be restored. Chiropractors have been
doing their work, using a theory that is entirely wrong, but in practice
they have only loosened such joints, and in that way have secured good
results. They would secure better results if they paid some attention
to surrounding tissues.
A Chiropractor performs his work by placing
both hands on a spinal vertebra, one over the other, enforcing it,
and giving a quick thrust. The patient is in the recumbent
position, and this thrust is given with the idea of adjusting misplaced
vertebrae; but the only effect is to secure more mobility of the
joints. Were force used sufficient to move the vertebrae serious
injury would result. This has proved to be the case resulting
from some treatment given by both Chiropractors and Osteopaths.
Fig. No.51a illustrates the
manner in which the Chiropractor thrust is delivered. Some
have the elbow bent, and in straightening out the elbow the thrust
is given. Other practitioners attempt to withdraw the hands
after making the thrust to allow the vertebrae to recoil.
The effect of working on a spinal articulation with
sufficient force to loosen the joint, is to stimulate the segments of the
spinal cord nearest that joint, and send nerve impulses in increasing numbers
over the nerves that find their origin in that portion of the cord.
This nerve stimulation will be caused by any mechanical force acting on
the spinal column sufficient to influence the cord.
The circulation of the blood, both arterial and venous,
must be kept free. Tightened, tense muscles and ligaments, various
abdominal organs out of position, as in enteroptosis, interfere with the
proper circulation of the blood, lymph and nerve impulses. This quickly
leads to disease. For example, when the tissues tighten in the neck
from any cause, circulation is obstructed and inflammation of the tonsils,
pharynx, and other structures takes place. And on account of the
stagnation of the circulation, pathological germs find a lodging place
and various diseases such as diphtheria, scarlet fever, etc., begin.
When there is trouble with the ears, eyes, nose or throat we may be sure
that there is interference with their blood and nerve supply somewhere,
and oftentimes that obstruction is in a tense muscle or ligament.
Spinal vertebrae, of course, are found out of position,
but this is very seldom a cause of disease, unless such malposition is
the result of a severe accident. Displacement of a vertebra sufficient
to cause pressure on a nerve would be very serious, indeed, but is very
The founder of Osteopathy is very fond of claiming
that " the Great Master Mechanic left nothing unfinished in the machinery
of his masterpiece - Man - that is necessary for his comfort or longevity."
But if spinal vertebrae are so easily misplaced as to cause pressure on
nerves and blood vessels and thus cause disease, Deity has made a mistake
in designing his masterpiece - Man.
The reader must not think from the above that I undervalue
the good results to be obtained in Osteopathy, or mechanical treatment,
only to obtain better results than have been secured in the past we must
perform our work with a view to loosen tight joints, relax muscles, ligaments
and fascia, and not attempt to move bones that are not causing pathological
conditions. Much good has been accomplished with the old theory as
a basis, but where it has been carried to its logical conclusions harm
has also resulted.
All honor to the founder of Osteopathy, even if his
theory was, in part, resting on false premises.
Diagnosis, Methods of.
The method of diagnosis most in vogue and the principal one which the Osteopath
uses is palpation, the use of the hand or hands in determining the condition
of nearly all the tissues of the body. With careful work and much
practice, comparing the normal with the abnormal, the sense of touch becomes
very acute, and the least difference in the density and the motility of
the various tissues is readily determined. The patient should be
requested to relax all tissues as much as possible and not to make any
resistance to the various movements unless requested so to do. The
other methods of diagnosis are inspection and percussion. With the
beginner, inspection is also important, as by it he notes curvatures, unequal
development of muscles, differences in the color of the skin, apparent
age, height, weight, peculiarities of gait, manner of standing, sitting,
Percussion enables us to learn the condition, size,
shape and position of various organs, the presence of cavities, gas, tumors,
etc. This form of diagnosis calls into use a small hammer, but more
generally the second and third fingers of the right hand are used to strike
the middle finger of the left hand which has been placed over the part
to be percussed. In examining a patient it may be well to begin with
The important point in the diagnosis is to discover
the pliability and mobility of the spine. If it is too pliable
there is danger of curvature. If portions of the spine are
too stiff and there is not proper motion in the joints of the vertebrae
it is a cause for disease. This may be determined, for the
dorsal and lumbar portions of the spine, by examining as in Fig.
32; in the cervical region by examining as indicated in Figs.
14 and 15. The ease
with which this movement is accomplished, together with a rotation
of the head, determines the amount of pliability. By examining
a few persons who are in health you can determine what the normal
EXAMINATION AND TREATMENT.
In many of the descriptions of treatments which follow
you might think that you were to put a bone into its proper position at
once, but you will not, and it would not be best to do so. It often
only results in making an articulation more pliable, which is the real
object in view, looking to the ultimate result of restoring the patient's
health. The utmost care must be taken not to injure a patient, which
may be easily done in the case of a child or a weak person.
for Treating. In giving a general treatment, try to do the work
in twenty minutes. When you begin to practice Osteopathy it will
take thirty minutes or longer to give the general treatment, but after
you have practiced for a while you will feel that you are wasting time
if you do not give it in twenty minutes or less. In using the shorter
time you will do the work very effectively. In treating many cases you
will obtain better results to give a short and very specific treatment.
Not more than five minutes is necessary for the entire operation.
As the founder of Osteopathy used to say, "Do what is needed and then quit."
He called those who spent time in going over the entire body "engine wipers."
He wished Osteopaths to be mechanics, first-class engineers, and to fix
what was wrong in a workmanlike manner.
In nervous troubles and in many constitutional diseases
Osteopaths have discovered that they get better results when they give
the general treatment. This helps the circulation and makes a tired
patient feel like new; and the treatment, after all, when there are no
specific lesions to remove, is but little more than deep massage, in which
nearly all the muscles of the body are manipulated.
One may give this treatment, in such a manner that
many patients come to look upon it as a luxury. And many will take
it when they are only slightly indisposed. Some business men take
the treatment as a means of relaxation. Many others take it when
they are simply tired.
In acute cases the Osteopath treats every day and
sometimes more often. When the patient becomes better, three treatments,
and then twice per week, will be sufficient. In treating chronic
cases I have obtained good results by giving the treatment every day for
a week and then treating three times per week. When the patient became
better, treatment was given twice per week, later only once per week.
In chronic cases I found it necessary to treat my patients for three to
six months, though some did fairly well after one month's treatment.
A number of cases I have found it necessary to treat from one to two years.
That is a long time, but results justified the time spent. In treating
such cases I have found it to be beneficial to let the patient rest from
the treatment for from one to three months and then begin treatment again.
Some patients do not seem to improve for the first
six months; then they continue to improve until they are well. I
have had patients who did not make any visible improvement in a year.
They would quit the treatment and begin to improve from that time on.
That is one reason why I have found it advisable to have patients rest
from the treatments for a month or more.
In outlining the examination of patients in the office, where by far the
greater number of an Osteopath's patients are treated, I will give my own
methods, which I tried in every way to simplify and was successful in doing
so as time progressed.
My reception room was well lighted and kept very
clean. Everything about it was bright and cheerful. The hardwood
floors were well covered with bright-colored Indian rugs. There were
plenty of rockers. A good supply of up-to-date popular literature,
including some bearing on Osteopathy, was always on hand. There was
a good library of the latest medical works.
