Principles of Osteopathy
Dain L. Tasker, D. O.
CHAPTER XIV - Subluxations
Definition. - The word subluxation was so new, to
the general medical profession, that much ridicule was heaped upon the osteopaths
because they advocated such a ridiculous theory as that "all diseases are caused
by dislocation of bone." We are not so sure but that this ridicule was, to a
large extent, well merited by the osteopaths. The loose way in which the
words luxation, dislocation and subluxation are used in some of our literature
shows that they do not always cover a definite idea in the mind of the writer.
They can not be used interchangeably. The word subluxation should be used
to denote a definite condition. Subluxation is defined as a partial dislocation
in which the normal relations of the articulating surfaces are but slightly
Da Costa describes subluxation of the shoulder, also
of the head of the radius. For the latter condition he has collected
eight different explanations. We have not been able to find the term
used in reference to any other articulations. The osteopath uses
the term to define certain inequalities in the arrangement of vertebrae
and ribs, sacroiliac and other articulations. Perhaps we hear the
term used in connection with the atlas more than with any other bone.
Characteristics of Subluxation. - Subluxations
allow considerable movement in the articulation, but to the trained hand
there are evidences of malposition. Pain is developed when the complete
normal movement is attempted by the operator. Digital pressure
around the joint causes deep pain. There is usually a history of
accident, exposure or visceral disorder.
Primary or Secondary Lesions. - From experience
we know the frequency of very evident malpositions of vertebrae, commonly
spoken of as subluxations, and as being true or primary lesions causing
disordered function in the area of peripheral distribution of the nerves
from that segment of the spinal cord.
The Characteristic Structure of Joints. -
In order to get at a true understanding of what subluxation is, we must
make a careful study of the structures which form a joint and their vital
manifestations. The bones of the skeleton are bound together by ligaments
and muscles. The opposing surfaces of bones forming movable joints
are covered with cartilage. The muscles execute and the ligaments,
or soft parts around a joint, limit the motions of the articulation.
All movable articulations have their bony parts maintained in their normal
relations either by the form of the bones and cartilages attached to them
or by the equal tension of all the controlling muscles. Enarthrodial
joints have freest movements and yet are the least dependent on muscles
for retention of their normal position. Air pressure and the form
of the bones are responsible for the integrity of these joints. These
joints are less frequently subluxated than those possessing more limited
motion. Arthrodial joints depend upon the equal tension of their
governing muscles to keep the opposed surfaces in their proper relations.
Coordination of the muscular tension is usually so perfect that the joint
surfaces are perfectly opposed to each other. The disturbance of
this nicely balanced muscular tension results in the drawing of one or
both bony surfaces away from their true relations; not entirely, but sufficiently
to make it possible for the physician's fingers to note the change.
The Atlas. - The atlas is placed not only
first in the vertebral column, but also first in importance to the osteopath
on account of the great possibilities for slight displacement between it
and the occiput. All the conditions are present which make a very
movable joint and close at hand are important nerves and blood vessels
whose slightest maladjustment causes instant disturbance at the very fountains
of fife. No physical examination is considered complete without noting
accurately the position of the atlas. There being no spinous process
all reckoning must be made from the transverse processes.
Occipito-Atlantal Articulation. - According
to Gray's Anatomy: "The movements permitted in this joint are flexion and
extension, which give rise to the ordinary forward and backward nodding
of the head, besides slight lateral motion to one or the other side.
The Recti Laterales are mainly concerned in the slight lateral movement.
According to Cruveilhier there is a slight motion of rotation in the joint."
According to Gerrish:
"Some lateral gilding is also allowed, by which the
outer edge of the condyle on the one side is depressed and on the other
is elevated in relation to its socket. Or the movement may be obliquely
lateral, one condyle advancing slightly at the same time that it is depressed
toward the median line, while the opposite condyle takes the reverse position.
This is the position of greatest stability, and is assumed in the most
easy and natural attitudes. Lateral movements are restrained by the
check ligaments and tile lateral parts of the capsules. No true rotation
The capsular ligaments are very loose, hence the
strength of the joint lies in the anterior, posterior and lateral ligaments.
There is no cartilaginous disk between the atlas and occiput, hence motion
is limited only by the ligaments named.
