Manual of Osteopathic Technique 1993

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Manual of OsteopathicTechnique

By: Alan Stoddard



MANUAL OF

Osteopathic Technique

ALAN STODDARDM.B, DO DPhysMcd

C/ultI Physica kledijnrk HopiU Lo

HUTNON MDL LON

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HUTCHINSON MEDICAL PUBICATIONS TD

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O N ENS

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RCIES OF OSTEOPATHC TECHIQUE

ing dg no Roron of mobiliY Rlxon of xnou uu v momn (uon)-nd dj mn D dmnS thrusts-Minimm fr

TE DIAGOSS OF E OSEOAHC SIAESIO

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3 ATAS OF TECHQUES

Arlo nq So nq S nq Croor r o or g um rgon l

4 THE ERVERTEBRA DISCS

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PREAE O THE SEOND EDTO

t s wth cosdrabl pasr ad ot a tt prd that wrt thsprfac to th scod dto of y aa h fact that thr s a dadfor th book shos thr s st d for a dscrpto of th apatvtchqs sd by ostopaths.

Oy a or pots hav b atrd th tchqs thsvsbt th thortca dscrpto of th so wrtt by r osa Brs

thrty yars ago has b ottd. as advsd by dca coags todo ths bcas so tt s ko abot th hstoogca ad orbdaatoy chags whch foo traa to spa jots ad th obsrvatos ad by Dr Brs r o aals. Sch chags do ot cssaryocr ha ss, ad orovr th chrooogca sqc of thoschags s bod to b faacos.

Th dscrpto of th ostopathc spa so haptr 2 s a dscrpto of a cca tty basd o obsrvato rathr tha o xpr

ta vdc ad thr s o dobt that th sydro s a raty hraso why I prfr to rta th spca ptht ostopathc for ths codto s that th ostopaths r th rst to attpt th dscrpto of thsv tty ad thy dsrv th crdt for ths t ght l b cald atra dragt of a vrtbra jot bt sch a tr s raly o bttrxcpt that t wod b or accptab to oppots of th ostopathccocpt.

Wh ad by what procss th ostopathc spa so rgs to th

dsc sydro s dbatab bt as say haptr 4 J bv that chatcds th advt of syptos dsc sos, ad sch procsss rtcos stdy Thos of s ho ar trstd th sbjct st kp or ysop for w owdg whatvr df t has ay barg o thsbjct

0 th at a dscrpto of tchqs of apuato whchhav b fod to hav practca va v thogh prcay prford, s dsrab t wod b odrf to b ab to pa xactywhat happs h a jot s apatd, but th dtas ay awaysra obscr f th tchqs do ork, as fact thy do sg thodsbasd o aatoca ad chacal cosdratos, w ar achvg orobjctv. f th practtor dvops a k ss of tss tso adpapato, ad ars to coordat th varos copots ayapato howvr sp, h w achv sccss May patts wb gratf ad provdd h dos ot orgt th cotra dcatos toapato h w ras th stats both of hsf ad of th art of

7



8 CE

apaton a a o I od or rg t pacttonr ot tococtrat cvy on t dta of tcq no to t orzo o t ng ad oatd pna ot, bt aay to bar n d

tat on jont t a part o t kta fraork o p to body t o an a to b adtd to ont



PREFACE TO H S D I TON

The purpose of this book is o set down and ilustrate the main tech

niques of mnpultion used n osteopathic pracice. here are numerousechniques d mny more of hem are i consa use hn 1 hve descibed, but have incuded ony those whch I personly have found to bemos e ecive he at of mapuaon is a very individul matter adcert techniques re more appoprite or some prctiones han ohes

he techiques my all hve o be modied to the needs of both pracitioner ad pie he deais of pocedue are clery somewht pesoalbu whe hese my vay between on practitioer nd another theuderlying method shoud be bsed upon he same prnciples Thesepiciples have eborted i he rst chpe bu the prcioe my

well nd th he hs to dap he er detis to himself d his paiethe reder w nd tht he principles of echniques here enuncaed esomewhat deetsubmi hat hey are bsed upo antomic nd mechicl cts and resuppored by the prcLicl expeience of may yers of ctive pactce nhe osteopthic ed.

he mnua is meely n outine nd is not an aempt to be comprehesive Nor is he book wrien just for begnnes and while t is pri

mrly diected to he osteophc studet nd graduate it is hoped hata practioers of whtever school of thought wil nd something of

vlue in is pges have written it for al hose who spre to peecion inthe art of mnipution nd lthough the oseopahc profession hascontibuted moe thn ny other o the elboration of techniques, theart o manpulLion is ot the sole perogtive of the osteopth Rther iis the prerogative of the ptient he pient has a right to expect highdegee of ski in those who puport to pctise mnipulatio t isdesiabe therefoe to dissemnte s widey as possibe the vableknowledge of this work so h the mxmum umbes of sueng

humity may derive beet. As far as I kow no purey oseophicechique extbook has been pubished in this couy hough severlexcelent ones hve been witen in Ameica

A geat deal more coud hve been written nd pobaby w be lae,on he wide aspects of Osteophy, but I hve restricted mysef pimaiyto pactical mers in this book

t must ot be thought howeve, tht becuse he maua is limiedto technique procedues tht oseopahc teatment s so mted The

underying prncpe of Osteopathy is that structure governs function that9



10 ECS

distbes o se i wteve tisse wii te body wi ed odistbes of fiog i tt stte d i of te ftioof te body s woe. Te obetive eefoe i e osteopi

ppo is te ompete estotio of te stt itegiy i te body.Tis ig im my ot be ieved b tt is te go d weve mese sed to estoe moios st itegtio tese f wiie mbi of oseopti ptie Witi is fmewok of osteoptitetme U ief gey is m miptio of oits bt so ofimpote e te impovemet of poste te eogeme of goodympti d veos dige e impoveme of te tei bood

ow e emov of mei obsttios by sgi mes if ees

sy te epositio of vise te se of exeises fo segeigmses o te stetig of otted tisses. e teme is tt give sty sod fmewok te bodiy ftios wi poeed moiosy d etiy e ebotio of ese osteopti mesesbeog te moe to texbook of iipes i Oseopty b seit ee st to emete some of te meods

e eiqes of mipio desibed ee e imited to teveteb om d pevis pty ode to keep te book witi

esobe imits b so bese te osteopti iee po te tof miptio is m moe sigit i spi t i ote oitmiptios-bt te ede ms ot ssme tt osteopti etmet is imied to te spie. vey oit evey tisse evey e i te bodyiees evey oe stte i tt body. Tee e stimtoy diibitoy tetmets to vise d soft (isses; etmet my be dietedto omizig te toomi evos system etig vi eomoio dvsomotio d so o Osteopti tetmet te s m wde

sigie t meey oit teiqes d eefoe tis m isb t sm pt of e ge sbe of Oseopty tsef.

ee e f mi setios to te book. e st pte des wite piipes of miptive teiqe te seod wi desiptio ofte osteopi spi esio is sigie i te ove ptte ofte oseopi oep of et d disese foowed by detiedot of e digosis of te osteopti spi esio. te tidseio e ief sbste of te m is to be fod. t is s ofteiqes wit istios det to te desiptios t ws togtdesibe to ge te me ts so s to mke te poede moeediy desood. t is otoiosy di to desibe te detis ofeiqe d wiot te ep of isios it is most impossibedey teiqes sod be demosted te t be ed bot beve wit e best tees i te wod extbooks e ivbe fo te

stde to dwe po d efe bk to time d gi wi be see tttee e tee sbdivisios i tis pte vi. sottisse eiqes



PREFACES

ctoy tchnqs d spcc tchqs d thy d whgoly so ht h tchnqs of ch go covn

sqnc fo chng d tmt pposs h n chp s dvotdo h mnpv chnqs whch ppcbl to h vos sgsof ntvtb dsc sons nd ths sco tco chnqs dscbd dt bcs thy ply sch mpon ol n h tmt of dsc sons.

Dng th ppon of hs mn I hv bn mch ndbdo my scty Gln Wgh fo h pskg d ptn typgnd ypng to my dogph Edh Kott fo h hp sh gv n

mkng th Xy lms o M A S fo h photogphy so mydght nd Ms B Sh fo bng sch xc mods, oDs. W gvWson B. Pnny d T fo dng ndccg th scp b mos of I hv bn dbtd to . AndwTyo Stl who 1874 sttd h st schoo Osophy Kksv Msso SA Wtho D S's ponng wok Ostophyth t of mpon wold nv hv chvd h pc of mponc whch t hods ody Stdy nd conosy snc thn hos

ds of osophs hv md t h f's wok o s hs mhod ofng h jd d h sck Som my hv fd mntbly hvng ndq kowdg of h smt hy w sg b thmjoty hv sccdd n dng nvlb svc o mknd nh ots to dvnc h t d scc of Ostopthy.

Th mdc pofsso hs ggd f bhd h ostophc pofsso dvopg d chg th t of mplto d hs sdyngctd th mchc css of dss d dsbly t s bcs

of ths ht spt schoo of hogh hd o b mtd n th pstnd st hs o b mtd; bt whn th mpotc of hsc fco hs bn fy cognd, d wh h mdc pofsson hs modd s hnkng on hs ns d ddd mchcdgmnts o th lst of oogc fcos dss thn th wno ong b ny d fo spt ogto nd h wod wl b hth nd hpp pc to v Aldy h cogon of h tvb dsc so by othodox mdc hs focsd tnon o th

spnl comn; ts oc d mo cs btt ndsood nd t sbng cognd ht hs sos cs dsbncs of h oomcvos sysm s osophs hv cmd fo mny ys. A p ths kn nd wkng ts mnpon d my docos yg dn chnqs whot sct kowldg nd whot pop nlyss of h on mchncs h chqs h ond h ocom of somthg k ghty ys of dvopmt mpon nd thfo wothy of h to of who ds to xc

n hs hod of pcc.



RCLE O OEOPAHC ECHQE

I

N Y we ae coceed with the etabihmet ad mai-eace o he orma uctual iegrty o the body ad o achieve

h ed we ue divee method hee mehod may be claied ithee goup

he techique o oi mapatio e the omaiaio omobiy ad poitio ad he elie o abomal teio i muceigamet capue ad aca.

2) aplative echque oher tha oit coectio diected o eample o impove cicuatio veou ad lymphaic dage the

epooig o vicea ad o tiue eatmet

3 Other mehod which have a heir aim he impovemet o eoa-io o omal mechaic i the body ch a the coeco opotue he rgical removal o abomal iue which ae impedigatue attempt a retug the body to oma ad eecie adacivitie which help o maita ad impove omal mechaic.

All hee come wihi he boade apec o the oteopathic appoachbu i thi boo we ae maly coceed with the t headg Let deal the with he prciple o he techique o oit maipulatio Ourimmediate pupoe i he etoatio o omal codiio the oit weae dealig with t i clealy ueceay o maipulate omal oithereoe beore decibig the detail o mapulaive techique it ieceay to kow ad udead what abomal tate i peet

H R RP, the i he kg f a dgns A the etabihmet o a diagoi i o paamout impotace I have devoeda whoe chape (Chaper to thi probem. it ae decibed echiqeo diagoimay mobty tetwhch ae o great vaue ad muo eceiy be ued pio to ay echque o mapulao

aivg at a diagoi o the oi aut we mut rt ecldepahoogca chage. ha i to ay we mu eclude thoe chage de todieae which lead to loca tructual ateaio i the vaiou com

poet o the oit; chage which may milead u ito thikig hat a



4 IILS TQ

impe oteopathic leion i peen I do not propoe to dea wih thedagnoi of pathoogy n on. For the peent our objecive thediagnoi of falty mechanic in the joint or goup of joint we are pe-ened wh and we are concerned with the maniplaion of oint whchthough fncioning poory ae ye not actually dieaed he fncion ofa oint movemen and it i ditubance of joint moblty whch command OUf atenon learly a joint may have reriction of movemen oi may have an abnormal range of movement i t may be hypomobleo i may be hyprmobil. Both of th at au diabiiy t a graror leer een

In hy/biit there ubjecve ine and oen pain paricualywhen he joint i fociby moved Such etrcion oen force adjacent joint to become hypermobJe to compenate and enable a full range ofmovemen o ke place n the area. he binati f h- an hebiit i te ine i ve n, and the lack of reaiaton of thimpotant diagnotic point a frequent cae of failure o acheve goodreut by manplaion It i o eay to retch the aleady freely mobileon wihout materally aecting he etriced joint. The tandad tech-nique of orhopaedic manipulation of the pine diegard thi type of cae.The method ed to fee he pine n every diection without he obecof enurng movement o the fll range in al the oint manpuated. Themehod may wok uie wel n ay a knee jont where ony one atculaion i nvolved but in he compicaed eie of oint in the pine hemehod i inadvable and may we be harmful by the very fact that thehypermobie jon ae forced til further ino a tate of hypemobilitywhie the hypomobile one may ail o yield All the kill and at of he

opeao i euied o ocalie he manipulative force to the one ontwhich equire the forced movemen whie proecting and prevenngundue movement in the hypemoble on. he derential diagnoi ofhyper and hypomoblity wi be diced length in he chaper ondiagnoi he method whereby force ae localized to one joint are de- cribed laer togeher wih deal of loaiing device o proect adjacen joint

Having ecluded pathological condion and etablhed a dagno

of hyper or hypomobiiy we mu acertain if there i any potiona change n cae malalignment i alo a facor in the faulty mechanic of he joint If the poitional relaonhip of adacen bone ae alered a wella the mobiiy hen we mut note i down and attempt laer to retore thenorma anatomical relation f thee are altered poiional elationhpand yet norma mobliy then the poition not of materia ignicancet i de o anomalou hape or oue hckening and we can ignorethem An atonihng amount of tme and dy ha been wated pon

the potional queton becaue th le ha been ignored Much of the



TE YERBE JT 5

oeopatc ad copactc lteaue aboud wt te dea of te boeout of pace ad aplao ave bee deved to epace te dplacedboe T a cocepo. Te faul a ot eo ot a boe leo.We ae 0 coced w, ay te 3d luba veteba be a fatypoto bt wt e 3dt luba jot wc ot ov popey

TE EN PNLE TE IQ o a at e si1 bii al ubequet teatet ubeve to tobecve A t te o of etcted oveet wc eed apulat al e folow pcple of ecque appea to te eaet ofypooblty, b befoe poceed to tee pcple let u code oe dea te queo of ypeoby.

Th H)rbi Ji

Te dao of ypeoblty et upo e te of pave ovee. Dclt ae edatey tat wat te oal obty a ve jot becaue te ae o pave oveet a ot a veydvdual ae deped upo te et ad elacy of e a·et of at peo Soe people ae atualy t ad oe ae double·

joede te ay people ve to dvdual wo ave eceve aeof ovee cea jot Te cld a a c eae ae ofovee ta te adul wo t a a eae ae ta e edelypeo. ae ay be leeed by eece, te eaably feeae of ovee cdood ca be ataed touot ade· cece ad eay fe by dlet daly eece deed to tetc aeT ow e acobac dace aceve uc wed ad wodefu

poo, ou c people ae bo wt lo ae aywayqualy o laet ay alowed o ote by actvy ad teavodace of eece. Ye we caot ay tat ete codo aboal Te ae of oveet eeally a dvdual atte adtee a wde ae of oalty o wde t ta t would be dcult oate wat te aveae oal ae fo a pacula ot te pe a c eae ae to copae te ae of adacet jot ad toobta a eeal pe of te oal obty of te dvdua we ae

dea wt. Te deee f oveet vae dee ecto of epe, bt vaao fay adua a e ove fo o eco oaoe o at ay poouced deece oblty of adacet veeba ot ca codeed aboal. A decpo of te oalovee of e pe ve te Apped

Te ypeoble o ut be codeed aboa we t ve eton figes igin te type of pa wc develop wete pat ude couou tetc. Te pa develop aduay ate

a oe pote wc te jot eld at te lt of t ae a



6 PRNCPLES ECNQE

f xmpl th pn wh dlps n th lmb spn th ptnths bn sttng ld p n n mh wtht ny sppt f thlmb spn h dlps n th spspns nd ntspns lg

mnts nd pssbly n th pst lngtdnl lgmnt f th spnnth mpl f lgmnts h s tht whh dlps n th plntfs nd lgmnts f th ft n 1st dg ps plns th ptnths bn stndng f lng tm Th h tnds t g whn th stths lsd thgh t my t sl hs f mplt st bf thshppns Lgmnts h s b dsbd s n md ntst tth typ f pan as by ahsins a ighe apses whh s thbss f 0st hypmblty. Th pn f dhsns s t n whn

th psl s stthd nd f dhsns stthd fth shppn nss lng th jnt nd sndng msls n lmp ndtn. Th ntnsty f th pn s dng t th st nd sz fdhsns, bt t s mmnty nd ls dll h whh slly gs n fw mnts. Th pn f tght psl s nt ntns !t jst htst stth th jnt bynd tn pnt nd nsntly th ptntds th pnfl ng

lty lgmnts th stthd tght ns s l tnd

nss nd wh thy ssbl t pss s f xmp th spspns lgmnts nd th pst sl lgmnts w h th dn f th st f sn ll lgmnts whn spnd g s tpn lly nd wh th lgmnts n th sf th dgnss s sy bt wth dp lgmnts th pn my b sgmntl n pttn fd pns whh n s dlty n dgnss lbl ntbtn t ths sbjt ws md by G . lthgh h fls t ds mnt btwn ld lgmnts nd tght ns is rita f

'lax igants :

( Pn llzd t th f th lgmnt( Th s ftn fd pn f ptl pn(3 Th pn s ggtd by tty whh pts stn n th lgmnt4) t st lf fm stn th pn s n lng psnt(5) Tndss n b ltd by pss th gmnt.(6 Th pn s pdd by nstn f ndl nd th njtn f

d nt th gmnt(7) Th dgnss s nmd by njtng n nstht sltn nt

th lgmnt nd blshng th pn

Th hypmbl jnt hs hd ts gmnts stthd ndly nt jstn f ths pds spn bt ptdly; th lgmnts lngnd w thn thy shld b nd thf n Iating sh j s:

I HK G MD., LRCS Joint Lgamet Relxatn (C. C Ths, 1956)



LAXAN 7

() th ttchig t b oidd Th hpobil joit tthfo ot b ipltd o h will i fo gtl co-tolld ttchig of ch joit bt litt i chid i thi w

d th bt ft lo Th ptit t b wd to oidot d ctiiti which ttch th joit fth

() Sppot t b gi to bl th ligt to gi thi oltgth Thi i low poc d of i oth of ppot.

() Th oth ppotg tcti pticl th cl whicho th ctd joitt b tgthd d gt cotolchid i doig ob tht th ot piil dgd o do.

(4) Th djct hpoobil joit t b dd o obil o tht

o ifo ditibto of ot i h c occtd of p ct of th ot i gop of th oitoccig i o oit d ol p ct i t djct joit thg bco ll diidd d p ct occ t ch joitTh thod whb th hpoobi joit c b ipltdwihot tiig th hpob joit dcibd lt h otopth c do thi i pctic h h idd chd hig dgof il i ipltio

(5) cloig id c b ijctd ito th lxd ligt t th dcibd b ctt

(6) Th tg of hpobilit i ittb dic io dicd ihpt 4.

I chiig th cod picipl of tchi which i th totioof obi i th hpoobil joit w t t x o ttch xtiictct Thi ld to th thid picipl of tchi

ID PINP NIQUE i raxa r srhg f xras strrs. cocd h pii wth thc which o th joit i lo Th cl ft ogd xl cotctd d bod th ptit cotol Th dgd xtt of ch gdig dpd po th dg of t d thct o choicit of th lio Th l thd whb cotctd cl c b cogd to x t d t th

ppo dibl bt l thod of o cti d xpditio

( ppoxitio of th oigi d to of th cl cobid withdp p o th bll of th cl I otopthic tiologth dp p i fd to hb d whi th i otifcto xpltio of wh it wo it i ctil ct wof lxig odtl cotctd cl Th p b pplid

B



18 PINIPLS NIQU

wi bs o of e d osdble prssr s o bsd d id d fls gdl exo of s. Serl pplos of pessr r sy rd or

or o is po o oee d ese pessregrdy o od rio of e se

2) Seprio of orgi d isro of sc cobied wikdg of sc blly rig gls o dircio of sl brs. Tis is of odry corcd scls ogsple sreig of e scle is ry eecie i cp seees corio of l

3 Trsrs frios Tis cqe s id e b y wll be

sfl i crolly orced broc scl

s rsoble iew odiio of e scle is los lwyssecodry o e se of e joi is fro e joi i is gesri rlge syoi ebres d psle e bolr ipses rise Tese plses rexly ie e o of escs w o ecd joi. Tr erfor i dired o sces oe wold be rely pliie b if rlxio o sclss cssry pior o corrcio of o obliy i fors

sseil sep Soeies sl codiio c b igoredsolsos re bl o spec plo lo i wic cse esls c b lf o ori sls Ts y wil do if or joi obiliy d posiio is rsored i c or sbc joi sios. cro lesios owee lsig cges y ocred esrrodig ses d specil eio y o be direced o scscls bfor wo lesioed r b osideed or Deisof re o sof isss re o b fod Cpr 3.

E OU PRNIP O -NQUE is e rsoro ofobiliy by pasive I'mS to nrinic trutures by slow dyicl ods rr srp qik oes s i sbsqeods. T obci r is o src ligs d psle of e oi d o src desos wc y b prs b wc oory fored o yid o sppig ciqs.

Tre srl wys i w ese pss os c bprfored

I ) sig log lergs ilo' of jos i osoprology dils of wi wl b fod i pr 3

(2) sig sor lergs.g pl or ps ciq gs siosprocesses o r djc eebre

3sg ssid ro Tis cq y ddiiol



SPF DJUSTNT 9

beide meely tetcig mely te eio o ticul ucewic y be imed d e wideig o iteetebl omi

4) Itemittet utied tcio Ti t objectie e me utied tctio but it i metod oe o moe cticl lueMy ime it i oible to gie itemittet utied tcio weutied tcio i mctcble.

Moe deil o cio will be oud i Cte 4

H rH PRP OF QU o te etotio omoblity te u o dr s djst wit te object o ele-g xtio i joi by uig log lee woig uo xed oto exmle uig e leege o te emu d teio tig mucleto moe te omite boe uo xed cum t te coilic joitTi meod omeime oduce udible clic t te joit but leequetly bequet metod.

PPL i i te ue o di s djsttwi te object o udde elee o joit xtio uig ot eege d

eeIocig o dcet joit te ccute oitioig o te tie duig ig elocity moemet o ot d oweul mlitude Tediectio o te moemet my be:

) Alog te le o te joit uc( A igt gle to e ot uce

ee moeet we e coceed wi te ig o deio

d te elee o xtio I ee i oitio ult uc elee omoeme uully ebe te oml eig oiio to be etoed

l V PRP OF HQU i te oe o sthrs uo oe eeb witout djcet locig wi te object olteig e etii o oe eteb wit te oe boe o below Timeod ued miy by e ciocic cool o miuio A igelocity ut i ieced git iou o tee oce wit ll

uoudig tiu exed te lie moig oe bic i colum obic wiout mig y o e ote o e ue o mme wi ot moemet d ecoil etg blow ited o il-diig' blow

I lyg tut we e to coide it diecto timig elocityd mlitude. e e to coide te oitio d elxtio o etiet We e to coide otectie deice to eue t te tutdoe ot go too d to oid te locig wic i ued i diect



20 PNCIPLES INIQU

pei oeent While thee i no oplete lokin, we eqie oedeee of tabiliaton. We t e the in of leeae in fat, theleeae of the pino poe o tanee poce we ae thtin ponWe t poition oele o that all lak i taken p befoe we appyhe tht We t nd o poition of tht and tik to it, aoidin thelihtet aiation while the tht i appied By takin p the lak Iean that the noal elatiity of the tie ha been abobed atheike ihtenin the y ope of a tent, to take p the ak in the ope heope i not by thi ean eeiey tait wold be poibe to tihtenthe ope till fthe bt the a ha been taken ot of it. he ae idea an be applied to a oint. t i tethed by poitionin the patiet o that a

liht feelin of tenion i peent, and yet with oe foe it i poible toteth the liaent fthe din the tht

In the tht tehniqe, we ae not onened with the beakin downof adheion, athe the eleae of atila ation hee i oethin

io abot an nteetebal oint it an e hithed a it wee fo noappaent eaon it an fee in faty poition then it an be liked andthe poition and oeent etoed 1 i dilt to beliee that thihithin' o bindin i de to adheionfo they ae not painl to

beak no an one eniae a ynoal fine ein into the oint o alooe body o any othe opletely atifatoy eplanaton

t a phenoenon wth whh all oteopath and hiopato aeabndantly failia. Ftheoe patient ae aely awae of a hithand ae iediately eieed by the anipation. It i not a painflanipUlaton when epetly done. How o why the oint et hithed i aytey It i of oe eay enoh to pop' a noal oint and weahiee nothn by doin it t i only whee thee i etition of oe

ent peent that poppin the oint ahiee any eltAdjuste manual ractn i a peial type of tehniqe whih i of

patia ale in heniated di bt t i alo of eat ae in beakindown aton in the onitdinal dietion of the pine ( hapte 4)

n etoin obility to a oint we ae onened not only withetoin atie oeent i.e with thoe oeent whih ae ndethe ontol of the patient own le, bt alo with aeoy oe-ent e with oeent whh ae not nde atie le ontol Fo

eaple a patient ay well be able to e, etend otate and idthi holde to the fl ane and yet the holde oeent ae painflbeae of liited ldin oeent p and down o fowad and bak-wad within the lenoid aity iilaly in the pine, a oint ay haeappaenty fl atie ane yet h beae of lonitdinal adheionwhih a only boken by adte anal taton. Aain in the elbow

MEfEL, ' JO;I Mapulatf Vo & A Chuhi d 952, p. 6.



RULES OF POCEDE 2

adhesions in the later ligment, ofen responsible for tennis elbow, cnony be released by adducting the elbow at the radio-humerl joint Adduc

tion at this joint is not under the control of the patient. Only by pssivetesting of the joints cn we obtin the information we need bout movements which re not under vountary control. The operator who wishes

to exce in manipulation must learn to detect these pssive rnges of

movement and be aware when they re normal or bnormal and he mustbe able to manipuate the oints to restore those movements.

We cnnot leve the question of principes of technique without indicating importnt aspects reltive to body stnce of both patient ndoperator, and 10 their relaation; to the rhythm of movement and to thetiming of specic manipulations

We might cal these rules of procedure.

(I) he part of the ptient being held should be hed rmly but not rudey

Gripping shoud be ight and the skin not screwed up or undulystretched by the gripping. he limb should be held as closely s possible

to the operator's body so that the limb of the ptient becomes temporarily prt of the operator as it were

2) Where possible, make use of the patients own weight to do the workof moving rather thn using the operators muscles. he patient'sweight must be carefuy poised ginst the operator's so that at allsteps of the manipuation the movemen s under full control To slipfrom ones blance is sign of faulty technique

(3) Obtain elaation in the ptient by suggestion, entreaty, distraction or

any other method so long s it is achieved he objectives in manipulting joints are lost by resistance on the part of the patient If the

condition s too pinfu or the patient too nervous to rela a generlanesthetic my be necessary but this is only rarely indicted In my ownpractice, I nd only about I per cent of pients require an n aestheticMuch resistance to mnipUtion rises from fer on the prt of theptient Very often this fear cn be overcome by gining the patientscondence. he tttude of condent ssurance helps enormousy andsuch condence s the opertor has in himself is imparted immeditelythere is contct between the opertor and the ptient it is a subtle

thing which the patient cn sense at once No amount of verbal ressurnce wil be eectiveoutcome of the tretment and it is virtuy impossibe for the opertor

to disguise his own itud here is something about physical contactof the operator nd the ptient which registers very uicky Thepatient knows' whether he can trust you the moment you put yourhands on him. his aspect of manipultion hs receivd scnt ttentionin the past It is surprising the dierence



22 PRINIPES OF TEIQUE

etween two oatos een tou tey ae aaently oin esae oeent

Wile an oeato is aniulain a atient e aien eels eessue o e oeato's ands entle and o ou and as osot and ay e atient senses te soo yt o te oeen ote jekiness o disconnected unuoseu aniuation e eels elocaiin eects o tension ceated y te osiionin o lis and etkin u' o lack eoe n djutie ont i don it w osilo an oea to aeciate wat e aient eels as a esult o isaniulaion te oeato would lean ey uickly te it and wonways o alyin teaten ut unotunately tis is iossie Teneaes aoac to tis eod o leanin ecnique is o ae a co-leaue as a atient wo will descie aiuly te eceiin end o teteaent

By continuous actice and tinkin ad ou e nes inote wods concenatin uon te sensaions o tissue ension osedo te neis and as in ontact wit te atien i is ossile toacuie an undestandin and wokin knowlede o at eusie uaityo te aniulatos skil tissu-nsion sns Tis sense is te oeatossixt sense and wiou it no oeato wil ee aciee a success inaniulaion

issuetension sense is not eely alation, ou a ily deeloedalatin sense is a eeuisite o tissuetension sense o aaioneely eels sationay tissue one liaent uscle, connectie issueascia a al o tese ae tei own uality eceied y alationalone ut tissue tension sense is te aeciation o te aoun o stetc is in oin tssues an inteetation o sc tension duin teocess o oeent in i joint o uscle t s dynaic ate tansatic

An undestandin o te condition in wic you nd a joint dendsuon isoytakin insection and aation o te joint osein eane o acie oeent ut aticulaly in sensin te estictions onassie oeentstis oseation is dendent uon e actitionesissuetension sense I a not ee eein o oss esictions o oe-ent wic ae oious o te eye ut ate te oe sutle esticionso ose oeents wic ae not noally unde te atients contol

Aain, issueension sense is o aaount iotance in eaenBy actice and eeience one deelos a sense o te aount o ocewic can saely e alied to any issue it is e disead o tissutensionsense o te asence o suc sense wic leads to te inexcusale colications o aniulation in ineeienced ands Tissuetension sense enaeste oeato to coose te ecise oen at wic te tust sould e



ilE MNMM SE O ORE 23

ppid nbls t prtr t rdnt t mpnn prs mnpln nd t md m nt smt rytm w s s

sy nlkr nd s s iv t ptnt.A kn isstnsn sns wil nb t prt mk all is

mvmns ppsl S tn mnpltin is rrid t n rl b bss r vn in pzd wy wit sp pps nvw S mnpl my b plsn ng t rv b t isvirly ws im

Prpr and iv manpan ris ntins ntinn t pat t prtr nd tat is wy it is s tirng patinsing p n mrly pysil nrgy in pplying t trtmnt b n- nrad mntal rt Prrming sris mvmnts in n misin wil ryng n n nimd nvrsn wt t ptin isrrly m v y ll mns lt t ptin alk i my lp m tl btr bt d nt yrs ttr awy nlss y r ntn was t ttmn tim

rytm and timing mnipltiv tnis imprant ndm prati sd b pmd in n ttmpt t btin smtnss rytm nd ry in timng Idlly t psiinng t pint ndprtr, king p slak, t prtiv grdng djan jintst mbinain in tnsi sidbnding and ttin nd tnl trs sld ll b dn in n y mvmn At rst ll ts sps tni wil v t b dn spraly nd prisly, bt witprt t wl may b smtd t nt n mnis mvmnT tni my b mprd wi driving r. T lrnr driv st prm al t mvmnts sprly wt individl tgt r tbrks lt, gas nd lrr nd t sltnt mi t ris rky nd nplsn bt pt drivr prrms all t pass in

nins min s t t gds way rm rst btiy n gdal alratin mtin t sisn nd mr ispssngrs

E EGHH PRL O EHQE is t w sld s mmm oc content wh achvng o objecte Tr is n pain skild spti ni r br r r sld b n ndr nd r i w btin rst ndn t n, nd tyis r r rlatin nd tn pply r r wtr it is in r

titin r trs in t prpr dirin Carl appitin tisprinipl wll sav t pan t nnssry rin a tramnt, nd will arn r prtinr t rpatin gnlnss nd skillw is s minnly dsirbl ll rnd. T id gntlnss n, s rid t r nd in tis s r mnipltins bm in ta and w may st s wll by t laying n ands' N"



24 RNIPLES NQ

dob hi h i pl b i o opy I rlio o bobid or y o l i i r r d mor dirbl o mi- dr hi h o hv o wr wih h pi I i h

o d or i ri whih bri miplo iodir. Wih hi prii o l ppl v moro b o h oml b o rt rm h ml



H E D I G N S S H E S E A T H CS I N A L E S N

! TEPT pnl ln ndn f mpd mby nn nbl jn n hh h my my n b d

pnl ln f djn b Whn ld pn pn y hn h nml ng f mmn n h jn.

Th mmn hn bl phlg hng k p n hn, b py ph n Smly hn hd pn h h l f n n ppn nng n ph ln dln, nd h d hmnng f h m.

h dnn h dlbly lmd b h h ndnhh pnd mnpn, nd h nmlzn f hh gh fy l. nd h h n f f h jnf mn f mmn. In h p hp h dh dl dn h nm ng f mmn n n nbl jn b h n nddl m b n mp md n h Appndx db h nd b h nmlmmn f h n f h pn I pnd l h hn f m nlly h mpn f dn jnmby Any n f h ng f mmnn, xnn,n, dbndngmy b d h my b mbnnf n

N h dnn d n h h lmn f mmn

d , xp h h mn n d d md mn njn xldng phlgy, n nly fm gh p lgmnnd f fm hnd ml fm dhn n- xpl) nd fm h -lld hhng f jn

h haraerss f h pn n p fm h d mmn nd bnm bny ln pn ndn, lng f ndng f (hgh h ly ppbl) ml nnnd n hng Th my b hyph nd mm hng n

h ld gmn 25



26 DIAGOSIS O S ESO

h ain f n ph ln m b ll fd. Pfl nd h f p h f dg f b mmm h f d pn h g f h l h pn

gl h h h hl hd h hn h h p f hng h dndb, f , b h h gn f p dpl d h llzn f p p nd gm n dbn W k fm h h f L nd Kllg . S193943 nd 47) h f n n dp g fml dbd nd gml llzd pn h phf m b fl h gn f h bl p p m b fd h dmm, lm mm

gmnll nd h h lFh ain ases in e muses ndg h W k h

h ml hh m n l d hn h nd. In dd kn h d n f ml lld nd n n h m d h ml f pd lk l d d P b L, . Med. 193249, 713). h p h ml I nl h mp nd h ln nd, hf, nl h

p, b mm f h ml b n pm f hml h d b d h. h ml h dd h p fm h n pn nd hld b nfd h Whh m h mnd d f plgd pdn hg k pl h h p f plm b nd h ml bm hd d g d d h h h d, gh l d hl d

hn h h an due die imnemen p h nbl fmn h pn fl n h db f h f, nd gmnl fd p N n nlkl h nmpd pnl l, hgh n b ld nl R m kl nplpd d d h l ppng, b m b mmbd hh p mpn f h nb fm h p fh pphl d p f h l l lng nd

d d h n p d h m b n p, l mpl Fhm h lg m d ln d h ppng [ h f d l, m bmmbd h h d b ngl mpn f h h nbl n, nd m f h fl n h pph ndpd f h d mp

h endeess f h ph pl ld n h pnp, ppn lgmn d h n p



DIITIO 27

St tndn f th bn pnt dl dt fndn f nttd l, pll whn h l lth tn p

h pphl d d t dp f V d tht b ppbl, xp h l gn wh h l p t p t pbl pp wl lg n th plf h pphl jnt h pl th nl wllg pb dtt n th l, nd h t t fl.

t dt Th n l ntnft th th pn ln Th l nd llth ll dp h th td ntpn nd ntn l nl wh pn n th n ttbl jnwl h pl pn pl l b nd ptnt t l h h p-k p fwhl gp th pn l, h nt tb h ptn l nt n d tpth pnl ln th th d d ppln ft phlg n th bn jnt

Ml ntt plpbl nd th t n b dnd b knwldg f th nt f th pl l, th whl f h bll l whll td h d w fl gp f b th d nd L whn h t nt hgn w t hn t, th l b fl lkd d hd nd lghtl nd

Th lld l tt th -lld bt fh phthpt lg nd th plpbl p l bd th ll dp n d th l lf A lwhh xl nntd wth th gn ld n dlp hgp f nttd l b, n th tpz f 3-4 . ln,p nd nf pt f 5 . l, gl x nd df LS l. tt h bt' l l b ht ndg, wtht dlng wth h flt jt g h, w ft; t l pd tp f d ht wh n h fth phthpt t wd bbg w b h l ntt wl l lx f t wh th hlp f h nd gbt t pl b th f th l tb kld St t t dl wth l ntt bht nd g t th th pp f th npUltn h td jt nll th bt l h dg hg tlf ht f th f tn d th l f f pn d . h d thn l t db tt th l b ll ft g d nttn wth n. It pbl l t b bhdl tbl



28 DAGNO O PA O

mtg the j flt whh t t mt the mle rrbl Bth mpe my he t be rete t bre he yle pmetly Where le$ he bee preet f yer the ge temle my be etblhe t they t be reere. t e wehe a tepth le w reqre mblg t teat eta m memet tere pbe t tp y frtereterrt the jt A hr tepth e, f trete wlllmt ery erg egeerte hge eetlly pyperee. b the l f memet eqet eee fb pply t the t repble fr the egeete hge.

e amus haes wh r the teph pl lemt epe p pt ftr f flty pt etbhe tme t me lgmet wll be permetly trethe me pemely rtee. gmet wee eer ege t te ttretg Whe tey e tey beme weer lge. e lgametfttey re t ppabe pr frm te prp lgmet thee we e they re lg a th the ypermble teerebrljt we they re t th e hypmble jt.

e sk hge rg te e epe mewt ttee r hrty. here ree wrmth peprt metme ypeetee t th te te le bt ter le tee hge e le b yperethee gg pemerely t tg.

e mtr ge bet be felt by g the ger erylgtly qly e the pete te bth frm be belw.he ger eperee ree f frt t the leel f the le. ehyperetee be etete by me f p te e eppprmtely wth the pterr prmry rm f the relte plee Ather efl tet tg t by me lwy pte te rlg tet e by pg p lmp f bte te well wy frm the e betwee the thmb exge rlg pw r wwr t the ee f te le At thtee the pet expeee ee f teere the btete we te tet pte pte f the tet t beg lwy

pte whe th ree teee preet t rrep rtelywt the ee f ther brml g efl rmt f teher g.

