PR IN C IPLE S f

O S T E O PAT H Y
‘

By D A I AS R, D O . .

M E M BE R O F TH E F A C U LTY O F TH E PA CI F I C
C OLL E G E O F O S T E O PA T H Y
18 98 -
1907

F E LLO W O F TH E S OU TH E R N C A L I F O R N I A
A CA DE M Y O F S CI EN C ES
P R ES I D E N T O F T H E C A L I F O R N I A S T A T E
B O AR D O F O ST E O PA TH I C E X A M I N E R S
19 0 1- 1 9 02

P R E S I DE N T O F T H E C A L I F O R N I A S T AT E
B OA RD O F
'

M E DI CA L E XAM I NE R S
1 9 1 0 19 11
-

M E M BE R O F TH E A M E R I C A N O ST E O PA TH IC
ASS O CIATIO N

T5 im E di ti on
’ —
R e w w d IZ/m z m ted
’

P UB LS E
I H D BY
B IR E L E Y a: ELS NO P R IN TIN G c o
A N ELE S
.

LO S G , CAL .
C O P Y R IG H T E D 1 9 1 3 BY T H E A U TH O R .

D A IN L TA S K E R D O
.
, . .

LO S A N G ELE S C A L IF O R NIA
, .
 P R E FA C E .

Thi s b o o k th e P ri n c ip le s o f O ste o p athy i s i n te n ded

on

as a m an u al fo r th e u se o f s t u de n t s an d pr ac titi o
.
_ n er s .

Th ere has b e e n n o e ff o rt O n th e p art o f th e au th o r to do

m o re th an give a sh o rt te r s e e x p o s iti o n o f th e e ss e n ti al
,

f act s u n der lyi n g o ste o p athy R e al izi n g f u lly th e g r e at

.

e ff o rt r eq u ired to ke ep p ac e with th e rap i d p r o gre s s o f .

m edi c i n e i n ge n er al we h ave tried to i n cl u de i n o u r c h ap

,
'

ter s o n ly th at whi c h wi ll b e so l id f o o d fo r o u r re ade r s W e .

h ave lo n g s i n c e l e ar n ed th at th e h u rri ed s t u de n t an d b u sy
pr ac titi o n e r h ave n o tim e to re ad lo n g di ss ert ati o n s o n
an y s u bj e c t Ti m e i s an e ss e n ti al f act o r i n c o ve ri n g th e
.

n e c e s sary s t u die s o f an o ste o p athi c c u rri c u lu m .

In der that the st u d e n t m ay re ad th e se c h apter s

or
-

i n te llige n t ly h e m u st h ave c o n c lu de d at l e ast te n m o n th s

s t u dy o f B i o lo gy H i s t o lo gy A n at o my an d P hy s i o lo gy
, , .

Th e s e s u bj e ct s f o rm th e b asi s o f th e sc i e n c e o f o ste o p athy .

The th o r has kept i n t ou ch with the gr o wth o f o ste o

au

p athy fr o m ye ar to ye ar th r o u gh c aref u l p er u sal o f i ts pu b

li she d b o o k s an d p e ri o di cal s .

; The te nt s o f thi s b o o k ar e the co n d e n s e d re su lt s

co n

o f th e au th o r s s t u dy o f re c o g n ize d m edi c al te x t b o o k s o u
’ '

An at o my P hy si o lo gy H i s t o lo gy P ath o lo gy Bac teri o lo gy

, , , ,

an d Di ag n o s i s o f th e w o rk s o f th e f o u n d er o f O s te o p athy
, ,

D r A T S ti ll H azz ard R igg s H e n ry an d M c Co n n e ll ; o f

. . .
, , ,

s i x ye ar s ex p e r i e n c e i n th e c l i n i cs o f th e P a c ifi c S c h o o l o f
’

O ste o p athy an d th e I n firm ary i n c o n n e cti o n with th i s

,

c o ll ege an d si x ye ar s o f c o n ti n u o u s te ac hi n g tw o o f wh i ch
, ,

wer e dev o te d to An at o my an d P hy s i o lo gy an d th e rem ai n

8 PR E F A C E

i ng f o u r to Th e o ry an d P r acti c e Of O s te o p athy an d P hy s i
c al D i ag n o s i s .

TO e n u m er ate th e b o o k s fr o m wh o s e p age s f ac t s h ave

be e n g le an ed fo r c o rr o b o r ative te s ti m o ny c o nc er n i n g the
P ri nc ipl e s o f O ste o p athy i s imp o ss ib l e Bo o k s h ave b ee n . .
.

re ad an d l ai d as i d e an d wh at is h e re w ritte n may b e th e
’
re s u lt o f so m ethi n g whi ch cau ght th e au th o r s atte n ti o n
‘

fo r a m o m e n t o n ly an d th e n be c am e a m averi c k .

The i llu str ati o n s e lu c i d ate th e te x t h ave b ee n fu r

to

n i s he d p ri n c ip ally by th e l ab o r at o ri e s an d C l i n i c s o f th e

P ac ifi c S ch o o l o f O s te o p athy With o u t th e h e arty an d .

e flfi c i e n h a i d o f my ass o c i ate s o n th e f ac u lt y o f th i s co ll ege

m u ch o f th e co nc i s e det ail o f th i s b o o k w o u l d h av e b e e n
i mp o s s ib l e I am i n debted to s eve r al o s te o p ath i c phy si
.

e i au s fo r dr awi n g s o f h i s t o l o gi c al ti s su e s wh i c h th ey had

prep are d d u ri n g th ei r c o ll ege w o rk Th ey ar e give n c re dit

. .
.

u n der t hei r d r awi n g s .

The l arge nu mb er e x c e lle n t ph o t o gr aph s o f m i c r o

of
= ~

sc O p i c s tr u c t u re s p ati e n t s an d m o vem e n t s i s th e re su lt
,

o f th e ski ll o f J O H u n t D O. . A few o f th e ph o t o gr aph s

, . .

were m ad e by M E S p erry D . . w ho al so t o o k gre at,

.

care t o s e e th at we had th e b e s t o f ph o t o gr aphi c l e n s e s

with wh i ch to w o rk l am also gre at ly i n debted to C H

. . .

P h i nn ey D O an d J E S t u ar t D O fo r th ei r ac cu rate
, . .
, . .
,
. .
,

d em o n str ati o n o f o ste o p ath i c m o vem e n t s .

M y th an k s e x te n de d to M i s s L o ui sa B u r n s B S
ar e ,
. .
,

fo r re adi n g th e m an u s c ript an d su gge sti n g co rre cti o n s

th e rei n al s o to M i ss G ertr u de S mith fo r p rep ari n g th e
,

m an u script fo r th e p ub li sh er .

D AI N L TA S K E R D .
, . O .
 PR E F A C E 9

PR E F A C E TO TH I R D E D I TI O N.
i

A l o n g tim e has e lap se d s i n c e th e s e co n d editi o n o f

th i s b o o k w as s o l d o u t The pre s e n t e diti o n i s i n re ality . ,

a n e w b o o k i n ste ad o f wh at is o rdi n ari ly u n der st o o d as a

revi si o n The m ateri al wh i ch w as deve lo p e d fo r th e fir s t

.

an d s e c o n d editi o n s w as e n ti re ly d e s tr o ye d by th e dy n a
\
.

mi te e x plo si o if an d fi re whi ch wre cke d th e gre at e s t ab

‘

, _

li shm e n t o f the Lo s An g e l e s Tim es an d k i ll e d m o re th an a

'
'

sc o re o f i t s emp lo ye e s .

The d em an d fo r thi s b o o k h avi n g gr o w n s te ad i ly

m
.

m o re i ns i ste n t an d th e ore i mp o rt an t fac t th at d u r in g

.

th e tim e s i n c e th e p u b li cati o n o f th e se co n d e diti o n th ere ,

has b ee n a gre at d eve lo pm e n t i n every ph ase o f o ste o p ath i c .

te achi n g an d p r ac ti c e has l e d u s to at tempt to p r o d u c e

,

an ed iti o n o f P ri n c ip l e s o f O s te o p athy wh i ch wi ll b e eve n

m o re u s ef u l to S t u de n t s an d p r ac titi o n er s th an o u r f o r m er
I

editi o n s .

The e x p erim e nt al w ork d o n e i n th e lab o r at o ri e s o f

o u r c o ll ege s an d o i p r iv ate i n ve s tig at o r s
. .
- . _
as we l l as th e ,

re c o r ded e x p eri e n c e s o f o u r p r actiti o n er s te n d m o re an d

'

mo re to su b st an ti ate th e P ri n cipl e s o f O ste o p athy as se t

fo rth i n o u r p r evi o u s editi o n s The fee li n g th at th i s b o o k .

wi ll f u r n i sh ge n u i n e as si st an c e i n th e te ach i n g an d p r ae
ti c e o f o ste o p athy l e ad s th e au th o r to s e n d it f o rth with ,

th e b e li ef th at i ts i mp erfe cti o n s wi ll b e ki n d ly e x c u s ed by
i ts re ader s i n vi ew o f th e spi ri t o f g e n er o u s h e lpf u ln e s s
,

t o w ard all S ch o o ls o f m edi c i n e whi c h has b ee n m ade th e

re as o n fo r its ex i s te n c e .

Ne ar ly every ch apte r i s In so m e degre e c h an ge d o r

co mp l ete ly rewritte n S ever al n e w c h apter s o f p r acti cal
.
,

v alu e h ave b ee n adde d M u c h o f the m ateri al i n e ar ly

, .

ch apter s o f th e f o r m er editi o n s
. re lati n g to h i st o lo gy has , ,

b e e n e lim i nate d .

The writer wi s h e s to e x p re s s hi s gr atit u de to J o h n

Co m s t o c k fo r hi s v alu ab l e as s i st an c e i n i llu s tr ati n g th i s
editi o n .
 T AB L E OF C O NT E NTS

C H A PT E R I—C aus e s o f D is e ase 27

N o r m al an d A b n o r m al— The I de al N o r m al—V ar iat i o n s i n

S tr u c t u r e a d n F u n c t i o n — A d a p t a t i o n— N o r m a l H e a l th — C o m f o rt
an d E ffi c i e n c y — V ar i at i o n o f the N o r m al— D i str e s s an d In e fi i
’

i n
c e cy — D i ff r
e e cen i n B e l ie f a s to C a u s e s— I nt e r p r e t at i o n o f
Ph e n o m e n a o f D i s e as e — F avo r abl e R e act i o n to E nvir o n m e nt
K n o w n C au s e s o f D i s e ase—The Te nac it y o f L if e— L e s i o n
D i s e as e A sso c iat i o n— R e m o v e the C au se O f D i s e as e — Pr e ve n
i
tat v e M ed ci i n e — S y m p t o m s — A N o rm al S t i m u l u s— A Ch an g e
of R e s i st an c C au s e an d E ff e ct—C e ll R e l at i o n s— E x c e s siv e
e

t
S i m u la o t i n — S tr u c t u r al D e ef c t s— C e l l L i f e D e p e n de nt o n C i r
c u l at i o n—I nt e r c e ll u l ar Te n s i o n— S c i e n ti fi c Th e r ap e ut i c s—The
o l —
Pr o bl e m as a Wh e N t r R c v r y E x tr i n s i c C au s e s o f
a u a l e o e —
D i s e as e — I nh e r e nt R e cup e r at iv e P o w e r—D i stu r b e d Ti s su e R e
l ati o n s— The B i o l o g i c al R e lat i o n o f F u n c t i o n an d S tr u c t u r e
The Tr u e A r t o f H e ali n g
‘

C H A PT E R II —Th e Le s i o n as a C ause

D e fi n i ti o n— Char act e r i st i c s o f a L e s i o n— C las se s O f Le s i o n s

—
‘

C au se s o f L e s i o n s—S e c o n dar y L e s i o n s E ff e ct o f V i o l e n c e o r
F at i g u e — F ailu r e o f A dap t at i o n —
Ch e m i c al C au s e s o f S p i n al
L e s i o n s—The R e as o n fo r the P e r si st an c e O f a L e si o n— The
!

S e q u e n c e o f L e s i o n Ph e n o m e n a—V ar i at i o n s i n D e v e l o p m e n t
P alp at i o n o f a L e si o n— D e s cr ip ti o n— F i n d the L e s i o n— In sp e c
t i o n o f the B ac k— P alp at i o n o f V e rt e br al S tr u ctu r e s— H i st o r y
o f A c c i de n t—Tr au m at i c L e s i o n —
We i ght C arr y i n g an d Balan c
i n g F u n ct i o n D i st u r b e d— L ac k o f Ph y s i o l o g i cal R e st—In fl u e n c e
on C ir c u at o
l i n a n d I n n e rv t
a i o n— S e gm e nt al C o o r di n at i o n -

E x am p l e o f F at i g ue —L o s s o f M u s c u lar To n e — E x p e r i m e nt al
L e si o n s— L o s s o f M o t i o n—N e c e s sit y fo r S tu dy o f S tru ct ur e
-

C H A PT E R III—The Le si o n as an E ffe ct 55

A naly s i s o f the Cau s e s o f L e s i o ns— The Attr act ive n e s s o f the

Tr au m at i c L e s i o n Th e o r y— C las s i fi c ati o n o f L e s i o n s— E x am p l e s
,

o f S e co n dar y L e s i o n s— The S p i n al L e s i o n an O bj e c t iv e S y m p
— V sc e r al R e e e s P le ur i sy—C ar di ac L e si o n P att e r n s
—
,

to m i fi x

U nit y o f the B o dy
C H A PT E R IV—S pi n al H y p e rae s th e s ia an d M us cul ar Te nsi o n 5 9
.

S u bj e ct iv e S y m p t o m s—I rr it at i o n o f the S p i n al N e rv e s—S p i nal

Tr e at m e nt—C o ntr o l o f the B o dy by the N e rv o u s S y st e m —A
C o c e pt o t e N rvo s S y t e
n f h e u s m — N e u r al g i a—V i s c e r al D i st u r b
an c e D u e to D i st ur b e d N e rv e C o ntr o l—C o e x i st e n c e o f S p i nal
-
 T AB L E OF C O NT E N TS 11

Te n de r n e s s— S y mp t o m s S p i n al Ir r i tati o né D u r at i o n o f Aff e c
of
-
—
t i o n s D u e to S p i nal Irr it at i o n— A ff e ct i o n o f the U p p e r C e rvi c al
R e g i o n— I rr it ati o n o f the L o w e r C e rvi c al R e g i o n— Irrit ati o n o f
th e U pp e r D o r s al R e g i o n— Irr i t at i o n o f th e L o w e r D o r s al
R e g i o n—I rr it at i o n o f the L u mbar an d S ac ral R e g i o n s—The
_

E ff e ct o f R e c u m b e n c y— I rr it at i o n o f S p i n al M arr o w Not Ne c e s
s ar i l y D e p e n de nt o n D i se as e O f V e rt e brae — L at e r al Cu rvatu r e
— Tr e atm e n t— G an g li a o f the S ymp ath e ti c N e rve s— S ympt o m s
O f Irr i t at i o n o f S y m p ath e t i c G a n g l i a— M i ddl e an d L o w e r Tho
r aci c S y m path e t i c G an g li a— S p i n al Tr e atm e nt H y p e r ae m i a
M u s cu l ar Te n si on—D i g it al E x am i n at i o n o f the S p i n al Ar e a
,

Th e Us e o f S p i n al M usc u l ar Te n s i o n i n D i ag n o s i s— C au s e o r
Eff e : t
.

C H A P TE R V—The S e g me ntati o n o f the Bo dy

1 1: e L e si o n as a G u i de i n D i ag n o s i s—The S p i n al S e g m e n t
'

11 1 y o f a S i n g l e N e rv e —A U n i lat e r al C e rvi c al S p i n al L e s i o n
_

: 1 11
—i r e at m e n t—I nvo lv e m e nt o f the C e ntr al N e rv e C e ll s— C e rvi c al
T
,

l\ i 1 S cl e s— E m br y o l o g y— S e g m e nt at i o n— Wi de s p r e ad
r *
I n fl u e n ce
a S p i n al L e s i o n— A s so c i at i o n o f M u s c l e s I n n e rv at e d by the
.

g
o
S a m e S e g m e n t— E ff e ct o f S e ct i o n i n g S i n g l e S p i n al N e rv e
D e ve lo p m e nt al Ch an g e s i n M u s c l e s
C H A PT E R V I—The Ne r v o us S y st e m
The M e diu m o f C o m m u n i c at i o n— The Attr i bu t e s o f N e rv e Ti s
s u e — N e rv e an d M u sc l e Irr it abi lit y— C o n du ct ivit y— Tr o ph i c ity
— U n it y o f the N e rvo u s S y st e m — O th e r S y st e m s o f I n t e g r at i o n
— M e c han i c a1i r i tati o n—E ff e ct o n C o n du ctivit y—A ff r e nt an d
r e

Eff e r e n t F i br e s— O r g ani at i o n o f the N e rv e B u n dle—I ntr a

z

s p i n al F i b e r s — S e g m e nt at i o n o f the S p i n al C o r d S e gm e nt al In
The S i mp l e R e fl e x —The
-

te g r a to m C
i — e a s e l e s s P l a y o f R e f l e x e s —
S e n s o r y S i de o f the R e fl e x Ar c — Pr o t e ctiv e R e act i o n s— E x am
.

—
e

p l e C o m p ar a t iv e S e g m e n t a t i o n — E ff e r e n t I m p u l s e s— E ff e r e nt
_

F i b e r s to th e S y mp ath e t i c G an g li a—G an g li o n i c C o ntr o l— Thr e e

F i e l ds f o r R e c e p t i o n o f S e n so r y Imp r e s s i o n s— Pr o p r i o c e p ti v e -

—
F i l d S e g m e nt al
e Co O d r i n a toi n é -
Plu i s e g m e n tal r C o n tr o l
C l i n i ca l Ev i d e n c e G r o u p L e s i o n s — D i ff e r e nt i at i o n o f S p i n al
"

L e s i o n s—L e si o n s Du e to F u n cti o n al F at i g u e
, _
-
.

C H A P T E R V II—The Ne rv o u s S y ste m ( C o ntinu e d) 1 14

A g me t o e
l i n n T n R e fl e x e s — C li n i c al I l lu str at i o n— I n sp e ct i o n
P at e llar Te n do n R fl e x — G astr i c S p i n al R e fl e x — S n sati o n
, ,
-
e e

V i s c e r al S e n s at i o n— D e p e n de n c e o n O bj e c tiv e S ympt o m s
D e p th an d E x t e n t o f L e s i o n s— L e si o n P i ctu r e i n A u t o t o x e mi a
— L e s i o ns I n de p e n de nt o f S e gm e nt al R e fl e x e s— The L e s i o n as
an E x p r e s s i o n o f S o m e F o rm o f I n t e g r at i o n — C i r c u l at o r y I n t e
g at i
r o n L es i o n— Pr o t e c t iv e R e a c t i o n s— P ai n s In c i de n t to Ch ill '

an d F e v e r—The Pr ac t i c al U s e o f K n o w l e dg e .

CH AP TE R ~ —
mpath e ti c Ne rv o u s S y ste m
V III The S y 12 5

U nit y o f the N ervo u s S y st e m — O r i g i n—L at e r al G an g l i a— F o u r

Pr e v e rt e br al P l e x u se s V s c e r al G an g li a — C o m m u ni c at i n g
'

i
— —
F i b e r s Wh i t e R ami c o mm u n i c an s—
t e D str i but i o n— F u n ct i o n i
.
12 TA B L E OF C O NT E NT S

G r ay R am i co mmu ni cant e s— D i stri but i o n—F u n ct i o n s o f the

-

S y m p ath e t i c S y st e m —I n de p e n de n t o r D e p e n de n t— G ang li a
C e rv i c al G an g li a o f I m p o rt an c e to O st e o p ath s—S up e r i o r C e rvi
c al G ang lio 11 —C o n n e ct i o ns — V as o — c o n str i ct i o n—D i str i but i o n
H e adach e —M i ddl e C e rvi c al G an g li o n—D i str i but i o n—F un ct i o n
—M an ip u lat i o n— R e cap itu lat i o n—The Tho r aci : G an gli a—R am i
e if e r e n te S —U pp e r Fiv e Th o r ac i c G an g li a—N e rv e D i s tr i bu t i o n
—The I nt e r s cap ular R e g i o n—A C as e I llu str at i n g the Ci li o sp i nal
C e nt e r—E ff e ct s o f Tr e at m e nt F i r s t to S e v e nth D o r s al— G r e at
— — —
,

—Th e o r y—L u m bar G an gli a—

S p nc
l a h n i c L es es r S p l an ch n i c L e a s t S p l an ch n i c F u ncti o n s
S ac r al G an g li a—D i st ribut i o n
t i —
F u n c o n C a d ac r i P l e x u s — P o s i t i o n a n d F o rm a t i o n— P ulmo
n ar y P l e x u s — Ph y s i o l o g y — F u n c t i o n s —Tr e at m e nt — R e su lt s
Ar g um e nt— S o l ar P l e x u s—L o cat i o n and F o rmat i o n— D i str i bu
t i o n—F u n ct i o n—C e nt e r s—— H y p o g astr i c P l e x u s— L o cat i o n an d
1

F o r m at i o n — P e lv c P
i l
”

— i i i —
D tr b t o n S u bsi di ar y P l e x u se s
—F u n ct io n—S umm ar y—A ut o mati c V i sc e ral G an glia—C o n clu
e x u s s u
.

S l O Il .

C H A PT E R IX— C i rcul at o ry Ti ssu e 14 9

—
F u n ct i o ns L y m ph D i str i bu t i o n o f the B l o o d—The Ci r c u lat o r y
—
A p p ar at u s— The H e ar t R e g u lati o n o f C o ntr act i o n—Co o r di -

n at i n g C e nt e r s—The P n e u m o g astr i c N e rv e — A c c e l e r at o r C e n
w

te r — St i m u l at i o n o f t e H e rt
h a — I h t
n i bi i o n o f t e H e art
h — V aso
m o t o r C o ntr o l o f the C o r o nar y Art e r i e s—A n g i n a P e ct o r i s
A ct i o n O f the H e art Ce nt e r s—V as o m o t o r N e rv e s—V as o c o n
— S u mm ar y—S e n s o r y N e rv e s—Cap i llar y
- -

str i ct i o n—V as o di l at i o n
—
C i r c u lat i o n Re c ap tu at
e
-

i l i o n — V as o m o t o r C e nt e r s— Conclusi o n s
—H y p e r ae m ia—Th e rap e uti c s— Case I llu str atio n s
-

C H A PT E R X—H i lt o n s Law ’
18 1

The Law S t at e d—M e th o ds o f S tu dy i n g A n at o m y—E x am p l e o f

H i lt o n s Law—The K n e e—O bj e c t o f su ch a D i str i buti o n—Uni
’

f o r m it y o f the Law—Pr e ci si o n O f N e rv e D i stri bu ti o n to M u s c le s

—I n di cat i o n s f o r the U s e o f Th e r ap e ut i c s— The U s e o f H i l
t o n s Law i n Ph y s i cal D i ag n o si s—C o m p ar i s o n o f M e th o ds
—
’

H e rp e s Z o st e r— The D i str i but i o n o f an I nt e r co stal N e rv e

So e m o f th e Ev i l E ff e c t s o f R e s t H e a d s L a
’
—
w A pp li c ati o n o f
the Law—The V i s ce r a—N e rv e s o f C o n s c i o u s S en s at i o n
.

'

C H A PT E R X I—
.

O st e o path i c C e nt e r s 19 4

n i —
D ag o s s F ir st F o u r C e rvi cal N e rv e s—E x am p l e o f H ilt o n s
i l ’

Law— The P n e u m o g astr i c N e rv e —The H y p o g l o s sal N e rve

S up e r i o r C e rv i c al G an gli o n—S u bo c cip i t al Tr i an g l e s—C e rvi c al
P le x u s—I nt e n sit y o f R e fl e x e s—The S p i nal A c c e sso r y—The
Phr e ni c N e rv e H i cc o u gh s—The Tr ap e iu s and S p l e niu s Capit i sz

e t C o l li M u sc l e s—V aso m o t i o n H e ad F ac e an d N e c k—Aff e c

,

t i o ns o f the C ervi c al N e rv e s—B r ach i al P l e x u s—A ff e cti o n s o f the

, ,

B r ach i al N e rv es—A C ase o f H e m ip ar e si s be lo w the F i fth C er

v i cal V e rt e br a—S ubl ux at i o n o f the S c apu la The N e rv e o f '

Wr i sbe r g—The I nt e r s c ap u l ar R e g i o n—The L u n g C e nt e r Cili o

I m

S p i n al C e nt e r—H e art C e nt e r—S t o m ach C e nt e r—L iv e r an d '

S p l e e n C e nt e r—L ar g e I nt e st i ne —S m all I nt e st i n e—C e nt e r f o r

C h ill s— T h e L a n g u a g e o f P ai n— O st e o p ath i c vi e w o f P ath o lo g y
 TA BLE OF C O NT E N TS 13

—C e nt r f O th G al l bladd r— I nt e sti n — U t ru s— O var i an d

e r e -
e
‘ ‘

es e es

Te st e —K i dn e y— S e o n d Lu m b ae
s a ap l g i a—L u m b ar
c an d r e

r
S ac a l P l e x u — T h e B l ad d r—
se sS p h i n t e r V ag i n ae — C o n lu
e c c

Sio ns .

C H A PT E R —
X II The Back 2 39

The S p i n al C o lum n— The S p i n al L i g am e n t s— F l e x i bili t y— No r

m a S p na C
l i l u rv e s—L i m i t at i o n o f F l e x i bi l i t y — Art i cu lar P r o
c e ss e s — C e rvi c al R e g i o n— D o r sal R e g i o n—L u m b ar R e g i o n
Fl e x i o n an d E x t e n si o n— S i de B e n di n g R o tati o n—B e st P o s i t i o n
—
t,

f o r F r e e st M Ov e m e n t— R o t at i o n i n th e D o r s al R e g i o n Ch ar
—
_

a c te r i i
st c M o v e m e n t i n th e L u m b ar R e g i o
-
n R o t at i o n To w ar d
C o n c avi t y o f a C u rv e — A dap t ab ilit y o f P o s it i o n to B o dy W e i ght .

C H A P T E R X III—The P e lvi s 2 63

The F i fth L u mb ar— L o s s v s E x agg e r at i o n o f N o rm al Cu rv e s

—M o ti o n i n L u m bo s ac r al Artic u lati o n— A dap t ati o n i n L umbo
.
.

s ac r al Art i c u l at i o n— S t abi l i t y o f the L u mb o — s ac r al Art i c u lat i o n

—D e c o m p e n sati o n o f the Lu m b r O sac r al Arti cu lati o n— P art o f -

th e P e lvi s— Ch ar ac t e r i st i c s o f the S ac r o i l i ac Art i cu l at i o n— Ph y s -

i o l o g i c al R e l ax at i o n—The M al e P e lvi s— L O S S o f S t abili t y 4

A n al y si s o f S acr o i li ac Arti cu l at i o n s— R e lati o n o f S e x to S acr o

-

i l i ac L e si o n s—I nh e r e n t W e ak n e s s i n the Ch ar act e r O f the S t u c r

t u r e— C au s e s o f S u blu x at i o n s—R o t at i o n—C o mp e n sat o r y P e lvi c

i l —
T t C ass e s o C se
l f a s — S s —
ymp t o m P l an o f Tr e atm e nt
C H A P T E R X IV—
.

S u blu x ati o n s 28 3

D e fi n i ti o n—Ch ar act e r i st i c s o f S u blu x at i o n s— Pr i m ar y o r S e c

‘

o n da y r L o e si'

n
’

s— The Ch ar act e r i sti c S tr u ct u r e o f Jo i nt s— The

'

At las— O c c ip it o at lant al A r ti c u l ati 0 1 The C au s e s o f S u blu x a

-
1
-

ti o n s— N o rmal R e l ati o n s o f the At las—A b n o rm al P o sit i o n s o f

-

the At l as— The E ff e c t o f M u s c l e C o ntr ac t i o n—The E ff e c t 0 11

C ri c u l atoi n — E ff e ct o n S u p e r i o r C e rvi c al G an gli o n— Atl o ax i al -

Arti c u lat i o n U n e q u al D e v e l o p m e nt C ar i e s D i sl o cat i o n

S po t n an e o u s R d ct
e u i o n— C rv c a
e i l e —
V rt e br ae D i sp r o p o rt i o n
b e t w e e n C au se an d E ff e ct— E x amp l e— U n e q u al D e v e l o p m e n t o f
S p i n o u s Pr o c e s s e s o f C e rvi c al V e rt e br ae— P alp at i o n o f D o r s al
S p i n o u s Pr o c e s s e s— N o rm al D o r s a1 M o v e m e n ts—F al s e L e s i o n s
— L at e r al S u blu x ati o n— M u s cu lar C o ntr acti o n— C o mp ar i s o n O f
_

E ff e ct s o f M u s cu l ar C o ntr acti o n— S e p ar at i o n o f S p i n o u s P r o
e
c ss e s — A pp r o m t
x i a i o n o f S p i n o u s s —
Pr o c e s e s Primar y S u b
lu x at i o n s—S e c o n dar y S u blu x ati o n s— L i m it e d Ar e a f o r L at e r al
S u bl u x a t i o n s — L ow e r D o r s al V e rt e b r ae — .

D o r so lumbar A r ti cu
l at i o n— K y ph o s i s L o w e r D o r s al—L u mb ar R e g i o n—E x am i n a
t i o n o f the R i b s— C o st o — c e n tr al Art i c u l at i o n s— C o st o tr an sv e r s e
,

Art i cu l ati o n s— C o o r di n at i o n— In c o o r di n at i o n— N e rv o u s C o n
- -

tr o l o f R e sp ir at i o n— C o stal S u blu x ati o n s—F i r st R i b— Te nth R i b

— E l ev e nth an d Tw e lfth R i b s— E ff e ct o f P o sit i o n o f V e rt e br ae
o n P o s i t i o n o f R i b s— The C l avi c l e s—S umm ar y

C H A P T E R X V—
.

The Diag n o st i c V alu e o f Back ach e 311

E l asti city—A F i e ld fo r S tu dy—O bj e ctive an d S ubj e ctive S y m p

t o m s—P ain—P o i s e—S tru ctur al D e f e ct s—S t ati cs—G e n e r al D e
bili ty — S acr o i li ac S ublux at i o n—S pi nal R o t at i o n—
-
S pi nal Cur
14 TA B L E OF C O NT E NT S
— C ar i e s— R i g i dit y—Arthr o p ath i e s— S p o n dy lit i s D e f o r m
v atu r e
a n s—R ach it i s— M al i g n ant G r o w th s—Ty ph o i d S p i n e — L u m bag o
—P o st ur e —To x e m ia—Tr au m a—Cr i c k i n the B ac k— I nvo lv e m e nt
Of the S p i n al C o r d—I n f e c t i o u s F e v e r s—R e f e rr e d V i s c e r al P ai n s
‘

—In fi am n1 ati o n O f S e r o u s M e m br an e s— Co li c y P ai n— S u m m ar y
'

— P l u r i s e g m e n tal C o ntr o l o f V i s c e r a— R e fl e x S u blu x at i o n s—In

t e n s ity o f R e act i o n— L o c at i o n o f R e fl e x e s— R e fl e x P att e r n s .

C H A PT E R —
X V I A dapt ati o n an d C o m p e nsat i o n 332

D e fi n i ti o n— The C o l u m n— C o m p e n s at o r y C u rvat u r e
S p i nal
The Th o r ax — The H e art—S k i n an d K i dn e y s— P o w e r o f E m
.

c y s ti n g — The E x tr e m it i e s— Law— The Att it u de o f R e st .

C H A PT E R X V II— Inh ib iti o n 3 54

A c c e l e r at i o n I nh ibit i o n— M u s c u lar C o ntr act i o n—S e c r e t i o n

A c c e le r at i o n an d I nh i bit i o n as Attr i but e s o f Ne r v e Ti ssu e—In
,

hi bi ti o n a N o rm al Attr i bu t e o f the C e n tr al N e rv o u s S y st e m
H i st o r y—Arr e st o f A ctivit y— S h o c k— F at i gu e —L o cat i o n o f In
hibi ti o n—M u sc u lar A ct ivit y—Thr e e Ch ar a ct e r i st i c s o f the N e rv
o u s S y st e m — D e v e l o p m e n t o f I nh i bit i o n—N e u r o t i c D i ath e si s
Ch o r e a— P ar aly s i s A g it an s—D e v e l o p i n g I nh i bi t i o n by Tr ai n i n g
,

—I nhi bit o r y Eff e c t o f Pr e s sur e— D o s ag e—I m p air m e nt o f

F u n c t i o n—Ph y s i o l o g i c al A c t ivi t y i s the R e s u lt o f S t i m u l at i o n
H ilt o n s Law — I nh i bi t i o n Th e r ap e ut i c— H o w V aso m o t o r C e n
.

’
-

t e r s A c t— O ve r s ti m u lati o n E q u al s I nh ibit i o n—The G u i de f o r

,

the U s e o f I nh i bit i o n—P ath o l o g i c al Ch an g e s Wh i ch A e c o m

.

p a n y O v e r — s t i m u l at i o n— R a t i o n a l T r e a t m e n t — H y p e r ae sth e si a
of S e n so r y Ar e as -
D g i a n o s i s — R e s u lt s o f I nh i bi t i o n—The
Phr as e R e m o v e L e si o n s — The H u m an B o dy i s a V it al
,
“ '
” “

—
M e ch ani s m O st e o p th c M e a i a n i n g o I hbto
f n i i i n — The S c i e nt i fi c
— —
,

Us e o f I nh i b i t i o n I n h i b i t i o n a s a L o c a l A n a e s th e t i c In hi bi
t i o n to R e m o v e L e s i o n s— I nh i bit i o n as a Pr e p ar at o r y Tr e at
m e nt .

C H A PT E R X V III—S o un ds P r o du ce d in Jo i nt s 3 71

N o r m al S o u n ds—A bn o r m al S o u n ds—P ath o lo g y o f Jo i nt s P r o

du c i n g A b n o rmal S o u n ds— S y n o v i al A dh e s i o n s— No n u s e o f a
‘

S li ght ly S p r ai n e d Jo i nt— Rh e u m at i c Jo i nt s— S e m i l u nar C art i

s al an d C arp al S u blux at i o n s— E n arthr o di al an d Arthr o di al

Jo i n t s— S l o w v s Q u i c k R e d u c t i o n o f a S u b l u x a t i o n— B o ne
— —
.

S e tt e r s Phr as e s D i ff e r e n c e s o f O p i n i o n
“
’
A ff e c t i o ns o f th e
Sp ei n
”
D r H o o d — “
C r i c k i n t h e B a c k ”
— M a n i p u l a t i o n O f the
N e ck—M an ip u lat io n o f the B ack —Tr e at m e nt o f U pp e r D o r sal
.
, _

—C o m m e nt — D iff e r e nt ia1 D i ag n o si s— S i z e o f the V e rt e br al

C an al—C o n s e rvat iv e v s R adi c al Tr e at m e nt . .

C H A PT E R X I X—P o s iti o n f o r E x am i nati o n 38 4

O b s e rvat i o n—Te st i n g A li g n m e nt an d F l e x i bi lit y— S e n s e o f

To u ch I n s p e ct i o n— P alp at i o n o f the R i b s— P alp at i o n o f the
S p i n e —E x tr i n s i c an d I n tr i n si c M u s c l e s o f th e B ac k— Te st
M u scu lar Te n si o n—Th o r aci c F le x i bilit y—E x am i nat i o n o f the
A bdo m e n—E le vat i o n o r D e p r e s si o n o f the R ibs—E x ami nati o n
 T AB L E OF C O NT E NTS 15

o f the R e c t u m an d Pr t t G
os a e lan d— E x ami n at i o n o f the N e c k
The is o H t ry of L e si o n s— The E x tr e mit i e s— S u bj e ct iv e S y m p
to m s
C H A PT E R XX—
.

M an ipu lati o n 402

M e th o ds O f Pr o c e du r e—R e lax ati o n O f the L at i s si m u s D o r s i

R e lax ati o n O f the Tr ap e i u s— R e lax ati o n o f the R horn b o i ds
z

The P e ct o r ali s M aj o r an d S e rr at u s M ag n u s— Q u adr at u s Lu m

bo r um— Er e ct o r S p i n ae —Tr e at m n t O f S imp l e K y ph o s i s—Lo
e r

do s s U p pe r D r a
i o s l— Th e P o s s i bl e V ar i e t y o f M o v e m e n t s
w h i ch W i ll S e c u r e the S am e R e s u lt s— The H e ad an d N e c k as a
,

L ev er— L o r do s i s o r K y ph o si s M ay A ff e ct a F u n ct i o n S i m il ar l y
—S p l e ni u s C ap iti s e t C o lli— K y ph o s i s U p p e r D o r s al—K y p ho
— — Ne w S ch o o ls— V ar i o u s
,

i
s s D r
o so l-
u m b ar O th e r M o v e m e n t s

A pp li c ati o n s o f a Pri n c ip l e — The U s e o f a F u l cr u m — C O o r di

,

C o rr ct v e M v m t s D o r s al R o t at i o n—
-

—
_

n at i o n o f e i o e e n L at e r al
C u rv atu r e —K n o w H o w to A p p l y Pr i n c ip l e s — D O No t C o p y
M o v e m e nt s
C H A PTE R X X I—
.

R e du c t i o n o f S u blux at i o ns 443

L at e r al S u blu x at i o n s— L ux at i o n s o f the I n n o m i nat e B o n e s

A nt e ri o r R o t at i o n o f the I li u m— P o st e ri o r R o t ati o n o f the
I l i um
C H A PTE R XX II—Tre atme nt o f the C e rvi cal R e g i o n
.

471

To R ai s e the C l avi cl e —S u blux at i o n o f the C lavi c l e — Pr e p ar at o r y

Tr e at m e nt o f th e N e k Tr ap e i u s— S t e r n o l e i do —
c z -
c m ast o i d
S c al e n i— S p l e n i u s C ap it i s e t C o lli—E x t e n si o n— R o t at i o n— The
,

— —
H y o d B o e M y hy o d d H y g
i n 4 l o-
i a n o l o s s u s S t e r n o th y r o i d an d
-

S te r n o h y o i d— I ntr i n si c M u s c l s O f the L ar y n x — The At l as

-
e

S i x th C e rvi c al—G e n e r al Pri n c i pl e U n de r l y i n g C o rr e c t iv e M o v e

m e n t s—The S i m p l e st F o r m o f C o rr e ct i o n— To r si o n an d C o u n
te r Pr e s su r e — R i g i di t y— The F av o r abl e P o s it i o n f o r C o rr e c t iv e
M o v e m e nt s .

C H A PT E R XX III— E x tr e mi ti e s 49 3

D i ag n o si s— C au s e s o f S t iff Jo i nt s—A n k y lo s i s— The S ap u lo c

h u m e r al Arti cu lat i o n— E x ami n at i o n o f the B r ach ial P l e x u s

R e du cti o n O i D i s l o c at i o n s by Tr act i o n— R e du ct i o n o f D i slo c a
—
t i o n s by L e ve r ag e E bo w D s o c t o l i l a i n s— T h e R ad i u s — O ld D i s
l o c at i o n s— M u sc l e s o f the L o w e r E x tr e m it y— Q u adri c e p s E x
— —
t e n s o r The A ddu ct o r G r o p D i s lo c ati o n o f the F e mu r
u
— —
.

S tr e t c h i n g t h e S c i at i c N e rv e T h e C al f M u s c l e s S c i e n tifi c
M an ip ulati o n—S aph e n o u s O p e n i n g —S e m i lu nar C artilag e s o f
h K — P ar aly s i s o f E x t e r n al P o p lit e al N e rv e G lu c o k i n e si s
—
t e n e e

an d M o bi sl i a t i o n
”
P a i n i n t h e L g
e s a n d F e e t— V ari c o s e V e i n s .

C H A P TE R XX IV—M an ipul ati o n fo r V as o mo t o r Ne rve E ff e cts 52 2 -

The F i i l —
fth C ran a N e rv e I nh i biti o n o f S u bo c c ip it al .
 INTR O D U C TIO N .

G re at tri de s h av e b ee n m ade d u ri n g th e p as t twe n ty

s

five ye ar s i n th e p r ac ti c e Of m edi c i n e The re lative p o s i

.
~

ti o n s f o rm er ly h e ld by dr u g th er apy an d su rgery h ave

b e e n co mp l ete ly rever s ed The co n c o cti o n s o f th e phar m o
.
’

C O po e i a with th ei r v ag u e an d u n c ert a i n e ff e c t s u p o n h u m an
,

ti ss u e s an d f u n c ti o n s n o l o n ger e n ti c e th e e ar n e st seeker
,

after m edi c al tr u th s to s p e n d a l ifetim e e x p erim e n ti n g

with s u b s t an c e s whi c h ar e ab so lu te ly f o reig n to th e h u m an
b o dy .

Th ere w as a ti m e n o t far aw ay wh e n th at p er so n
, ,

w ho tre ate d h u m an di s e as e s by m an ip u lati o n w ater di et

, ,

an d ge n er al hygi e n e w a s c o n s id ere d to b e t he ch ief o f

imp o st o r s G O a litt l e f arth er b ac k i n th e hi st o ry o f m e di
.

c i n e an d we se e s u rgery di s h o n o re d b e c a u s e it w as me

chan i c al n o t my sti c al e n o u gh fo r th e p o n der o u s mi n d s

,

wh o s e f o rt it w as to d e al with s tr an ge s u b s t an c e s o f the
an i m al veget ab l e an d m i n e r al ki n gd o m s
,
.

—
D u ri n g all th e ye a r s i n wh i ch dr u g th er apy flo u ri s hed
th e re were a few re al s c i e n ti st s w ho dev o ted tim e an d
t al e n t s to th e str u ct u re o f o u r b o di e s an d th e f u n c ti o n o f
e ach p art D i s co veri e s c am e slo w ly alo n g the s e li n e s be
"

c au s e th e m aj o rity o i m edi c al m e n were c o n c e n tr ati n g

th e ir e n ergie s o n ferreti n g o u t th e e ff e ct s o f dr u g s F act s.

i n an at o my an d phy s i o lo gy wh i c h a r e s o p ate n t to u s at
thi s tim e rem ai n e d o b s c u re fo r c e nt u ri e s si mp ly b e c au s e
,

th ere w as n o th o u ght o f st u dyi n g th e f o rm an d acti o n o f

[

ti s su e s whi le all n at u re o u t sid e o f Ou r o w n b o di e s s eem e d

,

to b e a gr an d lab o r at o ry o f s p e c ifi cs fo r h u m an a i lm e n t s
.
.

I f o s te o p athy had bee n b o r n fif t y ye ar s ag o it w o u ld

,

h ave die d b e c au se th e p o p u lar an d s c ie n tifi c mi n d s were

n o t i n a c o n diti o n to re c eive it . E ve n th e ti m e at wh i ch
18 I N T R O D U CT I O N

it w as b o rn r ely thi r ty fi v e ye ar s ag o w as h ardly ri pe

,
sc a c -

fo r th i s n e w d ep art u re i n m ed i c i n e Twe n ty ye ar s e asi ly .

co ve r th e p eri o d o f i t s ac tive h i s t o ry .

—
A S c i e ntifi c G r o wt h Th ere i s o n e d i sti n c tive p o i n t
ab o u t o s te op athy whi c h sh o u l d b e e sp e c i al ly emph as ized
'

I t i s n o t an empi ri c al sy stem ; n o thi n g i s d o n e o n th e c u t

an d dry p lan I t has be e n d eve lo p ed i n a p u re ly se i e n
.

tifi c w ay . We might Ob s erve th e ac ti o n o f th e h u m an

b o dy i n h e alth an d di s e as e i n defi n itely with o u t s e c u ri n g
any e x act d at a to p ass o n to th e n e x t ge n er ati o n O f o b _

s e rve r s i i we f ai l t o k n o w th e s tr u c t u re o f th e b o dy . A

phy si c i an m ay l e ar n m an y thi n g s i n an empiri c al w ay

whi ch ar e ve ry p o o r ass et s fo r s c i e n c e .

The s tr an ge p art o f m edi cal h i s t o ry to th e m o de r n

'

i nve stig at o r i s th e fact th at di sco v e r l e s l n anat o my an d

,

phy si o l o gy whi ch ar e o f s u c h vit al i mp o rt an c e to th e s u c

,

c e s s fu l tre atm e n t o f h um an di s e as e s were l eft st o red aw ay ,

b etwe e n th e co ver s o i b o o k s n o t d eem ed o f any v alu e,

e x cept to Wh et th e m i n d o f th e di lle tan te i n m edi c i n e

_

O ste o p athy as a di sti n c t s y s tem o f m ed i c i n e has

gr o w n to its p r ese nt p r o p o rti o n s at a t i m e wh e n the o ld er
s c h o o l s o f m edi c i n e ar e m aki n g r adi c al c h an ge s i n th ei r

t h e r ap e u ti c al p r o c e d u re s e g ser u m th er apy
, . .
,
In sp ite -
.

o f all th e s e s o call e d sc i e n tifi c adv an c e s 1 n dr u g th er apy -

o s te o p athy has m ad e ste ady adv an c e i n t o p u b l i c f av o r ,

th ereby sh o wi n g th at it i s f u l ly abl e to co mp e te w 1th th e

o l de r sy s tem s o f pr ac ti c e .

The F o u nde r o f O ste o pat hy D r A T S ti ll o f K i rk s

.
-
. . .
,

vi lle M o i s th e h o n o red f o u n d er o f th i s sy stem o f th era

,
.
,

p e u t i c.s H i s w o rk w a s i n s
-
t u dyi n g th e s tr u c t u re o f o u r

b o die s dire c tly an d th u s g ai n i n g an ac cu r ate k no w ledg e o f

,

ho w b o n e s lig am e nt s an d m u sc le s b lo o d ve ss e ls g lan d s
, ,
-

an d n e rve s ar e pl ac ed Th e n h e so u ght th at dep artm e n t

.

o f k no w l edge wh i c h we c all phy si o l o gy an d l e ar n ed ho w ,

th e se ti ss u e s act i n h e alth H avi n g had p revi o u s t r ai n

.

i n g i n tre ati n g d i s e ase s by th e d r u g meth o d he w aS s lo w , , .

to di s c ard th e o ld m eth o d fo r o n e whi c h had n ever b e e n

 I NT R O D U CT I O N 19

trie d eve n th o u gh it had go o d s c i e n tifi c re aso n s b ack o f

,

i t Bu t th e sub s tit u ti o n di d t ake p lac e by d egree s u n ti l hi s

.

sy stem o f th er ap e u ti c s n o l o n ger dep e n d ed o n th e u se o f

dr ug s .

I t seem s to b e a p o p u lar id e a th at it i s n e c e ssary fo r

th e f o u n der o f a sy stem to h ave a Cre ed o r st atem e n t o f
bel i ef We do n o t d o u bt bu t th at it i s g o o d fo r u s at tim e s
.

to try to pu t o ur b e li ef s i n writi n g n o t to f o rm a fi x ed ,

p os iti o n bu t j u st as th e ar ch ite ct dr aw s m an y p lan s to

,

gr ad u ally deve lo p hi s m e n t al pi c tu re s Th es e st atem e n t s .

u s u ally c o n t ai n th e tr u th ab o u t o u r w o rk so far as we

k n o w it We can th u s se e ho w far we h ave ad van c ed

.

an d r ealiz e th at we h av e m u c h to l e ar n .

D r S ti ll has fr o m tim e to tim e e x p re sse d th e re s u lt

.
,
'

o f hi s s t u di e s th at i s th e o b s e rve d f ac t s u p o n wh i ch h e
, ,

has b ui lt hi s sy s te m o f th er ap e u ti c s In 18 74 D r S ti ll , .

s t ate d hi s Ob s e rv ati o n s as f o llo w s : A di s t u rbed artery

m ark s th e p e r i o d to an h o u r an d m i n u te wh e n di se as e , ,

b egi n s to so w i ts s e ed s o f de str u cti o n in th e h u m an b o dy

Th at i n n o c as e c o u ld it b e d o n e with o u t a b r o ke n o r su s
p e n ded cu rr e n t o f arte ri al b lo o d whi ch by n at u re i s in
' ‘ '
'

, ,

t en de d to s upp ly an d n o u ri sh all n erve s ligam e n t s m u s

'

, ,

c l es,
s ki n b o n e s an d th e artery it s e lf
,
The .

r u l e o f th e artery m u st b e ab so lu te u n iver sal an d u n o b , ,

s tr u cted o r di s e as e wi ll b e th e re s u lt
,
All .

n e rve s d ep e n d wh o lly u p o n th e arteri al sy s tem fo r th eir

q ualitie s s u ch as s e nsati o n n u triti o n an d m o ti o n eve n

, , ,

t ho u gh by th e law o f re c ip r o c ity th e y f u r n i sh f o r c e n u ,

tr i ti o n an d s e n s ati o n to th e art ery it s e lf .

D e fi n t on s
i i — M an y d efi n iti o n s have bee n f o rm u late d
an d p u b l i sh ed to th e w o r l d E ac h o n e te n d s to limit
.

one s c o n c epti o n o s te o p at hy i n s o m e p arti c u lar A

’
of .

defi n iti o n alw ay s l imit s th e thi n g defi n e d th eref o re n o , ,

defi n iti o n o f o s te o p athy c an b e c o mp lete b e cau s e We ar e ,

de ali n g with a p ri n c ip l e th e u n ive rsality o f whi ch n o o n e,

k n o w s Wh ere as l e s s th an seve n ye ar s ag o it w as th o u ght

.
, ,

th at o ste o p athy w as an e x c e ll e n t m et ho d o f tre ati n g

20 I NT R O D U CT I O N

c h r o n i c ai lm e nt s we n o w fi n d o ste o p ath s w o rki n g day

,

an d n ight at th e b ed s id e o f th e ac u te ly s i c k Th u s d o e s it .

s pre ad an d be co m e th o r o u gh ly re c o g n ized as a sy stem

app li c ab l e to all di s e as e s .

In o rd er to b ri n g b ef o re th e s t u de n t as f u ll an d c o m
p reh e n sive an i d e a Of th e sco p e o f o ste o p athy as p o s si bl e
.

a s eri e s o f defi n iti o n s ar e q u o ted Th e s e d efi n iti o n s h i ve .

be e n t ake n fr o m c u rre n t o ste o p ath i c li te r at u re an d ar e

.

c red ite d to th ei r r esp e c tive au th o r s .

’
O n e o f th e sh o r t p ar agr aph s i n D r S ti ll s au t o .

bi o gr aphy is s u ffi c i e n t to give a c le ar u n der st an d i n g o f hi s

“
i de a o f th e h u m an b ody The h u m an b o dy i s a m ac h i n e
.

r u n by th e u n s ee n f o r c e c all ed life an d th at it m ay be r u n ,

h arm o n i o us ly it i s n e c e ssary th at th ere b e l iberty o f b l o o d

, ,

n e rve s an d arteri e s fr o m th e ge n er ati n g p o i n t to de s

”
ti n ati o n .

The f o l lo wi n g d efi n iti o n i s b e e n use d o ne wh i c h has

“
i n th e A m eri c an S c h o o l p u b l i c ati o n s fo r a lo n g ti m e : O s
te o pathy i s th at s c i e n c e whi c h c o n s i s t s Of s u c h e x ac t e x ,

hau sti v e an d verifi ab l e k n o w l edge o f th e s tr u c t u re s an d

f u n c ti o n s o f th e h u m an m e chan 1s m an at o m i c al p hy si o , ,

lo gi cal an d p sy c h o lo g i c al i n c lu d i n g th e c h emi s try an d

,

phy s i c s o f i ts k n o w n e l em e nt s a s has m ad e di sc o ver ab l e

c ert ai n o rg an i c law s an d rem edi al re s o u r c e s withi n th e ,

b o dy it se lf by wh i c h n at u re u n der th e sc i e ntifi c tre atm e n t

, ,

pe c u li ar to o ste o p ath i c p r acti c e ap art fr o m all o rdi n ary ,

m eth o d s o f e x tr an e o u s artifi c i al o r m edi ci n al sti m u lati o n

, , ,

an d i n h arm o n i o u s acco r d with i ts o w n m e c h an i c al p ri n

c i ple s ,
m o le cu lar activitie s an d m et ab o li c p r o c e s s e s m ay
, .

re co ver fr o m di spl ac em e n t s di s o rg an i z ati o n s der an ge .

,

m e n t s an d co n s e q u e n t di se as e an d reg ai n i ts n o rm al eq u i
, ,

”
libri u m o f f o rm an d f u n c t i o n i n h e alth an d S tre ngth .

M aso n W P re ssly A B P h D D j o
.
, . .
,
. .

“
O ste O pathy i s th at s c i e n c e o f h e ali n g whi ch e m pha
'

s ize s, ( )
a th e di ag n o s i s Of di s e a s e by phy s i c al m eth o d s

with a vi ew to di s co ve ri n g n o t th e sympt o m s b u t th e c au s e s
Of di s e ase s i n c o n n e c ti o n with mi sp lac em e nt s o f ti s s u e
, ,
23 I NT R O D U CT I O N

or phy s i o lo gi st th at m ay no t be Of vit al i mp o rt an c e to
th e s c i e ntifi c o ste o p ath H e n c e a c o rre ct di ag n o si s b ased
.
‘

u p o n s u c h k n o wl edge i s h alf th e b att l e With o u t it se i e n .

tifi c o ste o p athy i s im p o s sib l e an d th e p r ac ti c e is n e ce s

s ar i ly h aph az ard o r m e re ly r o u ti n e m o vem e n t s The de fi .

n i ti o n l ay s stre ss u p o n ( 2 ) rem o v al Of th e c au s e o f d i s e ase .

A de r an ge d m e ch an i s m m u st b e c o rre c te d by m e c ham cal

m e an s spe c i fi c ally app li e d as th e m o st n at u r al an d o n ly
‘

di re ct m eth o d o f p r o c ed u re Th i s w o rk i s n o t d o n e by .

any o f th e m eth o d s o f o th er sch o o ls After th e m e c h an i s m .

has be e n co rre cted litt l e rem ai n s to b e d o n e to re s t o re

f u n cti o n bu t stim u lati o n o r i nhibiti o n o f c e rt ai n n erve
,

c e n te r s m ay give temp o r ary rel i ef an d ai d n at u re The .

adj u v an t s u s ed by o th er s c h o o l s s u ch as w ater diet e x e r , , ,

c i se s u rgery
, etc ar e th e c o mm o n h erit age o f o u r pr o i e s
, .
,

si o n and s h o u l d b e re s o rte d to by th e o s te o p ath i f th ey ar e

”
i ndi cate d E R B o o th Ph D D O E x P r e s ide n t
. . .
, . .
, . .
,
-

A O A. .