If one should judge of the prevalence of dislocations
of the atlas by the number of times such a condition is mentioned in osteopathic
literature, we would draw the conclusion that everyone's atlas is dislocated.
The term dislocation is a strong one and ought not to be used in connection
with the atlas. Its dislocation would cause death instantly.
Subluxation is the proper term to use. Subluxations can be readily
diagnosed; the fact that they exist can not be doubted; all positions between
the normal relations and complete dislocation are possible. The complete
dislocation of this bone from the occiput means death; intermediate positions,
subluxations, mean irritation of nerves direct and both direct and indirect
disturbances of circulation; direct disturbance by pressure exerted on
arteries and veins, indirect disturbance by excitation of vasomotor nerves.
The Causes of Subluxations. - It is difficult
to account for these subluxations of the atlas without bringing in the
contraction of muscles. This seems to us to be the most prevalent
cause of misplacement of the atlas. Even though we recognize the
numberless jars, twists and strains of this articulation, still the resultant
bad effects are maintained by the unequal contraction of opposing groups
of muscles which is brought on by these accidents. Take, for instance,
the various twists of the atlas found by osteopathic methods of physical
diagnosis. Gray says: "The Recti Laterales are mainly concerned in
the slight lateral movements." This is the movement concerned in a lateral
subluxation. The position in which we usually find the atlas is an
oblique one, having the right transverse process hugging the angle of the
jaw while the left is too close to the mastoid process. Gerrish describes
this position as the "obliquely lateral," a normal movement. We also
consider it normal if it possesses the ability to slip back into a position
having similar relations on both sides. It is a subluxation when
it can not get out of that position without assistance. If there
is free movement in the occipito-atlantal articulation, every change of
the position of the head will change the relations in this joint.
Our bodies are constructed so that when the bones, forming a joint, are
moved to their fullest extent, pressure is usually exerted on the soft
tissues around the joint. This is normal, but when these normal relations
are retained too long and the bones do not resume their easy resting position
the condition becomes abnormal; it is then a subluxated joint.
There is no articulation in the body whose bony parts
are abnormally related when the extreme movement in the joint is made.
(We will except the sacroiliac articulation, because it is not ordinarily
considered a movable joint.) The subluxation consists in the relation of
the bony surfaces in a position other than that which they should hold
during relaxation or equal tension of all the muscles. The normal
position of the transverse processes of the atlas is pictured in Fig. 102.
The subluxations are pictured in Fig. 103.
Normal Relations of the Atlas. - The normal
relations of the atlas are illustrated by photographs of the skull and
first vertebra in Fig. 104. Fig. 105 shows an oblique side view.
In Fig. 106 the atlas is slightly twisted, so that the right transverse
process is posterior. This rear view shows the distance between the
left mastoid and left transverse process increased. The right transverse
process is prominent. The same relations viewed from below are shown
in Fig. 107. The right transverse process is slightly posterior to
Abnormal Positions of the Atlas. - Fig. 108
and Fig. 109 show side and lateral views of a twisted atlas. In preparing
these bones for photographing, it has been borne in mind that the articulating
surfaces must be kept in close apposition. The relations illustrated
are normal to the articulation, but abnormal when retained in these positions
after relaxation of opposing muscles.
The Effect of Muscle Contraction. - If, as
Cruveilhier says, there is a slight rotation in this joint and osteopathic
practice proves Cruveilhier's statement true, then what muscle could by
its persistent contraction cause this rotation to be maintained?
The Rectus Capitis Anticus Minor is so placed as to cause this movement.
It arises from the anterior surface of the lateral mass and root of transverse
process of the atlas, and passes obliquely upward and inward. It
is inserted into the basilar process of the occipital bone. This
muscle has as its external relation the superior cervical ganglion of the
sympathetic, and as a contracted muscle is thicker than an uncontracted
one, pressure may be exerted on this ganglion which may also be irritated
by the transverse process of the atlas being pulled toward it, thereby
lessening its normal space in more than one direction.
The reflexes originated by this irritation of the
superior cervical ganglion, or its connections, may initiate changes in
the caliber of the blood vessels of the brain, eyes or any other circulatory
area under control of the ganglion.