There were four good-sized treating rooms in connection
with the reception room. These contained a treating table, costumer,
dresser with mirror attached, and a couch on which many of the patients
rested after treatment. This added greatly to the benefit of the
treatment in the cases of many nervous patients. For the ladies there
were many full-length and full-fashioned kimonos, which were kept well
laundered. In the treating rooms were running water and a good supply
of towels and soap. The kimonos were open in the rear, which permitted
of a thorough examination of the back, which I always did on first treating
the patient. The gentlemen were nearly always examined the first
time on the naked back. They removed only the top shirt, and I lifted
the undershirt when I wished to examine them. This permitted of a
The patient sitting, the examiner stands behind and
notes any inequalities on either side of the neck. Sometimes one
side bulges and on the other side there is a corresponding hollow.
This condition indicates curvature in this region, with the convexity to
the full side. On this side the tissues will be found to be hard,
tense, and tender. When this condition is present it is frequently
indicative of a curvature lower down. We now note whether there are
enlarged tonsils, hypertrophied lymphatic glands, goiter, or any unusual
pulsations or enlarged vessels.
With the patient now reclining on the back in a comfortable
position, with all muscles relaxed, we proceed with the examination by
palpation. The neck may be gently manipulated by placing one hand
on the forehead, for the purpose of rotating it by using the forehead as
a lever, while the other hand manipulates the muscles in the back of the
neck for the purpose of further relaxation. In examination, as in
treating, the Osteopath never rubs.
He never allows the hand to slip on the skin, but
is concerned with moving all the deeper tissues.
The Osteopath now with the points of the fingers
examines the tissues just beneath the skull. Often these are found
tense, and the patient complains of pain here during examination and treatment.
The fingers are now allowed to travel down the mid line at the back of
the neck, and find the spinous processes. The first one to be felt
beneath the skin is the second, or axis. The position of the first,
or atlas, is rarely determined by the spinous process, though in some cases,
about one in fifty, it may be found. We are able to count the vertebrae
in this manner and to note their position. The seventh, or vertebra
prominens, has a very prominent spinous process. It can be differentiated
from the first dorsal, the one just beneath it, by rotating the head when
the patient is in a sitting position and noting that the spinous process
of the seventh cervical moves perceptibly while the spinous process of
the first dorsal does not move.
Anterior, posterior, or lateral deviations may be
determined by the examination of the spinous processes. The position
of the transverse processes may be noted by turning the head to one side,
moving the examining fingers up a little and to one side from the spinous
process. A prominent projection will be found when the one on the
other side will be found in the same manner and the fingers will then move
down from one to the next process on both sides, determining the relative
position of each with reference to neighboring processes. This enables
us to determine lateral deviations, twists, or torsions of vertebrae; also
posterior or anterior deviations from the normal.
Osteopathic treatment of the neck is for the purpose
of removing lesions, which may consist of any departure from the normal
in any tissue and which is causing abnormality of function. In following
the description let us remember that all patients are not to be subjected
to the same routine. This is too frequently done, to the detriment
of the patient. What follows is for the purpose of describing the
work in detail and to describe the work necessary for the removal of the
various lesions usually found. This section of the book will be very
frequently referred to by the numbered paragraphs where the description
of the specific treatment is referred to in the proper treatment of each
1. While the patient is in a sitting position
on the side of the table, the operator, standing behind, the right
hand placed on top of the patient's head, rotates the head so as
to bring the neck of the patient against the thumb of the operator's
left hand. The left thumb is moved successively along against
the arches of the vertebrae, as shown in Fig.
1. In this manner there is secured a free motion between the
vertebra, and the movement also assists in relaxing the tissues
preparatory to removing any vertebral lesion that may be present.
2. The patient is sitting
and the operator is standing behind, and bends the neck of the patient
as far forward as possible on the chest of the patient. This stretches
the strong posterior neck muscles, including the ligamentum nuchae.
3. The patient sitting, the operator stands
in front and puts his arm about the neck of the patient, so that
the bend of the elbow comes beneath the chin of the patient, and
the hand grasping the base to the skull. The other hand is
free to manipulate any of the vertebrae in any desired direction,
though this hold is more applicable to the atlas and the axis.
The head of the patient may be given a lifting motion and moved
over in the required direction. See Fig.
4. The scaleni muscles, the deeper ones
at the side of the neck, are often tight and contracted. Pressure
may be made on the first rib on the contracted side, as in Fig.
4, while the other hand bends the head forcibly to the other
side, at the same time rotating the head.
5. The patient lies on his back. The
operator stands at one side with one hand on the patient's forehead,
the other beyond to the other side of the neck. The hand on
the forehead rotates the head from side to side, alternately relaxing
and stretching the muscles at the side and back of the neck, while
the hand placed at the side of the neck stretches the muscles toward
the operator with each movement of the neck. The hand on the
neck will be moved from one position to another as the tissues relax
beneath it, and the hand may be brought down onto the shoulder during
the process of relaxation. This same treatment may be applied
to all the tissues in front of the neck down to the clavicles.
See Fig. 5.
6. The hyoid bone may be found just above
what is often called Adam's apple, the thyroid cartilage, the largest
cartilage of the larynx. The bone feels as if it were shaped
like the wishbone of a chicken, minus the protuberance at the angle.
While it should be freely movable it is often held tight by the
muscles, the supra hyoid and the infra hyoid, attached to it.
This bone is frequently drawn backward and downward, and by pressure
on nerves is the frequent cause of nervous coughing and may be responsible
for complete loss of voice. By manipulating the neck from
side to side the thumb and forefinger may be gradually insinuated
under it, and it may be lifted up and forward. The tissues
all about it should be thoroughly relaxed. See Fig.
7. The pneumogastric nerve may be pressed
upon, manipulated and stimulated by deep pressure behind the anterior
border of the sternomastoid muscle on a level with Adam's apple,
as in Fig. 7. This is a very
important nerve, osteopathically, owing to its large distribution
to important organs.
7A. The spinal accessory and glosso-pharyngeal nerves may be reached
by deep pressure upward and inward behind the angle of the jaw.
7 B. The sub-occipital, great occipital, small occipital,
and great auricular nerves may be stimulated as in cases of fever,
headaches, etc., by deep pressure on both sides of the spine, just
at the base of the skull, as in Figs.
8 and 9. The founder of Osteopathy, Dr.
A. T. Still, when but a small boy, made pressure on these nerves
by placing his head in a swing. See Fig.
10. He found that this pressure relieved his headache.
This accidental discovery may have had something to do with his
discovery, later in life, of Osteopathy.
7 C. By deep pressure of the tissues of the neck against the transverse
processes of the second and third cervical vertebrae we may stimulate
the superior cervical ganglion. See Fig.
8. We will have occasion to refer to springing
the lower jaw by opening and closing the mouth
against resistance. The operator stands behind the reclining
patient, with bands under the chin and at both sides of the jaws of the
patient, who is directed to open and close the mouth slowly, the
operator resisting. This frees the tension of muscles and allows
more freedom of blood vessels
below the jaw. See Fig.
8 B. In connection with the above the hands may be used to draw
up the tissues under the chin. Let the movement be circular
and deep. The points of the fingers are used to execute this
movement. See Figs. 12
9. The head may now be twisted as far as
possible to one side without causing inconvenience to the patient;
then to the other side in the same manner. We often notice
in executing this movement that it moves further to one side than
to the other. On the side to which it turns the least we look
for muscular or ligamentous lesions. See Fig.