O s te o p athy i s
th at s c i e n c e o r sy ste m o f h e al i n g whi ch ,

u si n g every m e a n s o f di ag n o s i s with a vi e w to di s c o ver ,

i n g n o t o n ly th e sym pt o m s bu t th e cau s e s o f d i s e ase s

, , ,

by sci e n tifi c m an ip u lati o n s Of the h u m an b o dy an d

’

s eek s , ,

o th e r phy s i c al m e an s th e c o rre cti n g an d rem o vi n g o f all

,

ab n o rm al iti e s i n th e phy s i c al re lati o n s o f th e c e lls ti s su e s ,

an d o rg an s o f th e b o dy p arti c u l arly th e c o rre c ti ng o f m i s

,

pl ac em e n t s o f o rg an s o r p a rt s th e re lax i n g o f c o ntr acted ,

ti ssu e s th e rem o vi ng o f o b str uc ti o n s to th e m o vem e nt s

,

o f fl u id s th e rem o vi n g o f i n terfere n c e s with th e tr an s

,

mi s si o n O i n erve imp u ls e s th e n e u tr ali z ing an d rem o vi ng

,

o f septi c o r f o reig n s u b s t ance s fr o m th e b o dy ; th er eby r e

st o ri n g n o rm al phy si o lo gi cal p r o c e s s e s thr o u gh th e re ,

e st abli sh m e n t o f n o rm al ch emi cal and vit al r e l ati o n s o f

th e c el l s ti ss u e s an d o rgans o f th e b o dy an d re s u lti n g i n
, ,

re st o r ati o n o f he alth thr o ug h th e au t o m ati c stim ul ati o n

,
.

an d free Oper ati o n o f th e i n h ere n t re s i s t an t an d rem e di al

C M Tu r n er H u lett D O
”
f o r c e s withi n th e b o dy it s e lf . . .
, . .
 I NTR O D U CT I O N . 23

O s te o p athy th at sc i e n c e wh i c h re aso n s o n th e
"

IS

h u m an sy stem fr o m a m e ch an i cal as we ll as a ch emi c al -

'

s t an dp o i n t t aki n g i n t o c o n s id er ati o n i n its di ag n o s i s

, ,

h ere dity th e h abit s o f th e p ati e n t p ast an d p re s e n t ; the

, ,

hi s t o ry o f th e tr o u b l e , i n c lu di n g s ymp t o m s f alls str ai n s , ~ , ,

i n j u r i e s t o x i c an d s epti c c o n diti o n s an d e s pe c i ally i n every

, ,
‘

p
c as e a p hy s i c al e x am i n ati o n by i n s e c ti o n p a l p ati o n p e r , ,

c u ss i o n,
au s c u lati o n e tc to dete rmi n e all ab n o rm al phy s i
, .
,

c al Con d iti o n s th e tre at me n t emph as izi n g sc i en tifi c m an ip

u lati o n to c o rre c t m e c h an i c al l e s i o n s to s tim u late o r i n ,

b ibit an d reg u late n e r ve f o r c e an d c i r c u lat ory fl u id s fo r

th e re c up erati o n o f any di s e as e d p art u s i n g th e vit al f o r c e s
,

With i n th e b o dy ; als o th e h ab it s o f th e p atie n t ar e reg u

l ate d as to hygie n e ai r f o o d w ate r re st e x er c i s e s c lim ate
, , , , , ,

an d b ath s ; s u c h m e an s as hydr o p athy e l e c tri c ity m a ss age , , ,

an ti d o te s an d an ti s epti cs an d s u gge sti o n so m etim e s b ei n g

,

”
u s e d as adj u n c t s . C h as C R eid D O . .
, . .

The ab o ve defi n iti o n s h ave n e ar ly all be e n t ake n fr o m

th e J o u r n al o f th e A m e r i can O ste o p ath i c A sso c i ati o n .

O ste o pathi c D i ag n osi s — Phys i cal di ag n o s i s i s an d al

—
.

Way s wi ll b e th e l e adi n g f ac t o r i n th e su cc e ss o f o s te o
p athi c p r ac titi o ne r s T hi s abi l ity t
. o t ake h o l d o f an ai l i n g

hu m an b ei n g an d dete c t the di st u rbi n g fa

-
c t o r i n it i s th e

highe st att ai n m e n t o f the phy s i c i an O s te o p athy has d e .

v e lO p e d the ar t o f p alp ati o n to a w o n derf u l d egree Bas

'

in g t h i s ar t o n a d efi n ite k n o w l edge o f s t r u ct u re an d
f u n c ti o n m ake s it th e ch i ef re l i an c e in di agn o s i s E very .

phy si cal di agno s i s b egi ns wit h p alp ati o n an d p r o c ee d s with

au scu l ati o n an d per c u ss i o n an d n o t f ai l i n g to u s e c h emi c al
,

an d mi c r o s c o pi c al m et ho d s w he n n e c e s sary The s t u de nt .

mu s t l e ar n to u se hi s s e n s e o f t o u ch c o n ti n u ally i n f ac t , ,

l e ar n to s e e with hi s fi n ger s A dd to thi s deve lopm e n t o f

.

t o u ch a t r ai n i n g i n chemi c al an d mi c r o s c o pi c al an aly s i s o f
-

s e c r eti o n s an d e x c reti o n s o f th e b o dy an d we h ave a ,

pr actiti o n er th o r o u gh ly e q u ipp ed to m ake an acc u r ate

s c i e n tifi c di ag n o si s .
24 I N TR O D U CT I O N

O s t e o pat hi c The r ape u ti c s— O ste o p athi c tre atm e nt i s

.

b ased o n th i s ki n d o f phy s i c al di ag no si s whi ch we h ave

j u st d e s c rib ed .It t ake s i n t o acc o u n t th e f ac t th at the
o rg an i s m i s a sel f re c u p e r ati n g m e c h an i s m an d re q u i re s
-

p r o p e r f o o d p r o p e r s u rr o u n di n g s an d pe rfe c t ac tivity o f
, ,

eve ry ti s su e e sp e c i ally th e bl o o d Th us we divi de tre at

, .

m e n t i nt o th re e divi s i o n s ( l ) m an ip u lati o n fo r th e pu r
,

p o s e o f c o rre cti n g th e m al p o s iti o n o f any ti ssu e wh eth er

-

th at ti s su e b e b o n e o r b lo o d ; ( 2 ) p r o p er fe edi n g i e , ,
. .
,

di eteti cs ; an d ( 3 ) p r o p e r s u rr o u n di n g s i e hygi e n e , . .
, .

I f th e c o n diti o n o f th e b o dy i s s u ch th at n o n e o f th e
th re e m eth o d s j u st m e n ti o n ed wi ll right th e di ffi c u lty i e ,
. .
,

i f the re ar e br o ke n b o n es r u pt u re d m u scle s an d c o nn e c
,

tive ti s su e s o r f als e gr o wth s we c an th e n u s e su rgi cal

,

m e an s S u rgery i s a p art o f th e o ste o p athi c sy s tem j u s t

.
,

as it i s o f all s y s te m s o f medi c i n e
'

The c hi e f a ss u r an c e
.

J
li e s i n th e f ac t th at th e o s t e o p athi c sy s te m i s very c o n
“
-

s e r v at i v e as reg ard s th e u s e Of th e k n ife .

O ste o p athy i n c lu d e s all th o s e q u al iti e s whi c h m ake

u p a s u cc e ss f u l sy s tem ; i ts di ag n o s i s i s ac c u r ate an d it s

tre atm e n t i s c o m p reh e n s ive i n c l u di

,
n g s c i e n t i fi c m an ip u l a

ti o n s sci e ntifi c d ieteti c s hygi e n e an d su rge ry

, ,
-

In a re c e n tarti c l e i n th e A m eri c an M o n th ly R eview

0 1 R e vi ew s th e f o llo wi n g s e n te n c e s appe ar z W ith bu t
,
r

few e x c epti o ns the e ntire veget ab le and m i n er al ki n gd o m s

,

h ave give n u s litt le o f s p e c ifi c v alu e ; bu t sti ll u p to th e ,

pre s e n t day th e b u lk o f o u r b oo k s o n m ateri a m edi ca i s

-
,

m ade u p o f a d e sc ripti o n o f m an y v alu e le s s d r u g s an d

p rep ar ati o n s Is it n o t to b e dep lo re d th at v alu abl e tim e
.

s h o u l d be w as te d i n o u r s t u d e n t d ay s by c r ammi n g in t o

o u r h e ad s a lo t o f th er ap e u ti c b allast .

Thi s i s p ro b ably th e m o s t re c e n t s t atem e n t o f th i s

ki n d i n th e p u b li c p r i n t s I t s u b st an ti ate s th e p o s iti o n
.

t ake n by th e o ste o p athi c c o llege s We fe el j u stifi ed i n

.

c laim i n g th at o ste o p athy t o d ay o cc u pi e s a p o siti o n whi c h

every o th e r sy stem o f m edi c i n e m u st c o m e to s o o n er o r '

late r . I t i s br o ad e n o u gh an d lib e ral e no u gh to ac c ep t

 I NT R O D U CT I O N 25

tr u th wh e rever dem o n str ated Its f o u n d ati o n s b ei n g lai d

.

i n th e b as i c s c ie n c e s an d i ts tre atm e n t n ever dep arti n g

,

fr o m th e f ac t s o f th e s e s c ie n c e s m ake it a sy stem o f lasti n g

,

w o rth an d c ap abl e o f addi n g an e n ti re ly n e w c o n c epti o n

Of th e ph e n o m e n a o f life to m edi c al lite r at u re .
.

The f o rm ati o n o f th e n am e O ste o p athy ( fro m o s te o n ,

b o n e an d p ath o s s u ff eri n g ) s eem s to be as p erfe c t a de

, ,

s c riptive n am e as it i s p o ss ib l e to f o rm whi c h w o u ld c o ve r

th e b as i c p ri n c ip l e o f th e s c ie n c e
,
The b o n e s ar e th e .

f o u n d ati o n u p o n wh i ch all th e s o ft ti s su e s ar e l ai d an d ,

th e o s te o p ath m ake s all hi s e x ami n ati o n s u si n g th em as ,

fi x e d p o i n t s fr o m wh i ch to e x plo re f o r f au l ty arran ge
m e n t l The n am e d o e s n o t m e an b o n e di s e as e bu t s i n c e
.

I
,
i

th e o ste o p ath fi n d s m an y di s e as e s re su lti n g fr o m i r r i t ati o n

du e to s l ight ly di sp l ac ed b o n e th e n am e i s u s e d i n th e ,

s e n s e o f di s e as e c au s ed by b o n e W e do n o t co n s i der th at
.

all di s e a s e s a r e c au s ed by di s p lac e d b o n e bu t it i s a c au s e ,

whi ch has h eret o f o re be e n o ver lo o ked We re co g n iz e th at .

th ere ar e m an y c au s e s o f di s e a se an d do n o t W i sh to b e ,

u n der st o o d a s tryi n g to fit f ac t t o th e o ry bu t as a re s u lt ,

of c e rt ai n f ac t s thi s b asi c pri n c ip l e o f o ste o

,

p athy has b ee n m ad e c l e ar .

W e b e lieve th at h e alth i s th e n at u ral S t ate an d th at ,

thi s co n diti o n i s b o u n d to b e m ai n t ai n e d s o lo n g as every

c e ll has an u n i n terr u pte d b l o o d s u pp ly an d i ts c o n tr o ll i n g ,

n erve i s u n di s t u rb ed
‘

Th eref o re th e fi r st e ff o rt Of th e
.
,

o s te o p ath i s t o rem o v e all o b str u c ti o n s t o b l o o d an d n erve

‘
-

s u pp ly ,
fe e li n g c e rt ai n th at wh en t he s e Ob str u c ti o n s ar e
rem o ved h e alth wi ll f o llo w
,
H i lt o n i n hi s l e ctu re s o n
.

“
R e s t an d P ai n wh i c h ar e co n si d ere d m ed i c al clas si cs
, ,

has e x p re ss e d h im s e l f f o r c ib ly o n thi s s u bj e c t as f o llo w s : ,

I t w o u ld b e we ll I thi n k if the su rge o n w o u l d fi x u p o n

, ,

hi s m em o ry as th e fir s t p r o fe ss i o n al th o u gh t whi ch sh o u l d
,

ac c o mp an y him i n th e co u r s e o f hi s d ai ly o c c u p ati o n th i s ,

phy si o lo gi c al tr u th — th at n at u re has a co n st an t te n de n cy
to rep ai r th e i n j u r i e s to whi c h h er str u c t u re s m ay h ave
be e n su bj e c te d wh eth e r th o se i n j u ri e s b e th e re s ul t o f
,
26 I N T R O D U CT I O N

f atig u e o r e x h au sti o n o f i n fl am m ati o n o r acc i de n t Al so

, .
,

th at th i s rep ar ativ e p o wer be c o m e s at o nc e m o st c o n

spi c u o u s wh e n th e di st u rbi n g c aus e has be e n rem o ved ;
th u s p re s e n ti n g to th e co n si der ati o n o f the phy s i c i an an d
s u rge o n a co n s t an t ly re c u rri n g an d so u n d p ri n c ip l e fo r hi s
”
g u id anc e in hi s pr o fe s si o nal p r acti c e.

E ve ry sy ste m o f c u r i n g h u m an i ll s wh i ch i s b ase d o n
th e k n o w n fac t s o f anat o my an d p hy s i o l o gy wi ll l as t ,

b e cau s e it i s tr u e Wh e n sy stem s o f d r u g m e d i c at
. i o n ar e
k n o w n o n ly as hi sto ry o s te o p athy will b e m i n i steri n g to
,

th e h u m an r ac e be c au s e it k n o w s no o th er p ath th an th at
,

whi ch le ad s to gre at e r tr u th s i n phy s i o lo gy an d anat o my .

 PR I N C I PL E S OF O S T E O PA TH Y 27

C H A PTE R I .

C AUS E S O F D IS EA S E .

No r m al an d Abn o r m al — Ino rder to

th e w o rd ab
'

. u se

n o rm al with refere n c e to the s tr u c t u re an d f u n c ti o n o f l ivi n g

,

ti s su e s we m u s t h av e k n o w l edge o f th e no r m al No rm al i s
,
.

a w o r d h av i n g app are n tly as m an y i n terpret ati o n s a s th e

, ,

”
w o rd be au ty i e s t an d ard s to wh i ch th e s e w o rd s ar e
, . .

app l i ed di ff er eve n as th e i n divi d u al s w ho u s e th em In

,
.

o r d e r th at w e m ake c l e ar wh at w e c o n c eive as n o rm al an d
-

ab n o rm al co n diti o n s it i s n e c e ss ary to call atte n ti o n to

,

v ari ati o ns i n s tr uc t u re an d fu ncti o n whi c h sh o u l d be r e c o g

,

n iz e d as n o t b ei n g far e n o u gh rem o ved fr o m typ i c al c o n di

ti o n s to i n di cate th e e x i s te n c e o f a n ee d fo r co r r e ctive
i n te r f er e n ce :

The Ide al No r mal — O u r fir s t s tep s i n th e ac q u irem e n t

.

o f a m edi c al e d u c at i o n ar e p r ac ti c ally all c o n c er n e d with

st u dy o f t he n o r m al We di ss e ct b o di e s whi ch h ave b ee n
.

chan ged by di s e as e an d the ref o r e we c o m e i n c o n t ac t with

ab n o r m al ity . To co u n te r act t hi s we s t u dy de s c riptive an at

o m y an d i de alize o u r re al k n o w l edge wh i ch w a s o bt ai n ed by

di ss e c ti o n O ftti m e s o u r ide al has s u c h attrib u te s o f pe r fe c

.

ti o n th at no thi n g e v e r c o m es u p to st an d ard an d h e n c e ap
p e ar s to us to b e defe ctive Thi s hyp er criti c al attit u de le ad s
.

to e x agge r ati o n o f th e i n te rp ret ati o n pu t u p o n sympt o m s

an d h e nc e l e ad s to m i s dire c te d e ff o rt s at co rre c ti o n

V ar i ati ons in S tr u ct u r e and F u ncti o n —W e n eed th ere

.

fo re fi r st o f all a f ai r ly go o d k n o w ledge o f th e v ari ati o n s i n

, ,

s tr u c t u re an d f u n c ti o n wh i c h m ay be re c o g n ized as c o n s i d

e r able dep art u re s fr o m typ e bu t sti ll n o t ab n o rm al i n th e

,

s e n s e we u s e th at term wh e n s p e aki n g Of di s e as e No ti s su e .
28 PR I N C I PL E S OF O ST E O PAT H Y

in th e b o dy is u nyie ld i n g an d h e n c e will ad apt it s e lf to eve n

a very m o d er ate f o r c e if th at f o r c e i s lo n g c o n ti n u ed
, Thi s .

is we ll i ll u str ate d by th e gre at C h an ge s wh i c h can b e pr o

du ce d i n th e alig n m e n t o f th e te eth u n d er co rre c tive b r ac i n g .

A dapt ati o n —The c h an ge s i n s tr u c t u re whi ch ar e fr e

.
,

q u e n t ly re c o g n ized m ay be evid e n c e Of ad apt ati on i e th ey

, , . .

h e b o dy s e ffo rt to m ai nt ai n i ts e x i s
’
ar e th e fi nal re s u lt o f t

te n c e at th e high e s t p o i n t o f e ffi c i e n cy o f whi c h it i s cap abl e .

With th is th o u ght e ve r i n o u r m i n d s we m ay s afe ly Ob s erve

th e ch ar acte r o f s t r u ct u re s an d dr aw mo re j u st c on c l u si o n s
as to th e e x i s te n c e o f n o rm al o r ab n o rm al c o n diti o n s .

No r m al H e alt h —P e o p l e u su ally s eek th e s ervi c e s o f a

.

phy s i c i an b e cau se th ey su ffe r s o m e d egre e o f di s com f o rt .

Tr u e it is th at s o m e s eek a c o s m eti c e ff e c t bu t th i s m ay ,

h ard ly b e s eri o u sly c o ns i d ered No rm al h e alth m e ans a co n

.

diti o n wh erei n we ar e u n c o n s ci o u s o f b o di ly d i stre s s an d ar e

ab l e to do wh at is o rdi n ari ly c o u n te d as o u r s h are o f w o rk .

This s tate o f b o di ly c o m f o rt u n de r th e o rdi nary s tre ss o f

,

l ab o r i s n o t n e c e s sari ly b ase d u p o n symm etry o f s tr u ct u r al

,

deve lo p m e n t i e ab s o lu te co n fo r m i ty to o u r ide al o f s tr u e
,

t u r al p erfe cti o n ;
C o m f o r t an d E i
ffi c e n cy — No rm ality fr o m the c r ad l e to
the gr ave s e em s to b e a p e r so n al eq u ati o n i e b o dily co m , . .

f o r t u n der th e stre ss o f m o der at e phy s i cal an d m e n t al e x e r

ti o n I n c re ase o f phy si c al o r m e n t al e xer t
. i o n e ith er thr o u gh ,

ad a pt ati o n p r o d u c e s i n c re as e d c ap ac ity o r th r o u gh f ai lu re
, , ,

o i ad apt ati o n p r o d u c e s d e s tr u ctive c h an ge s Co m f o rt an d

'

.
,

e ffi c i e n cy ar e th e re al attrib u te s o f n o rm ality I f th e s e ar e .

pre s e nt i n aver age degre e th e re i s litt le li ke lih o o d o f a phys i

c i am b ei n g c o ns u l ted

V ar i ati o n o f the No r m
.

al The n o rm al o f any i n divi d u al

'

-
.

v ari e s at di ff e r e n t p eri o d s o f life an d f o llo wi ng acc i de n t s o r

s evere i lln e s s e s The phy s i c i an i s fre q u e n tly c on s u lted with
'

th e h o p e th at the n o r m al o f later ye ar s might b e r ai s e d to

.

th e degree c o n sc i o u s ly p o ss e ss e d at a f o rm e r tim e o r in th e ,

h o p e o f b ei n g re s t o red to th e no rm al whi c h e x i ste d previ o us

to an ac c i de n t o r s evere i lln e ss The n e w n o rm al s whi ch
'

.
3O PR I N C I PL E S OF O ST E O PAT H Y

ph e no m e n a o u t o f i ts co mp ar ative v al u e with any o th er

gr o u p I t is h o pe d th at by p re s e nti n g as well as we ar e abl e
.
, ,

th e le si o n the o ry Of di s e ase we may b e abl e to sh o w p ath s o f,

c o nve rge n c e l e adi n g t o a b etter i n terpret ati o n o f di s e ase

ph e no m e na an d th u s th e tr u t hs wh i ch u n d erl i e th e l e s i o n
th e o ry will n o t be co m e di st o rted i nt o f an t asti c v ag arie s .

We do n o t wi sh to be u n de r s t o o d as c l ai m i ng fo r o ste o p athy
th e di sc o very o f th e cau s e o f di se as e Th ere ar e m any .

cau s e s wi d ely div erge n t i n ch ar ac ter

,
O s te o pathy bri n g s to .

y o u r atte nti o n a c au s e freq u e ntly f o u n d an d o f su ffi ci e nt

,

de fi n ite n e s s to w arr an t c o n c e n trated atte n ti o n .

F av o r ab l e R to e acti on we ar e E nvi r o nm e nt— S i n c e

m e ch an i s m s o f livi n g ti ss u e s o u r su rviv al dep e n d s u p o n r e ,

ac ti n g f av o r ably to e n vi r o n me n t We fi n d th e el em e nt s ai r .
, ,

light h e at an d co l d all aff e c t u s adver s ely at tim e s

,
They .

be co m e de str o yer s o f b o dily co mf o rt an d e ffi c i e ncy w h e n

i nte ns ified Ch an ge s i n atm o sph e r i c p re s su re i n te n sifi ca
.
,

ti o n o f light i n c re as ed h e at o r co l d aff e c t u s s e r i o u s l y
, , .

K no w n Cau se s o f D i se ase —Che mi c al p oi so n s s u ch as ,

l e ad ar s e n i c m e r c u ry ph os ph or u s c arb o n m o no x ide an d
”

. , , ,

ot h e r g as e s ar e cau s e s o f p r o f ou n d i n j u ry The o rgan i c

,
.

p o i s o n s alco h o l Op i u m m o rphi n e c o cai n e f o o d p o i s o n s

, , ,
’

, , ,

s n ake ve n o m s au t o i n t o x i c ati o n s pl ay n o s m all p art i n c au s

, ,

i n g b o di ly di sco mf o rt an d i n e ffi c i e n cy The veget ab le o r .

g a n i s m s f u n gi an
, d b a c ter i a c l aim ab u n d an t re co g n iti o n as

c au s e s o f di s e as e P r o t o z o a ar e p r o pe r ly l i sted as c au s e s
.
,

fo r h ave we n o t th e w o n d erf u l di s co ve ri e s c o n c er n i n g m a .

lar i al fever s l e epi n g s i c k n e s s am o ebi c dy s e n tery an d yel l o w

, ,

feve r ; s u ffi c i e n t sc i e n tifi c achi evem e n t s to st ar tl e th e w o rld «

.

The fl u ke c e s t o d e an d r o u n d w o rm i n fe c ti o ns h ave l o n g
,

be e n re c o g n ized c au s e s o f di s e ase Add to th e fo rego i n g all .

th o s e adve r s e co n diti o ns i mp o s ed by th e n at u re o f o u r
c r o wde d e x i s te n c e i n c iti e s n o i s e an d u n re s t s u rfeit and
, ,

p o verty fati g u e an d w o rry it is littl e to b e w o n dered at th at

, ,

we fi n d o u r s elve s s e ar c hi n g alm o st hy s teri cally fo r so m e

th i n g to ai d u s to su rvive it all .
 PR I N C I P L E S OF O ST E O PAT H Y 31

The Te naci ty L i fe —It i s m arve lo u s ho w o u r b o di e s

of .

ad apt th em s e l ve s to all th e vi c i ss it u d e s o f e n vi r o n m e n t s u r ,

vive th e e ff e c t s o f i n o rgan i c an d o rg an i c p o i so n s i nv asi o n s ,

Of b acte r i a o r p r o t o z o a m ai n t ai n e x i ste n c e i n S pi te o f de fi
,

c i e n t f o o d an d r e s t The te n ac ity o f li fe i n h u m an ti ss u e s
'

.
,

th e ad apt ati o n s an d co mp e n s ati o n s th at ar e d e ve lo p ed ar e

‘

w o rthy th e pe n o f s o m e s c i e n tifi c ge n i u s w ho has the liter ary

abi l ity to m ake th e l aym an h ave f aith i n n at u r al l aw

— —
.

.
Le si OnD i se as e As s o c i ati o n
x
With all th e se cau s e s o f
.

di s e as e we m ay we ll ask Ou r s e lve s wh at re lati o n th e sp i n al

o r o th er j o i n t l e s i o n has I t w o u l d b e di ffi cu lt to fi n d any
.

di s e as e p r o c e ss th at d o e s n o t e x h ib it a S pi n al o r o th er j o i n t
l e s i o n i n th e s e n s e we o s te o p ath s r e co g n ize Thi s co i n
, .

c i de n c e o f di s e as e an d s pi n al o r o th e r j o i n t l e s i o n d o e s n o t
, ,

n e c e s sari ly i n di cate a seq u e n c e o f eve n t s s t arti n g i n th e le

si o n As s c ie n ti st s r at he r th an s p e c i al p le ader s fo r a th e o ry
.
, ,

we w ant to k n o w th e s ig n ifi can c e o f thi s as so ci ati o n I t i s .

o u r ai m t o dev o te th e p age s f o l l o wi n g t o an an aly s i s O f thi s

le s i o n di s e as e asso c i ati o n
-
We ai m to write h e lpf u lly an a
.
,

ly z i n g o u r f ail u re s th at we m ay k n o w o u r we ak n e ss e s an ,

aly z i n g c ur s u c c e s s e s s o th at we m ay m ake o u r so l i d p ri n
a

c i l e s m o re wi de ly re c o g n ized
p .

R e m o v e t e C au s e o f D s e
h i a s e — No gre at am o u n t o f .

an aly si s o f th e v ari o u s c au s es o f di s e as e i s re q u ired b ef o re

“ ”
we r e al iz e th at to rem o ve th e cau s e we m u st do so m ethi n g
m o r e th an tre at i n divid u al m emb e r s o f s o c i ety There is a .

ph as e o f m e di cal p racti c e wh i ch re q ui re s u s to vi ew th e g o o d
r

o f th e c o mm u n ity r ath er th an an y p o rti o n o f it S o m e l ive s .

ar e s ac rifi c e d be cau s e we h av e n o c u re fo r th e i n divid u al .

W e cu r e th e c o m m un ity th e r ac e by sac rifi c i n g the i n divid

P u b li c h e alth re q u ire s wh at s e e m
, ,

u al . s t o b e c r u e lty t o w ard

th e i n divid u al fr o m wh o s e di s e as e we mu st be pr o te cted .

P r e v e nti v e M e di ci n e — A s fa st as cau s e s o f c e rt ai n di s

e as e s hav e b ee n dem o n s tr ated p lan s fo r preve n ti o n t ake

,

pre c ede n c e o ver tre atm e nt Of th e i n divi d u als w ho s u ff e r fr om

th o s e di s e as e s Th u s a n e w c lass Of phy si c i an s is devel o p ed
.
,

i e th o s e tr ai n e d to co p e with th e p r o b l em s o f p reve n tive

. .
32 PRI N C I PL E S OF O ST E O PAT H Y

m edi c i n e r ath er th an m eet th e e x ige n ci e s o f tre ati n g i n

divi d u al p ati e n t s I t is th e n e c e ssari ly ag gre ss ive adv an ce
.
'

o f p reve n tive m e di c m e wh i c h ar o u s e s an t ag o n i sm an d s o c i al

di s co rd NO o n e c o u ld s u cc e s sf u lly c o nte n d th at all p reve n

.

tive m eth o d s th u s far e n f o r c ed ar e sati s f ac t o ry Th e n to o

, ,
.
, ,

it i s n o t p o s sib l e to d em o n str ate q u i ck ly to all th e m emb er s

of a c o m m u n ity th e n e c e s s ity fo r c ert ai n p r o c ed u re s S acri .

fi ce o f th e i n divi d u al b e it ever s o s light fo r th e g o o d o f th e

, ,

wh o le i s n o t agree ab le to th e vi cti m o r hi s fri e n d s Alt ho

,
.
.

we ar e d eve lo pi n g m eth o d s p ri m ari ly appl i cab le to th e i n

_

divi d u al r ath e r th an s ervi n g th e aggre ss ive p u rp o se s o f p re

v e n ti v e m edi c i n e th at whi c h m ake s th e i n divi d u al an e ff i
,

c i e n t m embe r o f s o c i ety s u b s erve s p u b l i c h e alth .

S y m pto m s — D i s e ase s m an if est th em s elve s by c e rt ai n

.

phe n o m e na whi c h ar e de s ig n ated as sympt o m s S ympt o m s .

ar e ab n o rm al d egre e s o f n o rm al re ac ti o n Thi s i s m ad e evi .

d e n t by th e f ac t th at so m e s ympt o m s repre s e n t s ub an d
o th er s s u p er n o rm al f u n c ti o n i n g The su pe r n o rm al f u n c ti o n
.

i n g repre s e n t s a re ac ti o n o n th e wh o l e f av o ra b leto re co very

, ,

wh ere as th e sub n o rm al re ac ti o n i s n o t f av o r ab le S i nc e th e .

s ympt o m s repr e s e n t ph as e s o f re ac ti o n o r n o n — re acti o n i n

ti ss u e s th e e ffo rt pu t f o rth by th e b o d y as a wh o l e to r e
, , _ ,

c o ver i s i n p r o p o rti o n to the e n e rgy c o n t ai n ed i n i ts cel ls

, .

In a re s tri c te d s e n s e th e c au s e Of di s e as e i s i n th e c e ll s o f th e
b o dy . Th ey c o n t ai n th e st o re d e n ergy i e po , .

te n ti al e n e rgy W he n thi s p o te n t ial e n ergy is r e

.

l e ased by so me f o r c e o r stim u lu s we h ave ki neti c e nergy

, , .

P o te n ti al e n ergy d o e s n o t tr an s fer it s e lf s p o n t an e o u sly i n t o

-

ki n eti c e n ergy with o u t fi r s t b ei n g affec te d by so me o th er

f o r c e whi ch m ay b e c alled a sti m u l u s The am o u n t o f po
, .
.

te n ti al e n e rgy c o n verted i n t o ki n eti c i s n o t pr o p o rti on al to

'

the am o u n t o f th e s tim u lu s u s ed to i n iti ate th e p r o c e s s Al l .

s t o red e n e rgy i e p o te n ti al e n ergy , re q u i re s a c ert ai n

, . .
, .

s tre n gth o f s ti m u lu s to st art th e p r o c es s o f c o n ver s i o n i n t o

ki n eti c Whe n th i s s tr en gth o f sti m u lu s i s k n o w n it is cal led

.
,

th e n o rm al Th ere ar e u s u ally s eve r al ki n d s o f s tim u li e ach

.
,

o n e h avi n g a v aryi n g degre e o f i nte n sity F o r e x amp le th e .

,
 P R I N C I PL E S O F O ST E O P A T H Y 33

p o te n ti al e n ergy i n a m u scl e fib er wi ll b e c o n v e r te d i n to k i .

n eti c e n ergy as a re s u lt o f m e c h an i c al th erm al c h emi c al o r , ,

e lec t ri c al s tim u li C ert ai n am o u n t s o f e ac h o f the s e sti m u l i

.

ar e re qu i red to i n iti ate th e c h an ge i n th e f o rm o f e n e rgy .

A No r m al S ti m u u sl — Th e p o te n ti al e n e rgy i n a m u sc l e
fiber has a c ert ai n degre e o f re s i s t an c e to sti m u fi A d efi n ite .

am o u n t o f a n y o n e o f th e f o u r f o rm s o f s tim ul i n amed is

n e c e s s ar y to c au s e th e m u s c l e fibe r to c o n tr ac t Th i s de fi .

n i te am o u n t whi c h i s c ap ab l e o f stim u lati n g th e m u s c l e to

,

an av e r ag e co n tr ac ti o n i s c al le d the n o rm al sti m u lu s an d
'

'

, ,

th e acti o n Of th e m u s c l e i s call ed th e n o rm al c o n tr acti o n I f .

th e m u s c le s ho u ld c o n tr ac t m o re vig o r ou sly th an u s u al i n
'

re s p o n s e to th i s n o rm al s tim u lu s th e r es i stan c e o f th e po ,

t e n ti al e n e rgy o f th e m u sc l e fiber i s b e lo w no rm al The . ,

s tre n gth Of s tim u lu s an d di s c h arge o f e n ergy may v ary

gre at ly i n th ei r p r o p o rti o n s with i n n o rm al l im it s bu t th ere ,

ar e we ll m arked l i n e s ab o v e o r b e lo w W hi c h re s i st an c e is
sp o ke n o f as ab o v e o r b e l o w n o rm al .

A Chan g e o f R e s i s t an c e —W h e n the re s i s t an c e o f th e .

p o t enti al e n ergy i s b e lo w n o rm al a n o rm al sti m u lu s cau s e s ,

to o gre at ah e ff e ct th at i s to o m u c h po te n ti al e n ergy i s
_ , ,

tr an s fe rred i n t o ki n eti c e nergy W h e n th e r es i st an c e o f th e .

p o te n t ial e n e r gy i s n o rm al an d th e s tim ul u s ab o ve n o rm al
,
'

t here al so r es u lt s an e x c e ss iv e di s ch arge o f p o te n ti al e n ergy .

The ref o re e x c e s sive d i sc h arge re s u lt s fr o m lo were d r e s i s

,

t an c e o r i n c re as e Of s tim u lu s R e s i s t an c e i s a q u ality Of th e
, .

c e ll p r o t o pl as m The Sti m u lu s i s an e x te r n al f o r c e
. The .

c e ll dep e n d s o n p r o pe r s u rr o u n di n g s i n o rder to m ai n t ai n i ts
'

re s i s tanc e to e x te r nal sti mu li s u c h as b ac teri a The s tre n gth , .

o f b ac teri a m a al so b e i n c re as e d o r de c re as ed by th e n at u re
y
o f the i r s u r r o u n di n g s
'

—A fter p te n ti al e n ergy
.

Cau s e an d E ff e ct bee n o has

ch an ged i n t o ki n eti c e n ergy thi s latter m ay ge n er ate m o re ,

p o te nti al e n e rgy an d th i s als o m ay b e c o n vert ed i n t o ki n eti c

, .

Th u s c au s e i s c o n ve rted i n t o e ff e c t an d e ff e c t i n t o c au s e .

Thi s i s an e n d l e s s ch ai n Wh e n s u c h a p r o c e ss i s b ey o n d th e
.

no r m as i n th e b o d y wh e n E
‘

"

al , v aryi n g sympt o m s p re s e n t
34 PR I N C I PL E S OF O ST E O PAT H Y

th em se lve s th e r ap e u ti c e ffo rt s m u st b e c o n c e n tr ate d o n

,

so m e p arti c u l ar refl e x i n o rd e r t o bre ak th e ch ai n .

C e ll R e lati o n s — The re lati o n s o f a c e ll with i ts fe llo w s

'

.
,

th at is i ts str u c t u r al re lati o n s ar e th e b asi s u p o n whi c h i ts

, ,

re s i st an c e i n large me as u re d epe n d s Th e ref o re anythi n g

, , .
,

wh i ch di s arr ange s i ts n o rm al re lati ons wi ll i n all p r o b a ,

bi li ty ch an ge
, i ts re s i st an c e to s tim u li A ll th e r ap e u ti c .

m eth o d s wh i c h ai m at le s s e n i n g th e to o r apid co n ver s i o n o f

p o te nti al i nt o ki n eti c e n ergy th at i s i n c re as i n g c ell re s i s t
, ,

an c e m u s t s e e th at co rre c t s tr u c t u re i s att ai n ed
, .

E x ce ss i v e S ti m u l ati o n — In c as e s wh ere alm o s t c o m

l e te e x h a u s ti o n o f p o te n ti al e n e r gy has re s u lted fr o m lo w
p
ered re si st an c e an d we fi n d th at eve n i n c re as e d stre n gth o f
stim u l u s f ai ls to ev o ke a re s p o n s e th e s am e s t r uctu r al f au l t
,

m ay e x i s t ; We k n o w th at s tim u lati o n wh e n e x c e ss ive , ,

p ass e s i nt o i nh ibiti o n P e rh ap s it i s tr u e r to s t ate th at o ve r

.

ac tivity o f a c e ll l e ad s to e x h au s ti o n o f i ts p o te n ti al e n ergy .

The s t age o f e x h au s ti o n i n th i s s e n s e i s c o n so n an t with i n

, ,

hi bi ti o n As an e x am p l e : In c as e o f str u c t u r al c h an ge s i n
.
-

th e lo we r d o r s al regi o n th e re m ay re s u lt a ch an ge i n r e
,

s i stan c e i n th e s e c ret o ry an d c o n tr ac ti l e c e lls o f th e i n te s

ti n e s du e to ch an ged b lo o d s u pp ly Di arrh o e a re su lt
, . s fo r a .

tim e f o llo wed by c o n stip ati o n A t th e begi n n i n g O f the

,
.

r apid c o n ver s i o n o f p o te n ti al i n t o ki n eti c e n er gy th e m u s c l e s

fe e l te n s e A fter th e co ns t i p ati o n o r p eri o d o f e x h au s ti o n
.
, ,

s et s i n th ey ar e fl abby
,

S t r u c t u r al D e f e ct s — S tr u c t u r al defe c t s m ay re s u lt i n
lo we red re s i s t an c e i n gr o u p s o f c e lls Th ey als o ac t as s tim .

u l i to s e t fre e th e p o te n t i al e n erg y i n th e s e c e ll s In m any .

cas e s we n o te o n ly a p re di s p o s iti o n t o yi e ld to we ak s tim u li .

Th i s i s th e c on diti o n i n i n divi d u als w ho ar e f ai r ly We ll

“ ” - r

bu t c an n o t e n d u re an y o f the n o rm al s ti mu li i n ave rage

Th ey c ann o t e x er c i s e free ly with o u t a bad r e ac
'

am o un t .

ti o n A slight ly h e av 1 e r m e al th an u su al th e e x c item ent du e

.

to th e p re s e n c e o f m an y p e o p le a r o u s e s sympt o m s
”
, Th ei r .

phy si o l o gi cal p r o c e sse s ar e e asily p erve rte d by n o rm al s tim

u li b e cau s e a st r u ct u r al de fe ct eith er di r e c tly o r i n dire ctly
, ,
 PR IN C I PL E S OF O ST E O P A T H Y 35

has de c re as e d c e ll re s i s t an c e C as e s o f lo wered re s i st an c e
.
,

s u pp o s ed t o b e du e t o h er e dity s h o u l d b e c aref u lly e xam

'

i n e d fo r str u c t u ral defe c t s I t i s n o t im pr o b ab le that many

.
‘

“
an anc e s t o r i s wr o n g ly acc u s ed o f tr an s mitti n g a p r e di s po

siti o n
”
. W hi le c e ll r e si s t an c e rem ai ns be lo w no rm al all e x ,

ter n al s tim u li s u ch as atm o sphe ri c c h an ge s an d the pre s e n c e

,

o f b ac te ri a e v e n i f i n o n ly n o rm al am o u n ts m ay c all f o rth ,
,
“ ”
s ympt o m s o f d i s e as e .

C e ll-

L if
‘

e D e p e n d e n t o n C i r c u l ati o n — T h e i n d ivi d u a
. l
c e ll s o f t he b o dy d ep e n d 0 11 th e su pp ly o f n o u ri s hm e n t
b r o u ght to th e m by th e c i r c u lati n g fl u id s o f th e b o dy The .

pr o t o p lasm o f th e c e lls i s a c o mp l e x ch emi c al s u b st an c e ,

mad e up Of an e n o rm o u s n u mber Of co mp l e x m o l e c u l e s .

The s e m o l e c u l e s o n ac c o u n t o f th e lo o s e n e s s o f c o mbi n a
,

ti o n o f th eir at o m s r eq u i re s u ffi c i e n t c r u d e m ateri al b r o u ght

,

to t hem to m ai n t ai n th e p r o p e r a t o mi c te n s i o n
-

U p o n th i s .

te ns i o n i s bas e d th e re s i st an c e to no rm al o r ab n o rm al stim u li .

The n e c e ss ary f o o d fo r c e ll p r o t o p l as m i s br o u ght to th e

c e lls by b lo o d an d ly mph S i n c e c e ll p r o t o p las m i s e n ti re ly
.

d ep e n de n t u p o n th e c ir c u lati n g m e di a an y di st u rb an c e o f ,

th e se m e di a c hai i g e s th e m et ab o li s m o f th e c e ll an d h e n c e
g ,

a c h an ge i n re si s t an c e re s u lt s Thi s re s i s t an c e m ay b e v arie d
.

by f ai lu re o n eith er the ar te r i al o r ve n o u s s id e o f the ge n e r al

'

c ir c u lati o n re s u lti n g i n c h an ged ly mph c ir c u lati o n The

, .

co n s t an t rem o v al o f k at ab o l i c p r o d u c t s i s Of as m u c h i m o

p o rt an c e as th e c o n st an t re n ew al o f m ate ri al fo r an ab o l i s m .

In r ac e l lu l ar Te ns o n
t i — I n tr ac e llu lar te n s i o n i e th e
.
,
. .
,

c o h e s ive n e ss o f th e at o m s Of e ac h m o l e c u l e i s d ep e n de n t o n ,

lymph ati c c i r c u lati o n ; thi s u p o n arteri al an d ve n o u s c i r c u la

ti o n I f th ere i s ab n o rm al v ari ati o n i n any o f the s e c ir c u la
.

t o ry fl u id s th ere re s u lt s a ch an ge i n r e s i s tan c e o f th e c e lls

'

.
,

Th e ref o re a n o rm al s tim u l u s m ay pr o v o ke to o gre at a tr an s

,

fere nc e o f p o te nti al i n t o ki n eti c e n ergy an d th u s i n iti at e a

c hai n of s u c h t ran s fere n c e s Of o n e f o rm o f e n ergy i n t o a11
'

o th er . A s a r u l e th e ki n eti c e n ergy whi c h re s u lt s fr o m th e

,
»

rel e as e o f p o te nti al e n e rgy i n e x c e ssive am o u nt s act s as a

, ,

sti mu l us t o r el e as e st ill m o re p o te nti al e n ergy and so o n to

36 PR I N C I PL E S OF O ST E O PAT H Y

th e p o i nt Of e x h au s ti o n o f th e s u pply o f s u ch st o re d e n ergy .

Th i s ch an ge i s e x em p lifie d i n th e s erie s o f symp t o m s wh i c h

app e ar i n m an y di s e as e s E ach lib erati o n Of a ne w su pp ly.

o f e n ergy give s ri s e t o a n e w sy stem I f th e p o te n ti al e n .

e r g y re s id e s i n a g la n d e x c e ss ive s e c reti o n re s u lt s ; if i n m u s
‘

1
,

c l e e x c e ss ive c o n tr ac ti o n e t
,
c The w ay i n whi ch th e ki n eti c
, .

en ergy i s m an ife s ted d ep e n d s u p o n th e m an n er i n whi ch its

c au s e i e ,
p o te n ti al e n e rgy i s st o red The s e c reti o n o r th e
. .
, ,
.

c o n tr ac ti o n m ay ac t a s a s ti m u lu s t o l ib er ate s ti ll m o re po

te n ti al e n ergy .

—Th er ap e u ti c m eth o d s b e c o m e
S c i e n tifi c The rape u ti cs
s c i e n tifi c j u s t i n p ro po rti o n as they ar e b as ed o n th e k n o w n

str u c t u re an d f u n cti o n o f th e ti s s u e s an d th e e x ac t c au s e o f

th e di s t u rb ed c o n diti o n Of th e ti ssu es i e th e d i s e as e The , . .

,
.

e ff o rt to d evel o p s c i e n tifi c th er ap e u ti cs has l ed to v ari o u s

w ay s Of lo o ki n g at th e p r o b l em W e h ave m e n ti one d t he .

f act th at e ach c as e o f i lln e ss i s a p r o b lem with tw o u n k n o w n

q u an titi e s i e th e c au se o f th e i lln e ss an d th e re acti o n po w
, . .
,

er i e th e re s i s t an c e o f th e i n divid u al
, . .
,
The c au s e i n m an y .
,

i ns t an c e s m ay b e s u ffi c i e n t ly wel l k n o w n to go ver n th e
,

m eth o d Of tre at me n t at l e as t th e tre atm e n t appe ars sci e n

,

ti fi c i f we th i n k o n ly o f th e c au s e The p o ss ib l e we ak p o i n t
i n th e p lan o f tre atm e n t i s th e f ac t th at n o c o n sid e r ati o n has
b ee n p ai d to th e e x i s te n c e o f th e s e co n d u n k n o w n q u an tity ,

i e th e re si s t an c e o f th e ti s su e s to th e di se as e as we ll as to
"

,
. .

th e tre atm e nt The tre atm e n t o f typh o i d feve r by i n te sti n al

.

an ti s epti cs app e ar s s c i e n tifi c be c au s e it app e ar s to bri n g th e

c au s e o f typh o i d an d th e m e an s o f d e str o yi n g it i n p r o p er

re lati o n The tre atm e n t has n o t pr o ve n s u cc e ss f u l be c au s e

.

o f th e s e c o n d u n k n o w n q u an tity an d b e c au s e th at wh i c h i s

de s tr u ctive to th e c au s e i s likewi s e de str u c tive to th e ti ss u e s .

The P r o b l e m as a W hole —The d evel o pm e n t o f sc i e n

tifi th er ap e u ti cs i s evi d e n t ly n o t e as ily acc o mp l i sh ed eve n

c ,

wh e n we k n o w th e c au s e o f di s e ase Th ere ar e th o s e w ho .

tre at di s e as e s an d th o s e w ho tre at i n divid u als i e th o se , . .

,

w ho att ac k cau s e s with l itt l e reg ard fo r th e re ac ti o n s o f th e

,
38 PR I N C I PL E S OF O ST E O PAT H Y

is b u i ldi n g its p o rti o n o f s c i e n ti fi c th er ap e u ti cs b as e d u p o n :

a k n o wle dge o f c au s e s an d re ac ti o n s .

E x t r i ns i c C au se s o f D i s e ase — The c au s e s o f di s e as e
previ o us ly m e n ti o n e d i e e n vi r o n m e n t al co n diti o ns po i
,
. .
, ,
.

s o n s p ar as ite s e tc
, ,
ar e al l e x te rnal i n fl u e n c e s i n th e s e n s e
.
, ,

th at th ey ar e n o t a p art o ff n o r m al ti ssu e str u ct u re s The .

c au s e s n o te d e s p e c i ally i n o s te o p athi c d i ag n o s i s ar e a p art

o f th e s tr u c t u re o f th e b o dy The s tr u ct u r al rel ati o ns ar e
.

s u ffi c ie n t ly altere d to c o m pe l th e b o dy to re ac t 0 11 i ts o w n
'

s tr u c t u r al i mb alan c e .

I n he r e n t R e cu pe r ati v e P o w e r — S i nc e it hasi nh ere n t r e .

-
.

c u pe r at i v e p o we r to o ve r c o m e the e ff e c t s o f e x te r n al caus e s
o f di s e as e th ere i s n o d o u bt bu t t hat it u su ally S u rvive s lo
,

c ali z e d str u c t u r al l e sio n s o f thi s i n h ere n t char a c te r I t ad apt s .

it s e lf as we ll to i n t er n al str u c tu r al c o n diti o n s as to d i s e as e s
p r o d u c ed by o th e r c au s e s W e h ave n o te d th e n e c e s si ty o f
.
'

a n o rm al m o l e c u lar i n tr ac el l u lar te n s i o n i n o rde r to m ai n

t ai n th e e ffi c ie n cy o f th e c e ll also th e n e c e ss i ty fo r p r oper ,

re lati o n s b etwe en th e c e lls an d th e c ir c u lati ng fl u id s Any

'

s tr u c t u r al f au lt whi c h i n terfe re s with th i s r e lati o n ship co m

p e l s th e b o dy to re ac t to thi s f au lt ei th er i n a w ay to co rr e ct .

it o r i f it th re at e n s th e life o f the wh o l e b o dy get ri d O i lt

, ,
-
, .

W e s e e i n the s e re acti o ns j u s t Su c h ph e no m e n a as We ex
hibi t i n o u r s o c i al re lati o n s i e a s i c k m emb er o f th e c om
, .
,
r

m u n ity c au s e s n o gre at re acti o n i n th e b o dy p o lit ic u n ti l hi s

i ll n e ss m e nac e s th e wh o le p e o p le .

e l —
D i s t u r b e d Ti ssu e R ati o n s O s te o p athy emph asi ze s
th e di st u rb an c e s i n ti s s u e re lati o n s I t s ee s i n the s e b o t h .
-
.

p redi sp o si n g an d e x c iti n g cau s e s of di s e ase ; predi s p o s i n g i n ,

th at ti s s u e re s i s t an c e to o u t s id e i n fl u e nc e s i s we ake n ed ; e x
c iti n g i n th at i n m an y i n st an c e s the re ac ti o n s t ak e o n th e
, , ,

c h ar ac ter o f ac u te di s e as e s I n j u rie s ar e so ve r y freq u e n t

.

th at th ere i s s c ar c e ly an i n d ivi d u al w ho has n o tpu tthe str u e

t u r al ti ss u e s to a severe te s t Th e s e str ai n s u s u ally o f s u ffi
. .
,

c i e n t s everity t o p r o d u c e lo c al di s tre ss an d h e ali n g re ac ti o ns ,

l e ave th ei r i n fl u e n c e s an d i f a l on g ti me fo r h e ali n g w as r e
,

q u i red pe rh ap s i n fl u e n c ed th e ge n er al s t ati c s o f th e b o dy
,
 P RI N C I PL E S OF O ST E O PAT H Y 39

The Bi o l o g i c al R e l ati o n of F u n c ti o n an d S t r u ct u r e .

The au th o r d o e s n o t lo o k u p o n th e so call ed o s te O pathi c le

s i o n as b ei n g an evide nc e th at s tr u c t u re d etermi n e s f u n c ti o n ,

bi o lo gi c ally co n s idered The s tr u c t u r al L

. e si o n i s an i n ter
r u pti o n o f th e bi o lo gi c a1 c o n c ept th at f u n cti o n f ashi o ns th e
-

s tr u c t u re Thi s i n te r r u pti o n di s tu r bs f u nc ti o n bu t th e b i o
.
,

l o gi cal law is su re to ass ert it s e lf i n th e re c u p er ative pr o c e s s .

”
S i n c e bi o lo gy has n o s t ati cs l ivi n g ti s su e s ar e alw ay s be
,

i n g reb u i lt to s erve th e f u n c ti o n whi ch b ro u ght the m i n t o

,
-

bei n g Thi s abi lity to re pai r an i nj u red ti ss u e an d m ak e it

.

s e rv e th e s p e c i al f u n c ti o n fo r wh i c h it w as i n te n d ed i s th e ,

f o u n d ati o n fo r ad apt ati o n an d c o m pe n sati o n th o s e phe ,

mo m e n a wh i c h we s e e e x h ibite d by th e b o dy in s o m any
f o rm s i n i ts str u gg l e to s u rvive .

The Tr u e Ar t Of H e al i n g— If we t dy th e s e ph e
c an s u

n o m e n a u n d er s t an d wh at Nat u re i s tryi n g to do a ss i st ac
, ,

co r di n g ly th e n we ar e i n d e e d phy s i c i an s
,
In n o c as e c an
.

an ythi n app e ar i n th e f o rm o f di s e as e whi c h w as n o t p re

g
v i o u s ly p re s e nt i n th e b o dy as a p re di s p o siti o n ; e x te r n al
"

fo r c e s ar e ab l e m ere ly to m ake thi s p redi sp o s iti o n app are nt .

Wh e n th e phy si c i an by th o r o u gh Ob s e rv ati o n an d i n ve s ti
“

g a ti o n k
,
n o w s th e co n diti o n s th at i n fl u e n c e a give n p re di s

p o siti o n i n a de fi nit e w ay wh e n h e i s s c i e n tifi c ally tr ai n ed

,

an d has a tr u e c o n c epti o n o f hygi e n e an d i s at o n c e phy s i

,

c i an an d n at u r al i s t th e n h e i s ab l e to c u re di s e as e by u s e o f
,

th e very sam e f o r c e s whi c h s erve to c re ate o r alter th e hu

m an c o n s tit u ti o n In t hi s S imp l e s e n s e th ere i s a tr u e ar t Of
.

”
he ali n g .
4O PR I N C I PL E S O F O ST E O PAT H Y

CH AP TE R IL

TH E LE S IO N A S A CAU S E .

D e fi n i ti o n — The p r in c ip le s o f O ste o p athy t ake th ei r n at

“ ” '
The
4
u r al b egi nn i n g i n th e c o n s i der ati o n o f th e le s i o n .

w o rd le s i o n i s u se d by O Ste O patli s to d e sig n ate s o m eth i n g

“ ”
~

“ ”
m o re th an an i nj u ry h u rt o r w o u n d i n any p art O f th e b o dy
,
'

( G o u l d ) A
. n y s tr u c t u r al c h an g e wh i c h aff e c t s th e f u n c

ti o nal ac tivity o f any ti s s u e i s c all ed a l e s i o n Th e re m ay be .

s tr u c t u r al ch an ge s ab n o r mal d eve lo p m e n t wh i c h ar e very

, ,

evid e n t top alp ati o n bu t do n o t aff e ct fu n c ti o n al ac tivity an d ,

th e re f o re ar e n o t l e s i o n s A l e si o n i s n o t o n ly a str u c t u r al
, .

c h ange bu t s u c h a c h an ge a s i n fl u e n c e s f u n c ti o n de tr i
“

.
m e nt ally .Fig 112 i llu str ate s a stru ct u r al ch ange wit ho ut
.

detrime nt al i nfl ue nc e o n f uncti o n while Fig 1 13 il lustr ate s a

”

.
,

t ru e l e s i o n The rel ati o n o f th e s e str u ct u r al le s i O n S to the

.
-
'

m edi a Of co m mu n i cati o n an d e x ehang e n erve s an d bl o o d

‘

,
i

ve ss e ls i s b e li eved to b e th e c hi ef e le m e nt ac tiv e i n pr o
,
'

du c in g an d m ai n t ai n i n g f u n c ti o n al di so rd er s Thi s i s th e
“
.
“

c e n tr al p ri n c i l e o f o s te o p ath i c p r ac ti c e
p .