L N T L G A

() aum Lessa) Ate jt p

() jt prlly eel t a).



TOLOG I LESO S 29

(2) Compesalor Lsisn thee, he len mpeng fr ther jent n remte

en, nrmlly t wer levl. mpentn t hypmbly

hypermblty, tht the hypermble len nle here mpnn my be e the fly ptnng the vertebr nt bve tryngt revere the fty ptn f the ne blw. mpenry len mywell be ngle ne bt mre ten they re mltple n, n ,there re group len

(3) Grop LsiosVery fen we n ttenng r enn f he nrml rve f

the pne eg. thr lr n thr yph hee my bempentry ne bve bt yt they my be eel t nntl ngle tepth ln n gn they my re frm ptrlflt All h ptrl ft me ner he heng f grp len

4) Reexy Prdd Lionhee n re ee ntnt n repee bmbr

ment f he pnl egment lely nnete wth me ee v.

t h been repetely pne t by berver te he tepthh f thght (Mene ew) tht n ee f the her frempe here re tener re n the pper thr pne, r n gbler ee tener ple n the wer hr pne. hee tenerte re fn be enl lnlly wth the hrn trmt teph len. he vermt ree repnble nt nly fr pnn tenn n mle n the bmen r thr bt n he pne nprvertebrl mle. here n be n bt bt the etene f h

len whh pre ll gn n ymptm n the pne We, tepth wll g rher thn h n tte tht h len t reely n the revere wy tht bnrm mtver mple repre mh t the frther etrmen f the lrey ee vMe pnn veerng n th ren Smn Wrght tte

he hrp tntn whh mrly rwn beween thetnm n mt nerv ytem thgh efl fr prpef erptn, t nerble etent mleng. Aerent imp

fm somaic sucurs ma rey injunf the entr en f n r me nerve my reely e thehrt rte r bl prere nverely erent mple frm vermy nene he tvty f the ventrl hrn el Bth et f reltlre he phenmenn f rrtn

MACKENZI�" SR , ymptoms ai Ther nereQ (1920); LW. SRHO\A Pa 942

s AGRAV-, • Jal f merca eahc $oa 936 RG, ped Phyg (Oxford Med. Publicaton, 952 p 75



3 DIGNOSIS O SPIN ESION

he pesen nepn f he sepah spnal esn s well summaed by Wll Hay n hs lee he xpadng nep fOsepahy, Obe, 1955 He saes

he lesn s n meely a psnal dsbane f veebae beadjsed by an apppae mehanal pedue s an enypdued ad mananed n beng by a wde vaey f fas paaveebal sess, hypeably f spnal d ells, vsea ad hesses, and mena and emnal san al l f whh he panems ae n nsdean when pannng he ampagn f eamen

is he rei=i, a) h here re wie I-rie f fcrs,/r

e�'er pr he b n fr is eirel hich nribe he seig p f sephic spi esi; b) h he esi Jres i he fiii f ree er seges ) h_ hrghhe e f hese fciie seges, / perli�'elrs recelrie1l eh lher een fer he rigin srce f irriihs bee eiie; h hs e he sephic cOcep f he if isese, f he prn iprnce f he septhic spin esini he e"epe f isese prcesses f sephic s.e

echiqe i he isinegri f he iseseprcig pe

PES F ESIOS NIA

he sepah spnal les has been named and lassed n he pasadng fauly psn eg he exn lesn, he an sdebendng lesn he pse nnmnae, e cnsier h psiin

[s re f secr iprce h ee resricis re hei fere f he sephic esi and nseqenly have assedesns and named hem adng he ype f esn pesen n hen he de nmenlae efeed he exn lesn as ne n whhhe veeba was held n a elave psn f exn and hee waslmed exensn n he jn belw Suh a lesn nw we shuld all anxensn esed esn bee sll Bawad bendng esedlesn BBR.) (I wld ahe se he em bawad bendng han

exensn' bease f he nfusn ve he ems exn and exensnBy denn he em exensn means a sepaan f he pas whh ajn nes. n he eval aea hs wuld mean fwad bendng fhe head n he un ye ms peple all hs mvemn ex) Nwany all anges f mvemen may be esed s ha hee a hefllng ype f lesns

) Bawad bendng esed) Fwad bendng esed.

B B R.)FB.R)



A EO

Raio rrice o he ih or lef4 Siebei rerice o he rih or lef5 obie rericio

RRSR

3

Where here i a poiioal fau i aiio o a obili fau, wehou ecribe he poiio i uch a way a o avoi cofuio a oiply poiio rahe ha ovee. For exaple he 4h lubaverebra ay be ecribe a ile o he rih o le, ie bacwaror fowa, hife backwar or forwar a i poyloihei or iay be poerior rih or poerior ef The e poerior rfer ohe poiio o he ravee procee of oe veebra relaive o heaere proce of he verebra below f he ravere proce o oeie i poerior i ipie a poiio of roaio o he ih, bu i ieirable o avoi ui roaio i hi poiioal erioloy becaueroaio iplie ovee a o poiio

peviou oeopahic exboo here are ecribe ir eree aeco ere leio; a r eee leio bei o i which a verebrai r i a poiio of roaio a iebei o he ae ie heoaio of he verebral boy bei o he cocaviy of he curve; h

eco eree eio bei a xaio o a verebra where he roaio haoe o covexiy of he curve.

Thee ype of poiioal faul uoubely occur bu hey ar by oea ivariable Furheroe hey iply he cocepio ha he verebra ha bee ipac' io ha poiio, a ha uch poiio arehe reul of force aci upo he apophyeal joi. Whe exaiipie cliicaly a looi a X-ray of pie, I i ipoible o l he vaieie of aere poiio io hee caeorie, a while i i

uch eaier o call a leio a r eree leio ha i i o ecibe i ai le o he rih a poerior rih, I hik he laer ecripio i beerbcaue i eely ae he fac of he poiio, a oe o iply a precoceive iea o how he poiioal faul aoe

i y view ha o of he poiioa faul fou o occur are hereu of ieral rucural eraee wihi he ic ubace ielf;or ele he poiio i a poiioal copeaio o poiioal faul beowhere ae of coure poiioal faul ue o efec of he par ie

ariculae, a very arke il occu i ic heriaio a icproape

I will be ee fo he above ue of er I have rie o avoi cofuio. Oeopahic ieraue ha i he pa bee full of wor a ehavi pecia eai, a, alhouh failiar o he oeopah, have beeufailiar a ileai o he eica profeio. Thi i a piy aeceary becaue here are ucie coo or are eica woo ecribe all ha Oeopahy ha icovere A MacBrai ai:



2 DOSIS OF SI ESIO

The ler terinly in hich cn eical er arquie by the r tepathc, a in tpathic ein!!,"epathic pathly' an "tepathic iani an treatent

equre rientatin an explanatin fr te nt accue tthinkin tepathicaly The tepathic ter ave erve u ellin fcuin ur n huht but have ae t the cul fcunicatin th ther cienic rup They ay, in a nray, have eaye a braer unertanin an ceptance f urcntributin t eicine'

D E E T I L D O B K H E

The ubject f bakahe i ealt ih here nt ih he be fatteptin t be prehenive bu raher llurate the eh hihs ue in arrvin at a iani r i i tee t nt a etaleeipin f al the cniin in hch bakache i factr but a it rth en n ha the le n aue ae t fren nre

t i ur priary cncern hen a paien preent ith backache t akea iani ry by exclun pathica caue an hn e are aie n that cre, t ae a etaile iani f he echanical faut.

Cu o bh can braly be ivie int

General ieae in hich backache can ccur2 Referre backache fr viceral ieae.3 Dieae f the vertebral cun an nervu yt4 Mucular cnin

5 Mechanical faut ther than the ipe tepathic lein. Pychenic backache The tepathic lein.

Any acute feer can caue backache, t cn f cureinuena Backache ften perit ater he fever ha bie Thi aybe ue t ucuar txn fre urin he cure f the ieae r thebackache ay arie fr iaentu train thruh faulty pture in be

r a bay an atre r fr the l f ucular ne thruh inactivity r fr lcal eea f the ic fr reentin f intra-cel luarui

2 akahe an cal tenerne cnly arie urn the ure fertain vceral eae Th ha been el renie ince r aeackenie rte ptom hr tpto 92. e u

MACBRIN . oua o ' man eopa a (vb96



ERENTI IGNOSIS O BKHE 33

o so far as to say tat al l isease sos evience of spina joint irritabilityin e sements closely connecte reexly i te viscus involve bu eiseases most likey to ase backace are pleurisy, pepic ulceraion,kiny isease, pancreatitis colecystiis visceroptosis retroperitonalneoplasm aoric aneuisms, pelvic inammatory isease, terine misplacemens, prenancy Tou backace may be consierabe in ay of eabove conitions it is not ofen te presentin symptom. Te bakace isnot ell ene, nor is it relate to activity or posture an tere are nolalizin sins in te vertebral column Wen a patient presents itc backace it is especially important rst to exce visceral isease.

3 A i of iseases of te vertebral coumn an nervos system inic backace occurs is as follos: osteoartritis sponylitis ankylopoetica, primary an seconary neoplasms vertebral an sacroiliactuberclosis, osteomyeitis, Paets isease, osteoconritis, senie osteopoross an kyposis taes orsalis, syrinomyelia Friereick's ataiasubacue combine eeneration of te cor spinal cor tmous

Most of te above bone conitions are exclue by X-ray evienceTey mst alays be tout of because many are aneros contions of

te spine in ic manipulation is absoltely contra-inicate nfortnately early seconary carcinoma is not alays seen raioloical ly so tatit becomes especialy important to itol maniplation in sspectecarcioma o te breast tyroi prostate ln an stomac

n tuberclosis of te vertebral column even before a ibbs is present,te carefl practitioner ill immeiately sense sometin is serioslyron becuse of te intense localie mscle spasm an te constitutional sins Furter etails of ierential ianosis are obtainable in

stanar textbooks of ortopaeicsDiseases of te nervos system rarely present primarily it ackace

an ierential ianosis soul be straitforar.

4 M scular conitions Rareties like tricinosis an outy rematismmust be exclue bt laie brositic' musclar contractions aniname faty noules' are common sores of backace. Tey arerarely, oever, te basic case of te backace an are merey a mani

estation of eeper joint faults5 Mecanical falts oter tan te simple osteopatic lesin are

sponylolysis sponylolistesis scoliosis, kyposis lorosis, saypostre sort le conenia asymmetry an anomalies an te variosintervertebral isc lesions

All te above are emonstrable raioloically ecept te intervertebrais lesion. As tis is sc an important subjet an as ere ar specialosteopatic tecniqes appertainin, a separate capter is evote to tis

c



34 D AGNOS S O S A E S O

( Pychoic backach. Thi harly a parat ha. touht to b i vry a prit bcau th icic of pychooaticbackach i vry all i t i cutoary i cal practc to ay acoitio i fuctioal' wh o oraic bai ca b fou for th ypto coplai of Oriary curory xaiatio of th back w failto iicat th ourc of ay backach but thi i or oft h faultof th xar tha that of th pat Dtal aalyi of th p aiicat latr w otra ay chac faut whch ar apottial cau of backach hthrto Th bt iicatio of thpychoic backach i xcv ractio to th uual tt i th pi.

Wh all h abov cau of backach hav b xclu thrai a orou ubr of bckach which ar u o atroblity a poiio of th trvrtbra jot h ar th otopathi lio which ar cor luv by th ical profohy ar uiv bcau fw octor hav ak th troubl to xath pia colu with th car that t rv fw hav a kow ofth oral aatoy phyioloy chac a till fwr hav p thi cary to acuir th palpatory kil l cary to apprciat orcha i ucl liat to a joit obility. Th vrttyro ca iao a lar ovaria cyt a tablih carcioa of thbrat or a ra obar puoa but t ruir kill papatio awi xpric to iao alpti arly appicii a ary pialtubrculoi Siilarly it i ay ouh to ao a colio a aularkyphoi a paoic torticoi but i t ruir ki ll palpaio a wixpic to tct iiviual vrtbral joit xatio acr-ilac loa occpio-alatal io Ju bcau a w tu caot fl a ofta i th rht iiac foa it o ot a that th xprc uroi wro wh h ay h ca. Siiarly jut bcau a raw octor opial jot xaiatio caot fl rtric ib to th riht ith 34 . joit it o ot a that th otopah i wro wh hay tha h ca t ay b prfctly obviou to hi

D A G N O S O E D U E

arrivi at a iaoi of a chaical fault i th vrtbral couthr ar two ai avu op to u cliicaly that of pcto a thatof papaio. A abolut prru bfor ipctio a palpatioca b u itlitly i a viv al pcur of th aatoy of alltructur blow th k . hi tal pictur hou b carri th wholti i th i' y of th tut particularly whil palpati Hhou b abl o ay which tructur ar ur hi r i whchvr



DAG OS ROEDR E : A A O 5

p o boy i plpig, o rly big bl o o uur bu lo p irio o ruur. Sur

oy i lo ipo ubj o oop i i o uro H oul iliri il rply wi orl livgoy Hi gr oul b ri o pik up o y boliu oiio. i oly pi xpri w will u ipor ulii So o ipor lrk ou oy r l wi i Appix.

Ppio

Plpio quir vryig p o pur o rvl ll ioro vibl i giv r, , workig rul, vir prur pr ruur wi bo plpb, bu ligr plpio br, priulrly ro pi' poi o viw.My r o boy r orlly r o p plpio, yiu i r w pr r oug o o u o b ilio uig u b oig wrog r A uloprio, uig qul pru o bo i o boy, b rul o voi kig ik Tr i y or u o opio o w o xp y o w yr lookig or, bu i y b wiul ikig or l-pio I iy o pr rr o i you xp or w o r o lii i ro pi So u will ir ub ouul or plpio, or prp will ix or il gror iiv I i iiviul r i b ou by ril rror Ebli bi ik o i W ppig or ovbw j bo, ry rrg or wo boy poi o bovr by o gr o prio pproxiio i ilyl i o goo i o v o o gr o i ooo y ory iprio riv by bri kig i oriul o ipr your g vr plp ully wil ikigo oig Mk ur you r kig o u o iliprio big riv by your gr or ub i y o plpi lipo or uoi io , w iu plpio,

you v o or iorio bou your pi you bor Alwy y o yourl, W iorio obiig oplpig i ruuri i orl or owi?'

T liil ig obi ro ipio ppio r ivlubl o ll you or ril o pi ypoGiv xpri prior, i ig r o o rlibl pi' ioy. I i o vbl o bli ouio pyil xiio o ipo po r o i T



3 DIGN I P IN E O

or or squ o th xaao o ot att bu sou b astabs rou o that t s sabl o ssary aways o o aop xao of al struts th boy. uth s osab to hav a xb s sat say fo th a awo ow o tos saly w a pat os oplof p s b o s po o hav a ook a t b to st a t you k sar at th a work ow throuh you ow sh oxao

Futhr t s pota that xaatos ar out ar puposful tha s o say, a ta tst s s o v ta forao, tst shou b su as o lay th aoss a ot to ofus t Apysa s t shoul hav so a to t xa xa sou kow xaly wa h s tst fo a how to tprt abo pysal ss lts I t ary stas of aquaos skl t s ssay o put ow your s wr soly t xpoally xpr who a tt fauts olla t asyths th to a opsv aoss wthout t hp oror th o pap A xat trprtao o a phys ss

o possbl ou pst stat of kowl a whl t s parularlypota to o s whh hav a la a s stl worwhl ror aboral phys ss a sypos v thou yaot b ra to a s sp aoss t ay b ta oraos ss a syptos w l l o o lh atr a w ll xpl thprvously xpabl os

CO!ar eece of your palpaory s by X-rays sraba valuabl T typ of X-ray ls rqur r ar o th sa

vws o th staar tho thou ths ay b of o vau xlu ora sas. W wat t b Xralstak ful xo ful xtso a ful sb. s so takshoul b o t hooal posto baus w ar tst tpassv a of ovt a a ot Fquy t s usful to avbo oblty vws a orary owt-bar saa vws foropaso. Thr s so valu ak oby vws th vrtalwt-bar postos bu s ot asy o obta ar pturs a

suh X-ray s wl ot taly wth your al tsts w ar opassvly t horotal poso.vual oblty ls ar o ttl valu but f w xa latral

vws of th rva sp xo a xso, pla t sby s o t vw box w a opar t ras of ovtsW av vsual v of oby obaabl s jots seeFs 5 a 9 (pp 48 9 52 a 53

urt oatoy v of jot lsos abs of s

as a b obta by us of loal aasthsa By our stoy-tak



DGNO OE SPEO 7

an cinical obsrvaions o th join lsion w shoul b in a oo position to say ro which structur th patints pain is arisin whthr it isro liant scl bon carila or nrv. By th in tration o hpainul sit with a local anasthti w onr or rut our suppositionsan whr this tho is appliabl it can b an invaluabl ai oianosis

As pain arir prvious osopahic books an articls ontchniqu us a positional notation or th scription o osopahicspinl sions an thy hav bn na or apl ionsibninroation lsions F R bas it was onsir that th vtbra abovwas rlativly sibnt an rotat copar with th vrtbrablow Whil this syst has rit an has bn cllntly poun byH H Frytt in his book Pricip of sopahic Tchiqu, 195it has in y opinion th isavanta o phasizin th posiiona aulto th lsion whras h obi iy aul is th all-iportant on.

[lspio of h Pal

ilscs!o cHic l o assis il cariy i is assum Ihah pai is a 0al a h opao a a his abs h wi o lss o a opaor al hr a pail a so avoi Ih cosapiio of opro a pai is o cours not ipli that thopror is always al nor tha th patinis always al

h purpos o insption is to obtain a nral iprssion o th typo patint to b alt with an to assss hr chanial stat broaly.Gnra iprssions will otn a to aination in ratr tail ortain aras whic appar on nral inspction to b auty

Obsrv th patints postur in all h positions o aination notin any tnny o avoi wiht-barin or prssur notin th annrin which sh ovs ro on position o anothr. As th pain waks intoth roo on can sotis tll at a lanc or apl that th patintis surin ro pain in th riht lowr trity or whn a patint sisan avois prssur on on thih sustin snsitivity o th siatic nrvor hastrin uscls Havin takn a oprhnsiv history an obaina nral iprssion o th patint th nt stp is to ain th patintin th sadig posio ally th paint shoul rov all arns sothat nothin an ip th insption o al l parts o th boy but aconvnin arnt is on ivi at th back i an unti wthtaps.

In obsrvin h postur o th stanin paint w ar concrnwith h cntral ravity lin o th boytions o th boy ontoursabout th cntra ravity lin inicat th typ o postural aut which isprsnt



8 DIAGOI O INL LION

n gry l n p rg t p ndyl prt t rl bd tn g t bdy ntr gn t tr pn nd n rg t bdy L Wgt tn dddtrg w lg nd ntr gy n p pt t p jn nrr t t n nd nl jn nd nly p trgt gl-pd n

nml bln t mt b n l wg n rnt tn gry ln wl bnd f n mr rt mnltm t mmnt t ntrr ntr gty ln m mmnt t ptrr ntr grty ln

m wg dpd wd t nrl grty n xmpl xn t d wrd n t n r m b nq t bwd t t n d rrd xtly t bdy p rgd nd t d xd wd ntn rwrd mmn t bdy w nb d by rmr pr t t n t gnd Bdy wgtn b rd rwrd tt t ntr gry ln p nrr tglpd jnt b t n n y pn d

mlly nrl grty ln n b md t m bwrd bt n nrty bt t pn nd m r pd ngrd w t tr t ntr gty ln tw bn wd b lt nd nddl wld

Wn bln gd y mnnd b t pn ndnt w xmy bn dgnd mnn nrmr ptr wt nd mlr rt ntrr nd ptml r rdy t ntr ny t ntrl gry ln

b n t y t ptn t ptr ml r n n tt nn bn wn t b ng ltd n mlnd dng tr lr drg wt n ltrmygp

Arn nm nr-ptr bln r n n t mpn w \r g l n wy pt drng pgnny nd nt b lly ltn ld t n xggtn nmlr pn lmbr lrd r yp nd rllrd wt bwrd ttng t d. d

rn try n t jnt wr mxmm rg r g mb jnt L., nd p-tnljn

Bdy wgt mlry mt b qly ddd bwn t w gnd n t nrml ptr n q wgt pprtd by Q ndrb mgn rl t nl gy l n pb

JOSEPH, . and NIGHALE A., JOI"ol f Physilg (od 126 ( 8954 85: BAAA Y ad BTZO \ Sure GYacg b!C

Chicag 86 auary t) 66



) AGST P UE S PEO

bcu ch l can ta th h f th by iht t ny t. Aby iht i tnitt f n ft t th th, labt ucula

c-nti n blnc ut b pf t aiti quilibiuBy hiftin by iht lt ntily n t l n ti thili-tibil bn in th n f th nqui th plvi i all tp th th i tht iht itibuti i cplty lt, ltal cuv i ct in th ub pi t th ppt i f thiht-bi l a cpati cvxity t th a i hihup in th pin A hat iila pctu ccu in th Tnlbu tt, h th iht i tn th l ith cnitally i

lct hip n that i hn th utu iu i ply n th i th plvi int f ti ti up tit thiht-bai i. uch latal hif f pt f th by aay th cnta vity ln ut invitably hv th cptyhift t th ppit i i tht quilibiu i intin.

W g s ho th th th, vn if by ht i qullyh, it la t lta hift y f th cntal vity n t cpnt. th pint f vi f pnal chanic t i th cl bhich tt t f thi i hizntl thn th ll b ltcuv u cplicati fct i pnt bv It i pibl fxpl, f tticlli t cu a cuvtu thi h it cpati futh n, but t i uu f cpti t t pcbv f titin n f ltl hi bl. t ha bn hn I tht i i f y c f ptint pnti ith citi thth bacch p ct f th h inch f htnf n l but i a cncutiv i f patit ptin ithbacach p ct f th fu t hv inch htnif n l inicain that bacch i fquntly u t th tan ctby th plvic tit cnqunt ltti f th ctl vity lin t pnt f th ht l lttn ccu bv. h tcpnatin t plac in th cic jit n th ht i.ti thi i ucit n cal lv a n If th cil icjit cnnt cpnt uh thn th lub-cl jint th 45 .int ut v th a pup Occily th t jint cpnt nuh, but f than nt ual cptin ccuith uif cuvtu cnvx t th ht i th lub cnvx t th l i in th thacic pnatin y p f th cvic a n ccinlly t th ccipit-tlntl jit futh fc th ht l hpt h Plv, p.

tl yty y ccu in cbitin ith t-ptiyty pci viu cbitin li yph-clii.

STODDRD A., "he Short Leg and Lw Backace Syndome' Pa peened ate Ineioal Coness of Pyca Medne, 15



4 D I A G O S S O F S A S O

W ispti t spi, su ltr sis ust b bsrv rr i t rri t , t sulr lvls spulrlvls lvls t t rsts t ili, ut ls. t ust b ttr i xiti if su ltr r tr-psrir futs riti r lst t ptit sits r lis ults prsist itsusts stbls x rity but i ty isppr t tiits t rrtiv surs il r rily iv suss irstri rl by utlis

I ki tis iii ispti t ust t b frtt ulsi t fr rqutly iv ris t isurbst ir vls.

Gr Mb Tt

Our xt sp is srti t r f t rs vts fxi xtsi sibi rti f t spi s

Ask t ptit t b rrs t tu t ts iut srii t ppxit is r rs r y r r bsrv t i lvl t spi t st xi tks pl iif tr is liitti t t ip jits. W liit si t pvisill t t rtt rs t r ip si tis b usit uitrl rti f t rtr spi usl t is quipssibl r pti t b bl t tu t ts yt v vrylitt l xi i t spi. tis s x tks pl t ipjits. Msurt t r xi by ti t istbt rs trr is y vry ru iitibut it is usful r pris t ltr t t bsrv prrss rtris.

Ask t ptit t sib t si, ti y r f liitvt T frly bi spi ill v uifr ' urv, rst rstrit spi ill v strit' sti t urv ivr lvl t stiss is prst Ask t ptit if vt uss ypi ti i, tr prssi r strti, i rspsibl frirsi t pi r xpl, t pi y b rrr t t rit li i y b tut by prssi sibi t t rit rliv by strti i sibi t t lt. T rvrs y ltru.

Ask t ptit t pl r s bi r t rtt truk t t ri t t lt i s ti rstritis tr r t pi is irs It s ssry t t plvssttiry tris it s iult t s if rtti is r r illysk t ptit t b bkrs ti liitti irsp



AGOC PRceRE OY

i f to rcor a approximat prcta ra of movmt ith ca ot, raliz it i tiay a approxmato oly a it

mai i compario for ftr rfrc Each movmt may brcor paraty a, of cor, it a mor valabl rcor bu acomprhiv approximat ur ca b ma for ral pia movmt a thi may b cit i om ca

Whl ach movmt i bi prform, to acrai th ra ofaciv movmt, a frthr pic of fl iformatio ca b obtaiby vi th patit a xtra p trtch to if th pi yi a ittlmor, ot if th ritac to frthr xio i troly block or oy

looly Qit apart from mr limitatio of movmt omim th paitwll how a colioi which wa ot obviou i th rct poitio it mayhow rotatio of th vrtral boi to o th hih i whr thtravr proc ar mor promit tha o th othr i Compatio for a pc tilt may ot cau a colioi but mrly a rotatio ofvrral boi Sch compatio i omay mor raily ilxio tha i h rct poitio.

aio to paiv trtchi uri th ra mobiiy tt thtat of to i th rctor pia mcl hol b obrv a papat Thi hlp to irtiat mr ti from ar'.

ilatral rctor pia mcl pam oft occr a for xamp iacroliac lio a aymmtrica rctor pia mc pam occri rvrtbral ic lio, o hat uri xio th plvi t to hilarally or forwar o o i. All th pot rquir oti bcauthy iicat broaly th ara of pial xatio Such ara wil rqir

pcial atttio wh maki th mor tail papaory xamiaoatr

Siinh x poitio of xamiatio i itti o a lvl tabl, to ot

h potr a ay alraio i pia cotor from th tapoitio f a latral hif of th plvi or a hort l or a coioi ha b

otic i th tai poitio, it i importat to kow if th fctprit i h itti poiio Obviouy a hort l caot hav aybari o th poitio am whil itti, a thr oht to b omatratio i potioi f obrvatio hav b accurat whia

If th patit' ymptom a poit to om falty potur itti, i t i cary to quir frthr ito th poit a ak th patitto am hr uua potr i a appropriat chair.

Whil at, th uprcial mcl of th ck a holr



42 AG NO O N A EON

hoa a bar aea ay be alate befoe aki a ore eaie alatio wth the ae lyi ow May raitioer rely ohe i oitio fo etaie aao but he oio i o eirelyatifatoy beaue weiht-bear of eeiy aler the ate a toei the weiht-bear ule

h Nk

A A N N A

Whe alai he e a the a to ie ue wth a ileeiu-ize illow ue her hea The hea hol be uiey raieo eable the oerao ie o oe freely i al area of he ek

eo houl be ote i he uboia aea a oerior erialule, he lateally i the latera rou of ule f loalize uleteo a be eee a ore by the aet reoe the aeaof te houl be elieate it ize a eth oe a he ireo

of the bre he traee oee of he ala are oe bewee heatoi oe a the au of he jaw. The elatio of he traereroe to he ti of he ao i iortat tioally a laer foroaio of ae oee I hou be reebee ha the atraee oee ae orally ihtly teer a o uue iiaehoul be a ahe to hi

he artiuar roee of the eia ol ae the aate ouue teee a roee Moe foratio i obaable fo

the arua roee tha i obaable fro the aere or oroee beaue the taere roee are aot away teer aiu to feel while he iou roee ae o ireuary ariable eei the ora ube ha o oioal faut a be eee hi wayiou oee i he erial ara ae ueful fo etei he rae ofexio a exteo but hey are erey elie by the orae aalue of ati the ariular roee It ut be oe ha thearua oee ae oray o euar a oiee i oe

artiular oe i a reiable i of a oitioa fauThe atiular roee ae the aefully a ae r with the ehtly exe a the with he e fuly exe For thi a oo ethoi to et he aet' hea o you aboe thu holi the heaexe lea he two ha fee fo alatio. he ful exio oiiof the e oetie eable you to aate roiee of he artuarroee oe eaily

ai oe otioa faut, our ext te i to e iitatio or

exaeratio of oeet ay retio



l E C K M B Y E

M B T Y [ E C R V A A R E A

Tel Ool

Wh he pate upie pe he ps f yu has ve eah sef e ptie' e gty verig te ears se h ps f te iex e gers t he he fet argis f te air pessesa he o he ea a e ui the verebra t be fet is iue he rti As he erebr begis t ate he agis te artiurfes a be ft t ve. The rage f veets ust paewi he age f veet the segets bve bew f uyis experiee ig this use he spus presses as rs r

estig rati.



DGNSS O SN ESO

s Siebening. IG m pii i ud i Fig tig cr t ur t id

bdg i cd t idivdu ricui t b ttd d tt tc i t idbt w. F ti r i w ud pfu t ptit d yu bdm Sidbd t ck vr yug kpig t vrtx f ptit d i t mid t wm Sm prctir wi d it ufu t u t tr pct t

idx g pu t rticur prc A f rtcdvp udr t g w tr rtiti f iddig d i iqt dirt rm t rtc t djct jit

es r r n Bk Benng. F. W tig frwrd bdg d bckwrd bdg f t cvic

jit it wi fud t f idvidu mvmt btw pupc rt t rticur c Wit t dx gr tumb f

t d pcd v t piu prc upprt t cciput wi



E EK : M OB Y e 45

FG

t rgt d d r xtd k w ppg jt

ccpA/ J

Rdgp tud f t t-t tut d ttt t p m rg mmt w t p tr t trm xur f t d d ek drt tr mm w u t ft f t ptd t uprr t tur ft A t d d kpp t p f fu t gt rtr mmt f tput u Smr frwrd bdg bkwrd bdgd dbdg tke p w t j f k ppr r



46 DI AOS I S OF S A S O

u cuson o ovnt hus n tsts o occpto-tnt obt,th hd nd nck ust b cd though ng o ovnt

O B L S S

Wth th ptnt sng and th opto stndng bhnd h pc ng ght on th sd o th patnt nck so tht th ng-tps contct th atnt tnsvs pocss nd th tp o th stod pocsshn nstct th ptnt sow to ott, tnd nd sdbnd thhd s s possb whst th opto nots n chang n thtv ostons o th atas tnsvs pocss nd stod

Nt tst o passv ovnt hs b cd out \ h thptnt sttng bt th supn poston s s s nd o convnnt

Te o ROol Wth th ptnt on h bck, th hd s pcd n n s poston

dwa btwn owd nd bckwd bndng, usng on thn powo tst otton gsp th th chn o th vt o th ptnts hdn on hnd nd cd th occpt n th ngs o th oth hnd ngth dst phn o th thb coss th tps o th atnta tnsvspocss nd th stod bon th hd ound c nto otton, vodng n hv pss o gppng whch cs thptnt scoot. Assng tht otton to th ght s bng tstdth optos t thub w b pptng th ptnts t tnt tnsvs pcss and, obt s no u otton o th hd to thght w cus th t astod tp to bco appotd to th tnt tnsvs pocss. hs ppoton w b ppab nd thoptos thub. t st b pontd out tht so pctc s ncssbo th tst cn b sd ctv nd n so ncks t s v dcutto both th stod nd th ts t th s t

h ccptotant ovnt on th ght ust now b tstd stotng h hd u to th ght nstd o sng th thub o th thnd to tst th t occpto-tnt jont sht th t hnd coss so thtth t dd ng ppts th ght stod pocss nd tanvspocss th ts. At th t o otton th sd tp s ound toov w o th tnsvs pss o th ats.

S tsts a b usd to tst o tton o otton to th tn both ccpto-tnt jonts.

Bckr bellg il h ocpo-l jOil b tstd wth thptnt on h bck th opato sppotng th hd wth hs hnds pcdso tht th ngs sppot th occpt gon nd th thubs toch th



OCCPTO-TL OI ILITY STS 47

tt t p mt p. h ipit·tti i th uy t. f mbiity i m th mti pwi bm ppimt t th t p t hu

b pit ut h tht y itt fw bkw bi ut th ipit·tt jt u i th t-i jit. hmbiity X-ry hw h m (Fi ) tit mmtt th ipit-t ji hw Fi.

Fw bi my b tt with imi ip th tx hpi h ti th pt bm. A m wwpu with h h wi thw h ipu it xi wh hmti p wi bm m p fm h tt t

p



48 D I N O S I S O F S P N L S I N

b

Normal mbility X-ays f the cen' sp



MOB S 49

b

Mbity Xys sw; sttd ttt mvmeJ



50 D A G S S S A S

FG

fo o Bk Beig 7

Aor st somtims dvod for fowd bdg t oitot jo is o tit si o ow rd out t ft d so tt t tumb d mdd gr suboii r rig d s d o t ford d rokigmovmt of d obtid o oiito-t joit W dotv t wo torso movs u d dow wt s s tst sof imid u bus o is mtig to t r o stroug t k mus mss of tris sius tis d smi

siis tis d o o ti tis it b ud



O TO- T N MOB S S 5 1

Tst for Sideldng. . 8Agi utiiig th sm gip sibg m b st b pp

tg th s ms b s whis mtg thvx f h ptits h i h m As h h sbs hrgt f t trsvrs prcss wi bcm ss prmitr sprt m th msti prcss h sprti bqu ri fi f i is grr mr s pp thn th

g f in.



GN SS S IN ESI N

o 9.

The Ccrvio-Toa Aea

Ahugh th cvc d thrcc rg f th p r tcy prtd by vru f th b, vrth bth fr h dgtcp vw d th trtt, th r 6 C3 . cvy cdrd r S d tchq ppy t 6 d C t d 3 hr r why hud cud 6 C d bu cry t uu t grup h jt tghr hr grdurt th rg f vt fr j t h xt bu thdvt f h rb d dc rthr hpy h frwd d bcwd

bty f th

jt cprd wh h6 C

jt.



rR O- THORAIC A EA

FIG {ym

5

Cidrig r biy r u rwrd d bwrdbdig dr i rg w prd dw h hr p

p f 6 C d dippr bid 7 C durig x y bu C p pr i uh hr than 7 C i a fpr i rf y d r ug prp Sidbdg i qui fr, drig r bv dwwrd bu ri i pryrprd i hi r Hwvr, 6 C d r x ji dbdig prdu rpriig f ri yprb 67 C. ji g biiy Xry vw idbdg hig rg f h v bw h piu pr f

6 C d C. w rrdd ( ig 9 a d b



D AGN OS S O S N AL L S ON

.