10. The head may be pushed as far forward
as possible onto the chest, loosening the posterior muscles and
other tissues far down the spine. See Figs.
14 and 15.
11. Some operators can use a very effective
spiral treatment of the tissues of the back of the neck. One
hand is placed on the forehead of the reclining patient, the other
beneath the neck. The neck and head are both raised.
The head is rotated in one direction, the neck in the opposite direction.
Then the movement is reversed. See Fig.
12. A number of movements have been devised
to reduce atlas lesions. One has been given above as in No.
3. These movements may be used in a slightly different way for
the other cervical vertebrae. The operator stands at the head
of the table, the patient reclining. The operator grasps the
head firmly with both hands and makes pressure with the fingers
against the arch of the atlas behind. He raises the head slightly,
supporting it against the body. Now as he rotates the head
he presses the bone toward the normal position. See Fig.
13. The neck tissues may be stretched as
in Fig. 18. In some cases
it will be of material assistance in the case of light patients,
to have an assistant to hold the feet of the patient, to afford
greater resistance. Many other movements in the treatment
of the neck will be developed in the regular routine of practice
by the skillful operator. This will be true of every portion
of the anatomy as well as of the neck.
Most Of the treatment for the purpose of affecting
the head is given in the neck, upper dorsal and other portions of the body.
Nevertheless the Osteopath does some direct work on the head.
14. While the patient is lying on the back
the palms of the operator's hands are passed from the center of
the forehead each way, with varying pressure down over the temples
and behind the ears. This movement has a quieting effect on
the patient, soothing the nerves, and is frequently used in headaches.
It affects branches of the fifth nerve on the forehead. See
15. One palm is placed across the forehead
and the other beneath the skull, or both palms may be placed on
the forehead, one on top of the other, and great pressure exerted
for a few seconds and repeated several times. See Fig.
21. This is useful in colds, headache, etc., as it helps
to relieve the pressure in the longitudinal and lateral sinuses,
large veins of the brain.
16. Treat along the midline of the skull,
from the nose to the back of the neck, using the thumb in a circular,
pressing motion with varying degrees of pressure for the same purpose
as Nos. 14 and 15. See Fig.
17. We may tap with the knuckles or percuss
with one finger laid upon the center of the forehead in treating headaches,
18. Manipulate on each side of the nose
and loosen all the tissues for the purpose of affecting the fifth
nerve and freeing structures in close connection with it.
See Fig. 23.
19. Use deep pressure, with a gliding movement
of the little finger, to work over a portion of the fifth nerve,
supplying the tear duct, for the purpose of opening it or keeping
it open. Begin at the inner corner of the eye. See Fig
20. The forefinger will find a little depression
in the skull, just below the eyebrows, between the center and inner
margins of the eye, where the supraorbital branch of the fifth nerve
emerges from the skull. It is a nerve of nutrition to the
eye, and passes outward over the forehead at an angle of forty-five
degrees. Free the tissues about and in this little opening
with a gentle, pressing, circular movement of the tip of the forefinger.
See Fig. 25. Work along
the nerve with the palm of the thumb. In some cases of neuralgia
it will be found to be extremely sensitive, which will be greatly
lessened as tissues are relaxed about it. In treating the
eyes this nerve is often stimulated. The nerve may be felt
beneath the skin.
21. The fifth nerve may be treated where
it emerges from the skull above the eye, in Figs.
25 and 20. Also
over both jaws, above and below the roots of the teeth. It
may also be treated below the malar cheek bones, as in Fig.
26. It may be treated along the sides of the nose, as
in Fig. 23. Thorough
treatment of this nerve is frequently necessary in cases of neuralgia.
22. The fingers must be very clean as they work
inside of the orbit to tone up weak or contracted muscles in cases of strabismus.
The finger may be inserted deeply, yet carefully, and worked around the
eyeball, both to relax and free up the tissues and to promote a better
23. The nail must be thoroughly clean as it
is used to break up the little blood vessels which form a network running
into the pterygia, which, if let alone, will grow towards and cover up
the pupil of the eye.
24. Granulations may be broken up by crushing
them between the thumb and forefinger. For this purpose, folds of
the lid may be lifted up, or one finger may be inserted beneath the lid.
25. The patient, lying on the back, the eyeballs
may be pressed back into the orbit several times with the palms of the
thumbs and held there for a few seconds. This helps in toning up
the various structures and assists in the general circulation of the eyes.
26. The palm of one finger may be placed
over the eyeball and tapped, as in percussion, by the forefinger
of the other hand. This acts very much as No. 25, and is useful
in cases of cataract. See Fig.
27. The patient sits on the side of the
table and the operator notices any deviation from the normal in
exaggerated curves, lateral curvature, or any number of vertebrae
or a single vertebra which may be misplaced. He notes any
tenderness, as he palpates with the fingers, that may be found in
the tissues on either side of the spine or between the spinous processes.
See Figs. 28 and 29
for fairly normal spines.
28. The tips of the spines, the spinous processes,
may be noted by the red color brought out on them by swiftly passing the
hand over them with some pressure. In this manner their position
may be noted, thus disclosing any deviation from the normal.
29. A finger may be placed each side of
the spinous processes and passed down, in this manner noting any
lateral deviation from the normal. This may be done either
on the bare spine or over the clothing worn in treating. See
30. The palm of the hand may be passed
down rapidly, from the base of the skull to the sacrum, for the
purpose of noting any deviations from the normal, either posterior
or anterior. Pressure exerted on the top of the head, as in
Fig. 69, will frequently reveal
tenderness at some point in the spine.
31. The patient rests in the prone position,
lying on his stomach, while the operator, with the palms of the
fingers, notes contracted muscular tissues, pulling the muscles
away from the spine on either side. These contracted muscles
often feel like small ropes beneath the fingers. See Fig.
32. The limbs of the patient are flexed
as he lies on his side, and the operator holds them in this position
as he gently springs the spine, as in Fig.
32, noting its relaxed or contracted condition.
33. While the patient is lying on the side
in a comfortable position the vertebrae are carefully examined by
the fingers of the operator. Pressure is made between the
spinous processes of each one, to note the condition of the ligaments
and the approximation or separation of the various vertebrae.
See Fig. 33. When the
ligaments have grown too thick they fill the spaces and produce
what is known as the smooth, stiff spine.
34. With the patient sitting on the side
of the table, and the operator standing behind, he may begin the
treatment of the back by placing the tips of his fingers on the
patient's shoulders and with the thumbs loosen the muscular tissues
in the upper part of the back. If the hands are long he can
travel up and down a good portion of the back with the fingers in
the above position. See Fig.
34. The fingers may now be used in relaxing all the tissues
on the shoulders from the neck over the top of the shoulders.
35. While the patient is sitting the operator
passes one arm over one shoulder and under the opposite arm in front.
With the other hand he makes fixed points on the spine with the
thumb, against which he rotates the body with the other arm, and
in this manner thoroughly loosens the structures and replaces misplaced
vertebrae. See Figs. 35
and 36. The position
is reversed and the other side of the spine is treated in the same
manner. The patient may be held, as in Fig.