Char ac t e r i s ti cs o f a L e si o n — L e s i o n s m ay b e p re s e n t i n
.

an y ti ss u e bu t th ei r e x i s te n c e i s m
,
o s t e as ily re c o g n ized i n

b o n e l ig am e n t an d m u s c l e D i s lo cati o n s a n d s u b lux ati o ns

,
.

o f b o n e s th i c ke n ed lig am e n t s an d c o n tr ac te d m u
,
scl e s co n

A tr u e l e si o n i s usually
“

st i tu te th e u s u al v ari eti e s o f l es i o n s .

p alp ab l e ; th e f u n cti o n al d i st u rb an c e i s rel ate d anat o m i cal ly

an d phy s i o lo g i cally ; th ere i s hyp er ae sth e s i a at th e p alp ab l e

are a . Th e s e th re e co n diti o n s co ns tit ute th e Char ac teri sti cs

o f th e l e s i o n as it i s d e s ig n ated by th e o s te o p ath Its p alp a .

bility m ay v ary bet w e e n very wide lim i ts ; th e l o cati o n o f th e

s tr u ct u r al ch an ge an d f u n cti o n al d er an gem e nt m ay b e d i r e c t
 P R I N C I PL E S O F O ST E O PA TH Y 41

or in dire ct th e hyp er ae s th e si a di sti n ct o r i n di sti nc t ; sti ll

, ,

the di agn o sti c i an is j u stifie d i n c e n teri n g atte n ti o n u p o n th e

l e s i o n if a re as o n ab l e am oun t o f as so c i ati o n can b e dete c ted .

Class e s o f L es i o n s — L e s i o n s acc o r di n g to o ste o p athi c

.

the o ry m
,

,
ay b e o f tw o c lass e s i e fir st ch ange i n s iz e o f , . .
, ,
i

ti ss u e s ; se co n d ch an ge i n p o siti o n G e n e r ally spe akin g a

‘

,
.
,

c h an ge i n si z e i s far m o re di ffi c u lt t o o ver c o m e th an a ch an ge -

i n p o s iti o n be cau s e th e f o rm er i s a re su lt o f m o re pr o f o u n d
,

c h ang e s . Ti ss u e s m ay i n c re as e in s iz e as th e re su lt o f c i
fo r ts to rep air i nj u ry e g th e f o rm at i o n o f callo u s i n b o n e
, . .
, ,

o r thi c ke n i n g o f l ig am e n t s f o llo wi n g a s pr ai n .

C au s e s o f L e si o n s —The c au s e s o f le si o ns f all u n der tw o

ge n er al divi s i o n s : F ir st vi o l e n c e ; s e co n d f ai lu re to r e ac t to
, ,

e nvi ro n m e n t In th e fir s t divi s i o n all th e l e s i o n s ar e p r i m ary

.

i n char acte r i e th e vi o le n ce im m edi ate ly c h ang e s th e r el a

, . .
,

ti o ns o f str u ct u re an d thi s ch an ge b e co m e s an o b st r u cti o n

,

to vit al ac tivity o f th e b o dy fl u i d s I f th e l e s i o n i s no t co r .

r e ct e d by th e re c u p er ative p o wer o f th e b o dy i tse lf o r by o u t /

s i de e ff o rt s th e ch an ge i n p o s iti o n i s very apt to be co m e

,

co mpli c at ed by a c h an ge i n s ize The i nj u ry r e su lt s i n t hi ck

—
.

e n i ng o f t he li g ame n ts o r o th er fib r o u s ti ss u e s
“

S e co n dar y L e si o ns —The s e c o n d divi s i o n o f l e s i o ns i s a

very large o n e Th e s e l e si on s deve lo p as an evide n c e o f th e
.

fai lu r e o f th e o rgan i s m to b e co m e p erfe ct ly ad apted to i ts

f o o d c lo th i n g lab o r o r ge n er al e nvir o n m e n t They ar e
, , .
,

th eref o re s e co n d ary i n ch ar act e r an d m us t b e re c o gn ized as

,

Obj e c tive sympt o m s o f o n e f u n c ti o nal der an gem e n t whi l e ,

at the s am e tim e th ey Op e r ate p r im arily to c au s e f u n c ti o n al

d e r an ge m en t e l sewh ere Th u s th ey m ay b e rem o ve d by .

m an i pu latio n an d c e ase to ac t as an ac ti v e cau se o f f u n c

ti o n al c h an ge bu t wi ll ret u r n ag ai n s o l o n g as e n vir o n
,

m e nt al f o r c e s ar e o verwh elm i n g .

E ff e ct o f V i o l e n ce o r F at i gu e —The fir s t d ivi s i o n o r pri .

m ary l e s i o n m ay re su lt fr o m s u dde n vi o l e n c e o r fr o m a f o r c e
c o mp ar ative ly we ak b u t lo n g co n ti n u ed In o th er w o r ds a .
,

l e si o n m ay b e dev e lo p ed i mm edi ately u n der gre at f o r c e o r , ,

42 PR I N C I PL E S OF O ST E O P A T H Y

l wly as th e re su lt o f gre at f atig u e An e x ampl e of a l e s i o n

s o .

d eve lo pi n g u n de r f atig u e i s no ted i n th e fau lty p o s iti o ns as

s u me d by th e b o dy f o llo wi n g p r o l o n ged e ffo rt o r i n p erf o rm

i n g c ert ai n t ask s .

F ai l u r e o f Ada p t ati o n — T he s e c o n d div i s i o n o r s e c

o n dar y l e si o n s m ay re s u lt fr o m f ai lu re to re ac t p r o pe rly t
‘

o
c h a n ge s o f t emp er at u re T .h e te mp er a t u e
r o f th e s u rr o u n d ;

i n g ai r m ay b e th e sam e at v ari o u s ti m e s bu t th e ch ar acter ,

o f th e c loth i n g m ay n e c e s s it ate a gre ater e ff o rt at ad apt ati o n

'

Th e re m u s t b e su dde nn e ss i n th e ch ange o f tem pe r at u re o r

C lo thi n g i n o rde r t o pr o d u c e th e l e s i o n i e th e re sp on s ive
, . .
,

n e s s o f th e ti ss u e s m u s t b e o ver t ax ed The fir s t e ff e ct o f
.

f ai lu re o f ad apt ati o n i s th e co ntr acti o n o f m u scl e and ac

c o mp an yi n g s e n s iti ve n e ss The di s t o rti o n o f th e b o ny s tr ue
.

t u re i s c ons e q u e n t o n th e c o n t rac ti o n O r di nari ly if th e

'

.
,

s h o c k i s n o t to o gre at the ad aptive f o r c e s o f th e o rg an i sm

,

wil l e x ert s u ffi c ie n t p o we r to co rre c t th e co n diti o n bu t ,

wh e n th e e n v i r o n m e n t i s n o t s u it abl e th e le s i o n m ay be
'

c o m e pe r m an e n t H u mi dit y o r e le ctri c al c o n diti o n s o f th e

'

atm o s ph ere m ay o p er ate to p r o d u c e th e s e l e s i on s

—
.

i
C he m c a C l a u s e s O f S p i n al L e s i o n s
'

W e h ave n o ted
th at th e s e l e s i o n s h ave be e n di sco ve re d c o i nc i de n t with v i s
c er al di so rder . We m ay th eref o re s afe ly assu m e th at f o o d
, ,

wh i ch i s to o di ffi cu lt o f di ge s ti o n o r th e u s u al f o o d t ake n
d u ri n g f atig u e m ay ac t ch em i cally to p r o d u c e spi n al le si o n s
,
.

In thi s i n s t an c e th ey ar e c ert ai n ly o bj e c tiv e s ympt o m s o f

vi sc e r al d i s e ase b u t as st ated b ef o re th ey m u st b e p rim ary
,

c au s e s o f o th e r di so rd er s To rem o ve s u c h a l e s i o n by man
.

i pu lati o n i s h e lpf u l to th e o rg an i sm bu t th e p ati e n t m us t ,

k n o w th at di eteti c i n di s c reti o n s o r e ati n g wh e n f atig u ed w as

th e re al st arti n g p o i n t o f th e di s e as e H ere is w he r e di e te ti c
.
‘

an d hygie n i c k n o wl edge m u st b e a p o rti o n Of th e phy si c i an s

’
_

th er ap e u ti cs I f th e p o i nti n g o u t o f s tr u ct ur al change s as a
.

re su lt o f f u nc ti o nal di s t u rb an c e du e to i n di sc reti o n s i n e at
i n g an d o th e r appetit e s wi ll le ad p ati e nt s to s impl er l ivi n g ,

th e phy s i c i an m ay fe e l th at h e has p erf o rm e d a d u ty m o re

v alu ab l e to th e p ati e n t th an th e rem o v al Of his s e c o n d ary
 P RI N C I P L E S O F O S T E O P A TH Y 43

le s i o ns Th e r e d ou bt bu t th at th e r e m o v al o f a
be
’

c an no
‘

prim ary le s i o n du e to vi o l e n c e i s abso lu te ly e ss e n ti al bu t ,

,

Wh e n we m ai n t ai n th at all l e s i o n s m u st b e rem o ve d bef o re

fu n Cti o nt c an right it s e lf we b e c o m e ab s u rd , F u rth erm o re .
,

if we c o n te n d th at a s tr u c t u r al l e s io n an t e d at e s all f u n c
‘

ti o n al di st u rb an c e s w e m ake o f l if e a s eri e s Of acc i de n t s i n ,

ste ad O f a f o r c e g o ver n ed by fi x ed law s .

The R eas n o f o r t e P
h e r s i st e n c e o a L
f e s —
i o n The q u e s
ti On ari Se S why d o e s th e m u s c u la r co n tr ac ti o n p er s i st after
~

i
th e p r o p er ch an ge s n h abit s h av e bee n m ade ? Thi s q u e s
ti o n can n o t b e an swere d at p re s e n t S c ar c e ly o n e Of u s wi ll .

v o lu n t ari ly m ake th e c h an ge i n h abit s u n ti l f o r c ed to do S O

by f ai l u re o f th e b o dy to re s p o n d to o u r dem an d s M an y .

thi n g s Of a s o c i o lo gi cal ch ar ac te r ar e at w o rk to c o m pe l pe o r
‘

p l e t o l ab o r a fte r f at ig u e i s evi de n t to e at s l e ep an d dre ss

, ,

u n hygi e n i c ally Vi ewe d fr o m thi s s t an dp o i n t th e pr ac ti c e

.
,

o f m edi c i n e i s a pr o b l em i n so c i o lo gy The o rigi nal irrit a .

ti o nwhi c h cau s e s th e t e n s i o n p r o b ab ly cau s e s m o re Or l e s s

c o n ge s ti o n Of b l o o d T h e c o n ge s ti
. o n re s u l t s i n o ver —gr o wth
Of ti s su e whi c h b e co m e s a fi x ed co n diti o n m ai n t ai n i n g the
,

l e s i o n i e , i t i s a p o rti o n o f th e l e s i o n
, . .
1 - h

The S e q u e n ce o L f e s i o n P h e n o m e na — W e h ave c o n
s i de r e d thre e p o i n t s c o n c er n i n g l e s i o n s— hyp er ae s the s i a ,

m u sc u lar c o n tr ac ti o n an d su b lu x ati o n Th ey h av e bee n

, .

c o n s idered i n thi s o rder m ere ly o n acco u n to f hi s t o ri c al ref

"

ere n c e In o ste o p athi c p r ac ti c e th ey ar e rever s ed W e n o te

.
, .

fir s t the s tr u c t u re th e n th e te n s i o n wh i c h acc o mp an i e s th e
,

c h an ge i n s tr u c t u re th e n th e hy p e rae s th e s i a
m
.
,

V ar i ati o ns i n D e v e o p l e n t — It i s n o tu n c o mm o n to fi n d
c h an ge s fr o m th e u su al f o rm s o f th e b o n e s S o m et im e s th e s e .

c h an ge s m ay b e ve ry de c eptive bu t wh e n an alyze d with ,

refere n c e to th e e x i s te n c e o f f u n c ti o n al di so rder i n th e a re a
Of th ei r n o rm al i n fl u e n c e an d th e p re s e n c e o f hyp er ae sth e s i a ,

the y w ill b e re c o g n i zed as m o rph o lo gi c al c h an ge s du e to

i

n at u r al c au s e s L e si o n s whi ch m ight h ave bee n active at a

.

fo rm e r tim e ar e so m eti me s n o n ac tive o n ac co u n t o f law s o f

acc o m m o d ati o n whi ch ar e alw ay s ac tive i n th e b o dy I f th e .
44 P R I N C I PL E S OF O ST E O P A T H Y

bo d y has su c ceed ed i n re c u pe r ati n g fr o m th e e ff e cto i th e s e .

le s i o ns it i s u nwi s e to di st u rb th e m
, AS an e x ampl e o f an .

acco mm o d ated l e s i o n we m ay m e n ti o n th e fo r mati o n o f : a

,
~

n e w s o c ket fo r th e h e ad o f th e fe m u r f o l l o wi n g di sl o cati o n ,
.

Th e re ar e v ari ati o n s i n d evel o p m e n t all th r o u gh th e b o dy ,

an d e ac h phy s i c i an sh o u l d s trive to b e c o me ac q u ai n te d with

th em .

P alpati o n o f a L i e s o n —The fir st S ig n o f a l e s i o n i s .

n o ted by p alp ati o n i e th e ch an ge i n str u ct u re i s felt Ac

,
. .
, .

c o rdi n g t o wh at we h ave j u st s ai d th i s i s no t su fli c i e n t evi ,

-

d e n c e of th e e x i ste n c e o f a n active l e s i o n I t m u st b e ac .

co mp an i ed by o t he r S ig n s F ir s t tr y to el imi n ate th e ap: .

/

p are n t e x i ste nc e o f th e le s i o n by h avi n g th e p ati e n t assu me

di ff ere n t p o s iti o ns S e c o n d n o te wh eth er th e b o n y l an d
.
,
'

m ark s i n th at are a v ary fr o m th e n o rm al Th ird n o te .

,

wh eth er th e l e s i o n c au s e s th e p ati e n t to assu m e any s p e c i al

attit u d e F o u rth te s t th e amp l it u de o f m o v e m e nt i n th e
'

.
,

arti c u lat i o n to d eterm i n e th e ch an ge s i n i t s e x te n t I f th ere .

i s p e rfe c t fl e x ibi lity it i s s c ar c e ly p r o b ab le th at a l e si o n e x

is ts fo r an ac tive l e s i o n l s q u i te i n co n ce i vabl e with o u t te n
,

si o n F ifth fe e lflo f th e s o ft p ar ts o f th e j o i n t m u scl e s an d

'

.
, ,

c onn e c tive ti ss u e s No t e any swe lli n g o r ch an ge i n t emp er a

.

t u re S i x th i n sp e c t th e s u rf ac e as to co lo r an d te x t u re
'
’

.
.
,

S eve n th te s t se n s ibi lity by p re ss u re

, O rdi n ari ly an e x am .

i n ati o n o f th e b o dy fo r l e s i o n s c o n s i s t s i n co mprehe n s ive

p alp ati o n wh i ch n o te s sy nch r o n ou s ly th e e x i ste nc e o f p o s i
,

ti o n al c h an ge te n s i o n temp e r at u re s we lli ng an d s e n s itive

, , ,

n e ss . The e x i s te n c e o f te n s i o n i s s u ffi c i e n t evide nc e o f d e

c r ease o f fl e x ibi lity Whe n vi o le n c e i s th e c au se o f th e le
.

si o n it i s n e c e s sary t
,
o c o rre c t s tr u c t u r e di re c t ly Wh e n th e . .

o s s e o u s l e s i o n i s th e re s u lt Of m u sc u l ar te n s i o n du e t o refl e x

s tim u lati o n m eth o d s diff e r acc o rdi n g t

,
o th e vi ewp o i n t o f th e

phy si c i an S o m e m an ip u late fo r di re ct red u cti o n o th e r s r e

.
,

lax m u sc le s an d th u s rem o ve th e cau s e o f th e o ss e o us le s i o n .

The re al ly c o mp reh e n s ive p lan s h o u l d t ake i n t o acco u n t th e

c au s e o f t he te ns i o n whi c h o ccasi o ns th e o ss e o u s l e si o n
'

H avi n g d o n e thi s th e phy si c i an m ay m anip u late th e l e s i o n

, ,
46 PR I N C I PL E S OF O ST E O PAT H Y

p r acti c ally all p e o p le s i ck o r we ll I t rem ai ns th ere fo re

, .
, ,

n e c e ss ary th at we add to th e s e phy s i c al c h an ge s s o m eth ing -

o f a d eterm i n i n g c h ar a c te r i n o rd er t o re co g n iz e an active
le s i o n . Te n d er n e s s to p re ss u re i s the de te r m i ni n g S i g n '
.

H avi n g lo cated a le s i o n 1 e an o ss e o u s devi ati o n with m u s?

, . .
,

c u lar te n si o n an d te n d er n e s s i n th e s am e spi n al s egm e n t s ,

we can n o w pr oc e ed to analyz e it with refere n c e t o it s e x ,

“

i s te n c e as c au s e o r e ff e c t The s pi n al v
. ertebral l e s i o n j u st
n o te d m ay i nv o lve tw o o r m o re ve rteb r ae wi th t hei r at
‘

tac he d ti s s u e s S o m e o b s e rver s c laim th at a l e si o n o f a

‘ “

S i n g l e vertebr a i s r are S i n c e o s te o p athy has fo s tere d th e

”

vi ew t hat s tr u c t u re aff e c t s f u n c ti o ni n p re fe r e n c e to th e r e
ve r se th e au th o r fee ls j u s tifi ed so lely by hi st o r i cal c o n sid e r
, ,

ati o n s i n b egi nn i n g al l an aly s e s o f l e s i o n s fr o m th at vi ew

,

p o i nt
. It i s c an did ly u n de r s t o o d th at i n d o i n g th i s th e -

auth o r i s n o t h o l di n g a bri e f fo r e ith er s i de o f any c o n tr o

v e rsy whi c h c i r c l e sab o u t th e q u e sti o n wh eth er th e egg p re

c ede d th e c h i c ke n o r th e rever s e .

H i s to r y o f Acci de nt—In an y c as e u n de r e x ami n ati o n

th e di ag n o sti c i an d e s i re s to u n co ver th e hi s t o ry Of th e l e s i o n ,

"
h e n c e th e m o st -dire c t q u e st i o n p o ss ib l e i s as ked i e “
Is .
, ., ,
”
th e re any h i st o ry o f acc i de n t ? I f a hi s t o ry o f accide n t is
'

give n h avi n g di re c t b e ari n g o n th e l e si o n u n de r co n s id era

ti o n th e n we ar e q u ite j u stified i n b e li evi n g it to b e th e p ri
m ary c au s e o f di st u rb ed f u n c ti o n F o r e x amp le a p ati e nt .
,

wh e n attempti n g to alight fr o m a s tre et car j u st b ef o re it

st o pp ed f o u n d hi s f o o ti ng i n s e c u re an d he n c e cl u n g to th e
,

h an d r ai l o f th e car with o n e h an d in an e ff o rt to pr o te c t
.
-

h im s e lf The f o rw ard m o ti o n o f th e c ar ro t ated h im an d

.

wr en ch e d his b ack H e w as ab le to g o to his h o m e with ou t

.

fee li n g m o re th an a s e n s e o f we ak n e ss an d p ai n i n th e a rea
o f th e d o r s o l u mb ar arti c u lat i o n
-
The n e x t m o r n i ng h e w as
.

q u ite u nab le to ri s e E x am i nati o n S h o we d gre at m u scu lar

.

te ns i o n i n th e m u sc le s c o n tr o lli n g th e m o vem e n t o f th e
twe lfth d o rsal an d fir st lu mb ar P r e ss u r e o n th e S pi no us .

p r o c e sse s o f th e se ve rtebr ae cau sed i nte nse p ai n The b owel s .

b e cam e co nsti pated an d th e cut ane o us ar e as su pp li ed by the

s
 PRI N C I PL E S OF O ST E O P A THY '

47

twe lfth d o r s al an d fir st lu mb ar pai r s o f S pi nal n erve s g ave

s o m e su bj ec tiv e sympt o m s o f be i n g di s t u rbe d Th i s cas e .

re c o vered i n a few we ek s u n der th e i n fl u e n c e o f ho t p ack s to

the i n j u red are a re s t i n b ed an d after ac u te s o re n e s s ab ated
, , ,

p a s s ive m o ti o n T hi s c ase fo r m an y y e ar s has had att ac k s

.
, ,

Th e s e att ac k s u s u ally f o llo w chan ge s i n th e

“ ”
of lu mb ag o .

we ath er an d s o m e e x e rti o n bey o n d the o rd i nary The le s i o n .

alw ay s e x hibit s i ts o ld c h ar ac teri s ti c s viz te n d er n e ss m u s

, .
, ,

c u latr igidi ty a nd lo ss o f m o ti o n i n th e arth r o di al j o i n t s b e

twe e n th e t w -
e lfth d o r s al an d fir s t lu mb ar U s u ally an o s te o
.

p ath i c tre atm e n t to e st ab li sh re lax ati o n an d m o vem e n t i s

s u ffi c ie n t t o s e cu re r api d re c o very .

Tr au m ati c L e si o n — W e h ave in thi s cas e a co n diti o n

.

s im i lar t o th e re s u lt s o f a s pr ai n e d wri s t o r an k l e Th i s i s a
cas e o f su c h o r ig i n t hat no o n e w o u ld
thi n k o f it fr o man y o th er st an dp o i n t The le s i o n i s a ch ar
.

ac te r i s ti c o n e derived i n a c h ar ac teri sti c m ann er an d f u l fi ll s

,

o u r c lass i c al pi c t u re o f lo c al ize d s pi n al i n j u ry I t is f air ly .

mi l d i n i ts di st u rb an c e o f f u n c ti o n o f th e n erve s fr o m th e i n
_

j u red are a It Was re c o vere d fr o m to s u ch an e x te n t th at th e

'

p ati e n t has co n si dere d h im s e lf we ll e x c ept at s u ch time s as

the fo rm er ly i n j u red ti ss u e f ai l ed to f u n c ti on p r o p er ly u n der
so m ewh at u n u su al c o n diti o n s Th ere has n ever be e n co m
. .

p le t e re c o very o f f u n c ti o n i n th e a rti c u lati o n T h i s i s evi .

“
de n c e d by p arti al lo s s o f fl e x i o n an d e x te n s i o n h e n c e th e ,

”
l e si o n i s alw ay s app are n t to th e tr ai n ed s e n s e o f t o u c h .

Thi s l e s i o n p re s e n t s th e s am e c h ar ac te ri s ti c s so co mm o n ly
n o ted i n p eriph er al j o i n t s whi c h h ave b ee n s p r ai n ed an d r e

c o v e r e d f r o m with p arti al lo s s Of m o t i o n I t i s u su ally m any

.

m o nth s b ef o re th e p o i n t o f att ac hme n t o f a s tr ai n e d lig a

m e n t i s fre e fr o m s e n s itive n e ss to pre ss u re o r te n si o n .

W e i ght Car r y i n g an d Balan c i n g F u ncti o n Di s t u r b e d .

W i th an i n j u ry o f thi s ch ar ac ter lo c ate d wh ere it has a

‘

w e i g ht,c ar r y i n g an d b alan c i n g f u n c ti o n to pe rf o r m f o rmi n g ,

p art o f th e p r o te ctive c o veri ng o f th e S pi n al c o r d an d i ts .

m embr an e s as we ll as b ei n g a p art Of th e w all o f a vi sc er al

,

cavi t y the re ar e m any far re ach i n g i n fl u e nc e s wh i ch may b e

,
-
 48 PR I N C I PL E S OF O ST E O PAT H Y

ttrib u ted to it The rigi dity wh i ch nat u re m ani fe sts fi r st

'

a .

as a p r o te c tive re ac ti o n 1 e ,
to p reve n t m o ti o n i n th e i n
. .
,

j u red p art wi ll b e m ai nt ai n ed as a co ns t ant f act o r in any

,

c as e o f j o i n t i n j u ry wh i c h h e als with a p arti al ret u r n o f m o

ti o n By thi s i s m e an t th at b ef o re the m o ti o n o f the j o i n t

.

re ach e s i ts li mit th e m u s c l e s ass u m e th e f u n c ti o n o f lig a

m e nt s s o as to p r o te c t th e we ake n ed l ig am e nt s Thi s ac
, .

ti o n Of th e m u sc le s we no te as a p r o te c tive rigidity whi ch

u n de r t he i n fl u e n c e o f p ass ive m o ti o n m ay b e ab s e n t bu t r e
app e ar s wh e n th e j o i n t i s p u t th r o u gh i t s v o l u n t ary f u n c

tio nal te s t s Th u s th e f act th at the l e si o n u n der di scu ssi o n

.

i nv o lve s str u c t u re s fo rm in g a part of th e we ight carryi ng

an d b alan c i n g m e c h an i s m o f th e bo dy m ake s it m o r e di fli

c u lt o f re co very In o rde r to p r o t e ct it fr o m m o ve m e n t
.

rigi dity e x i s t s i n s egm e n t s j u s t ab o ve an d be lo w it A l e s i o n .

at th e p o i n t m e n ti o n e d wi ll te n d to p r o d u c e a s tr aight s pi n al
’

co l u m n b e ca u s e it i s S it u ate d at t h e j u n c t i o n o f tw o c u rve s ,

th e d o r s al p o steri o r an d th e l u mb ar an teri o r Any e x ag g e r a .

ti o n o f th e s e c u rve s n e c e s sit at e s gre ate r mo vem e n t i n thi s

j o i n t Th eref o re i f thi s j o i n t b e i nj u re d an d i ts m o ve m e nt
.
,
'

limite d th ere i s gre ate r rigidity i n b o th c u rve s i n o r de r to

p r o te c t th e i njiIr e d j o i n t th r ou gh wh i c h th ei r co mp e n sati n g
m o vem e n t s Op er ate The te n si o n Of the p o s te ri o r spi nal
.

m u sc le s i s m et by c ou n te r b alan c i n g co n tr acti o n o f th e p s o as
-

m agn u s th e di aph r agm an d th e ab d o m i nal m u sc l es The

,
.

t en s i o n o f th e di aph r agm re su lt s in le ss e n e d re spir ati on The .

te ns i o n Of th e abd o m i n al m u scl e s s u btr act s o n e f act o r i n th e

m ai n t e n an c e o f b ow e l ac ti o n L e ss e ned o x yge nati o n an d
'

e limi n ati o n ar e th u s p o s sib l e re sult s o n a p u rely m e ch an i cal

b as i s To co mpe ns ate fo r the s e de c re as e s th e wh o l e b o dy
.

m et ab o l iz e s at a slo we r r ate an d with o u t th e sy mp ath eti c ,

n erv o u s sy s tem i s vig o r ou s th e de c re as e i n vi s c e r al act

, i y i ty
s o o n m ake s it s e lf s o app are n t th at th e p atie n t m ay b e C on

s i de r e d c o n s tit u ti o n ally i ll Th u s it app e ar s th at a spi n al

.

l e s i o n m ay i n fl u e n c e b o dy m et ab o li s m adver s e ly as a re su lt
o f th e n at u r al h e ali n g re ac ti o n as m an ife s te d i n rigidity The .

'

de c re as e o f rhythmi c al m ov em e nt i n th e w alls o f th e abd o

 PR I N C I PL E S O F O S TE O PA TH Y 49

men th o r ax i s th e i mm edi ate c o n s eq u e n c e o f spi n al rig

an d

i di ty . Th e s e f u n c ti o n s ar e l e ss i n terfere d with wh e n th e
weight c arry i n g f u n cti o n o f th e s pi n e i s l e as t call ed u p o n ,

h e n c e th e h o riz o n t al p o s iti o n i s n at u r ally ass u m e d to le ss e n

p a i n a n d get rid o f th e d em a n d f o r c o mp e n s at o ry te n si o n s
-
.

L ack o f P hy s i o l o gi c al R e st—W h i le th es e i n ju rie s ar e

ac u te we n o te e as i ly th e c o mp e n s at o ry re acti o n s j u st de

sc rib ed b u t n o d o u bt th e m aj o rity o f s u ch case s fee l the

,
.

r e ss o f e c o n om i c n e c e ss ity an d h e n c e try to ad apt th em

p
’

s e lve s to la b o r th r o u gh h o u r s m o re th an s u ffi ci e n t to pr o
d u c e a f atig u e aki n to s i ck n e s s The l e s i o n d eve lo p s a chr o
.

n i cit o r r ath er has n ever had a c h an c e t o h e al u n d er th e

y ,
'

be n ig n i n fl u e n c e o f phy s i o lo g i c al re st Thi s ch r o n i c le s i o n .

n e c e ss it ate s p erm an e n t c o mp e n s at o ry ch an ge s su c h a s we

h ave n o ted Thi s p atie n t de ve lo p s p eri o di cal dige stive we ak

n e s s sy n c hr o n o u s with hi s ti m
.

,
e s o f f ati g u e H e vi s it s a do c . .
v

to r an d fr o m th e n o n s u ff e r s m an y thi n g s o f m an y phy s i
”
c i an s . Th r o u gh tim e an d th e c o mp e n s at o ry c h an ge s i n
’
thi s p ati e n t s b o dy the o ri gi n al l e si o n an d i ts s ig n ifi can c e ar e
lo s t to vi ew The e ff o rt m
. ade to c o rre c t o r p all i ate th e di

g e s ti v e d i s t u rb an c e pr o b ab ly has n o refere n c e to an ythi n g

bu t th e p r o m i n e n t sympt o m s I t i s s u ch cas e s as the s e

.
,

s u ff e ri n g fr o m c hr o n i c i lln e s s wh o s e h i st o ry o f tr au m ati c
,

l e s i o n i s di s c o vere d by th e o s te o p athi c e x ami n ati o n whi ch ,

h av e give n p re s tige to o s te o p athi c th er ape u t i c s The tre at .

m e n t give n by th e o s te o p ath to th i s o ld l e s i o n ree stab li sh e s

m o vem e nt i n th e j o i n t an d th eref o re th e c o mp e ns at o ry te n
, ,
'

si o n s i n th e b ac k ab d o m e n an d ch e s t ar e l e s s e n ed
.

,
.

I n fl u e n ce o n C i r cu lati o n an d I nn e rv ati on — H avi n g th u s

f o llo wed th e m e ch an i c al i n fl u e n c e o f thi s tr au m ati c l e si o n
thr o u gh so m e o f its c o mpe n sati on s we can with pr o fit t u r n
o u r atte n ti o n to th e far m o re s u bt l e i n fl u e n c e s u p o n c i r c u l a

t i o n an d i nn e rv ati o n The tr au m a u n de r co n s id er ati o n has

.

b e e n suffi c i e n t in s o me d egre e to r u ptu r e ti s s u e c o nti n u ity

, ,

an d th eref o re r eq u i re s i n c re as e o f c i r c u lati o n fo r rep ai r .

The swe lli n g o ccas i o n e d by the c o n g e s ti o n o f th e c ir c u la

,

ti On bei n g u n der th e s p i n al appo n e u r o si s d o e s n o t evid e n c e

, ,
50 PR I N C I PL E S OF O ST E O PAT H Y

i ts p re se nc e by a lo caliz ed t u m ef acti o n S o m e fiber s o f an .

i n tri n si c s pi nal m u sc l e i e o n e o f th e fifth l ayer acco rdi n g

, . .
, ,

to G r ay s gr o u pi n g has be e n i nj u re d h e n c e o u r rep ai r i n
’

, ,

fl amm ati o n i s de ep s e ate d The de epe r s e ated th e l e s i o n

.
,
'

th e m o re p re s su re wi ll b e e x erte d o n the br an ch e s o f n erve

t r u n k s em e rgi n g fr o m th e i nt ervertebr al c anal an d th e m o re
l ikelih o o d wi ll th ere b e th at the p ati e n t wi ll co mp lai n o f
s o m e sympt o m s o f a c h ar ac ter w hi c h m i ht b e i n terp rete d
'

g
as o f c e n tr al o rigi n e s p e c i ally if bi later al
, The s u bj e c tive .

sympt o m s p ai n an d p ar ae sth e si a i n th e are a o f c u t an e o u s

, ,

di s trib u ti o n o f th e twe lf th d o r sal n erve ar e u su ally u n i lat

er al h e n c e sh o wi n g th at th e les iOn cau s e s a p e riph er al n e u
,

riti s o r at l e a st a p re ssu re o n th e n erve s u ffi c ie n t to cau se

, ,

th e b r ai n to regi ste r as th o u gh th e p e riph er al di s trib u ti o n

o f thi s n e rve w as i rrit ate d .

S e g m e n t al C o or d i n ati o n — A s egm e n t o f the s p1nal c o rd

.

c o o rdi n at e s th e i mp u ls e s re ac h i n g it o ve r i t s aff ere n t fibe r s ,

h e n c e in th e c as e o f o u r l e si o n th e b o mb ardm e n t o f th i s
, ,

s egm e n t with imp u l s e s fr o m th e i n j u red ti ss u e as we l l as

fr o m th e n e r ve s s u bj e c ted to p re ssu re as a re s u lt o f th e r e
p ai r i n fl amm ati o n wil l c au se e ff er e n t i mp u l se s to b e s e n t to
,

s o m ati c an d s p lan ch n i c are as s u ppl i e d fr o m thi s s egm e n t

'

Th e s e o u tg o i n g i mp u l s e s ar e i n fl ue nc i n g m o ti o n se c reti o n , ,

n u triti o n whi ch ar e pr o b ab ly di s t u rb ed i f th e s e n s o ry n e r ve
-

i mp u ls e whi ch c alls f o rth th e re ac ti on IS a di st u rbed o n e .

I t i s h ard ly pr o b ab l e th at re ac ti o n s o f th e ki n d h ere m e n
ti o n e d te n d to rem ai n ac tive withi n o n e spi n al s egm e n t .

The n e rve c e n ter s i n v o lve d ar e v erti c al i e e xte n d th r o u gh , .

o n e o r m o re s egm e n t s an d h e n c e o ur re ac ti o n s te n d to
S pre ad . A s s o o n as V i s c er al ac tivity i s di s t u rbe d by v as
o mot e r c h an ge s a tr ai n o f refl e x e s o f a c o mp e n s at o ry ch ar

ac ter ar e i n iti ated an d wit ho u t we h o l d firmly i n m i n d th e

ch ar ac te r an d l o c ati o n o f th e l e s i o n an d r e aliz e t he p r o b able ,

as w el l as p o ss ibl e co mp e n s at o ry re ac ti o ns o f a m e ch an i cal
, ,

c i r c u l at o ry an d ne rv o u s c h ar ac ter d ep e n de n t u p o n it we ar e ,

q u ite apt to b e l e d astr ay by th e b o ld n e ss with wh i c h so m e

o b sc ure ly rel ated sympt o
m c r o wd s i ts w ay i n t o th e f o re
 P R I N C I PL E S OF O ST E O P A T H Y 51

gr o u n d o f o u r atte n ti o n The p e r s i s te n c e with whi ch m any

.

o f th e o l d er o s te o p ath s h ave w o rked u p o n th e l e s i o n an d r e

f u se d to b e l e d aw ay i n fr u it l e s s e ff o rt s to p alli ate sy m p
,

t o m s has co n trib u ted m u c h to th e su c c e ss o f th ei r s ch o o l

, .

E x am pl e o f F ati gu e A n o th er p h as e o f th e le s i o n as a
.
-

te n ab l e c au se o f di s e as e i s f o u n d i n th o s e c as e s wh o s e s tr u c
t u re s u ff e r s o n acc o u n t o f f atig u e o r eff ort to b e co m e
ad apte d to p o s iti o n W e wi ll t ake tw o le s i o n s c o m m o n ly
.

ass oc i ate d i e m u s c u lar te n s i o n with a v ari ab l e am o u n t o f

,
. .
,

di st o rti o n o ver th e splan chn i c a r e a an d m u s c u lar te n si o n ,

ce n tere d o ver o n e o r all o f th e u pp er three c ervi cal vert a

b r ae A b o o kkeep e r f atig u e s his b ac k m u scl e s by hi s po s i
.

ti o n The e ff o rt to s e e cl e ar ly e s p e c i ally if th ere i s any i n

.
,

tr i n si c defe c t o f v i s i o n o r o f th e c o o rdi n ati n g p o wer o f th e

o c c u lar m u s c l e s re q u ire s c o mp e n s at o ry ac ti o n o f th e c ervi c al

m u s cl e s to m ai n t ai n th e h e ad i n the m o s t f av o r ab l e p o s iti o n
-

fo r s eei n g T he f atig u e re s u lti n g fr o m m an y h o u r s o f thi s

.

c o mp e n s at o ry e ff o rt s u pp l em e n ted by o the r eve n t s o f d ai l y

,

l ife p r o d u c e s a s o—
“ ”
,
c all e d b o n y l e s i o n u s u ally ab o u t the ,

s e c o n d o r third c ervi c al o r eve n a s l o w as th e f o u rth d o r sal .

By c arryi n g th e weight o f th e h e ad f o rw ard o f the c e n ter o f

~

th e b o dy th e str ai n o n th e e x te n s o r c ervi c al m u sc l e s i s e as ed
so m e wh at by r o u n d i n g t he s h o u l der s d ep re s s i ng th e th o r ax
, ,

s h o rte n i n g th e di s t an c e b etwe e n th e e n d o f th e s ter n u m ,

c o s t al ar ch e s an d t h e p e lvi c brim th u s r e lax i n g the abd o m

'

i n al m u s c l e s an d p e rm itti n g gas tr o an d e n ter o pt o s i s Thi s

.
.

saggi n g o f th e s t o m ac h an d b o we l m u s t b e ch e c ked if po s

si b l e h e n ce th e e x te n so r m u s cl e s o ver th e s p lan ch n i c are a

‘

c o n tr ac t to m ai n t ai n th e n o rm al ere c t attit u de b u t f ai l eve n ,

tu ally be cau s e th e b o dy i s n o t p l ann ed to su s t ai n th e weight

o f th e h e ad i n a p o s iti o n co n s t an t ly o ff th e c e n ter o f th e

b o dy Thi s i llu s tr at e s th e grad u al deve lo pm e n t o f le si o ns

.

du e to e ff o rt s o f ad apt ati o n
—
.

Lo s s o f M u cu a
s l r T o n e L o ss o f t o n e i n m u scl e s wi ll
.

allo w th o s e ti ss u e s to wh i ch th ey ar e att ach e d to yi e l d to “

th e f o r c e o f gr avity an d h e n c e l e s i o n s wi ll be pr o d u ce d A s
, ,
.

e x amp l e o n e o f my s u rgi cal cas e s c o mp lai n ed bitter ly o n

, ,
52 PR I N C I PL E S O F O S TE O PA TH Y

th e th i rd day afte r a hy ste re ct o my O f p ai n i n th e b ac k an d

at th e l o we r e n d o f th e abd o m i n al w o u n d I n sp e cti o n o f th e .

w o u n d sh o wed no thi n g u n u su al The c o u r s e o f th e p ai n .

w as e x ami n ed an d it w as f o u n d to f o ll o w th e co u r s e o f th e
twel fth d o r sal n er ve The fe eb le n e s s o f th e p at
. i e n t allo wed
all her ti ss u e s to s ag with th e re s u l t th at th e right twe lfth
,

rib lay ag ai n st th e tr ans ver s e p r o c e ss o f th e fir st l u mb ar v e r

te br ae A p re s su re th u s e x erted o n th e twe lfth d o r sal n erve
p r o d u ce d p ai n i n th e are a o f i ts di strib u t io n A small pad
.

o f g auze an d co tt o n s u ffi c ie n t to keep th e rib aw ay fr o m th e

,

tr ans ve r s e p r o c e ss fo r a few d ay s u n ti l ge n er al b o dy n u tri

ti o n re as s erte d i ts t o n i c e ff e ct w as s u ffi c i e n t fo r rel ief , .

As h e ret o fo re s t ate d it i sn t th e ac u te l e si o n s o e as ily

’

, ,

re co g n ized th at has c on trib u ted s o m u ch pr e stig e to O ste

,
/

hy I t i s th e le s i o n h avi n g b e e n o ver lo o ke d o r m i s
'

o pat . x

t r e ated an d co ns ide re d a n eg ligib le q u an t ity as a c au sative

fact o r .

E x pe r i m e ntal L e si o n s —As a f o u n d ati o n fo r better c li n

.

i c al o b s erv ati o n an d u n der st an di n g e x p erim e n t s h ave b e e n ,

c o n d u c ted n ot ably by D r L o u i sa Bu r n s i n t
,
he P hy s i o lo g i
.
,
~

c al L ab o r at o ry o f th e P ac ifi c C o ll ege o f O s te o p athy Lo s ,

An ge l e s an d by D r C ar l M M c Co nn e ll o f C hi cag o Th e s e
,
. . .

e x p eri m e n t s c o n s i sted i n p r o d u c i ng artifi ci al l e s i o n s o n s m all

an i m al s u s u ally d o g s an d n o ti n g th e im m edi ate an d rem o te
, ,

e ff ect s th e n ki lli n g th e an i m als an d m aki n g a caref u l p ath

,

o l o gi c al s t u dy o f th e c h an ge s in th e l e s i o n ed ti s s u e s Dr . .

M c Co nn e ll s de sc ripti o n o f th e m ann e r i nwh i c h h e p ro d u c e d

’

“
e x p erim e n t al l e si o ns i s as f o l lo w s : The p r o d u cti o n o f th e
”

l e si o n is a si mpl e bu t stil l very imp o rt an t m atter I t can .

n o t be p e rf o rm e d su c c e s s f u l ly i n a h aph az ard m an n e r S tri c t .

atte n ti o n to th e th o r ou gh re lax ati o n o f ti s s u e s ab o u t th e

fie l d o f Op e r ati o n an d defi n ite app li c ati o n o f m e ch an i cal pr 1n

c ipl e s ar e dem an de d A fte r s el e cti n g a h e althy an im al ( a
.

s m al l o r m ed i u m s ize d o g i s b e s t ) s u rgi c al an e s th e s i a i s ,

i n stit u ted Co mpl ete re lax ati o n u n d er an asthe si a i s n e c e s

.

s ary . F o llo wi n g th i s f u rth er re lax ati o n o f th e are a o f i n

,

te n d ed o p er ati o n by tr ac ti o n is e s s e nti al fo r e a se o f l e si o n
54 PR I N C I PL E S OF O ST E O P A T H Y

te n de r ; o th er s do no t and sh o rtly sh o w n o app are n t i ll e f ~

fe c ts . L ate r o n a n u mb e r p re se nt m o re o r l e s s sy stemi c dis

,

tu r banc e s d ep e n di n g u p o n th e l o c ality o f th e l e s i o n
,
The .

p eri o d s o f o b serv ati o n h ave ranged fr o m thre e to eighty

d ay s th at is th e t
, ,
im e fr o m p r o d u cti o n o f th e l e si o n to
”
au t o p s y .

L s o
o s f M o ti o n — The m o ve ab le vertebr al an d co st o
. .

vertebr al arti c u lati o ns ar e ar tho dial i e g lidi n g h e n c e any

, . .
, ,

c h an ge i no n e o f th e s e arti c u lati o n s s h o rt o f di s l o c at i o n IS
, ,

i n a n o rm al di re c ti o n In o th e r w o rd s th e l e s i o ns w hi ch
.
,

w e re c o g nize ar e p arti al fi x ati o n s h e n c e it i s n t th e p o siti o n

,
’

whi c h c o n stit u te s th e les i o n so m uc h as i t i s th e lo ss Of m o '

ti o n i e th e lo s s o f f u n cti o n an d th e e x aggerated m u scu

, . .
,
.

lar c o n tr ac t i o n whi ch ma1n ta1n s th e fi x ati o n an d th e ch ar ac ‘

te r o f th e i nj u ry wh i ch i s the c au s e o f th e s e ch an ge s .

Ne c e s s i ty fo r S t u dy Of S t u c t u e
r r — B as e d o n th i s i de a
of wh at th e l e s 1o n 1 8 we m u st s t u dy th e no rm al st ru c t u re
,

an d f u n c t i o n o f eve ry verteb ral an d c o s t o verteb r al arti c u la

-

ti o n s o th at we m ay re c o gn ize n o t o n ly the co mp e n sat o r y

,

c h an ge s o n t he im m e di ate gr o u p aff e cte d bu t als o tho s e ,

-

wi de sp re ad c o m pe n s ati o n s o f a me ch an i cal C i r c ul at o ry an d ,
.

n erv o u s c h ar ac te r wh i c h a r e part o f every re par ative and

ad aptive e ffo rt o f th e b o dy S i n c e p ath o l o gy i s th e st u dy

' '

o f th e p erve r s i o n s o f th e n orm al we c an n o t u nd er s t an d
'

wh at th e b o dy IS tryi n g to do i n any give n cas e with ou t

t aki n g i n t o acc o u n t th e s u cc e s s e s an d f ai lu re s o f c o mp e ns a -

ti o n as ar e m ad e evide n t by thi s div 15 1o n o f m edi cal sc i e n c e .

 PR I N C I PL E S OF O ST E O P A T H Y 55

C H A P TE R I I I .

TH E LE S IO N A S A N E F F E C T .

An aly s is of the C au se s L
of e si o n s .
—As p revi o us ly
n o te d th e i n s p e c ti o n o f th e vertebr al an d p ar avertebr al ti s
,

s u e s i n al m o st all c as e s o f i lln e s s i n v o lvi n g th e tr u n k o f th e

b o dy wi ll sh o w p hys i c al s ign s Of c o mp e n s at or y re acti o n s .

The s e phy s i c al signs we call le si o n s “ ”

.Th ey s e em to b e
i de n ti c al i n c h a r acter with th o s e wh i c h we n o te d as tr au
mati c l es i o n s i e th ere i s d evi at i o n i n o ss e o u s alig n m e n t
,
. .
, ,

m u sc u lar c o n t r ac ti o n an d hyp er aes th e s i a I t m ay b e i m pos

.

s ib l e t o s e c u re fr o m th e p ati e n t any h i s t o ry o f tr au m a as the

fo u n d ati o n o f thi s l e s i on th er ef o r e tw o e x p lanati o ns ar e

,

o p e n to u s ; eith e r we m u s t wi l f u l ly h o l d t o the hyp o th e s i s

th at a t r au m a di d o c c u r o f s o light im m ed i ate e ff e c t as to
e scap e th e n o ti c e o f the p ati e nt o r u s e th e fact so f anat o my
,

an d phy s i o lo gy to b u i l d u p a r ati o n al th e o ry o f n o rm al r e ac

ti o n s I t i s m u ch e as i e r to de c lare tr au m a as th e cau s e th an
.

an alyze th e pr o te c tive re ac ti o n s o f th e b o dy Thi s f ac t has

.

le d the e x p o n e n t s o f the v ari o u s f o rm s o f spi nal a dj u s tm e n t

to e x plai n e v e r
y l e s io n by c lai mi n g an o b sc u re t r au m a as th e
i

c au s e . S i n c e n o o n e eve r g o e s th r o u gh l ife with o u t m an y

s l ip s f al ls an d o th e r str ai n s whi c h c an b e c all e d t
, o mi n d it ,

i s e asy fo r th e p atie n t to b e c o n vi n c e d th at so m e rem o te e x

p e r i e n c e o f thi s ki n d i s i n fa c t th e f o u n d ati o n f o r all th e

tr o u b le .

The At tr acti v e n e s s O f the Tr aum ati c L e si o n The or y .

The th e o ry th at an o b sc u r e t rau m a i n; th e s p i nal ti ss u e s is

:

th e e ss e nti a l an d ade q u ate c au s e o f b o di ly di so rder s i s cap

ti vatin g b o th to th e phy s i c i an an d the p ati e n t It has so
.

_m y a n defi n ite e l em e n t s whi ch ar e evi de n t b o th t o th e m i n d

56 PR I N C I PL E S O F O ST E O PAT H Y

of th e phy si c i an an d o f th e p atie nt The phy s i ci an s palpat .

’

i ng fi n ge r fe el s th e ch an ge i n o s se o u s alig n m e n t an d m u sc u
lar t o n e The p ati e nt re c o g ni ze s th e di ff ere nc e in se ns itive
.

n e ss betwe e n th i s l e s i o n are a an d th o s e o u t s i de th e l e s i o n

i n fl u e n c e S p e c ifi c m
. anip u lati o n h avi n g fo r i ts ai m th e co r

re cti o n o f alig n m e n t in th e le si o n ed are a give s so fre q u e ntly

al m o st i ns t an t s e n s e o f reli ef th at it i s n o w o n der phy si Ci ai i

an d p ati e n t be c o m e co n vi n c e d th at th e hyp o th e si s o f tr au m a

i s co rre c t U n der th e i n fl u e n c e o f s u ch a th e o ry as t hi s o ur
’

o s te o p ath i c liter at u re i s well s pi c ed W ith st atem e nt s te n di n g

to b e l ittl e th e i n fl u e n c e o f all o the r c au s e s o f d i s e ase The .

write r wi sh e s to emph as i ze th e fact th at l e s i o ns c an be di

v i de d i n t o tw o gre at c l ass e s i e p rim ary a,
n d se co n
. d ary.
,
.

The fir st c l a s s i s m ade u p o f th o s e o f trau ma t i c o r i g i n an d

ar e u n d o u bte dly c au s e s o f di s o rd er i n th e i r are as o f i n fl u

'

The s e c o n d c lass i s m ade u p o f th o s e le si o ns wh i c h

‘

e n ce s .

ar e phy s i c al s ig n Of th e b o dy s e ffort s at ad apt ati o n an d

’

c o mp e n s ati o n .

Classifi cati o n o f Le si o ns A give n 1e 5 1o n c an b e

.

c l ass ed as p rim a ry o r s e c o n d ary o n ly a fte r c aref u l s t u dy Of

all th o s e f ac t or s w hi c h con s tit u te th e h i s t o r y an d sympt o m
‘

ot ol o gy o f th e case V i sc e r al l e s i o ns cau s e m u scu lar co n

.

tr acti on s i n th e spi nal are a f r o m whi ch th ey re c e i ve th eir

c e reb r o s p i n a
-
l n erve co mm u n i cati o n s Th ey also cau s e p ai n .

i n are as o f high er s e n s ibi lity c u t an e o u s are as with wh i c h

, ,

th ey ar e as so c i ate d by i nn e rv ati o n fr o m the sam e s egm e n t

o f th e s pi n al c o rd Th e s e referre d p ai n s an d c o n tr a
. c ti o n s o f

S pi n al m u scl e s ar e begi nn i n g t o b e re co g n ize d by sp e c i al i st s

-

i n p u lm o n ary dige s tive an d re n al di se as e s Th ere has b ee n

,
.

nO w e ll o rd ered e ff o rt to c o o rdi n ate th e fac t s wh i ch li e a t t

'

he
fo u ndati o n o f th e s e ph e no m e na I t i s h o p e d th at w e ay . m
m ak e fo r o u r stu de nts a begi nn i n g i n thi s w o rk by wh at
'

i s to f o l l o w
—
.

E x am pl e s o f S e c o n dar y L s i e o n s P AS e x ampl e s o f var

i o u s se co n dar y le Sio nS w
‘

e wi l l c all atte n ti o n t o th e l e s i o n

ph e no me na f o und u sually to be sy n ch r o no us with e nvo lv

ment s o f so m e o f th e organs o f th e b o dy R ath er th an rush '

.
 P R I N C I P L E S O F O ST E O PATH Y

i n t o an analys i s o f le s i o n s we deem it m o re to th e s t u de nt S
,

i n tere s t to h av e a c l e ar p i c t u re o f the ph e n o m e n a we de sire

to a naly z e later o n . O u r pr ac titi o n e r s w ho ar e dev o ti n g
m uch tim e i n tre ati n g th e eye re co g n i ze th at i n di s e ase s o f
the eye an d orbit al ti ss u e s th ere ar e p o i nts i n th e n e c k whi ch
ar e r are ly free fr o m te n der n e ss A l o n g with the te n de r n e s s
.

are f o u n d m u sc u l ar c o n tr ac ti o n an d m alal ig n m e n t the se ,

c o mp l eti n g o u r tri n ity o f l o c al ize d l e s i o n ph e n o m e n a S u ch .

le s i o n s m ay be l oc ated as lo w as th e s e co n d d o r sal .

The S pi na l L e s i o n a n O b j e c ti v e S y m pto m — D i s t u r b .

an c e o f c i r c u lati o n i n the t o n s i l i s ass o c i at ed with s p i nal 1e

’

S i o ns .Thes e l e s i o n s v ary i n nu mb er an d e x te nt acc o r di ng

.

to wh eth er th e di s e as e p r o c e ss i s S imp l e an d de c idedly l o cal ,

o r i s o f e n o u gh s ev erity to p r o d u c e co n s tit u ti o n al symp t o m s

su c h a s c hi ll fever , e tc
,
The s pi n al l e s i o n s m u ltip ly an d i n
.

te ns ify i n pr o p o rti o n to th e e x te n t an d S everity o f th e di s

,

tu r ban ce o f th e b o dy Thi s i s th e c as e no m att e r i n what

.

o rgan o r ti s s u e o u r o rigi n al di s t u rb an c e m ad e i t s appe ar

an c e . J u s t as th e Sympt o m co mp l e x v arie s acc o rdi n g to th e

s eve r i ty o f adi s e as e S O th e s p i n al l e s i o n s p r o p o r ti o n t he m
,

s e lve s i n l i k e m an n e r Th eref o re i n thi s s e n s e sp i n al le s i o n s

_ e
, ,

ar e p hy s i c al S ig n s : o bj e c tive an d s u bj e c t ive evi de n c e O f di s

tu r banc e i n ti ss u e s i n n erv ated by br an c he s Of n erve s f ro m
t he s am e s egm e n t o f th e S p i n al co rd .

V i sce r al R e fl e x e s —E ach vi scu s o r lo cal ize d ti ssu e , ,

s uc h as g lan d s ,
m u c o u s o r s er o us m embr an e s te n d to e s ,

t abli sh refl e x l e s i o n s i n th e S p i n al are a ti ss u e s whi ch ar e

s u pp l i ed with n erve s fr o m th e s ame S p i n al c o rd s egm e n t as

th ey th em se lve s ar e s u pp lie d In p r o p o r ti o n to th e am o u n t
.

o f c o mp e n sat o ry as s i s t an c e r eq u ired by an y o rgan o r ti s su e

fr o m th o s e p art s o f th e b o dy o rd i narily c alled u p o n fo r su ch

as s i st an c e, o u r S p i n al l e s i o n i n c r e as e s i n e x te n t an d i mte n

s it y. A S a c o mm o n e x amp l e o f th e f or eg o i n g th e st o m ach ,

m ay fail to do i ts w o rk th o r o u gh ly an d th u s thr o w added

w o rk o n th e s m all i n te sti n e an d i ts rel ated g lan d s l ive r an d ,

p anc r e as I f th e s e ar e s o mewh at o vert ax ed by th ei r c o m .

p e n sa to r y e ff o rt s ,
o u r S p i n al l e s i o n wh i c h repre s e n ted th e
58 P R I N C I PL E S O F O S TE O PA TH Y

t m ach e x te n d s f u rth e r d o w n o ve r th e S pi n al are as fr o m

s o ,

w hi ch th e live r an d p an c re as re c e i ve a p o rti o n o f th eir i n

n e rv ati o n . S u ch e x amp l e s as thi s can b e re co g n ize d i n a
m aj o rity o f cas e s .

P l e u ri sy — D i seas e p r o c e s se s i n th e l u n gs pr o d u c e
. .