B L ESS

h by t bt d t h p.y b td h h y p ly fd- ddbd b td y

Forwrd Bendng 0h ptt td t t hht h pt d

f th pt bk d htly t th h ppt ht t h h ddd f y hd th pt th x ppty f x hh tl f tt bty d p h pt thp th t f h ht hd th tp f th pt hd. hft thb h plpt bt h p p h ptthd xd t t h l d th th ht f xd l h t p f th p p

hh dttd by th thb



O·O OT TSTS 55

Bwd Bndn n hs r bkrd bndng s sd n xyh s y s orrd bndng ths t xndng th d o lt bor rokng to nd ro

o h ur thor r s ry ld by rbs b n hlor r s ost unobnbl x th sdbndg T sn b rord n h s nnr s bo but no usng urotory on os r roton o ours ours h 12 C

on h drsng oun don to 2 T o h hd ugn b rotd to l l bor ny ont n b dtd

Sdebendn s sd or n t s oson bu t th rgt hndor sdbndng to th rgh st ltng snous rosss t th ltub, nd rrsng usng l hnd on th tnt's hd to tssdbndng o th nk to th t.

Sne nh obty ss usd h th tn sun r or orrd- nd

sdbndng n sng orrd bndng suort th n's hd n thrg hnd ushng urds ro th otl r nd usng th hub o t t gng o th snous rosss

n tsng sdbndng o rght l th rg ub gns rgt sd o to djnt snous rosss h l o t rg hndnd t ho o th l hnd r usd o suort hd nd nk n

o t ol rl r sdys unt (Fg ).



DINOSIS OF SIN LSION

G

Th 0

his r is considrd or t uros of tchniu to b from 3 to h chf movmnts hr r orwrd nd bcwrd bnding forboth sidbnding nd roion r sricty imitd by th ribs. orwrdbnding s imid by osition of th vrtbr bodis ntriory s ws tnon in th nrsnous gmnts Bcwrd bndng is mid byconc btwn h djcn sinous rocsss.



THORA X : MOB

ddg sg rg dss fro o dod o 5 T. u sddg o h ruk xl sj hrshoud oxy hrougho h ho o h hor sp

u or o h o sddg os o 7 T d ssdords o h r

RO hs r olos h h s p s sddg uosy ous h o ho d upp l sos o hsp

M TY E

gg Te A os ll gud o lo jo xos h hor sp s

h spgg hod Wh h p pro, pl h hl o hhd o h spos prosss o h hor d prss rllydords usg ory pss oly o o pssoo h spgss' o h o h s s rlly s o xso, gs or foo ou h o h hs o gs prsso of h sy of h ssus hr, d f p s psh p l rxly gurd gs h o, gg s urhrfoo o h ssy of h jo o o Exrssy d sl-grdg hs s r sros rg hphology s ps d h hd

I ordr o por h s ly, h l shod lo d hp oply rxd, prrly h h hd h d .dly h l sd shod h ddd hdp so h hps os s h goo, lg h p o rh oor d o rx ly ho rg h hd o o sd or hohr h opro ds o l or h p d kp hs rgd h lo ll xso d h h opor shod l hsgh o h p hrogh h rgd r so h h os prsso h hs ho ody hr h h js h hl o hs hd

Th s s o dd fo r lolo s xly prry o or r ss of dd r joo Th opror soo s o dsgush orl o or spgss d o rqly os rgd gop h hy rly sypo, u hs gdy ogh o o gord shoud old y lo d sp plos Ayrgd group o rr ps ddol sr o h jos o do h . o o d sypos rs h jo o hgd d h ol os hr hr s o opsory hyp

oy



58 D A O S S O F S P A O N

. 13

e for For'd ld Bck'rd Bdilg F 1

od nd bkd bndng n dy b tstd fo n htho th h ptnt sng nd th opto xng o xtndngh nk h h gh hnd l l th hl pptng th ntsps btndjnt spnous posss h hs ft hnd. As dsnd futh ntoth tho y b nssy o u o poful lg bypssng on th otho usng th ght hnd uld undth ptnts ght xll nd pd on oho Wlontold xon n b obnd n ths poston



R OB Y T 59

4

Bkrd Bd G 1 4

o bd bndng n th ow tho t s sosnss o h nt to fold h s o nd fon of hfohd Ths fodd s s onnn hold b th opto nxndng h ho ho



60 N O OF N L ON

Tet Sidebedg 15

Sdbndng s sd n h sng poson Lookng h pnsbk nd sndng l o h rgh pl h gh hnd o h rxo h pn's hd o h hd ll no sdbndng o h l plh l hub on h l sd o djn spnous prosss nd g nxr sdbndng psh h hs l h o s h ss ndspngnss o h sdbndng o

Fo h o hor b nssr o p ou rgh xlor h pns gh shoud rhng rond oss hr hs h ourrgh r so h our gh hnd s n h pns l xll ordsdbndng o h rgh sng shodr g s hn sl hdll h h usng h l hub o d nspnos on



T R X : lTY T 61

o6

Te f Ra 16R s sd th sg. sk hr t p h rg

hd hd hr d hd u rg r rug th rgul spts ks s r hd trs fr fr d th urs rudt st pt's rth gd g s thustd rtt ts t t rght l fg fr rspus

d th hl r d t-ubr rs.



6 D O S O SP SO

o

ub A

F h pup tchiqu hi cv 1 0 T t itvtji It i i th wht tict tbi th thcic ji t h bi y ub j vt cpivy with xiu i th ccug i h jit. Bcu th icti th icuigct, i t pb pu tti pu g ccu ythig but th t w g vt big t thight with h i th ct pit i xti cu th vt bi t th , th i, th cvxty th cuvwh i xi u ig th ight th vt i t h gh h i, h ccvty th cuv h p u

b b i i wh pg h iity tt thi



M L TY TET

Tes d Bedig. F. 17Frwd bning i t nninly td wh h pnt n

h d xng h n hip nd lbr pin ight p t h tilbr Wth h ptint n hr ght i pprt h x nin yr righ nd th pr y wn bn gin pn n n h xin. Thn p h l inx ngr h npin lign t ppt gppng h jin

A nntin th rng nt in gn dirin

by h g

ning nyinng r n

nng rd n3 ning n rng n ning n ind rng n i hypbiy.

y rring h gr w n prgr whn ng biyt lr t Obily th nbr r n ppxn t thnbr d r ng l pw n ppxi nyhy l r nl rrd I h h nntin ylprly n ding rwrd bnng b hy n qly w b in ding hr din nt

Te Backward Bedg F 18wd bndng i b n with h pin pn lng bh

lwr xri wih h right r ndr th pn thigh n ingth hn t ppt nt h T. . A ii n b wring b dwn thi i ling h wihh t ppt th bdy wight Th ptint r dhigh h th pin rhd n rt n hr d r Thirngn nnint hd h ptr' l r

Sidebedig bt td n h ing piin r hi id

bndng (Fig. )

Ra n b td n h ting piin h pr ing hpnt b (Fig Th pin p hr righ hnd bhind hr n ht th prr n hrd hi r thrg th pint ght r br bwd ht h prtr' hnd n h pint-T r Rtin th lw T n nw b iy hid bying th ptint ight hdr gin bwd Frwrd bnding

bwrd bnding n b tii t th ti t tt rin6



4 D I A G O S S O F S P A L S I O

e Rib

The hi ge ves s ui duig respiri There is erlpsii f he ribs whe usle er is requied f whih fredexpiri eils d whih fred ispiri reurs r psiif fred expiri e f fed ispiri he ribs ler heipsii i hree diere wys. ( The seu s whle ises durig ispii d he erir eds f he ribs rise wih iexeuig wh slled pup-hdle ype f vee his, geher wih he dese

f he diphrg, ebes he veril dieer f he hi ge irese rder h he hri diee f he hes iresed w her ypes f rib vee ur bue-hdlevee whih s he e idies ipl ies risig f he shf f herib wh revely ed err d pserir pis d ( ervee i whih he ser ed f he rib ves elly I hisvee here is srehig f he sl rilges d he sl glebees wider. This lel vee is ed he 6h 10h ibs



TE B S

ndeng he b ndvdy the t nd 2nd b e nd wh he m o th ony pmphnde mvement oc Fom the

d o h 6h b cmbned pmp- and bcket-hnde mvemen occand m the 6h to the 0h bcket-hnde nd ate mvement cc.he oatng b move vey tte a they ae tetheed by the admbm mce b a they ae not xed ntey they do enabe heowe thocc vetebe t debend nd otate moe eey thn heyhee d

LSOS

I B S I S I I D X O

S I I OS

In he de txbok Oteopthy two type o b eon e decbed pmphnde nd bckethnde eon whch may n t beeth expatoy o npay hat t ay he b may be xed n apon npatn o one o expton nd the ty poon maybe o pmp-hande type o bckethnde type h vew dc

econce wth act bece ceay mpobe a b o be xedn pon o nptn o exptn ne the whoe cage xed n a ptn npatn o expaton h tte tate ade cc exmpe n emphyem xed npton nd pomye nvvng he nec xed expton bt the nge oteopathc b eon doe nt envge ch poond chnge the hea mvemen w djacen b etcted he majty beon e de to ntecot mce pm whch dmnhe the nom

expanon and contcton between the two b. he commnet cae neee nexpected cgh Ate the neee except one gp necot me ex hee mce ty cntacted n em-campke tte nd they pevent nom movement between the b. an occong the coe o the necot pce nd the pn aggvted byoced epatn o cghng I the mce pam pet dhenom nd the mce ndegoe b edng to chonc b en

F th pm to oc at t vey pobbe tht ome pedpong

eaon ext the mca tby he ntecot mce my betted om a cen ce tht n nteveteba ont eon myce neve ttn and mce cnacton whch ed to the ectedb mbty. neveeba dc henton ndobtedy occ n thethocc e nd hee to gve e to eeed pn ond the chet wo jt t the anteo dvon o he thoacc nevet oten oceo cnn wh cadac ng g-bdde nd gtc pan ntecotapn wtho a b eon oen occ the pn beng meey eeed bt

n hee cae thee ae n ocang mechanc at t be nd n the



D I A O O B L O N

ribs. ersverebrl j xis fr desis ur d useresried biiy By relesig ese jis we relieve e ierslpiis s bee de iuerbe ies d i e se eve fere lpse f welve yers, e pie vig d vgue iersl pi d durig e wle f perid

Te t and nd b re peulir i eir r vee ispup-dle i ype. ey re ls uusul i e slei uslesre ed e Ay udue r f e slei wud ve elevig ee ee w rib lug e rl veesre pup-de e lesis re ily bukedle in ype Oeipr liil sigie f is lesi pr fr y irrii f e

1 s d 2d iers erves is e sie f e sslee rigeis redued s y f e rs f e bri plexus y be irriedby su lesis

e 1 d 1 2 ribs re s uusu ey ve pr rgef vee d r y i lesi s resul f qudrus lubrusps r sedry d 2 T irverebr j lesis

Tere re si ll ree re ypes f rib lesi-xaton ofthe tena/jotsly due iresig ge by wi e rl erpserirvee e lwer ed f e seru igig e serl ji isspped. Te sed lesi is pa ofthe cot-chonda cton isis eug d is due dire vilee r usle irdii.Te pie plis f welied pi e ex sie f e sdrl jui Te ird esi is ppng of the aag end fe lwer ribs s ey ji e er fr e sl gle. Seiesese rilges bee deed, d e ie ey slip ver e erey use pi

fO AC V B OB

Geerl bliy i ribs be bserved by wig e respirryrge eriry d pserirly. As e wuld expe ispei f eri ge erirly gives re ifri we viewed pseriry ug e lwer ribs f e rx bes be bserved pserirly A verll esuree f es expsi be de wi pe esure rud e regi f e 6 d ribs dul 3-i expsi is verge 4 ies is very gd d yg ver 5 iesis exepil Oe us lk fr syeril rb veegreer expsi e side e er suggess plgy r ei fulsi e lesser expsible side e weer expsi is ily sl rdiprgi. Observe espeilly if ispiri is rresed suddely ris f urse suggess piful pse e pi were e



FOR TIE Ri OBY

prn brpy h ptn w ay nda th pnwhn h r nd t w hp n th dtd xmntn r Rpr

tn b brvd n th tng ptn thgh t n y w bdn n th pn ptn" "/$ n tn b nptd w paptd

patn nnnty rrd t wth th patnt pn thndx ngr nt rrpndng ntrr ntrpa nd r pprxmtn r prn pb 1 p th tp th ngr n vrnrpa t n, b d mk vr brtn t thm tm nd th ng ngr mthd mr try mprng

th rng th m wh th thr d nd wth djnt nrpxt pp th rng pratn nd apprxmn at h mdxary n h th rb n addtn ppt th rang rrngvr h ng h rb th rng mvmnt prry vrym ndd nd rrpndngy dt t papat

Nxt ppt r pn rtn h m b trn n vrn h rb rt pprxmn t th rb bv th hwr rb mrgn bm mr prmnnt h t th hnd hd

b pd n h wr prt th ht w nd md pwrd thn thprmnn rb mrgn n b t mt rdy, bth n th md ryn nd vr th ng h rb Fw th r h rb rm tng rwd t t nd h nt wy y n th b nd r th p nd brt nr h dty h pn b mvd rwrd m xtnt nd th brt phd d btmtm t nary t nt th rb ntrry nd ptrry t br ppng h m rb nd ntrp vng td th rb n

trry nd ptrry ppy rt vr th rb antrry nd r rrpndng mvmnt ptrry y r n th m rb ntrrynd prry, t hd b pb t dtt ght mvmnt ptrry mprd by th hrt ntrry Ppt th ptd rb drngth rng prn bth ntrry nd ptrry nd n nyk mbty h rb my mprd antr-ptrry t ttthr prngn and t r, vab tt whn a rtr pd.

h t nd 2nd rb r bt pptd wth th pnt ttng nd thpratr tndng bhnd png th at h hnd vr th ng ndpradng th ngr rward ang th r th rb. It dt t th rb thrgh h m trp bt mprng th tw dnb ny drpny t b ntd.

h thr g m nvr b xamnd prty rm th hrpn b, r, ny mttn mvmn th thr pn bnd t rrpndng mttn mvmnt n th rb

hra nvrby t th ptnng nd hp th rb



GN F R L E

1 9

F R P V R B B Y

Th bjt hs tss is t ssss th mn f sptin ndppxmn which ks pc wn w dcnt rs whi thtrs s wh is mvd Th ribs mv n rtin t n nthr whnt thx is y xd xtndd rd r sdbnt. Pssi mmns mpyd in rd t tk dvntg f this mhnism f thpps ppn

t Uilg tti G 1

With th pnt sing nd h prr stnding bhnd h th



OR PV RB OBY 9

p pc n ng h hnd n n h pn nct pc nd p h gh hnd c h pn ch gp h hn y png gny n h pn hp h nk y h gh h mmn p h cp y m h d ppn nd h m m c gh pn mmn h h mn d nd pp h gh d

Te Usng Siding . 20Wh h pn ng, h p nd hnd n ghy

h nd p h gh m h pn gh hd hx n h gh hd nd p h gh hnd nd h ch hn pp h npc h h hnd h p ngdn n h pn' gh hd h h gh nd phnggny n h pn' gh d h h ch. h c hhx dnd h gh h h nc pc p

n h .



0 GN R EN

1

Uing Baard Bendn F 2Agi stdig behid the seted pe he pertr plptes the

terir iterstl spes he le sde with his le gers. The ptieples her et hd the bk her ek s h the lbw pis upwds The per r gsps this elbw i his righ hd d getly pullsi bkwds whle pshg the pie's bk wih his hest. hishrws the hrx t etesi, eerts srg tti the petrl

sles d septes the erir iterstl spes the le.



ub

Mr n f wgt f t w bdy s b tnsmttdg t mbr spn nd s t fcts r ms rc wf wgt mst b tkn trg t rtbr bds nd t dscsbtwn tm wndr tt ts sng wgt-brng srfcs t b spprtd wt pwrf gmnts nd mscs nd sm wndrs tt wn t rbr bcm ttd r t scrm ttd t tstrns st p g rs t bckc dscs r qt tck n ts rgn

fctt mmnt nd c ncs ppss cs s d b nt sckt f t rtbr bdy nd nns brss wgt f bdy ws dsgnd t b trnsmttd rtcy nd t s nt srrsng ttt dscs nd tr cmpnnts g wy wn sbcd t prngdsng frcs s n stng r rtr sggng n n rmcr w tmbr spn kypsd w bckt sts f crs r n wrsbcs t jtng nd ft prssr gnst brks nd ctcs frct mbr r st mr n kypss Lgmnts w rct w

ntrmnt strtcng, bt bdy t cntns strtcng d n mw g wy nrm mbr mmnts cnsst mny f frwr bndng

bckwrd bndng nd sdbndng Frwrd bndng s frest mmnt rng f sc mmnt s fry cnsstnt trgt mbr spn In f frwrd bndng t nrm rdss s srgtnd, bt cnxty bckwrds s ns Bckwrd bndng s ryrb mmnt rngng frm t xcss mmnt n t crbtc

dncr t ry nn n mny ds r ty yrs mmnts md by tnsn n t strng trr ngtdn gmnt ndsmtms by bny ppstn f djcnt spns prcsss mtms fs jnt s frmd btwn s spns prcsss (kssng spns.mtms t ntrspns gmnts bcm nmd frm cncrrttn nd scrss dps n t spns prcsss wr trs ppstn Frcd xtnsn bynd t ppstn f spns prcsss rty rs t rtbr bds prt nd gps t dscs

nrry W t spns prcsss r nt spcy rg bckwrdbndng s mtd by t nfrr rtcr fct mrgns cmng nppstn wt t prs nrrtcrs f rbr rc. mtms frcd xtnsn w dr t fcts nt t bn bw ndcs crck n prs ntrrtcrs t cndtn knwn s po"do�ys Wn bt prs ntrrtcrs r dmgd t bdy wgfrcs t rtbr bdy frwrds n t n bw t g rs t tcndtn knwn s podoithei.

d bndng s qt fr n t mbr spn t s t mxmm t71



GNO OF PN ON

.

34 but h is i sidbnding t th umbo-scr jont. Whncrrid byond crtin pont it no ongr rmins pur sidbndingmomnt but combins with rotton. ch rotion my b thrto th conxity or to th concity o th cr dpnding pon whhrth spin is in orwrd bndng or bckwrd bnding h pin issidbnt to th right rom d position th bodis o th umbr



H U M B A S I N 73

e e td the me de (t the vty, t the eet d exte the bde tte t he e ( he

vexty. he mb e ed t tte debed edbee he de he t t he vt t ht h� ete e the ee ee thee m e he ee e t he ee Kede thee t mtt he e me t theet k det vetebe see et t d met e k, hte 1 0 .

Pe t m mbe the m e bee d

t the ee k t eh he he ee t deed be thh the d bt he tt deed mvemet the bve h the ete he x tt tey Rtt ety me the m e , eme, h e the h e hthe ev d m e ted d the ht h e he mbe tey tht vexty t he ht d, metethe de he vetebe e td he vety d hh de

e the ht (ee F 22At the m- jt, the m mvemet d bk

d ed th debed d tt mt Heve theee de vt e he e d h my eee mvemet t tke e theethe e hy the m t me je t t th the mb j.

M O S O L U M B A N

Fd ed be ed t h the et he de Fexth h kee d h, t he e t y bdy dt e e h the e ee F 1 2

Tes f Bakwad Bedg. F 2

d ed be teted th the tt e d the e dd t my be ed by eev the t e hem d h e m de the thh d t themvemet h he the hd.

Tess f Sdebedigdebed be teed h the te tt td behd the

et d e t he ht he tet d he m hed y

ht m ve he ht hde he het d de he et



74 NO OF IA ON

. 23

th o th o dy tod th t h tg thght hod dod b h o tht ovty to th t om th mb d th movmh th t hmb

dbd g o b do th h o g h vg o h g d v o th dbdg o my b do thh t o h ght d ( Fg 24 h oto h ho g d t th d h d hod h d o

m h th gh m d th g d btok vt o tht th btto d h oy d h th 'gh modt

Rtati b dttd h h o h d g h vd ottg h oo do to h o yo tg Roto ob td h h t tg m od h oo hgthogh h gh o h ht to th t houd d g

oo vg o o dod o th o o



MAR S PNE MOL TY S TS 75

Flo. 24

e c-c s

MOBLY STS

here re fou tess for detetg the rge of moemet the sro jots d oe is esy to fee beuse the ge of moemet i theorm o s so sm Frhermore t is du to od mog theumbr spe durg the tests, thus gg rse to se mpresso thtthe sro ots re mog. A deted cot of orm sromobty w foud he Appedx. wo sbete tests for hyper

moby re so sed



76 DIANOSIS O SPINAL ESON

F 25

Singing Tt. F. 2

he r tet ree o prgg he jot e the pte proe othe be d wth the hee o yor rght hd ppy prgg prereoer he pex of the rm he eft thm pped oer the ro-jot de to he poeror peror pe. he prgg ymmer d moe both ro- jot he dty of detegmoeme reed by he hke of me oeryg the jotEe f the tet ojetey tftory t bjetey ery ef th f he pet refer p to the ro- re drg the tet t

trogy gge h th p rg he ro- jot.



S C O A C OINS OBI I Y E SS

FIG. 26

() appig Tst I. he ed tet wth the ptet pe Std he rh de the

pet d ex her rht kee d hp y, rp the e d thhrtby wth yr rht r ert yr et hd der the bk

ht ter phe yr et dex d dde er ret ther d he dde phe thee er ret n the pterrperr pe I th pt the pp hd e the rethp betwee th r d the he tehe w t e rk the rht the r he ptet rh thh eed tbe ddted the y exed pt t k the er t the te he the ked t be rked by re ex dddt the hp. here re e tedey r the whe

pe t ve t d r e r e xt the r



78 N F P N N

FG

o ou fIh i Ihih {d r od to hl or Ih I th othr d hs silizn t on th lis nd nss htoson ithn h si join his tst nbls on o dtith in or rottion o th sro-i joint h uho is o th

onion ht both o hs ys o on n our n th sro-ijoint dndin uon h onuron o th djn surs o thuriu s on th sru nd th iiu ( ndx).

3 Gil Tt F 27h thid st s wih th tint on h ortor stnds on th

riht sid nd xs th ns ht kn nd hi wl so ht h n isbow h o th tb urthr xon is ontold by h ortors

rh thih. H n lts or th riht sro-li r with ns o



SCOL A C ONS MOB L Y ESS 7

2

bo ads ad uvs is l foa od patits t bokad is it foa ov t ps ili st ops foas a s y lp tosioal sai pld po t soii oi ptily tiad by t d ip ad k pattsl sao-ia joit is stitd otio y t atio of t lt aaist t t. s tst is sil to st bt ss duo o t

i opd t ull xo o dtt oki o appi of sao l a o.

(4) Gag t . fou s is i pai po opo stds o t

pits it sd s it k ad asps itis l ad t t objt of itally o fu. t poo ia oaio (povidd tat ad p jots a oa

t plvs bis to ift p o t lft d a appi stai os t bot



8 DANOSS O SPNA LrSON

scro-ilc jons his ovnt cn b plptd wth th rht hubh scond, third nd fourh tsts us hip lvr nd cn only b

rlid upon whn w hv rst povd th hip jon o norl

Cmpei Te 9

With h pin supin, pply coprsson o th plis by prssinon th innoin t th nior nd o h crss n dircon towdsh ubiicus his hs ppin ct on th scr-ic oints nd is subjctiv tst only f th pin rfrs pin to th scro-iic thnit s sronly sustiv of scr-iic hyproblity or scr-ilic diss.

eprt e I 30Wth th ptnt supin pply prssu with th h of both hnds to

th ntrior suprior lc spins in downwd nd outwrd drcon



S CROL C ONS : DF F ER ENT D NOSS 8 1

0

d k th ptit if h fl pi th io of h acolicjoit t i a pul bjctiv tt d of vu i dcti hpmobiit d co-i1ic di

DF F [ R EN L D NOSS OF S CR O�L C ESONS

At hi poit i t would b oppotu to dcu th ubjct of ditil doi of ow bck pi with pcil fc to th ditiuihiftu of co-ilic ti co-il ic di i mtiod , p 85A oth o th m hpmobili o h m b hpomobiit Hpmobilt i foud i wom dui pc d thpupium. It i foud i m d ol th wh v tumh tk plc hv o m with ppi of ich t th



82 D IG N OI O P A EIO

ymyi bit ru of fl l from or wil o t unin Homlind of rt intbilty in t li n or t ymyi ndro-il oint nd oud ony wlk wi tron ro-ii bindr On

t or nd t onrtion of r nd i urulr rfi o rrur t ty nd tml o bomin d in lilyflty nmnt. Su lion r u of r dl of inynd mnilion of tm mo rtifyn ru.

n Jm Yon' tdy of li rroty of Prnny onot tt i norml for ymy b o inr i wid in tr lf of rnny nd on n r nr fom t normlwdt of 5 mm o bou 9 mm Grr widnin of t ymy

onidr o b toloi wid dmini r bor ndro t r-rnny murmnt by rd to 6 mon Sn inr of wdt t ymyi mu by mni mn droriorly nd iotin rond ro-i on b ditnbwn ntr of ro-il joint nd t ymyi i roximly four m t din bwn nr of t ro-ii oinnd t orior ror ii in r nnot b mor tn mm.roximtion i mm on d i n xtrmly ml rn o

momn nd inlly dilt o dt rirly b of t oinidn momn of orlyin of u Su in of ymyi do or wold ro n roximon t roili oin in orionl ln b t momn of roon i lonid m on t:

forwrd rottory momn of t i l i bon of t ro-iijont if lld ino ly durin lbor wi rry ub downwrdnd forwrd nd t ld to n inr in t nro-oriordimtr brim or wn rottion l in ooidirtion, o n nr of nrootrior t ol

S roton lily o t l rond t ond rl mn.Oiony r i romontory l wr momnold io b mor tn lily momn io round owrful lolid onnrion of introou ro-i mnt jorior o t r-li joint ndx. By kin -ry durnrnny of n wi ry rlxd imnt rt tndn on onl nd n on otr Yon dmonrt n uwd nd downwrdmomnt of 2 mm t ymy i o y by wi brn ont rit l t f innomint rott forwrd nd downwrd nd t ub i 2 mm. lowr on lt n rt By imlr rmn to

1 YOUNG, JAME, 'Relaxaion of the Pevc Jots n Pregnacy Joual jObsretic3

m GYl1aec gy ofh nUh Ep, Vo 47 o. 5 (ober 1 90), 493



ACO-I A C JO : IFIA AGOI 8

th bv din hint ppin th n f ty vnt tth psti supi ilic spin cnnt b thn vn in thincsd n duin pnncy.

liniclly, hwv, such sl n f vnt pps t ccu,nd if h int bcs hitchd t th liit f such n, thnsypts is nd thi dintil dinsis is disussd blw tintchniqus f sc-ilic niputin by thi vy chnics cn nyinunc th sc-iic int nd it is pssibl t btin cick f thisnt whih in y xpn ss withut ny shdw f dubt n thtsc-ilic int Shuld th ptints sypts subsid flwin suchclid nipultin thn it is litit t ssu tht th sypts

w isin in tht int nd niputin cud th.h dinti pints thn :

Scilic sins cn in wn scily duin ndt pnncy

Th typ inuy s usuy tsin n nd nt cssntypth swin f th s t lf wth th ft xd is yt cus sc-ic sti thn sy fl l dwnstis n t th s

Occuptin stins s n dntl suy wh th ts sfquntly twstd n n dictin ny ikly t stin thsciic int thn, sy, din in th dn

sht hs t cpnstd f nd th sc-ilic s thint which is piiy invlvd p. 1.

h pn s lwys untl nd v n th d in. t is nvpnt but usful n, ht lub-scl sts disc sis cncus p ith cntlly v th sc-i1c ints but sc

ic lsi nv cuss cntl pi4 h sit f pin isin f sc-ic lsn s ith v th

psti supi iic spin ust dilly v th sc-liclints.

5 h fd pin f sci1ic sns s int th buttck ndpsttl spcts f th thih nd clf ccdin t ckttth upp p f th sc-iic lint cuss pin pst-tlynd th lw pl bslutly pstily in th thih nd clf.

(6 h n bnl nulicl sns wth sc-i1ic lsins. Thisin is ntv sin but usful dinti pnt f v-tcpssins in disc lsns. h stiht l isin tst y shw sll nl thn n th th sid but th n s ikly t b60 d. t 80 d thn 0 d. t 0 d s is s tn th cs with plpsd disc.

h s unt tnsn in th ct spin uscs t is wth

t HACK, G S Joint Lgam!It Relaxat (C. C. homas Sprfd , 1956)



84 NOSS O SNA LESON

nng tht thr r n muss whih mtivt th r-ii jnt,but Hins aw s bains nd th narst mus t th sar-iijint is th rtr spin mss tking rigin frm h sarum and

innmint. Thr is prtiv mus-gurding thrfr n th smsid s th sr-ii sin.

(8 hr is tndrnss in th psrir sriia igmnts ndvrying mus h sr-ubrus igamnt is frqunty ns ndndr spiy whr thr hs bn frwrd rtain f th srumn th innminat arund 2 S sh tht th apx f h sarum ismr prminnt nd th pstrir suprir iia spin is mr prminnt (h psrir innmint f stpathi trmigy Oasin

y thr is ndrnss vr th symphysis pubis bt this is midt h prgnany rthrpathis

9 Thr is trd mbiity in th sar-iia jint ihr hypr- r hypmbity nd th prvius tsts ar dsignd dmstrat this

1) hr may b psitina hngs th srum and innminat may bpsitinay ard his pint is fraugh wih snags ad diuis tnm ust fwth shp f th pvi bns is subj idvriin thr is rry prft symmtry n h tw sids, nmais

r mmn th g ngths ar frquny dirt h rativpsitin f th umbr spin nd pvis s � wh is subjt variatins frm dis and hr sins musuar guardng trs thrtiv psitin f h pvis nd umbr spn nd if h guardng isasymmtria i n �us nfusin f psitin

Evn s th vs f th rsts f th iium shud b ntd with hptint sanding and siting; simiry wth th vs f h pstrir

suprir ii spins and th ntrir suprir iia sin, th pubiubr vs Again ths vs shud ntd prn nd supns th rtiv prmnn f th pstrir suprir ii spns mparng n with th thr A ths psitins hp n t bud up mnt pitur f th shp f th vis nd Xays wi p sti furthrspy whn tkn in th rt psin

mk psiin dignsis f th pvis and th sin

pstrir innmin' r n up ntrir innmint' in my vw is n

dqut Th dignsis is primriy n f mbi ty and ny sndariyf psiin and th thniqu f sr-iia manipatin is n f unhithing' th jint, tmpting t ras it by rtatin r gpping Thhyprmbi sar-ii jint f urs shud nvr b anipuatd butshud b givn xtrn supprt r srsing uid injtins afr thmnnr f Hakt

h qusn f sr-ia diss hs bn purps ft ut f th

Ibd



E C RO-COCCYE L JO 85

above discssio becse s we have sid ll lo coce is wihmechical lesios oly Howeve stted biey we sspet sacoiiitiseithe tbeclos o pt o a ayosi spodylis whe thee is

a viable bckache eeabe to the saco-iic aea dii to thebU poseoael aspects o he thih ad ca o aboml ecoical sis a iid lmb spie wih mscle-adi ised sedimetio ae pehaps a histoy o iiis o hee pais he -ay ppeace o the eay saco-iliiis shows some loss o the cotical ie o thejoi especilly of the ilic potio some bi some ppi pehpseosios d sbchdl scleosis he coditio is ilael it mybe tbeclos b i bilteal is amost cetiy a pelde to aylosi

spodylitis. Fo the dieetial poits he ede shod ee tosdad othopedic etboos

Sacro-eocc) gal Joint

occydyi is a commo-eoh symptom bt i ohly h thecses thee e bsotely o bom physicl sis to ccot o thpi locly t the coccy o i he sco-coccyel joit My o schcses hve bee cosideed psychoeic d some o them may well beb mos o those withot physical sis ae de to lowe lmba disclesioscet dis poplsios csi iiatio o the coccyeal evead tesio i the lm temii d heeby ceed pis to thecocye e.

Aohe poit woth maki hee is that ijy to the coccy eey cses smied shock ad dme o he lmb e deve whee hee a well-maked loc sis o saco-cocyeal stai helmb spie shold be eamied mos caely i ode to avoid beimisled ito thiki that al the pai ises localy

Whe eamii the coccy we make se o ect eamitio tociite plpatio bt lso to saisy oelves tht thee is o patholoyi the s em o tes Havi doe so we mst test the eioeesio d otatio o the sacococcyeal joit ad palpate o edeess i th imets Nomy oly eio ad etesio ae possiblet the saco-coccyea joit bt ottio d sidebedi is possiblebewee the semes o the cocy While i the ectm i t is easy to swithe e od to palpate the saco-tbeos limets i cse thee isa sc-iic lesio i ssociaio edeess shold also be palpated oi the -coccye body a ectal emiaio is ot doe it is sti lpossible to obtai ood deal o iomatio abot the coccy by palpatio eteally oti the eact site o tedeess eei o lateal oad o bckwd displaemets Aohesel test wih he piet poe



86 I AS S S I A [S I O

i t ly the he l ver the yge e, reing uwrd btin ene th rinene the y thrgh the ie the gtei Shuld rere in thi wy eliit in t i likely tht itng

dwn will e in t the y. It i utry t eine erre with he tien n the de bt i i eully ey t ke theeintin wih the tient rne nd enble ne the bette ble tjudge the yetry the y reltie t the r nd eli tletFrthere, i niltin he y i deided n then ne nreed witht hnge tue

hee re three ule thent t the y the yge ndletr ni whih, when ntrted ue ight ein the jint

nd erirly ew bre the gteu i re tthed t hey We n ke ue thi ltter tth en when eining ndwhen treting the y By eing the hi nd knee nd bdting thethigh t the ull, we e treth n the glte i nd ltin he y in uh itin will gie inrtin bt biity.Siilr leerge the lwer etreity ed gint nter-rere nthe y n eully be elyed biie the y ( p.



3

TS F TECHQ

M

ANIPULATVE iq dbd i thi hpt dvddt t: -ti tniq, tity th

d pi hi Eh mhd hv thi pthi ttmn I i mphid mipti i bt p th bd tpi pph th bdy d m mnipti d tpthy byn m ynym Nt v th tm mpv ttmt ndtpti ttmt m t m hin pint my b mptd n id pd dn mdi pviin iht tbi pt pin tt v i bi

idd ptint i vi tpthi tmt t tpthi phyii my th m iq p i ttmN tpthi ttmt i ivn by ptiti t hpph i mhi-tt t it i qtin mpi p it pii t hd my b miptd by tph nd in xty th m y b th d i ypt th pt t nd th tpth d xmi d tt h bdy mhy h my b ii pndy

hih i pdip th ptint t th pi d t pdipit mt b dt ih i t ptit i t hiv mpt vyimiy pit i nv dyppi my b td by thphyii it i pd nd div bt h tpt dxm t pin nd pt nd, i pt d k t thmid hi th pin t i t ny mhi i pdp th pi t i ditb ditin

t t t th qtin thniq t-ti thniq imi t h d by phyipit and ny di i dtai ad nt ppiti h m m a dint imptn it tpthi mpd ith md pph M n thw i nidd ppy mthd, mi b th titynd pi thniq th th pt mdity it

Whn iti ti mn in in pd t m pthpt yp tni bt d tht th bq tt dibin t mthd y y mpyd n

87



88 T OF TCH

p trtmt. Lo tr wrd w mm trmt -t wrk d prd rtry t d wry trtmt w p mpt.