The Effect on Circulation. - The influence
exerted directly on circulation by the subluxation of the atlas is probably
most active where the vertebral arteries pass through the foramena in the
transverse processes. It might be argued against this view that nature
has not failed to provide a certain amount of elasticity in the artery
and surrounding structures to meet just such a condition. Nature
has certainly done this, but not with the idea in view that any such exaggerated
condition is to be maintained for any great length of time.
Effect on Superior Cervical Ganglion. - Subluxations
of the atlas are found in connection with a great number of disturbed areas,
but the condition in each is the same. For example, there is no difference
between a hyperaemia in the nasal, pharyngeal or laryngeal mucosa and a
congestion of the retina, except in location. We must not view the
phenomena of retinitis as especially different from those of laryngitis.
If we should do so, we fix our attention on symptoms and see a picture
which conceals causes. When the superior cervical ganglion has its
function of vaso-constriction inhibited by continued irritation, the work
of maintaining vascular tone is passed along to peripherally placed ganglia.
If the eyes are strained by overwork, the resistance of their nerves is
decreased. This, added to the weakened vaso-constrictor action of
the superior cervical ganglia, allows congestion, a retinitis. Wearing
high collars weakens the resistance of nerve endings in the skin of the
neck. This, added to low power in the ganglionic station, leads to
congestion in the pharynx or larynx. Treatment must be applied to
the structures around the ganglion, and peripheral nerve power increased
by gradually exposing the skin to the atmosphere.
Atlo-axial Articulation. - The articulation
between the atlas and axis is the most intricate in the whole spinal column,
consisting of four distinct joints. Rotation takes place between
these bones, but this motion is limited by the check ligaments. Dislocation
of the odontoid process causes instant death by pressure on the lower part
of the medulla oblongata. The articulations between the articular
processes of these bones are arthrodial. The articulation between
the odontoid process of the axis and anterior arch of the atlas holds the
bones firmly together. Most of the rotation in the cervical region
is in this joint. Although there is so much movement allowed by these
articulations, we seldom find the axis subluxated.
Unequal Development. - Deviation of the spine
of the axis from the median line is a frequent condition, but in the majority
of cases is its normal relation on account of uneven development.
Caries. - Hilton describes cases of disease
of the articulation between the atlas and axis, showing how destruction
of the transverse ligaments allows the head to tip. forward, thereby causing
the odontoid process to impale the medulla.
Dislocation. - We may safely say that dislocation
of the atlo-axial articulations is probably the rarest condition we will
ever meet. Various degrees of rotation may be met with which are
in the nature of subluxations due to muscular contractions.
Spontaneous Reduction. - Since the above paragraph
was written, an article in the Medical Record, March 3, 1900, has come
under my observation. The article is entitled "Spinal Fracture-Paraplegia."
The author, Dr. Robert Abbe, exhibits a radiograph illustrating a case
of dislocation of the neck. The dislocation is between the articular
processes of the atlas and axis. The most interesting feature of
the case is the spontaneous reduction of the dislocation while the patient
was asleep. The author thinks that the relaxation of sleep and the
restlessness of the patient combined to reduce it.
Cervical Vertebrae. - The remaining cervical
vertebrae are occasionally forced from their proper relations by violence.
Quite a number of cases are on record which show how great the disturbance
is in such conditions. Those cases recorded in medical literature
are complete dislocations, and hence can not be classed with subluxations
such as are met with in osteopathic practice. In order for complete
dislocation to take place, i. e., so that the articular processes are both
locked, the intervertebral disks would have to be torn and would probably
bring great pressure on the cord.
All grades of subluxation are found between cervical
vertebrae. Where the violence has not been sufficient to cause locking
of the articular processes, it has exaggerated the normal movement sufficiently
to injure the ligaments or muscles, which therefore maintain the subluxated
Disproportion Between Cause and Effect. -
We cannot estimate the extent of the systemic effects of a lesion in the
spine. What might appear to us to be a very' slight lesion might
be the cause of a very profound nervous disorder. The position of
the lesion is the chief means of estimating results.
Example. - To illustrate this point, we may
mention the case of Mr. Norton Russell. A lesion of the sixth cervical
vertebra was found. The vertebra was slightly twisted. Mr.