S p i n al l e s i o n s o f v ari o u s ki n d s acc o rdi n g t o their i n te n s ity

,

an d d e str u c tive n e ss P le u ri sy pr o d u c e s so gre at c o n tr ac

.

ti o n i n re s pi r at o ry m u s c l e s whi c h ac t p arti c u lar ly o n th e

,

rib s lyi n g o ver th e i n fl am e d are a th at fri cti o n o f th e pl e u r al

,

s u rf ac e s at thi s p o i n t i s re d u c ed to a mi n i m u m hy s i ci an s
P .
,

t aki n g th ei r pl an fr o m thi s n at u r al co mp e n sat or y c o ntr ac

ti o n freq u e n t ly rei n f o r c e n at u r al effo rt s by str appi n g o v er
,
'

th e co n tr acted ar e a w ith adh e s ive The th o r ax ad apt s its e lf

.

to th e s t ate o f i ts c o n te n t s h e n c e wh e n a p o r ti o n o f th e l u n g
,

i s d e s tr o ye d th e an te r o p o s ter i o r di am ete r o f th e ch e st i s le S
-

s e n ed i n p r o p o rti o n The verteb r al an d co s to vertebr al ar

.
- -

ti c u lati o n s e n te r i nt o thi s ad aptive p r o c e ss an d h e nc e e x

hi bi t d e c ide d l e s i o n ph e n o m e na .

C ar di ac L e si o n P at te r n s — In c as e O f h e art l e s i o n s th e
b o dy is c alle d u p o n to m ake e x t ens ive co mp e nsat o ry r e ac
ti o n s an d h e n c e o u r spi n al le s i o n ph e no m e na m ay b e lim ited
to th e are a o f th e h e art s i nn erv ati o n o r e x t
’
e n d i n p ro p o r ,

ti o n as th e h e art s c on d iti o n i n v olve s th e p u lm o nary ci r cu

’

lati o n th e p o rt al c i r c u lati o n o r the ki d n ey

, .

U n ity o f the Bo dy .
—
D i se ase p r o c e ss e s i n th e p elvi c
vi s

c er a p r o d u c e th ei r ch ar ac teri s ti c spi n al l e s i o n ph e n o m e na

j u s t as th e th o r ac i c an d abd o m i n al o rgan s The p o i nt we .

de si re to em ph as iz e i s th at th e u n ity o f the b o dy is e x empl i

fi e d by th e S pi n al l e si o n ph e n o m e na NO o rg an o r ti ssu e
.

c an o r d o e s s u ff e r i n j u ry with o u t o th e r ti ss u e s bei n g d r afte d

to c o mp e n s ate fo r i ts co n diti o n S O as to m ai nt ai n n o t o n ly
e x i ste n c e bu t th e m o st sati sfact o ry l ife o f whi c h th e o rgan
i s m i s cap ab le I f th e S p i n al le si o n i s vi ewe d no t o n ly as a
,
.

p o ssib le c au s e bu t al so as a q u ite p r o babl e e ff e ct o f ti ssu e

, ,

di st u rb an c e e l sewh ere we wi ll appre ci ate m o re f u lly th e

,

m ann e r in wh i ch th e b o d y S trive s to l ive up to i ts be s t .

 PRI N C I PL E S O F O S TE O PA TH Y 59

C H A PTE R IV .

S PI NA L HYP E R A E S TH E S I A A ND MU S CUL AR
TE NS I O N .

O s te o p ath s th e fir st o r o n ly phy s i c i ans w ho

ar e no t

have : u s ed th e S pi n e as a m e an s o f di ag n o s i s as well as an
'

are au p o n whi c h to c o n c e n t rate th er ap e u ti c m et ho d s I t is .

i n tere sti n g an d i n st ru c tive to n o te th e s tep s i n th e d evel o p .

me n t o f th e k no w ledge o f spi n al co n dit i o n s an d o f the i n di ca

t i o ns Of rem o te f u nc ti o n al di st u rb an c e s whi ch ar e r egi s t e r ed
th ere .

S u bje cti v e S y m pt o m s — S u bj e ctive sympt o m s p r e c ede

an y attempt to di sco ver o bj e c tive evi de n c e s o f di s e ase It .

w as e ar ly n o te d by phy s i c i an s th at p ati e n t s co u l d n o t b e r e
l ied u p o n to n terpr e t th ei r o w n sympt o m s
g s
i Thi s l ed to e f .

f o rt s to di sc o ver sympt o m s wh i ch Were i n d ep e n de n t o f the

p a ti e n tS i
’
m p er fect p er c epti o n s P al p ati on w o u l d nat u r ally
.

be u sed at t he are as c o mpl ai n e d o f by the p ati e n t S i nce .

t he b rai n take s c o g n iz a n c e o f o n ly th e peri ph er al are as o f

di s trib u ti o n o f s e n so ry n erve s i n ste ad o f th e wh o l e co u r se

'
,

Of th e n er ve fib er s the phys i c i an might s ti ll be mi s led i n ap

,

p lyi n g p al p ati o n b e c au s e h e w o u l d b e largely g o ve r n ed by

,

th e pati e n t s s e n s o ry i mp re ssi o ns P alp ati o n m ade wit h ref

.
’
.

ere nc e to a r e al iz i n g s e ns e o f th e di strib u ti o n an d f u ncti o no f

the n e rv o u s s y s tem be c o m e s a m o re s ati s f ac t o ry m e an s o f
,

di ag no s i s A S th e k n o w le dge o f th e n erv o us sy ste m i n

.

w as call ed m o re an d m o re to the spi n al

c o lu m n o n a ,
cco u n t o f i ts re lati o n s to th e gre at n erv o u s m ass
with i n it P alp ati o n o f th e S pi n al co l u m n dem o nstr ated
.

the e x i s te n c e o f s e n s itive are as asso c i ated wit h vi sc er al o r

, .

o th er di so rde rs theref o re hyp er ae sth eti c are as ar e th e fi r st

,
60 PR I N C I PL E S O F O S TE O PA TH Y

di ag no sti c p o i nt s m e nti on ed i n m e di c al liter at u re i n r eg ard ,

to th e S pi n al l e si o n . S u c h hyp er ae sth eti c are as were co n

s ide r e d as evide n c e o f S pi n al i rrit ati o n ; th at i s i r r it ati o n o f
,

th e S pi n al co rd
I r r it ati o n o f the S pi n al Ne r v e s —The fi r st refere n c e
.

to s pi n al i r r it ati o n w hi c h I h ave f o u n d i s c o n t ai n e d i n a
“
m o n o gr aph e n tit led A Tre ati s e o n Ne u r algi c Di s e as e s
D ep e n de n t o n I rrit ati o n o f th e S p i n al M arr o w an d G an gl i a
Of th e S ymp ath eti c Nerve by Th o m as P r i dg in Te al e 18 3 4
, , .

H e q u o te s a l etter fr o m M r R P P l ayer to th e ed it o r o f
. . .

th e Q u arter ly J o u r n al o f S c ie n c e O n Irrit ati o n o f th e

S pi n al Nerve s ,
d ate d D e c e mb e r 10 18 2 1 as f o ll o w s :
, ,
I
t ake the lib erty to su bm it to y o u r n o ti c e a p ath o l o gi cal
f ac t wh i c h has n o t to th e b e st o f my k n o wl edge be e n
, ,

ge n er ally rem arked an d at te nti o n to whi ch S O far as my ,

o w n e x p e ri e n c e g o e s p r o m i s e s s o m e di mi nu ti o n o f th o s e
,

di ffi c u lti e s with whi c h th e h e ali n g ar t has to co nt en d .

M o s t m edi c al p r actiti o n er s w ho h ave atte n d ed to th e sub

j e c t
. o f .s pi n a l di s e as e m
,
u s t h a ve Ob s e rve d th at i t s sy m p
t o m s fre q u e n t ly re s emb l e v ari o u s an d dis s imil ar m aladi e s
an d th at c o m m o nly eve ry f u n c ti o n o f every o rg an i s i m
_

p aired wh o s e n erve s o rigi nate n e ar th e s e at o f the di so r de r .

The o cc u rre n c e o f p ai n i n di s t an t p art s fo r cibly att racted

my att en ti o n an d i n d u c ed fre q u e n t e xami nati o ns o f the
’
S pi n al co l u m n ; an d afte r so m e ye ar s atte n ti o n I co n s i de r e d
,

my s e lf e nab l e d to s t ate th at i n a gre at n u mbe r o f di s e ase s

m o rb id sympt o m s may be di s co vere d ab o u t th e o rigi n s o f th e
n e rve s wh i ch p r o c e ed to th e aff e c te d p art s o r o f th e S pi nal
,

br anch e s whi ch u n ite ; an d th at i f th e S pi n e b e e x ami n e d ,

m o re o r l e s s p ai n wil l co m m o n ly b e fel t by the p ati e nt o n

th e app l i cati o n o f p re ssu re ab o u t o r b etwee n th os e v e r te
br ae fr o m wh i ch su ch n erve s em erge .

S pi n al Tr e atm n t e — “
Thi s s p i nal aff e c ti o n may pe r ,

h ap s b e co n s i dered as th e co n se q u e nc e o f di s eas e s bu t O f
, ,

i ts e x i ste n c e at th eir co mm e n c em e n t an y o n e m a y s ati s fy

h i ms e lf ; an d thi s c ir c u m s t anc e c o mb i n ed with th e s u cc e s s
,

whi ch has atte n d ed th e empl o ym e n t o f t o pi cal appl i cati o n s

62 PR I N C I PL E S O F O S TE O PA TH Y

whe n we co ns i d er ho w v arie d ar e th e f u ncti o ns o f th e dif

fe r e n t n e rve s an d ho w d ive r sified th e ti s s u e s an d o rg an s to
'

whi ch th ey ar e di strib u ted .

“
To th e atte n ti ve o bs e r v e r o f di s e as e s n e u r algi c aff e c
'

ti o ns u n de r th e m o re e x te n ded s ig n i fi c ati o n m u st repe at

, ,

e dly p re se n t th em s elve s The S ki n fo r i n st an c e, m ay b e

.
,

th e s e at o f every degre e o f e x alted o r di m i n i sh ed s e ns i

bi l i ty fr om the s l ighte s t u n e as i n e s s to th e m o st ac u te su f
'

fe r i n g an d fr o m th e m o s t trivi al dimi n u ti o n o f s e n
'

s ibil ity
'

to th e c o m pl ete o b literati o n o f fee li n g — sympt o m s n o t de

p e n d e n t u po n di s e as e aff e c ti n g th e di ff ere n t ti s su e s o f th e '

p art b u t s o le ly r e fe r able to a mo r bi d c o n diti o n o f th e se n "

ti e n t n e rve s The v o l u n t ar y m u s c le s m ay i n like m an n er

.

i n di cate i n a v ari ety o f w ay s a m o rbi d c o n d iti o n o f th e .

n erv e s with wh i c h th ey ar e s u pp l i ed Th ey m ay b e aff e c te d .

with we ak n e s s sp asm s trem o r s o r a v ariety o f o th e r dis

, , ,

o rde re d s t ate s i n c lu de d with i n t he tw o e x tre me s O f c o n

v u ls i o n an d p ar aly s i s The i nv o lu n t ary m us c l e s m ay h ave
.
,

th e h ar mo ny o f th ei r ac ti o n s i n terr u pte d fr om a mo rbi d

c o n diti o n o f th eir n e rve s ; th e h e art m ay b e aff e c ted with
p alpit ati o n ; thef v e r m ic u lar m o ti o n o f th e st o m a ch o r th e

p eri st alti c ac ti o n of the in te s ti n e s m ay b e s u bj e ct to i rreg

‘

u lar i t y T
. h e s e n s ibi l ity Of th e i nter n a l o r g an s m ay like
wi s e be aff e c ted th e h e art th e s t o m ach th e i n te sti n e s
, , , ,

be i n g th e s e at o f p ai n refer ab le to th ei r n erve s an d i nde

, ,

pe n d e n t o f i nfl am m ati o n o r an y alte r ati o n o f str u c t u re

, .

The s ec reti on s m ay al so u n de rgo alter ati o ns b o th i n q u an ,

tity an d q u ality fr o m a p erverte d age n cy o f th e n erve s

,

u p o n whi c h they dep e n d S u c h i s a very imp erfe c t re c it al

.

o f th e v ari o u s m o rbi d aff e c ti o n s wh i ch m a be i n c l u ded

y .

u n d e r th e te rm Ne u r al gi a an d S O fre q u e n t i s th eir o c c u r
,

re nc e th at th ey m u st b e f am i li ar to eve ry pr actiti o n er Th ey .

ar e h o weve r o fte n p erpl e x i n g i n th ei r tre atm e nt an d n o t

, ,

u n fre q u e ntly e x h au s t th e p atie n c e o f th e affl i c ted s u ff ere r ,

an d als o o f th e m e di c al atte nd an t .

The d i ffi c u lty an d e mb arr as sm e n t wh i ch h ave atte n de d

“

th e di ag no s i s an d tre atm e nt o f th e se aff e c ti o n s I am i n ,

 PR I N C I PL E S O F O S TE O PA TH Y 63

c li n e d b e li eve has pri n c ip ally ari s e n fr o m mi st aken view s

to ,

of t hei r p ath o lo gy Th ey h ave too Ofte n b ee n reg arde d as

.

ac t u al di s e as e s o f th o s e n erv o u s fi lam e n t s wh i c h ar e the

‘

'

imm edi ate s e at o f the n e u r al gi a i n s te ad o f b ei n g c o n s i d

ered as sympt om ati c o f di s e as e i n th e larger n erv o u s m ass es
fr o m whi c h th o s e fi lam e n t s ar e d erived ; h e c e the tre at
n — "

me n t has too freq u e n t ly b ee n i n e ff e c t u ally applie d to the

s e at o f n e u r al gi a ; i n ste ad o f b ei n g dire cte d to th e m o re

rem ote an d l e ss o bv i o u s s e at o f di s e as e
'

“
I t i s n o w p retty ge n er ally admitted as a p ath o lo gi c al
ax i o m ,
th at di s e as e o f th e larger n erv o u s m ass e s as th e ,

br ai n an d S p i n al m arr o w i s n o t so m u ch evi n c e d by phe

,

n Om e n a i n th e im m edi ate s e at o f di s e as e as i n th o s e m o re
-

rem o te p art s to whi c h th e n erve s ari s i n g fr o m th e di s e as ed

_

p o rti o n ar e di s trib u ted In th e m o re s evere f o rm s o f di s

.

e as e th i s p ri n c ip l e i s re adi ly adm itted an d re c o gn ized

, .

Whe n fo r in stan c e o n e — h al f o f th e b o dy sh all h ave lo st i ts

‘

s e ns ibi lity an d th e c o r re s p o n di n g m u sc l e s th eir p o wer o f .

ac ti o n ,
th e S ki n an d th e m u sc le s ar e n o t regarded as the
s e at o f di s e as e bu t th e br ai n i s imm edi ate ly r e f e r r e d to
, . .

In th e s l i ghte st f o r ms o f di s e as e o f th e br ai n an d s p i n al
m arr o w s u ch as do n o t co mp lete ly o b literate bu t m ere ly
,

i mp air o r p ervert th e f u n c ti o n s o f th e n erve s— s u ch as do

n o t p ar alyze th e s e n ti e n t an d m u s c u lar p o wer s o f th e p art

bu t pr o d u c e we ak n e s s trem o r s s p asm s e tc i n th e m u s
, , , .
,

c u lar s y stem an d n u mb n e ss an d p ri c ki n g s p ai n s an d o ther

, ,

m o rbid fee li n gs i n th e n erve s o f s e n s ati o n thi s imp o rt an t ,

p ri n c ip l e whi c h as s tri c t ly o bt ai ns as i n th e fo rm er i n s t an c e
, ,

is t o o Ofte n e n tire l y o ver lo o ke d ; an d a n u m er o u s clas s o f

co mp lai n t s o f very freq u e n t o cc urre n c e ar e reg arde d as ,

n erv o u s o r s p as m o di c di s e as e s o f th e p art aff e c ted i n s te ad ,

-

o f bei n g c o n s id ered as ac t u al di s e as e s o f th at p o rti o n o f

th e b r ai n an d S p i nal m arr o w fr o m wh i ch the n erve s o f the

art ar e de rive d
p .

Vi sce r al D i st u r b an c e D u e to D i s t u r b e d N e rv e C o n t r o l .

The sam e p ath o lo gi c al p ri n c ip l e i s I be l i eve e q u ally , ,

app l i c ab l e to th e s ym path eti c sy s tem o f n e rve s ; alth o u gh

64 PR I N C I PL E S O F O S TE O PA TH Y

i t m ay be di ffi c u lt to e st abli sh thi s Opi n i o n by act u al e x

p e r i m e n t yet
,
I thi n k it m a y b e re s ted u p o n a well gr o u n d ed
an alo gy ,
wh i ch wil l j ustify u S i n reg ardi ng th e n erv o u s
m ass e s o f th e gan g li o n i c sy stem as be ari ng th e sa m e rel a
ti o n to th e n e rve s d erive d fr o m th em as th e large n e rv o u s
,

m ass e s o f th e c e rebr o s p i nal sy stem b e ar to th eir re s p e c tive

-

n erve s . H e nc e m an y n erv o u s aff e cti o n s o f th e vi sc er a o u ght

n o t b e co n si d ere d as di s e as e s o f th e vi scer a th e m s elve s b u t

as s ympt o m ati c of di s e as e i n thos e p arti c u l ar g an g li a

wh e n c e th ei r n erve s ar e de rived .

Co -
i t
e x s e nc eo f S pi n al Te n de r n e ss I n flu e n c ed by
.

su ch c o n s i der ati o n s I h ave fo r a few ye ar s b ee n i n th e

,

h abit o f tre ati n g m any o f th e se n erv o us aff e c ti o ns as dis

e as e s o f s o m e p o rti o n o f th e s pi n al m arr o w or g an gl i a ; an d
h ave b ee n s till f u rth er c o n firm e d i n my Opi n i o n by the -

freq u e n t an d al m o st u n if o rm c o e x i s te n c e o f te n d e r n e ss
-
.

o n p re s s i n g s o m e p o rti on o f th e vertebr al c o l u m n an d th e

c ir c u m st an c e s o f th e te n d er p o rti o n o f th e s pi n e b ei n g i n a

p arti c u l ar s it u ati o n wh e re th e n erve s o f th e aff e cte d p art

o r i g i n ate .
3

S y m pt o m s o f S pi n al Ir r i tati o n The s ympt o m s o f

.

s pi n al i rrit ati o n c o n si s t i n an i n fi n it e v ari ety o f m o rbid

f u n c ti o n s o f th e n e rve s o f s e nsati o n an d vo l iti o n wh i ch .

h av e th ei r o rigi n i n th e s pi n al m arr o w an d th e p art s i n

,

wh i ch th e s e m o r bi d fu n c ti o n s ar e e x h ibited o f co u r s e be ar
, ,

r e fe r e n c e to th e di s trib u ti o n o f th e s pi nal n erve s

‘

“
The m o rbid s t ate s o f s e ns ati o n i n c lu d e every v ari ety ,

fr o m th e s li ghte st d evi ati o n fr o m th e he alth y s e ns ibi l ity o f

any p art to th e m o st p ai n f ul n e u r al gi c aff e c ti o ns o n th e
,
-

o n e h an d an d to c o mp l ete n u mb n e ss o r l o ss o f fe el i n g o n
,

th e o th er ; i n clu di n g p ai n s whi c h m ay b e fi x ed o r f u git ive

o r d arti n g in th e di re c ti o n o f th e n e rve , p ri c ki n g an d ti n g

li n g s e n s ati o n s a s e n s e o f c reepi n g i n th e s ki n o f co l d
, ,

w ate r tri c k li n g o ver it an d n u m er ou s o th er st ate s o f pe r

,

verted s e ns ati o n o f wh i c h w o rd s ar e i nad eq uate to c o nvey

a de s c ri pti o n In th e m u scu l ar sy stem we fi n d we ak n e ss
.
 PR I N C I PL E S O F O S TE O PA TH Y 65

or l o ss ofp o wer trem o r s sp asm s o r c r amp s an d so metime s

, ,

a te n de n cy to rigi dity .

Th e s e s ympt o m s s o m etim e s e x i s t i n so s light a degre e

“

t hat th e p ati e nt c o n sid er s th em u nw o rth y o f n o ti c e an d ,

o n ly adm it s th eir e x i ste n c e wh e n p ar t i c u lar i n q u iry i s m ade

re s p e c ti n g th em ; th e o n ly c o mp lai n t whi ch he mak e s b e
- i

i n g o f an u nac c o u n t ab l e s e n se o f we ak nes s and i n abi l ity

o f e x erti o n .In o th er c as e s th e trem o r s h ave e x c ited alarm ;
s o me ti m e s t he n e u r alg i c p ai n s i n the S c alp o r th e fi x ed
'

p ai n i n th e m u s c l e s p arti c u lar ly wh e n it o cc u r s i n th e i n
,

te r c o stal m u s c l e s h ave s u gge ste d th e ide a o f s eri o u s di s e as e

,
.

i n th e br ai n o r i n th e l u n g s ; an d wh e n th e p ai n i s s e ate d
i n th e m u s c l e s o f th e ab d o m e n a fe ar th at s o m e o rg an i c
,

di s e as e o f th e ab d o m i n al vi sc e r a has t ake n p lac e h ar asse s

th e m i n d o f the p atie n t The m u sc u lar we ak n e s s i n so m e
.

c ase s te nd i n g t o p ar aly s i s o fte n Su gge s t s th e fe ar o f ap o p l e x y

o r p ar aly si s fr o m c e rebr al di s e ase .

D u r ati o n o f Aff e cti o ns D u e to S pi n al Ir r it at i o n The .

aff e c ti o n i s o fte n o f very p r o tr ac te d d u r ati o n u n derg o i n g,

alte r n ate v ari ati o n s fr o m th e sanative p o we r s o f th e c on

st itu ti o n and the di ffe re n t e x i sti n g c au s e s o f di s e as e Th ere .

ar e m an y i n d ivid u al s i n wh o m th e c o mp lai n t has e x i s te d ,

i n v aryi n g de gree s Of i n te n s ity fo r a s eri e s o f ye ar s with ,

o u t i ts re al n at u re h avi n g be e n s u sp e c ted ; th e p ati e n t s an d

th ei r m edi c al atte n d an t s h avi n g reg ard ed it th r o u gh o u t as

a rh e u m ati c o r a n erv o u s a
-
ff e c ti o n .

“
In th i s c o mp lai n t te n de r n e s s i n th e p o rti o n o f the
verteb r al c o lu m n wh i ch c o rre s p o n d s to th e o rigi n o f th e
aff e cte d n erve s i s ge n e r ally i n a s triki n g an d u n e q u iv o c al
, ,

m an n er evi n c e d by p re s s u re In s o m e i n st an c e s th e te n
.

de r n e ss i s 8 0 gre at th at eve n slight p re s su re c an scar c e ly

be b o r n e an d w
,
i ll o fte n c au s e p ai n to strike fr o m th e S pi n e
to th e s e at o f sp as m o r n e u r al gi a .

“
Thi s aff e c ti o n o f th e S p i n al m arr o w o cc asi o n ally e x i st s
t hro u gh o u t i ts wh o l e e x te n t ; m o re freq u e n t ly h o wever it , ,

i s c o n fi n e d to s o m e p arti c u lar p o rti o n an d o c c as i o n ally i s

,

se ated i n d i ff e re n t an d rem o te p o rti o n s at th e sam e tim e

 66 PR I N C I PL E S O F O S TE O PA TH Y

th e p arti c u l ar sym pt o m s and te n der n e ss o n p re s su re i n di

c ati n g th e aff e c te d p art .

“
The sympt o m s o f co u r s e v ary co ns i derably acco rdi n g ,

to th e p arti c u l ar p art O f th e S p i n e whi ch i s aff e cte d an d ,

b e ar refere n c e to th e di strib u ti o n o f th e di ff ere nt S pi nal

.

n erve s .

Aff e cti o ns o f the U ppe r C e r vi cal R e gi on ; Wh e n the .

u pp er c ervi c al p o rti o n o f th e sp i n al m arr o w i s di s e as ed we ,

fre q ue ntly fi nd n e u r algi c aff e c ti o n s o f th e scalp ; the p ai n

strike s i n v ari o u s di re c ti o n s o ve r th e p os teri o r an d l ater al

p art s o f th e h e ad ; so m etim e s th e twi g s in th e n ei ghb o r h oo d

o f th e e ar s o m eti m e s th o s e w hi ch asce n d o ve r th e o cc ip u t
‘
’

to th e s u p e ri o r p art o f th e sc alp ar e m o re p arti c u l arly th e

,

s e at o f th e co mp lai n t ; t he n erv o u s twig s di s trib u ted to the

i n teg u m e nt s o f th e n e ck ar e o c c asi o nally aff e cted th e p ai n ,

d arti n g ac r o s s th e n e ck to th e e dge o f th e lo we r jaw an d ,

s o m eti m e s e n c r o ac h i n g a littl e u p o n th e f ac e Th e s e n e u .

r al i c di s e as e s fre q u e n t ly as su m e an i n te rmitte n t f o rm th e
g ,

p ar o x y s m s ge n e r ally o c c u rri n g i n th e e ve n i n g A sti ff n e c k .

o r i m pai r e d acti o n Of th e m us c l e s m o vi n g the h e ad tr e

'

q u e n t ly atte n d th e aff e c ti o n o f th e u pp er c ervi cal p o rti o n

Of th e sp i n al m arr o w ; an d o c cas i o nal ly th e v o i c e i s co m
‘

p l e te ly l o s t o r
,
s u ff er s alte r a ti o n and th e act o f sp e aki n g i s
,

atte n ded with p ai n o r di ffi c u l ty .

Ir r i tati o n o f the L o w e r C e r v i cal R e gi o n I rrit ati o n .

o f th e l o we r c e rvi c al p o rti o n o f th e spi n al m arr o w give s ri s e ,

to a m o r b id s t ate o f th e n erve s o f th e u pp er e x trem iti e s ,

S h o u l de r s an d i n teg u m e n t s at th e u pp er p ar t o f th e th o r ax
,
.

P ai n s ar e felt i n v ari o us p art s o f th e ar m S h o u l der and , ,

br e as t; s o m e ti m e s th e p ai n t ake s th e c o u r s e o f th e an ter i o r
.

th o r ac i c b r an ch e s o f th e br ach i al pl e x u s o ccasi o nally th e ,

p ai n i s fi x ed at s o m e p o i n t n e ar th e clavi cl e scap u l a o r
.
,

o
sho u l de r j o i n t at th e i n s erti o n o f th e de lt o i d o r n e ar ,

th e e lb o w o r S h o o t s al o n g th e c o u r s e o f so m e o f th e c u tan
'

e o n s n e rve s F re q u e n tly o n e o r bo th o f th e m amm ae be

.
-

co m e e x q u i sitely s e ns ibl e an d p ai n f u l o n p re ssu re an d ,

so m e d egre e o f s wel l i n g o cc asi o n al ly t ake s p lac e i n th e

 PRI N C I P LE S O F O S TE O PA TH Y 67

bre ast atte n ded with a k no tty an d i rreg u lar fe e l i n g wh e n

, ,

th e n e u r al gi c p ai n s h av e e x i s te d a co ns i der abl e tim e in

th at p art pri c k li n g an d n u mb n e ss ti n g li n g an d c re ep i ng
, ,

s e n s ati o n s ar e O fte n fe l t i n th e u pp e r e x trem itie s ; an d

al so a s e n sati o n o f c o l d w ater tri c kli n g o ver th e su r f ac e .

O n r u bbi n g th e h an d s o ver th e p art aff e cte d a s o re n e s s i s

freq u e n t ly fe lt wh i ch is de scrib e d as n o t m erel y s it u ate d
,

i n the i n teg u m e n t s bu t also i n th e m o r e de ep s e ated p art s .

In the m u s cu lar sy stem ar e Ob s e r ved m o s t freq u e ntly a

we ak n e s s of th e u pp er e x tremitie s so m etim es r eferred par
ti c u lar ly to th e wri st s trem o r s an , d u n ste adi n e s s o f th e
h an d s ; also c r amp s an d sp as m s o f v ari o u s degr e e s o f i n
te n sity O cc as i o n ally th ere i s an i n abi li ty to p erfo r m co m
.

p l e te e x te n s i o n o f th e e l b o w s th e ar m app e ari n g re str ai n e d

,

by th e te n d o n o f the bi c ep s ; an d tight n e ss b e i n g pr o d u c e d
-

i n thi s p art w he n e x te n s i o n i s attempt ed b ey o n d a c ert ai n

p o i n t A S far as I h ave o b serve d th e p ai n an d o th er mo r
.
,

bi d fe e l i n g s i n th e u pp e r e x tremiti e s an d ch e s t ar e fe lt
-

m o r e fre q u e n tly an d m o re s everely o n th e l eft th an o n th e

r ight s i de .

F em al e s o f s ede n t ary h abit s app e ar p arti c u lar ly su b

_

j e c t to th e s e a ff e c ti o n s o f th e u p per e x trem iti e s an d it i s

,

n o t u n c o mm o n f o r th em to c om p l ai n o f bei n g s c ar c e ly ab l e

to fee l th e n e ed l e wh e n it i s h e l d i n th ei r fi n ger s an d th at ,

th eir n eed l e s an d w o rk fre q u e ntly dr o p fr o m t heir h an d s .

Ir r i tati o n i n the U ppe r D o r sal R e g io n — “

Wh e n the
u pp e r d o r sal p o rti o n i s aff e c te d i n additi o n to v ar i o u s m o r
,

bi d s e n sati o n s S i mi lar to tho s e i n th e e x t r emiti e s th e r e i s ,

o fte n a fi x e d p ai n i n so m e p ar t o f th e i n ter co st al m u s c l e s ,

to whi c h the n am e p l e u r o dy n i a has b e e n as s ign ed ; an d wh e n

th i s p ai n has e x i s ted a lo n g tim e th ere i s te n de r n e ss o n
,

pre ssi n g the p art .

Irr i tati o n i n the L o w e r D o r sal R e gi on Wh e n th e

.

lo w e r d o r sal h alf o f th e S pi n al m arr o w i s th e s e at o f irri

tati o n o r s u b ac u te i n fl a m m ati o n th e p l e u r o dy n i a wh e n it
, , ,

e x i st s i s fe lt i n th e lo we r i n ter co stal mu sc l e s ; fre q u e n t ly

,

th ere i s als o a s e n sati o n o f a c o rd ti ed r o u n d th e w ai s t ; an d

'
68 PR I N C I PL E S O F O S TE O PA TH Y

o pp re s sive se ns e o f tight n e ss ac r o ss th e epig astri u m an d :

lo we r st er n al regi o n ; an d so re n e ss alo n g th e cartil age s o f

th e lo wer rib s o r i n th e c o u r se o f i ns erti o n o f th e di aphragm .

V ari o u s p ai n s fi x ed an d f u gitive ar e al so fe lt i n th e par

, ,

i e te s o f th e ab d o m e n th r o u gh o u t any p ar t o f th e abd o m
,
'

i n al an d lu mb ar m u s c le s ; the p ai n i s freq u e nt ly fi x e d i n
s o me p o rti o n o f th e re c t u s m u s c l e an d n o t i n fre q u e n t ly i n

th e Ob liq u e m u scle o r tr ans ver sali s a l itt le ab o ve th e c re s t ,

o f th e i l i u m , p arti c u lar ly wh e n the o rigi n o f tw o o r th re e

o f th e lo we s t d o r s al n erve s i s di s e as ed
’

I r r it ati o n i n the L u m bar an d S acr al R e gi ons The .

aff e c ti o n o f th e l u mb ar an d Sac r al po rti o n o f th e S pi n al c o rd

o fte n p r o d u c e s a s e n s ati o n o f s o re n e s s i n th e sc r o t u m an d

n ei ghb o ri n g i n teg u m e n t s ; an d th e lo wer e x trem iti e s b e

c o m e th e s e at o f v a ri o u s m o rbi d s e n s ati o n s s p a s m s trem o r s , , ,

et c. fo r th e m o s t p art re s e mb li n g th o s e whi c h h ave be e n

,

de sc rib ed as o c c u rri n g i n th e u pp er li mb s The p ati e n ts

als o co mp lai n o f a s e n s e o f i n se c u rity o r i n st abi lity i n

w alk i n g ; the i r k n e e s t o tte r an d fe e l sc ar c e ly ab l e to su p

l
,

p o rt th e weigh t o f th e b o dy .

The E ff e c t o f R e cu m be ncy In so m e ca se s very c o n

.

s ide r ab le re lie f i s f o un d fr o m re c u mbe n cy th e p ai n fr e ,

q u e n t ly b ei n g di m i n i sh ed as so o n aS th e p atie n t reti re s to >

b ed i n dep e n de n t ly o f any p ar o x y s m al rem i s si o n

,
.

I r r i tati on o f S pi nal M ar r o w No t Ne ce ssar i ly D e pe n de n t

“
Thi s i rrit ati o n o r s u b ac u te i n
'

o n Di s e as e o f V e r t e b r ae
.
.
-

fl am m ato r y st ate Of th e sp i n al m arr o w i s n o t n e c e s sari ly

c o n n e c ted with an y defo rm ity o f th e s pi n e o r di s e as e i n ,

—
th e v erte br ae I t m ay c o e x i st with the s e as we ll as with
.

any o th er di s e as e s b u t it s o rep e ate d ly o cc u r s with o u t th em

, .

th at th ey c an n o t b e reg arde d as d ep e n de n t u p on e ach

o th er . W h e re h o weve r i nfl amm ati o n a n d u lc e r ati o n o f
, ,

th e vertebrae o r i ntervertebr al c arti lage s e x i st it i s pr o b ,

ab l e th ey m ay p redi sp o s e to an d i n s o m e i n st an c e s ac t
, ,

as an e x c iti n g cau s e o f an i n fl am m at o ry st ate o f th e n e rv o u s

'

s tr u c t u r es whi c h th ey c o n t ai n ; fo r we n o t fre q u e n tly fi n d

i n fl am m at o ry aff e c t io n s o f th e vertebr ae i n c o n j u nc ti o n wit h

7O PR I N C I PL E S O F O S TE O PA TH Y

bli ste r s to th e aff e cte d p o rti o n o f th e s pi n e ar e th e p ri n ,

c i pal rem ed ie s A gre at n u mb e r Of th e cas e s wi ll fr e

.

q u e n tly yi el d to th e S i n g l e app li c ati o n o f any o f th e s e

m e ans S o m e cas e s wh i ch h ave eve n e x i ste d seve r al m o n th s
.

I h av e s e e n p e rfe ct ly re li eved by th e si n g l e app li c ati o n o f

a bli s te r to th e S pi n e alth o u gh th e l o c al p ai n s h ave b ee n
,

i n e ff e ct u ally tre ated by a v ari ety o f re m edi e s fo r a gre at .

l e n gth o f tim e A rep eti ti o n o f th e l o c al d ep l eti o n an d

.

bli ste r i n g i s h o wever o fte n n e c e s sary af te r th e lap s e o f a

’

few d ay s an d so m
,
.

, eti m e s i s req u i re d at i n te rv als fo r a co n

s i de r abl e l e n gth o f ti m e In a few v ery o b sti n ate c as e s
.

‘ ’

i ssu e s o r set o n s h ave be e n tho u g ht n e c e ss ary ; an d wh ere

.

th e di s e as e has b e e n very u nyi el di n g a m ild m e r c u ri al ,

c o u r s e has app e are d b e n efi c i al .

“
Wh e n my atte n ti o n w as fir s t di re c te d to thi s s u bj e ct '

I co n s id ere d re cu mb e n cy a n e c e s sary p art o f the tr e atm e n t

'
'

it i s fo r a m o der ate l e n gth o f ti me u n d o u bted ly b e n efi c i al

, ,

an d fre q u e n tly very m u c h ac c e l er ate s r e co very bu t s u b ,

se q u e n t O b serv ati o n haS c o nvi n c ed m e th at it i s by n o

m e an s e ss e nti al . I h ave s e e n s ever al i n st an c e s o f th e m o st
~

‘
s eve re f o rm s o f th o s e c om pl ai n t s o c c u rri n g i n th e o o rer
p .

c l ass e s o f s o c iety where co nti n u e d re c u mbe ncy was i m

,

p r ac ti cabl e whi ch h ave n everthe les s yi e lded with o u t di f

, ,

fi c u lty to th e o th er m e an s Of th e tre at m
,

e nt whil st th e i n di ,

v i du al s wer e p u r su i n g th ei r lab o ri o u s av o cati o n s .

“
The s e ob s
erv ati o ns ho w elv e r , , ar e no t i n t en d e d to
apply to t ho se cas e s i n wh i ch the re is ac t u al di s e as e o f th e

verteb r ae .

“
Whe n e x i s t s a te n de n cy to rel ap s e I h ave
. the r e ,

th o u ght it adv an t age o u s to co n ti nu e th e u se o f so m e s tim .

-
,

u lati n g l i n i m e n t to th e spi n e fo r a few we ek s afte r the

o th e r m e an s o f tre atm e nth ave be e n di s co n ti nu ed A l i ni .

m e n t co n si sti n g o f o n e p art S pirit s o f t u rp e n ti n e an d tw o

o f o l iv e o i l i s wh a t has ge n e rally b e e n emp lo yed .

Ne r v e s — The g an gli ao f
,

“
G angl i a of the S y m pathe ti c
th e symp ath eti c n erve s app e ar su bj e c t to a s a t te of d i s e as e
 PR I N C I PL E S O F O S TE O PA TH Y
‘

71

S im i lar to th at whi ch has bee n de sc ribed i n th e pre c edi n g

c h apter as o c c u rri n g i n th e S pi n al m arr o w
, .

A s th e di s e as e m ay b e c o n fi n ed to o n e p art o f th e
S pi n al m arr o w or
,
e x i s t S im u lt an e o u sly i n di ff ere n t po r
ti o n s o r m ay eve n p erv ade i ts wh o l e e x te n t S O th e ai
, ,

f e cti o n o f gan g l i a m ay b e co n fi n ed to o n e o f th ese n erv o u s

m as se s m ay e x i s t i n s ever al whi ch ar e c o n tig u o u s o r i n
,
'

li re mot fr o m e ac h o th er ; an d as th ere i s re as o n t
'

g a n g a e o

be lie ve the w ho le c h ai n m ay o cc asi o n ally b e aff e cte d .

“
The di s e as e Of th e gan g l i a i s s e l d o m f o u n d e x c ept i n ,

co n j u n c ti o n with th at o f the c o rre s p o n di n g p o rti o n o f t he

S p i n al m ar r o w w here as th e S p i n al m arr o w i s o fte n aff e c ted
,

wit ho ut th e n eighb o ri n g g an g li a b ei n g u n der th e i n fl u e n c e

o f d i se as e .Th u s we fre q u e n t ly fi n d sympt o m s o f di s e as e
i n a p o rti o n o f th e sp i n al m ar r o w with o u t any evid e n c e
o f i ts e x i s te n c e i n th e c o rre s p o n di n g g an g l i a f r e q u e n t ly th e
,

s ympt o m s o f b o th c o mbi n ed an d o cc as i on ally bu t r are ly

, , ,

sy mpt om s refe r abl e t o th e g an g l i a with o u t th e S pi n al m ar

r o w b ei n g imp l i c ated .

S y m ptom s o f Ir r i tati o n o f S y m pat he ti c G an gli a The .

p ri n c ip al sym pt o m s r e su lti n g fr o m i rrit ati o n o f th e g an gli a

o f the s ymp ath eti c ar e to b e f o u n d i n th o s e o rg an s whi c h
‘

derive th e i r n erve s f r o m thi s so u r c e They c o ns i st o f p er

.

verte d f u n cti o n s o f th es e o rgan s an d ar e e x emp lifie d by a

,

v ar iety o f ph e n o m e n a The i nv o lu n t ary m u scl e s d e r ivi n g

.
,

thei r p o wer f r o m th e symp ath eti c h ave th ei r ac ti o n altere d

,

as i s evi n c ed by sp as m s an d i r r eg u larity i n th ei r c o n tr ac

ti o ns The h e art i s S e i zed with palp it ati o n s th e l arge v e s

.
,

s e l s with i n o rdi n ate p u lsati o n s ; th e m u sc u l ar fib er s co n

n e c ti n g with th e br o n chi al app ar at u s ar e thr o w n i n t o

s p asm s ,
co n s tit u ti n g a ge n u i n e asth m a i n dep e nde n t of

b r o n chi al i n fl amm ati on The m u scu lar fib er s o f th e st o m

.

ach a n d i n te s ti n e s b e c o m e th e s e at o f s p as m s an d v ari o u s

o th e r de vi ati o n s fr o m th ei r n at u r al O p er ati o n The s e n si

.

bi li ty o f th e o rg an s wh i c h d e rive th eir s e n ti e n t p o wer fr o m

,

th e gre at symp atheti c i s v ari o u sly p e rve rted the n erv o u s

, ,

fi lam e n t s b ei n g th e se at o f p ai n The he art an d lu ng s, fo r

.
72 PR I N C I PL E S O F O S TE O PA TH Y

i n st an c e ar e su bj e ct to m o rbid s e n sati o n s be ari n g gre at

,

an alo gy to th o s e wh i c h h ave be e n de s ig n ated tic d o u lo u

‘

re au x wh e n o c c u rri n g i n th e spi nal n erve s The s t o m ach

’
.

an d i n te sti n e s ar e li ab l e to s im i lar n e u r algi a to wh i c h th e ,

n ame s g as tr o dy n i a an d e n te r o dy n i a h av e be e n app l ie d The .

ki d n ey s th e b ladde r an d th e u ter u s ar e li ab l e to th e s am e
, ,

p erverted st ate o f th ei r s e n sibi lity The se c reti o ns also .

u n derg o alte r ati o n s pr o d u c t s b e i n g f o rm ed wh i c h i n h e alth

, ,

h ave n o e x i ste n c e Th i s i s e x emp lifie d by th e e n orm o u s

.

s e c reti o n s o f ai r whi c h s o m eti m e s o cc u r i n th e st o m ac h .

‘

L arge q u an titi e s o f c le ar tr an sp are n t liq u id ar e als o s e creted

by thi s o rg an c o n stit u ti n g wh at is c alle d pyr o si s The
’

, .

s e c reti o n s o f th e st o m ac h u n de rg o v ari ati o n i n t hei r q u an

titi e s re n d eri n g th em u n fit fo r dige s tive p r o c e ss It is

'

, .

p r o b ab le th at th e se c reti o n o f th e liv er al so e x pe ri e n c e s
s o m e alter ati o n i n t h e s e c o m p lai n t s The u ri n e i s so m e -
.

ti m e s i n fl u e n c e d an d I am i n c li n e d to su sp e c t th at so m e
'

f o rm s o f di ab ete s p art ake o f n e u r algi c c h ar ac te r Le u .

co r r ho e a i s fre q u e n t ly a co n c o m it an t Of th e s e di s e as e s an d
”

c e as e s o n th ei r rem o v al ; b u t I am n o t prep ared t o s ay th at

it i s ever sympt o mati c Of th em I rreg u lariti e s i n th e cata

‘
~
.

m e n i a ar e o fte n o b s erved th e d i s ch arge Ofte n bei n g g e n

,

e r al ly i n e x c e ss .

M i ddle an d Lo w e r Tho r ac i c S y m pat he ti c G an g l i a .

The g an g li a m o st li ab l e to th e di s e a se ar e th e m idd l e an d
lo wer th o r ac i c fr o m whi c h th e sp lan c h n i c n e rve s ar e de
,

rived givi n g ri s e to v ari o u s di s o rder s Of th e s t o m ac h an d

,

dige stive o rgan s wh i ch w i ll h e re afte r b e m ore f u lly di s

,

c u s s ed .Ne x t i n freq u e n cy i s th e aff e c ti o n o f th e c ervi c al

g an g li a p r o d u c i n g p ai n f u l an d sp as m o di c s t ate s of th e
,
-

h e art The s ympt o m s de n o t i n g di se as e o f o th er gan g li a al

.
,
a

th o u gh o c casi o n ally m et with a r e l e s s freq u e nt i n thei r ,

o c c u rre n c e I rrit abi lity o f temp e r an d depre s s i o n o f Spirit s

.
'

o fte n atte n d th e s e c o mp lain t s p arti c u lar ly wh e n th e s t o m

'

ach i s th e p art wh i c h s u ff er s .

“
The d i se as e o f th e g an g li a like th at o f th e spi n al ,

m arr o w i s n o t n e c e s sari ly c o n n e cte d with di s e ase o f th e

,
 P R I N C I PL E S O F O S TE O PA TH Y 73
‘

ve rtebr ae o r di s t o rti o n o f th e S p i n e I t m ay . with —

c o e x i st

th e s e c o mp lai n t s and wh e n it d o e s S O th e sympt o m s

, , ,

p r o p er to th e g an g li o n i c di s e as e ar e o fte n err o n e o u sly sup

p os ed to b e pr o d u c e d by di st o rti o n o r by di s e ase Of th e
verteb r ae ; th ey ar e ho weve r fre q u e n t ly re l ieved by tre at
, ,

m e n t whi l st th e di s e as e o f th e b o n e s rem ai n s u i ri n fl u e n c e d
,

by it an d th e m o st e x trem e d i s t o rti o n o f th e S pi ne o r de
'

str u c ti o n Of th e vertebr ae fr o m i n fl amm ati o n m ay e x i s t

witho u t th ere b ei n g any sympt o m s attrib u t ab l e to n e u r algi a
o f th e sym p ath eti c n e rve s

In c o n j u n c ti o n with th e s ympt om
.

“
s de n o ti n g di s e as e

o f th e g an g l i a t e n der n e ss t
,
o a gre ate r o r l e ss d egre e m ay

ge n er ally b e f o u n d o n p re ss i n g so m e p art o f the S pi n e an d ,

th e te n der p o rti o n i nv ari ab ly c o rre spo n d s with th e sy m p

t o m s ; o r r ath er th e s e at o f te n der n e s s i s n e ar th e p art
,
-

o cc u pie d by th e p a rti c u l ar gan g l i a fr o m wh i c h th e n erve s

o f th e di s o rd ered o rg an ar e d erive d ; fo r e x amp l e wh e n th e ,

h e art i s aff e cte d th e te n d er ne s s i s f o u n d i n s o m e o f the

c e rv i c al vertebr ae an d wh e n th e s t o m ach i s th e s e at o f
,

c o mp l ai n t it i s i n so m e o f th e mi dd le Or lo wer d o r s al ver
,

te br ae .

S pi n al Tr eatm e n t H y pe r ae m i a
. With re sp e c t to th e
.

tre atm e n t I h ave bu t l itt l e to add to wh at has be e n said

,

i n th e pre c edi n g c h apter re sp e c ti n g th e tre atm e n t o f irrit a

ti o n o f th e s pi nal m arr o w L ee ch e s c u p i n g b li ster s e tc
.
, , ,
.
,

to th e n eighb o rh o o d o f th e aff e c te d g an g l i a c o n stit u te th e

”
e ss e n ti al p art .

M u scu l ar e T n s i o n — F o llo wi n g th e o b s erv ati o n o f s p i n al

te n der n e s s c am e th e n o ti n g o f m u s c u lar te n si o n ac co mp any
i n g it . A s n e ar as I c an d etermi n e fr o m p er u s i n g m edi cal
l iter at u re m u s c u lar te n s i o n w as n o t re co g n ized u n ti l afte r
,

th e adve n t o f O s te o p athy S i n c e th e atte n ti o n o f m edi cal

.

writer s w as calle d to th e co n diti o n s o f th e s pi n al co lu m n

l e si o
“ ”
c all ed ns th ere ar e fre q u e n t p as sage s de sc riptiv e o f
th es e i n m e di c al l iter at u re O n e o f th e be st o f th e s e ref
'

“
e re n c e s i s f o u n d i n Bo ardm e n R eed s w o rk o n
’
D i s e as e s
o f th e S t o m a ch an d I n t e sti n e s an d i s as f o l lo w s
,
74 PR I N C I PL E S O F O S TE O PA TH Y

D r J o h n P A r no l d has re c e ntly cal led atte n ti o n to

. .

a n o vel o bj e c tive S ig n wh i c h m ay b e re c o g n ized u p o n pal

p ati o n o ve r th e s e n s itive regi o n s a l o n g S id e o f th e sp i nal

ve rteb r ae an d so m etim e s i n su ch r e g i o ns w hi ch ar e n o t
'

s e n sitive t o p re s su r e th o u gh i n all c as e s h e m ai nt ai n s th at
,

th e p art o f th e b o dy s u pp lie d by th e v aso m o t o r n e rve

fib re s im m ergi n g in th e c o rre sp on d i n g i n tervertebr al S p a ce

will b e f o u n d to p re s e n t s o m e ab no rm al c o n diti o n The

p e cu li ari ty de sc rib ed by h i m i s i n su ch case s a so m
.

,
ewhat ,

d o u ghy an d i n ch r o n i c o n e s a gri st ly te n s e co rd l ike fe el

, , ,
-

i n g o f th e b an d o f lo n git u d i n al m u sc u l ar fibre s whi c h r un

u p an d d o w n o n eith e r S id e o f t he s pi n e Thi s ab no rm ality
'

i s s u pp os e d by A r n o ld to b e du e to a co n ge s te d o r i n filtr ate d
co n d iti o n o f th e m u sc l e wh i l e th e c o rd it s e l f i s an ae mi c ,

p r o b ab ly i n ch r o n i c cas e s H amm o n d b el ieved the S pi nal

.
'

c o rd t o b e an aemi c i n su ch c as e s The fi n di ng s o bt ai n e d by
.

a c aref u l p alp ati o n o ver th e s pi n e sh o u l d th u s as s i st i n di

r e ct i n g o u r atte nti o n to th e o rg an o r p art o f th e bo dy whi c h

m ay b e s u sp e c ted o f b ei n g di s e as ed .

D i g it al E x am i nat i o n o f the S pinal Ar e a Yo u S h o ul d.

m ake it a r u l e to e x am i n e caref u l ly th e spi n e s o f all ch r o n i c

i nv al i d s by p re ss i n g de eply with th e fi n ger tip s ( o r with

th e th u mb s as F li n t advi se d ) c l o se to th e verteb r ae and

,

th e n e x ert ge n tl e tr ac ti o n i n a later al d i r ec ti o n o u tw ard

f ro m th e sp i n e o n eith er S id e The p ati e n t sh o u ld b e lyi n g
.

u p o n hi s right S i de wh i l e y o u p alp ate al o n g the l eft S id e o f

th e v ertebr ae an d S h o u l d th e n ch an ge to hi s l eft S i de i n
,

o rder th at y o u m ay p alp ate u p o n th e right S id e o f th e

m
.

l atte r so th at th e ti s s u es m ay b e i n th e u t o st co n diti o n
o f re lax ati o n p r ac ti c ab l e In b o th cas e s y o u will fi n d it
.

b e s t to st an d i n fr o n t o f th e p ati e n t an d re ach o v er hi s
u pp er S ide to m ake p alp ati o n alo n g th e regi o n O f th e u pp er
s ide o f th e Spi n al c o l u m n .

“
In n u m er o u s p ati e nt s e sp e c i ally th os e s u ff e ri ng fr o m
,

dige stive d e r an gem e nt s y o u will be l ikely wh i l e p alp ati n g

,

i n th e w ay d e sc ribe d to re co g n ize i n th e l o n git u di n al m u sc le s

r u nn i n g p ar all el and c l o se to th e S p i n e th e te ns e co rd li ke ,
-
 P R I N C I PL E S O F O S TE O PA TH Y 75

s e n sati o n ab o ve m e n ti o n ed I f s im u lt an e o u sly with y o u r

.
,

re co g n iti o n Of s u ch a co n diti o n th e p ati e n t c o mp l ai n s o f

s e n sitive n e ss i n th e s am e regi o n s th e ac cu r acy o f y o u r
,

fi n di n g wi ll b e at o n c e c o n firm ed ”
.

The U s e o f S pi n al M u s cu lar Te nsi o n i n D i ag no si s .

The u se o f th e s e te n s e c o rd like m u s cl e s as di ag no s ti c evi

-

de n c e s o f di s e as e has be e n a c o n st an t p r ac ti c e o f O s te o
p ath s f r o m the b egi nn i n g Of D r S ti ll s w o rk J u dgi n g fr o m
.
’
.

th e q uo t ati o n the tr u e s ig n ifi c an c e o f the s e co n tr acti o n s has

n o t be e n app reh e n d ed by th e m edi cal p r o fe s si o n i n ge n er al .

I t i s ve r y evi de n t t hat a c o n tr ac te d m u s c le i s sh o rter an d

thi c ker th an wh e n re lax ed also th at wh e n c o n tr ac ted it
,

e x ert s for c e to dr aw its e x tremiti e s t o geth er The e n d s o f .

the m u sc l e b ei n g att ach ed to b o n e s f o rmi n g p o rti o n s o f

a m o v ab l e arti c u lati o n ,
a c h an ge i n th e re lati o n o f th e

b o n e s m u st f o llo w Thi s ch an ge is c all ed a su b lu x ati o n

.

an d i s de s c rib ed m o r e i n det ai l in an o th er c h apter .

Cau s e o r E ff e c t ?— H avi n g n o te d th at s e n s itive n e ss an d

m u scu lar co ntr acti o n ar e we ll re co g n ize d c o n diti o n s f o u n d
'

al o n g th e S pi n al co l u m n ,
th e q u e s ti o n a ri se s ar e th e s e
, ,

mere ly Ob je cti v e sympt o m s o f di se as e o r ar e they to a

l ar ge e x te n t cau s ativ e f act o r s i n th e o rigi n an d m ai n te nan c e
Of di s e as ed co n d iti o n s o f th e are as o f p eriph er al di str ibu
ti o n o f sp i n al n e r ve s Ar e th ey c au s e s o e e ct s
- ? r ff ?

They h ave b e e n n o ted alm o s t e x c lu s ive ly as e ffi c i e n t

c au s e s o f di s e as e. F u r th erm o re o ste o p athi c th erap e u ti c s
,

h ave b ee n admi n i s tere d fr o m th at st an dp o i n t with m arke d

s u cc e ss
. Th i s c h an ge i n p o s iti o n an d s ize o f ti ssu e s i s
re co g n ize d as an Ob st r u cti o n to th e m o vem e n t s o f fl u id s ,

an d th eref o re i s a c o n diti o n Op er ati n g i n th e sy st em to

cau s e di s e as e.
76 PR I N C I PL E S O F O S TE O PA TH Y

C H A P TE R V .

TH E S E G M E NTATI O N O F -
TH E B ODY .