TITORY T H

Nw t d try t rt jt mt t tpty r mp rprt d b-t'mk t yt t mtd d w ppd prpry, rty rdr p typ

mp ry. rr t t dtd prdrwr p t r b r tr-dd. Mtdr, py d r d w mt

by t rm mp Mp t t r dr rp t d rd mmt dr w pt dr d t wrd ty. prdr d wdr t dr ppd t. T rtpdr r m r pt mp d t r·

pr t t r prtr r t w pt10 b mtd t t N wdr mp d rptVy t dtr m tpt d m rt t ptt Nt d rr rm tr M t pt rtmt tm dtd articulatoy tehnqes osistg f pssive memets appled a smoth hthmi/sn gradall stethoted musles, lgmets d apsules.

t pr typ trmt rtr rd tmp

md t r t t t p mm rm d r t mm w r rmy dr rytr r r r xmp ddt d bdt r rm mmt t k jt bt py m r mmt s pb W mm rm x dx wd t b d r d t y mpr rd tr p mt

prp rttry t mry t tr

t t t t m mprt m. y trty trtd t m mt d p w prd pwrm t rt t jt. m r kjt w tmt t w d ty bttr t y pytrpt t T m pp mr t t p jt tr wrd rry mprtt p p rtmt d ppd d k rrpdy pdy t wr p mpt t



TITIO 89

ld b dd. h tpth tht h dt dt-d h v t mlv t.t dd pty tht th mdl pf k l bt th

apt f mpl Ev mt dt h hv tet thmlv mptv thpy th mp tlty tehh pd thm hy hv bm fm h ft thd th p mpl bt hv lttl d f h vl fth pv -p mvmt.

k ft- th tlty th ftlyppty p mplt d a tpth ttmt myt tly tt t ft t th tlt th ppp jt jt (lt ppld mly h th jt) d lly a p th ppld t l t x djt t pt. h d f the mhd my l b teed t tt dt mthd my b t th mehd t bt by d l flty jt h t ft tmd t, ple thd d ly p mpltppld th de. Wh pp th t by m d t p t p mpl blv tht th ttmt me tv h th l t d tht the bet m pld.ly t dbl ev ey v v tt dtlty tetm bf mp y p k. h pplplly th ptt v t h y mmty mpt t h d, d ft a f h ttmt mkt ey t y d mvmt a .

O-Tt TEI

f db th dtl f f h, lt t d bjtv W h ( tt th ft pptyt fhe tv k th td jt (b) tt th ftt per s m t lt th ml thmlv. h f hh th ltt ttm d ltvly f btth mthd mtd bl

(I) ibtohb dep td p ppld v h blly f th

m h th ptt lxd pbl. help th lxtf th ml th d t h ml ppxmtdd th p pld h p t hv h h ptm, f , b mftbl. I vtally mpbl t l fllyh th mth d t h pk h pt



90 ALAS ECHNIQUES

Mak r h i cmrab by akg May patit i accp thdcmr hikig tha i itdd r t i gd r thm ad thy i t mti it ! Havig baid a mch axati a i pib ithi

th pat capaci h appy p ih th at h thmb gr r thar mc. Th pr mt b cmmcd ycag graday ti thr i cdab pr big xrd.Sch prr a th pat ca ak hd b mataid r ab ami i th i a papab raxati th mc Th prmt b ad graday ad atr a hr pa pr may b appidaga h am pac a adjact cti h mc Th gadacmmcmt ad grada ra h pr i impta bca

h avid d timai particay a ar tratigmc hch ar i a tat mi-cracr ad ar thr airtab cditi

Fr ch bact mc tat kadg a dcbd b db itab bca it d b t magi act i kadig ampd i ch a a h mc mry g it hr pam, aggravatig h ympm rahr ha vig hm I i aay pibt th mc br rax d yr thmb bt t i a mt gatyg

g h d happ Th tat ctacti m may b markd ha v ihibti t iriaig ad th ha ad r thpmm pi raxati i h y tramt hch achiv ma i.

2 Kldg

Thi mhd d r mc hch ar chricay cracd r ihch m atati i rct ha ccrd. Th ct did maiy a icra i crcati thrgh th mc Th ram imatig i characr a pik g dvp i th k vyig hmc tratd thr am th kadg i th ttchg hrdmc ad t d thi th pati pacd i a pti hch d ttchth mc h a drct ravr t th mc b appy a m,y mvig hythmica pr t th mc i t itdd t rlb

th mc r k r th ki ad mc hd b mad t g ag th th h th had r h p th gr thmb Smim a10 ad r mvm i d tarig ith a iiti traight trtch thhad may r a cica r va trkt i mm caryt mv vr th ki r a hrt ditac bt v q t rbvr h ac th k a ch [ mt itac bh had ard tghr r rircmt ad t hp makg th mvm timr irm ad hyhmca.



Spe£'ia Musc Treatme

r<hngucl rqur trtch h thy a hrtd f y r

du, ptcty, ctl cactur. Exapl htr prd blzat pt ptcty hpl lctr txa ttl da crcu talp ad trtclhrt by kltal fault lubar rd ht l c. ucy b hrt fr bu r tht td-chll tht hr. Orly fc d td y b hrtd a Dupuytctrct, p cu. All f th cdt rqur lly ppldad trly utad trtch th tudal drct thucl. y f th b r chc tractbl tt ad ltducc y y b chd. Locali=ed musce OIractions ccu cld brt. arbly th urc f th ucl rtt ca btracd t th atcult tlly cctd th th uc d t cay t cp th th cu th brt r, h brt' h b prt fr H t ca cha ccur th uc,ad tr th rl f th ral cau a fc pt f rtt prt th ucl Such t bt dlt th by dp fct

Dee Fricioh lclzd ctract carfully dtctd ad trr prur

appld t d fr th tdr t. h thd l y alublr pful td ucul-tdu rt hrtd lt

h da f th frct t prt crad bld upply t thactd tuuch tu ar uualy but ply uppld th bdad th a pbl xplat f th fqucy f trubl th uprpatu td l purtca td-achll xt drucu tc

Hammring ad quashingh ufuly ppld t br-ftty dul th lutl ar. h

bct hr t brk th lt bra f th dul that thftty tral ca cap Athr t th al th rt r akltd hth. urt th al l cu th cdtthuh t d t ur t rcurrc.

Perissagtr, r pck up d quz th ucl ad rly fat

luabl thd f dal th paful fatty dpt d r9 1



9 ALAS OF TCQ

mucl, h ocd pcut n whch codon w nd bnd of run rht n from h kn dow to fc d muchu prn h t to con If th oft tu r uzd 'puoge ct formd h k. Such tu h vr poo blooduppl nd rouh hd uz ndn twt pur wllcu locl tu dm conut htmc pon thrchvn r ood uppl. t up how ftr fw uchtrtmnt th hrd douh rulr tu c b rokn dow nto oft,mooh d p u



NEC SO SSU

Efurg

Eeue he e ued f rk the k cree ve d

lphc dre, u he ethd lr t rthdx e. O e he te ppct ha the tepathc ppch peclcce r expe ere e pped dd dd dect r the de the e, cr the cheek theale he adle d the l the terr rde 0 he tertd h vle pv lphc d ve de the ee e d hed d prcull pppate herehee cet thee eld.

The Neck

\DS O SOTISSUE NIQU

(I) Kndng. . 3The pet le pe the te h her hed ret cplee

relxed l pll A h pl ed th t eve cetr r the hd t rk crtl. Std hd th patet thepertr plce h hd ether de the ck th h e pred ver the pterr d te cervcal ucle. The peratr pll

et prd d utrd thee cle, tretch d relx theuce the p prcee ll the hle e crel t tlet the er lp ver the k.

2 Kneding I 32Wth the pet l upe, the perr d t the lt the

ptet d pce h rh hd her ehed hle h le hd placed the rht de her eck keep the tp the er erl

t the pu prcee.The perat pll trd hel th the e hd hle h rht

hd rtte the hed etl r h d t retceTh vee huld b de ll d rhthcll crdat theveet the t hd ht he rht hd rte he hd ar h d at the e te, the let hd pul the cle rthe p pcee th veet the patet' k is ttedl t ech de. Ft the let hd pple re pul ad the eck



94 ALAS OF TECHNIQU(S

I 32

aed 10 e e ad he he h had appes me psh ad he heads ated 10 he h eect the hyhm the mvemet s ceatedby aeat the pl ad psh betee the t hads. Whle he hthad s psh the let shld mata sme esstace ad hle he

let had pll sme essace shld be maaed by the hthad.

3 Rxilg

T ela the deep sbccptal msces the patet assmes the sameps as bee The peat sad a the head the table lts thepaes had pads slht ees ad ests the vete hehead aat hs abdme hs pst by appma the ad



E NC SOFT I 95

FG

er the mle mak t eaer r he pertr t ked rethad relax them

4 Knading I. 33Wh h patt a tl a h ta, he akd la

ard t h ldd arm a h er th ta d he aeh head h lded am. By ad hd the pat r jlhty e de, the prar al e h had t rela allthe m r the pt the pper thra area. h thm may d al mat th th had



96 ALA O CNQ

FIG. 34

ALAOR C"Q CRVCAL ARA

hese mvemes my cveetly be ced ut th the ptety supe d he pet sd t he hed

he mvemets used duce fd- bckd- d sdebedtt d ccumdct

Forward Bending

he pet plces hs lef hd the ptet's le shulde d



TH CK ICI 97

FIG. 35

crade the occpa reon h h hand he head then ed nt fu exon of the eck obaned, the moeme ben repeated moothand rhhmca eera tme

Fw Bnng F Aternate the opeaor oe h foear and ret boh had o

he paen hoer o hat he head ppoed o h croed fore

a a he arm he opeator carre he head and nek nto troneon un the houde conact a a fcrm.

Bacw Bg F 5The opeato pace oe had uder the pate' neck o ht the

thumb and foee pre aan he poteror apec of the arcaprocee o eher de of a en cerc ertebra. n th contac a

a fucrm the operator h rp he pae chn th the othe hand



98 AA OF NQU[

d lt the ch ht the eck exteded. y m he ulcrm echrtcl my e reted

Roaio. F. 6

htly rp the ch th e hd d the ccptl re hthe her the pertr lly bt rmly rtte the hed, repet thememet eer tme ted lhtly t cree he re ech tme

Sbing. F. 7he pertr plce e hd the ptet hde crdle the



T K: TCU 99

FIG. 37

occpl eon n he othe hnd nd mly debend the neck wy omthe hode he movement my be enfoced f he opeo ennt the hed

In ode to obn moe ocled debendn he opeto my phe chn nd ppo he de of the hed wh the foem nd m

Amn th to be he ht m the ltel de of the left ndex ne pd eny no th lt d of th n at a vn veba lv andmoved mly o the ht whle the opeto eet lht pee on theveex of the hed by pen wh h chet n the hed l necey o bend he knee to e centy low to do th movement

Ccuuci 8

he opeto p he occptl eon wth both hnd he ne

pontn downwd nd he thmb lyn ove the mndbl nd chn



100 T I IIE

FIG. 38

Applyn h ptm t th t f th pt d pt lt dm p kpn t x t md, whlmkn cc mmnt w hnd. h wl c th ppccl p th th mm f n dndn dtnn ccly

A f-ht mmn my ppld t th wl nck yppt th ccplnt t pm f h d dcyn th d nd ck h th mmn f ttn d d

d lnt d



CKING HNI

All he tcuty techues bve e -secc th ll thejs f the e tke t he mvemet bt secc techues wewsh t mve e jt ly. de t cheve cccy f mt thee e cet ules t be bseved wth ed t st theet t ly e secc thust he tet mst be cmfble d the et cecly sed, blced sely hs tw feets ht the mvemet c be ced ut smh me but tfm these elemey ts the st f the f jts the f the se we e de wh mst be sch tht the djustvefce s dected t the jt uest d tht djct jts e fcbly mved fc delly the djcet jts shld be tectedby lck, .e lcked st fthe mvemet

Nw thee e tw wys f chev lck e vlves thest f tcul fcets (cet Ast ck d he thevves the tk f the slck the sft tssues (metses ck.

Fa Apposiio ogy ths we me th he fcets e fced st ech the t ht

les t the m le f mvemet If such fce s used hethee wll be she mvemet d the jt d ssbty f sde-s f the jt whle the sedded fce f the seccmut s led.

I de t udestd d ly ths cle t s ecessy f the

et t hve detled kwlede f the les d les f thehysel jts Aedx d t kw wt hes the sewhe cmbed mvemets cc he subject s smewht vved becuse mvemets c ccu thee es I fd d bckwdbed, 2) tt d ) sdebed, but becuse f the l mes ddect f the fcets lmt s lced the e e dect dy fuhe mvemet must ccu cmbt wth secd dectf mvemet. ht s t sy, t s ssble t sdebed the eck f sht

dstce, but uckly the fcets cme t st d y futhesdebed mst cc cmbt wth tt smlly, ttct ceed f befe sdebed s vved s.

the vetebl clm cssted f vetebl bdes seted bydscs ly d thee wee hysel jts, ue tt d uesdebed culd cc thuh eve the, becuse f the te dste cuves, thee wuld be dstct lm t t the e f e ttd e sdebed As t s, the se hs ly t mve few deees

0



2 T OF EIQES

m h ut ct p (h th ct mv ypl) h ct th ch h. Th td h pvt mvmt th tvl dc, th pv h th pphyl t d uth mvmt vd y h pl h c

th cvc dd d ccu th m dhth th ck t pt x xt h p. h ck , y dt th h d pudd th ct cld d thy c h vt t thht d th cmd dd-tt uth mvmt pl. Smly th ck ttd t h ht th ly pu tt c ccu mly th tlxl jt, u th ct pp ch h d uth t c ly tk pc cm th dd th ht

Much th ly k d p mvm ly dy ytt d mt th cdt udtd h h clphylc mvmt du t hm h k mly hlpdy ldy, h ppd vl clum p-mm hch h lmt tc d xl tt. h Hdy p hd much c u udtd pl mty I my hv l t cm ytt ccu y X-y mlty m h, Xy tk h p h l mt mvm

Alhuh h cvcl p tt d dd mut ccu tth m d h d /lot pply t h horcic d m hp. Oy h th x d dd d tccu h m d I th hcc-lum p h ul ckd-d p th t d sdd ccu pp

t d l th h mpt h ut c-ck pt th pt ck h tt d dd tpp d h c h c ch h d lck thm. xmpl y dd h ck t th ht d t thlt c th ht pphy j tth W l p th pphy j th lt d th ck, . c-lck thht d h ck d lmtu-lck th t d th ck

Ah y t chv c-ck h ccl y ckd d. A h lm ckd d h l m th ct cm t ppt h the l m h up

ct d v h pu pc pp ch th t p uthmvm W u th pt ull ckd d h h u th cvcl cum v du th upp thcc d upp

1 IYETE, . • D.O, merican seopahl oaon Conveio 198

t HALLADY H D.

O,

Apped namy f , Spn (20)



TH C : OCN TCHNUS 10

We e ervl lm lked by rttn nd deedn tppte de, e l l need t de te mnt f e mpenteer lt f deend r lt f rttd t vernedrer mre y t type f retr pree e. f ee rt et e te 5 e r e ere t v dd mpe ttn mpred t debednee rete renement f tene.

ee e etn f te d d kd re beet e n te lczt te level j n mnpnI e t d e . j, e e e netrl pt dyetee ex nd exten f te j en ler dn erere end e neck frd e pppe mnt eeme deend c I f te len . e eed e t eckd ed mt e deend t te ppe jn I nte rd e rere e cmnt d d bcdendn deedn d rtt lze fce t te ex level e len d bn t eexc m fck, t ptet den

A te lkn m t be t mple ere te djve

e te pne f te ft ll nt eve te jet f freen ten. te ervl mn te per fet e lmt detlyptepely d e dret f r trt m be pe. Abette ppretn f tee p b bted by tdy ed p m (e Appendx)

e mnt f tt mt be f ent mpde t ee te jn e rt de nd t mt be f rt ne t e re rredr de n l p te ppyel t te left de f te

ervl lmn.e tt my be ve eer t te tmb r te d def e be f te er bt e ferm d be det le tte tn mvement rder t b ent fre t rt rne

Liglo Ton Lokng

Wen te fet e eprted rm e ter te ple f teppyel j e ped nder te d frer mvement f e

nt peveted A mdere mnt frter eprtn te d n rm nd be ke p by e ely te lmett t pble np e metrpplnel jnt by frntem ltly eynd er nm re d lkn dt dn y rm t tt jn fct tee dded ee ffeedm ere. Smrly pble t p te ntervertebrl j fe pe nd mke lk ne ee lk nd re f pr vle f te jnt ve rml re f mvement lredy, t

f e jnt ere prevly retrted d te mpltn prde



104 LS O ECNQ

lk, thn omhn dntly ahvd. Th lat lk a allyah ot ad a mo aal than adl

d fo d to a h jot h th ae od

yod lat an ad w a' h jot, w ta h alam and w j th a.

a thnq w a omnaton of aok and amno-lokn A wa ad al, w dd h k to h had otat to h lf w n th ht ow o aet o aoo adth lf ow a ad W a tho a oo to fatok wh lan th ht ow of aohyal on o to amnolokn wh la th lt ow o aohyal jo Somtm a

manato of ay th 6 C ont ahev oh th amnta t omtm dlt to whh ha od d amanUaton and t do not atly ma a o ojv to elad movmt ovdd w do not xv oe o alto maat, ay, th 6 C jot aay ad avod mov 5 C.ad 67 C ma th oao ha a hh d of malatv k he am of fton to mt th dtv o, ay o h haohya jo at 6 C. and not mov th lt 6 C aohyea o.

Whn unK ft-oing nd thrut thniqu w q to otonth ant jt hot of omt xaon o tha a ma an o movmnt ol h jont qo t l at h jon aov andlow. he ht ha to of hh vloty ow amltd ov avy ho a and ly h ot dton wha whuin igntou-tnon-oing, th movmnt low th ow haf and th oton fo do th an not th ht. ha t th xaaon of th dnd ad oato whh a th jot

Whn lamtoon hnq, dal, n aneay o loalzaton o to ton xato wh th o th adjant vta. o xaml F 50 7 f w w h to td otato to th ht of th h 4 C aohyal ontwe aly o xaon on th 5h C. atla o wtho ft dx o th h 5 C. aa o and o l thmo th lt 5 C. ata o W thn a h an hn wth oh had to dnd th nk to th ft dow to 4-5 C and otat to hh down to45 C. A lmay l oton d movmn v thoato a n o t ton ad y an xaton o th otaton hht aohyal jot ad ad hjot d o otaon eto.

h aov mthod o at aoto ok o lamntotnon lok a an laoaton of h nl ad Chat Whn ndir p djun w a lamtotno lok Wh dirt p djutn, w a fa

aoo lokn.



TilE N SPC CNQUS 105

FG. 39

SPC CQUS

Opt-Alnal Jins

lty my e rercted ech f thee drectfrrded ckrd ed deed d rt.

Blaeral Technqu or Fowardbendng Reriion. F 9Wth the ptet pe, the pertr d t the hed the tle,

d the ptet hed pprted y t pll, the pertr pce hlet hd der the ccpt d phe cdly he frehed th hrht hd the hed therey frcly exed t the ccp-tltl A rck mt cet t ce mlr mt the ret fthe dy c e ed ely fr rtcltry prpe r vrly dpecclly fr ree the jt frm xt We re drectpecc djtmet here th lmetlck the ret f thecercl pe.



106 Al LAS OF CNQU

FIG. 40

Bt Tchnqu r Bc'r-bnng estrctn IG The atet es se h her head e ll. he eratr

sad at he head f the table laces hs left had der he hsrh had der the atets ch hs left had shes ards crea

a erfl etes meme at the ccatlaal t t reqrest be de sharly t achee sucet searat f the arclar faces

Untr Tc/lq th ccp-A tl Jnt these techques f bh sdes are led the resrct each sde

s treated searately eably sch laeral techues sme deref rtat ad sde bed frard ad backard bed s sed heechqes therefre are fte f ale cmlcated jt resrcts



C: S'EC ECNIQU 107

4

Baka-blg h e F. 41e pent le pe nd te opertor, eted t te ed of te tble,

rp er cn t rt d e lef nd plced nder te occpt o tt lef tb c x te lterl proce of te tl on te leftd left dde ner oppoe te rc of te t o te rt etb ctly ook over te rnvere proce of te tl o tt teeft condyle of te occpt c ft forrd pon te let fcet of tetl No te ed tlted bckrd to dce fcet-lock of teloer cervc vertebre prd nd te ed rotted rond to te rt fr cofortble cdety t con oy old ppot

te ed o tt en te ctl otton tke plce te opertor' rtnd coe nto ontct t te pllo ety ere to prevent too c rotto e nl oveent rp, ort exertoof te rotton cobed t xton of te tl by te left nd tece ele on te lon lever of te kl nt dt xto of tet nd terefoe coe nder te ed of ndect pecc dtet It y lo be ed . leon of te left occpto-tltlont



108 AL Of T[I IQU

Flc. 42

Frwrbeng ril h Lef F. or h chq h ll placd ch a poo ha a drc

hr o h arch o h ala pobl o orc h l ala ac oraddr h l occpal ac

To ach h objc pac h pa p; a al dgr oo, lgh dbdg o l ad roao o h rgh brg harch o h ala pro o h l Th h radal d o h l dgr dr aga h arch h dirco o h pla o arclarac. No ral ocg pob h h chq h prcpl old hr ha o h co o c a harp dd hr ll



Tl NECK: SPECIF TECHIQUS 109

o. 43

sh o b tho dstrbg h ohrs. Tha s o say a sg

a s ths' y o thq

Rtat Retiti t t Rg. 4Pl th at s hr had fly o as lgatos

so loig o a h os bo h ota th had o h righ fly bygrasg th h th th ght had ad th ot th th lf hadg th trass oss o h aas o th l h h oraors lt. Th adjs s a aggrao o roao



TL OF TQU

FIG. 44

Sdg st Ih gh G 4

Pac ptt pn t r ad pord b t o toabt 4 dgr f xo. tand a t ad of t tab d bd pat ad gt ad ra t t ft to ca ac-ocng of r cca j o gt. oat t ad t o p and t t tora ar f t aag tpo g a xd r ad fy xtdd b. Pac y rgtand agat t at rgt c ad xr a dad r t

t gtr t a ad pr f t t ad cratg a rg



TE ECK: ECIIC TECQU

IG 45

frc a cc-aata j. I rd b c c ca a h abl ad t gt ll r atnt tha t lt a ral. h ax dbdg frccc a l ccaaa j b hrg fr alfl rgh chq a g dc cc adjtt drt r big ald th f.

Aax Lel

r ar ra rc a t t tr al bca h trar pr f . r a addl bddd d -atd thrr h a d ag f ra ha a r ar d a.h l dagd r b cl a ahg f h

a trt ta h ttg at ad h



1 1 ATA or TCIQU

o a oal by o 1 C. o

Maao o jo by oao ad

al oo day b o ad o No dbdg d

ROain R n o Rig FG 5 d oao o g a oao

a ad o abl ga g ad o l oa ad a a a obl o g ad a oa a o oao jo T o a o lo ay

adja jo o o a o alaodd o ad ol laao o a. o ablao o a l g ad b aga ao o a d o loalao o T ll adaa o a a .

o l Cvia Jot 2-

Ro o o go ojo a ally a obao o d oao ad dbdg ad aly o do q b d dbdg ad d oao dg Fo oo o d o oo ally do by laal q a o oaodlo. l o b dbd a ll a o o o blaalq

l old alao o al ol a

o a aoo log by dbdg ad oao ooo d ad odly o d a a d ao ala a (a d ad. T oo ad a dbdg a a a lod aoyal jo adoao d o a all la al o oyo . T dbdg o ad by ly bdg ado d b a by g o ad d lad g o oo d g g g a a

l a l o o ag a oay o d o Fally b ad ad oad l la o aoyal jo

T hne Sdbndng R in 10 Rig F. 6

W a ad oao a ad o abl ad all o g ga yo l ad ad o ad yo l oa ad lbo la ada d o yo g d



TE C: C C CHQU l I

Flo.

gr o arclar roc o r o o rbra old lo ly a c o l o ac a dbdg o rg a dcad abo amo o dbdg drmd by a o rac l dx gr ad road o localzd o o yo o mo o ma r corrc drco rg orarm m b arclar ac cary o a yor rg boamo ocg a rg odr o a r ardad orard drco o a' l roal ara. Oly bydyg ad g drco o ac ll bobl o alz drco o r. A commo ma or oo larallyladg o a jammg o aoya jorar a a aao o m

H



1 1 4 ATLS O ECHNIQUS

FIG. 47

2 Sdbnding Ricton to th RightThs hod s h sa as h abo b h hs s ad hrogh

h hb sad o h d gr. Th choc o hod dds oso o h oraors o hads. I h oraors hbshd h ar or sl or hs o hrs ha h dg.

(3 clu fo Sdbndng Rstton to th Right 47

Ths hod ss h rls o drc scc ads sad o grasg h ch ad had h h hol rgh had orarad bo as Mhod O gras h gh sd o h as hadarl lghl h h gh had ad h sd o h as had hh had. Th o hads hror loos hod h had hoso o oao o h gh ad sdbdg h c o h l. Th



T N P HQ US 1 1

.

1f nd ng s pacd a n Mhod On at h ll of h lon bh man dnc h s hat h dbndng and aon d 10

cat a l of th pp ccal pn. h opato oll th had abotn h hands nng th coct poton and a a contnaton of thollng sddnly and haply nca th otaton and sdbndng toa a capa gappng of th apophysal jont on th ght d of hnck. Mthod On and o hold b pactd st hs thd mthod mo comfotabl fo h pant and s hfo a to oban

axaon b t q pcon and accat ts sns on th pat ofh opato

() Tcniqu fo Rotation Rsttion to t ft G 8In th mhod h patnt s satd facng h opato t sa

z a lon of stctd otaton to th lft Plac yo ft palm agansth gh d of t patnts nck and yo ght hand acos th patnschk and mpoal aa. Sdbnd th pan' nck to th ght and



1 1 6 AA O HIQU

FlO. 4

otat to th ft oazg th fors to th jont yo sh to mov. h

had s kd, as t nrasg t rotato to th ft and sdbndng to th rght hpg to oaz th fors by appyg th pamarsrfa of th ft mdd gr po th artar pross of th vrtbraabov. hs th ss th prp of ndrt sp adjstm

and ass a gappg of th aps o th ft sd of th k

5 TJmu f Ran Rtn t t Lef. IG. 49

Aga th th patt sttngth th sam sostand at hr ftsd spport th patnt's rght hk n yor ft hand pa yor rghthad rod th patts nk postrory so that th rght mdd ngr sovr th artar pross on th rght sd of th pants nk ad yor

ght thmb s pad agst h ft mastod pross. hn yor ft hand



SPE EHQU

Flo. 50

a otol h otao to th lf ad yo ght th dbdig to h

gh. Loalzg fos a b boght to ba aatly to h o qo by ths mthod g h ppl o d sp adjstm.

6 cq r ROl Rscl 1 h Rgh 4-5 . I 50

Th mthod s pmaly sd d oao lo Wth hpatt yg p tad a th had d of th tabl ad gap thpat h th th ght had hod h k h th had mlyxg ay th C ata poss yo lt d g ad thmb



1 8 ALAS OF ECHNQUE

Sdbnd th ad t th lft and roat don o t sng a xon a sam tm avng t had sortd by llos to abo10 dg or dg. of xon. hs tcnq agan ss ndrc scc

adjsmn and lgamnostnsonockng of r . ons txaton of th vrbra blo th jont hc s rstrctd h adsvforc s an ncras of th roaon ckng t chn rond o rght s sfl o hav th llo arrangd so that th roaon cann b carrdbyond safty lm.

CervoThora Aa

SOF- SSE TCHIQ

rm th clncl ont o f v th soldr grdl and cvcohc mscl gros ar arclrly moran bcas thy ar sofn ctd by brosts. h socalld nodls n mscls rlocad ros of mscl contracton and ar aays scondary o somjont or nrv lson sgmntally connctd th t mscl nvovdWhl ras s ofn an ondr I nd a vaor scaland rombods ar mor frqntly nvolvd. hs s ossby bs 3 and nrvs to t ras ar manly snsory hras thoso th lvator scala and rhombods ar manly moor 3 dld srasnats nfrasnas and rs mnor ar aso commonss for locazd mscl conracons and tr nrv sly s 6 h tys f arclar lsons most frqntly bamory for s msclrrablty ar jon strans of thaoysal ons and dgnratv lsonsof th dscs and aohysal jonts Aoysal jontstrans ar f anythng mor common at 3 o . ras dgnrav dsc changs armor common at o 7 . Irrably of scaln mscls cass mcan n shodr and arm bcas of thr clos assocaton brachal lxs. I s ossbl as hav sad arr o hav lvatd1s and nd rb lsons and ths ar scondary to nd nson n scaln mscls. Sch ncrasd tnson and lvaton dcrass szf th - tiangl and u brah lx. nothr ords aohysal jontstrans say at 3 and c., may ll casrrtaon of h scaln and so n trn cas an rfrabl o th bracallxs at to .

Wn rlaxng th mscl nsons of t crvcothoracc ara cans many of cnqs dscrbd for crvcal softss ork . 93bt thr ar svral ohr mods rmarly adatd for ths gro o

mscls



CCO-I O U 1 1

I) Keag e Tapez Aea IG. 1 pa s spn ad sppod by a mdmszd

plo lang t nck f. opato sod b sad at ado t plnt so a s ams can st comfotaly on t abl on acsd of t patnt's ad Hs tmbs can o connnly placd n C.. aa and t gs ca st gly .. o dggng n ) acosst clacla aa to ms a no sd to kad ad oatand smoot ot t locazd sotss tckngs c a fond n apzs lato scapla and ombod mscs.

By sng g pllos t tscapla aa ca b acd com

foably n s posto.



10 AAS O ECHIUES

( ooseig the houldr rdle Musles FG. 52Wth th patt p th opato tad o h ght d od

to loo th ght hod gdl mc ap th patt ght amtckg h ght had to yo ght axlla ad ppotg h ghtam ad foam th yo ght had ad foam. Yo ft had

pacd o th patt' ght hold to tady ad at th pochch cot of a ccla moto h latv poto of th hmcapla ad cavcl a ot atd th movmt h moto coldphap b bt dcbd by compag th am th th cakhaft oth hl of a tam g. By xctg ch a cca movmt allth mcl attachd to th capla ad clavcl a altatly ttchdad laxd ad t hlp to f ay tco caplothoacc movmt.



CEVICO- ORAC C AR A SOf ISSE 1 1

53

3 trethg the terscapula Musces FIG 3Aot fl mtod fo ttcig t ig itcapla mcl

i to av t patit pi t opato adig o igt id. Hgap igt am t abov lbo ad ogly addct told o at am i focd aco ct oad t lft

od. opato plac i lft ad o mdial bod of tigt capa ft to ait i motio of tcig igt itcapla mcl. motio old b a lo ockig actio o obtaia imitt c of t mcl.

(4 trethg the hulder dle Musles IG. 4 pait i o lf d i t opato facig t

opato t la ov t patit ad ppot t patit' igt d



1 22 ATLAS OF TECNIQUES

54

lbo th his on xd ft lbo his lt orarm ndath hr

right arm and raching ih his l hand to th mdial bordr o hr rightscapla. h oprators righ hand grasps th ppr part o hr rightscapla. n ths ay th right sholdr girdl can b movd as a nit in anpard and donard movmn or in a circlar movmnt ; or h mdialbordr o th scapa can b plld aay rom th chst allall thsactions bg dsignd to strtch and rla th shodr girdl and intrscaplar mscls. his sidlying position is also sl or applying dirctknading or fricions to th rapis and intrscaplar mscls sing

th thmb to prss dpy into ths mscls

( tretching the ecora Musces IG. Somtis on has occasion to trat th pctora mscls and,

althogh th prvos srtchng movmnts do hav som ct on thpctoralis ajor and minor thy do not spcically srtch thm. Agood mthod or this is to hav th patint spin, th oprator standingn hr righ sid grasping hr right rist ith his lt hand and srongy



C V I O - II O A C C A A A I C AO 13

tthg h ptoal by g th hold to th l. Som op a b appd h th opato ght had o th bly o thptoa majo

AIAOY EIUES O E EVIOHOAI AEA

th atatoy thq o th val aa a b d to omxt mog h othoa gop b t ll b at h mt ofh ag bo ay hg a o lo do. h thqdbd blo ao applabl to h a gop b a b do b advatag th pp hoa ot.



1 ALA O HQU

56

( I Artcutil. FIG 56

Wh h nt yng on h gh d h oao fng hot h hd and nk th h lft hand and fom h atntght am llod o on th abl omfotaby h h holdand lbo xd at ght angl. H ft hod addtd o that thfoam dangl vtay ov h d of th tab and t an b hldmly f dd y gang h foam tn th oao kn.

h oato l h ght hnd on th hoa aa and gaa no o h h ng and thmb h ght hand an hn ata a tal o h lft hand hh d o th x xnd dbndo ota h nk to th mt of ang n ah dton n th ataoy ty of atmn a not attmtng to b to any onont and thfo a not onnd th vy aat loalng offo no a ntd n aaoonIokng; ah a ng gmnto tnon o ahv o ojv of thng th nd



CVHOC C R : CUON

FIG. 57

da n n th crcthacaa. W thf hd cnn arcatn t p dbndng, p xn p xtnn andp tan and nt any cbnan f th n

() Aruao FG 7

Anhr ptn n hch artcatn f h crcthracc aracan b card t th th patnt pn and rtng pn h xdb h fa bng paatd by abt 1 8 n. and yng paah ach th. In h ptn th had can b d a a f fcngxn xtnn dbndng tatn n h ccthracc gpf jn. Dng x th ct nhancd by appyng dgf x p n th k and cntp f th thb aganth pn pc



1 ATLA S O TE QUES

FIG. 58

THE EVO-TlORAIC SPEF IC ENIQUES

F pup i-ai aa xd m . dw T T yp u maiy d i aa i bydi pi adm ug a appii ig By bawadbdig dw id w au baa a

ig. J xi ia pi ii a a a mpg up ama ba bw. Ayu bawad dig a y a pa a x agidia igam

i pb i a diab, a a appi ig byidbdig ad a i pp d. A wa xpad a ma mm ddg i ia pi ampaid bym dg a ba bdi am id, w



CERVICO-THORCIC A RE A : SPECIFIC TEHNIQUE 17

e moeme ar rom a poio o exio o exeio or i eera poiio. ereore o oba appoiio o ae we m arragea e idebedg ad roaio are oppoie direio. e ide owi idebedig or i oed by ae appoiio ad e oer de ixed by gameo eio oer word i we wi o reae a aeoig o e e row o apopyea joIS i e e we m ide bede e o e e ad oae o e ig

o obai oaizaio e erio-orai area ad poeio i e we use a ombaio o bwad bedig idebedig adreere roaio ad a e oowig meod ae ee priipe beidem ey merey ay beae e arig pore o e paie adoperaor i diee I w be od a oe poio more iabe ooe ype o paie ad aoe poiio moe abe or aoer ype.Te ee appropiae o a ge paie a oy be deermied bypreimary poio ia o dioer e opimm reaxaio poio

Snng Rtiton o2-3 T to t Rg IG. 8ae e paie ig o a p or a oo wi e opraor adig

bed igy o er e. e operaor pae i e oo o e oobeide er wi i ee exed o a e paie e axa a re oeri ig ad er e am a ag ooey dow. i pio eoperaor draw e paie oer owad im i e i igy o baaereig omoraby o e e bo ad er ba ppoed agaie opeao body. e operao ow pae e mb o i rig adagai e rig ide o e pio poe o 3 T. Te ger o e ead are paed o e erex o e ead ad oeead. g i e

ad e opeao bed e ria om baward o ae-o eera area e e debed e e o e rig ad roae o ee. e eere roaio ep i rer ae appoio o e apopyeao A dre pe adjme i made by maeo aereore agai e rig de o 3 T. po proe wi e rig mbad g exaggeraio o debedig o e g wi e e ad.

Pror o e aa adjme i i mo impora a e paie'rig oder gde i ompeey reaxed ad e rig arm od ag

impy dow. Te paie od o be o oo ig a oo A oo 2 o24 ie i idea ad mae e proede eaier o e opeaor Teopeao ig oream od be i ie wi e mb o a er i dowward a we a aee ad i a parae wi epae o e ae wi be ee rom e poograp a e g ebowi ig ad we orward o e paie rig oder. A preimaryroig o e paie rom ide o de g e rm o e e eei deirabe o a e paie i omewa o baae ad e apex o e

idebedig i oad a 23 .



128 ALAS OF TECHNIQUS

Sidebending Reson o T o e Righ. 59h pant ls o h lt sd o th plnth h h opato acg

h H ght am s doppd doads o th sd o th tabl andhld btn th opao's ks hs ll hp to stablz h ghtsod. H shod hch s cotact h th tabl s sctlystablzd by spcmbnt ght h sholds shold b sqa onth tabl and h t am sts o th tabl ot o th ay th shodad lbo xd at ght angs. h opato's lt thna mnc splacd mly aganst th ght sd o 3 spnos pocss H no ls pth patnt's had and nck placng hs ght ngs my ond th

o "cal aa h hs ght oam sppotg th l lata aspcto h n ad had. h opato no tds th ck don to thlson and sd bnds th had ad ck toads hmsl .. to th ghtth otaton toads th lt ntl tnso s lt bt th 2 and 3 spnos pocsss Adjstmnt s mad by a sddn tass . donads oc aganst th spnos pocss h th lt had ad a smltaos cas o sdbndg th th ght hand h sam pcp odct spcc adstmnt s sd as n Mthod O.