Russell had not slept during one hundred nights and days without the use
of sulphonol or morphine. The first osteopathic treatment applied
to the sixth cervical vertebra made it difficult for him to keep awake
until he reached his home and then he fell into a profound sleep.
There was a history of severe accident. Muscular contraction was
Unequal Development of Spinous Processes in Cervical
Vertebrae. - Fig. 110 illustrates the appearance of the posterior surfaces
of the cervical vertebrae, second to the seventh, when all the vertebrae
are in normal position, i. e., articular surfaces evenly opposed to each
other. The changing character of the spinous processes is readily
noted. Nearly all of these processes are unevenly developed, showing
that palpation of these prominent points can not help being unsatisfactory.
The tubercles on the back and outer surfaces of the inferior articular
processes present a much more uniform development and they can be easily
palpated after one has become accustomed to the feel of the cervical muscles.
Fig. III shows the third cervical subluxated to the right.
The tubercle on the left inferior articular process is made more prominent.
The muscles over this point will be found contracted.
Palpation of Dorsal Spinous Processes. - When
the spines of the dorsal vertebrae are palpated, the trained fingers may
find individual spines which are not in line with those above and below,
or that the spacings between the spines are not equal. The deviations
from the normal are indicative of changed relations between the vertebrae.
Normal Dorsal Movements. - The normal movements
in the dorsal region are flexion, extension and rotation. The lesions
in this region correspond with these movements.
False Lesions. - We must guard against being
misled by the deviations which we find, especially lateral ones.
Fig. 112 illustrates a decided lateral inclination of the third dorsal
spinous process. Such a deflection from the median line would be
noted by the unskilled touch of a layman. This deflection has no
diagnostic significance, unless there is pronounced sensitiveness around
it, and then it is the hyperaesthesia and not the osseous formation that
must be noted. A very skillful osteopathic diagnostician might be
misled by this lesion. There does not appear to be any way to protect
against a wrong interpretation in a case like this except the experience
of the physician in weighing all the evidence.
Lateral Subluxation. - Fig. 113 illustrates
a genuine lateral subluxation of a dorsal vertebra. The arrangement
of the Rotatores Spinae account for such a lesion as this. They arise
from the upper surfaces of the transverse processes and insert into the
laminae above. The subluxated vertebra in this group is the fifth.
The digitation of the Rotatores Spinae between the right transverse process
of the sixth and lamina of the fifth must contract in order to produce
this condition. This digitation may respond to a severe visceral
reflex and cause a stibluxation of this character. Direct violence
may cause it, also a cutaneous reflex initiated by temperature change in
Muscular Contraction. - Muscles contract as
a result of excessive straining or wrenching, or exposure to cold and of
reflex irritation. If opposing muscles under all conditions of temperature,
mechanical and reflex irritation would continue to exert equal influence
on a joint, then nothing but a complete dislocation would be possible.
A movable joint is enclosed in a synovial membrane which facilitates the
rapid return to a normal position. All the mechanical conditions
in and around a joint are conducive to the quick return to normal.
It is the vital and not the mechanical principle which keeps up a condition
of maladjustment. No intermediate position is possible, there being
no unevenness of surface to become locked, unless we take into consideration
the vital activity as manifested in a contracted muscle.
Comparison of Effects of Muscular Contraction.
- J. E. Stuart, D. O., has made an apt comparison between the pull of the
muscles of the back on the individual vertebrae and the well recognized
insufficiencies of the ocular muscles. All physicians recognize the
serious effects of long continued insufficiency of an ocular muscle, but
few, indeed, have given any thought to the possibility of a similar condition
affecting structures less movable, or less sensitive, than the eyeball.
The relation of a vertebra with its fellows is of great importance to the
delicate nervous tissue which it surrounds. It is not necessary for
a vertebra to press upon the spinal cord, or nerve fibers coming from or
going to it, in order to produce irritation. There is a nerve strain
in connection with these lesions which is not the result of direct pressure
but of the efforts of the central nervous system to balance and coordinate
the contraction of the muscles pulling on the vertebra. It is not
necessary for divergent or convergent squint to be so marked that the expression
of the eyes is instantly noted by all observers before any symptoms of
eye strain are felt by the patient. Neither is it necessary for a
vertebra to be dislocated in order to create a disturbance. It is
conceivable that a completely dislocated vertebra might, after a time,
cause as little irritation as an eyeball which is so divergent that no
effort is made to use binocular vision. The body becomes accommodated
to the change.