The L e s i o n as a G u i de i n D i ag n o s i s — S i n c e th e S pi nal
.
.

l e si o n m ay b e eith e r c au s e o r e ff e c t i e a tr au m a o r an e x
, . .
,

p re ss i o n o f th e b o dy s p r o te c t i ve re acti o n we n e ed c ert ai n
’

f u n d am e nt al f ac t s u p o n whi c h to b as e j u dgm e n t NO m at .

te r wh eth er th e le s i on i s c au s e o r e ff e c t the phy s i ci an m u st r

re c o g n ize it as a g uid e fo r th e u n rave lli n g o f a s eri es o f ph e

mo m e n a wh i ch ar e q u ite s u re to b e pre s e n t i n any ca se I t i s .

a we ll re c o g n ize d f ac t th at e ff e c t s b e c o me c at i s e s an d th u s a
]
'

cy c le o f refl e x e s b e c o m e e st ab l i s h ed m aki n g i t di ffi c u lt t o
'

re c og n ize Wh ere th e s e ri e s b eg an Any di agn o si s w o rthy

.

th e n am e m u s t b e b a s ed o n s tr uct u re an d f u n cti o n M u c h o f .

th e ph e n o m e na w e ar e c alle d u p on to i n terpret is di fficu lt to

u n der s t an d u n l e s s we k n o w n o t o n ly n
, o rm al s tr u c t ure bu t
th e d eve lo pm e n t p r o c e ss e s wh ere by th i s p re se nt str u ct u r al
f o rm ati o n w as achi eve d .

The S p n al S e g
i m e n t— The far re ach i n g i n fl u e n c e Of a
c e rvi c al l e s i o n c an re ad i ly b e u n der st o o d wh e n we st u dy th e

embry o lo gi cal d eve lo p me n t o f c ervi cal str u c t u re s To m e n .

ti o n a n e rve to a di ag no s ti c i an S h o u ld i n s t ant ly bri n g to hi s

mi n d all th e s tr u c t u r al as so c i ati o n s o f th at n erve i ts o rigi n ,

an d di s trib u ti o n . The th o u ght o f i ts o rigi n an d d i strib u ti o n

w o u l d n at u r ally bri n g to m i n d an asso c i ati o n o f all th e tis
su e s d ep e n d i n g o n it fo r i n nerv ati o n We w o u ld th u s have
.

a pi c t u re o f a l o c alize d c o mm u n ity o f i n tere s t s Co n sid eri n g .

th e sim i lar di strib u ti o n o n th e o pp o s ite s i de o f th e b o dy we

h ave pi ct u red a so rt o f tr ansver s e divi s i o n o f th e b o dy .

E very p ai r Of S pi n al n erve s wi th th e ti ss u e s d ire c t ly u n der

,

th ei r i nfl u e n c e sh o u ld f o rm i n o u r m i n d s an e ntity a me ch
, ,
78 PR I N C IPL E S O F O S TE O PA TH Y

I t i s re adi ly se e n th at th ere i s an e lem e n t o f p r o te cti o n i n

th i s fact A S light c e n tr al l e mo n 1 e an i nj u ry to the s pi nal
.
,
. .
,

co rd i ts m embr an e s ; o r a p re ssu re le si o n du e to di s e ase o f

,

th e b o n e as i n P o tt s di s e as e migh t n o t pr o d u c e c o mpl ete

,
’

l o ss o f f u n cti o n i n any s i n gl e m u sc l e b e cau s e th e g o ver n i ng

n e rve to th at m u s c l e i s m ade u p o f fib er s fr o mt
”

w o o r m o re
c o rd s egm e n t s .

I n j u r y o f a S i n gl e Ner v e E x am pl e : P o ste r i o r Tho r aci c

. .

Co mp l ete p ar aly s i s o f a s i n gl e m u scl e i s i nd icative o f

s er i o u s i n j u ry to i t s g o ver n i n g n e rve at s o m e p o i n t e x teri o r
"

F IG 3 D i a gr am of a se gm nt
e of th e b o d y an d l i m b . D r aw n b y J o h n
t k ft
. .

C om s oc (a er K o ll m ann ) .

to th e c e n tr al n e rv o u s sy stem ; i n f act b ey o n d th e p o i n t o f ,

c o al e s c e n c e o f th e fib er s whi c h f o rm it A S an e x amp le o f i h
'

j u ry o f a s i n gl e n e rve we m ay t ake a cas e o f p ar al y s i s o f th e

S e r r atu s M ag nu S Thi s l arge m u sc l e whi c h act s to h o l d th e
.

p o steri o r b o rd er o f the scap u la clo s e to th e th o r ax wh e n o n e ,

i s p u sh i n g with the h an d o r wh e n t aki n deep i spir ati o n

'

g a n ,

i s i nn e rv ated by th e p o s te ri o r th o r ac i c n e rve whi c h i s m ade

up o f fib er s fr o m th e u pp er p o rti o n o f th e b r ach i al pl e x u s ,
 P R I N C I PL E S O F O S TE O PA TH Y 79

fifth ,
i th an d s eve n th c e r v i cals E vi de n t ly an i nj u ry c ap a
s x .

ble o f i n v o lvi n g all th e fibe rs o f th e p o steri o r th o r ac i c n erve

an d n o o th er s m u s t b e p eriph e r al to th e p o i n t o f j u n c ti o n o f

i ts fib er s fr o m th e fifth s i x th an d s eve n th ce r v i cals

,
.

A p ati e n t c am e to me i n 19 0 1 c o mp lai n i n g Of a p e c u li ar
lo ss o f p o we r o f th e r i ght ar m
'

H e w as a l arge p o werf ully . .

F IG 4 P ar al y s i s of ri gh t t
se r r a u s m ag nu s S h o w s th e p r o m i
f
.

t
. .

n e n c e o f th e s c a p u l a , w h e n i t i s th e o u n da i o n f o r a m o v e
t t
m e n s u ch a s e x e n s i o n o f th e a r m to th e S i d e .

b u i lt y o u n g m an Wh o s e o cc u p ati o n as a lu mb er sh o ver u n , ,

lo adi n g l u m b e r o n th e S an P edr o d o c k s w a s l o s t as a re s u l t ,

o f hi s c o n dit i o n H e g ave a hi st o ry o f perfe ct h e alth at all

.

t im e s S ai d th at tw o d ay s p revi o u s o n S u n d ay h e had
'

.
, ,

e r e cted a te n t fo r h im s e lf an d as h e w as tighte n i n g th e g uy
r o p e s h e fe lt a sh arp p ai n u n de r hi s right sh o u l de r b lade ,
'

80 PR I N C I PL E S O F O S TE O PA TH Y

wh i c h w as i mm edi ate ly f o llo wed by i n abi lity to p u sh with

th e righ t ar m The p ai n w as o f S h o rt d u r ati o n H e d e
.

. .

sc ribe d hi s p o s iti o n as a s o m ewh at awkw ard o n e i he , .

w as k n e e li n g o n hi s right k n e e f ac i n g o n e o f th e te n t g u y
‘

r o p e p eg s With hi s right h an d gr aspi n g th e w o o d e n clamp

.

F IG 5 Pa r aly s i s of ri gh t S e r r a tu s m a g n u s . S h ows lo s s of
'

t th
. .

pow e r rot th e s c a p u l a; th e
'

.
to a e ,
on o r ax .

on th e g u y r o p e h e attempted to dr aw th e g uy r o pe t au t
,
.

H i s gre at s tre n gth e n ab l ed hi m to do thi s eve n th o u gh hi s ,

right h an d w as c o ns ide r ab ly b ehi n d him F ig s 4 an d 5 . .

S h o w th e e ff e c t s o f th e par aly s i s o f th e S err at u s M ag n u s i n

'

th i s c as e .

A s e c o n d c ase pre s e n ti n g e x actly th e sa m e sympt o m s

w as s e e n i n th e c li n i c o f th e P ac ifi c Co ll ege o f O s te o p athy
 PR I N C I PL E S O F O S TE O PA TH Y 81

a h o rt ti m e late r A te l eph o n e li n em an whi le e n gage d i n

s .
,

stri n gi n g wire fr o m o l e to po l e m ad e a vi g o r o u s aw kw ar d
p ,

p u ll with th e righ t h an d s o m e di st an c e b ack o f hi s hi p H i s .

l e gs were e n twi n ed ab o u t th e c r o ss pi e c e s o f th e p o l e At .

th e tim e o f gre ate st e ffo rt h e fe lt a severe p ai n u n der the

F IG 6 P ar a l y s i s of ri gh t t
se r r a u s
m agn u s g
. .

“
S h ow s th e wi n e d ”

g t
.

co n di ti on of ri h s c ap u l a w h e n
ar m is ex t
ended f o r w ar d .

r ight der f ollo we d by a p r o f o u n d s e ns e o f we ak n es s i n

sho u l ,
.

the s h o ul der an d ar m The sc ap u la imm e di ate ly t o o k a

.

wi n g p o s iti o n an d the p atien t c o u l d n o t sh o v e with th e right

arm .

Th e s e case s se rve to give u s a pi ct u re o f th e i nfl u e nc e

of po s iti o n an d m o ti o n o f th e s h o u l de r as g o ver n ed by o n e
82 PR I N C I PL E S O F O S TE O PA TH Y

n e rve t aki n g o rigi n fr o m th re e c e rvi c al s egm e nt s The .

-

l e s i o n w as n o t a S p i n al on e i e s u ch as we h ave be fo re d e
, . .
,

sc rib ed ,
n eith e r w as it o n e i n v o lvi n g th e c e l l s o f o rigi n of .

th i s n erve in th e S pi n al c o rd The awkw ard p o siti o n o f th e

.

p ati e n ts an d th ei r n at u r ally gre at stre n gth Op er ated to in

F IG 7 P ar a l y s i s of g h t S e at u
ri rr s
gn
.

tl i n
.

ma us
'

S how s ou f th e o e
t b b
.

ver e r al or de r s of th ap l a
e sc u e
whe n a r m s ar e ex t n d d f wa d
e e or r .

jure o
the m i n m u c h th e s a m e w a y a s th e v a ri o u s n erve h o ld s
'

i —
p r ac ti c e d by th e j u j it su wre st ler The p re s su r e wh ere th e .

n e rve c r o ss e d th e rib s b e c am e to o gre at an d h e n c e c au s ed , ,

a s evere tr au m a o f th e n erve
—
.

A U n i l t
a e a
r l Ce r v i c al S pi n al L e s i o n T h e f o reg o i n g .

c a se s p re s e n t th e c lass i c al fir st s ympt o m s o f a s evered m o t o r

 P R I N C I PL E S O F O S TE O PA TH Y 83

e rve In o rde r to p re s e n t th e sympt o m s acc o mp an yi n g a

:

n .

c ervi c al l e s i o n o f th e S pi n al l e si o n typ e we wi ll de s c ribe a

'

c as e wh i c h has b e e n u n de r o bs e r v at i o n fo r a l o n g tim e A
'

w om an 4 1 ye ar s o f ag e ha s b ee n u n de r my p r o fe ss i o n al
, ,

c ar e fo r th re e ye ar s A t th e ti m e o f my fir st e x ami n ati o n
.

F IG . 8 . S h ow s di g i tati on s of th e F IG 9 P a r al y s i s
th e r i h t s e r of g
gn g gt t
.

t t
.

se rr a u s ma us an d n o r m al po r a u s m a nu s N o di i a i on s ar e
t t k
.

S i ti o n of th e s c ap u l a ap p a r e n Th e s c a p u l a a e s an
g t
. .

reme
”
ext wi n p o si i on .

S he a ppe ared to b e c o n s tit u ti o n ally i ll b u t caref u l e x ami n a ,

ti o n f ai le d to di s c o ve r any o rg an i c di s e as e
_ F u n c ti o n al .

r hy t hm s e e m e d d i sco rd an t everywh ere h e n c e o u r fir st e f

_ ,

f o rt s we re to s e e th at e n vi r o n m e n t w as f air ly n o rm al R e s t .
,

n u triti o u s diet an d an Opti mi s ti c at mo s ph ere s erved to elim

i n ate m an y o f th e irrit ati n g sympt o m s .

84 PR I N C I PL E S O F O S TE O PA TH Y

The fi r st e x ami nati o n th e sp i n al are a di sco vered a

of

l e si o n betwe e n th e S i x th an d seve nth c e rvi cal ve rtebrae .

Th ere w as m u sc u l ar an kyl o s i s co ntr o l li n g thi s arti cu l ati o n

an d any attempted m o vem e n t o f th e wh o l e c e r vi c al are a ,

su ffi c i e n t to m ake d em an d o n th i s j o i n t c au s e d p ai n o f a
,

sh arp n e u r algi c ch ar acter to r adi ate i n t o th e l eft s h o u ld e r

an d ar m .Th i s p ai n co u l d b e p r o d u c ed m o s t e asi ly by eithe r

v o lu n t ary o r p ass ive r o t ati o n o f th e h e ad to th e l eft A p er .

si s te n t e ff o rt to ro t ate th e h e a d i n thi s dire c ti o n c aus ed t he

h an d an d ar m to be c o m e n u mb The h an d w o u l d b e co m e
.

bl o o d le ss co ld an d m o i s t ; p o wer to p i ck u p a b oo k o r c u p
,

w as gre atly l e ss e n ed .Th e s e symp t o m s w o u ld we ar o ff i n

twe ty f o u r to thi rty S ix h o u r s bu t th e p ai n W
n - — , o u ld l e ave he r

i n alm o st a s t ate o f c o l l ap s e M as sage o f the ar m and h an d

.
-

w o u l d bri ng no re ac ti o n ; h e at als o f ai l e d to sti m u l ate cir

c u l ati o n .

Th e s e att ac k s had b ee n b r o u ght o n by any s o rt o f ho u s e

w o rk at fir st o n ly swe epi n g o r su ch w o rk as re q u ire d ar m
,

l ever age .L ate r it s e em e d as th o u gh th e att ack s cam e wit h

o u t an y m e c h an i c al re aso n . Th ey were acco mp an i ed by se
ve r e h e ad ach e ” t achy car di a m ete o ri sm col d e x tremiti e s
. , ,

an d s u b n o rm al t e mp er at u re AS might b e e x p e c te d in su ch
'

a c as e th e s pi nal l e s i o n pi c t u r e w as a m
.

ix e d o n e an d i t
'

s eem ed i n view o f S O m an y sympt o

,
ms o f au t o i n t o x i cati o n
-
,

as th o u gh th e m id —d o r sal l e s i o n s we re m o re n early p ri mary

th an th e o th er s The s e ns itive n e s s Of th i s S pi nal co l u mn
.

w as s o gre at an d so m any c o mp e n s ati o n s we r e i n evid e n c e

th at it w as de em ed b e st to attempt at fir st m ere ly to S impl ify
th e sym pt o m co mp l e x as m u ch as p o ss ib l e by giv ing th e
'

S pi n al c o lu m n phy si o lo gi cal re s t The p ati e nt w

. as k ept i n

b ed th u s red u ci n g th e dem an d o n the weigh t carry i n g f unc

,

t i o n o f th e S p i n e Th i s an d th e p sy ch o l o gi cal i n fl u e n c e o f
.
,

tryi n g a n e w pl an u n d er Optim i s ti c ci r c u m st anc e s s e r v e d to ,

re d u ce th e n u mb e r an d c o mp l e x ity o f sympt o m s bu t i n n o ,

wi se ch an ge d th e ch ar acte r o r vi c i o us ne s s o f th e re acti o ns
, ,

ari si n g fr o m any di st u rb an c e o f th e a rti c u l ati o n b etwe e n th e

S i x th an d seve n th c e rvi cal verteb r ae .

86 PR I N C I PL E S O F O S TE O PA TH Y

u p o n e ach o th er i n an e ffo r t to ad apt th em se lve s to th i s

le si o n A S tim e we n t o n th e wh o l e b o dy w as e n g aged i n a
.

l o si n g e ff o r t at ad apt ati o n s i mp ly be c au s e th e l e s i o n are a

,

w as n eve r give n phy s i o lo gi c al re st 1 e eli mi n ati n g all de ,

. .
,
‘

m an d o n th e w e ig ht c ar r y i n g an d b alanc i n g f u n cti o n s o f th e
j o i nt The m an ip u l ati o n o f th i s S pi n al j o i n t w as also i n th e
.

n at u re o f phy s i o l o al a u ~
gi c re st be c se i t red u c e d th e hyp er
te ns i o n an d gr ad u ally ree st ab li sh e d n o rm al f u n ct i o n al m o v e
m e nt s .

F IG 10
. P y
a r a l s i s o f th e tr a p e i u s
. z
an d c l a v i c u l ar di vi s i o n of th e
'

s te r n o - c l e i d o - m a s to i d d u e to d e a th
of som e of th e c e n tr a l c e ll s o f
th e s p i n a l a cc e s s o r y
n e r ve .

In v o lv m e nt o f the C e n t r al Ne r v e C e lls —The

e t s tep n x

i n S everity i n l e s i o n s i s th e i n v o lv m e n t o f th e c o n te n t s o f th e
.
.

S pi n al c an al eith er th r o u gh dire c t i n v a si o n o f th e ti ss u e s o f
,

the c o rd o r by p re s su re du e t o d e str u c ti o n o f s e c ti o n s o f th e
-

S pi n al c o lu m n The p o i n t we wi s h to i llu str ate is th at th e

. .

di ag n o sti c i an m u st i n o rde r to do sc i e ntifi c w o rk rhak e a

, ,

di ag no si s b as ed o n th e f ac t s o f an at o my as i n terprete d by
e mb ry o l o gy I f sympt o m s were n o ted an d i n terprete d with
.

th e Sam e p re c i s i o n with whi ch th e tr o u b l e m an o n a tel e

”
ph o n e sy stem w o rk s o u t hi s p r o blem s we w o u ld n o t fi n d so i
 PRI N CIPLE S O F O S TE O PA TH Y 87

m any f an t as ti c m edi c al th e o ri es I t i s in large m e asu re th e

.
, ,

f ai lu re to te ac h th e f u n d ame n t a ls o f an at o my phy s i o lo gy ,

an d p ath o lo gy i n a t ho r o u gh m ann er th at i s re s p o n s ib l e fo r
'

h e v ag ar ie s i n m e di c al p r ac ti c e We ar e n o t f o rgetti n g th e
'

t .

F IG . 11 . A t r op h y of ri ght t r ap e zi u s .

f ac t t hat th e p u b li c i s n o t ed u c at e d to th i s view an d there ,

f o re th e o n e w ho attempt s to act i rre sp e c tive o f th e p u b li c s

,
’

s t ate o f ed u c ati o n has a har d r o w t o ho e

'

C e rv i cal M u scl e s —In th e fir s t ca se de sc ribed w her ei n ,

th e S err at u s M ag n us w as p ar alyze d we n o te d th at it te ,
-

c e iv e s i nn erv ati o n fr o m th e c ervi cal regi o n Th i s m ake s

i ts
'

it a c ervi cal m u s cl e In thi s s ame s e n s e th e tr ap ezi u s an d

.

l ati s sim u s d o r si ar e ce rvi c al m us c l e s an d wi ll n e c e s sari ly

e n ter i n t o any re acti o ns i n v o lvi n g th e s egm e n t s o f the S pi nal
co rd whi ch give o rigi n t o thei r n erve s In o rder to bri n g .

to y o u r atte n t i o n so m e o f t he s e p e c u li ar c h an ge s whi c h h ave

88 PR I NC I PL E S O F O S TE O PA TH Y

t ake n p lac e i n th e d eve lo p m e n t o f th e b o dy we wil l r evi ew ,

a few o f th e m o s t n o t ab l e whi ch wil l ai d u s i n th e i n te r r e

p
tati o n o f th e e ff e c t s o f l e s i o n s .

E m br y o l o gy —E mbry o l o gy i s th e hi st o l o gy o f very
We m
.

”
y o u n g bei n gs . ay q u e s ti o n h ere wh at c o nt rib u ti o n

F IG 12 S h ow s t
a r o ph y of ri gh t
t
.

r ap ez i u s .

th e st u dy of e m b ry o lo gy has m ad e whi ch has p r acti cal S i g

n i fi c an c e i n th e di ag n o s ti c a n d th er ap e u ti c w o rk o f o u r p r ae

S i n c e we h ave a divi s i o n o f l a
“ ”
ti ti o n e r s
. b o r as evi de nc ed ,

by a v ari ety o f ti s su e s h avi ng s p e c i al f u nc ti o ns an d s i nc e ,

s e l f pre s erv ati o n fo r p u rp o s e s O

-
f pe r pe tu ating or g ani sm s o f
-

a s im i lar c h ar ac te r i s a prim e req u i s ite o f l ife gr o u p s o f ti s ,

s u e s ar e as so c i ate d i n t o m e c h an i s m s Co mp ar at i ve embry
.

o lo gy has h e l p ed u s t o r ec o g n ize i n p art th e s e m e ch an i s m s

, ,
.

The re co g n iti o n o f th e s egm e n t al arr an gem e nt o f th e b o dy

i s o ne o f th e gre at c o n trib u ti o n s o f emb ry o l o gi st s .
 PRI N C IPL E S O F O S TE O PA TH Y .
89

m t t
S e g e a on
n i —E ar ly i n th e d evel o p me n t th e em of

br y o th e m e so d erm i c c e ll s On eith er s i de o f th e lo n git u di n al

gr o o ve S h o w tr anS v e r s e d ivi si o n s wh i ch f o rm a s eri e s o f s e g
'

m e n t s c all ed pr o t o ve r teb rae o r m e so derm i c so mite s With .

F IG 1 3;
. P y
ar a l s i s Of ri gh t t r ap e zi u s an d t
p o r i o n o f th e s t e r no
t
cl e i d o - m a s o i d .

out o ur g o i n g i nt o a l e n gthy d e s c ripti o n o f th e arr an gem e n t

o f th e m e s o dermi c c e lls t o fo rm t he spi n al co l u m n an d i ts
'

m u sc le s we w an t thi s e arly s eri e s o f divi s i o ns kept i n m i n d

, .

“
The app e ar an c e o f th e m e so d ermi c s o mite s i s an im
.

p o r t an t phe n o m e n o n i n the deve lo p m e n t o f th e e mbry o ,

s i n c e it i n fl u e n c e s f u n d am en t ally t
he f u t u re str u c t u re o f th e
o rg an i s m I f e ach p ai r o f m e so dermi c so m ite s b e re g ard ed
.

as an e l em e n t an d term e d a m et am e r e o r s egm e n t th e
]

n it ,

may b e s ai d th at th e b o dy is c o mp o s ed o f a s erie s o f m et a
m ere s e ach m o re o r le ss re s emb li n g i ts fe ll o w s an d Su cc ee d
, ,

in g o n e an o th e r at reg u lar i n terv al s E ac h so mite di ff ere n .

tiate s as has bee n s t ated i n t o a s c le r ato m e an d a my o t o m e

,
.

, ,

an d ac co rdi n g ly
,
th ere wi ll p ri m ari ly b e as m any ver
,

te br ae an d m u sc l e s egm e nt s as th ere ar e m e so dermi c ,

9O PR I N C I PL E S O F O S TE O PA TH Y

so mite s o r in o th e r w o rd s th e ax i al skel et o n and th e

, , ,

v o l u nt ary m u s cl e s o f th e tr u n k ar e p rim arily m et am eri c .

No r i s thi s all S i n c e e ach m et am ere i s a d i sti nc t u n it it

.
,

m us t p o ss e ss i ts o w n s u pp ly o i n utriti o n an d h e nce th e pr i
,
,

—
m ary arr ange m e n t o f th e bl o o d ve s se l s i s al so m et am e ri c a ,

b r anch p as si n g O ff o n eith e r s id e fr o m th e m ai n l o ngit u di n al

arteri e s an d ve i n s to e ac h m et am ere An d f u rth e r e ac h p ai r .
, ,

o f m u sc l e s egm e n t s re c e i ve s i t s o w n n e rve s s o th at th e a r.

r an gem e nt Of th e n erve s ag ai n i s di s ti n ctly m et am eri c

, ,
.

Thi s m et am eri s m i s m o st d i s ti nct i n th e n e c k an d tr u n k

“

regi o n s an d at fi r st o n ly i n th e d o r sal p o rti o n s o f th e s e r e

,
.

gi o n s th e ve n tr al po rti o n s sh o wi n g m et am eri s m o nly aft er

,

th e e x te n si o n i n t o th em o f th e my o t o me s Bu t th ere i s c l e ar .

evi d e n c e th at th e arr an g em e n t e x te n d s also i nto the he ad -

,

an d th at thi s l ike th e re s t o f th e b o dy i s to be reg ar d e d as

, ,

c o mp o s e d o f m et am e re s Th e re i s re aso n th eref o re fo r be
.
, ,

l i evi n g th at th e f u n d am e n t al arr an gem e n t o f all p art s o f th e

b o dy i s m et am eri c bu t th o u gh th i s arr an gem e n t i s c le ar ly
,

d efi n e d i n e ar ly embry o s it lo se s di sti n ct n e s s i n latter

,
.

p e ri o d s o f d eve lo pm e nt Bu t eve n i n th e ad u lt th e prim ary

.
,

m et am e ri s m i s clear ly i n di c ate d i n th e arr an gem e nt o f the

n erve s an d o f p a rt s o f th e ax i al s ke l et o n an d c aref u l s t ud y ,

fre q u e n t ly reve als i n di cati o n s o f it in high ly m o difie d m u s

c le s an d b lo o d ve ss e ls -

“
A lth o u gh th e d erm al m e s e n chym e is u n s egm e n t al i n
c h ar ac ter yet th e n erve s wh i ch se n d br an c h e s t
,
o it are se g

m e nt al an d it m i ght b e e x p e c te d th at i n di cati o ns o f t hi s co n
,

diti o n w o u l d b e ret ai n e d by th e c u t an e o us n e rve s eve n in , _

th e ad u l t A s t u dy o f the cu t an e o u s n erve supply in the -

a d u lt re al ize s to a ve ry c o n s i der ab l e e x t e n t thi s e x p e c t ati o n ,

th e are as su pp l ie d by th e v ari o u s n erve s f o rmi n g m o re o r

l e s s di sti nct z o ne s an d b ei ng th eref o re segm e nt al Bu t a , , .

c o n s i d er ab l e c o rnm i n g li n g o f adj ac e n t are as has al so o c

'

c u rred . Th u s wh il e th e di strib u ti o n o f th e c u t an e o u s
,

br an c h e s o f th e f o u rth th o r aci c n erve as dete r m i n e d e x pe r i ,

m e nt ally i n th e m o n key ( M acac u s ) i s di sti n ctly z o nal o r ,

s egm e n t al th e n ippl e lyi n g pr ac ti c ally i n th e middl e li n e o f

,
 PRI N C I PL E S O F O S TE O PA TH Y 91
’

th e z o n e ; th e upp e r h al f o f i ts are a i s al so su ppli e d o r o ver

‘

lapp e d by fib er s o f th e th ird n erve an d th e lo vVe r h alf by

fiber s o f th e fifth F i g 14 so th at an y are a o f s ki n i n th e
, .
,

z o n e i s i nn erv at ed by fiber s c o mi ng fr o m at l e as t t w o se g

F IG 14 S h ow i n g g
o v e r l ap p i n of
"

se gm en t
al se n sor y n e r ve s D r aw n b y
gton )
.

J
.

o h n C o m s to c k ( a f te r S h e r r i n
. .

m e nt al nerve s ( S herri n gt o n ) A n d f u rth erm o re th e di s

.
,

tr i bu ti o n o f e ac h n e r ve c r o s s e s th e m i d ve n tr al l i n e o f the -

m o re o r le ss e x te ns ive c r o s s ed o ve rlap .

“
An d n o t o n ly i s there a co n f u si o n o f adj ac e n t are as ,

but an ar ea may s hi ft i ts p o s iti o n re lative ly to th e deep e r

s tr u c t u re s s u ppl i ed by t he same n erve s o th at the sk i n o ver ,

a c ert ai n m u s c l e i s n o t n e c e s sari ly su pp l i e d by fib er s fr o m

th e ne r ve whi c h su pp l ie s the m u scl e Th u s i n th e lo wer .

,

half o f th e ab d o m e n th e s ki n at an y p o i n t wi ll be su pp li ed
,
i

by fib e r s fr o m high e r n erve s th an th o se s u pply i n g the u n

de r ly i n g m u sc le s ( S h erri n gt o n ) an d th e ski n o f th e limb s
,

m ay re c eive twigs f rom n erve s wh i ch ar e n o t rep re s e n ted at

all i n th e m u sc l e s u pp ly ( se c o n d an d thi rd th o r ac i c an d third
'

-
‘

Wi de spr e ad Infl u e nce a L

of — No s ki nS pi n al e si o n .

are a ( o r i n divid u al m u sc l e ) i s s upp l i ed wh o l ly by fibe r s fr o m

‘

o n e s e g m e nt o f the S pi n al c o rd bu t i n f ac t is i n n erv ate d by

, , ,

a n erv e m ade u p o f fib er s fr o m tw o o r m o re s egm e nt s A .

92 PR I N C I PL E S O F O S TE O PA TH Y

S pi nal l e si o n of
tr au m ati c o rigi n gr anti ng that o n ly o ne ar
,

ti c u lati o n is i nv o lved wi ll i n fl u e nc e i n s o m e case s wi del y

, , ,

s ep ar ated s tr u ct u re s F o r e x amp le : A l e si o n betwee n th e

.

f o u rth and fifth c ervi c al ve rteb r ae might i n fl u e nc e th e dia

phr ag m lati ss im u s d or si an d t r ap ezi u s an d th r o u gh th e
, ,

S pi n al ac c e ss o ry th e m u sc l e s o f th e lary nx S u ch app are nt .

ly wi dely s ep arate d str u ct u re s m u st b e kept i nm i n d wh e n

c o n s i de ri n g a l e s i o n at th e lo c ati o n u n de r di sc u ss i o n No r .

i s thi s e n o ugh b e cau s e s ki n are as m u st b e re c k o n ed with

, .

To le ar n th e s e ti ss u e ass o c i ati o n s thr o u gh the s tu dy ,

o f an at o my i s q u ite p o ss ib l e
, bu t e mb r y o l o gy f ur n i she s an
i nterp ret ati o n wh i ch te n d s to ke ep them in o n e s mi nd ’ ’
.

Wh e n we k no w th at th e di aphr agm tr ap ezi u s and l ati s sim us ,

'

d o r s i ar e e ss e n ti ally c ervi c al m u s c le s w h i ch h ave m igr ate d

bu t rem ai n u n de r th e c o n tr o l o f c ervi c al n erve s we c e as e to ,

th i n k o f o n e as th e d ivid i n g w all b etwee n th or ax an d abd o

-

m e n a gre at m u sc l e o f re spi r ati o n ; th e o th e r s as co n sti tu t

,

i n g th e fir st layer o f d o r s al m u sc l e s .

Ass o ciat i o n o f M u s cl e s Inne r vate d by the S am e Se g

me nt—S u c h str u ct u re s as we h av e j us t m e n ti o n ed have
, ,

migr ate d far fr o m th ei r o rigi n al s egm e n t s an d hav e t ake n

.

o n f u n c ti o n s an d ar e c o n c er ne d i n re ac ti o n s whi ch ar e n o

l o n ge r s egm e n t al but h ave fo r th e 1 r a1m the pr e se r vati o n o f

'

th e wh o l e b o dy h e n c e any i n j u ry to o n e o r all o f th e m
'

, , ,

w o u l d te n d to pr o d u c e a re fle x l o calize d i n th e segme nt f r o m
wh i ch th ey re c eived th e ir i nn erv ati o n Co mpar e w ith t he se .
l

migr ate d str u ct u re s a s egm e nt al m u scl e o f p rimitive char ac

ter like th e i n te r transve r sali s o r i nter s p i n al i s The i n flu ence .

o f th e s e pr 1 m 1t 1v e m u sc l e s i s wh o lly o n th e o n e arti c u l ati o n

'
'

bu t th ey ar e p art o f th e m e ch an i s m su ppli e d fr o m th e same -

s egm e n t as th e m igr ate d m u sc l e s The se s m all m usc l e s.

,

wh i ch ar e th e i n tri ns i c m u s c l e s o f th e spi nal ar th r o di al

j o i nt s ar e imp o rt an t p rim e m o ve r s i n th e e ffo rt to in aintain
'

th e ere ct p o s iti o n i e th ey e nte r i nt o th e wei ght carryi ng

,
. .
,

an d b alan c i n g f u n c ti o n s o f th e sp i nal c o l u mn In cas e o f .

th ei r i nj u ry a S pi n al le si o n th e lo st m o ti o n i n th e j o i n t
, ,
.

c au s e s w ide sp re ad i n fl u e n c e s as h eret o f o r e m e n ti o n ed
, The .
 P R I N C I P L ES O F O S TE O PA TH Y
'

94

ar e th u s d e sc rib ed by M c M u r r i ch : I t m ay b e see n th at th e
c h an ge s wh i c h o cc u r i n th e my ot o m e s m a b e refe rred to
y
o n e o r m o re o f th e f o ll o wi n g pr o c e ss e s
“
1 A l o n git u di nal S p litti n g i nt o tw o o r m o r e p o rti o ns
‘

.
,

a p r o c e s s wel l i llu str at e d by th e tr ap ez i us an d ste r no m as

to i d wh i ch h ave di ff ere n t i ated by th e l o n git u di nal spl itti ng '

o f a s i n gl e sh eet an d c o n t ai n th eref o re porti o n s o f th e sam e , ,

my o t o m e s The S ter no hy o id has al so di ff e re nti ated by the

.
-

sam e p r oc e ss an d i n d ee d it is o f fre q u e n t o cc u rre n c e

‘

, , .

“
2 A t ange n ti al s pl it ti n g i n t o tw o o r m o r e l ay e r s
. .

E x amp l e s o f th i s are al so ab u n d an t an d ar e aff o rde d by th e

m u s c l e s o f th e f o u rth fifth and s i xth l ay er s o f th e b ac k as
, ,

re co g n iz e d i n E n gl i sh te x tb o o k s o f an at o my ; by th e tw o
o b l i q u e an d tr an sve r s e la er s o f rt m
y h b d i l w ll d
‘

e a o na a s an

by the i n te r co stal m u scle s and th e tr ansv er su s o f th e t ho r ax

‘
'

“
3 A f u s i o n o f p o r ti o n s o f su c c e s s i ve my o t o m e s to
.
.

f o rm a S i n g l e m u scl e ag ai n a pr o ce S S o f fr eq u ent o cc u r
'
' '

,
‘

re n c e an d well i ll ustr ate d by th e re c t u s abdo m 1n 1s ( whi c h

,

i s f o rm e d by th e f u si o n o f th e ve n tr al p o rti o n s o f th e l ast six

o r s eve n t ho r ac i c my o t o m e s) an d by t he s u p erfi c i al po rti o n s
o f th e ere c t o r sp l n ae .

A migr ati o n o f p ar ts o f one o r m o re my o t om e s o ve r

‘

o th er s An e x amp le o f th i s p r o c es s i S tO b e f o u n d in th e
.
‘

latiss i m i s d o r s i wh o se h i st o ry has alre a dy b ee n r eferre d to ,

an d it i s als o be au tif u l ly sh o w n by th e s err at u s an teri o r an d

th e tr ap ezi u s b o th Of wh i ch h ave e x te n d e d far b ey o nd th e

,

l im it s o f th e seg me n t s fr om whi c h th ey ar e de rived .

“
5 A dege n e r ati o n o f p o rti o n s o r th e wh o l e o f a m y o
.

t o m e Thi s p r o c e s s has pl aye d a ve ry c o n si derabl e p art i n

.

t he ev o luti o n o f th e m u sc u l ar sy ste m i n th e v e r te br ate sl

Wh e n a m u s c l e no rm ally dege n er at es it be co m e s c o nve rted ,

i n t o c o nn e c tiv e ti ss u e an d m any o f th e str o n g ap o n e u ro ti c

,

S h e et s wh i ch o cc u r i n th e b o dy o w e th ei r o rigi n t o thi s pr o

c e ss . Th u s fo r e x ampl e th e ap o n e ur o si s c o n n e c ti n g the
, , ,

o c c ipit al an d fr o nt al p o rti o n s o f th e o c c 1pi t o fr o n t al i s IS du e -

to th i s pr oc e s s an d i s m u s c u l ar i n s u ch f o rm s as th e l o wer
m o n key s an d a g o o d e xam pl e i s also to b e f o u n d i n th e apo
,
 PR I N C I P LE S O F O S TE P O ATH Y 95

e r
n u os s i whi ch o cc u pi e s th e i n terv al b etwee n th e s u p e r i o r
an d i n feri o r s er r ati po s ti c i th e s e tw o m u sc l e s b ei n g c o n ti n ,

u o u s i n l o we r f o rm s The s tr o n g l u mb ar ap o n e u r o s i s o f the
.

Obli q u e an d tr ans ve r se m u sc l e s o f th e abd o m e n ar e al so g o o d

'

e x amp l e s .

“
I n d eed in co mp ari ng o n e o f th e m amm al s wi t
,
h a m em
be r o f o n e o f th e lo wer c lass e s o f vertebr ate s t hégre ate r
'

am o u n t o f c o nn e ctive ti ss ue c o mp are d with am o u n t o f

th e _

m u sc u lar ti s sue i n th e f o rm er i s very s triki n g th e i n fere nc e

-
,
‘ -
,

be i n g th at the s e c o nn e ctiv e ti ss u e str u c t u re s ( f asci ae apo -

n e u ros i s lig am e n t s ) r ep re s e n t p o rti o n s o f th e m u sc u l ar ti s

,

su e o f th e lo wer f o rm ( Bar de le b e n ) M an y o f the acc e sso ry

l ig am
.

e n t s o cc u r r i n g l n co nn e cti o n wit h di ar thr o di al j o i n t s ,

app are n tly o w e th ei r o rigi n to a d ege n er ati o n o f m u s c l e ti s

th e fi bu lar later al l igam e n t o f th e k n e e j o i n t fo r i n

‘

su e, ,

St an c e b ei n g p ro b ably a d ege n er ate d p o rti on o f the p er

,

o n e o u s l o ng u s wh il e th e s ac r o tu bu r o u s l ig ame n t app e ar s
,
-

to s t an d i n a s im i lar r e lati o n to th e l o n g h e ad o f th e bi c ep s
fem o ri s ( S u tt o n ) .

Fi n al ly th e r e m ay b e ass o c i ate d with an y o f th e fi r st

“ '

f o u r p ro c e s se s a ch an ge i n th e dire cti o n o f the m u scl e fi be r s

‘

-
.

The o rig in al an te r o p o s teri o r di re cti o n o f th e fiber s i s r e

-

é
tai n e d i n co mp ar ative ly few o f th e ad u lt m u s c l e s an d e x c el
le n t e x a m p l e s o f th e pr o c e s s h ere referre d to ar e to be f o u n d
'

i n th e i n ter co s t al m u s c l e s an d th e m u s c l e s o f th e ab do m 1n al ,

w alls In th e m u sc u lat u re as so c i ate d w

. ith th e b a n c hi al r

a r c h e s th e alt er ati o n i n th e dire c ti o n o f th e fib er s o c c u r s

eve n i n the fi sh e s in wh i ch th e o rigi nal dire c ti o n o f th e

,
.

—
m u scl e fi be r s 1 8 very p erfe c tly ret ai n e d i n o th er my o t o m e s ,

th e br an chi al m u sc l e s h o wev er b ei n g arr an ged p ar alle l

“
“

, ,

with th e b r an ch i al c arti lage s o r eve n p as s i n g d o r s o v e n -

tr ally b etwe e n t he u ppe r an d lo wer p o rti o n s o f an ar ch an d

'

s o f o rm i n g wh at m ay be r eg arde d as a c o n stri c to r o f th e
ar c h .Thi s alter ati o n o f dire c ti o n d ate s b ac k s o far th at
th e c o n stri c t o r arran gem e n t m ay we ll b e t ake n as th e pr 1
m ar y co n diti o ns i n st u dyi n g th e ch an ge s wh i ch the br an ch i al
'

m u s cu lat u re has u n derg o n e i n th e m amm ali a .

96 PR I N C I PL E S O F O S TE O PA TH Y

P l e ase n o te th at si n c e th e re lati o n betw ee n a n erve

,

an d th e my o t o m e b el o n gi n g to th e s am e i s e s t ab l i sh e d at a

v ery e ar ly p eri o d o f d eve lo pm e n t an d p er si st s th r o u gh o u t

l i fe n o m atte r wh at c h an ge s o f f u si o n splitti ng o r m igr a
, ,

ti o n th e my o t o m e m ay u n d erg o it i s p o ssibl e to tr ac e o u t
,

m o re o r le s s co mp l ete ly th e h i st o ry o f th e v ari o u s my ot o m e s
”
by dete rm i n i ng th ei r s egm e n t al i n n e rv ati o n In vi ew o f thi s
.

th e c li n i ci an o u ght to b e we ll ve r sed i n the k n o w ledge o f an

at o my i e
, . . th e gr o s s str u ct u re s i nn erv ated fr o m th e sam e
,

s egm e n t o f th e c o rd M u ch o f th e phy si c al di ag no st i c w o rk
.

o f th e o ste o p ath i s b as e d o n th e f u n d ame n t al f ac t s o f em

b ry o lo gy an d an at o my i e m et am e ri s m
, . .
, .
 PR I N C I PL E S O F O S T E O PA TH Y 97

C HAP TE R V I .

TH E NE R V O U S S Y S TE M .

The M e di um o f C om mu n i cati o n —A m as terf u l k n o w l

.

edge o f n erve ti s su e an d its arr an gem e n t i n th e b o dy to f o rm

th e n erv o u s sys tem i s an ab so lu te p rereq u i s ite fo r s u cc e ss
i n o ste o p athi c pr ac ti c e .E very vit al ph e n o m e n o n c alls fo r
i n terp ret ati o n by th e ski llf u l phy s i c i an I n terp r et ati o n c an
.

n o t b e attempte d with o u t a defi n ite k n o w l edge o f str u c t u re

an d f u n c ti o n o f th a t ti ss u e whi ch ac t s a s a m edi u m o f c o m

m u n i cati o n b etwe e n all o th er e l eme n t s o f th e b o dy .

The nam e o f o u r sy stem O s t e o p athy cal ls atte n t i o n

, ,

p rim ar i ly to o s s e o u s str u ct u re bu t it i s o n ly 1n c o nn e cti o n

,

with i ts e ff e ct s o n th e ti ss u e s o f c o mm u n i c ati o n an d e x
ch an ge vit al ph e n o m e n a we ar e ac t u ally i n tere s ted
, ,
.

The Attr i bute s o f Ne r v e Ti ssu e — A l l phy si o lo gi c al

' ‘

ph e no me n a ar e ch ar ac te ri z e d by th e m an ife st ati o n o f at
trib u te s o f n erve ti s su e r r i tab ili ty c o n d u c tivity an d tr o
'

, ,

p hi c i ty
. M o ti o n s e n,sati o n an d n u triti o n ar e th e vit al ph e

n o m e n a wh o s e p er ve r si o n c o n s tit u te s d i s e as e The ref o re .

,

wh atever the p ath o lo gi c al c o n d iti o n m ay b e we ar e c alled ,

u p o n to n o te a ch an ge i n s o m e o n e o r all o f th e s e attrib u te s
'

o f n e r v e ti ss u e .

Ne r v e an d M u scl e Ir r it abi l it y — S c arc e ly any th ou ght

.

o f m u s c l e i s eve r c o mp l ete with o u t th e n erve imp u l s e whi c h

c o n tr o l s th e m u sc l e i s al s o c o n s idered F o r c o nve n ie n c e sake

.

we may s ep ar ate n erve an d m u s cl e wh e n te achi n g th ei r S pe

ci al attrib ute s, b u t f o r all pr ac ti cal p u rp o s e s th ey ar e n ever

s ep ar ated . M u scl e an d n erve ar e b o th i rri t ab l e bu t we pay ,

n o atte n ti o n to th e i rrit abi l ity o f m u sc l e b e c au s e u n de r n o r .

m al co n diti o ns we do n o t s e e an y evi de n c e s o f sp e c ifi c m u s
93 PR I N C IPL E S O F O S TE O PA TH Y

c u lar i rrit abi lity We vi ew m u sc u lar i rrit abi lity a s th e r e

.

s u lt o f n e rve i rrit abi lity Th eref o re n erve ti ss u e IS th e ch ief

.

i rrit abl e ti ss u e I r rit abi lity i s an attrib u te o f c e ll pr o t o

.

pl asm wh e reby ch em i cal an d phy si cal ph e n o m e na ar e e n

acte d i n re s p o n s e to i rrit an t s I rrit ant s m ay b e m e ch an i cal
.
,

c h em i c al th erm al an d e l e c tri c al
, P r ac ti c ally all th at phy s i
.

o lo gi st s k n o w o f th e re acti o n s o f n e rve ti s s u e t o i rrit an t s has

be e n d erive d th r o u gh e x p e ri m e nt ati o n by m e an s o f th e e l e c “

tr i c al c u rre n t . O st e o p ath i s t s ar e bri n gi n g to l ight m an y

f ac t s co n c er ni n g m e c h an i c al s ti m u lati o n H ydr o th er api st s .

h ave d em o n str ated th e u ti lity o f th e rm al sti m u l i D rug .

th er apy m ake s u s e o f th e ch em i c al f o rm o f sti m u l ati o n

,
.

Co ndu c ti v i ty Nerve ti s s u e 1 5 n o t o n ly i rrit abl e bu t

'

-
.

p o s se s se s th e ab i lity to tr ans mit i ts i rrit ability to o th er US

su e s an d c au s e c ert ai n ac tiviti e s t o b e i n i ti ate d th ere ; Co n
du c ti v i ty th e s e co n d vit al attrib u te o f n erve ti ss u e i s th e
, ,

p o wer to c arry imp u ls e s fr o m th e p o i n t o f i rrit ati o n to o th e r

p o i nt s i n th e n e rv o u s sy stem I rrit ability w o u l d b e o f sm all
.

m o m e n t i f c o n d u c tivity w e r e : n o t pre s e n t to tr an s m it th e
m e s sage to th e c e n ter an d ar o u s e re s p o n s e The n erve c e ll .

—
an d i ts ax i s cy li nd er ar e a c o n ti nu o u s m as s o f p r o t o pl asm
"

an d as l o n g as th e c o n ti n u ity i s m ai n t ai n ed co n d u ctivi t
.

y wil l
be m ai n t ai n ed .

Tr o phi c tyi —
. The th i rd attrib u t e o f n erv e ti s su e tr o ,

p h i c i t
,y i s v ery i mp e rfe c t ly u n der s t o o d We d o n .o t u s e th i s

term h ere to rep re s e n t so m u c h th e n u triti o n al i nfl ue n c e s o f

th e c e ll b o dy o ve r its ax i s cy lin d e r as th e i n fl u e n c e e x erted
- -

by n erve ti ssu e o ver o th e r b o dy ti ssu e s c au s i ng th em to ,

gr o w an d p r o sp er Th i s n u triti o nal i n fl u e n c e o ver o t her

.

ti s su e s i s an attrib u te wh i ch we ar e c o mp el led to n o te q u ite

fre q u e nt ly i n p rac ti c e Th ere ar e i n divi d u al s i n wh o m m o ti o n
.

an d s e n s ati o n ar e n o rm al bu t n u triti o n f ail s h e n c e w e n o te ,

th at i n so m e c ase s m e ch an i cal l e s i o n s m ay c au s e o n ly a
s light c h an ge i n th e n erve ti ss u e u p o n whi c h th ey imp i n ge ,

an d th i s ch an ge i s m an i fe s ted by v ari ati o n i n n u triti o n o f

'

th e p art co ntr o ll e d by th e irrit ated n e rve I t i s p r o b ably .

th i s attrib u te o f n e rve ti ssu e whi ch is p erverted o r l o st wh e n

-
 P RI N C I PL E S O F O S TE O PA TH Y 99

th e ti s su e s ref u s e to t ake u p c ert ai n ch em i cal e l em e nt s wh i ch

ar e o rdi n ari ly n o rm al to th em ; fo r e x amp l e i r o n In o st eo , .

p athi c pr ac ti c e w e c o n s id er n u triti on al d i so rder s as bei n g

'

the r e su lt o f p erve rted tr o phi c i n fl u e n c e o f n erve s O f c o u r s e

'

i n cas e s wh ere it i s k n o w n th at th e i n ge ste d fo o d do e s n o t

'
'

c o n t ai n th e req u i red e l e m e n t o r e le m e n t s we m us t r eg u late

th e diet Bu t th ere ar e m any c as e s wh ere all co n di ti o n s ap

.
'

pe ar n o rm al e x c ept th at th e ti ss u e s do n o t t ake u p n o u ri sh
,

m e n t as the y s ho u ld In th e s e c ase s we s e ar ch fo r l e s i o n s
.
,
‘

i n the s am e w ay we w o u ld i f m o ti o n o r s e n sati o n sh o wed

p er ve r si o n o r lo ss Thi s ph as e o f o u r su bj e c t can b e st b e
.
.

c o n s i dere d at an o th ertim e .

—
U ni ty o f the Ne r v ou s S y ste m The u n ity o f th e n erv o u s .

s y s tem i s a phy s i o l o gi c al f ac t an d thi s b ri n g s d e ep an d

,

s u p erfi c i al are as i n c l o se re lati o n E very p o rti o n o f th e b o dy

.

i s ab l e thr o u gh th e medi u m o f th e n erv o u s sy stem to w o rk

i n h arm o n y with every o th er p art P hy s i o lo gi st s divi de the .

n erv o u s sy s te m i n t o c e n tr al an d pe riph e r al p o rti o n s bu t ,

fo r p racti c al p u rp o s e s th i s divi s i on i s o f l itt l e u s e to u s wh e n

attempt in g to m ake u s e o f th e irrit abi l ity an d c o n d u c tivity

of t he n e rv o u s sy s tem fo r th er ap e u ti c p u r po s e s S i n c e all .

p o r ti o n s o f t
he n e rv o u s s y s tem ar e c o n n e c ted th ere m u s t be
so m e p lac e wh e re i mp re ss i o ns m ad e u p o n termi n al n erve

fil am e n t s m ay be as se m b led co o rdi nate d an d re s p o n d e d to

,
-

h arm o n i o u s ly Whe rever large n u mber s o f n erve c el ls ar e

.

as semb l e d we ex p e c t to fi n d s u ch d u tie s p erf o rm ed

O the r S y s t em s o f Inte g r at i o n —An y i n fl u e n c e whi ch we

.

h ave u p o n th e b o dy th r o ugh th er ap e u ti c m eth o d s m u st b e

b as ed o n th e u n ity o f th e b o dy Th at th e b o dy i s a u n it .

m u st b e co n st ant ly b o r n e 1n m 1n d n o t o n ly a u n i t be c au s e ,

o f th e n erv o u s sy s tem bu t al so a m e ch an i c al u n it f o rm ed by ,

i ts fibr o u s ti ss u e s an d a c h emi c al u n it th r o u gh i ts c i r c u lati n g

m ed ia The n erv o u s sy st em i s s o p reem i n e n t ly the m aster
.

t issu e th at Wh e n we th i n k o f an y i ntegr ative r eacti o n we

, ,

attr i bu t whi ch n o t o n ly t ake s n o t e o f i m

'

e it to th i s ti ss u e ,

pre ss i o n s se c u red by c o n t act bu t re ach e s o u t i n t o su rr o un d

i n g sp ac e an d cau s e s the b o dy to re ac t to thi ng s ata di st an c e
'

.
.
100 PR I N C I PL E S O F O S TE O PA TH Y

M e chani cal I r r it ati o n —The p arti c u lar th er ape u ti c

.
p r o

ce du r e s with wh i ch we ar e h ere de ali ng ar e aim e d to aff e ct

by c o n t ac t an d h e nc e w e ar e m o st i ntere ste d i n th o se r e
.

fl e x e s o rigi n ati n g th r o u gh s ti m u li app li e d to ski n vi sceral ,

an d s o m ati c ti s s u e s .S tr u ct u r al di s p lac em e n t s i n th e h u m an
b o dy ac t as m e ch an i cal i rrit an t s to n erve ti s su e c h an gi n g
-
,

th e ch e mi cal an d phy si cal c o n d iti o n o f th e p r o t o p las m an d

th u s alte ri n g i ts i rrit ab i lity eith e r p lu s o r m i n u s acc o rdi n g
,

to th e i n te n s ity o f th e sti m u lati o n The di s pl ac e d str u c t u re s

.

m ay h ave o th er d etri m e n t al i n fl u e n c e s o n n erve ti ss u e f o r ,

i n st an c e th e p re s su re br o u ght to be ar o n th e n o u ri sh i n g
li q u id s s u rr o u n d i n g th e n erve i e th e b lo o d an d lymph
, . .
, ,

m ay cau s e s u ffi c i e n t Ch em i c al ch an ge i n th e s e li q u id s to
m ateri ally aff e ct i rrit ability o f th e p r o t o p lasm o f th e n e rve s
whi ch th ey ar e e x p e cte d to n ou ri sh .

E ff e c t o n C o n du cti v it y — C o n d u c tivity i s n o t de s tr o yed

.

by th e se s l ight m e ch an i c al p re ssu re s I f th e p r o t o p lasm o f .

th e c e ll an d ax i s cy li n d er were u n ab le to co n d u ct imp ul s e s
-

an d p r o j e c t th em i n s u c h m an n e r as to re ach o th er c e l l

b o di e s o f th e n er v o u s sy stem o u r w o rk w o u l d b e very lim

it ed . Co n d u c tivity depe n d s o n th e c o n ti n u ity o f p r o t o plas m .

The m e c h an i cal i rrit ati o n s we d e al with i n o ste o p ath i c pr ac

ti c e sel d o m d e str o y c o n d u ctivity If they di d so th ey w o u l d
.

c e a s e to b e c o m e i rrit an t s th e m o m e n t c o n d u c tivity w as l o st .

O th er i rrit an t s m ay act fo r a ti m e o n the s ev ered p o rti o n s o f

p r o t o p las m bu t th e o rigi n al l e s i o n w o u ld h ave de str o yed
,

th e co n ti n u ity o f th e p r o t o p las m .

Aff e r e nt an d E ff e r e n t F i b e r s —The fiber s co mp o si n g a

n erve b u n dl e m ay b e e ff ere n t o r aff e re n t s o far as dire cti o n

o f i mp u l s e i s c o n c er n ed . E ff ere n t fiber s m ay be f u rth er d if

fe r e n tiate d by th e n ame s m o t o r v as o m o t o r s e c ret o ry ac
, ,
-

, ,

c o rdi n g to th e str u c t u re s i n whi c h th ey e n d Aff ere n t fibe r s .

ar e u su ally te rm ed s e n so ry to d e n o te th eir f u n c ti o n o f carry

i n g i mp u ls e s to th e c e n tr al n erv o u s sy s tem Nerve tr u n k s .

co n t ai n al l o f th e s e v ari o u s fib er s th e ref o re ,
p re ss u re will ,

i rrit ate all o f th e fib er s an d co n du ctiv ity o f i n divid u al fiber s

wi ll tr an sm it th e imp uls e s i n th e dire c ti o n o f the n o rm al
10 2 P R I N C I PL E S O F O S TE O PA TH Y

l ntem al cut
-
aneous N
t
.

Lesser i n ernal cutaneousN .

Ibo hy pogastmc N
-
.

1Lto mgu mal N

-
.