EVO-HI AE PE IC TNIE 129

Sidebeg Rec T t e RgI. FIG 0h pa po o h a wh h h g o a hio

o x d h a om. h opao ad o h f d o hpai oppo h hod gd. a w o h pai ofa ha hi oo i amo paa wih h pai ad pa h ighhm my aga h gh id of h pio po of 2 Wih h had h idd h ia om away om himf i owadh igh. o a i i poioig h pai pp oo hod a h f id o h pih h oa h had ad o hf o ha h pai fa i owad him Adm mad yog di h agai h po po of 2 i a aad dowwad dio whi a h am m ighy iaig hddg wih opao had h had pad agai h id o h pa fa ad h pai pio o h hi o oaih i awad dg iddig ad oaio

I



30 AS Of EUES

61

idebending ericon / T o he Rgh Aher pii i whih he ehie a be ed i wih he paie

pie hi ime he paie reire be paed ha her head prebeyd he pih he perar i a he head f he abe ad e hief had ppr her head he paie hrax eed be phed

he ef f he abe fai iae idebedi f he ek he rih. hee i bakwad be dw 23 , he idebe he rih adraed he ef. Eah hee hree mpe f he meme ir hd bri ei bear a he 23 ji he dire peiadjme i made by a hr aai he rih ide f he p pref 3 i he perar rih hmb, mak re he ebw i apprximaey er he paie rih hder ha he hr i ravere adighy dwward



[VIIA A A SCI IC CN QUS J 1

62

Bcwd-nding ericio 0/ T FI 2Th opao ad a h had o ab wh h pai pi ad

pac hi xd ih o a chio a h had o h ab Thpai i aad o ha h had ad c a i o h opaohih wih h dia d o h m j bow h i o h bacwad

bdi id o Th pai ow io h bhid hhad ad abdc h am a a a h ca h opao had hihad hoh h pac h omd b h pai am o ha hi ca ach dah o h pp hoacic ba. Th opaob i p wih hi aai h a poc iocd ba pwad i o h ad a h am m pi dowwad wihhi oam aai h pai am ca o p h pphoacic ba io bacwad bdi.



2 LS O CQS

63

Backardbdg etrcto of / T FIG 63T mtod tiz t i trt ii. Wi t atit

ro t oao tad at ad o tab T ait r orwad to ira baward bdg o t ia ad torai ara. T oator t atit' w i ad ada o rig ad o t io ro o t ba

bow t rtto rigt oarm rt o t oit to toom ord xto o t Corrtio i mad by a og rtwit t o t ad i a dowward ad owad dirio yrozd wi a mar o ato by t ad o t ati' i

Forardbedg etricted Cericothoraci Leio ord o obai it xioa t o r toai

oi w i to a a r a i ord to aoid d



V T AC ; P ECHQU S 33

Flo. 64

rai i e uer C aea, we ay our oe o e owe C. eebaeug igameoueio-oig o he i oaizaio. ere are woway o aieig hi aer diu obeie.

owadbendng Retrictn f3 T.

FG 4e aie i o a oo wih her ba o e oeao wo re iigh oo o e oo ju behid he aie He ead hi oeamuder boh er axiae ad ieae hi ger ogeer behid her owereria area The aie i he bough ba io exeio ui heoero ee re o e iou oe o he erebae beow hereied joi Te adume i eeed by a har ieae o owardbedig o he ower C ombied wih a ireae o eue wi e

ee agai e iou roe



134 AAS ECHIQUS

FIG, 65

Fmardbedg Re f 2-3 T FI,

ai i, oaor adig o rig of a a ad ad bid r ad bow o og

oao ro ai oward imf by ig o r bow;i ab oraor o i i ig ad o x aga ar ad io ro of bra bow id joi oraor of i ad o x io ad ar ro am of i ad yig a agai -T. ara ad goiig owad T orao x ai ig rag of bow ad ma a idr iadjm by rg dowward o bow i i a

a io gaig for a joi iod



TIRA CIC SI : S ISSU 13

Te oraci Spne

SISSU CQUS

om of mod of ofi axaio a b dibdai w dai wi C- aa. a a o odo appoia fo am i o oa aa ad a ow dibd

( Kneadng the Rgh araereba! Muce I 66

W pai o ad ad d o i o b i

a ab wi a ap fo o o a pai a mmia



36 AAS O CHNIQUS

FIG. 67

wi ad mid i, pa ad f id adpa i w ad g paaba mc T f ad d b pad aa 10 w pi p a adig f gidia m b ab d a wd ad a pd aa fm p p



TH THX S TSS TCHNQS 1 37

ryig ake i a arge a area o mue a poibe Aoug ereod be o gidig or rubbig o e ad oer e ki urae emeod i a ow moeme e ad aeray ad roud bak io e

ame poiio. i o merey a moeme o e operaor adraer m e keep i arm airy rigid ad i woe body od akepar i e aio e keadig od be rymia ad moderaeygee aimig a reaxaio o e paraerebra me. raday eoperaor a moe i poiio pward or dowward iude ewoe orai or ee mbar area o e pie.

od oaized area o me oraio be eouered emore oeraed eor a be appied ere ad iead o uig eee o e ad e ba o e mb a be ued o pipoi e auyie.

A imiar irar ype o raere keadig a be aieed i eame poiio a aboe bu e operaor r ideway ookig owarde ead o e paie o a i rig ig re agai e e ide oe abe. o mb a e be ued oe o eier ide o e pioproe o r e mue aeray

() Dp adgo rea e deeper ayer o paraerebra me e mb oud

b paed oe o e pio proee preig aeraey upward addowward a i e rig umb preig raiay ad e e mbpreig aday o oppoie ide o e pie. i reae e muidad roaore mue wi are ruig amo raerey i eorai pie.

(3) Scg L Paavba Muc. G 67Wi e paie o e rig ide ad operaor adig aig er

e operaor pae e ip o a i ger o e paraerebra mueju o e e o e pio proee. i poiio e ger apu upward o e ogiudia bre o obai a re i a raeredireio

A e ame ime o obai a addiioa re o e e paraerebrame e operaor a pre wi i orearm agai e re o em ad oudr raig a oxi upard i orai ara e pie.

T TY TCNQUS N TE THC SP N

A deed earier (p. 88 ariuaio i e appiaio o paie

moeme a moo ad ryma aio graduay o re



138 AAS ECQS

. 68

corced msces igmes d cses, d i order o chiee hisobjecie we se riey o eers o ssis or gers i moig echiererebr joi i ossibe by drec ressre o sios rocesses oeec sm rge o sse moeme bewee wo djce erebred he mehod wi be descrbed beow b he se og erge ismch more eecie d ess comorbe or he ie

The eerges sed ricig he hocic sie re he ec, herms, he ribs, he mbr sie d he egs d ech eer hs is ce

i he rmmerim o he oseohic rciioer hose mehods iwhich he ec is sed s eer he redy bee esribed der hehedig o ricory eches he C- re o he se (. 23)Oher me hods re ow described

( ) oaiol FG 8Wih he ie siig, he oeror sds behid he ie d

sses his righ hd der he ie's righ xi o grs he ro o



ACC PINE AIULAN 19

h h hod e pae hi e hmb aai he pio poeie a he oae he oo o he ih Th hmb a a aoe pe o h oaio o he joi bow ad i hi waobai a mome a ah o h hoai joi.

() Roaio I 9

imia oao aiaio a be obaid b i h am aa . h pai pa h ih had bhid he ad he opaohad hi ih had de h ih axia ad io h pa omedbwee he am ad e o ap he ba o he he opeao'ih ad oappi h pa h had Thi ha mo powa ad eabe he opao o iopoae ome exio a w aoao.



L CQU

FIG. 70

(3 RaWith th patit ig th pratr tad bhid h patit wh

ha dd am; h thrad hi right had udr hr right axia ar

hr h t grap th hdr A trgr grap i baidth wa ad i maiy d r rtati th w thra ad mbarara.

(4) dendng G 0i bdig a b btaid i th ig pit by th pratr

tadig bhd th patit with am dd h pratr tr ightydway that h a pa hi right arm r hr right hdr ar



HR S RUL 4

FIG. 71

e est ad i o e e axa Te opeato a ow exe a dowwadpesse tog s igt axa o te pate's gt sode ad apwad i o te paiet's et sode wit is igt ad is waa oext is oed o e ete spie is sidebet to te igt adoe pesse a be apped wi e opeato's et tmb sessie o ea o te oai spios poesses

5) ma dg FG 71Fowad bedig is best obaed i te sttig positio wi te

patie aspig e ads beid e e ad sig e ebows osetogete as a ee to ex te toa spie



42 ALAS OF ECHNIQUS

7

(6) Bakad Bedg

Bckwd bedig c be cieved te sme wy bt te opetoeces de te ms d exets pwd oce o te elbows toexted te tocc ebe

7 Bakwad Bd FI. 72ckwd bedig te sitig post c lso be obtied by

sdig ot o te seted ptet wo s e ds csed bede eck d e ebows ogete Te oeto sds lile to e igtd plcig is igt soude ude e ms, eces od te piewit bot ms to pply coe esse gst te spious ocesses;te ypote emiece o oe d c be eoced by te ote d



ORAI PIN: ARICULAIO 1

7

d pessue ppled to eh spous poess s te eows pusedupwds the opetos soude

(8) Roation. G 3Wth he ptet poe he opeto stds t e hed o he

tle e sps he pet t jus ove e elow wt hs led d elevtes te , tee exed te shoulde e te usesths evee to otte he toso to the h Fo oot, the pte' hedeeds to e otted o te h d e ed o he pllow he opetoees coue pessue wt s h thu sucessve dow teo spous pocesses o out 5 T. dowwds



144 ATLAS O IQUS

4

(9 Sdebendng FI 74

T paie ies poe ad olds e as aboe e ead, ea ad

odig pposie elbows Tis os a oeiet est o e oeeadTe opeao, sadig o e lef side passes is let ad de boeas 10 asp e paies igt ebow, ad te patet ts e ead

to te ig Tis aageet os a eetie obed ek ad aleeage o sidebedig e toai spie Te opeato apples additioalpessue agaist suessie spios poesses wit is gt eaeieeto oe te spies ute to oexiy o e a se is ig tubgaist te igt side ote spie to oppose te oati o e oexiy



HOI SP IN A RCUON 145

. 7

eter wy e ceg tretcg o e cpe o ec dvdltorcc jot

e bove leverge c redly be oded to rtcle exteo

10) otation FG. 75

e pte le proe d te opertor tdg o er rg de

rece over d wt let d o grp er et lc cret d terorperor lc pe rego d pll te le de o te pelv pwrd t ect rottg te toro to te rgt, tog ct t rotto o tepelv o te let po ed pper toro e br pe d pelv reow bg ed lever to rotte te torcc pe ro below pwrdoter prere w te opertor rgt d eter tb or eDreece gt cceve po procee ceve eectverotory rtclo prtclrly o te lower orcc jo

K



146 AA OF CNQE

7

I ) Backward Bendngit t tint ron t orator ndng on t lef id of t

tint rac ndr t tint tig and ift lowr ritto forc t n into tnion f t tnon i cient t lveragwill tnd t toracic joint wll a lbr

12) Rotatn IG. 6

it t tint on t rigt d nd t oerator fcing r

t lvrg of t tint' lft oldr to rott t torcic in to tft o tbiliz iding oition t in old t knnd i owt nd ti wll to n wobbing of t lowr toro orator now rc ovr t tin and lc rigt ngr andtb r on torcic ino roc rigt forr rt ongt in blow ti tn li ing bcwrd ovent witi l nd gint t tn lft oldr nd b ncrng t

ont of ovnt c torcic joint cn b rottd in trn



OACC SPN: ACUAON 147

FlO. 77

e ae tenqe n be ed in reere xng te de gidlely and rking te ei baard t rtate te tai ine rbl ard.

(13) 'ul and ush F. 77

Witt ing any lng leeage it ible t artilae te trai

jint t e exten by aying a and ' eent it tenge and tb t e in ree r exale te inre 8 an be ed tard te rgt le te 7 T. ne

ed tard te let e ae atin i aied n tg te ret te tri and lba rea, tg litte eent an b aieedin te lbr jint by ti etd n rder t aitate t eente atient ld lie ne it a in nder er et e intr te tra area int exin



148 AAS O INIQUrS

F. 78

IIC CIIQUS

Supine Tehnques Usng ndec Specc Adjusmls

( I ) Fowad-bending Restricon of5 T. IG 78e pe le pe o e be d e operor d o er

rg de e erlok er ger bed er ek d r elbow rebrog ogeer over e er e operor ow grp e peelbow w le d d orer roll er owrd l d ke r xo o e 6 verebr w leed rg d d o rrged er eee be pled g e le



HOA P N E I I NIQE 14

Fo. 79

sese pocess of 6 T whle te middle phx of the mddle e isplced is the i sese pocess of 6 d te spous pocessesie i e ooe fomed b te kuces d the emiece Theopetos idex e les out sth d tes o p te xtoTe ptie is ow oed bck o to the ble oe te opeto's id us tis m xo of 6 T. s ulcum. Te opeto les oete pet d mkes sudde sp hust s he piets elbowswih his left d i dowwd diectio Tis focib exes hetocic etbe boe usi metous teso loc d if hetesios e ccutel pplied the 56 . o s pped.

l te hocic os c be miputed i hs w b lte eposiio of he fulcum d b tei he posiio of te ptiet' ds



ALAS OF EIQS

behid the e We require ess eio i the upper thorai ar ompared with the lower thorai area ad to ahieve this the patients handsshould be low in the e for the upper thorai joints and high in the ne

for th lower thorai joits.

(2 Bakward-bdig Resrtion 01 T. FG 79The method here desribed is similar in positio to the above but

i sted of plaing the thorai spine i eion it is plaed i etensio.The patiet lies supie with her hads asped low dow behid her

e. The ebows are brought together over the steum. The operatorgrasps the patients elbows with his left forearm and had rols the patiet

over towards him ad rmly paes his eed right had er 6 T. as i theprevious tehique The patiet is then allowed to roll ba at o to thetable over the operators eed right hand The patiet does ot requireay pilow as the head does ot e at al. The thorai spe is i fuletesio usig this rm ation of 6 T as a furum. The operator leasover his patiet maes a sudde sharp thrust against her ebows wth hisleft had in a dowward diretio so that the resultt fore will passthrough he artiuatio at 56 T.

3 Bkwrdb:dg Retritiol FIG 80

The above tehique may be varied by rossig the ptients ars overher hest istead of laspig the hads behind the ne The advatagesof this method are that it paes less strain o the sho"ders ad avoidsne leverage-this may be desirable in some ases.

The atiet rosses the arms fully rather than fods the arms so that shelasps her left shouder with her right hand and her rigt shoulder with her

left had. The same type of furum against the transverse and spiousproesses is used.

(4 Rottion-retrd Liol the Thoc Spe

Frequently if there is a restrition of rotation say to the right there isa positioal fault ad the vertebra is ed i rotatio to the lef so maigthe eft trasverse proess prominet. We therefore use this trasverseproess as a point of atio The other poit of atio is the opposite

trasverse proess of the vertebra belowin this way a strog very loalrotatio fore an be eeted

this esio the operator stands on the right side of the supie patientwho has lasped her gers behid her ne (as in Fig. 78) The operatorgrasps the two elbows lose together usig his left had ad forearm adi this way pulls the patient towards hm thus eposig the thorai spiewhih an be arefully palpated The operator plaes his right thenareminene o the promiet trasverse proess o the left and his eed



HORA SPNE SPE EHQUE 1 5

Fo. 80

kuke of the iht mile e o the piets iht tsvese poess

of the veteb beow. he oll the pte bck o to the opetosh he ives oww thus-so e s to buil up he tesiot he estte jot my o the eft of the joit We heeoe ee tobi he ebows l i le o the eft of the steum the h mwy ovehe steum s i the pevous tehiues t shoul be oe h mio of he h is the spe whie etu to the supie posos impeve othewise it is vey esy to lte you postio so lose theeectveess o he mipultio



5 ATLAS ECHNIQUE

FIG. 1

Pole Tehque l he Thoac Aea arg o s p o q s mpora o sr a

pa s lg o a wllpaddd or sprg fa f surfa s adr o rbs or srm ma rsl

I Back'adbendng Retton G 8 pa s pro w r k ad ppr s sppord o

sos o o ora sp o xso ad ad as



HOACC SP : SP CC CQUS 53

e id ine. Te opeo wi wi fy exended ppe i pifobone o e nvee poee of e veebe beow e xon enge of one nd poin owd e pien ed nd e nge

of e oe nd poin o e fee Te opeo en we ove epin ngng i weg o e on wi y o e p nd en vey pid foed of o pide veiydownwd wi bo nd. I i ipon no o e inii peebefoe deveing e . ppoe of e o be popye oin ion and e i efect i evd y foe dieed ig nge o e fe pne In ny pien epiy o woe eviy bi o iid e y be deveed e pien exe

in ode o enne exion In opivey f pien e od e deiveed e pien ee in, in ode o nee y.

( Faddg RttTi y e oeed in i nne exep e pien i

ppoed nde e ene of e e wi eve piow o ow eoi pine no f exion Te ed o f fowd ein ine d ne.

efeene o e ove wo enie dy of nge ofe fe wi ow e pp fe fe wd gypwd o e dieon of e downwd in e bove enie od no be boey vei wi few degee of ddieion Te d oponen of e vei inee yoend e pin on.

(3) Ratn RtrtnTe fo epe eiion of oion o e f of e 7 oin.

i e pien pone e opeo nd on e ef ide nd pe ef pifo ove e ef nvee poe of 7 T. e nge poningo e pien fee. e ig piifo i ped ove e ig nveepoe of T. nd e nge of i nd poin owd e pen edPee dieed down owd e e wi e ef nd nd pwdowd e ed wi e ig nd. A e pee i nd ifoowed by fobe pid of o pide

f s

Bakaddng Rstctn FIG. 8Te pien i eed e opeo fing e Se ie e nd

e e on e opeo ig ode. e opeo ee onde pien oo nd e i nge ogee o e n bodeof e ig nd einfoed by e ef nd n e ppied o e pino



154 ATLAS TENQS

FIG. 82

poe o e veeb beow e xed join Al e e e e opeobing e pien ino exenon b o ce e pien o bengoed ow o e pin, e opeo x e pien ignee wiin i wo g Noe e opeo u ge we own o

void peing on o e pien o wi i ode.

kddg srt e pien pone, e opeo gp bo ig w i ig

o eeve bo owe exeiie i i ony ibe o igpen) nd exen e b pne up o e join xion. e e n e e ie ppie ownwd pon e owe o e lWO

veebe in xion.



HACIC IN spCIIC CHNI 1 55

83

Frrd-bdig Rriti. IG 3

ih he ien ine he oeo n on he ien igh e

n he ien oe he ee nee o h he igh ne e oe heef nee. The oeo hen he hi igh hn n foeam betlreen

he ien ve o h he oeo igh hn n e on heien igh . Thi i ef gi o enbe he oeo o e hewhoe evi The oeo hen e he e veeb n ee hemb ine o he eion A ong eion foe n be eee in hway he ie of he eion b one ho e e no o e hiehnie in i eion



1 AAS O ECN'Q

Fla. 84

Khruss. Frward-bdig sricio I 84

ih the ptient itting the opeto tnd behind he ple hiight nee itby pdded t the te o the etited oint and et hioot on the tble o a tool o a uitble heigh The ptient no lce henge behind he nek nd the opeto thed hi hnd unde heaxiae and anteioly though the pae oed beteen the ptient aand oea to gp he it n thi poition ll the ange o eic

tion o oeent an be oeted by eely teing the pe o thethut. In etited od bending x the pino poe othe etebbelo by applying peue ith you tibl tubeoity and ex the ppepine by peing oad on the ptient it gging the degee oexion by papating the pinei neeay oentily eleae yo ehnd nd eel the oeent ith yo thb. Hing deteined thedegee of tenion the oetion i an ineae of exion agint thextion o the nee.



HRA SPI: S NQUS 157

-tts BkU/bdg RstReiio of bacwad bed i coeced by a mch moe poiive

owad h of he ee ad a pwad pll o he pae foeam

he opeao appe hi ee o he po poce of he lowe veebad he bi he paie bacwad io eio. he whole ppehoacc aea i ep i io a a ad he lowe hoacc boh oeio he h i dowwad ad fowad wih he ee whepplyi ome acio de he aila.

Roaio eco ca be imlaly coeced by applyi he hf he ee o he ave poce of he veeba beow h ecdoaio.

ay opeao wl d hi echie dicl paly beca heopeao i a lo way away fom h pae ad hefo £ lveaea vovd b alo he ee i o vey eve ad ca eaiy wobbabo ove he ie of pee. O he oh had he che eecv omime whe ohe echi fai

The Lower Thorcic Ara

Whe deai wh lowe hoacic leio i i poib o hleveae of he elbow a i mid-hoacic fowad-bedi eicioeo wh he pai pi b i bcom iceay mo dche fh w o dow he hoacic pi. he eao i paly becahe leveae become oo o ad he paie ha a dcly eaaio b alo becae i omime dic o foce h pai

ciely fowad o ceae eio i he lowe jo. Howev he maimoveme i he lowe hoacic aea i oaio ad eicio of oaio mch moe commo hee By ela oaio feely he fowadbedi eicio i alo eeaed. We heefoe ed o e combiedmoveme whe deali wih he lowe hoacic op ahe ha implefowad ad bacwad bedi.

Befoe oi o o dea wih he combied adve echie e eviw he omal moveme of hi aea ad coide he eec offowad ad bacwad bedi po face appoiio oci

I wil be emembeed ha i he cevica aea oao i aociaedwih idebedi o he ame ide whehe he ec fowad o bacwad bed hi o o i he hoacco-Imba aea of he pie.Oly fom fowad bed doe he -L. aea behave e he C. aeaom bacwad bedi ad i h eal poiio idebedi adoaio oc o oppoie ide

o mae hi clea by eample if we be fowad he -L aea



1 8 ATLAS OF ECHNIQUES

and ten dbnd o e ig te bodie of t vetebae otat to ig b f w t bawad bnd t . aa nd t debnd tot igt bodie f e vteba otat o e ft i o to

nab t aa f o gide pon a ote f w dbeaey tyand ov pine in dtion t v of bove w div tfaet into a o and ae w w a fa appoton ongi eod of ong f o in anipaion ba ep o oaie foe and ep o nd ovent in adaenon

ee a wo way tefo of podng faet appoion oingin t - aa o a poion of fowd bending we t dbnd

and oat to oppoi de wa fo a piton of bawad bndng w t idbend and oa to t ae ide point aebot o n e deipon of pe adent i t - aabow.

Aog tee ea od good fo e ow toai nd tb oint, ba oint oe onned in ei angbeae te fe a ao agia w in t toi y ao oon in pne, eefo it i ie to aiv fe oing

in t b pn tn i i in te owe oai ae we ned o fa o digi xin and t in te toi adtn tanwe do in te b n o wod oaion of foe i not o eay inte owe toi nd ti ft i eed in e tni.

Foe, e exibiiy of e ow toai ont i ien dit to ve fe appoition oing t a and w a oftendivn to ing gan tnion ing. n we onide t abovepoint abot obined ovent in ti owe toai aea ta fo

fwad bendng idebending and oaion o to t ae d weafo bawad bending, o fo t na poition, dbnding andto ou to oppoite ide) ere ms be a Oiiol 0 ver sigforward bending, when sidebelding i an amos pre moemen neiherroing o e side or he oher. Simiry i sigh eion, roaiol i amosa pre meme t i in ti potion of igt fowad bnding tat tot atfoy adent an b ad n ti a. n igt fowadbnding, tefo, w annot iv any oaion of fo by ing

dbendng; w p otation a o adtiv fo aangng toaon o tat t axi toion o at t titd ont w adaing wt i yp of eni wi be dibd bt t ee av etod uing fa-ong:

I ) Roin Resriiol o e Le FIG. 8ie t ptint on t igt ide fo a eft ottion tid eion nd

wi faing , x t patin ft ip nd ne ig on to t e



WR IRCC ARA PC fi CN U 1 9

Flo 85

i ct t th pint wh yu f tiss tnsi mtig t th rstrctdint Th p n th ptint's right rm t rig th right hudrfrwrd. Push hr ft shudr ckwrds t rtt hr trs dwn t th

xd jint In frwd dig w rqi t sidnd d rtt tppst sids t chi ctcking. Thrfr w nd t itducsm sidndig t th right. W d this y pcing cshins dr thptint right i s tht mxmm sidding ccus t th jint iixti Th crrtin i s n icrs f ckwd rtti f thshudr d frwrd rtti f t pis As fct-cking is t syt chiv i this r w d t ppy cnsidr gr prssurv th spius prcsss futhr t hp i th citin f frcs



6 LS OF EHNIQUES

IG. 86

2 Roaio Riio of /1-/2 T. h Lf G. 86Th bv chiqu c b mdd g bckwd id f

wd bdg i u ppy pitiig but idbdig dtti hv t b t th m d b uci fc ppitickig Th chiq th fw f ttiictd i fy T. t th f.

i th ptit th ght id d fc h. x h ft hip d kjt ucit f cmf (but t x th pi d w h ft kt th dg f th tb Th g piw ud h ighthud tht id bdig t mximm t f y hv McMi tb th upp hf f th tb c b ud t ct hidbdig t c b m ccuty d iy chivd th wy Nxtt t th ft ccmpihd by puig h ight hud fwdd phg h ft hud bckwd < bv d phig th p



WE HAI AEA : SPEII ECHNIQUS 161

FG 7

frwd. Bh f h prrs frms t p i this mi his ftfrm rsig th ptits f ptr r d his righ frrmstig hr lft ii rst r. I his psiti th prrs w hdsr fr ppy strg gr prssur th spius psss hI I th d 1 2th thri rr. h rrti is hid y irs

f rtti plus dditi g prssur r ths spius prsssttmpig t rtt th spi f I th ft d th spi f 1 2 th right

(3 Ra Rstl f 8-9 T. 10 h Rgh FIG. 87

Th pt s std with fdd rms, th prtr stdshid hr d xs h ft trsrs prss f 8 wth th psifrm f his f hd H psss his rgh rm r h ptits righ

L



62 ALA O EHIU

FIG. 88

shod stin his axia ov th point of h shoud h opatopasss his iht am acoss th patints chst and und h f axiah ns of th opatos wo hands a now pointin owads ach

oh and if possi thy shoud inacd. h opao must sandcos 10 th patint and maintain th xation of h t ansvs pocssof 8 sony h opa o now sidnds th pain to th iht ypssin down on h iht shoud with hs ht axia ckin thpaint as it w so that maximm sidndin os at 8 hn hpivots ound on his hips o th iht to in th patt ino ackwadndin and otation 0 th iht Whn in this postion o ackwadndin sidndin o th iht and oaion to h ih th patint is



OWR THRAI ARA : P II C HNIQU 63

skd rx d p r d ckwrds t rst prrs rgsdr rrc is md sudd srp trust t ft dgist ft rsrs prcss f 8 . i pwrd drcti cmd

w icrs f rtti t is imprtt ckwrd dig ft trs is xcsi rwis fcs w mmd d tjt srd. Addd stii d frc c tid t prrrsg s ft w is w ft ic crs

4) Rotto Rtto o to the Rght IG 88 sttig tciqu cms rtti d siddig

t ppst sds wit frwrd dg As std id t std

ptit w s r rms cspd d r ck prtr pcs isf tm t spis prcss f 9 wig is grs t sprdrud r f wr ris H t rds is rigt rm rg udr rigt xi d grsps r f rm H is w psti x trsdw t t 89 . si siddig t pt ft imxmm sddg t 89 d rtg t d t t rigt fgs muig t t 89 . wi is f tm, t crrcti s md csig r gst t x prssur f t prtr's ft

tm 9 .

(5) Rotto Rtto o 10-1 1 T. to the Let FIG 89s tcu uss psii f ght exo wit pr rti s

djusti frc cs, s xpid i t prm t s r tris pit tw t ur d f xi wr tr is scdrsiddg fwig primr rti.

ptit is pcd t rigt-d sid fr rt-rstrictd

s s 101 I prr fcs t p d pus r rigtsudr sig frwrd d t rtts dw t 10 pusig tf sdr ckwrds usig is ft frrm gist r pctr rgiH puss frwrds r rigt iim wi is rigt frrm. pis uppr k d ip prius xd sig t isigt gppig f t mr d wr trcic p t I Wit wfrrms ggd is ds r fr t pp ddi gr dm prssr t spius prcsss pig t spi f 0 t t

rig d spi f I I t t ft

(6 Rottol Retrto o 10-1 1 T the L IG 90 sm prcip is usd s i mtd (5. pti sd

stig d t prtr sdig d. S pcs r t d idr ck. prtr trds is ft d rug t rgur spc sfrmd frm fr ckwrds d rsts is d r r ft d ck f r ck. is s prr t us pwrfu rg i



J

164 AA O TCHQU

I 89

oaio o a i ub o iou oo I ad u i a xd o oao oa dow o . ad aia a ad o xo o oo.

I u i i o a o k ai a i o oiioad o ii owad i i diab o a a aian ood k o o a ai i aid ab.

) Sdbdg Rstrco

u idbdi iio i uuua i ow oa ou adidbdi i idoai aa iuay oxi bau o ib o a iu o ai oaio i ow oai aa



LO O C PE CI C ECHNIQE 65

FIG. 9

r d f iddi rtict W y i ci tf th iddi mmt f thi r (ee i. 70 d 7

McMn tehqe. h ptit pr with h ft trppd prt wi th wr th t i wihdrw ht thpit f iddi i d th f th wr hcc th ff th t i w t d i t ctrprr t thp pc with th tw thm tht h d thmpru c mxmm ddi t th it i trci



The Toracic Cag

S TwT I S S E T E C Q U E S R T E T H X

) Sthg th Sa Mus/sTs is n ip peiiny pcedre crec f 51 d

2d i esicns e etd suld b ided i tere is rcilpexs disnce i wc cin te plexus cses p epient lies spe e pert t te ed f e tle ds d suppts

te pients ed unde te ccputsy wi is left dd en exes er igt sulder wi is gt nd Te perr seces esceni y sdeending te ed e eft wle crg e sude e rigt s Fig 7, p 99

(2 Kdg th S

As te c pexs eeges etween e ntei d ed scleesces is clely udesrle ned er tse ces wen te

ptiet s cl pexs r erer riin ny cse e re se 10 e tende, teefe relx e scle y sideedg e nec tte se n wic y re wrking nd e fily getle

(3 hiIniin r deep pressure er e scle is ften e y etd

pen te perr. Te ptients ed sd e sdeent t e side fte r esin d deep, sustned pessue exeted wi e t sp. 89 fr deis f iiiry tecue)

4) Stthg th Lt trpar M/ IG. 9 e ptiet lies n er igt sde fcng te petr w les e

e ef sder nd ds it wt is left nd, e p er te detdre nd te ngers spredng er te scpu Te pertrs rigtcred r suppts te pties ef crked r nder er ew

eig s gt d free t rec e iterscpur uscles I tspsin te wle let slde grde cn e rtted r stretcedupwds nd dwnwds Te perts gers grsp te eter rdef te scpul t cntr e ee nd pply stretcg especlly e rds et scpe d trpezis usces

(5 Pa Mus/s

In rder t ec te pectr grup f sces te pent sld ie

66



IIAX : -SS C N QUS 1

91

supin d h prt grspig th ptits wist, ds th rm t pc th pcts n strtch

(6 [mta MusesIndid ircst muscs c rchd n cid gr

wr tw th rs Whr itcst spsm hs ccrd it wi css w th wh w und fm th strm t h gsf h rs. Th insctis srrtus mgus d dm muscsn r dtid ttti. Brsts d scpu prnt ctnin i h ppr is



8 ATLAS OF C<QS

FIG. 92

ARTCLATORY TCHQS OR TH R S

) r uan F 92

Wt t ptnt spn t oprtor stnds on r rg sd grspsr rgt wrst wt s nd nd strtcs r rm pwrds wxng t ntror nds o r rg rs w s rgt nd T oprtormy s t nr ord nd t ngr o s rgt nd or t tmnd nr mnnc or my grop t ps o s ngrs nto ow to xt owr o t two rs To rnorc strtc nd sprton o ts t ptnt sod sd to nspr dpy nd t oprtor syncrons s src wt nspron



i lE D S A CUAON 19

(2 Posto Arcuo. 93

Wih th pit p h had faci wds h ft th ptstds th had f th tb ts hd f h ptit's ft m ustpxim h bw d sttchs th m it fu bducti ig smwha bcwd swig with h bw h pt xs ch ribi t with hs thumb d h mc t th g f th w ibQuit pwfu stch f ch icst spac c w b chidusig h g f th tissimus dsi paticy th wibs.



170 TLA OF CQE

94

(3) Lter Atun FIG. 94

he pient ies n her ight side, he pe r ces her nd grsps heet exed ew wih his et m stetching he shder n u ducin nd xing ech ri in the mid-xiry ne wih his igh thum nd

thenr eminence

(4) Eevtn FIG 95

he ptient ies spine nd the petr n he e side he eis he pients m (e in u ducin s h her wris is hedrmy y his ight xi. n his wy he per hs IWO hnds 10 pssunder the ptien's e scp The tips he per rs nges re nwpessed upwrds ginst he nges he pien's e ri c-rdining



TH R BS ARTICLATIO 1 7 1

FIG. 9S

ths wih strtch h rm pwds nd uwrd is us ncss

f th p nd sigh th ns t d his chniq cmt nd c. I is nnspcic mhd ing th mddsti h rs.

5) Sgg. G. 96h pint is prn nd h prt t th hd h ing

wrds h t cims n t h t pcing n t ch sid f hpns hd. H hn ns fwds s tht th h f ch hnd rsts



17 LAS OF TECINIQU[S

FG.

h h i d hi pd y c h cpd ch w. Th p u kp hi w uy xdd. Thpi w h dpy d dui xpii h p mwih d y p h i h c i c pi h c- ji



E R IS : ARTCULATON 1 73

(6) tiuat G 97h pain s satd with h hands aspd hind h h

pat stands ang h sighty t h ight and xs h ight nwth h hs highs t pnt h m sdng at H ahs ndw th patints ams t appy pssu h angs h s wih ahand n ah sd th tps th ngs ng aagd ang th s



174 ATA O CHNIQUS

of th i aov th tiction. hn, in hi a aant th paint, hcan ct idndin and xtnion of th too thy cain ovnt of th .

C iC R I TQ

Fo h ppo of tchniq th i can convninty dividdino th op t and 2nd i 3d to 9th i and 10th, 1 th and12th i Th diviio a convnint ca dnt chanicafacto a opativ and thfo din ty of va a qid

in th th aa h t and 2nd i a paatd o ca ofh atachnt of th cani c whi th 10th 1 th and 1 2th ia y atachd to on vta intad of two a i th ca of thidd op of i.

A dicd in hapt 2 a i ay trictd in it an of ovn ca of intcota c pa o ca th intvtaoint aociad with th i i ao in ion. h ajoiy of individa iion a in appoxiationth ow i i appoxiatd to h on

aov and th i appa to vtd o that th ow ain i opoinnt hi ipi a poition of ativ inpiation and thfoestted epatn W hod ak of thi point whn appyinpcic paationa tchniq. Whn an xpiationtictd ion ifond w hod ak OUT tht at th point of axi xpiationwith th ojct of incain tht xpiatoy an. Siiay wih nspatonestted ion, w nd h i tnd to appoxitd o hi ow and xd in a ativ poition of xpiation. Sch ion hod

coctd at th point of f inpiation. n pactic thi dintiationi a nnt of tchniq and paationa tht a appid oth at thpoint of f inpiaionthtin pwad on th pp i and at thpoint of f xpiationthtn downwad on th ow i. Th ainojctiv i fdo of ovnt at th cotovta and cototanv joint and n th intcota c hav not cood and hotnd thn th i poition of th two i wi tod

Spe elques J the st and nd Rbs

( I ) Eeated st Le Rb. 98With th patint pon and th opato tandin at th top of th

ta, h pac hi ft pifo on on th an of th patint t fi. Th patint t h chin i n th id in whi th opato pac tha of hi iht hand on th pain' t chk wih hi n pad



UPPR R BS : SP IC NQS 5

I. 98

cross hr r nd scp h ptint's hd s now sidnt to th rightd rottd o h lft to lock th cricl column. orrcion is y nncrs of thrus of h oprtor's lft hnd downwrds nd forwrdsginst th stiizing ct o th right hnd.