Separation of Spinous Processes. - Figs. 114
and 115 give two views of the fifth, sixth and seventh vertebrae, illustrating
the separation of the spines, as in extreme flexion. Note that the
superior articular facets are uncovered by the movement. The vertebrae
assume this position in kyphosis. We frequently find that there is
a gap between two spines while the spacing above and below is quite even.
Either the space, directly above or that below this gap is lessened.
Fig. 116 shows the spine of the fifth, sixth and seventh dorsal vertebrae
in the position of extreme extension. The spines crowd hard upon
each other. These illustrations all show normal positions, but they
are the ones which our fingers discover as lesions of the vertebrae.
Approximation of Spinous Processes. - When
two spines are closely approximated, as in Fig. 116, there is necessarily
a widening of the next space above or below, depending upon which vertebra
is affected. The contracted space will usually be sensitive to digital
pressure. There is a contractured condition of the muscles causing
this extreme movement of extension., This contracture disturbs the rhythm
of nerve: Impulses from that section of the spinal cord in closest relation
with the disturbed vertebra. There is lack of coordination of movement
in the affected joints. When several vertebrae are tightly bound
together a straight, non-flexible spinal column is the result. The
muscles are tightly contracted and more or less sensitive to digital pressure.
Primary Subluxations. - These conditions,
as here illustrated, are what osteopaths usually designate as spinal subluxations
which are causative factors in disease. They are sources of irritation
to the spinal nerves in direct central relation with them, and these nerves
convey disturbed or arythmical impulses to the viscera and blood vessels,
thus causing the various perversions of function which are recognized as
symptoms of disease.
Secondary Subluxations. - These lesions must
also be recognized as structural changes resulting from excessive irritation
to the peripheral end of sensory nerves, either those ending in skin and
subject to the temperature changes or those ending in the visceral muscosa
and subject to irritation from the presence of food of an indigestible
character, products of fermentation, etc. We must recognize the fact
that sensory nerves are subject to excessive stimulation in casts of gluttony
or masturbation. Both of these bad habits may result from the stimulation
of a spinal lesion, but experience with humanity teaches the physician
that mankind in general delights in gratifying the senses. We do
not wish to place spinal lesions at the bottom of man's moral weaknesses.
Limited Area for Lateral Subluxations. - Lateral
subluxations may exist as low as the tenth dorsal spine. The articular
processes of the eleventh and twelfth dorsal take on the character of the
lumbar, hence rotation is practically impossible There is a digitation
of the Rotatores Spinae between the eleventh and twelfth dorsal vertebrae.
Lower Dorsal Vertebrae. - Figs. 117 and 118
give a posterior and lateral view of the five lower dorsal vertebrae.
The changing characteristics of the spinous processes of these vertebrae
should be carefully noted, so that the student may not be misled as to
the significance of that which his palpation may discover. The eleventh
dorsal spine takes a horizontal direction, and in some cases this makes
either a very narrow space between it and the tenth or a very wide space
between it and the twelfth.
Dorso-Lumbar Articulation. - The junction
of the dorsal and lumbar regions is very flexible. A large portion
of flexion and extension of the spinal column is made in this articulation.
The most common condition noticeable in the lower dorsal region is increased
prominence of the spines, and incipient kyphosis. This condition
frequently affects the junction of the dorsal and lumbar regions.
Kyphosis - Lower Dorsal. - A slight kyphosis
in the lower dorsal region is indicative of loss of tone in the extensor
muscles governing the articular surfaces. The spines are separated
farther than normal and the inferior articulating surfaces are partly uncovered
by the superior ones. This weakened condition of the back may be
brought on by injury, or reflexes from the bowels or kidneys. Continual
vibration of the spinal column, as in cases of street car men, weaken the
back and then functional disturbances of the kidneys are noted.