68, one shoulder braced against operator's body.
36. The patient sitting, and the operator
standing behind places one hand on the top of the patient's head
and with the other hand makes fixed points with the thumb along
the spine, using the head and neck as a lever. The use of the hands
may then be reversed and the other side of the spine treated in
the same manner. The operator will be surprised with the efficiency
of this movement and the power that can be exerted at any given
point along the spine against the thumb by making the right pressure
on the head. See Fig. 37.
37. The patient sits, preferably on a stool,
and places his hands behind his neck. The operator stands
behind and passes his hands under the patient's arms and takes his
wrists and places one side of the flat of his knee at the patient's
spine and lifts the patient up and backward against the knee. This
is an efficient treatment for loosening the various articulations
and stretching the ligaments which have become tightened.
It stretches the spinal, scapular and neck muscles. The lower
ribs are raised. See Fig.
38. The patient sitting, the operator stands
to one side and behind, or kneels beside the patient on the table,
and passes one arm back of the patient's neck and under the patient's
arm on the other side, thus bending the patient's neck forward.
With the free hand fixed points are made along the spine and the
patient's body is rotated against the thumb of the operator.
This movement is very effective in upper dorsal regions. See
39. The patient sitting, the operator stands
behind and places one knee beneath the arm of the patient in the
axilla. This holds the shoulder and the ribs on that side
in a fixed position. The operator may use one or both hands
in raising one or more ribs or in stretching the opposite side.
See Fig. 40. This may
be used in combination with Figs.
40. The patient is sitting, and the practitioner
stands behind to one side and reaching around the patient in front
grasps the lower edge of any rib. With the other free hand
he raises the arm of the patient on the same side as he lifts the
rib. This will be helped by having the patient take a deep
breath as the rib and arm are raised, then holding both as the patient
expels the air. See Fig.
41. The patient is sitting on a stool with
the knees against the wall. The operator stands behind and
places his knee on the appropriate round of the stool, with the
knee against the vertebrae he wishes to correct, seizes the patient
by the shoulders or under the arms and pulls the patient back against
the knee, rotating the patient to make the necessary correction
of the spine. Extreme care must be exercised in executing
this movement for fear of injury to the patient. See Fig.
42. The patient while sitting on the side
of the table is bent forward so that his head is between his knees,
the operator using forcible pressure on the upper dorsal region
and head. This relaxes the ligaments of the lumbar and sacroiliac
regions. See Fig. 43.
43. The patient is sitting on the side
of the table. The operator is standing in front of the patient,
with a pillow between himself and the patient. Both hands
clasp the spine of the patient as in Fig.
44, when deep pressure may be made, sinking the vertebrae well
in; then by rotating the body pressure may be made to the side wished.
This is an excellent movement to correct a lateral curvature or
any lateral or posterior displacement. In case of an anterior
displaced vertebra the vertebra above and below may be brought forward
in this manner, thus gradually correcting the one which is anterior.
44. The position is the same as in 43 for
both operator and patient. By grasping the spine firmly on
each side the patient may be lifted and the spine stretched, or
correction may be made in this manner when only two or three vertebrae
are approximated too closely. See Fig.
46 shows an excellent movement in cases of spinal curvature.
The side which is shortened may be stretched by using the wrist
under the patient's arm, and the hand, as shown in the figure, raises
and stretches the side. The other free hand moves from point
to point along the spine and forces it over into position.
46. The side may also be stretched, as
in Fig. 47. Firm upward
pressure may be made with the hand grasping the ribs while traction
is made on the upstretched wrist of the patient.
47. The patient lies in as easy a position
as possible, with the face downward, but for comfort the face may
be turned to one side, with the toes extending over the end of the
table. Let the arms hang over the side of the table.
Have the patient relax as much as possible. The operator uses
the palms of the hands in a circular, pressing movement to relax
all contracted tissues of the back. See Fig.
48. With the cushions of the fingers he can pull the muscles
away from the spine, as in Fig.
48. With the patient lying in the prone
position, the operator standing at one side of the table grasps
the hip of the patient on the further side in front. The heel
of the other hand can then travel up and down the spine, exerting
considerable pressure while the other hand pulls the hip upward,
giving the spine a torsion. The operator works from both sides.
This movement is very effective in removing lesions and relaxing
contracted tissues. See Fig.
49. With the patient in the prone position,
lying across the table as in Fig.
50, the operator stands at the head of the patient, and with
the thumbs working each side of the spine lie can further relax
tissues and stimulate the nerve through the spinal cord.
50. With the patient in the prone position,
and the operator standing at the head of the table with the thumbs
each side of the spine, as in Fig.
51, he can further relax the tissues and can also exert considerable
pressure when necessary to correct posterior displaced vertebrae,
or for the purpose of stimulating the spinal cord and through it
the organ or organs which receive their nerve supply from any particular
section of the spinal cord.
51. The patient is in the prone position,
and the limbs are raised in the operator's arm, as in Fig.
52, and rotated while the other hand makes fixed points with
considerable pressure on the lower part of the spine.
52. The patient is in the prone position,
and pressure is made in the lower part of the spine, while first
one then the other limb is raised, as in Fig.
53. This movement, as well as No. 51, assists the operator
in relaxing the tissues and replacing posterior vertebrae.
53. The patient lies on his side in a comfortable
position. The operator stands in front and grasps the patient's
uppermost arm, as in Fig. 54.
With the other hand he relaxes the tissues about the shoulders and
down to the spine and pretty well down the back, using the arm as
he holds it at the elbow as a lever, working it back and forth to
aid in the manipulation. The spine is manipulated and any
deviations are corrected at the same time and in the same manner.
54. The tissues may be so relaxed that
the shoulder may be manipulated quite freely. One hand may
pull up the scapulae, while the other presses on the shoulder, as
in Fig. 55. The hand
may also be insinuated under the scapulae, as in Fig.
56, and the tissues thoroughly manipulated and loosened.
55. While the patient is reclining on the
side, and one hand has made its way under the patient's scapulae,
the other hand grasps the patient on the shoulder and rotates the
entire shoulder. See Fig.
56. The patient is lying on his side on
the table. The operator places one hand beneath the patient's
neck and grasps the occiput, as in Fig.
58. The operator brings his chest against the other side
of the patient's head. In this manner considerable traction
may be made on the neck and upper dorsal region, and very effective
corrective work may be done with the spine with the free hand as
shown in the cut.
57. The limbs of the patient may be flexed
and braced against the operator, who bends over and grasps the spine
thus brought into relief, as in Fig.
32. The spine at any point may now be manipulated by pulling
it toward the operator.
58. With one elbow on the hip, the other
on the shoulder, as in Fig. 59,
as the patient is lying on the side, the operator's arms may be
extended, thus stretching the hip away from the shoulder while the
hands are free to manipulate tissues and the spine as well.
59. The patient lies on the side, and the
operator, with one hand in front of the hip and the other hand behind
the shoulder as in Fig. 60.
By pulling on the shoulder and pushing against the hip the spine
may be twisted for the purpose of relaxing tissues, including muscles,
nerves and ligaments. With the same motion the side of the
back upper-most may be stretched by separation of the operator's
61 is the exact opposite of the above, and the torsion is applied
by reversing the position and motion. This is very useful
for stretching and relaxing the various tissues of the back and
61. The patient lies comfortably on his
back. The elbow of the patient is held by the operator with
one hand, while with the other he reaches across the body of the
patient and grasps the muscles of the back, as in Fig.