2 Ee'aed Righ Rib. FG 99h pint is sing h oprtor fcing hr ck thn plcs h

rdil ordr of his right indx ngr ginst th ngl o hr st rght riTh oprtor plcs his lft hnd or th ptint's rtx nd rots hrhd to th lft nd sidnds hr nck to th right sing scn roionsidnding nd cwrd nding to lock th cricl r nd to ringth locliztion of forc to h s right ri h oprtors right low



16 TAS O NIS

, 99

must g s tt trust dwwrds d frwds trug isidx gr t sttr it

3) Ed Rg Rib IG 10

Wit t pit pr d rstig r i p t i xtsi t pr t f sid f t ptit ps is t yp-tmi my gist t ptit's rig st ri, is igt d psss



U P l R R i S : S E C I F I T Q 1

Flo. 10

udr is w ft frrm s pm f s rig d d grsi gis ig sid f pis d d ck. is wy pis d is rd r rig d sidb r . T crrcicsiss i sudd crs f xsi d sidbdig by prrs rig d d srp rs wi is f d Tr isppsii f prrs w wriss d y rrc d srg

c r NB. Tss sd b d wi ci i dir psiisi rdr m sr f si d crrc m f sidbdig

Sec Teique o he Midde Goup 0Rib eio

is grup f rbs frm rd w c s rspiri s d crrci bs d b rsricd ispi xpiri i ispir w sd bi p pi d curg

M



78 TLS O TE I IQUES

. 1 0

l of inpition y mking ou djtmnt t th poition of mximum inpiton Altntly with tition of xpition w nd to

mk o djutmnt t th mximum point of xpition

I ) npraorrd h f b FI 10

With th ptint pon th opto tnd on h ight id nd plth piifom pt of th lft wit gint th low od of th 6th it it ng. h piifom pt of th ight wit t on th ight tnpo of th 6th thoi t th ng pointing towd thptnt' f. m pu ditd pwd towd th ptint'

hd with th lft hnd nd tily downwd with th ight hndfollowd y hot pid thut in th dtion imultnouly withth two hnd.

o ot n pron-rrd on, th hnd houd do tht th ight hnd t on th upp od of th 6th i nd th lftnd on th tn po of th 6th thoi t diting dowwd fo towd th ft upon th nd tlly downwdfo on th tn p



M R DS : SPCf IC TCHNQUS 17

102

2 Tchqur th Lt Rb FI. 102An anati methd is wth he paient spine. h patients ams

a cssd he chst s ha h ngs casp ppsi shdes andh ws appximat n ae h th. Th pa standing nh igt sid th paient, s h a itt e wads himse with h hand cnchs his igh s my achs th paient and pacshe enhed s n the pinth in sch a way that h ang th h

i is sting n the thna minenc th kncks th st esting n hpinh h peat eans th patint gasps he ews in his hand ad s h patint away m him nti he weight he thax ist aancd n his cnchd st A sight incase pesseeicay dwnwads wih hs hest and hand wi then cause spaatin the th cstanses in At th mmnt spaain th smay cd sighy n the kncks in de diect the sindi pwads dwnwads as quid



1 ATAS ECHUS

FIG.

3) patioestcted h Lef ib G 3he ptient shd ie spine nd pe he et hnd ehind her nek

r n her gh shder keeping he ew ppximtey er the ngef he 5h r. he pertr stnds t the ptens right sde nd sig heeege f her et ew rs he twrds him s ht the nges fthe s eme eident the et side. The perr pes hs rightthen eminee n the ge f the 5th i nd ses this s xed pitt eet sepn stress eween the th nd 5th et is hepertr rs the ptient k it the spine pstin wtht sg hisxtin the 5h r. The petr's e m nd hest re nw sed t

ppy dwwrd thrst n he ptiets eft rm his thrs is gie the pit f mximm expin n rder t e the n nge exprin whh ws preisy resied.

A simr tehniqe is sed insprtin resriin t the dwnwdths s gien he pn mximm insptin The pet my weexpie n reeiig his thrst t s g s the expirg is ny respirty wi e we !

he psiin fthe ptient's ef ew s nd s pemiy the



LOWER R IDS : SPCF TEHNIQUS 8

104

tchiq y rig psti sighty ppig h whi r hdpm si th g th r.

Lwer rp f R Le

this grp ris h 0h h d th w r dig with ryry m s ddi t th pmp-hd d c-hdtyp mmt pry r mm ccrs d th hds thris rict wt tir w rr dy d trsrs prcss yThy d t rtict wth w rr dis s d h ris .rhrmr thr is sch wid rg mm h hrcic

mr grp rr h th rs h m qy ryscdry trs mmt. Th a r is hd dw y th chmt h qds mrm msc d it s s t g yhg thrth spiri rstric this ri

( Teer t R. IG. 0Wih th pti pr th prtr hr t sid rchs crss

with hs right hd grsp th pti right hip rgi c



12 ATLA OF TECHNIQUES

FIG. 1 05

grp s with th ngrs crd ond th nrior sprior iic spi Thopto pcs th h of his ft hnd on th ng of th siond i,sing it s xd poin whi ottng h ow n o h igh y

ng th ight sid of th pns pis Th opos ft hndthrsts pwds nd owrds on th siond r. t ty css gpping of th cos to-nsrs jon Wih hs tchn it s ot syncssry o comin rspirion wih h ths t if dcy occs,hn h thst cn gin t th pon of f xpition.

2) Epan Rectn IG. 1 05

h pint s on h gh sd, h I m rching pwrds nd



OW[R RIS SPIIC T IIQUS 83

gsping tp plint wil lt lg sts ind ig lgTis pcs cnsidl sptin stc lw l is p cs ptint d ss t ds t x nd st tctd i, t ps t ms pcd t i i t midxily li nd llwd t st tg wi t tn mics

ng wl cs t i T pt xpis t ll d t tismximm pssil sttc ts is dictd cdly t k xti.

) npirao titi F. 06

ptint is plcd s in v cniq (2 p stdsind t pit d spds is tms lg t ini d tlsind i At t pint mximm ispiti t tst is dictdcily k xtin



8 ATAS O TCHIQS

Fo. 107

(4) oto-vbra ctol IG. 17h ptit i n h ight id h t hnd ching upwd d

h g yig bhid th ight. h pt cg h pc h ghthnd h c ct. H w v th ptint tht hi thypth innc c b ppid t th nd ib; h p bw i pntig wy hi tht wd nd pwd thtcn xtd n th ib h pvi i did by th ight hnd hi cb d n iptin- xptin-tictd i



LOWR R DS : SPEC C CQ H5

Fl 108

(5) Expiratio Rstrictiol lo 108W ptit sttig t p stds id d ss t

p d id k w ps is xd igt k s t igt sid t sppt igt sid d. pt t s wds d t ptits x d tds isgt d tg t pis kd t w m ti psi t s w k t gsp igt sd wi sigt d H is w i gd psiti t sidd t pi t gt s w igt tig d s pts gd stt t ws T ps tsttd tm d idx g tppid ptits td i d tst g dwwds s

stidxp si.



86 ATLAS O TCQUES

FIG. 109

Te Lumbar Region

SOT-TSSE TECINI QS

Kneading the araerebra usces. FIG. 10

Wh h pit pro d h oprtor o hr t id h pc thh o oth hd o th rctor pi o c o th rght o hr

pio proc. H th kd h c i r drctio totrch th right g to th c y. O hd y udor th othr to riorc th ctio wh dpr prur i rqurdh oprto y th p roud o th othr id o h t o work oth pit t rcor pi uc or i workig ro th righthd id o th ptit, h y hi gr-tip i row jut tr toth t id o th piou proc d uig puig otio to chith typ o rtchig o th uc t right g to it r



MB AR S E SO T SSE 187

. 1 10

(2 he pen e pne nd he per pce h w thum

dcent he pnu prcee n ppng de nd ung crcurmn upwrd utwrd dwnwrd nd nwd emphng theuwrd mtn t tretch he muce trnerey

Where c mue tenn n e pped the pertr my cncenre h ttentn n th te ung h hum n tnere drectn he ntctd e

3 Srg L E S Mue. G 1 0

Wth the ptent n her ght de nd he pertr fcng her he exehe nee nd ppe peure wth h thgh gnt the nee t rcehe umr pne n exn h put me tretch n the erectr pnemuce the pertr en er nd grp the pent eft erectrpne m wth h nger rnged n rw jut e the pnu prcee. Agn knedng ctn n rnere drectn cheed whethe erect pne muce under tetch he degree f tenn n themuce my e red y erng he preure n her nee In fct



88 ATAS O TIES

I I I I

hythmic mn ginst th kns cunt-ncd y th puing ctnn th ct spn muscs is n cti wy f sing tight muscsh. hs tchniqu s sttchs th qudus umum ut thismusc is sti m ctiy sttchd wth tchniqu num (5.

nhin cn ctiy dn in this psiin using sustindpssu f th ng-tips I nhiitin cn s dn with th ptint

pn using th nm mthd (p 89, ut si m pssu cn usd y ppying th h f th hnd n f musc.

(4) trhlg h tssms os. FI. I I

t is smms dsi t x nd stch th tissimus dsimusc. this tchniqu th ptint is pn, nd h pt stndst th hd th pinth nd gsps th pint ight ckd w in hisft ckd w using his ft fm suppt h ight m h



BAR SPIN OT TI 89

FIG. 1 2

rtr h ls wll vr d lis sm utr rssur lg thurs h ltissimus drsi with his right hd whi strthig hr lrm by strgly bdutig hr shuldr

5) tching the uadatus umbum IG 1 2

With th tit hr right sid d th rtr ig hr h lis

bth hds t th lt rtr si musl bv th sius rsss,th tis his grs big rrgd i rws. Th his right rrm dbw rst th it's l li rst d his l rrm d lbw hr lt lwr ribs By lyig utwrd rssur with th w rrms thlumbr si is md t rh uwrds rig strth th it'slt rtr si d qudrtus lumbrum musls. This strth isurthr irsd by ullig uwrds with th grs ths muslsA rkig mti hs i rlxti ths grus musls.



90 LS O CHNQES

FIG. 1 3

ARAORY T E I Q S I N T M A R R G O

( idbdil/g F

Th pti is prn th tl with h ptr stndng h ftsid fig d n with th pis Th prtr xs th ptint'slf n d rhig rud h lg, grsps hr lft thigh wih his righthnd nd hdig hr lim gins his dy h duts h high th hip

t rt g th pis nd s sdds th lum r t thlft H th ppes pssur ginst th spinus psss wth his lftthum gist h lf sid f h spis prsss. h id is 10 rs muh siddng s pssi i the int immeditly lw th xd y th pr's thum.

(2) idbl/dil/g. FIG 4

T sm psiti s v is sd ut i this cs th pr



UM B SPI E : ARUIO 9

Flo 1 14

rchs crss t th ptints right thigh grsping th thigh with his righthnd st v th pt (B crf nt t hd th im y th p

fr this is npsnt fr th ptint h ptints n rmins xtndd.Th prtr thn ddcts th ptints rght thigh crss nd v hrft thigh. H ppis cntr prssr t ch f th spins prcssswith his ft thm n th ft sid f ch spins prcss ths frcng ft sidnding-rttin mvmnt in th mr r. his psitincn tiizd t cr cwrd ndng in th mr r n this csth ddctin is rpcd y pr xtnsin t th hip.

idndingBth gs sd in nisn cn n vn mr ctiv vr t pr

dcing sidndng r rttin r cwrd nding in this prnpsitin t it rirs gd d mr physic rt n th prt f thprtr. Stnding n th ft sid f th prn ptint th prrrchs ndr th thighs with his right frrm nd its thm int nypsitin h is gin sng cntr prssr wth his ft thm sccssivy n ch spins prcss.



A T L A S O F T E C H N I Q U E S19

1 1

(4) oaol. G . 1 5 r rtti i his psii p h ptis rgh thigh

d rss hr t thigh h rh r h thighs wih yr righ hd

grspig th pi's thigh riry s wig yr right rrt rs p hr right thigh Th tw rssd thighs r th rght rt th dg h pith t r hkd rm gig right r th dg yyr right thigh. Y r w i psii rt th pis t h rghy prssig gist hr right thigh with yr right rrmrig thptit s i t wr d pitig yr right kks This thi ds r s mh msr rt th prt th prtr s isrrd i h pris hi



M B R SP I N : R I I O N 193

Fo. 16

(5) exoWth the ent une he oertor ndng on he rgh e

exe oh her knee nd h y ng h rght orer nder oh hernee et hnd e under he ur ne he nger ngthe exon nd ng xton of the no oee whe the exon

gong on Sdeendng n e norored no th oeent whe nexon.

( F 1 6Me ore exon n e heed y exng oh h nd knee

nd the oero eng h rght eor re on her knee ehnground wth h rght hnd o her e on. A owerf exon oeent ne exerted eh eve o the ur ne n th wyN



194 ATLA O TCHQUE

FIG. ?

(7) Rotatiol. F I G . 1 7

Wit t pain iting atrd at t nd o t al t opratortand aing t patint and 10 r rigt id opraor a tpatint to old r ar aro r t and lan orward T opratorpa rigt ar ndr t paint oldd ar ra aro rt and rly od r lt odr patint i now rnd ligtyto r rg and lan rr oward o tat r ntir trn ppordon t oprator' rigt ar Wit i t t t oprator x alar vrtra n trn wi at t a i wing i trn arondto t rig Ti prodr wi an rpad on id ra lar artiaion to t ll xtnt in rotation and xtnion ri o ndny or t patint o ip orward o t opraor nd ox r rigt n y prr agan it wi i rigt tig



LMAR P N ARTAON 195

. 1

8) oiol wih tion FG 1 18T i tctin nd iun h i h th

ti td th inh d it yf id h t cig ity th yu ight d i gi h igh id Ak h ti hd h n igh i ih h f hnd t th ig t.Rh nd h igh xi th y igh hud Thn y igh ud h tnk nd hd h f c gin Ay ug h u in ih yu hnd n thi ii i i y ift th in th t nd t th i hunk t h igh idd h h t cii f hg f vn



196 ALA O NQ

.

(9) Extension. FIG. 19With th ptit p th pt stds h ft sid sp

h ft xd k with his iht hd H is th k v th sid fth t t fiitt xi f th hip t ut iht Th ptitsf k b dditiy supptd y th pts iht i Thpt ds w d thusts upwds th tih t f this wds d s f th um spi i xtsi d ttit th ft

ut pssu th ppd y th ps t thumist th spius psss pss fm L t I L



LMBAR P N PE TN Q 9

FIG 1 20

TE Q OR T LMBAR P "

Many o th introdutory ommnt whh prd th dripon op thoraio-Iumar manipuation ar ao appia to h pithiu or th umar pn ( p. 7 Th rang o momnt

normay poi n th umar ara ar to ound td in th AppndxMaximum momnt o omind orward and award nding ourat 34 L. Whn anayd into omponnt part orward nding inrasrom ao downward u th umo-ara momn i a. Bawardnding inra rom ao downward right down to th S jonSdnding r at 4 and rotation i r rtritd. hapophya at ar amot rtiay pad n a agia pa andwithin a w dgr th approximation o at h urthr



198 ALS OF THNIQS

FG. 1 2

roon We comid wit sidndi re o momtis iry ree s comied momet is imid y t nnsross o iererter disc. From ur or rom ck

wrd edn positio sidedin nd roon occr to opposisids, wres rom positio o orwrd endn sidendi ndroon occr o t sm sides Bcuse o tis, w mus rr orcomned orcs i pproprt mr o ce ce ppo i oocki As idcd on p 158 tere is postion o si orwrd endinwen sddn or roion occrs s pr moements so sitorrd ed is t strin posio or most mr corrcos.M uc ss dt pssu s rqrd o spnos proc ss o



UBA SP : SE C EHNQUES 1 99

mb a bc c appoitio ockin i o mc mo ctia in t toacico-mba aa A poio o backwd bdnc bia ct appotio ocki. Sc ockin d miny i maptio o ac-iiac joi.

Sideendg to he Lef G 120

Wn a pin i yi on id a two wy o obi ddto idbdn i . Fo xmp i w pin on d and w w o a dbd to w cn x t kn y pay x ip and n oc t

i into in tion by pcin xd k bw t opo i. Ti poito ti pi cady on it ndcaiy on t ocn t mba pin io idbnd o t tnd cain concity ppmo

Sdeeng to the Right G 12

on t o nd w wi to c idbdn to ii.. wi a coxiy ppmo wi t paint i yi o d

n w ow p' to o id o t pi kpn kn t nd p iy xd poio wi ot t p t f d o t pi cdy d o t pi t ft nd t mba pin dop a coxiy ppmo

Neural Posio. G 122

I w i a i mot nc o mak an adjm om apoiio o it owd bdi i no idbd at t cnbt b acid by paci p' ppmot imb iy dat t kn and p o at ppmo oot ook bind ok. c a poitio nd biity to t man d ab opato to concat i ntio on d o oatio do ocaiz tion o oi i io Somtim a itt mo xioi qid c b obaid wit pint' ppmo oo ookdbid t pai o k o t yo wi d to t oo adbin t pti' ppmo k ito t xio yo omtnio tin at joint i tion. xion i pacay cayw t pai cd mba odoi otwi inicitappin i obind to bk xation.

A id o oczton o oc in t mb ca bobind by i o om i om bo o bow. m i pcic o pp mba o w ot oo

o ay d p wa i ow mb ion w oa t



200 L O ECU[

FIG. 1 22

pvi on a laivly xd oo and fo mid-lma lion co-odinah oppoit oaion almo qaly

o xplain hi mo fully, uppoing hav a icd oaionIion o h igh at -2 . plac h paint on h lt d x h

lma pin fom lo upad 0 ach 2 L y ing lg lvaghn oa h too fom aov donad unil nion dvlop a2 L h lo ma aa i hld laivly xd and focd oaion ofh tn 10 h ight podc a die pe djuel of h ightapophya join of 2 L. h ligh xion and otaion cau a factappoion locing of h lf o of apophyal joint and nal agapping of th gh o

hn ppoing h to ma a dit pcic adjutmn at 45 L



DR E PE I TEQ 0

were ee rered rn e e we pe e pe eg de, k er ef f bend er rg kee ge g ex 45 , e re e r ngy e ef fr 45 ,

ung fe pp kng n e rg w f j. Hd pn rmy we yu ppy fbe ddn f e pefwd e ef

A 3 . we ue mbed r fre n ppg dre e pek f e ur e ered j

Regrdg e umb-r m w n ef pybeue e ge f meme g ywy bu beue eree mny nme ere A nded n e Appendx ee wde

ge f fe ge ere frm mpeey mpeey g,d n nfequey e w fe re by n men ymme w eer Fuer, e -umb gme re rmy ue rg dfr e nd purpe mke e umb-r j m yndem w e rum, e debedg d rn f n frwrdnd bkwd bendng

If we w e e rng pn f fu frwd bendg mke dre pe djumen g gmenu enn kg we

eue rge e debendg d r ppe de d, prury ey n e de-yg pn, enque mny ed e g p nd w be derbed (p 7 Fubkwrd bedg e er d k e fe bery rng p ny be prby ued fr - re

jstmts the r ie

e prpe f djue enqe e umbr e fr rnered d dbedg-ered en e bee dued beFreuey e ren ur mbn bu f e en pedmy debenng ere wud eed be me emp e debedg mpe f e djme, d equy f werepredmnny reed e ere wd eed be nree frn e dumen e m mmy ued enqe nwderbed f r-rered e.

tt ettl t 2-3 he e G 3Pe e pe e rg-d de d fe e pe Fex er

ef kee u yu fee g gppng f e jn Te e eef exed knee e be d, f ee uk er ef e be dbed er rg knee. pn w e wer bk rg ge we pn ed rmy we yu pu e pen rg der frwrd der re e runk e ef ee fr e en deep dwn



202 AAS OF INQU

I. 123

to 2-3 L., thn yo hav th statn poston oty. o thn aan foth patnt's ft foam to st on h ow bs so tht h bow spontn bakwads had yo own t foam thoh th tanths atd btwn h body and ft am so that th pp pat of yo

ft foam an st aanst th patnts ft ptoa on Yo s thspa fo appyn a bakwad otaton fo on h t shod tonas th toson to th ft. o ht foam now sts aoss thpatnts ft bttok and yo appy a ston aton pss wth yoht thmb ad ns on th spnos poss of 3 . Now by appyna bakwad thst wth yo f foam and a fowad thst wth yoht foam toth wth nfon pss on 3 L., ass 3 appnof th ft apophysa jont of 23 L



L UMB A R SP INE : SPEC F C TECHNQES 3

. 1

ebendng ecn al 10 FG.

a t patn as . 13, y n t sd. x tkn t caus st appn at 3 L Tn ask t patnt t d ams s tat s ds ppst suds t ands. ac und t sud t yu and ad am s tat yu can at tunk tt , sdbnd t t t dn t t 3 L Tt ta mnc s pacd cby aanst t spnus pcss 3 L. s tat a tcay dnad tust ca b appd at t sam tmas a ncas sdbd s ctd by yu t am.



04 ATLAS O

FIG. 25

otiol strtio t o h ft. 5th th patt sttg a ams o, sa bh h a tha

yo t ha bath h axa achg acoss h chs to gasp hght sho x h tk ow o th pot wh yo a sgh

gappg at 3 L. th appy yo gh thmb to th spos pocss o4 L o h ght. Th asm s by p otato o th pp k oth t agas h xato o L. by yo thmb It s as w to otatgty at st t yo th tso at 4 L a th appy a xtaoato o th tk a a thst o 4 L smtaosy Th s a ty o th patt o sp a ths a b ot by hag aassstat to ho h patts s o hag th patt stg astt th o th tab



LA SPN P TNQS 05

Flo. 126

bning stcton t / to t ft G 26Wt ptnt sttg nd rs fodd std bnd r nd

oss ft sod rstg yo ft x o sod, tn p

yor ft d dr t p's rg x o now posnto sdbnd t ptnt to fts t w o bk t sp wxm sdbndng t 2 L. Fx t sp to obn sgt gppng t2 d t psng dowwrds w yor ft on to fsodr nd tng r rg sodr wt yor f d you nt sdbndg strn 2 fod by trst wtyo gt tb gns sd of t spnos poss of 2 Ltsng ry to t rgt



6 AA O ENQE

FIG. 1 27

Rotaon Restrictol at 1-3 L. to t et F 27Wih th patit sitig aid at th d of h plih sad o hr

lt sid faig hr so that your ft thigh is rstig agaist hr lf his ats as a stailir wh rotatig th tru to h lft h pati'sarms ar loosly foldd aross hr hst. h oprator rahs with his lfthad udr hr foldd arms to grasp hr righ sapular rgio h opr

aor ds forward ad istruts th patit lt hr wight fll looslyo his lf shouldr It is importat that th oprator ds wll orwardso that h a ta th who wight of th paits tru aross hisshouldr th oprator rquirs good soud diss o his ow for thisprodur h oprator s th lumar spi do to ad throtats th tru to th lft whil holdig rmly agais th spiouspross of with h right had h adjusmt is ahid y axaggratio of ths motios



LR PNE HNQE 07

FIG. 18

ckin niq in xion G. 8 uiie e saig sii fl frard edig ad a

iai f sideedig ad ai sie sides ave e aiesiig i e ads ased eid er e e sad eid adrea uder e rig axia las e aie lef a. N eerea el e reried ji yur e u ad srgly ee uar sie a ig e aie sag i e sued sii esgly sided e u e le ad ae e ig aragigyu fres e a eir aiu a e lesi i uesi

wad-bndng icin a2-3 . ( FG 8)Wi e aie lyig suie sad er rig side ad rss e

rig exed ee e er ef eed ee. Te read yur rig ad



8 ALAS 0 INQES

FIG 1 29

t r g from d forard o at your rgt ad ca odr rgt k ovr t pata Wt t commadg vrag ro tpv aay from you o tat you ca rt your t ad udr rumar p to t pou poc o 2 o r ack ovr

your at adt ypotar mc rtg o 2 .ad t p pv ad or umar vrra to gap t 3 jot. cu u gamtou·oockg ad mu o cour avodd f a dc o upctd.

Thus nque F. 19A drct vrtca trut ca appd to t or o t to umar

vtra o t patt yg pro trut may



MR P IN PI TNIQ 9

130

dird aaist spius prss r aaist t trasrs prsss bt sids si trasrs prsss app t tips f ft idad midd rs ad pa tm t rasrs prsss ad t it ptar mi is usd t prss r s r-tips Tpratrs ri arm must b d wit a strait bw ad is w

truk usd t xrt t str sarp rtia trust ssar i tistiqu.

Bakwrdbning Rrt. FI. 3Wit t patit pr sad r f sid ad usi ur rit arm

udr r tis at t imbs t xtd t ps, pis ad umbarspi as far as si ad t app a rtia trus spiusprss f t rtbra ab t si



ATLAS OF TCHNIQUES

Lockg Thqu l Exio

ie he piet o the right ide ad t t the pei o the et byexig the patie eft ee ad hip ierig her ee bewee yor

thigh ad o forig her ower extremty io iera rotaio Fig The paiet eft oder i the preed baward to rotatethe tr dow to the eio The ea we over the patiet o that yo ppy a thrt o the pio proe of the ower vertebr i eioThe diretio of the thrt i vetray o fore the o ito exteioo it i eeary to pae yor right ebow we ot to eabe he forearmto be i ie wih the diretio of the thrt The ptiet hod be tedo to the other ide ad the proe repeated to fore both apophyea

joit i exteio

Th umbo-S J

The mboara faet have h a wde rage of age tht i weworth whie otig Xry m prior to ttempig yor adtmet Ithe faet approxmae to e agita type the he tehiqe above areappibe bt if the faet approximate to the oroa type the a peiatehiqe ow deribed i more eetive The idea of thi thiqe i toroate the pevi to the eft ag�it a xed mbar pie

Roio F

To reeae the eft mboara apophye joit pe the patiet oher right ide ad arrage her tr to b tragt wh the pith The atof the ba hod be veria o that the pe i er wihot rotaio

idebedig exio or exteio The patiet w eed to be ear th edgeof the pith o that whe he exe her eft ee t hg over the ideof the tabe The operaor fae the patiet ad pae hi right thighrmy agit he tabe dita to the patiet eft ee o a to he tepatiet from roig o the pith ad prevet he extedig her eedrig the mavre The operator ow ret the pam of hi right hdo the patiet eft af idig p o that hi thmb ad idex ger ieo either ide of the ee ad the web of i had bewee the idex

ger ad thmb i retg i the popitea pae The operator righforearm i the paed aog the paet eft thigh ad he ea we overthe patie i order to mae a thrt throgh the popiea pe o forethe pevi ito rotatio to the eft

The oppoig fore i the xatio of the paiet' 5 L. pio proeby the operator eft idex ger ad thmb p the body iertia Fexthe paiet eft thigh o that with a few tetative gete thrt with yorrght had yo a fee the rotatio of the pevi aig a movemet a



l UMBO-SACR 0 2 1 1

FIG. 3 1

th lo-scrl joit Wh yo r stis ot th positio th joitis gpp y s shrp thrst with yor right h i th poplitlspc h i is to ctch h joit th ptit wrs shokthiq which y its vry piity os ot rqi y ockig vico loliztio prt o th hlp oti i holig th 5 . spiospocss with yor t h

Te Pelvis

ro th chico-strctrl poit o viw th plis s thotio sto o th spi col is o th tost iportc wh iig th ptit or th rst t i th lvl o th p is is priry cosrto o ttpt to k chicl jstts



2 1 2 AAS O ECHNIQUS

the spe wthot payg de regard to the eve of the pelvs s a shortsghted pocy ecase the reslts of sch treatmet are kely to e oftemporary vale oly.

If o eamato the crests of the la are evel ad the spe straght,we ca assme clcally that the sacrm s leve also t f the lac crestsare ot level or f there s the sghtest scoloss the we caot assmea evel sacrm The oly really reale way of determg ths s to takea erect -ray lm of the pelvs oservg a precaos to avod errors arragg the lm cassette patet, etc. Wth ths provso, sch aray lm s a relale gde to the level of the sacrm. f the sacrm s otleve the evtaly aormal stresses ad stras wll develop the

lmar spe ad aove t teps mst e take to correct the sacra levelether y maUato or y the se of heel lfs efore attemptg torestore molty the rst of the spe.

Now the theme of ths ook t ow has ee that postoal falts the verteral colm are of mch less mportace tha molty flts,t where the pelvs s cocered the roe of posto ad molty caalmost e reversed The sacral eve s the vta oe, ot oly aterally tatero-posterorly as well A creased lmo-sacral agle wth ts

attedat mar lordoss ad thoracc kyphoss ca e almost as serosa mechaca dsorder as a lateral sacral tlt The commoest case ofa sacral tt s some dcrepacy of eg legths so that femoral leves mste take to cosderato at the same me. ere aga clcal measremets whle sefl, are qte adeqate for accrate mechaca workad we eed -rays of the pelvs take the erect posto ch lmswll demostrate femoral dscrepaces ad sacral tlts ad the practtoerw e a etter posto to assess the relatve mportace of these two

measremets They w ge the eamer sefl help dagosgtorsoal stras as etwee the omates themelves or as etwee thesacrm ad the omates

Becase of these pots T wold regard a strctral eamato of thepelvs as complete wthot erect -ray lms ad to led weght to theargmet wold pot ot that a seres of cosecve cases presetg wth low ackache whch eamed 195 , fod tha 6 per cetof the cases had ch or more of femoral dscrepacy ad 1 per cet of

them had -ch or more femoral dscrepacy t was terestg to dthat a cotrol seres of fty radom cases wthot ackache there were28 per cet wth ch or more of femoral dscrepacy ad 8 pe cet had-ch or more femora dscrepacy. other words, more tha twce theme of patets presetg wth ackache had a short eg comparedwth the cotrols ad who s to say that eve these cotrols wod othave deveoped ackache or some other reated symptom at a later date? t was fod that a short leg dd ot ecessarly prodce a scoloss, or



i PLVS 2 1 3

pis Adpai o sho hs, of cos, o k pcsomh d fqy ich is k p by h scoiic oisso ha h spio sfac o h sacm o h ppmos imi of h

a of h sacm h poi mos coi fo msm is mo h h hds of h fmo. Sch ki p by h sco-icois impis s of si hs ois, ad my h b fco i h bckach podco

h sc s of h ho sis msd ad h ss foh masms of sc discpcy as foos

Nmb of css ih -ch o mo saca d iscpcy

Nmb of css h -ich o mo sac discpcy h coo sis:Nmb of cass ih ich o mo sac discpacymb of cass ih -ch o mo sac discpcy

35 (35 '0I

7 14%)o

Wh h sacm isf is id compsaio o i ms ak pcabo, mos commoy 5 . S o -5 ois. A di ofh discs i hs os is s i a maoiy of cass

h mos dsdb yp of compsaio o h sc is

d scoiosis foo h d cio of h i so h h coxiyi h mb i hs css is o h sid of h sho oi a sm popio of h css h i is so makd h mbosco 5 mb oi h h coxiy is o h sid of h o Schmakd d of h ib discs c oy ak pac as sof o s cocy h pofod ia chas i h cspposs of h cd disc. his cs mkd imoss a h cd oi ad ds o fh backch

hs s sho is is pimiy o sacoic s dscody o mbosc o o mb si h compsoymchism sch as icsd msc o h i s dd d hhicki of iams, a of dq o cop ih h fmo osc discpcy b sch css pdisposd o backch. hh imos d msc si dos i f h oa cicio dads o di chs h ai ha hy od omy is.Sch pis qi iy mio ddiio si o bak do

h compsio ad pcipia a ack of bckach. Addio sissch s ch of hb fi oss of msc coo hohss o iciiy d/o som mio iy, schs h imsbyod hi oma h d hy i ay A cos p obis ih f h ch ops pl/S. Whi msc o is ood h doo ch, b ccsomd o pood sdi pcipis ih hd dopm o f chs ih coios d ch o hapid immoy cio of c afoo s



1 ATLAS or TECHNIQUES

3 Shor lef g

h cnca cognion of a shor eg s not c, cy whrthr s mo thn nch nc, y t s qnty ms o ob cons ngncnt by xnc actton A og o xm nt th oowng t



T SR G 5

3b Shot le/ le, coeed with a heel l

( I ) Th t g fd r.2 Th t dmp r t prr prr p r If

h dmp r nt b, thn pp f th pt prr pn v drpc I r y bb' n



2 1 6 T O HNIQ

spis bt papati t tmbs ar bro pards to rsto t ost proc t a mor accrat posito ca b obtaid

3 rst o t t iim is or id r sod rst ot rst o t iim at its ist poit, ad t r d ad dorizotay 10 i t y a ro masrmt.

) orma oaity i t aist oti is straitd o tt ad tat o t rit is atatd W t patit is obs trar oriota rass istad o crs ad t rs is t or ta t rit

(5) A scoiosis is rty prst it oity to t t i t

mbr ara ad to t rit i t toraic ara Wr t disrpayis sit t i o t spios prosss my b rtia d ompsatio appars oy t orm o rotato o t rtbra bodis (it ti sid o t t i t mbar ad o t rit i t toric aras).omtims t coity is to t oppost sid. ts ss a prood tit is obsrd t t t or 5t mbar rtbra o t X-raypat

(6) io o t spi it t patit stadi t

bttoc ara is s to b at a or is is bst obsrd by ooiao t spi tatiay, rom t ad o t ptit. is is probbyt ab [te inia signs [ a s g

(7 W t patit as t ad riss ad as y siior it is arrid o t

E to ts ciica sis o a sort ar airy asiy rcoid iica obsratio ao is iadqat bcas sra srpris

rsts r od dri tis istiatio or mp o ptit da i sorti o t rit mr yt t sarm as titd i topposit dirtio i. do o t t, it a dir o i at tsar aa. i cass r at t mor ds d ad idiscrpcy at t sara aa. o otrs r at t mora adsad ad as m as i disrpay at t sara aa

abo istiatio ad a pry imitd objti to so tratiosip o a pic tit to baa. mportat as tis is it dos ot

by y mas idicat t ct o pc tits o t spi obody is ctd 1 a ad tr patits it obsr atrior toricpai asd by a sort ir pai yidd to t prsriptio o aappropriat it ito ay otr orm o tratm. Nmros casso brositis', ritis adas ad rrrd pais a b trad to tiscs ao ad to ior it od b as oois as to ior t dit trati or ostipatio

Nottstadi t abo rmars, it is possib or t pis to b



RO- O N

d t t id id latally by i m t lmba piad b tamt i mmd t pl a mami t umba aa aully t ld t pibiity. ila

ml pam it pa ml t pa a ailypt bala t pli ad, l u pam it, ay tpi t t pti a miladig.

At-atal pli bala i ualy day t m t adp ad a td by attti t t pit agi tp ab a aal piti ampl a lta kypi m tdti a au a day lumbaldi ad a aggai t lmb-aal agl.

T apt pli mai a mly b td p i amaal tiu but y mt al b idd i t amt n patit' ttu

l Joits

ag mmt i t ji i y ma idd

Appdi) ad, a i t jit pia lm t may b ypmbity a ll a ypmbility W tabilty i a-mptat, a i tpl ypmblty i t b pd t ypmbility bt bt ault aau ymptm.

At amiig t pli m t pit i t aal ll t i ami t a-ilia jit t tt i mbility(p 5) ad t t b t liial ig li at t jitp. 8 ). t patt pt ig hermy t atmt mut

it adat ppt, tgtig i ad i ayijti a lig agt t tigt lgamt atiially iblmaiplai t jit jit ablutly ta-idiad y i i d i at, patd maiplati t jit i a di au ypmbility t mitak i t iitial amiat mlyttig ptial al ad t payig g gad t t mbiliyt

ppt t "-iia jit adaly a lmb-aa typ

t it dp i dabl, pl a tg id blt pagd t l t pli ad d it a g bkl ta tit a b ld tigtly tgt.

Hypmblty i ay jit i t lt -ttg t atiti i t ligamt ad ap t ji Nmal t i ligamti dpdt p atal ml itmittt ttigtygi ay d ilt ttg plgd uaid tigW t la tiu a g ay ad lt it t, it i pibl



2 8 ATLA O TECIQE

. 3

h igam to rgai thr o ony i h igamt ar not ortrhd or ra moh Cotod and gt trthig hot oaig pai a ad ara tim to h ati o hatit i to appy artiatoy thni in modation o t ar-iiaoit hr thy ar hypmoi.