Lumbar Region. - Figs. 119 and 120 illustrate
the lateral and posterior appearance of the normal lumbar vertebrae.
The spinous processes are easily palpated in this region. Their development
varies enormously in different individuals. The formation of the
articular processes prevents any rotation, hence we do not find any lateral
subluxations in this region. The position of individual vertebrae
is rarely affected. "Breaks," that is, separations of the spines,
are sometimes noted, but not often. Violence is the chief cause of
these separations. The muscles in this region are thick and powerful,
hence their influence is not exerted so much on individual vertebrae as
upon the whole series of vertebrae. Therefore we find curves instead
of subluxations in this region. Exaggeration of the normal movements
is responsible for kyphosis, lordosis or scoliosis. Extreme weariness,
as a result of maintaining a sitting or standing position, leads the individual
to shift the weight of the body so as to take some advantage of the ligaments
which limit a movement. The strength and flexibility of the lumbar
region is frequently a very good criterion of the patient's bodily vigor.
It is easier to affect this portion of the spinal column, by leverage movements,
than any other region.
Examination of the Ribs. - The position of
the ribs is always noted by the osteopathic physician. It is noted,
in medical textbooks on diagnosis, that the general conformation of the
thorax is indicative, to a variable degree, of either the past medical
history of the individual or is evidence of the present existence of predisposition
to certain diseases. A full, round, nonflexible chest denotes asthma
or emphysema; flat chest denotes tendency to tuberculosis, etc. These
statements are generalizations based on long observation, and are usually
very near the truth. The respiratory movements should be noted, whether
full and free, compared with the capacity of the thorax. The osteopathic
physician goes farther than these excellent generalizations in his diagnosis.
The relation and position of each individual rib are extremely important.
The condition of the whole thorax and its contents is dependent on the
relations of, the bones which form it. With this idea in mind, a
careful examination of each rib is made.
The ribs are, normally, quite movable. Their spinal
articulations are so arranged that an easy rise and fall of the shaft of
the rib is permitted. The rise and fall is the result of rotation
of the rib on an axis passing through the costo-central and costo-transverse
Costo-central Articulations. - The costo-central
articulations of the first, tenth, eleventh and twelfth ribs have no interarticular
ligament. The movement of the heads of these ribs is limited by the
capsular ligaments. The heads of all the other ribs are held in place
by interarticular ligaments attached to ridges on the heads of the ribs
and to the intervertebral disks.
Costo-transverse Articulations. - The tubercles
of the ribs articulate with the transverse processes of the vertebrae forming
arthrodial joints. The superior costo-transverse ligaments prevent
the dropping down of the costo-transverse articulation. There is
very limited gliding movement in this articulation. As before stated,
the movement in the costo-central and costo-transverse articulations is
rotary. The shaft of the rib lies obliquely downward, therefore the
rotation of the rib during inspiration turns the anterior extremity upward
and outward. The axis of the rotation through the costo-vertebral
articulations is obliquely downward, therefore the lateral position of
the shaft of the rib is elevated during inspiration and the lower border
is turned outward.
Coordination. - Fig. 121 illustrates the normal
obliquity of the fifth and sixth ribs. When the contraction of all
the muscles of respiration is properly coordinated, the intercostal spaces
are all equal in width. The respiratory rhythm should be equal in
all parts of the thorax.
Incoordination. - When through some nervous
reflex inspiration is made difficult, the inspiratory muscles expand the
thorax to its fullest extent and retain the expansion. Then the diameters
of the thorax are increased. This position of extreme inspiration
is typical of the asthmatic chest. There may be lack of coordination
of the muscles in any intercostal space. This incoordination may
be manifested by too much contraction or relaxation. The result is
a change in the normal width of an intercostal space.
Nervous Control of Respiration. - Respiration
is carried on by a complicated mechanism. Its chief center of normal
control is in the medulla, but subsidiary centers, in linear series, exist
in the spinal cord. Each spinal nerve which innervates intercostal
muscles, or other muscles of inspiration, arises from a subsidiary respiratory
center. One of these subsidiary centers may become too active or
passive as a result of local irritation, due to circulatory changes.
The muscles governed by this disturbed center will not act harmoniously,
hence the rhythmical movement of all the ribs is interfered with.