62. The arm may be stretched as movements are made to
loosen the tissues manipulated with the free hand. The spine
may also be manipulated with the free hand its entire length.
62. The patient lies on the back, and the
operator stands at the side of the table and reaches across the
body of the patient and grasps the spinal edge of the scapulae,
pulling it out as he brings the arm of the patient across the chest,
as in Fig. 63.
63. A small patient lies on the back.
The knees are grasped in one hand and flexed, as in Fig.
64. The free hand is introduced under the patient, grasping
the lower part of the spine and manipulating it as the knees are
made to describe a circle. This is a very thorough method
of manipulating the lower dorsal and lumbar regions of the spine.
64. The patient lies on the back.
The knees are flexed on the thighs and the thighs are brought forcibly
against the abdomen. The pressure may be relaxed, then increased.
This movement relaxes the ligaments and muscles of the lumbar and
sacro-iliac regions. See Fig.
65. The fifth lumbar vertebra is frequently
found posterior. With the patient on his back, the clinched fist
of the operator is placed under the vertebrae and one limb at a time is
taken by the ankle and forcibly put through the motion of external circumduction,
straightening the limb out with considerable force, thus bringing the weight
of the body on the vertebra.
66. In case the fifth lumbar vertebra is
anterior the lesion is more difficult to reduce. The ligaments
may be loosened, as in Nos. 63 and 64, and the vertebra moved from
side to side, as in Nos. 35 and 57, thus gradually bringing it into
its proper position.
67. In case we desire strong inhibition,
for the purpose of lessening the number of nerve impulses passing
from any section of the cord to any given organs, we may hold the
spine with a strong grip, partially lifting the body from the table,
as in Fig. 32; or we may place
a book under the spine, requesting the patient to recline heavily
upon it, as in Fig. 66.
The position of the book, as indicated in the cut, is for the purpose
of quieting the peristaltic action of the bowels in cases of excessive
68. When the sacrum is found to be posterior
it may be moved to its proper position in many cases by properly
relaxing the sacroiliac ligaments as in Nos. 47, 51, 52, 64.
Then have the patient lie on the side of the table. The operator
then places his knee against the sacrum and pulls back on the hip
and shoulder, thus gradually forcing the sacrum into position.
See Fig. 67.
69. Another movement for restoring to its
proper position a posterior sacrum is for the patient to sit on
a stool. The operator places his knee against the sacrum,
and holding the patient about the body rotates it as he pulls it
backward, thus bringing pressure to bear on the sacrum. See
70. The coccyx is frequently misplaced.
It can be manipulated after relaxing the tissues about it. Frequently
it is found necessary to insert the forefinger into the rectum, when the
coccyx may be grasped by the thumb and finger and moved in the desired
direction. This latter treatment should not be given oftener than
once per week, and must be carefully done for fear of injuring the delicate
71. The finger, anointed with vaseline, is inserted
into the rectum for various purposes by the Osteopath. In doing so,
time must be given for the sphincter muscle to relax. In piles, the
finger presses the blood out of the congested veins, and with a circular,
sweeping motion with the palm of the finger smooths out, frees and stimulates
the action of nerves and blood vessels. In case the rectum is prolapsed
it may be pushed up into position.
72. The clavicle, or collar bone, is frequently
found displaced. The sternal end, when out of position, affects
the tissues of the throat and is a prominent factor in diseases
affecting this region, including goiter and circulatory and nerve
disturbances in the arms. The operator stands at the side
of the table and takes the elbow of the patient, who is reclining,
and inserts the fingers of the other hand under and above the clavicle,
near the sternal end. The elbow is now brought over the breast
of the patient and the fingers inserted more deeply under the clavical.
This movement brings heavy pressure onto the fingers by the clavical,
which results in raising the latter, when the sternal end can be
placed in or toward its normal position. See Fig.
70. This treatment may be applied at either end of the
clavicle as the case may require.
73. The clavicle may also be raised and
placed in its normal position with the patient sitting, as in Fig.
71. The elbow is grasped and raised, which raises the
clavicle, when the thumb may be inserted above and under it.
By bringing the elbow upward and across the chest the clavicular
ligaments may be stretched and the clavicle properly replaced.
This treatment is effective for either end of the clavicle.
In treating the thorax we must remember that the
ribs are connected with the vertebrae, and that when the spine has a curvature,
or one or more vertebrae are twisted or displaced in any manner, the ribs
connected with those vertebrae are very frequently misplaced as a result.
These combined lesions cause secondary lesions of the muscles, ligaments
and cartilages. In correcting any maladjustment of the ribs advantage
is taken of the muscles attached to them, especially the pectoral and latissimus
74. The vertebral end, or head of the rib, is
nearly a fixed point. Pressure exerted at the angle of the rib tends
to move the rib about that fixed point. This movement is made more
effective by the forcible elevation of the arm and in some cases by the
rotation of the shoulder.
75. The first rib is often raised near
the sternal end. It may be depressed after the scaleni, the
muscles of the neck, are thoroughly loosened. It may be depressed
by pressure as the operator stands behind the sitting patient, as
in Fig. 4. The head is bent
forward and rotated, as in the cut. This stretches the scaleni muscles
attached to the rib. The pressure is still applied as the
head is turned toward the rib.
76. The first rib may be also corrected
as the patient is in the recumbent position, as in Fig.
72. The head is raised and rotated away from the rib,
while the pressure is applied to the rib. Later the head is
rotated toward the rib as the pressure is again applied.
77. A further treatment for the first rib
is applied as the patient is in the recumbent position, as in Fig.
72. With the head turned toward the affected rib and slightly
elevated, pressure is made on the rib with the thumb, and the elbow
on the same side is grasped and carried across the chest to the
78. When the first or second rib is displaced
downward it can be raised; the patient sitting, the operator standing behind.
The operator places the tips of the fingers at the lower border of the
rib and lifts on it as he rotates the head, with the free hand, forward
and then strongly backward. This uses the neck muscles, the scaleni,
to pull the rib upward. Should the anterior cartilages protrude they
may be pressed into position as the above treatment is being given.
79. Should the first and second ribs need
elevating, nearer the spine, the operator may stand in front of
the sitting patient while he presses and lifts up near the head
of these ribs, while he rotates the head forward and to the opposite
side with considerable force. See Fig.
80. The first rib may be depressed, with
the operator sitting at the side of the patient with the patient's
arm across the operator's shoulder. This elevates the structures
oil that side. Pressure is now made on the upper border of
the rib, just above the clavicle, as the head is rotated to that
side and forward. See Fig.
81. The practitioner stands in front of
the sitting patient. One arm reaches around the patient, a
little past the spine to the angle of the ribs, as in Fig.
47, while the arm of the patient is raised on the same side.
The arm is stretched up and rotated back and down while the operator
lifts on the angle of the rib. This serves to lift the rib
in front as well as at the angle, because of the traction exerted
on the pectoral muscles in front by the elevation of the arm.