Araory hniq ar ao aa n hypomoty hr hod am to gi og momt to otai a mh rhg a

poi

ARTICATORY TCIQ R TE AR·IL A JIT

) Srgg FI 33Pa th patint pro rtig h pi on a ot hio an

or th paint kp yor o traigh and appy a pringg prr



SO- OIN RION 19

I. 1 34

\i one nd ovr te pex of e rm nd te oter over te poteorprt o te et o te im i ete torion tret of te roii oin o>io in te oppoite dretion m be obtined b ppinone nd to te be o te nd te oter to te i tbeot

Drn ti teiqe ot i ometime or in te joint men o ve ieved bot n titor nd ppi ee

() Ariu/ol I 1 4Wt te ptient pine, tnd on er rt de nd e er rit nee

nd ip b pin er nee beteen or rt r nd petorre i eve o rit nd ree to t it nder te rt bond to rp te ii tberoit en od te ptient rit ii retit or et d nd exert rottion eet on te rit nnomnte,trin to pivot te i im or te rm ond bot te S. eve.



0 AT LA S OF TCIN IQUES

3

(3) Ar F. 3Wi e pien upine, nd n e ig ide nd w e ig

eg ng ve e ide e be ue n exenn e ip nd in ee n evee diein e pevi eniue Te

pe' ig nd n be ped n e ig pu e ip ine exenin nd e pe' e nd n b ppied epien ig pei upei ii pine, puing upwd ineee wd wi e ig innmine n e um

) Atcat F 136B gping e pien g exed knee wi u ig m nd

mvng e ip jin , u n pp gpping ee eie inveing



RO- JO NS : RLTON 1

36

o eeing he innonae by ong aion o abcion of he exeigh hip The opeao ef han cn e on he abe papaing he eaive oveen ing he anve

(5) rua (see FG. 27)h he paien pone an he opeao aning on he igh ie heho ex he igh knee an hip own by he ie of he abe ae heanne ecibe in e fo aco-iac obiy. The paien igh kneecn be kep exe y he opeao igh hgh an enfocing peecan be appie by he opeo' gh han appie o he ce of heigh ii n a poeio iecion an he opeao e han appieo he chia beoiy in an aneio iecion



2 ALAS CNIQUS

FIG. 1 37

SPE EHNQUS R HE SAO- L lAC JNTS

ypomobiroii on only ympom if r i lo poiol f d fo i oidrin iq for r oo of mobiy n join rqi py d no o poionl ompon of o.

: Bk-ttl Lsl01 t gt FG. 7W pi pro d o r f d d o i

yo ri nd o if xdd ri l j bo p Ed nd dd ip i your i d d pplyprr o r poior pio i pn i l of yorlf nd Mii io o joi y mximm xio dddon of p d pply or rp r i lf d.A fl mniplion prod o l dr yor f nd

T prinn nq drbd ndr din o iionqi of li d i o-i oin.



SOIIA JO NS SPEIf c I ur 223

\3

2 ackaal Lel l h Lef. FI 18

With the patent prone and the operator standn on her riht side, asthe patent to raise up on her hands or a moment whie you pace yourexed rih nee under her riht aia so that she can rest her rihtpectora area on your riht thh. Then reach across with your riht armto support the patient's et shouder Thread your hand oer her et

shouder and down throuh her e aia to rasp her e scapua areaYou are now n a postion to increase the bacward bendin o the patientsumbar spine riht down to and incudin the umbosacra acets Withthis amount o bacward bendin a the umbar jonts are acetocedad we can then appy our hrust oer the posterior superior iiac spine onthe et thrustin in an amost ertica direction in the pane o the sacroiac auricuar suraces

a reater deree o acetocin is desired in the e row o umbar



224 AAS O QS

FIG.39

modiy h bov hiq by ddiio idbdi droio o h o obi h idbdi yo m bri h pipvi ovr ord yor id o h b d p hr ordh ohr id o h b To obi h roio yo r irdp i hr hodr ih yor rih rm

Bkwrrt L th Rght. I 9Wih h pi o hr id ppord ih pio dr hr

hodr o r idbdi o h rih h opror h pid hr rih k d hih pUi h k b hi ohih d o ori h i rih hih io ddio d irroio ih h obj oi i h ho pvi p o h rih d doo h . hi ir h idbdi o h b pi o h rih



CO-C JO C C CN QU 25

FIG. 140

No ota th oo 10 h ight by puhig h gh hod bkad\ ih yo igh had. Kp th mba pi i tio to ia fppoiJio oig i h apophya joi do to ad idig hmboaa fa Th umba pi ad am a o okig aa uit ad poid a oid bai fo a adjumt of h ight ao-ii

joi Th opto houd o a o h patit o th h aappy a tht to th potio upio i p i a foad ditioTh opo' bo poi aay fom th pi o tht hi oam b did i th p of th oit

4) FO'rd-rtt sl th FtG. 140

od to at a bakad toio adtmt of th f aoiia joit ha h patit yig o h bak ad tad o h ight id

ad i od to at idbdig to th ft pa th pati' pi to youid of th pith, pa h ft hod to th oh id of thpith ad do th am ith h f thu fomig a oaity o th fti th mb pi. Th ak th patit to ap h hd bhid hhad bigig h bo togth had yo ft had hough hft am fom ft to ight o that yo a puh yo fom o hht ad you a yo ft had o th pith jut a h ightaia. Thi ag b you to otat th tuk to th igh ad to

p



226 AS O HNQ

FIG. 4

ig lmr pi io xio Ti tloing on l ro o lm joint rnging o or rl t mpi d m om ni nd o tr on t ptint ltinomi og t rior pior ili pin ovrd i in

ion or omort i or t roi o movAl ov i r digd o r o-ili joint

r lokd in roon t omtim i gpping n oiont pl

(5 Tqu fr Gp FG 11A vr mp mod o doig ti o v t ptint on t d

omot rgd i t ppr ligl d d t k t



SCROC JONS SPE THNES

.

rt a wi t p pac your orar o pv jtbow t ac cr riforc you oar wi t or ad ad tappy a vtica tr trou t pv i wi av a app co bo acriiac o bt pcay o t ppr of two

(6 Rve Gagappi i t rvr dictio ca b acvd wit t patt

upi ad appyi a rt to a arior prior iiac pi. To obtait aiu ct co yor a ad rut o oppoi ic piad a t pac ar iv i i jut a w to u a co fort prpo

(7) Gg o h Rgh FG. 14

o ap t rit acr-iiac joit pac t patit o t-ad d

tad fac r ad aow r rit o a ovr t id of t tab



28 ATAS OF CNQ

knee exteded Fee o eon deveopn ove te acoac ontby aen e deee of exo and adduco of e p At e coectae you ca fee a ten o e oft tue ove te aco-ac

ont en mana poo of te patent t by pacnyou ef t aan te tabe eav e e o a feey It tewet of te e wc on to ep te app tecnque Now puo e patent' et am to otate te oo down to e umbo-aca onto eect a dee o acet appoon ockn. e pace you e foeamaat te paent t ueu medu aea ad tut tou tefoeam aat te omnae to ap te ont t moe

ecque o eay tou to obtan a cck t way eay

enou e cck tend o occu n e owe umba ot becaue teock not compete e ecet to make you ut ot ad aponce avn ated youef tat e tenon coecty ocazed to teaco-ac ont. e tecnque oud ony be ued n ecent acoaceo becaue t woud be que eecve a on-tandn eo wtton ade It woud ao be unwe f tee wee co-extn dcpatooy becaue f te foce wee coecy aaned e ack of facetockn woud not poect te umba ont adequatey

Th SacrCyga Jil

rual of te aco-coccyea ot ca b aceved by un teeveae of te uteu maxmu (s F. 3 e paet e poe ande opeato tand o e ede e ten ap e ef exed knee udete t ut above te patea w t and odn te e mybetween cet and t am e opeato e exe own kee to

b te p to abou 90 de. of exon ad adduco. pace atec o te be of te uteu maxmu wc ae aaced to epoteo uface of e coccyx e opeao ca appy eft tumb tote et de o e paten coccyx to enace te tetc o te on ande o tue between e coccyx and te aco-ubeou amen.

Sp manpuato of te coccyx can ony be done pe ectum1 pefe to ave te pate pone fo t pupoe Ate pan te ndexne enty tou te ana caa you ca en cu te ne upwadto fee te aneo apect o te ont ad te coccyx e w youtumb efoced f neceay wt e ote tumb a we you can appyfoced exo foced exteno o foced otaton Any of ee moveme w ee te ont bu [ nd tat foced exo bet doe ayad te ote movement econday

ometme te coccyx dpaced aeay ad ten we eque oappy a coectve foce e oppoe decton av eed exexteo and oaon



TE ARO�OYGEAL OT 229

o 3

t w t rmmb wht w d i in h b th my

cccydy r d t n hghr p d i U w t hbr p c whr h cig g rnd h cyx rndi

Ring h dh rd h cccyx c i ciycin bc dh rrm iy in j which h ch mm ywy. Th xci ccg h ni iw wrh pcrbig fr mnipi f h cccyx \ ih h p imid.



E INERVERER DISS

WHEN pt psts wi isoy of c tck of lowbck p ft bdg dow o do p so, folowd dyo so lt wit scitic d sigs of -oot pss, w c

fom is isoy lo lmost cily m digosis of popsdlo mb dsc; b tis is o bgig of t soy, is it td l pisod i log ci of cgs i ibl disc smpl momt of xig fowds iot y fg o pligs is sly isci to cs dmg o oml discs ms b dcd dg cgs dy ps W s ldp to tis l psod? W s pdisposd is disc to gi wy dsc lly mo sti?

ms b mos pdisposig fcos, sc s ijy, cgl omis, costitioly w ctig omo d cmicldisbcs wk msclt, ligmos si bt old sy mo impot c i copion i of p f pi qsiod bo ijs ty will fqtly dy y isoy of mb po ft qsiog o scod isi pti wil oc fll dowsts o slip o ic o som o sc iy ysgo W is denitly o isoy of jy sc pis fqy

sot lg o plic il iil ijy o coos sof plic tit lds to dgi cgs o ys is idd fo ptit to pst imsf o slf wi sigs

d sympoms of disc polps wot pios sympomspp s occsiol c of mbgo o mild bcc fom tim o m sl xo y lg of t istoy sggsts wtpocss is goig o ms b y slow o dd my b om pocss wic is mly cclrd by ijy o mtt si

Scmol i is istigtios of fo tos spis fod dgi cgs i t discs y i lif d is iw ws sc dgio ws s dmosbl pos�mom idc of sgig pocsi omtos cgs o, fompl H picly fod ccks cigios pts btw cls pposs d t tbl bodis H lso otd t bocg

] D A The Inteverebral Discs', Medc Resech Counl pecial r; No. 61 (Lonon HM Saonery 19)

230



DEENERATVE ANE 23

of sma foaios catiagios ats. s foaoscoy tiss id bt cacllos bo of t tbal body ad cls oss. is aal t Uitio to disc

cod asly accot fo t slo dgai cag i t dscsDgati cag i ay tiss is casd by casig ag ad by

a dco bood sly to t tiss is a sabisd fact atsi o s y o ad mo oad o adgati cags i sc oits comad it ots t sambody sms asoab o am at t ii s i a ifc t blood sly to t damagd stct If osc itfc i blood sly it old b dic o xlai tdgatio o ay o basis

a aological cags iba discs a b stdidad obsd , b so fa t a cags a o, ad ca olygss a at occs iti t disc stct bfo symtoms aisDisc mig ll b comad i t i i ic fo-fts of itssbstac ca b dstoyd bfo symtoms ais fact tat discas o sly obably acots fo t dlay i sbci symoms, b t a obcti sigs of cag ti dscccayobsab sgs s X-ay cags i t aly sagscitd bycaf xamiato og bfo aytig so obos as a oas occsI is cocio mobiity X-ay ms a of mo a ta t sastagt X-ays 7)

ysical sigs of cag i t ttba oi i its alisstags a i my oiio t y sigs ic ostoats a bobsig fo yas ad a b callig t ostoatic sial sio.A dsctio of yscal sigs of tis lsio i b fod a 2

do o sggs ta t ostoaic lso cssaiy lads o to a oas of t itbal disc; af all dgai cags a sadoogicaly i may sis miimal symoms oy aoccd b by y a of osoai sial lsio yomobity mscl tso comx x distbacs icais fom it all a ily to if it blood sy to t oi fac to aa of sgmt iold Sc soig of cicao illitaby lad o ay dgai cags ad i d cos to t latdgai cags ko o as sodylosis iz aod dscsacs slayd tba bodis ostoyts, ostoaosis o aoysalots, iatios ad olasd dscs xasios d balooig of tdisc, focig is of calcicatio i t tbal bodis Scmoods, aod ittbal foamia oaig of aoysalfactsall ts a la cags i t dgati ocss i tbal o Qi aat fom a bo ad oit stcs i old t

imad cicatio lads o cags i s ad sial codt



22 TRVRTRAL D

mlophi nd oo-lv boi, h nv-oo p nd dibn o h onomi nvo m hogh iion of h gnd whi mi ommnn

Th in wihn h pin olmn h in pli fowhi h od h good il pp wh n ning hinvb fomn diving nd nomoing fl oming v longdin nk i h vno ding whh lv mh o b did.Th i n nl vno pl nd n inn vno pl h oning o fom wo nio nd wo poio longidinl hnnlTh innl pl ommni wih h oh o fom i o vnong on oppoi h vb bwn h di nd h bon Th

nnl p i linkd wih h nl p b bivb vinwhih n hogh h bodi of h vb nd pool hogh higmnm vm Now h ngmn do low nomo,b h noml mhnim o vno dng ml ion nd vlv no opiv wihn h pinl nl Th in f no vlv n hvn of h od nd bn nd no ml wihin h nl o h ongion o blood whn h vn m v l o On h vlhpohi Ald k h bl p who ho of h low bk

h ndom nd, whil nno g h vno ongon onfo lmo ll low bk obl h impli, I do onid h i nmpon fo no onl in h dgniv hng whh w diing, b o in h mhnim of podion nd non of hmpom ook how niiv h bk o oghing nd ning dingh ph of d hniion Compon of h jgl vin ndbdomnl vin in h imn mkd n n pinb nng h mhnil p on h nv h d nd h

igmn.To n dq vno ding n h vbl omn h

nvbl jon hold b fl movbl An iion of movmn (h mo impon qli o h ooph pnl lion) in hpnl olmn gong o low down h vno ding n h Ap fom m hpomobili, whih n onl inf wih ding in piv o of w, onid on m b inin o blok h il ppl b i wil inlb nogh o hk h vno ding. To idk momn, hl i h mhnim of mn ongiv hdhnion n hml boipil ml wod b in o inf wih dingof h vbl vin nd in h vno p wihin h nm

Th h bn mh wok don nl on h qion of vil

BRAIN, S RELL ·Spondyo Kown n th Unknown rhe "ceA54) p 68

t FKA LADA M. humatis Vo 6 o4 Otor 1950



M RX TUR 233

spodoss eg he spl od d s ee- uh o slbe bU he sud s he deed o he l sges h hee oes eeed s o he opo he mehl ompess om

el spodoss s del o he od b eeg w h heblood suppl hough he eo sp e S Russe posues sm mehsm he ee s de oe s kelo ou s esul o ex dsubes o smoo he ede posled es go b he oseophs The de s o mehllo ug dub o -moo d moo s he sog ew o he wes h he ees o he oseoph leso podued reexl b smulus sg seso ed ogs he

jos muses gmes d soudg ssues oled he odo o o s whh exss oseoph leso Ths wswe b dold d ge-Wso 1935 The oeded hhee s somaco-veral eex hs se he mplse ses som uue d mess sel sus sul oph omusu pheome. The used whoe hpe he book peseghe edee o he exsee o hs pe o eex

s ommo-eough dg ll ss due o ds polpss h hee s dsube o somoo he lowe exemOe ol ssume h hee s some meh o eex dsube ohe ge m ommues whh pss hough he eeebome

s-moo tS dsubed b meh spl uls wh oseo-moo hough ehe ge o whe m ommues?Smso Wgh he 19 edo o hs Appled Phsolog goes so s o s The shp dso whh s usoml dw bewee heuoom som eous ssem hough useul o puposes odespo s o osdebe exe msledg eentsoa stutre ma reel nuen era' (ls me

Ths s sdeg somewh om m heme hs hpe bu s s ow ue medl hough h som dsubes use sl hges he sp od seod o spodloss suel suhhges ou ee om he mehl lesos h eedespodloss

s sugges peedg jo sps d ompesso uesed o degeee poesss d o eeebl ds heoshe eme o suh heos ogh el o he sed log go

GREENFIELD. G, Re. md Suis rom 8 7 (1953) BRA, SR UE 'Spndylosis The Known an the nknown Th Wcel

(3454), p 68 MCND. GERE HRRVE-W W Th Oteopah Li ene

ann 3 p 44

WR Appied Pyg onon Oxfor nvest Press 952)



234 V

We shoud mipue d mobiize oseopic spi esios og beforee ed o ese degeeive chges d o eve hem o ke heircorse o emio of spie we d es o resriced mobii or

eve sige esios our d is o reese he resiced jois d esreom s fr s is wihi U power. ve e dmoios o Cri,1who ods mor disc eriios soud be mipued er opreve s uher disc cges, re mos ed oo e. Oce erii s occured we c mee pc i p s bes we c dope e pie wi be sesibe i voidig udue sr eegi

m o e m opio eied disc c someimes be repced

b mipuio bu we re propse o e disc occus m coviced i is impossibe o repce e cer mer b mipUio A sge h c be cieved b mipio is e empiicemp o sif he posiio of erve-roo d popsed ucer meriso h ess pressre occrs o he erve roo.

heiio of he disc evisge bugg of e us sucieo press o d irrie he poserior ogidi igme d dr merwiho compee rupue of e s d e poserior ogidi

igme f here is sucie ouer ur bres d poseior igmeo hod e heio from porudg righ rog e ik ougho be possibe o re-posio e ucer merio suc seof irsciic es sch cses re ewdig e obi drmicreief of smpoms, eve og er de he m we ve repse. Aer , rck hs bee fomed i e cicr bres of eus d sch rck does o repi we if , becuse crige

oce or is o repired wi cige b mere wih bros sse Abes we c ope for brous issue epir d provide ddiio suppoeiher b impovig he msces surrodig he oi or b sig ricieer sppors

We uce meri s escped io he spi c d bcomewedged bewee he erveoo d ieverebr forme, mipioc someimes er he sie of pressre or shi he propsed meri ooe sie were here is ess irrio of e eve-roos f e echiques re desiged o chieve his d he re sce gee o voiduher dmge he re we worh empig becse i oug he cses he emp succeeds. f sccessf, e pie s si o observecuio d e hope s h e popsed meri w i ime srik dcse ess robe he mime miecom hs bee voided f heemp is sccess d he eiqe is desiged o void ure

J CVIX J' Txbook o/Orthoc Mii"e Vol. (Cassel & C td odo

96)



ANPAON EHNQE 3

mg h pi is o wos o if csr c sill kg o srgicl procr

Criicism of mpio i h rm of irrbrl sc sios

is jsi o som gos i s jsi i h opor hks h is pcig isc props i is si i h procr ls o hrmg i is jsi i h proc cos hr isc io props isc Bw o com mipio origh bcs o cs hos hs b m mpori wos is hl ir

h chqs which oow h b o o b s s i ow hs Som chis which will mio lr h o bsf hrfo o b o ll css whr isc g

o is mos o sspch iril

s bs o h clicl obsrio of roo pssr o ohrwis. fhr r o bom roogicl sigs lik oss of rs loss of pow oss o ssio om h opiio h h isc s hr rhh prolpsh pi m b locl r b i is sgmlfc of pi rhr h sigl roo isibio of pi Wh hr s iico o h ic bw prolp hri scs b hr r mro sigs smpoms o b ko cosiio A ml of chi howr is o h plc oiscss ll h l irilwhich gi ris o ciicl pcs similr o hos cs b sc lsiosh r c rl o orhopic books or sch isJms Crx bk f Otpdc Mdn, Volm (Csslloo) is probbl h bs o his ppos.

EQE HE EO HEAE

E VE EA L

hhm Adjus Mnu n t

Plc h pi spi o h bl srp h kls ow (i iqi q o h ssiss hoig h h opo ss h h o h bl grsps h p h wh his righ hr the ccip the hmb pontg to h pe 's rgh mastodpocss h ix gr o h l msoi procss. h mi rciois ppl hogh h occp h l h ml is h h bhoig r h pis chi

Th opror's bo posiio is impor i h h shol h hs rml pl gis h bs o h bl. c h sl lrigh bck so h his wo rms r x h c ppl his rcio

sig his ow bo wigh rhr h his bicps ol Th slck is k



236 RVRR C

44

up by plimy pll mking su pi's body no movy u io.

n is poio opo ymy pus o pin'sd umb o su plls pomd ply o o o

on d liy o pn lso mk pini d Ti nu is i opss i pi is sisig o spnl mss mu og you m mls d n y w ws o mnmm o o i wi ivig OUf nd g o w i mo kly o do m n good.)

T ym s ply dmid y ii nd wig o pi ou own body wig is invovd lso bus yo own bodyd pn's body mov n niso On is o is uil o vyo lows d T vi pi sow is ym d ig pin uik is ym A pi opolns pin s ow ym nd oly pi will is l of pin. is si s o oopis-osnwou wi opo n v b n iv mipuloT di wn mnpuo w k o issu sod o w su nson ss is s wid s o p oois d pin o ous is wid s skill o sugo



HETE : NL CTO 237

nd h bhr h wmkr nd h bksmi slor d hoinr ri lis h dirrs o los ion o his r d oror wo hiks

lr mion fw s lssonsAr rlimir rmi ll o obin h l o h i d

sbish h righ rhhm o romo rlxion h oror sholds momn bor ring h ross nd hn h righmomn s fr six or igh ls oror xrs m srogrl. mniio sssl ik is b oror nd b is somims dibl lik b i so is robbl o lsslii sig hn so mos mribl lik wih on

os orTh osiion o h is d n his iq is imornh

ll m b s srigh s ossib W do no w o disrs or orswih h k in xion or xnsion On vr hin illow is dsirbl d hniq is on r sisor i riion bwn h in ndh b is rdd mnimm T b o hror nds b osmoo lr nd i lis o s or blk so hr skdos o sik h lhr This oi bo sr o b ismor imorn whn sing niqs or h hori nd mbrrs o h si is ossibl o s his hniq in h rvi rwih loovrd bl b vn so h smoo bl is rrbl

Whn ling h niq or dis lsios in h lowr sions o s w ms rs b sisd h sh rion will no hv dvrsrio niq dsribd r ( 29.

Rhmi dsv mnl rion is iniv i nds o sr nd rr h lrd irrib nrv-roo whihis big omrssd owvr i hs is iion i h ordinr oso�i sinl lsion whr hr is rsrid mobili somimshis is h onl ivsom lsios bs i is h logidinl dsons whih giv w wiis hiq

W ms b on or grd whn dlig wi rmobil joisObviosl i n on o h sil joins is hrmobil o willsrh rs nd m xrb smoms b i w r rs sr h rr no hrmobi jois w n sl l djsiv mnl rionnd obin mos sising rsls

Th niq m b sd on svrl sbsq osons d sl sqn is h r h sond or rd rm o mor lb lks or d rodr boms iss Tn w bsisd s l h logidinl dhsios hv bn rlsd

hroni osohi snl lsions whr ri mon o brosis



238 TERVR

o.

occured it s sometimes desirbe to ppy the techique t iters oour to eigh ees d the sme joits e reesed ec time oy totighte up gi i the iter



AD DC VECA ADJIV AC 23

othe po \h hs echque s that o the st occaso you myeease a cevca jot o he secod occaso a thoacc jot ad oyay o a subsequet occaso may the umba jots yed. he p

cpe o usg the mmum o oce cosstet th achevg the objecve s ee moe eeded tha ths techque Oe shoud be coetto eease oe jo a tme ad so educe the eacto o teatmet to hemmum. Whe you have obtaed he u codece o the pate adshe has he aby to eax competey t s supsg ho tte acto seeded t s possbe h hs mehod he usg ecessve oce toacuay poduce subuxaoso doubt that s hat medeva psooes had md he they used the ack o the vctms but hs s

o ou ojecve h ptes!

V A t 5

he pate ad he opeato stad back to back. he paet gaspshe o opposte shoudes ad aos the am to es agas each otheso that he ebos ae pokg oads he opeato the eaches oudbackads to gasp the patet' to ebos he beds oad adhods the ebos gdy thus g the patet om the goud (t s o

use a shot opeato attemptg to do ths o a ta patet i) he pates asked to e he head to ake up ay sack the gamets he theopeao ate a pemay t shakes the patet as t eehe sesthe eght o the patets egs to ceate he taco ad he obtas theeect by usg hs kees he shake s eected by sudde exteso o hskees to t the patet st hghe o the goud the pae s too tao ths techque the opeao coud use a o paom o he puposebut the method s ot so satsacoy because the pate eeg some

hat secue teds to esst too much he mehod eectvey paces asepaato sta o the oe thoacc ad umba vetebe.

he echque may be moded ad somemes ths s moe eectveby askg the patet to casp he hads togethe ot he opeatohe heads hs ams backads though the patets ebos ad oudaga o each do o hod the paes games aea to the hp

os. hs oms a eectve hod o tg the patet he same typeo shake o the patet ceaes adjstve acto to the umba aea.

Vt Aut n n Sl sn

Sometmes a patet th a heated umba dsc ds she cao takehe eght o he egs thout a good dea o pa but yet ca st aycomotaby

he patet sts th he hads casped behd he eck he opeatoca the stad ookg at he patets back ad thead hs to hadsbeeath the patets aae om back to o he each up to gasp the



24 0 EVTEAL C

atients riss. The oerator has a eectie gri nd by eanig bckrds h i he tiet o he tabe. h tient no he edency to try nd srighten her knees bu sh must be asked not to dothis d eax as fuy s osibe h oeraor th attemts o shke theatient fter the manner of the reious tehniques by using his knees.

the aboe tchniqus ork most eectieyreted ery dey the trtion shoud be ied n the rst e hourso the oset The tssues he not hd time to se nd he muses are



RON 241

e iiabe he ai i e iee ad thee i ome oect of eaatio ucet eha fo the mauatio to be eectie

f eig ad guadig ad ai hae had a chace to etabih

themee the thee i e oect of ucce by maiuatio foeea day uti agai the a ad muce-guadg hae etted ucey to e the aboe techique. I the meame et heat ad aagec ae idicated Sutaed aco o ay fom of moemet oyee to aggaate the muce-guadg ad theefoe the ai

t th tage eief may be obtaied by eidua tatio th ocaaeheia hough the aca hatu. oca aaethea to the eectoiae muce ao a uefu meaue i hi acue hae but it eed to

be ey dey aed to be eectiee ao uefu adjuct i h acutey aifu tage

Whee e hae a heiated dic it i eaey eay to tu it ito aoaed dic by maiuato! t ha thi tedecy ayay oaeou y ad ay ijudciou maiuatio ca eaiy coet a umbagoito a ciatica. hae foud fo eame fom eeiece that i uieto ay toioa echique Paticuay it i imotat to aod toio he ittig otio. he obabe ea fo thi i that the toio

ut tea the fe emaiig be of the auu bou hch ae eftto hod the uce mteia fom butig though Simiay ay focedeio techique ikey to coet a heiated dc ito a oaed dic.

f a heiated disc caot be educed by actio techique hich aeafe the atet i i a highy ueabe tateit i amot efeabe tohae a fu oae becaue he atiet t eat become fay abiiedee hough hee eeoot a itead of the egmeta efeed aiaiig fom the oteio ogitudia gamet ad dua

oee it i ot ou uoe to acceeate the chage fom a heatio to a oae ad ate hady hak u fo uch a ocedue. Ifhe heiao i ieducibe a ae of Pai jacke i the bet afeguadagait futhe oae

ohr Itho! of aue i educig a heiated dsc i o ay aetic thut hie the atiet i ude gete ogitudia tactio

he atiet ie oe o th cai abe the ke ed at theoe ed of the tabe ad the thoa ed by a ta he oe eaf of

abe i he uceed to eet a tactio eectgaduay ad ot a much a the atiet ca bea If the tactio gieeief the a itte moe ca be gie othe guide a to ho muchtactio to ay he ae of guadig i the eecto iae muce Ifdug the tactio the guadg dimiihe the omehg ha beechieed ad futhe tactio ca be aied If eaatio ad educedai eue fom he tactio it i the afe o ay a etica thut

Te e ge ad idde e ae aied oe o each de of the

o



42 RVERA C

7

spine oer the transerse processes and te hee o the other had thenappies a thrust oer these ngers In ths ay e hae to papating ngersthrough hich the thrust ca be appied successfu manpuation iaccompaed by a ery sof cic hich can be et by the gers.



LUAR PROLAPED D APULATO 24

dal tg o, t s possbl s to apply a plas ost (aftt ma of MK o a plast of as jat o at las som adsv sappg ( Fg 47 to pvt t pat fom g

sp at all. Smpl oad bdg at s stag to ay sta sst to at t ds aga lxo ms b avodd fo fo tosx s o abl bos o to ta pa.

If gtbag v t sp t bgs o pa agat maplato as fad ad a oly op a tm adat ll ts s a log ad tdos bsss bo o patt ad pato al.

MAPULAO LUMAR PROLAPED ERVERTERA C

s datd al maplato aot op o d a polapsdvtba ds bas t ta tog la mataas sapd s small ta t tdd maal ad t pss t ds s m ga ta a t vtbal aa All a op

fo by maplao s o alt t atv posto of v-oo ad poapsd la matal tly ts a b avd ad povdd avod damag to t voo mod albt mpa s l otlt may p t patt to avod sgy Notg as b lost byt pat v f t fals ad os as to b mad to sgy lat

My o ta o advsg sgy a:

(I) W pat s s sv pa ta o s ao

toat t ay log ad maplao ad al ot osvatvmass av ald(2) W patt as sd pplg attas of pa

a sosly ag s o lvlood, ad W a ada a pss symptoms ad sgs

al ot ass old a las atmpt t oog maplatvt. T as of sss dpd patly o sz of po

lapsd matal ad patly o s of lso. My o gd pogoss s t sagt lg asg st. If t st s postv at 3 dg o ss,t pospts of sss a dstly md. smal agl lss lly s maplao o b sss ad lo lvl o dslso t lss a of sss ad t pobab aso fo ts obsvato s ta t lost tvtbal foam as t smalls-szd ol

I McKE, G K 'The Tretment f Dis Lesis he Lubar Spie', rh ncl21456)

Q*



2 VA DC

and agst nvoot. s tfo ss oppotunt fo manuvand ataton of poston.

vn a patnt t a dsc poaps at sa 5 L., and a stagt g

asng tst postv of 4 dg. t cancs of succss b manpuaton aov 5 p cnt and b succss I do not man compt f of pan buta substanta ducton of pan and ducton of psca sgns Aft a,compt f of pan can ad b pctd fo t tudd nucamata s st t, but n a poston to caus ss pssu Suc apatnt oud st b qud to avod on stans and a a umbosaca suppot fo sva monts to nab snag of t nucamata to ta ts so cous

Technique Jar Slretchig the Sciic Ner'e. FIG. 148 tcnqu dscbd s bst given unde nesthesi n od

to obtan adquat aaton but t s not aas ncssa.T patnt s pacd on sd t t panfu sd aganst t tab

and t tosona mobng tcnqu fo asng t appopat jontpfomd as dscbd on p. 22 (Fg 123). da s to ma sutat t apopsa jonts a at ast mob and tat adsons a

asd on t nonpanfu sd T patnt s tn und ov on to tot sd so tat t panfu sd bcoms uppmost Nt, nstad ofusng t usua cnqu as abov, t patnts panfu g s no aodto com ov t sd of t tab (see Fg 1 f t patnt as, foamp, fsdd scatca fom a poapsd 45 L son, tn s b ng on gt sd and t opato pacs ft g btn sto gs, so tat s gt g contacts t patnts t caf and s ftg contacts ft tg Ts poston of t opato nabs m to

conto t dg of on at t p mantanng t patntsn n tnson; tat s, can app a sttc to t scatc nv attndng to t ot dtas of tcnqu. If t patnt s anasttdt opato soud no at at ang t stagt g asng tst spostv. If t patnt s conscous s soon ndcat t ang to mHavng postond t patnt and panfu g, t opato soud justt up' a f dgs to v tnson fo a momnt o to aangng t upp pat of t bod toso soud b otatd don to t

coct v (L

n ts cas as n t standad tosona tcnquT opato s no n a poston to ma a dct scc adjustmnt oft 45 ont n combnaton t a sttc of t scatc nv. o bctv t as of t jont and t sttc of t nv soud baccuat sncondb no mans as bcaus t opato s aad baancd, patcua n t stagt g asng s of a o od.

as ago bfo dsc patoog as undstood, t sttcng of tscatc nv und anastsa as mpca md t t da of



CAC RV RCI CU 245

4

bakg ad t pum ad a mall ptag f a wufl Nw w kw m lkly tat tat pdu faatd t pt f t t ad papd d tu mata, a ada t ld mtd f applyg a tgtt t t w patt lyg p t abl

A a u a pd a a tmpay aba f pa, dbt ba f t ttg f a tab [t dabl a tpat uld a bd t f a ftg af t mapuat t aka wk m f ammay uda t ubd t m uff maplat ad t b ad by bd . W t atmta b ufl dg maa p t w dt tagt g ag t a gud t pg W w t dayt ag ad ad t pa dm faly kly af ta.



246 NR VRRA L D C

Anothr gud to prognoss s h dgr of muscl-guardng n h lowrrctor spna group. Such guardng n sucssful cass subsds n awk. t s not possb to forcast wth complt crtanty that h

manuvr has bn tv n lss han a forngh bu th straght lgrasng and musclguardng ar a grat hp n assssng progrss.I do no nd tha tracton s of much hlp n th ary days aftr such a

procdur. My vw s tha th patnt should b ft alon and gvn faryhavy sdaon. Thn f th sraght lg rasng s rapdly ncrasng thrs no nd for tracton. If, on h ohr hand th straght lg rasng sshows ll chang, thn us th Camp Varco typ of racton apparatuswth a pull of about 2 lb and us t to apply susand racton wh h

foot o th bd rasd 9 nWhn th manpuaton has bn nctvusualy hp n rlf of pan, bu th progrss s much slowr and bd rstnds to b contnud vry much longr.

In h succssfu cas, prfr to apply a plasr of Pars ackt or atlas a strong lumbo-sacra corst bfor th patnt gts up from bd Wmnmz t rsk of a raps f hs s don.

MANPLAO CRVCAL PROA

RVRRA D

In my vw th manpuaton of th fully proapsd nrvrtbra dsccanno rplac h prolapsd mara and ths appls ualy w n thcrvcal ara as n th lumbar ara W can howvr fruntly alr thposton of th proapsd matral and th nrv-root and thrby achv

a masur of rlf for th patnt Such manpulaton s mor lly o bcvthr s ratvly mor spac and h sz of h prolaps s much smalr.

h cu usd s uch th sa as that dscrbd on p. 113 g46) for h drct spcc adustmnt of a rotaton-rsrctd lson butwh h addd us of racton durng h tchnu

Whl s possb to appy hs tchnu wh th pant consousand somms mak an ctv

v undr ntotha anasthsa, h rason bng that th dgr ofpan such patnts hav prcuds thm from gvng you adua raaon voluntarly. o attmpt th manpuaton wthout anasthsa somtms mry rrtas th nrv bcaus th ras of prssur s nctv.w ar dalng wth a dsc prolaps at 5 C, causng 6h crvca nrvroot rraon or comprsson on th rght th procdur s to rlas thlt sd and ap th rght at h sam momnt.



CE RV CA PROAPED DC RACN 24

ehniue Usng Ttion fo Cei Popsed Dis 49T pi s spi d opror sds d of b.