Extcut
.aneo u s N .

~~
G emto ~cr ur a1 N .

Anterior
Ob tu r a lo r N .

su pe r i or gl u tea l N
.

to py ifo r m i s r
Nto gemel lus su erior
.
.

p
-

Hto gemellua i nfer ior

N to ouad ratus
.

F IG 15 D i ag r a m of s p i n al se gm e nta ti g lati n b tw n th
on , sh o win re o e ee e
ri g i n f m g n
.

t p i nt
.

p oin s of o o the p i n al n
s v a n d th i
er es f e r o s o e er e ce
f ro m th e p i n al
s co lu m n ; a l th i
so d i t i b u ti n t
e r th mu l
s r o o e sc e s
by J hn C m t k ( a ft t Th ma m di fi d b y
.

ran D j in
gtarri
/ i o o s oc er e er e e o s, o e
 PRI N C I PL E S O F O S T E O PA TH Y 10 3

sp i nal c o rd imp u l s e s ar e d i ff u s ed b o th ab o ve an d b e lo w th e
p o i n t o f e ntr an c e The c e ll b o di e s o f the an teri o r r o o t s ar e
.

al s o s o m ewh at di ff u s ed bu t i n p r ac ti c e we n o te th at aff ere nt

,

an d e ff e re n t imp u l s e s s e e m to b e c o rre late d withi n co mp ar a

’

ti v e ly na rr o w li mit s i n th e S pi n al c o rd H o w th e imp u ls e s .

se t u p i n th e p r o t o p las m o f an aff ere n t fibe r ar e tran s m itte d

fr o m it to th e p r o t o p las m o f o th e r ce ll s l o cate d i n th e S p i nal

c o rd an d th e n c e tr an s m itted t o th e pr o t o plasm o f e ff e re n t ,

c e ll s i s n o t k now n n o r i s it n e c e ss ary fo r u s to th o r o u ghly

,

u n der s t an d th e meth od i n thi s i n s t an c e so l o n g as we r e c o g -

F IG . 16 . D i ag r am sh o w i n g tw o se g m nt
e s of th e S p i nal co r d .

n iz e th e re s u lt s O u r sp e c ifi c k n o w le dge m u st co mp reh e n d
.

th e e x ac t p o i n t o f e n tr an c e to an d e x it fr o m th e s pi nal c o rd .

o f e ac h n erve b u n d l e an d th e p e riph er al di strib u ti o n o f th e

sam e H avi ng a k n o w l edge o f th e str u ct u re th e f u n cti o n

.
,

c o me s n at u r ally a s a re su lt .

S e gm e ntal Inte g r ati o n — A s egm e n t o f th e S pi n al c o rd ,

i e th at p o rti o n givi n g ri s e to a p air o f spi nal n erve s m

. .
,
ay

b e c o n c eive d to act i n de pe n de ntly o f oth er segm e n t s O f

c o u r se it w o u l d b e di ffi c u l t to de m o n s tr ate thi s bu t fo r pu r ,

p o s e s o f an aly s i s we m ay b e permitted to s egreg ate th e

v ari o u s divi si o ns an d n erv o u s e le me n t s so as to bette r u n
de r s tan d th e s tr u c t u re s with whi ch we ar e de ali n g The .
.
104 PR I N C I PL E S O F O S TE O PA TH Y

c e ntr al n e rv o u s sy ste m i s co n st an t ly re c eivi n g imp u ls e s

fr o m aff e re n t fiber s an d co o rd i nati n g th em We ar e a l m o s t
-
.

e nti rely d ep e n d e nt o n refl e x acti o n fo r th e e ff e ct s we s e cu re

o n d eep ti s su e s O u r m an ip u lati o n s aff e c t s e n so ry n e rve s i n
.

n er ve

Mu scle
F IG 17 D i ag r a m m ati c r e p r e s e nta ti o n of a si n gl e S p i n al se gm nt
e a nd a
s i m p l e r e fl e x ar c D r aw n b y Jo h n k
. .

. C o m s to c .

ski n m u s cl e an d sy n o vi al m embr an e s Th e se i mp u l s e s ar e
, .

c arri e d t o th e c e n tr al n erv o u s sy stem an d tr an s f o rm ed i n t o

e ff e re n t i mp u l se s
C e as e le ss P l ay o f R e fl e x e s —D u ri n g l i fe th ere i s n o
.

p eri o d wh e n th e b o dy i s no t dep e nd e n t o n e x t er nal stim u l i .

Th e se o rdi nary m e ch ani cal an d th erm al stim u li keep a co n

s t an t s tre am o f i mp u l se s e n teri n g th e c e n tr al sy s tem t o be

tr ansl ated i nt o sti m u li o f m u sc le an d gl an d Thi s c e asel e s s .

1 06 PR I NC I PL E S O F O S TE O PA TH Y

a defi n ite c u t an e o us are a ar e i nn e rv ate d fr o m a li mit ed po r

ti o n o f th e c e ntr al sy ste m Th eref o re we may co u nt o n th e
.

stim u l i o rigi nated i n th e c u t an e o u s are a bei n g r e fl e x e d t o

th e d efi n ite m u scu l ar are a .

E x am pl e —An e x am pl e i n p r ac ti c e i s as f o ll o w s : P a
ti e nt s h e ad i s dr aw n S lightly to th e left si de Co m plai ns o f
’
.

p ai n s h o o ti n g to th e l ef t S h o u ld e r and o ve r th e l eft clavi cl e

wh e n ever m o vem e n t i s attempte d H i st o ry o f e x p o su re to
.

dr au ght o f co l d ai r P hy s i cal e xami nati o n d i sc lo s e s co n

.

tr ac ti o n o f l eft tr ap ezi u s l ev at o r an g u li scap u l ae an d se a

,

le ni . P re ssu re u pon th e s e m u sc le s c aus e s p ai n Wh e n i h .

str u c te d to t ake a f u ll i ns pi r at i o n p ati e nt say s h e can no t on

,

ac c o u n t o f p ai n wh i c h i s sh arp an d d arti n g 1 n c h arac te r an d

,

r ad i ate s o ve r th e i n tr aclavi cu lar p o rti o n o f the l eft c h e st .

Wh e n we co ns ider th e m u sc l e s i nv o l v ed an d th e are a o f
p ai n f u l s e n sati o n s o u r atte n ti o n i s i m m e di ate ly called to a
,

defi n ite segm e n t o f th e c o rd i n thi s c as e th e p o i nt o f o r i g i n

,

o f th e thi rd an d f o u rt h c ervi c al n erve s The c o l d air s tri ki n g

.

th e ski n i nte n sifi e d th e n o r m al s ti m u li an d th e e ff ere nt i m

.

p ul s e s fr o m th at S egm e nt o f th e co rd were i nte n sifie d as th e

dire c t r e su lt o f the cu t an e o u s i rritati o n The p o i n t of irrit a
.

ti o n th e cu t an e o us are a g o ver ne d th e lo cati o n o f th e refl e x

, , .

S o l o n g as th e o r igi nal sti mu l u s w as o n ly m o d er ately i mte n

s i fi e d all th e refl e x e s em an ated fr o m o n e s egme n t o f th e co rd ,

bu t if th ey had b e e n m o r e i n te n s e o r co n ti n u e d lo n ge r w e ,

might have f o u n d a gre ate r are a r e fl e x ly aff e cted The stim .

u li whi ch w o u l d h ave re ac h ed th e c ord w o u l d h ave b ee n

m o r e Widely di ffus e d ab o ve an d b e lo w th e p o i nt o f e n tr anc e

—
.

C o m par ati ve S e g m e t
n at i o n S i n c e w e k n o w th at th e
.

highly o rgan iz ed S p i nal co rd o f m an i s n o t to b e co mpared

with the sam e str u c t u re i n lo we r f o rm s o f an i m al life an d ‘

th at s egm e nt ati o n i n it i s i lly defi n e d th e p r acti cal q u e sti o n

,

ari s e s as to ho w m u ch dep e n de nc e we c an pu t u p o n refl e x e s .

i n th e h u m an n erv o u s sy stem Will th e refl e x e s g u ide u s to

.

d efi n ite s egm e nt s o f th e S pi nal co rd ? E x perie nc e te ach e s u s

th at a th o r o ugh k no wl edge o f th e di strib u ti o n o f aff ere n t
an d e ffe re n t n erve s i n m an wi ll i n t erp ret refle x e s with su ffi
 PRI N C I P LE S o r O S TE O PA TH Y 10 7

c i e n t e x ac t n e s s an d i nv ari ab ly le ad th e i nve stig at o r to a

s pi n al s egme n t whi ch i s it s elf aff e cted o r i s co o rdi n ati n g i m

p u l se s fr o m a k n o w n s e nso ry are a .

E ff e r e nt Im pu ls e s .
—Whe n we f o llo w th e e ff ere n t im
p u ls e s to their p o i nt s o f di st r ib u ti o n o u r w o r k i s gre at ly h

co mp l i c ated To r e a so n fr o m c o n tr acted v o lu n taf y m u scl e

.

to c u t an e o u s s e n s o ry are a i s a co mp ar atively s imp l e pro

c e du r e ,
bu t to s t art with th e se n so ry i mp u ls e an d tr ac e it
thr oug h th e c e n tr al sy s t em an d th e n c e alo n g e ff ere n t p ath
w ay s to estim ate i ts fi n al e ff e ct s as m e ch an i cal w o rk d o n e
, ,

by m usc le and g lan d i n m any comb i nati o ns re q u i re s a c o n ,

si de r abl e k n o w l edge o f s tr u c t u re an d f u n c ti o n o f all p art s o f

the h u m an sy s t em .

E ff e r e nt F i be r s to the S y m pathe ti c G angli a .

—M any of

the e ff ere n t fibe r s o f th e c e r eb r o spi nal sy stem -

t ake th ei r
c o u r s e th r o u gh th e sy mp at heti c g an gli a an d are di st r ib u te d

i n th at sy stem to pl ai n m u s cl e an d s e c ret o ry c e ll s o f th e
b o dy I t has b ee n asc e rt ai n ed by v ari o u s caref u l o b s erver s
.

th at th e se e ff e re n t fib er s after e n teri n g th e s ymp atheti c

,

sy stem eith e r e n d i n t
,
he g an g li a n e ar e s t th eir p o i n t o f em er
ge nc e fr o m th e c o rd o r p as s u p o r d o w n to gan g li a ab o v e o r
b el o w th e o n e o r igi n ally e n tered S o m e fiber s p ass th r o u gh
.

t he se g ang li a an d e n d i n th e m o re p eriph er ally p lac ed .

pl e x u se s .

G angli o ni c C o ntr o l .
—Wh ereveerve c e lls ar e acc u m u
r n

late d a c e rtai n amo u n t o f i n d ep e n de n t ac ti o n i s p r o b ab ly

"

carr ied o n . Te rmi nal fil ame n t s o f e ff ere n t fib er s i n symp a

t heti c S p i nal gan g li a ar e i n re lati o n with a large n u mb er o f
c e l l s an d t he n u mb e r o f fiber s l e avi n g th e g an g li a i s gre ate r
t han th o s e e nteri n g Th eref o re di ff u si o n o f imp u ls e s fr o m
.

t he s e g an gli a m u st b e very gre at The acc u m u lati o n o f .

s e n so r y imp ul s e s i n th e s e g an g l i a m ay b e e q u ally as gre at .

E ac h g ang li o n m u s t h ave a d o mi n an t in fl u e n c e o ve r a c e r
t ai n vi sc e r al are a an d thi s i n fl u e n c e i s su b si di ary to th e
,

c o n tr o l e x er c i s e d by th e s egm e n t o f S pi n al c o r d to an d fr o m

wh i ch th e large r n u mbe r o f fiber s p r o c e ed .

108 PR I N C I PL E S O F O S TE O PA TH Y

Gland

Muscle .

F IG 18 D i a g ra m of s e n so ry an d m o to r fi elds r
cc - o d i n a t ed in a s p i n al
g m nt ; b flu b
. .

se e an d th e i nhi y
i to r in e nce of th e r ai n .
1 10 P RI N C I P L E S O F O S TE O PA TH Y

co n diti o n to th e be st adv ant age In o th e r w o rd s i ts r e ac

, .
,
'

ti o n s rep re s e nt i ts e ff o rt to m ai nt ai n i ts e x i ste n c e
P lu r i s e gm e ntal C o ntr o l —
.

J u st as no ski n are a o r mu s
‘

.
,

c le o th e r th an a d i sti n c tly s egm e n t al o n e

, as m e n ti o n e d in
Ch apte r V n o vi sc u s i s wh o lly u n d e r th e i n fl u e n c e o f o n e
,
-

s egm e n t . Th eref o re o ne s egme nt i s me rely a co n trib u t o r o f

a p arti al i n fl u e n c e o ve r s ki n m u sc l e and i n ter n al o rg an O ne
,
. .

s egm e nt m ay f u r n i s h th e m aj o rit o f fiber s t o a c e rt ai n pe r

y
;

i phe r al n erve bu t c o mp l ete co n tr o l is div ided b etwee n tw o

Thi s S ee m
,

o r m o re s egm e n t s s t o i n di cate t hat phy sio lo gi

'

c al c e n ter s i n th e spi nal co rd c o n si st o f s eri e s o f c e lls pl ac ed

‘

ve rti c ally wh o s e fib e r s th u s em erge at v ari o u s l e ve ls Wit h

, .

th i s f ac t in V i ew we re co g n iz e th at any r e acti o n to Sti mu li ,

ari s i n g i n any o n e o f th e th re e r e c e pt o r fiel ds wil l b e e x -

,

pre ss e d in e ff e ct o r ti ssu e s b el o ngi n g to at l e ast tw o o r mo r e

m et am e re s The ref o r e a ny p r o te ctive re acti o n i n spi nal
.

are as wi ll i n v o lve m o re th an o n e spi nal ar ti c u l ati o n .

i i
C n cal E v de nc
l i e G up
r o L e s i o n s —Thi s ag r ee s wit h
,
.

th e c li n i c al fi nd i n g s Take S p i nal te n d er n e ss fo r e x ample :

.

A p o i n t is u su ally f o u n d wh i ch s h o w s co n s ide r able te n d er

n ess an d th i s te d er n e s s sh ade s o ff th r o u gh a m et am e r e
n
ab o ve an d be lo w t he m o st s e ns itive p oi n t C o n t r acti o n o f a .

S pi nal m u sc l e i e o f a p o rti o n o f t
, . . he ere ct o r spi nae e x te n d s
, ,

o ver t w o o r m o re m et am ere s O s se o u s l e s i o n s ar e u su al ly .

o f th e gr o u p ch ar acte r The app r o x im ati o n o r s ep ar ati o n o f

.

tw o s pi n o u s p r o c e ss e s re pre s e n t s th e I n v o l v e m e nto f at l e ast

fo u r verteb r ae i e o n e ab o ve an d o ne be lo w the c e n te r o f
, . .
,

th e l e si o n L ikewi se th e l ater al d evi ati o n o f a spi n o u s pr o

.
,

c e ss m e ans th e i n v o lvem e n t o f th re e verteb r ae Thu s w e s e e .

th at all r e acti o ns ar e p r ac ti cally pl u ri s egm e nt al i n ste ad o f -

s egm e n t al The verti cal arr an ge m e n t o f the go ve rn i n g C CllS

.

i n th e S p i nal co rd i s th e f o u n d ati o n fo r thi s J ust as we .

n o ted th e m igr ati o n o f m u scl e s fo r p u rp o s e s o f bette r g uard

i n g o f th e b o dy so al so we no te th at s egme n t s have divid ed

,

th ei r i n fl u e n ce with adj o i n i ng o n e s .

D iff e r e nti ati o n o f S pi nal L e si o ns v i e w o f the s e .

f act s it i s h ard i n f act i mp o ss ibl e to di ff e r e nti at e spi nal le

, ,
 P RI N C I P LE S o r O S TE OPA TH Y 11 1

MOTOR S ENS OI
U

S tem mastoi d
-

Diaphr agm

pg
i m ast

Abdominal

Gluteal

0 11 11 5

! 5 km fr om
to ar ms
cocc x.
y

F IG 19 D g i a r am an d t b
a l e sh ow i n g th e a p p r o x i m ate r e la ti on to th e
t fl fu n t
. .

s p i n a l n e r v e s o f th e v a r i o u s m o o r se n sor y and r e ex c i ons of

r
th e s p i n al c o d . G( ow e r s )
.
1 12 PR I N C I PL E S O F O S TE O PA TH Y

i
s o ns as prim ary o r s e c o n d ary i e tr au m at i c o r refle x,
. .
, ,

b ase d o n p alp ati o n o f th e ti s su e s The c h ar ac teri sti c s ar e .

q u ite sim i lar b e cau se th e p r o te ctive re acti o n s o f th e b o dy ,

wh eth e r i n re sp o n se to s tim u li fr o m the e x te ro i n ter o o r

p r o p ri o ce pti v e fi e lds wi ll b e m an ife ste d i n th e e ff e ct o r tis
-
,

s u e s m u sc l e an d g lan d
,
o f th e pl u ri s egm e n t s b e l o n gi n g to
,
-

th e re c ept o r fi el d s re c eivi ng th e s tim u li F o r e x amp l e : I rri .

tati o n o f th e s ki n o f the b ac k s u ppl ie d by n erve s fr o m th e

s egm e n t s o f th e co rd wh i c h h ave r am i c o m m u n i c an te s c o n -

n e c ti n g with th e re n al splan chn i c s m ay p r o d u c e re ac ti o n s i n ,

all th e ti ss u e s g o ve r n e d by th at p lu ri s egme n t al c e n t er A -
.

stre am o f c o ld ai r bl o w n o n th i s ski n w h e n it i s wet w o u l d

.
—
p r o d u c e a pr o no u nc e d re ac ti o n L ikewi s e a co unt er irrit an t ,

w o u l d p r o d u c e a re ac ti o n In th e c as e o f th e re acti o n to co l d
.

th e m u scle s u n der thi s ski n are a w o u l d c o ntr ac t Th e r e .

w o u ld b e lo st m o ti o n in th e verteb r al arti cu l ati o n s o f th e se

m et am ere s du e to th e hyp erte n sio n o f th e m u sc le s S e n si .

ti v e n e s s to p re s s u re an d a fee l i n g o f l am e n e s s w o u ld de

v e lO p . The p r o b abiliti e s ar e th at th e ki d n ey s w o u l d S h o w
m arke d ch an ge in f u n cti o n We h ave k ept ou r r eacti o n s .

th u s far i n th e met am ere s wh o s e cu t an e o u s su rf ac e s ar e af

fe c te d b u t c li n i ca lly we k n o w su ch a c o n diti o n a s thi s i s
'

, , ,

s e ri o u s an d h e n c e t he w ho le fighti n g p o wer o f th e b o dy i s
'

c al l ed u p o n t o p r o te c t it fr o m thi s h igh te n s i o n i n a s erie s

o f i mp o rt an t m et am e re s .

i F i —
L e s i o ns D u e to F u nct o nal at gu e Le t u s reve r s e th e
pi ct u re an d s t art with a f u n cti o n al di st u rb an c e o f th e ki d
n ey s du e to to o gre at d em an d s o n the m i n e l i mi n ati n g n i tr o g

e n o u s w as te m ate ri al Th i s f u n c ti o nal f atig u e might pr o

.

d u c e m u sc u lar c o n tr acti o n p ai n o r te n de r n e s s in th e spi nal

,

i e the plu r i S egm ent al

'

are as as so c i ate d by i nn e rv ati o n , . .

,
-

are as an d th u s d u p l i c ate all th e ph e n o m e n a m e n ti o n e d i n

,

The fi e l d o f p r o p ri o ce pti v e i m
'

o u r p revi o u s de s c ripti o n
-
.

pre s si o n s th at i s th e s tr u c t u ral ti ssu e s i n thi s p arti cu l ar

,

p lu ri — s egm e n t al fi el d m ay likewi s e b e t
,
he p o i n t at wh i ch all
th e s e re acti o n s ar e i niti ate d I nj u ry o r f un cti o nal fatig u e
.
, ,

as i s see n i n s tre et c ar m e n wh o s e b ac k s s u ff er fr o m th e c o n
114 PR I N C I PL E S O F O S TE O PA TH Y

C H A P TE R VII .

TH E NE R V O U S S Y S TE M ( Co nti nu e d ) .

Al i g nm e nt, To ne , R e fl e x e s .
—O st e o p ath s me have , to so

e x te n t di scard e d su bj e c tive sympt o m s be l ievi n g th at they

, ,

ar e o f ve ry d o u btf u l v al u e i n th e l arge p r o p o rti o n o f p ati e n t s .

H avi n g di scarde d s u bj e ctive sympt o m s th ey h ave d ev e lo p e d ,

a m eth o d whi c h give s e q u al o r b etter re s u l t s I t has thre e ,

p hase s two o f whi ch ar e str u ct u r al an d o n e wh i c h i s p arti al

,

ly s u bj e c tive F i r st in o rde r c o m e s s kel et al alig n m e n t ; s e c

.

o nd ,
mu s cu l ar t o n e ; th i rd c o n diti o n o f r efl e x e s The s e
, .

th re e divi s i o ns all co m e u n de r th e ge n er al h e ad o f p alp ati o n .

Cli ni cal Illu str ati o n — As an il lu str ati o n o f th e v al u e o f

o bj e c tive i n p re fe re n c e t o s u bj ect ive sympt o m s th e fo l lo w? ,

i n g cas e 1 5 o f co nsi de r abl e v al u e

. The ge n tl em an wh o se
.

phy s i cal c o nditi o n is pr acti cally i llu str ate d i n F ig s 2 0 and 2 1 .

w as e x am i n e d i n th e cli n i c Of th e P a c ifi c C o ll ege o f O s te o ,

p athy H e has bee n o p er ated o n s u rg i cally fo r a p e cu li ar

.

e n largem e nt j u st ab o ve an d e x te r n al to th e right k n e e The

l i n e o f th e i n c i s IO n 1s s h o w n i n F i g 2 0 H e s t ate d th at h e
. .

ha d s u ff ered p ai n at th i s p o i n t d u ri n g m o re th an a ye ar an d ,

hi s phy s i c i an had de c i d ed th at th er e w as a t u b er c u lo u s co n
diti o n o f th e b o n e The o p er ati o n di d n o t co nfirm thi s di ag
no si s . No u nh e althy ti ss u e Was fo u n d .

—W e n o ted hi s p e c u li ar h an d li n g o f th e l eg
.

Ins pe cti o n h
wh e n w alki n g C omp ared b o th l imb s fr o m to e to hip an d
,
'

.
'

di sco vered a marked di ff e re n c e i n siz e as i s i nd i c ate d i n th e

,

ph o t o gr aph B y f o ll o wi n g th e co u r s e o f th e n e r ve s to th e
.

sp i n al co l u m n we di s c o vere d th at th e m
,
u sc l e s o n th e right

S ide o f th e spi n e we re atr o ph ie d i n pr o p o rti o n t o th o se o f

th e e x tremity Fig 2 1 S h o w s th e f act th at th e atr o phi e d
. .
 PRI N C I PL E S O F O S TE O PA TH Y 11 5

F IG 20 C a s e i ll ut t g t
s r a i ny a r o p h o f th e m u s c l e s o f t g t
he ri h
f ty fl
. .

l e g d u e to au l tr o p h i c i n u e n c e o f th e n e r v e c e ll s i n th e
s p i n al c o r d t b g t t
Th e s c ar , j u s a o v e th e r i h p a e ll a, i s su
.

y t t b
.
.

e r fi c i a l t o a h p e r r o p h i c c o n d i i o n o f th e on e
p .
116 PR I N C I PL E S O F O S TE O PA TH Y

F IG 21 G e n e r al vi ew of cas e i l lu s t r ated in th e
g figu
. .

p r e ce di n re Th e s p i nal t
c u r va u r e is
l a ly i n d i at d Pa te ll a r te n d o n fl x
.

c e r c e re e ab
i gh t i d l ft
.

se nt n o r s e bu t p r e se n t on th e e .
1 18 PRI N C I P LE S O F O S TE O PA TH Y

n e c ti o ns q u ite s m all Thi s alo n e m ake s th e co nc l u s i o n

is .

p o ss ibl e th at th e re ar e i n de e d m any se n so ry i mpre ss i o n s

, ,

wh i ch arrive at th e sp i nal co rd bu t th at w e ar e aw are o f bu t,

few o f th e m at th e tim e All th e vi sc e r a o f the b o dy as the

.
,

st ai n i n g m eth o d has di sti n c t ly s h o w n ar e tr ave r s ed by an ,

,

alt o geth e r u n e x p e c te dly l arge n u mbe r o f n e rve s an d their

arr an gem e nt an d co u rs e th e i r re lati o n s to bl o o d ve ss el s an d

g lan d s an d to m u sc le fiber s b o n e s an d e n am el m
,

, , ak es it ,

m o re th an pr o b ab le th at th ere i s i n thi s co n n e c ti o n a large , ,

sy s te m w hi c h s erve s e ss e n ti ally t o reg u late i m pr e s s i o n s a n d

refl e x a cti o n .

i —
V i sce r al S e n sat o n It i s th e refl e x e s m e n ti o n e d i n thi s
.

q u o t ati o n in wh i ch we ar e i nte re st e d S e n sati o n an d p er .

ce pt i o n ar e di s s imil ar S e n sati o ns fr o m th e vi s c er a ar e c o
.

o rd i n ate d i n f ai rly we l l m arked are as o f th e s p i n al c o rd an d

w he n th e s e se nso ry i mpre s si o n s ar e i n te ns e th e e ff e r e n t
fib er s o f th e spi nal co rd m an ife st th e co n d iti o n e x i st
- i ng in a ,

vi s c er al are a by cau si n g an ab no rm al c o n diti o n o f m u scu lar

to n e i n th e i n tri n s i c m u s c l e s o f the b ack Th i s c o n tr ac t u r ed .

co n diti o n o f th e mu s c l e s 1 5 n o t th e o n ly evi de n c e o f t he vi s ,

c e r al refle x P re ss u re o n th e co n tr acte d m u scl e cau s e s p ai n

.
w
'

The i nte n sity o f th e ae sth e si a Is u su ally i n p r o p o r ti o n t o th e

'

vi sc er al irrit ati o n E ve n th o u gh th e p ati e nt d o e s no t say

.
‘

i n so m an y w o rd s th at th ere IS pa1n o n s light p re ssu re th e ,

e x ami n e r if hi s p alp ati o n is g o o d c an dete c t the refl e x in th e

, ,

ac ti o n o f th e m u s cl e
—
.

i m o m
D e pe nde nce o n O bje ct v e S y pt s A p atie ntco m e s .

to an o ste O path d e s i ri n g tob e e x ami n ed H e d o e s n o t v o u c h

l

i n f o rm ati o n as to 11 15 c o n diti o n m
.

safe any ere ly sayi n g ,

“
I wan t y o u to e x am i n e m e an d fi nd o u t wh at i s th e matt er
with me Th i s i s a c h alle nge to th e S k i ll O f th e ex am i n e r
.
‘

an d c al ls fo r so m eth i n g b e s ide s a l o n g di st anc e cate c hi s i n g -

as to s u bj e ctive fe el i ng s The o s te o p ath p r o c eed s wit h ab

.

s o l u te p re c i si o n t o dete rmi n e th e c o n diti o n o f hi s pat

’
i e ri ts
str u c t u ral f o rm ati o n S ke l et al al ig n m e n t ( )
2 m u S c u ,

lar t o n e an d ( 3 ) s egm e ntal spi n al refl e x E ach yi el d s v al u

,
;

The e x am i n er s fi nge r s may devel o p a re

’
abl e i n f o rm ati o n .
 PRI N C I PLE S O F O S TE O PA TH Y 1 19

fl ex r
a o un d th e si x th d o r sal S pi n e Thi s i s no ted as a refl e x .

f r o m th e g as tri c are a Te s ti n g th e s egme n t s ab o ve an d be

‘

lo w th i s wi l l sh o w ho w gre at a s e c ti on o f the co rd i s i r ri
“

,
_

tate d an d wil l b e an i n di cati o n o f t

'

he e x te nt o f th e i n t er nal
i r r i tati On i e wh eth er o th er p o rti o n s o f the dige stive tr ac t
‘

, . .
,

—
ar e a ffe c ted The r efl e x might e x te n d as far asgthe f o u rt h
.

d o r sal an d sti ll i n di cate th e gas tri c are a F i n di ng the refle x

.
.

at th e S i x t h d o r s al S pi n e has dire c ted the atte n ti o n o f the

ex ami n e r to the gas tr l c are a an d hasloc ated a p o i n t f ro m

u

whi c h fu r the r e x ami n ati o n i s to p r o c e ed P e r c ussi o n o v e r .

the s t o m ac h w o u ld r e v e al o th e r f ac t s an d th e n the e x ami n a

‘

ti o n w o u ld b e p urs u ed alo n g ge n eral li n e s o f p hy si cal di ag

no si s t o d ete r m i n e the char ac te r o f th e g ast r i c di so r d e r The .

m o m e n t th e e x ami n e r cen te r s his e x am i nati o n o n the st om

ach th e co n fide nc e o f th e p ati e n t i s as s u r ed
, Is n o ta thi s .
.

co n fide n c e g r e atly to b e d e s i r ed i n every cas e ? Is i t no t a

f o r c e wh i ch co m p e ls th e p ati e n t to f o llo w the di r e cti o n s o f .

hi s p hy s i c i an i n m at ter s o f diet and hygie n e ? In t his e x am -

p l e w e i llu s t r ated the at trib u te s o f n erv e ti ssu e ( 1 ) ,

i rri tabi lity ( 2 ) c o n du ctivity O th er c o n diti o n s whi ch m ake

, .

th i s ( )
l m l tr ti n i
”

u s c u a r c o n ac o n r e

sp o n s e t o n e r ve s tim u lati o n ( ) s egm e nt ati o n o f the S pi nal

2 ,

c or d ( )
3
,
refl e x ac ti o n .

D e pth and E x te nt o f L e si o n s—Fr om the cl i ni ca l s t an d

p o m t l e s i o n s m a y b e c l ass ified so m e w h a t ac co r di n g t o d e pt h
'

an d e x te n t fo r ex ampl e the l e si o n s wh i ch ar e du e to tr aum a

, ,

o f so m ati c tl ss u e s i n v o lvi n g o n e sp i n al ar ti c u lati o n w ou l d

, ,

b e d eep an d as so o n as the p atie nt i s plac ed i n a p o s i ti o n o f

re st the e x te n t o f th e m u sc ular c o n tr ac ti o n w o u l d gre at ly
,
‘

de cr e as e Thi s i s n o t the c as e w he n th e l e s i o n i s du e to a
.
'

vi sc e r al i rr it ati o n The vi scu s has a plu r I s eg m e nt al c o n

.

ne c ti o n with th e n e r v o u s s y s tem an d h e n c e the co ntr ac ti o n

o f m u s c l e s i n th e S pi n al are a i s u s u al ly o f gre a te r e x te n t .

The po s iti o n o f r e s t i e r e c li n i n g d o e s n o t u su ally cau se

,
. .
, ,

th e mu scl e s to re lax Thi s S h o w s th at th e c o n tr acti o n i s n o t

.

a n o rm al e ff o rt to m ai n t ai n t he u prig ht p o siti o n b u t a hyp er

te n si o n du e to vi sc er al di st urb ance .
12 0 PR I N C I PLE S O F O S TE O PA TH Y

L e s i o n P i c t u r e i n Au t o tox e m i a — AS so o n as we h ave an
.

au t o t o x em i a to d e al with o u r l e s i o n p i c t u re i s gre atly e m

large d Thi s i s we ll i ll u s tr ated i n th e v ari o u s m an ife s t ati o n s

.

o f i n dige sti o n In s u c h cas e s n o t o n ly l e si o n s i n th e a re as

.
,

s egme n t ally asso c i ated bu t als o ab o ve an d b e lo w wi ll be

, ,

f o u n d S o m e c ase s wi ll co mp lai n o f th e wh o l e le n gth o f th e

.

S pi n e wh i l e th e au t o i n t o x i c ati o n i s at i ts h eigh t As th e i n .

te n s ity o f th e au t o i n t o x i c ati o n de c re ase s th e l e s i o n are as

b e co m e re stri c ted to th e phy si o lo gi cally a s so c i ate d s pi n al
are as . Thi s i s tr u e i n th e i n fe c ti o n s as we ll The b ac k ac he .

i n t o ns i liti s la gripp e s m allp o x e tc ar e we ll k n o w n an d

, , , .
,

evi de n t ly no t l o c ate d i n ph y s i o l o gi cally asso ci at ed are as .

The ph e n o m e n a o f sp i n al hyp e rte n si o n an d hyp er ae sth e si a

ar e very p r o m i n e n t in th e s e c as e s No thi n g s e em s to p al li ate
.

thi s sp i n al c o n diti o n du e to t o x emi a to th e sam e e x te nt as

m an ip u lati o n We s ay p alli ate be cau s e th e t o x e mi a whi c h
.

cau s e s th e te n s i o n i s n o t o ver c o m e by re l ievi n g th e s pi n al

te n s i o n .

L e si o n s In de pe nde nt o f S e gm e ntal R e fl e x e s —A S so o n
as we fi n d l e s i o n s th at s e em to h ave ari s e n i n dep e n d e n t ly of

wh at we can r e adi ly re c o g n ize as s egm e n t al re fle x e s » th ey ,

m u st b e e x p lai n ed o n the b as i s o f so m e i n tegr ati o n o f the

bo dy o th e r th an n erv o u s Thi s i s th e case i n th e t o x emi as
. .

The c i r c u lati n g m edi a ar e th e i n tegr ati n g fac t or s whi ch e x

pl ai n th e b ac k ach e as we ll as m an y o th er ach e s i n th o s e
c as e s wh ere th ere i s n o vi sc er al i n v o lv e m e n t w hi ch m ay

r eas o nabl y b e ass o c i at ed with th em . I nc r e as i n g elimi nati o n

wi ll u su ally co rre ct th e se sp i nal l e s i o n s du e to t o x emi a .

The L e si o n as an E x pr e ssi o n o f S om e F o r m o f Inte gr a

ti o n .
— An y s pi nal l e s i o n m ay b e an alyzed fr o m s ev er al
st an dp o i n t s b e c au s e it m ay be a p arti al e x p re s si o n o f O n e o r
,

m o re i n tegrati n g f act o r s o f th e bo dy iI e the s tr u ct u r al , . .

, ,

c i r c u lat o ry o r n erv o u s The tr au m ati c l e si o n sh o w s it s el f

.

s u bj e c t t o p o s iti o n i e can be re sted an d l e sse n ed by a

, . .
,

p o s iti o n whi ch m e c h an i cally l e ss e n s the str ai n The l e si o n .

du e to n erv o u s i n tegr ati o n is n o t so qu i ckly re li eved by th e

m e an s wh i ch re li eve the tr au m ati c l e s i o n The f ac t th at it .
12 2 PR I N C I PL E S O F O S TE O PA TH Y

l e sse n s b e cau s e p ai n i s le sse n ed As so o n as th e tu be rcu

.

lar p r o c e s s sh o w s co nstit u ti o n al sympt o m s th e spi n al l e si o n

pi c t u re v ari e s fr o m m o r n i n g to night th at i s fl u ct u ate s
, ,

with th e v aryi n g i nte n s ity o f th e di se as e re ac ti o n s The .

’
p o sitive an d n egativ e ph ase s o f th e b o dy s re acti o n s ar e
re fl e x ly evi d e n c e d i n th e sp1 nal are as . As th e di s e as e pr o
s a n d are a f p u l m n ary ti u e a r e l o s t o r fi br Ou s
g r e ss e s o o ss s

ti s su e f o rm ed with co n s e q u e n t l e sse n i ng i n an ter o po s

,
-

te r i o r d i am eter o f th e ch e st an d de c re as ed amp lit ud e o f

th e re s p ir at o ry m o vem e n t s l e s i o n s o f a str u ctu r al ch ar
,

ac ter app e ar i n th e spi n al a re a s uch as fl atte n i n g o f th e

,

d o r s al cu rve an d el ev ati o n o f th e an g le s o f th e rib s cau s e d

by th e r o t ati o n d o w nw ard o f th e an te ri o r e x trem iti e s o f
th e rib s i n th e fl atte n i n g o f th e ch e s t The ch ange i n th e
.

c h e st c au s e s a c h an ge i n th e te n si o n o f th e s cal e n i m
,

u sc l e s

i n th e n e c k an d i n cas e o n ly on e p u lm o nary ap e x i s i n
.

v o lve d th ere i s u n e q u al te ns i o n i n th e scale n i o f th e tw o

s i de s o f th e n e c k ,
t hu s cau s i ng th e e x te n so r s o f th e ne c k
to e x ert a c o mp e n sat o ry actio n . The ch an ge i n c ervi cal
vertebr al alig n m e nt an d m u s c u l ar te ns i o n co nstit u te s i n
thi s i n s t an c e a spi n al l e s i o n whi ch i s p r o p erly co mp e n sa
t ory an d th eref o re n o t h e lp ed by co rre ctive m o ve me nt s .

M any su ch l e si o ns p r o f o u n dl y co mp e nsat o ry i n ch ar ac te r
, ,

sh o ul d re c eive no dire ct co rre c tive m an ip u lati o n S in ce .

th ey ar e d ep e n d e n t u p o n t issu e i nv o lv eme n t el sewhere We

m u st m ake o u r di ag no si s fr o m cau se to e ffe ct i n o rde r to
get o u r th e r ap e u ti cs i n right s eq u e n ce .

P ai ns Inci de nt to C l hi l a n d F e v e r — . The h e ad ach e ,

‘

n e c k ac he b ac k ac h e an d l e g ache o f chill an d fever ar e su b

,

j e c t i v e s ympt o m s p r o m i ne n t i n a h os t o f c as e s T.h e se

sympt o m s ar e o f v aryi n g i n te n sity bu t ev e n wh e n n o t c o m

pl ai n e d o f a te n der n e s s i n th e n e c k an d b ack i s re adi ly

,

e l i c ited by digit al p re s su re As th e fever su b s ide s th e s e

.

are as o f s e n sitive n e s s to p re s s u re gr o w l e ss an d l e ss sh ow ,

i n g th atth eir gre at e x te n t i n th e begi nn i n g i s a co n stitu

ti o nal c o nd iti o n . I t is re adily re co g n ized th at o u r spi nal
l e s i o n i n p u l m o n ary t u b er cu lo s i s has change d with e ach
 PRI N C I PL E S O P O STE O PA TH Y

h a e f th e di e e T hi i b abl tr e f l l di e e
'

a u a a
‘

p s o s s s s p r.o y o s s s ,

h e nc e th ere i s n o fi x e d le s i o n as so c i ate d with any vi sc e ral

‘

o r s o m ati c di s e as e ;
z A s lightly v aryi n g s e t o f re ac ti o n s
—
acc omp an i e s e ach di s e as e p r o c e s s Th e s e re acti o n s ar e .

u s u ally tr u e to typ e bu t n o t cap ab le o f c las s ifi c ati o n e x

c ept i n a ge n er al w ay The o rg an s o f th e b ody ar e i n n e r

‘

~
.

mfair ly de fi n ite a r e as o f th e co rd an d we sp eak

‘

v ate d fr o
'

o f th e s e as n erve c e n ter s bu t as bef o re s t ate d th e s e c e n

,

trs co nsis t o f c e ll s plac e d v er ti c ally an d e x te n di n g thr o u g h

,
.

s e ve ral s eg m e n t s The S p in al l e s i o n s f o u nd i n vi sc er al
-
~
.

di s as e e h e c e p u S egm e n t a
e a r n l e r i — l an d if th ere i s t o x emi a , ,

th ere i s a se t o f l e s i o n s e x pr e s siv e o f t hi s c o n diti o n su p er

‘

i mp o se d o u th e fir st th e n i n cas e o f de s tr u c t io n o f ti s su e
, , ,

c o mp e n s at o ry ch an ge s i n str u ct u re ar e n o ti c e ab le The .

th r e e m aj o r f o rm s o f i n teg rati o n ar e i nv o lve d in any severe

i ll n e ss an d h e nc e th e di ag n o s ti c i an m u st try to s ep ar ate
th e v ari o u s evi de n c e s o f th e b o dy s p r o t ec tive re ac ti o n s ’
.

The gre ate r v ari ati o n wi ll b e i n th o s e sy mpt o m s du e to

-

c ir c u lat o ry i ntegr ati o n Thi s i s evi de n c e d by th e r api d

.

c h an ge s i n cas e s o f au t o i n t o x i c ati o n The l e si o n whi c h i s .

c h ar acte riz ed by i ts p e r si s te n c e wi l l b e l o c ated i n th at se

_ g
m e nt o r segm e nt s m o s t c lo se ly alli ed with th e c e n ter o f
vi s c er al d i st u rb an c e The le s i o n o f sti ll m o re pe rm an en ce
.

will be th e p rim ari ly tr aum ati c o r s e c o n d arily co mp e n sa

.

t o ry
The P r acti cal Us e o f Kn ow l e dge —We h ave added
.

n o th i n g n e w to th e w o r l d s k n o w l e dg e o f n e r ve ti ss u e bu t
’ '

we h ave app l ie d ge n er al k n ow ledge o f thi s ti s su e to S p e c ifi c

u se s We h ave t ake n th e re su lt s o f lab o r at o ry e x p erim e nt s
.

an d m ade th em p r ac t i c al m eth o d s i n th e dete c ti o n an d

al l evi ati o n o f di s e as e It app e ar s to u s th at s u ffi c i e n t r e
.

s e ar c h w o rk has b ee n d o n e o n th e n e rv o u s sy s tem by m ed

i cal m e n an d S uffi c i e n t ge n er al co nc l u s i o ns dr aw n fr o m
th ei r i n ve stigati o n s to j u stify all br an ch e s o f th e p r o fe ssi o n
1n m aki n g m o re e x te n s iv e u s e o f s u ch d at a The Co r re la .

ti o n o f lab o r at o ry d at a with th e re su lt s o f cli n i cal e x pe r i

e nc e m ake th e f o u n d ati o n o f o s te O pat hi c di ag n o si s at the
12 4 P RI N C I PL E S O F O S TE O PA TH Y

p re s e n t tim e . By thi s b o l d appl i cati o n o f k no wl edge ,

wh i ch by th e m ed i cal p r o fe s si o n at l arge has b ee n reg ard e d

as S p e c u l ative an d at l e ast i mpr ac ti c ab l e , o st e o p athy has

g ai n e d an imp reg nabl e p o s iti o n i n th e h e al i n g art s .

L ab o r at o ri es m ake sc i e nti st s n o t phy si ci an s ; h e n c e

phy s i c i ans h ave n o t alw ay s gr asp ed th e f u ll sig n ifi c an c e
o f th e sc ie n tifi c di s c o veri e s i n phy si o l o gy an d appli ed th e m

to th er ape u ti c s .

Wh ateve r o ste o p athy m ay at p re s e n t p o ss e ss or g ai n

'

i n th e f u t u re i s du e s o l e ly to a c lo s e adh e re n c e to th e f act s
,

o f an at o my an d phy s i o lo gy ; an d th e appli c ati o n o f th e se

f u n d am e n t al f ac t s to s c i e n tifi c th e rap e u ti c s
.
[ 26 PR I N C I PL E S O F O S TE OPA TH Y

F IG 22 S ch e m ati c r t ti
e p r e se n a on of th e c o nn e c ti on s t
be we e n
b
.

y m p ath e ti c yste m s
.

th e s an d c e r e ro- S p i n al n e rv o u s s .
 PR I N C I PL E S O F O S TE O PA TH Y 1-2 7

m ai n t ai n s it s e lf .
—B yr o n R bi nso n o in th e Abd o m i n al
”
Br ai n p ag e 55
,
-
.

O r i gi n .
—The symp ath eti pp e ar s to o rigi nate fr o m th e
c a

th e p o steri o r r o o t s o f the Spi n al n erve s

'

g an g l i a o n .

La te r al G an gl i a — The su b st an c e o f t he sy m pthe ti c
'

( )
1
'

i s co n ve n i e n t ly divi ded i n t o f ou r p o rti o n s :7 ( 1 ) The l ate ral

chains o f g an gli a p lac e d o n e o n e ach s ide o f th e v ertebr al
,

co lu m n The c h ai n s ar e c o nn e c te d ab o ve by th e G an g li o n o f
.

18 0 0 s it u ated o n th e an teri o r c o m
_
-

mu n i cati n g arte r y and j o i n ed b e lo w by th e G an g lio n Im

,

p i e teri r rf e th e y T h e e
'

ar s tu at e d o n th a
. n o s u ac o f c o cc x s .

C h ai n s o f g an g li a ar e c o nn e c ted with th e c ereb r o s p i n al -

n erve s by we ll m arked c o r ds .

( )
2 F o u r P r e v e r t e b r a l P l e x u se s — T h e n e x t pr o m i n e n t
agg r eg ati o n s o f n erve ti ss u e ar e th e g r e at p rev ertebr al p l e x

u s e s s it u ate d ve n t r al to the b o die s o f th e vertebr ae _

The .

fi r st o r P h ar y n ge al i s S it uated ar o u nd th e lary nx The

,
.
, .

se co n d o r Ca
, rdi o P u lm o n ar y P l e x u s li e s i n th e th o r ax
-

,
.

The third o r S o l ar P l e x us e n c i r c l e s the C o eli ac Ax i s a

, ,
nd

s u p e r i o r m e s e n te r i c arte r y The f o u rth i s the P e lvi c P l e x u s

.
,

vhi c h g o ver n the ge n er ative o r g an s an d r e ct u m

s
‘

v .

( )
3 V i sc e r al G an g l i a — T h e t h ird p a rt o f th e s ymp a

th eti c ti s su e 1 8 co m p o s e d o f t hos e g an g li a p lac ed b etwee n

th e c o at s o f vi s c e r a an d c alled th e p eriph e r al app ar at u s o r
,

“ ”
A u t o m ati c Vi sc e r al G an g li a ( R o bi n so n ) .

( 4 ) C o mm u n i c at i n g F i b e r s — A ll o f th e s e g a n g l i a a n d
‘

p l e xu s e s ar e i ntim ate ly co n ne c te d w ith e ach o th er by nu

'

m e ro u s n erve fiber s Th e s e f o ur p art s c o n s tit u te wh at i s

.

c o mm o nly k n o w n as th e symp ath eti c n er vo u s sy stem The .

n erve fiber s i n the symp ath eti c sy s te m c o n si s t o f b o th th e /

m ed u llated an d n o n m ed ullated v ar i eti e s i e wh i te an d -

“

, . .
,

g r ay I t is c o mm o nly be li eved th at th e white ar e c ereb ro

.

s p i n al an d the gr ay ar e symp ath et i c fib er s th o u g h wh et her

' “

,
.

"
th e y be lo n g to th e o n e o r th e o th er sy stem c ann otbe t o ld by
app e ar an c e alo n e F u n c ti o n mu st al so b e co n s i de r e d
. The .

fi be r s in the symp ath eti c sy s tem ar e pri n c ip ally o f th e n o n ?

[ 28 PR I N CI P LE S O F O S TE O PA TH Y

me d ul a l t ed v ari ety ; h e n c e gr ay fib er s ,
ar e c all ed s y mp a
th eti c .

W hit e R am i -
co —The ch ai n s o f the l ateral
mm u n i can t e s .

g an g li a ar e co nn e cted with th e s p i nal n erve s seri ally by tw o

di sti nc t n e rve b un d le s to e ach gan g li o n Th e s e b u n d les ar e .

cal l e d r ami c o m m u n i c an te s an d are c o mp o s e d o f : ( 1 ) A

’

-
.
,

b u n d le o f whit e o r c e r ebr o spi n al fib er s p ass i ng fr o m th e

-

an teri o r an d p o s te ri o r r o o t s o f th e S pi n al n erve s to th e g an

g li o n i n Wh i ch a few fiber s m ay e n d ; bu t th e m aj o rity p ass

,

o n to b e d i strib u te d to th e prevert eb r al p l e x u s e s th ereby ,

givi n g di re c t c o mm u n i c ati o n b etwe e n vi sc er a an d th e spi n al

co rd .Th e s e white fib er s c o ns i st o f b o th m o t o r an d s e n s o ry
fiber s T h. e —
wh it e r am i c o m m u n i cant e s l e ave th e S p i nal
c o rd b etwe e n th e s e c o n d d o r sal an d se c o n d lu m bar verte . .
-

b r ae o n ly M any o f th e fib er s ar e de m e du llated i n the lat

.

'

e r al a n l i a ; o th er ret ai n th eir h e ath a f a a th e pre ~

g g s s s s r s .

v erteb r al p l e x u s e s wh ere th ey als o b e c o m e de m e du llate d

, .

The c e rvi cal regi o n has n o wh ite r ami — c o mm un i c an te s .

Di st r i bu t i on —The n erve s 1n th e s ac r al regi o n wh i ch

co rre s p o n d to White r am i c o m m u n i c an te s p ass to th e V i sc er a
-
,

with o u t e n te r i n g the symp ath eti c g an g li a We m ay — S UITE

._ .

m ariz e wh at we h ave writte n co n c e r n i n g th e e n di n g s o f the

white r am i — c o m m u n i can te s as f o llo w s : ( 1 ) E n d i n t he lat
er al gan g li a ( 2 ) P as s th r o u gh later al g an g li a an d e n d in
.

p reve rtebr al p le x u s e s ( 3 ) S p lit u p be fo re e n teri n g later al

.

g an g li a an d s e n d so m e fiber s to th e g ang li a o th er s to g an ,

l i b ve d b e l o w afte r p ass i n g i n t o i ts o w n g an g l i a
g a a o a n ,
.

ti
F u nc o n — The white r ami co m m u n i can te s h ave m any -

f u n cti o n s an d th e s e c an b e determi n ed by a clo s e s t u dy o f

,

di s trib u ti o n an d phy si o l o gi c al acti o n The f u n c ti o n s m ay .

b e t ab u l ated appr o x im ate ly as fo llo w s : F i r s t i t has b ee n ‘

,
'

—
dem o n str ated th at v aso co n stri ct o r s p as s o ut o f th e c o rd be
twe e n th e s e c o n d d o r sal an d s e c o n d l u mb ar vertebr ae ; se c
o n d c ardi ac au gm e n t o r s
,
e n di n g i n th e lo wer c ervi cal g an
,

g li a an d fir s t th o r ac i c gan gl i on ; thi rd m o t o r fiber s to th e ,

p lai n m u scl e s o f th e i n te sti n e s ; f o u rth m o t o r fib ers to th e ,

‘

s ph i n c te r o f th e i ri s l e ave th e co rd at th e t hi r d do r s al an d
[ 30 PR I N C I PL E S O F O S TE O PA TH Y

m embr an e s The n e rve s p assi n g fr o m th e late r al gan g li a to

.

th e p revertebr al p lex u s e s th eref o re co nt ai n white and gr ay

, ,

fibe r s h avi n g th e f u ncti o n s o f th e symp ath eti c an d c erebr o

s pi nal sy stem s an d fr o m th e s e p revertebr al pl e x u s e s fib er s
,

p as s to th e d i st al g angli a i n th e w all s o f th e vi sc er a Th u s .

we s e e th at all th e g ang li a o f th e symp ath eti c ar e clo s e ly

c o nn e c t e d with th e c e rebr o spi n al Th e s e gan g li a de m e du l
-
.

late th e s pi n al n erve s wh i ch en ter th em an d m o re fiber s ,

l e ave th e g an gli a th an e n te r th em Th e s e g an g li a h ave a .

-

tr o ph i c i n fl u e n c e o ve r th e n e rve s wh i c h p ass fr o m th em to
th e p eriph ery Th ey ar e refl e x c e n te r s
. .

F u n ct i o ns of the S y m pat he t i cge n er al it

'

Sy ste m . In
m ay b e s ai d th at th e symp ath eti c p re s i de s o ver I nv o lu n t ary
m o vem e n t s n u trit i o n an d se c reti o n h o ld s an I mp o rt an t i n
, ,

fl u e n c e o ver temp e r at u re an d v aso m o t o r acti o n an d i s e n -

" “
d o wed with a d u ll s e n s ibi lity ? ( R o bi n so n s A b d o m i nal ’

In de pe n de n t D or e pe n de n t —W h eth er th e
ac ti o n o f th e

symp ath eti c i s i nd ep e n de n t o r d ep e n de n t i s n o l o n ger s u b

j e c t f o r e x p erim e n t an d d i sc u ss i on Y o u h ave s ee n th e .

h e art be at after e x ti rp at io n fr o m th e b o dy ; also th e v e r '

m ic u lar m o ti o n o f th e i n t esti n e s Th e s e ar e o ff ered as evi

.

de n c e s o f i n dep en d e n t acti o n bu t it m u s t b e b o r n e i n m i n d
,

th at u n der n o rm al Co n diti o n s th e c erebr o s pi nal n erve s c an -

i n fl u e n c e th e s e ac tiviti e s eith er rep re ss i n g o r au gme n ti n g

,

th em .

G an gli a —The g an g li a o f th e symp ath eti c c o n t ai n ( a)

n erve c e lls b
( )
,
a ff ere n t fiber s ( c ) e ff ere n t fi b,
e r s— an d a r e

th e ref o re g o v er n i n g c e n ter s Th ey ar e ab le to re c eive se n

.

s ati o n an d tr an s f o rm thi s i n t o m o t o r 1m pu lse s an d h e n c e ,

ar e i n a m e asu re i n d ep e n de n t
, , .

C e rv i cal G an gl i a o f Im po r tan ce to — The O ste o paths .

c ervi c al p o rti o n o f th e g an g l i ated c o rd c o n t ai n s th ree g an

g li a wh i c h ar e de sig nate d as su p eri o r mi dd l e an d i nfe ri o r , ,

ac co rdi n g to p o s iti o n Th e s e gang li a ar e i mp o rt an t to th e

.
 P RI NC I PL E S O F O S TE O PA TH Y 13 1

os te o p at h be c au s e th ey ar e i n a m e asu re aff e cted by dire c t

, .
-

m an ip u lati o n i e p re s s u re c an b e tran s mitted to th em

,
. .
,

th r o u gh th e so ft ti ss u e s o ver the m .

S u pe r l o r —The s u p eri o r c ervi cal

C e r v i cal G an g l i o n .

gan g li o n li e s o n th e re ct u s c api tl s an ti c u s m ajo r mu s cl e an d

s e n d s br an c h e s u pw ard whi c h f o rm a p le x u s ar o u nd the i n

t er n al c ar o tid a rtery ( car o ti d p le x u s ) The c aver n o u s .

p l e x u s i s a c o n ti n u ati o n o f th i s F r o m th e s e pl e x u s e s m an. y
c o mmu n l c at b r h e ite with th e r i
'

s t l
”

ln a n a o u n an a
-

g c s p s c

n erves o th e c erebr
f o —s pi n al s y stem .

ti on s —Thi s g an g li o n i s c o nn e cte d with th e fir s t

C o n ne c -

f o u r s pi n al n er ve s an d the n i n th te nth an d twe lfth c r an i al ,

.