This motion should be carefully executed, yet sufficient strength
should be used to make it effective. It may be repeated several
times if necessary. The hand which holds the ribs may select
one after another, as may be necessary, as the arm is stretched
and rotated. In giving the above treatment the muscles, nerves,
and ligaments are strengthened and toned. If one rib is very
much lower than it should be the patient should take a full breath
when the rib is pulled up, and as the breath is expelled the rib
is still held for a few seconds.
46 represents another method of elevating and separating ribs.
The patient sits and the operator stands in front. The operator
forces the spine to the side in question, which helps to separate
the ribs. The arm of the patient is raised by the wrist on
that side, which raises the ribs. A combination of 81
and 82 is frequently effective.
83. The patient sitting and the arm of
the patient across the shoulder of the operator, as in Fig.
75. This gives more of a hold on the lower rib while the
patient's head is bent away from the side being treated, curving
the spine and throwing the rib more into relief.
84. The patient sits on a stool and the
operator stands behind, with his knee against the angle of the rib.
With one hand the operator elevates and rotates the arm of the patient,
and with the fingers of the other hand, beneath the rib in front,
lifts upon it as the patient takes a deep breath. The entire
treatment may be reversed and the rib depressed. See
85. The patient is sitting. The operator
standing in front grasps the head of the rib in question, with one hand
passed about the patient, while the other hand presses on the sternal end
of the rib. By rotating the body of the patient the rib may be sprung
86. The patient is reclining on the back.
The operator, standing to one side, reaches over and takes the arm
of the patient on the other side. With the free hand he takes
the rib at or near the angle, as in Fig.
62, and as he pushes it into place he lifts up on the outstretched
arm and rotates it backward. This calls into play the anterior
muscles attached to the rib or ribs and assists in the movement.
The patient may further assist the operator by taking a deep, full
breath as the rib is lifted up, which the operator holds for a few
seconds as the breath is exhaled.
87. The patient may lie on the side.
The operator uses the same general movements as in No. 86.
This of course applies more to the upper ribs.
88. As the patient lies in the prone position
the heads or angles of the ribs may be replaced, as in Figs.
76, 50, 51,
by working directly over them.
89. When the patient lies in the prone position
many cases of luxated ribs may be treated by pressure of the thumbs against
the angles of the ribs, throwing the ribs either upward or downward, as
indicated by the needs of the condition.
THE ELEVENTH AND TWELFTH
90. These ribs are very frequently found displaced.
The surrounding tissues must be fully relaxed. When the rib or ribs
are displaced upward we have the patient lie on the side, with the limbs
flexed on the abdomen, when the ribs may be grasped by the operator and
pushed into position, forcing them upward.
91. The patient sits on the side of the table,
while the operator holds each end of the rib. The patient takes a
full breath, and as the patient exhales, the rib is pushed into position.
92. When the rib is displaced upwards the patient
takes either position, lying on the side or sitting, and the rib is manipulated,
as in Nos. 90 and 92, only in the opposite direction.
93. Frequently we find the ribs flattened
over the liver or stomach. They may be pulled out, as in Fig.
77. Then they may be rounded into shape by using pressure
on the ribs at the sides, as in Fig.
78. Repeated treatment in this manner will materially
affect their shape. In treating and manipulating affected
ribs or misplaced ribs we find it necessary to repeat the treatment.
In some cases it takes considerable time, a number of treatments
being necessary for permanent results. The ribs are so prone
to slip back into their old positions when they have been out of
position for a long time.
The Osteopath in examining the abdomen uses inspection,
percussion and palpation. The latter conveys the most information
concerning the condition of this important region and its contents.
We note displacements of various organs, new growths, tumors, relaxed or
tense conditions of the muscles, differences in temperature, enlarged or
pulsating vessels, muscular contractions, distended or contracted walls,
94. A general treatment of the abdomen
is frequently very helpful, either for relaxing or toning muscular
tissues, for increasing or decreasing the amount of blood in the
abdominal vessels, and for its general effect on the nerves.
The patient lies on the back, with the knees flexed. The operator
stands at one side of the table, and with the palm of the hand,
not the tips of the fingers, relaxes the muscles of the abdomen.
The operator may begin low down to one side and work up on that
side, then on the other side in the same manner. The ribs
may be slightly sprung inward to assist in the relaxation of the
abdominal walls as they are undergoing manipulation, as in Fig.
79, which shows the general position of the hands. The
abdomen may be spanned by the hands, with the thumbs on one side
and the finger tips on the other side, and the abdominal contents
moved in this manner from one side to the other.
95. In treating any part of the body, but
especially the abdomen, the hands should be of such a temperature
as not to be disagreeable to the patient. Cold hands used
here will cause a contraction of the tissues, and thus interfere
with the work. Direct pressure may be made with the flat of
the hand, as in Fig. 80, over
the center of the abdomen well below the umbilicus. Pressure
may be gradually increased, with some side pressure to force the
contents of the small intestine toward the caecum, the lower part
of the large intestine which lies low down on the right side.
96. It is often advantageous to lift up
the intestines, as in Fig. 81.
With the patient reclining, the knees should be flexed to allow
of more thorough relaxation of the abdominal muscles. This
movement should be repeated several times and the abdominal contents
held for a minute or so each time.
97. The patient is sitting, and the operator
is standing behind. He places the sides of the palms of the
hands deeply beneath the abdominal contents, as in Fig.
82. The patient is requested to bend forward as the operator
twists his wrists, so that the sides of the hand next to the patient
are turned inward and upward. Then request the patient to
straighten up as the operator lifts the contents, and holds for
98. The patient lies on the side, permitting
a relaxed condition of the abdominal walls. The operator stands
behind, as in Fig. 83, and
lifts the abdominal contents upward, and may also lift them toward
the median line, thus straightening out the caecum, or sigmoid flexure,
as the position may allow.
99. The operator may straighten out the sigmoid,
and at the same time tone up the muscular tissues, by insinuating the palms
of the hands deeply and low down on the left of the abdomen, and suddenly
lifting the contents. The movement must be carefully and cautiously
100. It is often of advantage, as
will be indicated in various treatments, to tone up the solar plexus.
This may be done by deep steady pressure, with a slightly circular
motion just below the sternum. Pressure should be directed
backward and upward, as in Fig.
101. The liver, spleen, and stomach
and other upper abdominal viscera may be toned by placing one hand
on either side of the ribs, as in Fig.
85. Pressure, alternating with a few seconds of rest,
is made as indicated.
102. The liver and adjacent abdominal
viscera may be toned by alternating pressure and relaxation directly
over that organ, as indicated in Fig.
103. The gall bladder lies underneath
the anterior portion of the liver, just beneath the points of the ninth
and tenth ribs on the right side. The bile duct leaves it at this
point and proceeds to the duodenum, in the shape of a reversed letter "
S " when it enters that portion of the small intestine, about one and a
half inches below the umbilicus. In cases of gallstones, or inflammation
of the bladder or duct, we may assist nature in emptying the bladder and
pass stones along the duct by manipulation.
In the treatment of diseases peculiar to women, and
some diseases peculiar to men, lesions of the pelvis play a most important
part. One may never expect to effect a cure while these lesions are
permitted to remain. To remove them is of the greatest importance.
Pelvic lesions will also be considered here because they affect the limbs,
causing sciatica, paralysis, enlarged veins, errors in circulation, etc.