H pps s f idx gr o riur pross of 5 C o lfd olds pi's i wi rig d is rig forrm d rmsupporig r rig k d r of r d i su wy s o bl o xr rio s wll s sidbdig d roio sidbdigis orold by lf d psig lrlly o rig (o us sdbdg of o l) d oo s orolld by rgd sq of posiog is rs o dow o 56 C sidbd o lf 56 C d ro o rig ll wil miig modr dgr of rio T l djsi for is uio of oion

T pi sold b lowd o om rod fro si db p yig spi wi low pilow for wo or r dys is dsrbl

o s omforbl yp o ril olr o rsri om for bo



28 NRVRRAL DC

two wks I ha trd a wd rang o dsgns o crcal collars and hacom to th conclson that th hom-mad on o paddd cardboard sth most ct It can b asly ttd t allows som momnt and t

rstrcts scntly It can b mad n a w mnts and can b rplacdas and whn nssary wthot pns

Wth ths tchnq [ ha nr ond th condton acntatd, andJ consdr t always worth whl and sa n n th prsnc o markdnr-root comprsson A snglarly ct and dramatc rslt occrrdsng ths thnq n a armr agd stytr who had bnt down to gtndr a ralng at a rac mtng; h msjdgd th momnt and ros toosoon, catchng th back o hs nck aganst th lowr bar o th ralng

Wthn tn mnts pns and ndls had dlopd down th rght arm,thn pan o ncrasng ntnsty and n twnty-or hors commncngwaknss o th tnsors o th wrst ngrs and thmb Whn J saw thpatnt thr days latr h had had no slp, and was n grat dstrss andn no condton to manplat wthot anasthsa h nt mornngatr th manpaton ndr ntothal ollowd by gm. o morpha tog hm a nghts slp, all th ntns pan had gon and thr was somrtrn o powr spcally n th tnsors o th wrst Thr was a prma

nnt rsda parss n th tnsor dgtorm commns and th twotnsors o th thmb bt rcory n th tnsors o th wrst whn saw hm a yar latr

Whr manplaton o th crcal spn als to rdc a hrnatddsc or als to altr th poston o a proapsd dsc w mst thn stracton thr sstand or ntrmnt sstand Whn to s sstandtracton and whn to s ntrmttnt sstand s largly a qston o thsrty o th symptoms Whn ry sr, susd to s dsrabl

h patnt ls spn n bd, a comortabl haltr appld rond hr chnand occp, and th tracton s mantand by wghts or a plly atth top nd o th bd

Th arag wght rqrd s 35 lbt shold b scnt to rlth pan at last partaly whl th tracton s mantand, and th nckrqrs to b kpt at abot 30 dg o on h rason or ths s thatdrng on th ntrrtbral oramna ar opnd whras n thntral and tndd postons thy ar narrowd Yars ago J trd

applyng th tracton rtcally wth ndrntabandond t or horzontal tracton. Whn sng rtcal tracton t srtally mpossbl to aod backward bndng o th nk and thror tdats or objct o rlasng prssr on th nr-root n th ntrrtbral oramn Frthrmor th patnt s almost always apprhnsn ths poston and nds t practcally mpossbl to rla, agan datngth objct o th tratmnt.

Imllt usd Tc/o has a mor rqnt applca



CVCA POLAP C ACO 2 4 9

.

to ta ssaed or to reasos Te rst s ta t sstaed ractote ate reqres to be bed, c saly meas osta ad tesecod dsadaage s tat matag te ec e sl eds o redcee o of bood e area. [f mc o te a s de o cogeso adselg te erertera forame ad ere-roo as I belee aes tese cases e are sg a less eecte measrea certa amot of moemet to tae lace Moemet, oeer sgt,ecorages te o of bood ad mroes draage. erefore lesse symtoms are etremely seere d termet sstaed ractomore eecte

Te meod s to se a comfortabe aer ad e best desg s e oesraed Fg e alter s attaced o a sreade ad ba beeec s aced a srg baace o eab e oerator o see o c



0 INTER VEREBRAL DC

a h s applg. Th aag pll s 3 b. d 30 bs a ad 40 lb ds a h - happpa as hs a b dsad baf A 3 lb h s

f fm pa has a 30 b h s hag ad a 40 lb hpa s aad I am aa ha h ga f s sd b spas b d d hs ssa dsab.

h a a dals f hq hh d b bsd f hmhd s b sssfl s f al h pa ds b mfab d lax. Sh ms ha d h pa ad ms bml hd p sppg. h ha has b h gh dsg adsz s ha h maj pa f h pl s a h p ad a h h

h pl h h ms h h h ad h pa ms b ab ls h mh h pa. h f gh b lsd sb ak saps hgh bd gh s sall s f h pa s bd a abl h a lh p O h s as s pfabl appl h a d sg hads h h da f gg h pad ad ab h pa mak s hs pa s laxg.h sg h ha ad ba s dl fl h laxa ppO s las pll a ghl 3 1b b had b s a g ped

ad a b maad as g as h sg h haf h hal ad ba a sd s q as f h pa js a

bakads h hs ams xdd ad ml lg hs bd ghd h k. O ld g all da h hs appaas f h d as

I s imie mm ad d h a gadall f ha s jkl sad shd h - s ml ad adhg s ahd; s mm h a sl ad sa h a pf sa 0 lb. js g h pa a da f ha xp ad

h ll h h x p ll b 30 b ad h 3 b All hs l pshlp bag laxa, h hh mgh as ll bh

Hag gadall pd 3 lb., ssa h p ab half am ad h qy swy d h a; a a f sdsad h app h a Sx gh plls a sa s a sss ad hs shld b d dal hl a, ad aa dash s sbsdg h maj f ass bg sh sgs f pgssaf h f ams ad s sal f pgss b mad

af sx ams B h a h pa shd b lg sph plls maa ab 30 dg f x

f mapa ad a fa ad hs s a s a ala s ssa ad asall a sab ds ls I hafd ssa s a a f h mhs s a la f mhlg ha hs ads mpas f adhss ad gd bh dsab ad a h sl f h am ah ha f hd



HORACC DC LO

e oracc tervrtebral dscs udoubedly become eraed deve prolpsed but as er rge o movemet s smll ad tere s petyof room te teverebal forama te cdece of torac dscesos s small ad ter eecsrecogzed We very cute ad we te p s refered terorly tep may be sucetly severe as to cuse dcultes deretal dagoss wt suc codtos s aga pectors pleursy perfored ulcesest d g-bldder coc f suc cases te spe s ot emed

eedless lrm s creted o eve paotomes performeddjustve mual trcto sould be ttemped ese cses dwee t ls furter mpulo sould be avoded compleely Wbed rest te p usully subsdes two to tree weeks soude brceto ep spl te toracc spe s useu adjuct to e bed rest

H LAR A O D C PAOLOY

us fr we ave det wt mpulve pocedues pplcable to teacute d subacue pases of dsc ptoogy Now le us tu o osemapultve procedues wc are of vaue te lte stages of dscpoogyo te cses wc te acue sgs ad symptoms of ereroot pressure ve dmsed but ye persst grumblg wy mymots ater te orgal ttck; so tose ot sucetly severe towrrt surgery or makg ay progress wt plaster of s jackets,cosets ad varous pysoterpy modltes pates wt resdualstess d bckce patets wo ave lost codece ter spes;patets wt croc degeertve cages ter dscs d dcetapopyseal jots

Tese ptets do emarkaby well o o-specc osteopatc tculatoy tecques My of tese tecques were descrbed ealer Capter 3 bu tee are some addtol tecques descrbed beow fortose prctoers wo ve a McMas or Gro osteopc treatmet tble

Tee tble ae vluble beue e ete pl llow up-ddow moveet o rse o lower e evel o te ble e lower lef ote tble c be moved up d dow or fro sde to sde or rotted eete porto s a a cuso or sprgg tecques d te upperporo wl gap a te ere to povde bretg spe for e proelyg paet urteroe t ges so te o ed c be ted up tofom a bk-rest kle strps ca be ppled te lower ed of te tbead s secto ca be woud out ad used o sustaed trato

251



252 NTERVERTEBRAL DC

McMni dbndng cnu 1

The patent les prone and he operator stands on eher sde so hat hean se the meta hoop rond hs thgh to ontrol he sde-to-sde movement of the lower leaf of th table. Ths lower leaf s drawn ot so th thepvo of movemnt s nder e mbar spne and the patens anklessered loosely n the ankle sraps sde-o-sde movement s obaned

and ontrolled wh he operators hgh. Ths leaves boh hands free toapply pressre over eah spnos proess n trn. Pressre may be appledon the sde of the onavty to fore the jons nto st more sdebendngor pressre may be appled on the onvexty sde o oppose the sdebendng n the jon above whe enoragng l sdebendng n he jontbelow the xaon hs rhythma sdebendng artlator tehnealternaey srethes and seezes he soft tsses and blood vessels andan be ept p for several mntes. The sdebendng may be ombned



CHONC DEEEATON: TECHQUES 253

lo 52

wt rotto by pllg o t oppos sd of t pls d o-dnng t lftng of pls wt t sdbndng

s t n b sd n oplt sfty n l ndds lsons n lbr sp d s on s los s ut sr n t orty o ss w r sos

oon hnq on ns b G. 152

ptnt s pron wt r kls oosy strppd o tblWn t oprtor stds o t ptt's ft sd ppls pssd ontrol of t lowr lf of tbl wt s rg nd optorsl d s t f to oppos o nn t rotoy ont wtprss o t spos posss



254 N VAL D C

Fxio d Exsio his th MMis b 1 53

h pn g pron o h bl rpp n h kl h hol h hlb h op of h bl or hol opobl for n ro p m ppl on h p owrb h ow lf o h crw o o p rch on hlbr pn h opor h mo h owr lf o h l p n

ow n low rhhmc fhon wh on h ppl corprr wh h ohr hn on ch ccv pno poc.

h chq o b wh crcmpcon whr hr c gnon bc h lrg forc lbl corbl.h lowr lf ogh no o b pr f ow o oo mch o nc gppng o h o c hrno of h c. mbr ofc wh h pophl jon r hch forwr-bnngrrc lo) h mho m b h o o whch wll nhch



CC E GEERAT TECQE 25

j I gvs way w a s k ad pa bas rmmdaly

Drg x spns prsss a b l spara and n

ass wr r s spara r ada spara a dwwardrs an b appd w r and vr spns prss abva lsd j

s applabl ra sp as wll as lmbarara b r w ms rly pas -pra ad r ably0 grp mly a p abl and y rax r sp. S nrlld raxan s n by ay mans asy b sld b pssb by avrag nlg pan

mbnan mvms a b band by sg wr la Mas ab p w s rags b s bd vms ar mpx asy nr ad ar rarly dad anyway p rmbr s ry and arrag pv v bs blw v ls ad wh arag a a vs lwr ra and lbar js pay spal a jsr r s a rsrd rang mv

y mvms a b sd xr a arlary

wr ra as wll as mbar jns b w nd av lwr a xdd s s x

tizd Rhhmi tinRymal ra band by sng a mr pll a ra

wlv pr mn s dsgd av an mprvm dnrag rvrbral dss and s nsmabl val n ramn r dgnrav angs dss

ral bass r assmpn a rvrbral ds dxang an b mprvd s as llws s r s n bld sppy dss s r ms b bad by ss-d dsn bwnalls b vrbra bds ad nls plpss ds. r ar mrs small prras n arlagns plasw spara bn ad ls s plas a as sm-prmablmmbrans alw r d nrang w bld nrag.r ms b a baan bwn ydrsa prssr ad sm

prssr ad w w d a a dssd nrvrbral w alls lgams svrd r s ab a mlmr nras wd wrrs apprxmaly 30 lb mprss 0 rsr s prvswd ndas w g sm prssr ms b wn ns plpss ad w srg als brss ms b maan apprxma vrbra

r s a nsdrabl dral varan n d nn rvrbral dss bas avrag al g dvdal



26 NTERVERRAL DI

s -. to - tller fte ghts rest bed compred wth fter dy ofcLvty Presmbly drg the dy, supermposed body weght compressesthe tervertebrl dscs d educes ther wter cotet d durg the

ght they ted to expd g he spogy tre d wter-mbbgpropertes of the dsc re those of the mucopolyscchrdes (chodroLsulphte) wth the crtlge d t s ot uresoble to suppose thtmy of the dsc peome re due to the vrLo of d cotet.J. Chrley the Btsh Me u of .2., dscusses ths theoryd ogclly exps the cte epsodes of lumbgo o cresed udteso bss. A. Nylor d D. L Swe the Btsh Mdc uof 31 10.3 postulte tht the possble seece of chges ledg o the

developmet of the dsc sydrome cossts of Depolymerzto of thepolyscchrdes of the coge poyscchrde compex the uclesplposs ledg to (2) cresed power of wter bsorpto cusg(3) bsorpto of ud by the cles the d eterg v the ed-plt4) crese of pressure wth the dsc he forces developed by leverged mscr cto wold ugmet ths.

lowrd d Buzrd (Amer etge, 68 2 1 92 demostrted tht cosderble d terchge c occr, s show by rpd

bsorpto of 3 per cet dodrst whe sed dsc cleogrphyBerg md tht the tervertebr dscs hve these hydrophlc

ultes d tht there s drl vrto of heght, t s ot uresoble to ssme tht the crese of heght occsoed by rhythmc trctos de to d expso of the tervertebrl dscs. 1 hve demostrtedto my ow stsfcto crese of heght of . to -. lrgeumbers of ptets sbected to rhythmc trcto. Sch crese of heghttes bout two hors to retr o orml f the crese of heght were

due to elstc stretchg or strghteg ot of the crves of the spe, twoud be resoble to expect such crese to retr to orml mmed"tey po the ssmpto of the erect posto.

If t tes eght hors of bed rest to produce - crese of heghtd oy ftee mtes of rhythmc trcto the horzotl poso toprodce - crese of heght t s resoble ssmpto tht thetretmet s powerful stmlus to the mbbg of ud to the dscs

Now f we c crese the d terchge rtcly ths wy we

must lso mprove the trto of the dscs the process, d chrocdegeertve dscs he method s of doubted clcl vue. hve otbee ble to demostrte y permet crese thckess of dscs butthe clc mprovemet ptets symptoms s estoble d thebove theory ppers to t the pctre well. de such tretmet thecresed d teso wth the dsc my be scet to cuse bulggof the dsc d hereby sgs d symptoms of herto. oe or twoosos ths fct hs hppeed so tht I ow vod usg motored



CROC DE GENERON TECNQ 257

FG

rhyhic racion upon paiens where I consider here is insabliy and

risk of herniaion her do conne his ehod of racion o hechronic ow backache syndroe associaed wh -ray eidence of narowed disc spaces.

There are several oorid rhhic racion ables in use he oneshown n ig. 154 has been in connuous use sinc 4 Idealy eapparaus should have a spring balance a he op of he able o easrehe racion beng eered a he head nd anoher aached o he lowersrap o easure he racion bing eered a he pelis.

PN RCON

Iio Co·iiio wll be seen fro h above discussion on he reaen of ner

erebral disc esons h spnal racion hods an iporn place ndplas a denie role in he araenariu of reaen. I is desirable



258 INTERVERTEAL C

owr to p it n it popr prpti wit otr form of trtmntnd wi pointing ot it nd indition o to mpi tddntg i nd ndiimint of tton w ony

bring t mtod into dirpt types of tcto n mntiond rdyty r )

tind, 2) intrmittnt tind, 3) ytm nd 4) djti, of wi my b ppid mny or wit om mni id

Drng t ppition of tind trton it i pob to t no inr in igt of bot on n in t rg yong dtPt of ti i d to trgtning ot of t bt mot of ttrt n dmontrtd on -ry to b d to prtion of t

rtbr bod m ow wdning of t di p nd intrtbr formin, nd om prtion of t popy joint At t n

pupos of ttion

) djtmnt of poiton2) fring of ongitdin dion3) T rf of nr-oot prr.

4) prtion of popy joint5) obtning of irtoy t.

) Dongton ond t ntrrtr formin, nd) Rdton of ydrotti prr inid t dis

By t djtmnt of poition i mnt tr t poitioning of rnitd di or t rignmnt of dnt tbr bodi. Oftntimbot t objti r rid t t m tim bt no im i md

tt fy popd di n b djtd ding trtion. typ oftrtion d fo t prpo ytmi djti mn ttionp. 235) for t i nd toi nd rti djti ttionp 239) in t owr tori nd mbr .

fing of ongitdin dion my w obtind by tdjt trtion jt mntiond nd frnty t tni tony on w tiftoriy i r.

rif of nr-oot pr or rrittion my obtind wit

tind or intrmttnt tind ton nd t po nd on of typ did on p. 248.

prtion of popy joint i prtry b in otortriti of t jont j trtion i b in ototriti in mototr joint.

probb pntion of t bnt of tton in otortiti i tt t tron brk into t iio y of pn, m pm ndpin rmy ontt of t rognd oppoing rtir rf



PNAL ACO 25 9

ed aboal aeet ple to the pal od wh ae reelar·ad rod he ot. Sh e otrato ae oreappoo o ot ae heeoe oe pa ad oe aboal

a eee ee o paprovded he pae elae well ad the trato et to eparate the rae ad e o oo o pll o eveehe thee be a redo o the aboal aebadet o the pa od ewer abora eeet peo o tele ad hereoe reaao Te break to th vo leeve ol or a ew te, ha a lat eet a ltrato o aoal aaee a ave a a eet b beak to te le o

pa pa paWere thee oderable erve·root prere there t el be a

ood dea o oal oeto ad well Whle trato appled, e..terte taed rato o he ek he pae ote ee releqkl ad the bee elt lo ater he tao ha opped, o that reaoabe to ae tha here ha bee oe redto the veooeo ad wel rod te everoot

The othe rlao eet o tao the redo o dro

tat prere wth e le o e d theeb a reatve reae ooo pree ad e bb o oe d wth eltat welo he d. Th rdt a be a dadvaae heaed d, bt a be o rea vale the treate o deeeraed d ( p 55 botorzed rt trao.

h Coniction o rato are to oe ete elevdet rowha ha bee ad, bt here are everal oher ad ee are led below :

( Trato t ot b appled the preee o aato ordeae

) Trao old o be appled where tere a k o ovea heraed d to a polaped d.

3 Rhh trato ora-daed oral opreoleo.

(4 Trato advabe the preee o hpeobt.(5) Trato table he patet who ha a trtral oo

or a arked kpholordo

Traon eed ever be more tha b ad reae oe a oradaed, vew.



APPENDX

THE PPYE FCE

A to th ndtandig o h noma pina movmn to bond in h tdy o th apophya oin ad o th ppo omaipativ thniq it tia to hav a woing nowdg o thagles of rhe faces.

h pio ad iio at oppo ah oh and in th mai thtwo d a ymmtia o that it i ony nay t viaiz and d i h pio at Boady aing th io at o th via gion a pwad ad bawad tho o th thoai aa

owad and bawad whi ho o th mba aa a inwad andbawad

h ang gvn h a an avag o a nmb o di o tton and ay A th mamn a o th pio at andth ang a bad pon h noma t anatomia pition h ga mad to th nat 5 dg ba hi i a ogh o paiappo ad i ay a it i not ay o mae h ang moaaty day wh aning hniq on hod hav a ati

atd pin to oo at at th am tim a o poition th patit Thnth viaizig o th a wi no b my a qt mmoy

The Arias

Th pio at o th ata idyhapd onav in bohdition and thi og ax poit owad mting at a ag o 50dg Thy a pwad maig an ang o 6 dg with th vtia oona pa and inwad maig an ang o 75 dg with th via

agita pa Th ang vay o o with th va o th on aviy Th abov ag a tho o th intio pat th at

The xs

h pio at o th axi a amot ia with a attnd pao h a potomdiay Thy a onv antoptioy and apwad (85 dg with th vtia oona pan) and twad (0 dgwih th vtia agitta pa

260



• \, . f_

\ ·

15 The alas. r superior aspect Rh: poseio aspe Imra asp

8 -

/

\ " -

156 The axis sperio aspe Rih poserior asp aera aspe



2 PPEX

3 C.-7 C p a ac bacwad and pwad A l jg

plan ac pacca ca dctn ad a am

h g md wth th ca cna pa a: 0 dg 4 50 dg c dg dg and c 40 dg

7 cer'ical vertebra e: superor apet. g lateral apet

\ 2 5" :

58 A thora ertebra. L ueror apet. g lr,/ apect



P 263

2

The suprio facts face backwards and slighty outwards and theuppr ons upwards If the paes of th acts ar joind togehr they

form a arc of a circ whose ctre is w forward o th body of hvrtbr

Th upward ad bckward angs formd with th vrtica coroapane ar:

60 deg; 2 45 deg; 3 35 dg; 4 30 dg 5 25 deg6 T 25 deg 7 T 20 dg; 8 5 dg 9 0 deg 10 T 0 deg; T5 deg 2 10 dg

The outward ags formed with th verica coroa pa are

I, 5 dg 2 10 dg; 3 T 20 deg; 4 30 dg 5 30 deg6 20 deg 7 20 deg 8 20 dg; 9 15 dg; 10 T 10 deg 0 dg d 12 facs inwards at a age of 50 dg

1£5

The suprior facets of th umbar vrtbrae face backwards and iwardsand ar amost vertica They are curvd concav backwards ad if thirsurfacs ar projctd towards each other thy form the arc of a sma

circe whos cntre is approximaty at the midd of th spious processh -3 superior facts ar vrtica but 4 ad 5 L fac a itt upwards

4 L formig an ange of 10 dg and 5 L 20 deg wth th vica coroapae

19 A lumbar eeb: supior ct



64 AN

The L-S Jn

The anges of the lumbosacral facets are otorously varabe ad therplae may be almos sagttal or actualy coroal. Dunng' made an

ecellent study of thee agle n 330 scmen of acra and foud theseanges may be as smal as 27 deg (almot sagtta) to as large as 9 degUus beyond the coroal plane) The agle 5 deg deg were codered average Thee are the angle formed by the uperor surface of he S faces wth he vercal agtal plane hee facet ed to be les cocave tha those of the lumbar facets

160. The sm le pec

S F

he aurcular artcular face whch form the acro-ac jon are etremely varabe hape, and the surface are mo rregular but therregularty of the sacra facet t wh the oppong rregulartes of heac facets The outle of the aurcular surface s roughtly L-aped wth

1 DUNNNG MUR O., MR n nays of he Lumb-Saa iaFa n he Proceedigs of , Otathi Aiat f Gal Bta;" (1956).



ANDX 5

a lge alms za se jed a se alms ealse

Reely I exmed 50 saa 30 f ee female ad 0 mae.

4 pe e f em ee a-ex, ad 0 pe e ee maly ae ad pe e maly ex ae-psely. pe eee edge-saped e de pa supely, ad 8 pe e ade sde de fey. f e saa ad asp ass asbee ag a ms saa ae a pmy a S. ee I fdly 4 pe e s feaue O e e ad, may sed a deepegula depess pse e auula sufae a e eel f S

f e aame f e esses sa-la lgame. s depess

as me maked e female saa, ad slgy ge leea S. ee S ae a a S ee e male saal depess assually saed 80 pe f e saa ae ey egua sfaes ad0 p e ee mpaely sm, e sufae beg paay aTe mpas f ese ps egad meme a dsussed e ex se

NOMAL MOVMTS O Til S

Vas efeees mal memes ae made e a ex fs maual paula e s f aladay ad yee ad sse s paly based up e dgs, gee ags f memes ake fm measemes f a lage umbe f mby X-aysAeage ges ly ae ge beause ddual aas ae sdeable e age f meme f a aba dae s adly m

paable e esed age f e adu akes le exese

Rages f meme deease easg age, s a e ages eedesbed ae se f mal yug aduls. Ee e mpag esame age gup ee s a sal fa sdeed Smepeple ae eaely lg games le es ae s es, s aa mg be sdeed ypmbly e pae l eessaly e s ae. I s e js examg e meaap

palageal js ad ebs ea pae ba a dea f epaua degee f lgameus elasy If e lgames f ese s

ae lax, e se e spe ae als key be lax.We examg a j e s k s ae age s, ad

sedly s passe age. I de ek u al dgs mbyX-ay lms ae used. Weg-beag mbly lms ge e age fae memes, eeas mbly es ake yg d ge epasse age f memes a aea F e pupses f eqese passe age s f me mpae, s a pae s ype fmbly lm s used ae a e eg-beag es.



APPl

It is esy enough to obtin Xy itues o the sine in owd ndbkw bendng, nd een n sidebending but it is diut o obtinlms showing otton o the sine nd n ny se suh lms e useless

o mesement uoses The ssessmen o otion the mins lnil mte whih nnot stistoly be heked diologily

Meauements of Anges of Mo\ee/1

hese ngles gien e eges only Eos o mesuement tenom Xy tues ineibly ee in beuse o the ulty in ostioning he tient uely Eos o ll ee in lso nd sometmes

the dwng o lines on the ms nnot be done eisey beuse ooelig o djent bones Howee with e these eos n beminimied nd they e guide though o ouse i is the lini tion whih hs to be elied on Just s in Xying the gstoinestinltt he ms e hel nd oen onmoy but the whole liiltue mus be the bsis o dignosis Howee eet the lbooyinstuments bcome linil judgment will ine\ tbly be the most imotnt to n dignosis nd this lies tiuy so "hen ming

mehni dignosis

Rnge oJ Moveen

e Op-a o/The oy nge whih n be mesued om rdioghs is owd

nd bkwd bending he ege s 0 deg Sdebendng nd ottion n be lted but thee is only sm nge whih ous t the

ey mit o the moement ie whe ll the othe eil jnts heehed he limit o thei nge

Te A n-axa n

The min moement hee is ottion nd it is ey esy to lte but

nnot b mesued. The owd nd bkwd nge is dg t s uious t this is gete nge eion-etension hn ous t theoitotlnt join

23 C ;IFowdbendingbwdbending nge 0 degSidebending nge ould not be mesued

3 C

Fowdbendingbkwd-bending nge 5 degSidebending 9 deg



AN

45 C

Forward-bedgbackward-bedg rage: 7 degSdedg: 8 deg

5 C

Forward-bedg bcwardbedg rage 12 degSdebedg 5 deg

6- C

orward-bedgbackward-bedg rage: 12 deg.Sdebedg 8 deg

7 CJ Forwardbedgbackward-bedg rage 4 degSdebedg: 8 deg

OA OVN

Forwad bending

nhck ning

3 deg 2T

23T

3 .

5

56

67

8 89

910T

IOIIT

12

2 -I L.

Sinng 3 deg

3 deg 3 deg2 deg2! deg2 deg

2 degI deg deg

4 deg7 deg 9 deg

MBAR MOVN

ord bnding ad

bw bnng 9 deg

II deg2 deg.12 deg

10 deg.

2 L.23 L 3

5

L.S

3 deg2 deg

2 degI deg2 deg

4 deg5 deg5 deg5 deg.6 deg6 deg

Sidbndng6 deg8 deg

10 deg8 deg.

2 deg

27



268 APPENDIX

Combinatn 0/ Spnal Movemns

lthough forward and backward bnding cr as simp movmntsin th spin, t is almost mpossibl to obtain pr sidbnding or prrotaton n any ara of th spin. This s bcas aftr a fw dgrs ofpr sidbnding th facts com into appositon and ths thn forcth vrtbral bodis into rotaon. Convrsly commncing with rotatonth facts nforc a masur of sidbndng afr th rst fw dgrss ofrotation. On cption to his rul is in th horacico�lumbar ara, whrsidbndng or rotaton can occr as pur movmnts provdd th spinis slightly d to start with. Th cincal implcations of ths facts ardscribd in th tchniq sction of this manual

Th dircon of th roation occurring scondary to sidbndingdpnds on th ara of th spin and whthr h sidbnding commncsfrom an orginal posion of rct normal or from n postion of forwardbnding, or from a poston of backward bnding

Th rul is that in th rvial ara h rotaion of th vrtbral bodsours to th sam sd as th sidbndng This ppis from whavrdgr of forward or bacward bnding you start.

n th thoracic and mbar aras on th othr hand, ration and sid

bnding cur to th sam sid ony from an orginal position of forwardbndng If th original postion is an rct or backwardbnding posion,thn th rotaton of th vrtbra bodis occurs to th opposit sid which th torso is sidbnt

Sacroilia MO)mes

Th maimm rangof sacro-iiac movmts occrs during prgnancywhn h ligamnts ar mor lasic than a any othr tim Stdis by

ams Young on movmnts of th plvis during prgnancs showd thatthr wr two componnts of movmnt, a hinglik on and a rotatoryon. H showd hat durng th rst si or svn monhs of prgnancythr was an avrag incras of widh of th symphysis pubis from mm.

to 9 mm. Such an incras of width at th symphyss mans a horiontalginglyms movmnt a th sacroilac joint, with an approimation of thpostrior sprior iliac spins Young also shod that by taking X-raysof th symphysis pubis in th rct positon, with th paint takng thwight arnly on on lg and thn on th othr, hat thr was an

pward and downward movmnt of th symphysis of 2 mm n achdirction. This movmnt mps a rotatory or trhoid movmnt atth sacro-iliac joint Th pvoting s likly to occur round th concntratdpostror sacro-iliac ligamnts at th2 S lvl mntiond arlir p 26rahr than at h promontory occasionally sn in sacra at 2 S lvl

t YOUNG, JAM 'Relaxaion of he Pelvic ois i regnay', hmal of ObSri(snd GYelg,J' /Ie Brit £pir�. Vol. 47 o S 1 p. 493.



AENX 269

Te dtance fom te ympy pub to e aco-ac jont aboutfou tme tat of te dtance fom te poteo upeo lac pe tote acoac jont and f e maxmum excuon of bot gnglymu

and tocod movement at te ympy 4 mm ten t follow tatte maxmum excuon at te poteo upeo lac pe 5 mmn ete plae T a mal-eoug ange and dcult to detect clncallybut t cetanly palpable wt entve ge

SURFAC ANATOMY O H NE

Fo detaled mecaca dagoe t eceay to locate te leve ofte veebal jont accuately o tat a ecod ca be made of dgSpou pocee ae te mot obvou to papaton an te level of omeof tee pocee ae moe ealy detemed an ote Ten t amae of countng upwad o downwad to te level of te jont nueto

Te vetebae bet ued fo t pupoe ae 2 C, 7 c, II T ad 5 LTe poteo tubecle dcult to feel but te tavee po

cee ue eay beween te am of te mandble ad te matodpocee

Te x pnou poce uually vey lage ad te t bone to bepalpated below te occput Te tavee poce of 2 C dcult tofeel but ca uually be found vetcally below te tavee poce of teatla deep to te teomatod

Te 7 C pou poce now a te / becauet pne o muc lage ta toe above t te t to be felt ealy

beow 2 C wen unnng te ge fom above downwad along telgamentum nucae If wle palpatg te 7 C pou poce te ec bet bacwad te pne of 6 C ed to become eve le copcuouT tet wll conm tat you ae ndeed at 67 C

We countg te emanng cevcal vetebae eaet to ex tenec wt oe and (pefeably wt te patent upe ad fully elaxedand palpate te pou pocee wt te ote tumb, tatg etefom above at 2 C o fom below at 7 C Te by movg te palpatg

tumb o nge ound te ec fowad you wll be able to palpate teatcula pocee coepondg wt te pou pocee n quetoTe tp o te pnou pocee ae on a level wt te nfeo magof te atcula pocee of te ame vetebae, e tey ae o a levelwt te apopyeal jot By papatg longtudnally oe often able tofeel te magn of tee apopyeal jot ad, of coue, f tee apotonal fault te mag ae felt moe eadl Te tavee poceeae deeply tuated te cevcal egon te tubecule ae coveed by



20 AND

he saleni aahmes and he spia eres makig heir exis hee ause dily ih palpaio Some degree o ederness hee ms noe onsdered abormal

he spous poes o I . s o he same horonal ee as s ranserse poesses and he agles o he 1s ibs.

As e moe do he spe e hae o disin suae·making. We

merely hae a rogh gde om he sapulae Wih he arms omoablyhangng don i he sing o sandg posios he spie o he sapla is

o a lee h he spinos proess o 3 T and s apex o a lee h hespinos proess o . o be arae i is neessary o on donrds rom C or Oasonaly og o approxmaion o spnes

he nera beeen is d o deeme ad hey are oe misshape Anoher onsideraio is ha he spnos proesses o he horai

area nline donads a a ieasing angle as a as 7 o 8 T hus a

I T he raserse and spos proesses are on he same horional leel ;a T he spnos proess is on a leel ih he anserse poesses o

5 and a 8 T. he spnous proess is on a eel hal-ay beee 9 and0 ranserse proesses

The spinos processes bo 8 T pidly shrink in lgh and derease

in obliqiy so ha om 0 T. don o 5 L. he middle o he spiousproess oresponds horzoaly h halay beee he anserse

process o he same erebra and he raserse poess o he eebrabelo.

A aily auae ay o ding he spinos proess o T. s o olohe lies o he las rbs They are sualy easy o eel and i he palpaiggrs moe along boh h ribs oards he ere hey lead direlyo he spne o l

The angles o he ribs ae imporan or esing rib mobliy andposiio. hy are oud o he same horioal leel as he raserseproesses.

Wih regard o he lba spous proesses e hae he es o he

ilim as a gude The sadad aaomy exbooks say ha he res is ona leel ih he spinos proess o L b his is 0 so n he majory o

ases. By sudyng he eels o he la ress on ere Xray pires end ha 60 per en o he rss ae on a eel mday beeen ad 5 .

spos proesses and oly per e o a leel ih L. spnous poesshe remide are o a leel ih 5 spous proess.

Thee is o ouse he probem o anomaies i his area ad aomaiesare more reqen here han elsehere i he spie, so ha ihou anXray e ms rely o palpaig or moeme a he lumbosaral joiThere are ery e lumbar spies ihou some palpable mobly a hiseel. Whe e nd he loes moable joi he erebra aboe is helas lumbar eebra heher i be 4 L, 5 or 6 L.



PPE 21

e se se lac ses f e maes ae f mcse cug lmba ss cesses g ey ae vaaby ae evel f e bdy f 2 S. Te dcly ee s a e sus cesses

f I ad S ae vey ly deed We cmag levels f ese sue lac ses w eac e s bes wbbleab a e eak f ese mes bu ae feel belw ad alae uwads e lwe mags f e se se lac ses.Ts gves a me elable emae f levels we esg f sacacad elvc less Oe suface-makgs ad levels ad e dec f

games ad mscle bes, ae descbed sadad ebks faamy. Te sude wll b well ead by a sdy f ese sface

makgse ca e becme ade a mecacal dagss ad ma

la w vg a mea cue f wa udees s alagges



INDEX

A

Adhesions 16 22 2

Adjustments dirct scic 1 1indit scifc 1 1

Anaesthesia 2 24lal

Artclr prses 2Articuation 8

cevic aea co�thocic. 12deniion 88

uba re 19McMni 22is Jsacr ygal oint 228acr-iiac oints 28

toacic aa 1

B

Backache dientil diagnosis 2sychogenic 4

c

D

Dis degeneration 20 2

dierential diagnosis 2uid interchange 2erniation 2patholo 21 21roa 2Ihoracic 21

Fats 2Ft , 21Fibrositis 2

F

G

Graity cntral line 8

H

ymobility 1 2182diagnoss 1sacriliac 21tatment

ypomoility 1218

Circlation sinal 2Clicking 20 10Cyx 8Cosets 21

nhibition 8Inspction, 3741

273



274 INDEX

L

igaments, hangs i lson 28

rlaxd 6 saro-ila 84 saotros, 84

Lok facapposiio, 10 157gamoustnson 103

M

Manplato 19 04 ompiaons, 20 241

Mimm fo 23Mobiy tss4

via ara 43 riothora aa, 52mbar ara, 73 opo-atanta45bs, 66

saro-a5hoa aa, 57horaiolmbar ara 62

Movmnts assoy20 viohorai ara, 52lmbar spn 71orma265 opio-alaa 45

b sao-ia, 82thoa spi56thoaoImba aa62

Mss 33 oatio, 27ramt, 89

o

Ohopai maplao 14Osopathi spna son hara-

ists26 honi28don25pathology 25postoa ompon 141

aon to ss 23yps2830vsal ts 29 30

P

Pai, igamos 523msar 26rv roo, 26 spial lsio 26

Papaon 34, 35, 42

Paits 92Pvs 21 astr o Pari jakt 21

Posr37

R

Ral xamiaion, 85

Rxs somtiovsal23Rlaxaon2Rib sios65

s

Sao-a sions, 81 213 217

Short 39 22 214Sof ss hqs, 89

cvohoa18lmbar spi 186nk93 sholr gir 120thora sp 135thora 166

S hniqs, aanoaxia, I

rvia vrtbra (26), 12 rviothorai aa, 26 oy228hra is, 235owr hoai 157mbar sp 197mbo-saal oi210 oipoalanta 05poaps is, 244 247



Si hnquri 74

aoia 222

INDEX 25

Traion oaindiion. 241 25ndiaion 25

inrmn aid 248

Documents

Manual of Osteopathic Technique 1993