We have noted that spinal muscles contract unevenly
as a result of direct spinal injury, exposure of the skin over them to
cold, or from visceral reflexes. The respiratory muscles are subjected
to the same conditions. A lateral subluxation in the dorsal region
carries its articulated rib with it. Palpation will discover their changed
relations. A kyphosis in the dorsal region causes the ribs to rotate
upwards, thus increasing the diameters of the thorax. Lordosis in
this region has the opposite effect.
Costal Subluxations. - Figs. 122 and 123 illustrate
the changes in spacing of the ribs due to incoordination of muscular contraction.
These positions of the ribs are spoken of as costal subluxation.
In Fig. 122 the upper rib is rotated downward as a result of a contraction
of the intercostal muscles in the space below it, or the relaxation of
those above it. Palpation elicits
sensitiveness at the lower border of this fifth rib. The sensitiveness
is usually found where there is compression due to the dropping of the
rib and the contraction of the muscles. This rib might have become
displaced as a result of violence, or the patient might have been exposed
to cold air while sweaty, or some disease of another part of tile body
might have caused sufficient weakness to allow this rib to drop as a result
of pressure occasioned by the position in bed or otherwise.
Whatever the cause of these subluxations, they certainly
become sources of great irritation to the nervous system. Sometimes
the body becomes accommodated to these subluxations, but the fact that
cases of asthma have been cured after years of suffering, by reducing these
malpositions, is prima facie evidence that accommodation is something that
can not always be depended on. The heads of the second to ninth ribs
cannot be dislocated without rupture of the interarticular ligaments.
Considerable change in the position of the shaft of the rib occasions very
little change in the position of the head of the rib.
First Rib. - The first rib does not move in
the same manner as those below. The attachment of the scalenus anticus
keeps the shaft always raised. No matter how flat the remainder of
the thorax may be, the first rib stands out prominently. The chief
change in its position is due to the contraction of the scalenus anticus,
therefore it needs to be depressed rather than elevated.
Tenth Rib. - The head of the tenth rib is
articulated with the body of the tenth vertebra; there is no interarticular
ligament. This allows freer movement. Its anterior extremity
is insecurely articulated to the cartilage of the ninth rib. This
connection is frequently broken, thus making an added floating rib.
Eleventh and Twelfth Ribs. - The eleventh
and twelfth ribs are very loosely articulated to the vertebrae. They
have no costo-transverse ligaments, hence depend on the action of muscles
to hold them in place. They are frequently found rotated upward or
We have endeavored to show that the normal movements
of the ribs, as a whole, may become very abnormal when made individually,
or out of rhythm with each other. The depressions or elevations of
individual ribs have not dislocated their articulations; they have merely
carried and retained them in positions out of harmony with the remainder
of the ribs. They have become discordant members of a harmonious
body, and unless made to cooperate for the general welfare, they will rapidly
make other members inharmonious.
Effect of Position of Vertebrae on Position of
Ribs. - Lack of symmetry in the dorsal vertebrae causes a change in
the position of the ribs. Both conditions can be corrected by reduction
of the vertebral subluxations.
The Clavicles. - The clavicles may be elevated
or depressed by muscular contraction. Their depression affects the
vessels crossing the first rib and from the upper extremity. The
subclavius is responsible for the depression of the clavicle.
Summary. - Every individual has his or her
particular development. When examining patients this must be taken
into consideration. All subluxations must be judged according to
the condition of the reflexes along the nerve tracts which they might influence.
A subluxation is evidence of unequal activity of
opposing muscles, caused by twist, strain, fall, thermal change or reflex
irritation from viscera. It is an evidence of vital activity unevenly
manifested. The mechanical condition which we call a lesion, may
be only evidence of a lesion which lies in the excessively active muscle
or at some other point in close nervous connection.
A subluxation may be called a primary lesion when it results from accident.
It is secondary when due to reflex action. It is not always possible
to determine whether a lesion is primary or secondary, but in general it
is best to reduce them wherever found, if any disturbance can be traced
In rare instances one treatment has been found sufficient
to reduce a subluxation. The fact that the majority of cases must be treated
two or three months proves that they are not easily kept reduced.