These lesions are often accompanied by spinal lesions, which also affect
the spine and through it other internal organs. The discovery of
these lesions requires considerable anatomical skill, and an attempt to
correct lesions here should only be made when the operator is absolutely
sure of his diagnosis.
The whole pelvis may be tipped backward, in which
case the superior posterior iliac spines will be found to be too prominent.
In case the whole pelvis is on a torsion, one side back, the other side
forward, one superior posterior iliac spine will be found prominent and
the other less prominent than normal. In case one side of the pelvis
is higher than the other, the superior posterior spine will be higher on
the high side. The limb on the high side will be shorter than the
limb on the low side. This may be determined by slightly manipulating
both limbs to relax all tissues, and then comparing the internal malleoli
of the tibia with each other. This may be done by placing them close
together. Another way is to have the patient hold a tape line between
the front teeth, and measure to the anterior superior spines of both ilia,
and also to each internal malleous of each tibia. In case the upper
portion of the pelvis has moved forward, the superior posterior iliac spines
will be found to be less prominent than in the normal pelvis.
In making the examination the operator will best
determine the condition by having the back bare. Great care must
be exercised in making the examination. The points of tenderness
in case of luxation will be found over the sacroiliac articulation, both
in the muscles and in the ligaments, interfering with nerves in the same
104. When the pelvis is tipped backward
patient sit on a stool or table. The operator stands behind
and places his knee against the upper part of the sacrum, while
he takes the patient beneath the arms and pulls upward and backward
on the trunk with a rotary motion to first one side and then the
other. The assistant sits in front and draws the pelvis forward.
See Fig. 42.
105. For backward tipping of the pelvis
the patient may recline on the table with the face down. With one
hand the operator makes pressure on the upper part of the pelvis, while
he lifts the limb on that side with considerable force. This treatment
is given first on one side then the other.
106. For a backward tipping of the
pelvis the patient lies on the side on the table. The operator
stands behind. 'The knee is placed firmly against the sacrum,
and the shoulder and the leg are both drawn backward. This
forces the pelvis forward. See Fig.
107. When the pelvis is tipped forward
the patient may lie on the side. The operator stands behind, and
as he presses against the lower part of the sacrum and pelvis with one
hand he pulls back with the other hand from the upper part of the front
of the pelvis, the anterior superior spine of the ilium.
108. The patient sits on a stool, while
the operator stands in front. The assistant is stationed behind the
patient and holds the pelvis in front and draws it backward, while the
operator with his arms under those of the patient manipulates the body
of the patient forward with a lifting, rotary motion.
109. Should the pelvis tip upward on one
side, the quadratus lumborum muscle may be stretched, as in Figs.
59, 60, 61.
Then No. 108 may be applied, with the assistant holding down the
high side of the pelvis.
We frequently have lesions which affect only one
side of the pelvis. We often find one of the innominates backward
and downward at the same time; again one will be upward and forward.
The former will lengthen the limb on the same side, the latter will shorten
it. These lesions are the most common, but we may find their exact
reverse. We may find both innominates luxated in different ways or
in similar ways at the same time.
In order to determine these lesions we must dependon
the position of the posterior superior iliac spines as indicated in lesions
of the whole pelvis. We must compare the length of the limbs.
Make measurements between the coracoids of the scapulae and the anterior
superior spines of the ilium. Look for tension and tenderness in
the sacroiliac ligaments; also at the pubic symphysis.
Examine the lumbar region of the spine for curvature or torsion.
Compare the waist lines. We may measure also from the teeth
to ilium and to the internal malleoli. See Figs.
86 and 87.
110. When the innominate is luxated backward
have the patient lie on the back. The operator places his fist beneath
the posterior superior spine of the ilium. The other hand grasps
the ankle and flexes the limb on the patient's abdomen, when the limb is
rotated outward and downward with considerable force. In this manner
the weight of the patient helps to force the innominate into position.
111. The operator may grasp the crest
of the ilium, and also the tuberosity of the ischium, and by alternately
pushing on the one and pulling on other may set either a forward or backward
luxation. This is done with the patient either lying on the back
or on the side.
112. Combinations of the above movements, 110,
111, or the work used in correcting the whole pelvis, may be used in correcting
any lesion of an innominate.
The general treatment of the limbs may be modified
in various ways for the treatment of different and definite lesions.
113. The limb may have various tissues
relaxed preliminary to other work, by manipulating the various tissues
by seizing the limb in both hands, as in Fig.
88, and with a rotary movement of the hands move and relax all
the tissues to the bones.
114. Both internal and external rotation
and circumduction of the limb may be performed, flexing the calf
of the leg on the thigh and the thigh on the abdomen, then straightening
the limb out with the proper rotation, with more or less force.
See Fig. 89.
115. The sciatic nerve may be stretched
by extending the limb, as in Fig.
90, at the same time bearing down considerably on the foot.
116. The patient reclining, the
knee may be lightly flexed and the operator works under it with
both hands, stretching the muscles outward and working in quite
deeply. See Fig. 91.
117. The foot may be flexed, extended
and rotated with considerable force on the ankle. Ligaments
and other tissues are thus relaxed and the circulation is promoted.
See Fig. 92.
118. In treating the feet the arches
may be sprung to increase the arch, and pressure and traction may
also be applied to it. This relaxes ligaments, permits of
replacing misplaced small bones and tones up the muscular structures
of the foot. See Fig. 93.
119. The toes may be stretched and rotated
with force at the same time. In some cases they must be handled with
care. The treatment assists in the circulation by freeing all tissues,
nerves and blood vessels.
120. The saphenous opening, through which the
long saphenous vein passes, lies one or two inches below the lower end
of Poupart's ligament, on the inner side of the thigh. This opening
is often practically closed by tense muscles. It may be made free
by external and internal rotation of the limb, as in Fig.
89. Then the opening itself may be manipulated.
121. The extended limb may be seized by
the foot when the patient is in the reclining position, and turned
outward as far as is comfortable for the patient, then be allowed
to come to its normal position, See Fig.
94. This may be done, say ten times. Then it may
be turned inward the same number of times. This movement puts
the muscles on a strain by torsion, tones them up and assists in
Old subluxations cause considerable trouble.
A slight misplacement of the hip is often treated as disease of the knee,
neuritis, etc. These misplacements are not always discovered by the
ordinary physician, but when the real cause is removed the case is cured.
Reducing these luxations, when the case is an old one, requires a course
of treatment to relax all muscular tissues, to render the parts flexible
and the ligaments more pliable.
122. When we discover that the hip is
dislocated, with the head of the femur up and back on the dorsum
of the ilium, in which the limb is short and the toes turned inward,
we flex the knee and rotate it inward. This frees the head
of the femur. Then we rotate outward and make extension while
we press on the great trochanter to force the head into the acetabtilum.
See Fig. 95. This luxation
comprises one half of all hip dislocations.
123. The head of the femur is sometimes
down and back near the sciatic notch. This also shortens the
limb and turns the toes inward. The treatment is the same
as above, as one writer puts it, "bend up, turn in, roll out and
extend." Use one hand to manipulate the great trochanter.
See Fig. 95.
124. Sometimes there is a thyroid
dislocation of the hip, in which the head has been forced downward
into the obturator foramen. In this case the knee is flexed
and the toe points either inward or outward. To make the proper
reduction the leg is flexed on the thigh and the thigh on the pelvis.