ItS bran ches ar e di strib u te d o n all th e b lo od ve ss e l s o f th e

'

h e ad and f ac e .

V as o -
co n str i c ti on .
—
P hy s i o lo g i c al e x p e r im e n t has dem
o ns tr ate d th at th i s g an g li o n e x er c i s e s a —
v as o c o n stri c t o r i h
fl ue nc e o ve r t
he b l o o d ve s s e ls o f th e h e ad and f ac e .

D i s t r i bu ti o n The te rmi n al fi lam e nt s fr o m the c ar o

.

ti d an d c ave rno u s p l e x u s e s ar e p r olo n ged al o n g the i n ter n al -

c ar o ti d artery f ormi n g p l e x u s e s w hi c h e n twi n e ar o u n d the

,

c e reb ral an d Ophth alm i c arteri e s ; al o n g th e fo rme r ve s s e l s

th ey m ay be tr ace d i n t o th e p i a m ater ; alo n g th e latter i n t o

'

th e o rbit wh ere th ey acco mp an y e ach o f th e s u bd ivi si o n s o f

,

the ve s s e l a s ep ar ate p lex u s p as s i n g with th e arteri a ce n

,

tr ali s reti n ae i n t o th e i n te ri o r o f the eye b al l

, The fi la -
.

m e nt s p r o lo n ged o n to th e an t eri o r c o mm u n i cati n g artery

f orm a s m all g an g li o n th e G an g li o n o f R ibe s wh i c h Se r ve s
-
, , ,

as m e n ti o n ed ab o ve to co n n e c t t he s ymp ath eti c n erve o f t

, he
right and l eft s i de ”
( G r ay s A n a t o my . p age ’

R e aso n i n g fr o m th e p o s iti o n o f the g ang li o n i n th e

‘
,

n e c k , i ts di s trib u ti o n to b lo o d ve s s e ls o f th e h e ad an d f ac e ,

an d i ts v as o Co n s tri c t o r f u n c ti o n s to t
-
he ve s s e l s we can ,

—r e adi ly u n d er st an d why m e c h an i cal le si o ns i n th e u pp e r

-

c ervi c al regi o n c an be th e c au s e o f gr av e p ath o lo gi c al c o n d i

ti o n s i n th e ti s su e s o f th e h e ad an d fac e An ythi n g wh i ch .
[ 32 P RI N C I PL E S O F O S TE O PA TH Y

di s t u rb s th e no rm al c i r c u l a
ti o n i n a defi n ite are a wil l n e c e s
sar i ly aff e c t th e n u triti o n o f th e ti ss u e s i n th at are a ; t here

f o re n u triti o n al d i so rde r s o f th e eye ar e f o u n d to b e c aus ed

,

by s u b lux ati o n o f ve rteb r ae o r co n tr ac ti o n o f m u scle s i n r e

,

lati o n to th e s u p e ri o r Cervi cal g an gli o n

H e adache — S i n c e symp ath eti c br an ch e s ar e di strib u te d

.

to th e bl o o d ve ss e l s o f th e pi a m ater we m ay re aso nably ,

e x p e c t to aff e c t th e calib er o f the s e ve ss e ls i n th e case o f

i v e he adac he by rem o v i ng all o b str u cti o n s —
'

co n g e s t
'

,
e g , . .
,

c o n tr acted m u s c l e s cau si n g di lat ati o n— to t he active f u n c

ti o n i n g o f th e s u p eri o r c ervi c al g an g l i o n The d i s trib u ti o n

—
.

o f th e s e symp ath eti c n erve s to t he o rbit n o s e ph ary nx , , ,

t o n si ls p al ate a
,
n d s i n u se s e x pl ai n s th e p o s sibi lity y e s
, ,

—
p r b abil ity o f a m e ch an i cal l e si o n i n th e u pp e r c ervi cal
o

regi o n i n th e s e c as e s .

M i ddl e C e r v ca G a g
i l n l i o n — iThe middl e c e rvi cal g an
s ,

“
gli o n i s th e sm al le st o f th e th ree I t is p lac e d O pp o site th e
.

s i x th c ervi c al verteb r a u s u ally u p o n o r c l o s e t

,
o th e s u p e r i o r

thyr o i d artery ; he n c e th e n am e o f Thyr o id G angli o n as ‘ ’

sig n e d to it by Hal ler I t s e n d s br an c h e s to th e fift h and

.

s i x th spi n al n erves .

D i str i bu ti o n —
It s e n ds br an ch es to ac co mp any the i n
.

fe r i o r thyr o id artery to th e thyr o id g l an d wh ere th ey co m ,

m u n i c ate with th e su p eri o r an d re cu rre n t l ary nge al n e r ves .

Th e s e b r an ch e s reg u late th e c al ib e r o f th e i n feri o r thyr o i d

arte ry an d i ts b r an c h e s The c h ief n erve tr un k p as si n g fr o m
.

thi s g angli o n is the m i dd le cardi ac nerve The cardi ac aug .

—
m e n t o r s le ave th e s pi n al c o rd as wh ite r am i co m m u n i cante s
to th e s e c o n d th i rd an d f o u rth d o r s al g an gl i a th e n p ass u p
,
.

w ard to th e mi dd le c ervi cal g an gli o n Th i s gan g li on i s .

c o n n e c te d with th e s u p eri o r c e rvi c al g an l i o n

g .

F u nc t i o n .
—
Th f u n cti
e thi s g an gl i o n ar e ( a) v aso
o ns o f

c o n s tri c t o r ( th r o u gh c o n n e c ti o n with th e s u p eri o r c ervi cal

g angli o n ) to th e b lo o d ve ssel s o f th e he ad and face ; ( b )

v aso co nstri ct o r to th e ve ssel s o f the thyr o id gl and ; ( c )
-

au g me nt o r i nfl u e nc e to th e he ar t .
134 PRI N C I PL E S O F O S TE O PA TH Y

R e capit u lati o n —It has b ee n m e n ti o n ed th at th e c ervi c al

.

g an g li a re c eiv e n o wh ite r am i c o mm u n i can te s fr o m th e c e r -

vi cal n erve s an d th at v as o c o n stri c t o r fib er s pass fr o m c ere

,
-

—
b r o s pi n al to th e sym path eti c sy s te m i n th e wh ite r ami c o m -

m u n i c an te s betwe e n s e c o n d d o r sal an d s e c o n d l u mb ar ve r
te b r ae ; th e ref o re th e c o n stri c t o r i n fl u e n c e m an ife ste d by
,

th e c e rvi cal symp ath eti cs i s derive d f r o m th e se co n d thi rd .

an d f o u rth d o r s al Th ey d erive fiber s also fr o m th e u pper

.

th o r ac i c re gi o n as f o llo w s : ( a) Au gm e n t o r fiber s to th e
,

h e art fr o m th e s e c on d third an d fo u rth d o r sal ; ( b ) s e c re

,

t o ry fibe r s to th e saliv ary g lan d s s e c o n d an d th ird d o r sal ; ,

-

( )
c p u pi l o di lat o r an
-
d m o t o r fi be r s t
o th e i n v o lu n t ary m u s

c l e s o f th e eye an d o rbit fr o m s e c o n d a n d thi rd d o r s al ; ( d )

aff e re n t fib e r s wh o s e s tim u lati o n c au s e s activi t y o f th e v aso

m o t o r c e nt er i n th e m ed u lla .

Tho r ac c G a g
i n l i a — “
The th o r ac i c p o rti o n o f th e g an
l i at e d c o rd c o n s i s t s o f a s er i e s o f g an g l i a whi ch u s u al ly
g
co rre s p o n d i n n u mb er t o th at o f th e vertebr ae bu t fr o m t he ,

o c c as i o n al c o al e s c e n c e o f t w o th ei r n u mbe r i s u n c ert ai n , .

Th e s e g an g li a are p lac e d o n e ach sid e o f th e S p i n e re st ing ,

ag ai n s t th e he ad of th e rib an d c o vered by th e p l e u r a c o s

t ali s ; th e las t tw o ar e h o weve r an teri o r to th e re s t b ei n g

,
-
, ,

l e d n th e i de o f th e b o d ie s o f th e e l eve n th an d twelft h
-

p a c o S s

d o r s al vertebr ae The g an g li a ar e Sm all i n s ize and o f a

.
,

gr ay c o lo r The fir st large r th an th e re s t i s o f e lo n g ated

.
, ,

f o rm an d freq u e n t ly b le n ded with th e l ast c ervi cal Th ey

,
.

ar e c o n —
n e c te d t o geth e r by c o rd like p r o l o n g ati o n s o f th ei r

su b s t an c e . In th e th o r ac i c regi o n th e g an g l i a ar e co nn e ct e d
with th e s pi al erve s by b th white a d gr ay r ami co m
n n o n —
m u n i can te s —( G r ay s An at o my p age 8 0 4 i n 19 0 1 E diti o n )
” ’

—
.
, .

R am e ff e r e nte s The r ami e ffe r e n te s o r br an ch e s o f

i -
.
-

di s trib uti o n ar e d ivid e d i n t o an i n te r n al an d e x te r nal s e t .

The e x ter n al br an c h e s ar e smalle r b ei n g di strib u ted to th e ,

b o di e s o f th e ve rtebr ae an d th ei r lig am e nts The i n ter nal .

b ran ch e s m ay p r o p e r ly b e divide d i n t o an u pp er an d lo wer ’

gr o u p wh i ch a r e di strib u te d to th e vi s c er ao f th e th o r ax an d
,

abd o m e n .
 PR I N C I PL E S O F O S TE O PA TH Y
'

13 5

U ppe r F i v e T h o r aci c Gang i a — The

u pp er five th o r ac i c
l .
_

g an g li a S e n d br anc he s wh i ch a r e di strib u te d ar o u n d th e u p

p er p o rti o n o f th e de s c e n di n g ao rt a F r o m th e s e co n d third .
,

an d f o u rt h g an g li a ar e giv e n bran c h e s to th e p o s teri o r pu l

m o n ar y p l e x us whi c h co n tr o l th e ti s s u e s of th e l u n g s Yo u
,
.

w i ll rem emb er th at the p n e u m o g as tri c n erve s ar e the m o t o r ‘

i
,

s e n so ry an d tr o phi c n e rve s to th e ai r p as s age s The symp a . .

th eti c s e c o n d to s eve n th d o r s al ar e v as o m o t o r an d tr o phi c

"

-
, ,

to t he b lo o d vess e ls o f th e ti ss u e s o f the lu n g s
i
We h ave .

n o w l ai d a fo u n dati o n o f an at o mi c al an d phy s i o l o gi c al f ac t s

u p o n whi c h we m ay b as e o u r p ri n c i pl e s o f tre atm e n t The .

'

u pp e r th o r ac i c reg i o n i s an imp o rt an t o n e b e c au s e i n it we ,

fi n d n o t o n ly th o s e white r am i — c o m mu n i c an te s whi c h ar e

di strib u ted to th e ao r t a an d lu n g s j o i n i n g with the p n e u m o ,

g ast ri c n erve to co mp lete th e p le x us e s whi ch co n t r o l lu n g

‘

ac ti o n bu t al so th o s e white r ami — c o mm u n i c an t e s whi c h as

'

Ce n d to the c e r vi cal g an g li a and a r e di s trib u te d as f o ll o w s

,

"

Ne r v e D i str i bu t i o n —
P u pi lo di lat o r fibe r s p ass by
.

r ami co m m uni c an te s fr o m th e fir s t s e c o n d an d t hi rd tho

-
,

r ac i c n e rve s asce n d i n th e symp ath eti c co rd to th e su p eri o r

,

c ervi c al g a n gl i o n to f0 r m arb o riz ati o n s ar o u n d the c e ll s

_ _ .

The s e gr ay fib er s p ass to th e G as s eri an G an g li o n an d re ac h

th e eye b all by th e o phth alm i c divi s i o n of th e fifth an d lo n g .

c i l i ary n erve s ; ( 2 ) m o t o r fib er s to th e i n v o l u n t ary m u s c l e s

o f th e o r bit an d e y e l id s fr o m th e f o u rth an d fifth th o r ac i c

,

n erve s f o ll o wi n g a s imi lar c o u r s e ; ( 3 ) v aso m o to r fiber s to

,
é

th e h e ad s e c ret o ry fiber s to th e s u bm ax i llar y g lan d s an d

, ,

pil o m o t o r fiber s to th e h e ad an d ne c k ar e derived fr o m the

-
,

u pp er t h o r ac i c n erve an d re ac h thei r a re a o f di strib u ti o n

, ,

after s imi lar i n terr u pti o n i n the s u p eri o r c ervi c al g an g li o n ;

,

( )
4 th e a c c e l er at o r fib er s to th e h e art ar e derive d f r o m th e
u ppe r th o r ac i c n erve s an d e n d S im i lar ly 1 n th e mi ddl e an d
~

l o wer c ervi c al ga n g l i a gr ay fiber s i n the c e rvi c al cardi ac

n erve c o mp l eti n g th e co n n e cti o n —( G e r r i sh s A nat o my
,

’
.
_ ,

p age
In t e r scapu l ar R e gi o n —The r e fo r e w e h ave an are a e x
‘

.
.
,

te n di n g fr o m the s e c o n d to th e s eve n th d o r sal i n w hi ch we ,

13 6 PR I N C I PL E S O F O S TE O PA TH Y

m u st m ake c are f u l e x am i n ati o n fo r le s i o n s aff e c ti n g vas o

m o t o r tr o phi c and se cret o ry activity in the th o r aci c vis
.

c e r a u pp er e x tremiti e s an d str u c t u re s o f th e h e ad f ac e an d
, , ,

ne ck Th i s e x p lai n s to y o u why a tre atm e n t i n th e i n ter

.

s c ap u lar regi o n ha s s u c h far re ac hi n g e ff e c t s -

A C as e Illu st r ati n g the C i l i o s pi nal Ce nt e r —A s an i l

.

-
.

lu str ati o n o f th e n erve c o nn e cti o n b etwe e n the c i l i o Spi ii al -

c e n t er fir s t s e c o n d an d th ird d o r s al an d th e eye
, , I wi s h to ,

c al l y o u r atte n t i o n t o a p ati e n t n o w i n th e c li n i c Th ere .

w as e x te n s ive i n fl amm ati o n o f th e c o nj u n ctiv a o f th e right

ey e sigh t i n th at eye w a s al m o s t g o n e o n acc o u n t o f th e

o p ac ity c au s ed by th e i n fl am m
,

atl o n of th e co n j u n ctiv a o ver

rt a b u t) ! ne r ves.

my
1
g g an li o n

2 md d o r sa l g g
an lio n

D i agr a m g t
’

F IG 23 sh ow i n c i l i o -s p i n al cen er an d th e cou r s e of th e
g v g g t t
. .

a c c o m m o d a ti o n
.

of th e to li h and d i s an c e
“

n e r ve s o e r ni n ey e .

D r aw n by J oh n C o m s to c k
( a er ft S ch u l tz ) .

th e c o r n e a Thi s co n diti o n w as p re s e n t fo r five ye ar s The

.
.

i n fl amm ati o n had tr ave l ed to th e n asal d u ct an d as a re su lt ,

’
it w as clo se d The d u c t had b ee n o p e n ed by th e s u rge o n s
.

k n ife lo n g bef o re we s aw th e c as e A C lo se e x ami n ati o n o f .

th e c e n te r l ike ly to be i rrit ate d i n S u c h a c o n diti o n di scl o s ed

th e fac t th at th e are a be tvif e e n th e fir st an d thi rd d o r sal
vertebr ae w as e x c e e di ngly s e n sitive an d m o st i n tere sti ng , ,

o f all p re ssu re o n th i s are a c au s e d i n te n s e p ai n i n th e i n

,
—
fl am ed eye an d cau s e d th e p u pi l to dil ate The m u sc l es in
,
.
138 PR I N C I PL E S O F O S TE O PA TH Y

E ff e ct s of Tr e at m e nt F i r s t
to D
,
o r s al — Tre at S e v e nth .

m e nt i n th e i nte r scap u lar regi o n fir st to s eve n th v ert ebr ae , ,

m ay re aso n ab ly b e e x p e c te d to aff e c t th e h e art be at th e n u ,

tr i ti o n al c i r c u lati o n i n th e l u n g s an d th e c i r c u lati o n i n th e
,

u pp e r e x trem iti e s h e ad n e c k an d f ac e
, , .

The rem ai n der o f th e d o r s al are a co n stit u te s wh at i s

call ed th e S p lan ch n i c regi o n Thre e s pl an c h n i c n erve s ar e
.

give n o ff fr o m thi s regi o n to b e di strib u ted to th e pr e v e r te

br al pl e x u s e s i n th e abd o m i nal cavity
The G r e at S plan chni cs —
.

The fir s t i s call e d the G re at

.

S pl an c h n i c an d t ake s o rigi n fr o m th e s i x th to th e te n th do r
s al n erve s an d p r o b ab ly re c eive s m an y fi lam e n t s fr o m th e
,

u pp e r d o r s al n e rv es I t i s a lar ge n erve tr u n k an d co nt ai ns
.

—
m any m ed u llated n e rve s fr o m th e c ereb r o S pi n al sy stem .

Its c o u r s e i s d o w n w ard an d i n w ar d p erf o r ate s th e c r u s O f , .

th e di aphr ag m an d e n d s i n th e s emil u nar g an gli o n S o m e .

fib er s e n d i n th e re nal an d s u pr are nal p l e x u s e s .

L e s se r S plan chni c — The L e ss er S p lanch n i c ari se s fr o m

.

th e t en th and e l eve nth gang li a an d th ei r co nn e cti n g co rd r

I t also t ak es a d o w nw ard an d i n w ard co u r s e pi er c i n g th e ,

c r u s Of th e di aph r a m an d e n d s i n th e Co el i ac P l e x u s I t
g ,
.

c o m m u n i c ate s with th e Gre at S p l an c h n i c an d so m etim e s ,

s en d s fiber s t o th e re n al pl e x u s .

L e ast S planchni c —The L e as t o r R e n al S pl an chn i c

.
, ,

ari se s fr o m t he last th o r ac i c g an gli o n an d e n d s i n th e re nal

p l e x u s I t so m etim e s c o m m u n i c ate s with th e l e ss e r splan ch
.

nic .

—
'

F u n ct i o ns F ir st v aso co nstri c ti o n ; s e c o n d vi sc er o
.
,
-

i n hibiti o n I m e nti o n m ere ly th o s e f u n cti o n s whi ch h ave

.

b e e n we ll dem o n s tr ate d by phy s i o l o gi cal e xp erim e n t s and

o s te o p athi c p r ac ti c e .

The o r y —The o ste o path re aso n s as f o llo w s co n c er n i n g

.
.

th i s S p lanch n i c are a : S i n c e th e G re at S pl an ch n i c e n d s i n
th e s em i lu nar g an g li o n fr o m thi s g angl i o n an d p le x u se s
,

ar o u n d it fib er s ar e di strib u te d to th e b lo o d ve s sel s o f th e .

st o m ach l ive r sp l ee n and i n te s ti n e s ; th e ref o re we o p er ate

, , ,

i n th e are a betwe e n th e fifth an d te n th d o r sal s pi n e s fo r

‘
 PR I N C I PLE S O F O S TE O PA TH Y 13 9
”

v aso m o t o r e ff e ct s o n th e ab o ve —m e n ti o n e d vi s c er a A g ai n
-
. .

th e G re at S p lan ch n i c s e n d s vi sc er o inhibit o ry fib e rs to th e
-

m u scu lar lay er s o f th e s t o m ach an d i n te s ti n e s ; h e n c e we ,

c o n tr o l e x c e s s ive m u s c u lar ac tivity i n th e s e vi s c er a by r e

m o v 1n g Ob str u c ti o n s to the n o rm al i nh ibit or y i n fl u e n c e o f

.

th e s e n erve s » The L e ss er S p lan ch n i c h as

.
-
fu nc
t i o n s , b u t e x er c i s e s i ts f u n c ti o n s c h i efly o n th at i
p o r ti o n o i _

th e i n te sti n al m u s c u lar layer c o mpri se d i n the are a su pp l ied

by the s uper i o r m e sen teri c artery ; t he r ef o re th e te n th an d
‘

,
.

—
e l eve nt h d o r sal are a i s a v aso m o t o r an d m o t o r i n hibit o ry —
c e n te r fo r a s egm e n t o f th e i n te sti n e s The re n al splan ch
.

n i c s e x e r t a v as o c o n s tri c t o r i n fl u e n c e o n th e b lo o d ve s se l s
-

o f th e kid n eys a n d the o ste o p ath s e c u r e s v as o m o t o r e ff ec t s -

,
’

o n th e b lo o d ve ss e l s o f the kid n ey s an d h e n c e e ff e c t s s e c r e
,

ti o n by r e mo v 1 n g o b str u c ti on s to th e n o rm al i n fl u e n c e o f
thi s n erve .

The t w e lft h d o r sal spi n e m a r k s a re n al c e n ter The s e .

n erve s c o n t ai n s e n so ry fib er s w h i ch c arry se n sati on f ro m

the p r e ve r tebr al p lex u s l n th e abd o m e n to the sp i n al co r d .

Theref o re a di s t u rb an c e i n the vi s c er a c an r efl e x i ts p ai n f u l
,

s e n s ati o n s t o t he ar e a o f gre ate r s e n s ibi lity whi c h i s i n c l o s e

,

C e nt r al c o n n e c t io n W ith the s e at o f di st u rb an c e .

I t sh o u ld b e b o r n e i n m i n d th at th e p o we r o f m o vem e n t
re s ide s i n th e m u sc u lar w all o f the i n te s ti n e an d i s in iti ated
by the A ut o m ati c G an g li a in i ts w al ls whi c h ar e e x c ited by
,

th e pre ss u re o f f o o d W e m ay st ate th at th e i n
. te s ti n e s po s .

s e s s an i n t ri n s i c n e r ve app arat u s whi c h i n iti ate s p eri st als i s ,

bu t th e co n tr o l o f th e m o v em e n t after i t i s i n it iated i s e x e r
'

—
c i s e d by c ere b r o sp i n al n erve s
‘

.
The p n e u m o g as tri c n erve
e x e r c i s e s a d e c i de d m o t o r i n fl u e n c e o ver th e i n te sti n e s .

A S p revi o u s ly s t ated th e gre at a n d l e ss er s plan c hn i c s ar e

,
-

i n hibit o ry n erve s to th e m u s c u lat u re o f th e i n te s ti n e s .

—
L um bar G an gli a F o u r sm all g ang li a co n n e c ted ab o ve ,

an d b e lo w by .
i n ter c o mm u n i cati n g fiber s c o n s titu te the
'

,
.

l u mb ar p o rti o n o f th e symp ath eti c g an g li a The se gan g li a .

ar e co nn e c te d with th e c erebr o S pi n al lu mb ar n erve s by

-

r ami c o mm u n ic an te s The fir st an d s e co n d g an g li a ar e th e
-
f
140 P RI N C I PL E S O F O S TE O PA TH Y

—
o n ly o n e s i n th i s regi o n re c eivi n g white r ami c o m m u n i

can te s .The f u n cti o n s wh i ch we f o u n d were e x er c i sed i n

th e lo wer d o r sal are a ar e c o nti n u e d i nt o th e lu mb ar g an gl i a
as far as th e s e c o n d Th e s e g an g li a s e n d fi be rs to th e ao rti c
'

pl e x u s th e hyp o g astri c p le x u s an d th e n c e to th e p elvi c

, ,

pl e x u s Th ey also se n d br an ch e s as i n o th e r regi o ns to th e
.
, ,

bl o o d ve s se ls su pp lyi n g th e b o n e s an d ligam e n ts Of th e
S p i nal c o l u m n .

'

S i n c e v aso co n s tri c t o r fiber s do n o t e n ter the symp a

-

th eti c g an g li a b el o w th e se c o n d l u mb ar we may re aso nably ,

e x p e ct to i n fl u e n c e th e c i r cu l ati o n o f th e lo we r e x tre miti e s

by m an ip u l ati o n s i n th i s are a
The de sc e n di n g c o lo n and re ct u mar e su pp lie d with v i s
.

c er o i n hib it o ry fi be rs fr o m thi s are a

-
V aso co n stri ct o r fib er s .
-

ar e su pp li ed to th e b lo o d ve s s e ls i n th e l o we r p o rti o n o f th e

ab d o m e n The i n fl u e n c e e x erte d by th e l u mb ar symp a

.

th eti cs m ay b e t ab u lated as f o llo w s

l st: Vi sc er o i n hibit o ry to de sc e n di n g co lo n an d re ct u m
-
.

2 n d : V aso c o n stri c t o r to lo wer ab d o m i n al bl o o d ve s sel s

-
.

—
3 r d : V aso c o n s tri ct o r to the bl o o d ve s sel s o f th e p eni s .

4 th : V as o m o t o r fiber s to th e bl o o d ve s sel s o f th e bl ad
-

5th : V aso -
m o t o r fib er s to th e bl o o d ve s sel s of th e
u ter u s .

6 th : V aso -
co n s tri ct o r to th e bl o o d ve s sel s of th e p elvi c
vi sc er a .

7 th : M o t o r to v as defere n s ( m al e ) , r o un d lig am e n t

( fem al e ) .

8 th : V aso -
co n s tri ct o r to th e b lo o d ve s sel s of th e l o wer
e x tremitie s
—
.

S acr al G an gl a i Th p elvi c p o rti o n Of th e symp ath eti c

e

c h ai n u s ually co n s i st s o f f o u r g an g li a s it u ated al o ng th e
i nn er sid e o f th e s ac r al f o r am i na an d co m m u n i c ate s with -
,

th e fo u r u ppe r Sac r al n e rv e s Th e se g an g li a ar e c onn e cted .

with e ach o th er as i n o th e r regi o n s The tw o ch ai n s co n

, _ .

n e e t by t he G an g li o n I mp ar o n th e an teri o r s u rfac e o f th e
c o c cy x .
142 PR I N C I PL E S O F O S TE O PA TH Y

The rdi ac n e rve s fo rm th e c ervi c al symp ath eti c ch ai n ;

ca

all e n te r th e c ardi ac p l e x u s b u t th ei r di s trib u ti o n i s v ari a

,

ble . The su p e rfi c i al p le x u s re c eive s th e l eft su pe ri o r car

d i ac n e rve o f th e symp ath eti c an d th e l eft i n fer i o r c e rvi c al
ca rdi ac br n
a c h of th e p n e u m o g as tri c
”
— ( M o rri s s A .n at ’

o my ) .

The d e ep c ardi ac p le x u s re c eive s al l th e o th e r cardi ac

”
n erve s F r o m th e s u p e rfi c i al c ardi ac p l e x u s br an ch e s p as s
.

to th e p l e x u s ar o u n d th e right c o r o nary artery an d p ass to

th e left lu n g to j o i n th e an te ri o r p u l m o nary p l e x u s .

F r o m th e d eep c ardi ac pl e x u s b r an ch e s ar e di s trib ute d

to th e an t eri o r p u lm o nary p l e x u s o f b o th s id e s th e l eft c o r o ,

n ary pl e x u s right au ri c le S u p erfi c i al c ardi ac p l e x u s an d

, , ,

righ t co r o nary pl e x u s .

P u lm o nar y P l e x u s —The an te ri o r p u lm o nary p le x u s i s

f o rm e d by a b r an ch o f th e p n e u m o g as tri c and th e symp a
th eti c I t i s s it u ate d o n th e an te ri o r su rf ac e Of th e br o n ch i
.

an d th e b r an c h e s e n te r th e lu n g o n th e br o n c h u s .

The p o steri o r p u l m o n ary p l e x u s i s f o rm ed by th e p n e u

‘

m o g as tr i c an d fiber s fr o m th e se c o n d t hi rd an d f o u rth tho

,

r ac i c gan g li a o f th e symp ath eti c Its b r an che s enter th e.

lu n g o n th e p o s te ri or aspe c t o f th e br o n c h us .

P hy si o l o gy — P hy si o lo gi c al e x p eri m e n t s h ave d em o n
'

e d th at th e pn e u m o g as t he m u s c le s o f
.

st r at r 1c 1 5 m o t o r to t

th e br o n chi o le s s e n so ry an d tr o ph i c , wh i l e th e symp ath eti c s

,

—
ar e v aso m o t o r an d tr o ph i c Theref o re th e f u ncti on o f th e
,
.

l u ng s an d h e art c an b e aff e c te d by Op er ati n g o n th e i n ter

s c ap u la r regi o n .

F u n cti o n s — The f u nc ti o n s o f th e th o r ac i c pl e x u s ar e
.

l s t: Cardi ac au gm e n t o r s p er symp atheti c s , .

2 n d : C ardi ac i nhibit o r p er p n e u m o g astri c

, .

3 r d : V as o co n stri c t o r to c o r o n ary art e rie s p e r p n e u m o

-
,

g astri c .

4 th : V aso c o n st ri c t o r to br o n chi al arteri e s p er symp a

-
,

th eti c fir st to fifth d o r sal

,
.
 P R I N C I PL E S OF OS TEO PA TH Y 14 3

fib er s to the p le u r a an d lu n g s p er s y mp a
5th : S e n so ry ,

th eti c fir s t to fifth d o r sal

, .

oth : S e n s o ry fiber s to h e art an d p eri c ardi u m per sy m ,

p ath eti c s e co n d to fifth d o r sal

, .

7 th : Br o n ch o —c o n s tri ct o r p e r p n e u m o g astri c , .

—
8 th : Br o n ch o di lat o r p er p n e u m o g astri c , ;

9 th : S e n s o ry fiber s to m u c o u s l i n i n g o f air p a ss age s .

per p n e u m o g as tri c .

Tr e atm e nt— A i n hibit o ry tre atm e n t w o u l d pr o

tr u e
d u c e gre at e st e ff e c t o n th e h e art if admi n i stered o ver th e
’ '

,
.

mi dd l e an d i n feri or c erv ical g an g li a The h e art w o u ld b e

‘

. .

slo wed S u ch a t re atm e n t i s r are ly give n b e cau s e ne ar ly

.
,

eve ry c as e p r e s e n t s s o m e phy si c al l e s i o n wh i ch if rem o ved , ,

allo w s n o rm al imp u ls e s to m eet i n the c ardi ac p l e x u s an d

be r e o rgani z e d fo r pr o p e r d i strib u ti o n
-
.

A lw ay s be ar i n mi n d th at a p l e x u s i s a r e o r g an IZ In g -

c e n ter f o r n erv o u s imp u l s e s an d we c an h o p e o n ly t

. o reg u ,

late th e f u n cti o n o f an o rgan by attempti n g to e q u al iz e th e

i m pu ls e s r e achi n g i ts c o n tr o l li n g p l e x u s Thi s e q u alizi n g .

p r o c e ss i s n o t o rd i n ari ly s e c u re d by th e admi n i s tr ati o n o f

i nh ibiti o n to a defi n ite n erve tr u n k whi ch e n d s i n th e p l e x u s
— ,

but by r erif o v fng a l e s i o n

‘
‘

— ‘
u s u ally b o n y o r m u s c u l ar ,

whi c h i s aff e c ti n g th e n erve fiber i n th e dire c ti o n Of i n c re ase

o r d e c re as e Of f un c ti o n .

The regi o n b etwe e n th e s c ap u lae is i n cl o s e c e n tr al

con n e c ti o n with th e l u n g s p le u r a h e art an d p eri c ardi u m ; , ,

h e n c e p ai n f ul se n s ati o n s o rigi n at in g i n th e s e o rgan s m ay b e

,

refe r red to thi s are a The m u scle s i n thi s a re a wi ll co n tr act

.

r e fl e x ly fr o m i r rit ati o n o f th e s e o rg an s o r fr o m e x p o s u re o f ,

th e S ki n o ver th em to a c h an ge Of t e mp er at u re H e n c e i n
.
.
,

th e fir s t i n st an c e th e co n tr ac ti o n i s a s e co n d ary l e s i o n ; i n
th e latte r a prim ary o n e ,
.

P re ss u re i n thi s are a p r acti c ally cau s e s re lax ati o n o f

m u sc le s re m o ve s a l e s i o n ; bu t th e p ati e n t e x p e ri e n c e s a
‘

c e ss ati o no f p ai n freer re s pi r ati o n an d l e s s r ap id ac ti o n Of

'

, ,

the he ar t
'

.
144 PR I N C I PL E S O F O S TE O PA TH Y

R e su lt s —After admi n i ste ri n g i n hibit o ry p re ssu re th e

.
,

o ste o p ath re alize s t hat th e m u s c l e s u n der hi s fi n ger s ar e

so fte r th an f o rm e r ly ; th e n h e k n o w s th at h e has ac t u al ly

ch an ge d th e phy s i o lo gi c al c o n diti o n o f an i mp o rt an t t i ssu e .

—
Ar g u m e nt Co i n c i de n t with th e fte n i n g o f th e m u s so

c l e s th e h e art b e at
, s s lo wer ; th eref o re h e has rem o ved an ,

i rrit an t to th e au gm e n t o r fibe r s o f th e h e art ; th e re spir ati o n

i s d e ep er th eref o re a c h an ge has b ee n s e c u red i n the ac
'

ti v i ty o f th e w alls Of th e th o r ax an d in th e c i r c u lati o n o f
,

b lo o d i n th e br o n chi al an d p u lm o nary b lo o d ve s s el s ; th e
p ai n has de c re as ed th eref o re th e s e n so ry n erve s i n th e l u n g
,

ti ssu e ar e n o l o n ge r i rrit at e d by hy p eraem i c pre ss u re o r

t o x i c s u b st an c e s i n th e bl o o d Th i s i llu st rate s to y o u why
.

th e o ste o p ath s t u di e s an d tre at s the i n ter s cap u lar regi o n S O

c aref u lly .

P l e x u s — In the ab d o m i nal cavity we fi n d th e so

S o l ar
lar p l e x u s whi ch o n acco u n t o f i ts gre at s iz e and w o n d erf u l
,

di s trib u ti o n Byr o n R o bi n s o n call s th e Abd o m i nal Br ai n

,
”
.

L o cati on a nd — F o rm ati o n
It i s pl ac ed i n fr o n t o f th e
.

ao rt a at i ts e n tr an c e i n t o th e ab d o m e n an d su rr o u n d s the ,
’
C o e l i ac Ax i s I t co n s i st s o f tw o s em i lu n ar g an g li a whi ch
.
,

ar e p lac ed o n e ac h s i de o f th e c o eli ac ax i s an d ar e c o nn ec te d ,

by a large n u mber o f fib er s whi ch p a s s ab o v e and b e lo w th e

c o e li ac ax i s F r o m th i s c i r cl e o f g an g li a an d n erve s fi ber s
.
,

ar e give n O ff whi c h ar e j o i n e d by br an c h e so f the right p n e u

m o g as tr i c an d by b o th s m al l s plan chn ic s
, The gre a t .

s pl an c h n i c e n d s i n th e s em i lu n ar g an gl i o n .

D i s t r i bu ti o n —The br an ch e s o f di strib u ti o n fr o m th e
.

so lar p l e x u s ar e p r o lo n ged o n th e br an ch e s o f th e abd o mi n al

ao rt a as su b s id i ary p l e x u s e s taki n g th eir nam e s fr o m t

,
he
arte rie s th ey ac c o mp an y as S p l e n i c g astri c h ep ati c dia
, , , ,

ph r a g m a t i c s u p,
r are n al an d re n al s u p eri o r m e s e n teri
,
c i n ,

fe r i o r m e s e nteri c ao rti c an d S p erm ati c

, The ultim ate di s .

tr i bu tio n o f th e br an ch e s o f th e so l ar pl e x u s i s t o t he m u s
cu lar an d s e cr et o r y ti ssu e s o f all t he abd o m i nal vi sc e r a and ,
146 PRI N C I PL E S O F OS TE O PA TH Y

Th es e g an g li a m ay re c ei ve fib er s fr o m so me of th e up

per d o r sal .

C e nte r s — The f ac t s j u st st at ed giv e u s a f o u n d ati o n “

fo r o s te o p ath i c tre atm e n t to i n fl u e n c e m oti o n se n sati on S €

,
, , _

c reti o n an d v aso m o ti o n in
,
-
vi sc er a The
. .

are a i n th e verteb r al c o l u m n whi c h we m ay c o n si der a s c o n

t ai ni n g c e n ter s fo r th e s e v ari o u s f u nc ti o n s li e s b etwe e n th e

s i x th and e l ev e n th d o r s al s pi n e s The fib er s fr o m thi s regi o n .

have a s egm e n t al di s trib u ti o n to th e ab d o m i n al vi sc er a ;

th erefo re th e s t o m ach live r g all bl adde r s p le e n an d in
, , , ,

te sti n e s e ac h h ave a l imited p o rti o n o f thi s are a whi c h i s

th ei r sp e c i al c e n te r ; at l e as t p ai n f u l s e n s ati o n s ar e r e fl e x e d
,

fr o m th em to a defi n ite po i n t i n th e vertebr al co lu m n be

twee n th e s i x th an d el eve nth d o r sal sp i n e s The e n o rm o us .

re g u l ativ e i n fl u e n c e wh i c h can b e e x c ite d by an o ste o p ath ic

tre atm e n t i n thi s are a i s b ei n g de m o ns tr ated d aily .

we h ave al re ady m e n ti o n ed th e f act th at th e i nte sti n e s

w il l c o ntr act afte r bei n g s ep ar ated fr o m th e b o dy th ereby
'

pr o vi n g th at th e i n tri n s i c p o wer to cau s e m o vem e n t li e s i n

th e n e rv o u s m e c han i s m i n th e g u t w alls K eep c o n st an tly .
'
in m i n d th e r e g ii lative c h ar ac ter o f th e i mp u ls e s wh i ch
-

”
e nte r th e abd o m i n al br ai n o ve r th e p n e u m o gastri c an d
'

sp l an ch n i c n erve s .

The v aso m o t o r ph e no m e n a i n th i s are a h av e b e e n di s

-

Cu s s e d i n ano th e
. r ch apter .

H y po gastri c P lexu s o c ation —L e an d F o r m ati o n

-
.
—Th
gre at r e o rg an izi n g c e n te r fo r th e p e lvi c vi sc era i s c all ed
-

th e hyp o g astri c p l e x u s wh i ch l i e s an teri o r to th e fif t

,
h lu m
bar verteb r a I t i s f o rm ed by a co n ti n u ati o n o f fib er s fr o m
.

th e ao rti c p l e x us Wh i ch ar e j o i n e d by fiber s fr o m th e lu m
‘

bar symp at heti c g an gl i a In fr o n t O f th e s ac r u m th e pl e x u s

.

divi de s i n t o tw o p o rti o n s whi ch j o i n the p elvi c p l e x u s e s

,

lyi n g o n e ach S ide o f th e re c t um an d b ladder i n th e m ale , ,

an d o f th e re c t u m v agi n a an d b lad der i n th e fem al e

,
.

P e lvi c P le x us '

.
—
The e p elvi c pl e x us e s c o n t ai n m any
s

sm all gangli a , and ar e j o i n e d by fib er s fr om th e u pp e r sacr al

 P RI N C I PL E S O F O S TE O PA TH Y 14 7

symp ath eti c g an g li a an d by di re c t b r an c h e s ,

of th e s e c o n d ,

thi rd an d f o u rth sac r al c ere e —

s pi n al n erve s .

i —
D i str b u t o n The
i br an che s Of th e s e p le x u s e s ar e dis
.

trib u te d o n th e co at s Of the arteri e s to th e pe lv1c V i sc er a

'

an d fre q u e n t ly e n ter th e su b s t an c e o f th e o rg an

P le x us e s —A cc o r di n g to th e artery fo l
.
.

S u bs i di ar y
lo we d we h ave su b s idi ary p l e x u s e s c all e d h em o rrh o id al
, , ,

vi s c e ral gpr o static v agi n al an d u teri n e

'

, ,
.

F u nc t i o n s —The f u n cti o n s o f th e p e lvi c p l e x u s ar e as

f o llo w s
( )
1 V a so —c o n s tri c t o r ( )
2 v as o m o t o r ( )
3
, s e n so ry ( )
4-

, ,

vi sc e r o i n h ibit o r p e r hyp o g as tri c p l e x u s

-
, .

5
( ) M o t o r to re c t u m v agi na an d b ladd er ( 6 ) se n s o ry
,
-

to re c t u m v agi n a an d b ladd er 7
( ) v di l t r e l
'

, a so a o to s
,
x u a -

O rgan s, ere c til e ti ssu e ( 8 ) v i s c e r o c o n str i cto r to n e c k o f

,

uter u s pe r s e co n d thir d an d f o u r th sac r al

, , .

S u mm ary —
With th e . a rr an gem e n t an d f un cti o ns o f
th es e n e rve s we ll i n m i n d w e r e c o gn i z e ,
tw o p ath s o ver
wh i c h we can i n fl u e n c e th e pe lv 1 c V l sc e r a
( )
l s en s o r y i n fl u e n c e s m a y b e r e fl e x e d th r o u gh th e

hyp o g astri c p le x u s an d th en c e to the s e co n d lu mb ar ; Or

, ,

th ey m ay p as s o ver s ac r al n erve s to th e s am e p o i n t s e c o n d ,

lu m bar In co n n e c ti o n with di st u rb an c e o f th e p e lvi c v i s

.

c er a ,
p ai n m ay b e r e fl e x e d o n to th e b ac k o f th e s ac r u m ,

or t o an ar e a ar o u n d th e s e c o n d l u mb ar D i s t u rb an c e o f .

fu n c ti o n i n th e u ter u s cau s e s refle x s e n s itive n e ss at f o u rth

an d fi fth l u mb ar .

( )
2 V a s o c o n s tri c
-
t o r i n fl u e n c e s c o m e th r o u gh hyp o

ga stri c p l e x u s fr o m sp i nal n erv e s ab o u t s e c o n d lu mb ar

.
.

( )
3 V a s o di l at o-
r i n fl u e n c e s c o m e dire c t l y to th e p elv i c
i

p l e x u s e s fr o m s e c o n d an d th ird s ac r al n erve s ; n ervi

erige n te s .

( )
4 Vi s c e r o m o t o r i
-
n fl u e n c e s c hi efly fr o m s e c o n d third ,

an d f o u rth s ac r al .

5
( ) Vi s c er o i n h ibit o-
ry i n fl u e n c e s c hi efly th r o u gh hyp o,

g as t r i c ple x u s p r o b ably fr o m upp e r l u mb ar sp i n al n erve s

, .
148 PR I N C I PLE S O F O S TE O PA TH Y

We h av e th e ref o re a v aso c o ns tri c t o r c e nter fo r p elvi c

-

vi s c e r a at se c o n d lu mb ar ; a v aso d i lat o r an d m o t o r c e n ter

-

at se c o n d an d thi rd sac r al .

Au t o m ati c l i —
V i sce r al G an g a The last po r ti o n o f the
symp ath eti c i s b u t li tt l e k n o w n,
an d phy s i o lo gi st s h ave

refr ai n ed fr o m sp e cu lati n g o n it u n ti l m o re d efi n ite k no wl

edge i s o bt ai n ed .

Byr o n R o bi ns o n m e nti o n s a n u mb er o f au t o m ati c

”
vi sc e r al g an g li a S it u ated i n th e w all s o f th e h o llo w vi s c er a .

The f ac t th at th e h e art i n te s ti n e s u te r u s bl adde r and

, , ,

fallo pi an t u b e s wi ll co n tr ac t rhyth m i cally i n r e s p o n s e to

m e ch an i cal stim u l ati o n afte r all n e rve co nn e cti o n s ar e
’

s eve red s e em s t
,
o p r o ve th e e x i ste n c e o f g an gli a i n th e w alls

o f th e s e vi s c er a wh i ch ar e c ap ab l e o f re c eivi n g s e n s ati o n

an d s e n di n g o u t m o t o r i mp u ls e s .

—W e will th eref o re c o n clu d e th at th e

C o n cl u s io n s .

s ymp ath eti c sy s tem c an ac t i n dep e n d e n t ly o f th e c ereb r o

spi n al ; th at it re c eive s s e n sati o n an d i n iti ate s m o ti o n ;

,

give s t o n e to th e arteri e s an d c o n tr o l s s e c reti o n We i n

, .

i o n s o f th e s ymp ath eti c th r o u gh its co n

fl u e n ce th e f u n ct
’

n e c ti o n with th e cerebr o S pi n al sy s tem

-
.
150 PR I N C I PL E S O F O S TE O PA TH Y

to d i s c u s s so s elf evi d e n t a p r o p o siti o n as th at h e alth p ri

-

m ari ly d ep e n d s o n a p erfe ct c i r cu lati o n I t i s n o t eve n .

n e c e ss ary to add t o thi s th e f a ct th at th e bl o o d sh o ul d b e

p u re b e cau se u n d er o rdi n ary c ir c u m st an c e s if th e b lo o d

,

c i r c u late s p r o p erly it will b e c o m e p u rified .

A ll sc h o o ls o f m edi c m e h ave a th er ap e u ti c p ri n c ip le
ar o u n d whi c h th ei r pr ac ti c e i s b ui lt F r o m i ts e ar li e s t i n . .

c e pt i o n th e o ste o p ath i c i de a has b e e n th at a p erfe c t c i r c u

lati o n i s th e f o u n d ati on fo r p e rfe c t h e alth .
The p ro p o rti o n o f b lo o d to bo dy weight i s ab o u t o n e
twe lfth o f th e wh o le i e twelve p o u n d s o f b lo o d i n a
, . .
,
'

b o dy weigh i n g 1 50 p o u n d s Thi s am o u nt o f b lo o d i s di s
.
“

trib u te d app r o x i mate ly a s f o llo w s : O n e f o u rth to th e

‘

h e art l u n g s an d gre at b lo o d ve s s el s ; o n e fo u rth to th e liver ;

,
-

—
o n e f o u rth to th e re s ti n g m u sc l e s ; o n e f o u rth to th e r e
‘

m ai n i n g o rgan s Th e re is n o t blo o d e no u g h i n the b o dy

.
-

to m ai ntai n all o f i ts ac tiv iti e s at th e m ax im u m at th e

'

s am e tim e Th eref o re it i s di ffi c u lt to do th e b e s t phy s i cal

.

or m e n t al l ab o r j u s t afte r dige s ti o n has b eg u n The .

s p lan c h n i c b lo o d ve s s el s ar e c ap ab l e o f c o n t ai n i n l a e
g s o r g
ap r o p o rti o n Of th e wh o l e am o u n t o f bl o o d th at de ath m ay
re su lt fr o m l ac k o f su ffi c i e n t b lo o d ret u r n i ng to th e he art .

to c au s e it to be at .

D s r bu
i t i ti o n o f the B l o o d — G r an ti n g th at th e bl o o d
’

p o s s e s s e s all th e s e f u n c ti on s th e q u e sti o n sti ll Co n fr o n t s

,
‘

u s ho w c an w e aff e c t i ts d i strib u ti o
, _
n ? Th i s q u e s ti on l e ad s
u s to a Co n s id er ati o n Of th e phy s i o l o gi c a l di strib u ti o n o f
th e b lo o d I t i s beli eve d by th e writer th at n o th i n g b e
'

si de s th e u s e O i w ater has s o gre at an e ff e c t o n th e Ci r c u

_

lati o n o f the b lo o d as m an ip u lati o n acco rdi n g to o s te o p athi c

meth o d s Th e s e m eth o d s do n o t dep e n d o n a m e re p hys i
.

i st an c e o f th e v en o u s fl o w by m e an s O f c e n trip et al
’

c al as s
'

s tr o ki n g su h i l
emp ye d by i m E ff i
'

,
c a s s o a a ss e u r e ct s on .

c ir c u lati o n ar e Obt ai n e d i n n e ar ly all cas e s by k nowi n g

w he re d efi n it e n erve s wh i c h c o ntr o l th e ac ti o n Of th e h e art
an d bl o o d ve ss e ls ar e pl ac ed an d wh at th ei r acti o n i n re
’

S po n se to i r rit ati o n m ay b e All m an ip u l ati o ns ar e g i ve n

'

.
 PR I N C I PL E S O F O S TE O PA TH Y 151

with defi n it e k n o w l edge Of th e lo c ati o n o f b loo d ve s se l s

a

an d th e n e rve c e n ter s wh i c h c o n tr o l thei r v ari ati o n i n

c al ib er .The re sp o n s e s e c u re d i s a n e w c o o rdi n ati o n o f

th e wh o l e c i rcu lati o n b r o u gh t ab o u t u n der th e c o n tr o l o f
th e n erve c e n te r s .

I t has b ee n st ate d th at th e b lo o d i s co n t ai n e d i n a
c lo s e d s y s tem o f t u b e s A s h o rt re su m e Of t
. he m o s t i m
p o rt an t p o i n t s in th e an at o my an d ph y s i o lo gy o f th e C i r
c u l at io n m ay p rep are u s fo r a c l e are r i n s ight o f t he m o du s
‘

o p e r an di o f o s te O pat hi c m eth o d s .

The C i r cu l a
t or y Appar at u s — The
r cu lat o ry app a Ci r

r at u s c o n si s t s Of th e h e art art eri e s c a i llarie s vei n s an d

p , , ,

lymph ati cs ; so m e writer s i n clu d e th e S p l ee n .

M u s c u lar ti ss u e i s fo u n d i n th e h e art s m all ar t er i e s,

an d v ei n s The he ar t i s p r ac ti c ally all m u s cl e an d i ts c o n

.
,

tr acti o ns ar e g o ver n ed by tw o s et s o f n erve fib er s fr o m th e

—
c erebr o spi n al sy s tem ; th e fir st s e t 1 s c al l ed ac c e l er at o r ;

s e co n d i n h ibit o ry
, .

L ikewi se th e s m all arterie s an d vei n s h ave tw o s et s

,

Of fib er s wh i c h i n c re as e an d de c re as e th e i nt e n sity o f th e

c o n tr ac ti o o f th ei r m u sc u lar fib er s d th h ge the
n a n u s c an ,

c al iber Of th e ve s s e ls .

The capi llari e s ar e sh o rt n arr o w t u b e s h avi n g a thi n

, ,

w all co mp o s e d o f n u cl e ated c e ll s whi c h p o s s e s s th e p o wer

Of c o n trac ti o n S O far as k n o w n , th e cap i llari e s e x p an d
.
'

an d co n tr ac t i n re s p o n s e to th e d egre e o f phy s i c al p re s s u re

e x erted by th e blo o d cu r r e n t c o mi n g fr o m th e arteri o l e s

_ .

Thu s th e c h an ge i n th e c al ib er o f th e cap i ll ari e s i s pas

s ive . The lymph ati cs b egi n i n s m all irregu l ar s p ac e s i n
th e c e llu lar ti s su e o u tsi de o f th e blO Od ve ss e ls Th ey ar e
'

'

f o u n d i n dire c t re lati o n w ith th e c e lls o f p eriv as c u lar ti s

su e s th u s br in g i fl g th e lym ph to e ach c e ll Th e s e Op e n
,
.

1 n g s l e ad to s m al l lymph ati c v e ss e ls whi c h co n vey th e

lymph to th e lymph ati c g lan d s wh i c h ar e s it u ated s o a s
to fi lter o u t th e imp u riti e s after whi c h i t i s emptied i n t o
,

th e ve n o u s c ir cu l ati o n by th e lymph ati c d u c t s The ly m .

1 52 PRI N C I P LE S O F O S TE O PA TH Y

ph ati c ve ss e ls p o s se ss p o we r o f c o n tracti o n The lymph .

eq u als ab o u t o n e thi rd o f th e b o dy we ight

-
.

The b lo o d i s a p ass ive ly m o vi n g ti ssu e I t i s kept i n

i

co n st an t c i r c u lati o n with i n a c lo s e d sy stem o f t u be s by a

c o mbi nati o n o f f o r c e s . The pr o p u ls i o n o f th e bl o o d i s al

m o st e n ti rely ac co mp li sh ed by the co n tr ac ti o n o f th e h e art .

Thi s i n iti al f o r c e is s u pp l em e n ted by th e as pi r ati o n Of th e

c h e s t d u ri n g re sp ir ati o n an d th e c o n tr ac ti o n o f th e sk e l e
,

tal m u sc l e s Of th e e n ti re b o dy I t i s a d eb at ab le q u e s ti o n
.

wh eth e r o r n o t th e m u sc ular co at o f th e arteri o l e s an d

'

ve n u le s as si s t i n th e dire c t p r o p u l si o n o f th e b lo o d p as si n g
th r o u gh th em .

I t i s th e f u n c ti o n o f th e h e art to m ai nt ai n a c o mp ara
ti v e ly u n i f o rm te n s i o n Of th e bl o o d i n th e large arteri e s .

The arteri o le s an d c ap i llari e s ar e co n c er n e d i n m ai n t ai n

i n g re si st an c e to th e p assage o f th e b lo o d The degre e o f
.

re si st an c e i n th e c api llari e s i n large m e asu re determ i n e s

, ,

th e am o u n t o f n o u ri sh m e n t re c eived by th e ti ss u e s The .

re lati o n betwe e n c api llary r e s i s t an c e to th e p ass age o f

th e b lo o d an d th e m et ab o li s m carried o n i n p e riv asc u lar
ti s s u e s i s a p o i n t o f gre at imp o rt an c e The cu rre n t of
.

bl o o d o rdi n ari ly p as se s th r o u gh th e capi llarie s very slo w ly ,

at a r ate o f o n e i n c h i n tw o m i n u te s an d u n der lo w t
, en

s i o n th u s givi n g amp l e o pp o rt u n ity fo r th e e s c ap e o f n o u r

,

i shi n g m ateri al fo r th e su rr o u n di n g ti ss u e s .

Te n s i o n i n th e arteri e s is m ai n t ai n e d by th ree f act o r s

( )
1 T he i n iti al f o r c e o f th e h e art be at ; ( 2 ) fri c ti o n i n th e

ve ss e l s ; ( 3 ) e lasti c ity Of th e v e s se l w all s The fir st an d .

th i r d Of th e s e f ac t o r s ar e u n d er n erve c o n tr o l wh i ch ac t
ac co rdi n g to a large n u mb er o f s tim u l i .

The c api llarie s bei n g p as sive i n ac ti o n th e te n si o n o f ,

th e b lo o d s tre am i n th e m is m ai nly dep e n de n t o n th e te n

s i o n i n th e arteri o l e s . I t may b e p r o fit ab ly n o te d th at
afte r th e i n iti al i mp u ls e i s gi ve n to th e bl oo d s tre am by

th e h e art th e d i strib u ti o n o f thi s b lo o d d ep e n d s so le ly o n

,

th e ar teri e s arte ri o le s an d capi ll ari e s

,
Thi s p eri ph er al
.

di strib u tiv e m e ch an i sm i s th e refo re re sp o ns ib le fo r th e

1 54 P RI N C I PL E S O F O S TE O PA TH Y

r ate an d s tre ngth o f th e c ardi ac co ntr acti o n s t o ge th e r ,

with th e re s i st an c e Off e red by th e arte ri o l e s an d capill ari e s .