The knee is rotated inward as far as possible, followed by extension.
Pressure is made at the same time to force the head of the bone
into its proper position. See Fig.
125. When the head of the femur is forward
and onto the pubis the toe turns outward. The head of the bone can
be felt and seen. Treat as in No. 124. Should this prove unsuccessful
place the patient on the side and draw the limb backward with considerable
force, stretching all the muscles about the head of the bone; then lift
the head over the pubis and place it in its proper position.
126. Ankle dislocations are reduced by
simple traction. The knee is flexed on the thigh, the thigh
on the pelvis. An assistant holds the knee and the operator
holds and pulls the foot, giving it at the same time a slight rocking
motion. See Fig. 96.
127. Dislocations of the knee are reduced by
strong traction. Pressure to force the tissues into place
may be made at the same time. The knee joint may be sprung
by placing arm under the knee and pressing down on foot. See
128. In treating the shoulder and
arm the shoulder may be rotated as in Fig.
57. The operator grasps it before and behind the shoulder.
129. The shoulder joint may be sprung,
as in Fig. 98. The forearm
of the operator is placed in the axilla, and the arm of the patient
pushed toward the side. This relaxes tissues and frees up
the circulation. It may be freed of adhesions and the circulation
promoted by seizing the wrist, bringing it back and up under axilla
and stretching out in front with force. See Figs.
130. The elbow may be flexed on
the same principle as indicated as in No. 129, by placing the clenched
fist of the operator on the patient's arm just above the elbow and
bending the arm upon the hand so placed. See Fig.
131. In some cases it is well to
work carefully down the arm, rotating the muscles on the bones and
working carefully on the forearm between the bones. See Figs.
103 and 104. Fig.
105 represents the stretching of the long head of the biceps,
after which the arm will be flexed and the tendon pressed into its
132. All dislocations of the shoulder
may be reduced by having the patient recline. The operator
places his stockinged foot in the axilla and makes strong traction
on the arm of the patient. The knee may be used instead of
the foot, as in Fig. 100.
133. In cases of elbow dislocations,
where both bones are displaced backwards or displaced externally
or internally, or the ulna is backwards, the operator places his
knee in front of the elbow joint, pressing against the ulna and
the radius with the knee and bends the forearm. This plan
uses the muscles to pull the bones into place. When the radius
is backward the above or simple pressure, with manipulation, may
be used. For forward dislocation bend the elbow over the knee.
Use extension and manipulation. See Fig.
134. The various wrist dislocations are
all reduced by traction. Some manipulations may be used.
135. Should the ulna be dislocated at
the wrist, pressure will be sufficient.
136. For the various dislocations of
the hand use pressure, traction and rotation.
In many cases of old dislocations a prolonged course
of treatment is necessary.
137. A table and stool are represented
in Fig. 102. The stool
is fourteen inches square on top and twenty-one inches high.
The table is a folding one with a steel frame and thin wood top.
It can be carried easily to the patient's home. One for regular
office use would be padded and more substantial in design.
The table represented in the cut is five feet and ten inches long,
and twenty inches wide and twenty-six inches high.
138. A General Treatment
is given by a great many Osteopaths in connection with the specific treatment
needed for the ailment for which the patient is being treated. General
treatment is an advantage in a number of cases. It is given for nerve
troubles and for the general circulation. The treatments will vary
greatly with different Osteopaths but the following is a sample:
139. The patient reclines on a table, lying
on his side. The Osteopath begins by loosening up the tissues of
the back, as indicated in Nos. 53, 56, 58. The shoulder is manipulated,
as in Nos. 54, 55, the lower limb as in No. 113. The spine is sprung
from one end to the other, as in No. 57. The patient then lies on the other
side and the treatment is given as before. The patient then takes
the reclining position, when further treatment is given the back as in
Nos. 47, 48, 50, 51, 52.
Afterward the patient lies on the back and the treatment
is commenced at the head, as in Nos. 14, 15.
The neck is treated as in Nos. 7B, 9, 10, 11, 13.
The arms are treated as in Nos. 130, 131.
Further treatment is given the back, and the ribs
are raised as in Nos. 61, 62, 86, 64. The abdomen is treated as in
Nos. 94, 95, 96, 100, 101, 102. The lower limbs are treated as in
Nos. 113, 114, 115, 116, 121. The patient now sits on the side of
the table and the back and spine are further treated as in Nos. 1, 2, 5,
34, 36, 37, 43, 44.
140. A treatment that has come into use,
recently among Osteopaths, is shown in Fig.
No. 108. It is spreading the ischia. It is used
in case of enlarged prostate gland. The founder of Osteopathy
claims that spreading these bones invariably helps this condition.
In sciatica, the pyrafomis muscle which crosses
the sciatic nerve is frequently contracted and causes pressure on
this nerve. This muscle may be stretched by forcibly carrying
one leg over the other as seen in figure No. 90B.
The muscles and other structures of the leg
may be stretched as indicated in figure No. 88A.
This movement helps to reduce contractions and assists circulation
in the lower limbs. The muscles in the anterior portion of
the leg may be stretched by extending the limb as in figure 89B
[Note: As there is no figure 89B in the original text, I assume
that he is referring to figure
89A - D. McMillin].
A good method of raising the ribs is illustrated
in figures 47A and 77A.
In the first mentioned illustration we see by holding and stretching
the arm upward we bring into play the pectoralis major and minor
muscles which help in raising the ribs. In figure 77A
it will be well to have the patient elevate his arms and while he
lowers them to spread and raise the ribs. This movement acts
in stretching the diaphragm which is attached to the ribs.
Another method is illustrated in figure 76A.
Figure 69A represents closing
and spreading the knees against resistance. In figure 29A
we have represented an abnormal spine. This patient suffered
a severe attack of typhoid fever, and was very badly constipated.
Notice the lateral swerve, but what is worse the anterior condition
of two lumbar vertebrae.
The spine, in its normal condition, is a chain of
flexible nature. It is formed of a number of bones called vertebrae,
from the Latin vertere, to turn. There are thirty-three of these
vertebrae, of which seven are in the cervical, or neck region, twelve are
in the dorsal region, which occupies the space from the neck to where the
small of the back begins, five are in the lumbar region, the small of the
back to the sacrum, five are in the sacral and four in the coccygeal region,
which is the coccyx. The twenty-four upper vertebrae should remain
separate and flexible through life. Those in the sacral and coccygeal
region, in the adult are firmly united and form two bones, the sacrum and
The spine has four normal curves, the cervical, dorsal,
lumbar, and pelvic. The first, or cervical, extends from the base
of the skull to the second dorsal vertebra. This curves inward.
The dorsal curve extends from the second dorsal vertebra to the first lumbar
vertebra. This is an outward curve. The lumbar curve extends
from the first lumbar to the sacrum. This curve is a forward one.
The sacral curve begins at the union of the last lumbar vertebra with the
sacrum and extends to the tip of the coccyx. This is an outward curve.
In very young children the cervical and lumbar curves are
absent, and when the child is sitting the spine presents only one curve from
the base of the skull to the end of the spine, and this curvature is an outward
one. The cervical and lumbar curves are called compensatory, and
develop a little later. The curves of the normal spine should be frequently
examined, until the operator has a good idea of the normal spine. He should
be acquainted with the normal flexibility of the spine as well.