Co n si d eri n g th e arte ri o l e s an d c ap ill ar i e s as p o s s es si n g

fi x e d di am ete r s an i n c re ase i n th e n u mber and stre n gth
,

Of th e h e art be at s w o u ld i nc re as e th e s p e ed an d pre ssu re

’

o f th e bl o o d c u rre n t A l e s se n e d cardi ac ac tivity w o u l d

.

h ave th e O ppo s i te e fte c t The s p e ed an d p re ssu re o f th e

.

b lo o d stre am m ay v ary with i n wid e lim it s an d still m ai n

t ai n a fai r degree o f h e alth .

Co o r di nati n g C e n t e r s .
-
The
e rve imp u l se s re achi n g n -

th e h e art ar e co o rdi nated i n tw o g o ve r n i n g c e n ter s i n th e

c erebr o — s pi n al sy s te m Th e se c e n ter s ar e lo cate d in th e
.

b u lb The i n hibit o ry c e n te r is c o n n e c ted with c el ls i n th e

.

w all s Of th e h e art by fibe r s whi ch f o rm a p art Of th e p n e u

m o g astr i c n e rve S e c ti o n o f th e p n e u m o g astri c n erve r e
.

’
m o ve s th e i nhibit o ry i n fl u e n c e o ve r th e h e art s acti o n .

S tim u l ati o n o f th i s n erve s l o w s th e h e art The re lax ati o n .

p eri o d i s l e n gth e n ed wh i ch re s u lt s i n gre ate r fi lli n g o f the

h e art an d th e p re ss u re i n th e vei n s is i n c re ased whi l e ar
te r i al p re ss u re de c re as e s Th e s e re su lt s h ave be e n no te d
.

by many phy s i o lo gi st s
'

The P n e u m o g ast r i c Ne r v e — The p n e u m o g astri c i s

~
~

. o ne

of th e n erve tr u n k s wh i c h c an b e re ach e d by di re c t pre s »

su re m ad e th r o u gh th e s ki n an d m u sc l e s o f t he n e c k Its .

i nh ibit o ry acti o n c an b e ar o u s e d by p i nchi n g th e ster n o

c l ei d o m ast o i d m u sc le b etwee n th e th u mb an d f o refi n ge r ,

t aki n g care to w o rk de ep ly u n d er th e i n ter n al m argi n o f

th e m u sc l e .

I t i s no u n c o m m o n ph e n o m e n o n to h av e a p ati e nt
f ai n t as a re su lt o f th i s m an ip u l ati o n I n divid u al s d i ff e r .

gre atly as to th ei r re sp o ns e to thi s stim u l ati o n The s tim .

'

u lati o n sh o u l d b e a ge n t l e pre ss u re o f a c o n st an tly v ary

i n g i n te n sity .

A p u l s e tr ac i n g i s app e n ded F ig 24 wh i ch sh o w s th e
‘

, .
,

re s u lt s o f stim u l ati n g th e p n e u m o g astri c i n th e m ann e r

j u st d esc ribe d The ge n t lem an u p o n wh o m th e e x pe r i
.
 PRI N C I PL E S O F O S TE O PA TH Y 1 55

me n t m ade w as i n e x c e ll e n t h e alth an d p os se s s ed a
w as ,

q u iet we ,
ll b alan c-
ed temp er am e n t T h e tr a c i n g s h.o w s

th at the n u mb er an d f o r c e Of th e b e at s w as l e s s e n ed an d
th e arteri al p re ss u re de c re as ed Thi s tr ac i n g i s pr o b ab ly
.

F IG 24 t
S i m u l a ti o n of th e p n e Ii m o g as tr i c by p i n ch i n g th e n e r v e t run k
k
.

l n th e n e c .

typi c al Of th e ch an ge i n a we ll per s o n i n re sp o n se to stirn

, ,

u lati o n o f th e p n e u m o g as tri c NO s e n s ati o n Of f ai n t n e s s

.

i
o r o th e r d sagree ab l e fe e l i n g w as n o ted .

The i n h ibit o ry acti o n o f th e p n e u m o g as tri c s e em s

to b e m o s t ac tive i n i n divi d u als w ho s u ff er fr o m so m e di s
o rd e r o f th e dige s tive tr ac t In s u c h p ati e n t s th e co n st an t
.

i rrit ati o n o f th e s e n so ry fib er s Of th e p n e u m o gastri c wh i ch ,

ari s e i n th e m u c o s a Of th e dige s tive vi sc er a s eem s to i n ,

c re as e t he irrit ab i l ity O f th e wh o l e n erv e tr u nk to s u c h a

de li c ate p o i n t th at th e slighte st stim u lati o n m ade at any
p o i nt alon g th e c o u r s e Of th e n erve Wi ll e x c ite i ts i n h ibit o ry
ac ti o n M an y o ste o p ath s j u s t s t arti n g i n p r ac ti c e h ave
.
, ,

had th eir s e lf p o ss e ss i o n s evere ly trie d by a p atie n t f ai n t

-

i n g d u ri n g m an ip u lati o n o f th e n e c k I h av e never he ard

.

o f an y f at al re s u l t s fr o m m ani pu lati o n o f th e pn e u m o g as
tri c Why s tim u l ati o n o f th e p n e u m o g astri c sh o u l d re sult
.

i n cardi ac i n h ibiti o n r ath er th an i n ph e n o me n a c o n n e c ted

wit h i ts o th er br an ch e s s eem s i n cap ab l e o f e x p lanati o n .
1 56 PRI N C I PL E S O F O S TE O PA TH Y

S o m etim e s p asm Of th e lary n ge al m u scl e s wi ll acc o mp any

s

c ardi ac i n h ibiti o n .

The i nte n s ity o f ac ti o n o f th e p n e u m o g astri cs i s so

we ll k no w n to e x p e ri e nc ed o ste o p ath s th at th ey ar e c aref u l
to te s t i ts irrit ab l e n e ss i n c as e s b ef o re u n d ert aki n g any
‘

e x t e n sive m an ip u lati o n s alo ng i ts co u r s e .

The i n h ibit o ry c e nter i s c o n ti n u al ly active an d ac t s

acco rdi n g to th e b l o o d pre s su re Withi n th e arteri e s A ri s e .

i n p e riph er al re si s t an c e cau se s a d e c re as e i n n u mb e r an d
stre n gth Of t he h e art be at s .

A cc e l e r at o r C e nt e r — The acc e l er at o r c e nter i s eo n

.

n e c te d with th e h e art by fib e rs whi c h de s c e n d i n th e c o rd

to th e u pp e r p o rti o n o f th e d o r s al regi on ; h ere c o n n e c ti o n

i s m ad e with th e c e ll s wh o s e fiber s p ass to th e symp ath eti c
spi n al g an g l i a fir st s e co n d an d thi rd d o r s al a n d e n d th ere
, , ,

ar o u n d o th er c el l s wh o s e fib er s c o n vey th ei r imp u ls e s to

th e h e art .

F IG 25 . S ph yg g
m o r a m s i ll u s t ati n r g th e e ff e t
c of i nh i b i ti on, fi t rs s e co n d
t
.
,

and h i r d do r s a l .

The ti o n o f th e acc e le r at o r c e n ter i s n o t s o re adily

ac

dem o n str ate d as IS th e c as e with th e i nhibit o ry c e n ter I t .

cau s e s th e h e art t o b e at f as ter an d str o n ger th u s bri n gi n g ,

ab o u t a ri s e i n arteri al b lo o d p re ss u re an d a f al l in v e n o u s

p re ss u re Thi s c e n te r ac t s i n re sp o n s e to lo we re d p er
.
-

i phe r al re si st an c e The p r o d u ct s o f m et ab o li s m b r o u ght

.

ab o u t by phy s i c al e x er c i s e al so e x c ite it D eep ste ady .

,

p re s su re m ad e o n th e m u sc le s lyi n g o n e ach side o f the

fi r st se co n d an d th i rd d o r sal sp i n e s c au s e s a d ec re ase i n th e
'

r apidity o f th e h e ar ts act io n ’
.
 ‘

1 58 PR I N C I PL E S O F O S TE O PA TH Y

S ti m u lati o n of the H e ar t —A m ake

bre ak p re ss u re an d

m ad e at th e edge o f th e
ster n u m i n th e fir s t an d se co n d

i nter c o st al s p ac e s wi ll u sually sti m u late th e h e art S o me .

tim e s th e fi r s t e ff e ct is inhibitio n bu t i t q u i c k ly p as s e s to ,

sti m u lati o n The m an ip u l ati o n m ad e anteri o rly i n c re ase s

.

th e n u mbe r an d i nte ns ity o f th e stim u li re achi n g th e s e g

me nt O f th e c o rd fr o m wh i ch th e acc e ler at o r n erv e s p as s
o ut A ll c e n ter s act ac c o rdi n g to th e su m o f th e sti m u l i
.

re ach i n g th em fr o m all s o u r c e s
—
.

I i iti
n h b o n o f h
t e H e a t
r In c as e s o f r api d h e art b e at
with high te ns i o n p u l s e th e b e st e ff e ct s ar e se c u red b y
digit al p re s su re at fir st s e co n d an d third d o r sal sp i n e s The
'

.
,

p n e u m o g astri c s h ave to o m any br an ch e s to imp o r tant v i s

c e r a an d act fre qu e n tly with u n e x p e c ted i n t e n s ity The .
.

ac c el er at o r s ac t m o re s lo w ly with l e s s i n te n s ity an d th e _

ac ti o n i s s u s t ai n e d l o n ger th at i s as a re s u lt o f m an
, ,

i pu lati o n .

V aso m o t o r C o ntr o l o f the C o r o nar y Ar te r i e s —A fu r

-

’
th er f act o r in rel ati o n to th e reg u lati o n o f th e h e art s ac ti o n
i s th e b lo o d s u ppl y fo r th e n o u ri sh m e n t o f th e h e art All
'

o rg an s ac t with g r e ater f o r c e wh e n th ei r b lo o d su pp ly i s

The h e art be at s s tr o n ge r W
'

ab u n d an t .
he n i ts c o r on ary
arter i e s ar e di late d th an wh e n co n s tri c ted th eref o re th e ,

p o we r o f th e h e art dep e d s n o n t h e v aso —m o t o r c o n tr o l Of

i ts o w n arterie s Th e v as o m o to r n e r v e s to th e c o r o n ary
‘

-
.

arte rie s l e ave th e c erebr o sp i nal sy ste m b etwe e n th e thi rd

- -

an d fifth d o r s al s pi n e s In case s o f an gi n a p e c t o ri s thi s

.

‘
,

are a wi ll b e s e n s itive S te ady p re s s u re h ere wi l l d il ate th e

.
\

c o r o n ary arte ri e s an d e as e th e p ai n A sh arp s tr o ke w ith .

_

th e hyp o th e nar em i n e n c e o n th e f o u rth d o r sal spi n e wi l l '

n e ar ly alw ay s s t art an att ac k with s u c h p ati e n t s .

i
An g na P e c t o r i s — P hy si o l ogi st s nam e th e pne umo g as
.
‘
‘

—
tri c n erve as th e v aso m o t o r n erve to th e c o r o nary arteri e s .

I m e n ti o n th e are a th ird to fifth d o r sal as a v aso m o t o r

, ,
-

c e n ter fo r th e c o r o n ary arteri e s b e c au se c li n i cal e x p e ri e n c e

se em s t o dem o n str ate it O th er o s te op ath s h ave n o te d

.

th e fre q u e ncy o f l e si o ns i n thi s are a i n co nn e cti o n wit h

 PR I N C I PL E S O F O S TE O PA TH Y 1 59

h e art di ffi c u lti e s The l e si o n s ar e co n tr acte d m u sc le s lat

. ,

e r al s u b lu x ati o n s Of th e vertebr ae o r i n s o m e i n st an c e s .

s u b lu x ati o n s o f th e f o u rth an d fifth rib s With any o f

"

th e s e l e s i o n s th ere i s i n te n s e s e n s itiv en e s s .

D r G e o rge K e ith O f S c o tlan d m e n ti o n s digit al p re s

'

' '

s u re i n th e s e co n d l eft i n ter c o s t al s p ac e as a r he an s o f i n
hi bi ti n g an attac k o f an gi n a p e c t o ri s an d s u gge st s th e ,

n erve c o nn e cti o n o f th e p n e u m o g as tri c as bei n g th e n erve

p ath over w hich th e i n h ibit o ry imp u ls e tr av e ls .

P e r son s s u ff eri n g w ith an gi n a p e c t o r i s wi ll p re ss th ei r

h an d s with all th e f o r c e th ey p os s e s s ag ai n st th e l eft
, ,

c h e st
. I h ave u s e d h e avy digit al pre s su re o n the l eft s i d e
o f th e f o u r th an d fifth d o r s al s p i n e s wh i l e th e p ati e n t w as

The p re s su r e n eve r f ai l ed to b e
.

i n a p ar o x y sm o f pai n .

gr atef u l to the pati e n t A f u rt he r e x p erim e n t with thi s.

c e n te r w as m ade by e x te n d i n g th e p ati e n t i n a re c u mb e n t

p o siti o n W hil e e x te n si o n w as m ai n t ai n e d th e an gl e s o f
'

.
.

th e rib s co u l d be r ai s ed th e l eft ar m co u ld b e e x te n d ed
'

O ve r th e h e ad a f u ll i n spi r ati o n co u
,
l d b e t ake n bu t as ,

sO o n as t he vertebr ae were allo w e d to appr o x im ate as a

r e s ult O L e e ss at
- i o n o f e x te n s i o n th e s e thi ng s c o u l d n o t ,

b e done .

H e at digital p r e ss u r e an d co u n te r i rrit ati o n ar e c ap a

,

bl e o f c a u s n o n - —
i g v as co stri c t o r p ar aly si s i e v as o di lati o n ,
. .
, ,

an d he n c e i n c re as e th e p o we r Of t he h e ar t i n su c h c as e s .

Acti o n o f the H e ar t C e nte r s The g o ver n i n g c e n ter s .

-

Of th e h e art act pri n c ip ally acco rdi n g to th e p eriph er al

r e s i st an c e m ai n t ai n ed by th e b lo o d v e s s el s The he ar t po s .

s e s s e s a n erve c all ed th e dep re s s o r n erve Its e n di n g s ar e .

i n th e w all s o f the h e art an d ar e aff e c te d by th e pre ss u re

'

o f th e b lo o d withi n t he h e art A ri se i n ar teri al pre s s u re

.

i s f o llo w e d by a ri s e i n pre s su re with i n the h e art The .

dep re s so r n erve n o te s thi s f ac t an d c arri e s an i n hib it o ry

.

i mp u l se to th e v as o di lat o r c e n te r in th e m ed u ll a th u s
-

b ri n gi n g ab o u t a f all i n arte r i al p re ss u re In thi s w ay th e

-

h e art i s p r o te c te d fr o m o ve r e x erti o n as a re s u lt o f to o -

high pre s su r e .
160 PR I N C I PL E S O F O S TE O PA TH Y

In c as e s h avi n g r ap id we ak h e art ac ti o n i nh ibit th e

, ,

acc e l er at o r s to S lo w th e h e art al so I n hibit i n th e ar ea o f

,

—
v aso m o t o r co n tr o l o f th e c o r o nary arte ri e s to i n c re as e
th e am o u n t o f b lo o d f o r n o u ri sh m e nt to th e h e art m us cle ,

th u s i n c re asi n g th e s tre n gth o f th e b e at .

In cas e s o f r ap id h igh te n s i o n p u l s e i nh ibit th e

, ,

S plan c hn i cs an d i n th e s u b o cc ipit al f o s s ae to l e ss e n p eri

p h e r a l re s i st an c e,a l s o i n hibit th e a c c e l e r at o r s o r s ti m u l ate

th e p n e u m o g astri c s .

-
e r —
V as o o t o r N v e s In 18 4 0 H e n le d i s c o vered an d
m
d em o n str ated th e m u sc u lar c o at O f th e arteri e s an d as a
.
,

re s u lt o f thi s s tep f o rw ard we h ave o u r p re se n t k n o wl e dge

—
o f th e v a s o m o t o r n e rve s As s o c i ate d with th e d em o n
. st ra
ti o n o f th e s e e rve s we h av e th e am e s o f
n n B r —
o w n S e q ua r d ,

B er nard W alle r an d S ch i ff
, .

I t has b ee n p r o ve n th at tw o se ts o f fib er s i nn erv ate

the m u s c l e s o f th e arte ri e s ; a v as o c o n s tri ct o r s e t wh i c h
-

c au s e s a de c re as e i n th e c al ibe r ; an d a v as o di lat o r s et -

whi ch cau s e s an i n c re as e i n c al ib er The c o n s tri ct o r s

.

We re d em o n str ated fi r st .

“
H e n le said th e m o vem e n t o f th e b lo o d depe n d s o n th e
h e art bu t i ts di strib u ti on dep e n d s 0 11 th e ve ss e ls
,
We .
’

h ave f o llo w ed th e ph e n o m e n a i n c o nn e c ti o n with th e fir s t

p art o f thi s qu o t ati o n h e n c e it r em ai n s fo r u s to st u dy th e
,

p art p layed by th e v e s se ls In th e d i strib u ti o n o f th e b l o o d .

In or de r to c arry o u r th o u ght s alo n g i n a p r op er m an

n e r we wi ll c o mm e nc e at t
,
he c e n te r an d w o rk t o w ard th e
p eriph ery .

The ch i ef v aso m o t o r c e n ter i s i n th e m e d u l la

-
De .

s tr u c ti o n o f thi s c e n ter c a u s e s an im m edi at e f all of b lo o d

“

p re s su re all Over th e b o dy S tim u lati o n o f thi s c e n ter

.

c au s e s a ge n er al ri s e o f b lo o d p re s s u re .

Th e re ar e su b s idi ary c e n ter s sit u ated at v ari o u s l eve ls

i n th e s pi n al co rd .

A fte r th e S pi n al co rd i s s evered t h at p o rti on w hi ch i s

'

n o lo n ger c o n n e c te d with th e chi ef v aso m o t o r c e nt er wi ll

-

e x e r ci se a v as o co nstri c t o r i n fl u e nc e o ver th e b lo o d ve ss els

-
162 PR I N C I PL E S O F O S TE O PA TH Y

The v aso m o t o r pp ar at u s c o ns i st s th e n o f thr e e

-
a , , l

c l as s e s o f n e rve c e lls The c ell b o di e s o f th e fi r s t c l as s li e

.

i n symp ath eti c g an g li a th eir n e u r ax o n s p ass i n g dire c t ly

,

to th e s m o o th m u scl e i n th e w al l s o f th e ve ss el s ; th e s e c o n d
ar e stim u l ated at di ff ere n t l eve l s i n th e c e rebr o s p i n al ax i s -
,

th ei r n e u r ax o ns p as si n g h e n c e to th e s ymp ath eti c gan gli a

by w ay o f spi n al an d c r an i al n erve s ; an d th e third ar e
pl ac ed i n th e b u lb an d co n tr o l th e se c on d th r o ugh i n tr a
s p i nal an d i n tr ac r an i al p ath s The n erve c e ll Of th e fi r s t .

c l ass l i e s wh o lly with o u t th e c e rebr o s pi n al ax i s th e th ird

'

-
,

wh o l ly withi n it wh il e th e s e c o n d i s p art ly withi n an d p art

,

ly with o u t an d bi n d s t o get he r th e rem ai n i n g tw o

”
’

, Am . .

Te x t b o o k o f P hy si o lo gy
- -
.

F IG 28 g fi
Th e s i n i c a ti o n o f a s p h m o am Th e —
yg gr
s p a c e S i s th e p e r i o d
.

t y t t D
. .

o f v e n r i cu l a r s s o l e w h e n th e a o r i c v a l v e s a r e o p e n ; th e s p a ce
t
th e p e r i o d o f v e ntr i c u l a r d i a s o l e ; t, th e ti d al w av e d u e to th e v e n
y t r
tr i c u la r s s o l e ; p, th e p e c u s s i o n wav e d u e to i n s r u m e n a l d e e c ; t t f t
t t
a i s th e a o r i c n o c h w h i ch m a r s th e c l o s u r e o f t k h e a o i c v al v e s ; rt
t
d , th e di c r o i c w av e .

V as o c on st r i ct i o n —The v aso co n stri ct o r n e rve s wh i c h

-
.
-

p ass fr o m th e b u lb ar an d spi nal c e n ter s O f co n tr o l l e ave th e

-
'

c o rd as whit e r am i c o mm u n i cante s fr o m th e an teri o r r o o t s

~

o f th e s e c o n d d o r sal t o th e s e c o n d l u mb ar n e r ve s an d e n te r .

th e sym p ath eti c g angl i a to b e di s trib u te d as has be e n d e

sc rib e d b ef o re It i s b eli ev ed th at all Of th e s e v aso co n
.
- ~

str i c to r fib er s e n d i n th e g an g li a th u s e x erti n g th ei r i n fl u ,

e n c e o n th e tr u e v aso m o t o r c el l s i n th e g an gl i a whi ch
- -

alo n e s e n d fib er s to th e b lo o d ve s s el s All th e s e co nstr i c .

to r n erve s ar e gr ay .

V as o di lati o n —The v aso di lat o r fiber s ar e n o t r e

-
.
-

st r i c te d to any o n e p orti o n o f th e cord o r br ai n bu t p as s ,

o u t with b o th c r an i al an d s p i n al n erve s an d do n o t l o s e ,

th ei r sh e ath s u ntil th ey re ach th ei r d e sti nati o n Th ey .

 PRI N C I PLE S O F O S TE O PA TH Y 163

ar e b e st dem o n str ated in th o s e regi o n s —

o f th e c ereb r o s pi n al

—
sy stem fr o m wh i c h v as o c on s tri c t o r s do n o t ari s e The .

v aso di lat o r s fr o m th e h e ad f ac e saliv a ry g lan d s e tc p ass

'

-
,
.
, , ,

to th eir de sti nati o n with th e c r an i al nerve s s u pp lyi n g the s e

p art s Th ey do n o t e n d i n th e sym path eti c s Th ey p r o b a
. .

bly l e ave the co rd in th e an te r i o r r o o ts Of th e Spn al n erve s

s i

an d p as s to th e p eriph ery with o u t i n terr u pti o n The v aso .

?

di lat o r s l e avi n g th e c o rd i n th e s am e regi o n as th e v aso

, .

'

c o ns t r i ct o r s to b e di s tr ibu te d to the vi sc er al b lo o d ve s se ls
’
'

p r o b ab ly p ass o u t by th e ve n tr al r o o t s an d re ach t hei r

d e s ti nati o n with o u t lo sing the i r sh e ath s i n th e symp ath eti c
g an gl i a .

F IG 29 S ph yg
m o r am s i l lu s r a i n g
a c h c ar d i an d t t g T
r a c h y c ar d i ayUp a B
bt g g t
. . .

p e r tr a gi ng ge r adi a l p u l s e o f a w o m a n e x h i i i n
g—
rea n e r v ou sn e s s a
g t Lo w e r r a c i n t t
.

s m al l o i r e b u t n o e x o p h h al m o s r ad i al p u l s e o f a
g g f
.

y ou n m a n w h o s e p o w e r o f r e c a l li n p a st e v e n s o r : h i s li e wa s t
s u dd e n l los y t
R e s u l o f m e n al s h o c
. t t k .

NO di s ti nc t e n te r s fo r v aso di lato r fi be r s h av e b ee n
c -

dem o n s t r ated Th ey p r o b ab ly ari s e fr o m segm e n ts o f the

.
'

br ai n an d s pi nal c o rd an d th eir i n fl u e n c e i s carr i e d al o n g

th e p ath s o f m o t o r n e r v e s an d is e x e r te d in a lo cal ar e a .

S u mm ar y — 1 The v aso dil at o r n erve s ar e c ereb r o

. .
-

—
s p i n al ; ( )
a an d ar e n o t d e
,
m e d u l l ate d i n th e s ymp a th eti c

g an g li a ( b ) They ar e di strib u ted p ri n c ip ally to the ar

.

te r i e s Of th e m u sc l e s ( c ) an d l e ave th e c erebr o sp i n al ax i s ,
-

with the m oto r n e rve s fr o m all p o rti o n s Their i n fl u .

e n c e i s lo c al .

2 The v aso —
. c o n stri c t o r s ar e e ss e n ti ally n e u r ax o n s o f
'

symp ath eti c ce ll s i n th e s p i n al g ang l i a ;

( )
a ar e gr a y fiber s ;
( )
b a r e di strib u ted t o vi s c er a an d c u t an e o u s b lo o d ve ss e ls ;

( )
c a n d ar e p r o b ab l
y c o n ti n u o u s i n a c ti o n to m ai n t ai n th e
164 PR I N C I PL E S O F O S TE O PA TH Y

t e
on Of asc u la
th e v r sys tem ( d ) The v aso m o t o r c ell s i n
.
-

th e symp ath eti c g ang li a can act i n dep e n de nt ly ( e ) bu t ar e ,

n o rm ally u n d e r th e co n tr o l o f th e c e ll s i n th e S pi n al c o rd

wh o se n e u r ax o n s e n d i n th e spi n al g an gli a ( f ) Th e se .

c ell s i n th e s pi n al c o rd ar e u n der th e i n fl u e n c e o f n e u r ax o n s

o f c e ll s i n th e m ed u l l a whi c h co n stit u t e th e c h i ef v a so

m o t o r c e nte r . g
( ) T h e re f or e th e v aso co n stri c t o r i nfl u
,
-

e n c e i s b o th l o cal an d ge n er al ( h ) The c o ntr o lli ng fi be r s

.

l e ave th e co rd in th e ve n tr al r o o t s o f th e s e co n d d o r s al to ‘

th e s e co n d l u mb ar n e rve s o nly .

S e ns o r y Ne r v e s — We h ave no w co ns idered i n det ail

o n ly o n e si d e o f th e v aso m o t o r
-
m
e ch an i s m th e m o t o r
, .

We h ave yet to n o te th e s e n so ry S i de th at wh i c h c all s f o rth

,

th e m o t o r re s p o n se If th ere were no chi ef o r s pi nal vaso

.

m o to r c e n ter s to tr an sfer s e n so ry i mp u l s e s to th e v aso co n

st r i c to r c ell s i n th e S pi n al g an gli a th e b l o o d ve s s el s i n t he
'

V i sc e r a an d s k in co u l d not c o n tr ac t o r rel ax acco rdi n g to

th e n e c e ss i ty fo r g r e ate r o r l e s se r am o u n t s o f h e at i n the
d e ep o r s u p e rfi ci al are as
The v aso — m o t o r c e n ter s i n th e br ai n an d c o rd s e n d
o u t i mp u ls e s i n r e sp o n s e t o s e n s o ry s tim u l ati o n th i s se n
so ry s tim u lati o n i s u s u al ly o f a th e rm al o r m e ch an i c al
.

ch ar ac ter .

I t i s d i ffic u lt to re ali z e th e e x te n t o f th e di strib u ti o n

They ar e l o cate d no t o n ly i n th o se
“
o f s e n so ry n erve s .

p lac e s u s u ally k n o w n to b e s e ns itive bu t al s o i n all o th er

,

ti ssu e s an d o rgan s Wh eth er o n e e x ami n e th e l ive r o r th e

.

kid n ey lun g o r th e w all o f a bl o o d ve s sel o n e al way s fi n d s

, ,

deli cate n erve arb o riz ati o ns i n u n s u sp e cte d n u mb er s A .

l arge p o rti o n o f th em e n d p r o b ably i n the p eriph er all y

pl ac ed e n d c e ll s b e lo n gi n g to th e refl e x ar c o f th e sy mp a
th et i c ; ano th er p o r ti o n m ay very p r o b ably be trac ed to
th e s pi n al g ang li a an d eve n to th e S pi nal co rd i t self e s
, ,

p e c i a ll y th e i n ve s tig a ti o n s o f th e p a s t tw o ye ar s m aki n g ,

u se o f th e silve r and m et hyl bl u e st ai n s h ave n o t o nly dis ,

c l o se d t he we alt h O f n e r ve s in the di ff e r e n t o rgan s but ,

have al so sh o w n t hat we have r eg arded the s e nso ry i n

1 66 PRI N C I PLE S O F O S TE O PA TH Y

f arthe r still o r wh eth e r th ey b e re co g n iz ed by th e i n

,

divi d u al as th ey o cc u r d o e s n o t aff e ct th ei r n at u re S e n
—Anat o my
.

”
s ati o n an d p e r c epti o n ar e n o t th e sam e th i n g .

o f th e C e n tr al Ne rv o u s S y s tem i n M an an d i n Verteb r ate s

i n G e n er al — E di nger
. .

Th u s we fi n d th at th e re ar e ab u n d ant s e ns o ry n e r v e s
i n su p erfi c i al an d de ep ti s su e to re c eive the m e ch an i cal
s ti m u l i wh i c h th e o ste o p ath m ay p r o j e ct u p o n th em .

R e c e n t i nve stig ati o ns p r o ve th at m an y c o n d i ti o n s

wh i c h h ave p revi o u s ly b ee n called i n fl amm ati o n ar e i n ,

o n
,
—
re al ity c ge sti o s du e to v as o c o n st ri ct o r p ar aly s i s an d
n ,

c an b e co rre cte d by s ti m u lati o n o f th e v as o co n stri ct o r -

c e n te r g o ver n i n g th e c o nge s te d are a ; th e st i m u lati o n o f

s u c h c e n te r be i n g s e c u red by m e ch an i c al sti mu l i app l ie d to

th e s e n so ry nerve s e n d i n g i n th e c e nter .

—
The v aso m o t o r m e ch an i s m re s p o n d s q u i c k ly to o ste o
'

p ath i c m an ip u l ati o n an d i s o u r m e an s o f co rre c ti n g any

,

d i st u rb an c e o f c i r cu l ati o n b o th l o cal an d ge n er al
, .

S i n c e the bl o o d carri e s th e n o u ri sh m e n t fo r th e ti s
s ue s an d th e v aso m o t o r s c o n tr o l th e di s trib u ti o n o f th e
-

m
,

bl o o d th e v aso o t o r n erve s ar e tr o phi c n e rve s In th e

,
-
.

s am e s e n s e th ey ar e s e c ret o ry n erve s .

Capi llar y C cu i r l at i o n — The cap ill ary c i rcu l ati o n i s de

.

p e n de n t o n th e st ate o f th e arte ri o l e s The i r w all s ar e .

f o rm e d by e n d o th e li al c ell s whi ch ar e el as ti c an d h e n c e ,

re s p o n d to th e f o r c e o f th e bl o o d whi ch e nter s th em I f
‘

th e v aso co n stri ct o r s ar e active in a l o cal are a the r e

-

si s tan c e o ff ered to th e p assage o f the bl o o d c u rre n t by th e

arteri o l e s i s i n c re as e d an d th eref o re th e p re s s u re e x erte d

,

o n th e c api l l ary w al l s i s l e ss e n ed al lo wi n g th e c ap il lari e s

,

to c o n tr ac t I f th e v aso c o n stri ct o r i n fl u e n c e o ve r th e
.
-

arteri o l e s b e l e ss e n e d th e bl o od c u rre n t i s al l o wed to e x ert

,

i ts pre s su re o n th e capi ll ary w all s th u s i n c re as i n g th e ,

cal ib er o f th e c api llary .

I f i n a l arge are a o f th e b o dy v aso co n stri ct o r s ar e

, ,
-

'

ac tive th e i n fl u e n c e o f thi s r e s i stan ce i s fe lt by the h e art

, ,

wh i ch i mm e di ately b e at s harde r to o ver co m e th e re s i st an c e

 PR I N C I PL E S O F O S TE O PA TH Y 167

to the p a ssage o f th e b lo o d thr o u gh th e c o ns tri c t ed arteri e s .

—
The h e art i s u s u ally r e l i eved by c o mp e n sat o ry di lat ati o n
o f th e arterie s i n s o m e o th er are a The vi sc er al an d c u .

tan e o u s arteri e s u su ally c o u n ter b al an c e e ach o th er i n thi s

.
-

w ay .Thi s co u n ter b alanc i n g e ff e c t i s p r o b ab ly b r o u gh t

-

ab ou t thr o u gh th e s e n so ry i mp re s s i on s s e n t ou t fr o m an
‘

o verw o rke d h e art t —

o th e v aso m o t o r c e n te r th u s c au s i n g ,

a l e s s e n ed c o n s tri c t o r e ff e c t i n so m e p o rti o n s o f th e b o dy .

The re lax ati o no f all th e arteri e s o f th e b o dy w o u ld

-

c au s e de ath b e c au s e th e b lo o d w o u l d gr avit ate to th e m o st

,

d ep e n de n t p art and th e re i s n o t b lo o d e n o u gh to fi ll all

,

th e arteri e s wh e n r el ax e d A s light rel ax ati o n o f ge n er al .

b lo o d p re ss u re c au s es the h e art to b e at m o re r ap i d ly fo r
a sho rt tim e R e lax ati o n o f th e p eri ph er al b lo o d ve ss e l s
.

i s no te d by the i n c re as e d Warmth an d re d n e ss o f th e are a

i n whi c h r el axati o n t ake s pl ac e .

R e capi tu lati o n — To re cap it u l ate : ( 1 ) C apill ary c i r e n

.

l ati o n i s p ass ive ( )

2 V a s o c o n s tri
. c ti o n o f th-
e a rteri o l e s

c au s e s a de c re as e i n t he l u m e n o f th e cap i llary ( 3 ) V aso .

di lati o n O i th e arte ri o l e s cau s e s i n c re as e i n the l u m e n o f

'

th e c apil lar y 4
( ) G e n er a
-

l v a s o
v

c o n s tri c ti o n o f th e-
c u

tan e o u s bl o o d ve ss el s S lo w s th e h e art an d cau s e s it to w o rk

ag ai n st highe r pre s su re bu t th e h e art i s rel i eved by rel ax a
,

ti o n o f bl o o d ve sse l s in vi s c eral are as chi efly th e splan ch ,

ni cs 5 D e re e f c o ns tri ct o r e ff e c t o n s u p e rfi c i al v e s
( )
.
~
c a s o

s e ls c au s e s a m o re r ap id he a rt be at whi c h i s q u i ck ly c o n ,

tr o l le d by co n stri cti on in th e s p lan ch n i c are a ( 6 ) The .

v aso m o t o r c e n te r i n th e m e d u l la act s acc o rdi n g to th e

-

s u m o f th e s e n so ry i n fl u e n c e s re ac hi n g i t fr o m all p art s o f

h
t e b dy_o ( 7 .T h e s pi n a l v a so —m o t o r c e n te r s ac t ac c o rdi n g

to the i n fl u e n c e s se n t to th em by th e c hi ef c e n ter an d th e
-

s e n s o ry imp u ls e s whi c h e n ter th e ir s egm e n t o f th e c o rd

”

- —
V aso m o to r C e nte r s The v aso m o t o r c e n ter s fo r th e -

v ari o us vi sc er a o rgan s an d m ember s ar e as f o llo w s

,

H E A D : The s up eri o r c ervi c al g an gl i o n .

E Y E : The s u p e ri o r c ervi cal g an gli o n thr o u gh th e fifth

n erve .
168 PR I N C I PL E S O F O S TE O PA TH Y

NO S E TH R O AT TO NS I L S TO NG U E
, , ,
an d GU M S °

By th e sam e p ath D i lat o r fiber s fo r th e t o n g u e p er the

.

l i ng ual b r an c h o f th e fifth c r an i al n erve .

B R AI N : S h erri n gt o n an d o th e r s h ave d em o nstr ated

“

th e p re s e n c e o f v aso m o t o r n e rve s i n th e ve s se l s o f th e
-

b r ai n I t i s p r o b abl e th at th e c ereb r al c ir c u l ati o n is wh o ll y

.

'

d ep e n d e n t u p o n th e ge n er al b lo o d p re ss u re a n d i nasm u ch , ,

as th e ge n er al b lo o d p re ss u re i s very m arke dly reg u lat ed

by th e cap ac i o u s sp lan ch n i c are a it i s o bvi o u s t hat th e
,
'

c ereb r al c i r c u lati o n m ay b e bette r c o n tr o ll ed b

y m o difyi n
g
th e b lo o d su pply o f th e splan c hni c ar e a th an by any at '

tempt s at th e m o difi c ati o n o f th e c erebr al c i r c u l ati o n it sel f .

S ymp ath eti c fib er s to th e an teri o r an d m id d le f o ssae

c o m e fr o m th e s u p eri o r c ervi c al g an gl i o n p e r th e car o ti d

p le xu s S ymp ath eti c fib er s ar e d i s trib u te d to th e ve sse l s

.

i n th e p o steri o r f o ss a fr o m th e vertebr al p l e x u s whi ch is

'

f o rm e d by fib er s fr o m th e i n feri o r c ervi c al g an g li o n .

THYR O I D G L A ND : M id dl e an d i n fe ri o r c ervi c al
.

g an gl i o n .

—
The v aso co nstri c t o r s fo r th e b lo o d ve s s el s o f th e h e ad,
f ac e an d n e c k wit h th ei r c o nt ai n e d o rg ans l e ave th e Spi n al
.

c o rd i n th e u pp e r d o r s al s e c o n d to fifth an d p as s the nc e,

t h r o u gh th e c e rvi cal g an gl i o n .

LU NG S : S e c o n d to th e S i x th d o r sal
'

I NTE S TI NE S : The v aso c o n stri c t o r s fo r th e m e se n

-

te r i c bl o o d v e ss e ls ar e f o u n d i n th e s p lan ch n i c n erve s C o m .

m e n c i ng at th e fifth d o r s al th ere i s a s egm e nt al di s t

’

,
rib u ti o n
to th e v ari o u s p o rti o n s o f th e i n te s ti n e s The lo we s t c o n
.

st r ict o r i n fl u e n c e c o m e s fr o m th e s e c o n d l u mb ar Vas o .

d il at o r fibe r s ar e al so f o u n d i n the splan chn i cs .

LIV E R i S i x th to te n th d o r s al right s id e , .

KI D NE Y : Te n th to twe lfth d o r sal .

S P L E E N : Ni n th te n th an d e leve nth d o r s al l eft si d e

, , .

The v ag u s i s a m o t o r n erve to the m u scu lar fib er s i n th e

tr ab e c u l ae o f th e s pl ee n .

P O R TA L S Y S TE M : F ifth to n i nth d o r sal .

1 70 PR I N C I PL E S O F O S TE O PA TH Y

Hy pe r ae m i a —A
s t u dy o f hyp er aem i a i s i n re ality a
, ,

st u dy o f th e v aso — m o t o r m e ch an i s m We h ave n o ted th e

.

f act o f v aso m o t o r n erve s co n tr o ll i n g th e cal ib e r o f b lo o d

-

ve ss els: The s e n e rve s ar e br an ch e s o f th e ce reb r o sp i nal ~

sy s tem . M o st o f th em l e ave th e S p i n al n erve s a n d p ass to

—
th e symp ath et ic s p i nal g an g li a as r am i c o m m u n i c ante s an d
th e n p ass u p an d d o w n to o th e r gangli a o f th e symp ath eti c
s y s tem . S o m e fib e r s ret u r n fr o m th e symp ath eti c to th e
S p i n al n erv es an d ar e di strib u te d t o bl o o d ve ss el s o f s ki n ,

m u s cl e an d b o n e i n th e are a o f di s trib u ti o n o f th e sp i nal

n e rve s . A few v aso m o t o r n erve s do n o t e n ter th e symp a
-

t h eti c sy stem bu t p ass dire ctly to their d e sti nati o n w ith

th e s pi nal n e r ve s Th u s tw o p ath s e x i st by wh i ch v aso
.

m o t o r i mp u l se s re ach th e b lo o d v e ss e ls a di re c t r o u t e with
,

th e spi n al n erve s an d an i n di re ct o n e thr o u gh th e symp a

th eti c s .

E x pe ri m e n te r s h ave l o n g n o te d th e ret u r n o f v asc u l ar

‘

t o n e i n an are a wh o s e v aso c on stri ct o r n erve s h ave b ee n

-

Th i s ret u r n o f v ascu lar t o n i c ity i s s u pp o s e d to be

'

cu t .

du e to th e p re s en c e o f a p e riv as c u l ar m ec h an i s m wh i ch
i s cap abl e o f act ing feebly after all o th e r co n stri c t o r i n
fl u e nc e s h ave b ee n p ar alyzed .

S o far as m eth od s o f tre atm e n t ar e con c e r n ed we h ave ,

p ai d ve ry l ittle atte n ti o n to th e p re se n c e o f v aso d il at o r -

n e rve s bu t phy si o l o gi st s s e em to p r o ve th at th ere ar e fib er s

,

l e avi n g th e co rd wit h th e p o s teri o r r o o t s o f th e n erve tr u n k s

wh i c h ac t as dil at o r s wh e n irrit ated The v aso co nstr i c
.
—
‘

to r n erve s ar e c o n si de r e d as c o n st an tly i n ac ti o n .

I rrit ati o n o f th e dil at o r n erve s o r p ar aly s i s o f th e co n

st r ic to r s wi l l re s u lt i n di l at ati o n o f th e arteri o l e s s o th at ,

th e c api ll ari e s wi ll b e di lated to th e ir f u ll e s t e x te n t S u ch .

“ ”
a c o n diti o n i s c all e d an ac tive hyp er aem i a .Whe n the
e x it o f th e bl o o d th r ou gh th e ve i ns is o b str u cted a n d co n
“ ”
ge sti o n re su lt s it is de no ted p as sive hyp e r aem ia
. .

The sam e i rrit an t s m e ch an i cal th erm al an d c hemi cal

, , ,

wh i ch ar e c ap ab l e o f stim u lati ng m u scle s to un u su al o r u n

eq u al co ntr acti o n s s o as to p r o d u c e m arked evi d e n c e s o f
 PR I N C I PL E S O F O S TE O PA TH Y I7 1

c h an ged bo ny alig n m e n t also c au s e s u ch de c i ded ch an ge s

-
,

i n th e c alib er o f b lo o d v e ss e ls as to c au s e t _ i ss u e s to b e
c o m e hyp er aemi c o r i sc h aem i c .

I f any hyp e r aem i a e x i st s i n th e m u c o s a o f th e sto m ac h ,

p alp ati o n ar o u n d th e s i x th d o r s al s pl n e wi ll di s c lo s e te n
ai

der n e ss Th i s S pi n al te n der n e s s i s pr o b ab ly due eith er to

i

th e i rrit ati o n o f th e d i lat o r fib er s whi ch acco mp an y th e

p o steri o r div i si o n o f th e fi ft h d o r sal n e r ve o r to p araly s i s
of t he v aso c o n st ri ct o r s o f th at ar e a
”
-
The r e s u lti n g di la .
'

tati o n impi n ge s o n s e n s o ry n erve s an d cau se s te n der n e s s .

The i r r i tati o n o f s e n so ry n erve s i n th e m u c o sa o f th e

*

s t o m ac h cau s e s di l at ati o n o f b l o o d ve ss el s i n th at are a

an d i n th e Spi n al are a f r o m wh i c h i ts s e n so ry n erve s ari se .

The i rrit ati o n might have o rigi n ate d c e n t r ally an d th e n i n

Vo lve d th e st o m ac h th u s rever s i n g th e c o u r s e o f th e irrit a
,

ti o n The s e refl e x hyp er aem i as ar e co n ti n u al ly n o te d in

.

p r acti c e an d i t i s th r o u gh th e r e fle x e s th at r el i ef i s o b
,

tai n e d , O n e o f the c las si c al e x p erim e n t s to p r o ve th e r e

fl e x ac ti o n o f v aso m o t o r n e rve s i s to im m er s e o n e h an d
‘

i n c o l d w ater th e temp e r at u re o f th e o th er h an d wi l l b e
“
:

l o we re d als o .

I t i s q u it e ge n er ally c o n c ede d th at th e sm all a rteri e s

an d arteri o l e s i n all p art s o f th e b o dy ar e s u pp l ied with

v as o m o t o r n e rve s Th ei r p re s e n c e i n the b lo o d ve ss e ls o f
-
.

th e br ai n has b e e n re c e n t ly p r o ve n by G C H u ber H i s . . .

d em o n s tr ati o n o f v as o m o t o r n erve s i n th e c erebr al b lo o d

-

ve s sel s ex pl ai n s m an y o f th e c ir c u lat o ry phe n o m e n a re su lt

in g fr o m o ste op athi c m an ip u lati o n s .

I rrit ati o n o f s e n so ry n erve s i n an y p art o f th e b o dy

cau s e s v asc u lar
.
di lat ati on i n th e i rrit ate d are a P hy s i .

—
o l o gi cal e x p erim e n t s s ee m to p r ve th at v a so di lat o r fibe r s
o

ac c o mp an y th e s e n s o r y n erve s o r th at i rrit ati o n o f s e n s o ry

,

n erve s c au s e s p ar aly s i s o f v aso c o n s tri c t o r n erve s -

I r rit a .

ti o n o f th e n erv e s o f o ne sid e o f th e b o dy by p ri cki n g w i t h

a pi n c au s e s a ri s e o f temp er at u re o n t hat s id e an d a de

c re as e o n th e u n irri tate d S i de th u s dem o n str ati n g th at

,

v aso di lati o n fo llo w S s e n s o ry i rrit ati o n

-
'

.
1 72 P RI N C I PL E S O F O S TE O PA TH Y

E x p e rim e n t s to te th e e ff e ct s o f di re ct m e ch an i cal
no

i rrit ati o n o f th e st o m ach m u co sa de m o n str ate th at dil at a

ti o n o f g astri c b lo o d ve s se l s f o llo w s m e ch an i cal irrit ati o n .

The phy si o lo gi cal hy pe r ae m a th u s pr o d u c e d i s fo r p u rp o se s ,

o f i n c re as e d s e c reti o n I t i s we ll k no w n th at wh e n th i s
.

phy s i o lo gi cal co nge s ti o n i s co nti n u e d with o u t c e s s ati o n as ,

i n th e case wh e n m e al s ar e fre q u e n t an d f u ll th e c o n ,

ge sti o n b e co m e s p ath o l o gi c al an d th e se c ret io n o f m u c u s

,

i s r api d The l ive r and i n te sti n e s b e co m e ch r o n i cal ly co n

.

ge sted fr o m s i mil ar c aus e s Thi s hyp e r aemi a l e ad s to e x

.

u date s an d hyp erp las i a whi c h f u rth er i rrit ate s s e nso ry

n erv e e n di n g s an d co n ti n u e s th e dil at ati o n o f th e arte ri o l e s .

Th u s a vi c i o u s c y cl e o f refl e x e s is e st ab li sh ed wh i ch te n d s
to ever i n c re a s i n g de s tr u ctive n e ss .

Wh e n the se n s o ry n erve term i n als i n the st o m ach ar e

‘

i rrit at e d an d hyp er aemi a o f th e g as tri c ve s sel s re su lt s th e ,

i nfl u e n c e o f th e i rrit ati o n d o e s n o t en d with g astri c c o n

'

ge s ti o n i e if th e hyp er aem i a b e e x c e ssiv e bu t cau s e s

,
. .
, ,

di lat ati o n of arteri e s i n th e s pi nal c o rd ar o un d th e r o o t s o f

s e ns o ry n erve s di strib u ted i n o th e r p art s o f th e b o dy whi c h
‘

ar e su ppli e d by bra n ch e s o f th e s am e n erve tr u n k The .

b

b r ai n d o e s n o t alw ay s no te th e re al lo cati o n o f th e irrit a

ti o n I t m ay refe r th e p ai n to any p o i nt suppl i e d by a
.

b r an ch o f th e n erve tr un k o n e o f wh o se br anch e s i s i rri

,

tate d . Th u s i n th e p re s e n c e o f c h r o n i c c o nge s ti o n o f th e
gastri c m u co s a as i n g astri c c at arrh th e irrit at io n m ay
, ,

no t b e i n te n s e e n o u gh to i mp re ss th e br ai n with a p ai n f u l

s e n s ati o n bu t a sl ight i nc re ase o f c api llary p re s s u re ar o u n d

,

th e tr u n k o f th e si x th d o r sal n erve su ch as w o u l d b e b r o u ght

ab o u t by digit al p re s s u re m ad e u p o n th e m u sc l e s ar o und

th e s i x th d o r s al spi n e w o u ld cau s e i n s t an t re c o g n iti on o f

,

hyp e r ae sth e s i a by th e p ati e n t Co n ti n u e d p re s su re m ad e

.

ar o u n d th e spi n e drive s th e b lo o d o u t an d l e s se ns th e se n

si t i v e n e ss I f hyp er aemi a has b ee n i nte ns e e n o u gh to

.

c au s e e x u d ate s p re ss u re i n c re as e s th e p ai n th e lo ng e r i t i s
, ,

c o n ti n u e d be cau s e the e x u d ate s h ave aff e cted th e ve n o u s

,

c i r c u l ati o n an d th er e i s n o o p e n p ath fo r e x it o f th e bl o o d .
1 74 PR I N C I PLE S O F O S TE O PA TH Y

s el s h e n c e i nte r nal co nge sti o n I rrit ati o n o f th e s e ns o ry

, .

n e rve s i n th e ski n m ay c au s e m u s c l e u n der th e s ki n to co n

tr act th u s o b str u cti n g th e c i r cu lati o n i n th e s ki n Th ere

, .

f o re o u r m an ip ul ati o n s fo r v aso m o t o r e ff e ct s n at u r ally

,
-
-

di v i de the m se lv e s i n t o tw o c l ass e s F ir st th o s e wh i c h i n.
,

hi bi t cu t an e o u s refl e x e s ; s e co n d th o se whi ch rel ax m u s c l e

,

i n o rd er to rem o ve o b str u cti o ns Thi s d1v 1s ro n l s p u rely

.

arbitr ary o n o u r p art bu t it se rve s to e x p lai n o u r w

, o rk .

We p u rp o s e ly l e av e o u t o f thi s di scu ss i o n th e th o u ght th at

we m ay h ave an o s se o u s l e si o n c au s i n g o u r v aso m o t o r -

di s t u rb an c e W e divi de th e spi n e i n t o are as ac co rdi n g

. .

to th e p red o m i n ati n g i n fl u e n c e whi c h i s s u e s fr o m it ; th u s,

—
th e s ub o cc ip it al f o ss a i s th e fi r st i mp o r tan t are a It has .

l o n g b ee n k n o w n th at p r es s u re app li ed to t hi s are a i n a
c as e o f c o n ge stive h e ad ac h e give s gre at re l i ef The g o o d .

e ff e c ts ar e n ot l o st wh e n th e p re ss u re i s re m o ve d Thi s
‘

p r o ve s th at th e e ff e c t o f th e p re ssu re is o n th e n erve s o f
"

th at are a an d that th ey ar e in cl o s e c e n tral co nn e c ti o n

,

with th e v as o m o t o r ce n ter i n th e m e d u lla Thi s c e nter

-
.

reg u late s th e c alib e r o f th e arterie s all o ve r th e b o dy I t .

—
has be e n st ated th at p re ss u re at th e b as i o c c ip u t ret ard s
th e bl o o d fl o w to th e br ai n th e p re s su re b ei n g o n th e v e r
,

te br al a rteri e s W e b e li eve a c aref u l e x ami nati o n o f th e

.

at las wi ll c o n vi n c e o n e th at i n th e aver age s ke l e to n th e

gr o o ve fo r the vertebral artery i s s o d eep an d we ll pr o

te c te d th at p re ss u re o n th e s u rf ac e o f th e n e c k c an no t af
fe ct th e arte ry I f o u r p re s su re e ff e ct is m e ch an i c al why
.
,

d o e s th e e ff e c t l ast s o l g
dn ? The b lo o d s tre am i s as s wift
as an o c e an greyh o u n d , an d w o u l d r u sh i n t o th e p art ly

fi ll ed ve ss el with i ts p revi o u s f o r c e Ju s t the m o m e n t th e .

p re ssu re i s rem o ved We c an o n ly e x p lai n the re s u l t by

.

n o ti n g th e f ac t th at a c h an ge ha s b ee n m ad e i n th e e n t ire

c ir c u l ati o n D o w n w ard p r e ss u re o n th e c ar o ti d s i s also

.

re co m m e n de d to ret ard th e bl o o d fl o w to th e he ad Th i s .

s eem s i mpr acti cab l e S i nc e th e pre ss u re c anno t h e lp af -

fe cti n g th e ve no u s ret u r n as wel l as th e c ar o tid stre am .

The b e st and m os t l as ti ng e ffe ct s ar e alw ay s v aso m o t o r -

.
 P R I N C I PL E S O F O S TE O PA TH Y 1 75

I t i s a we ll r e co g n iz ed f act i n th e o ste o p ath i c pr o fe s

s i o n th at p re s s u re i n th e s u b o cc ip it al tri an g l e s c au s e s a

l e ss e n e d b lo o d p re ss u re all o ver th e b o dy
'

Thi s f ac t i s .

m ad e u se o f d ai ly to lo wer th e temp er at u re o f th e b o dy
i n cas e s o f fever I f pre ss u re had a m ec h an i cal r ath er
.

th an a n erv o u s e ff e c t o n th e c i r cu lati o n w e c o u ld h o p e ,
g

fo r n o ge n er al e ff e c t su ch as we do s e c u re
,
Thi s p r o c ed u re
.

i s call e d i n h ib iti n g th e v as o m o t o r c e n te r
-
Why d o e s it
.

i n hibit ? t o n e i s n o rm al i n th e b o dy i n o rde r
”

to keep th e b lo o d e q ually di s trib u t ed Thi s v asc u lar

.

”
t o n e i s e as i ly di st u rb e d s i n c e it act s acc o rdi n g to th e su m
o f th e s e n so ry imp u l s e s re ac hi n g th e c e n te r i n the m e d

u lla. P re s su re i n th e Su b o cc ip it al tri an g l e s aff e c t s n o t o n ly

th e S um o f th e s tim u l i re ac hi n g th e c e n ter bu t m o s t i m , ,

p o rt an t o f all aff e c t s th e c api llary c i r cu lati o n in thi s are a

,

wh i c h i s i n c l o s e n erv o u s an d c ir c u lat o ry c o nn e c ti o n with

the m ed u lla A n y e x ter n al app li c ati o n s u ch as ho t o r co l d
.
,

w ter
a l
,
o c al an —
ae s th eti c s o r co u n ter irrit an t s m u s t s e c u re

wh ateve r i n ter n al ch an ge m ay b e m an ife sted by th e e f ,

fe c t th e s e th e r ap e u ti c p r o c ed u re s m ay h ave o n c u t an e o u s
n erve s .

P re ss u re i n th e s u b o cc ipit al tri an g l e s wi ll r e lax th e ‘

str u c t u re s f o rmi n g th o s e t ri an g l e s th u s l e s s e n i n g th e se n
,

so ry imp u ls e s e n te ri n g th e c e n ter fr o m th at s o u r c e The .

re laxe d str u ct u re s wi ll h o l d m o re b lo o d h e nc e th ey wi ll
,

i n a S light degre e re l i eve c o n ge s ti o n o f th e c e n ter .

Th e s e tri an gl e s ar e th e b i lat er al s u rf ac e c e n ter s i n

whi ch we Op er ate to c au s e di lat ati o n o f ve ss e ls i n th e S ki n
o f th e tr u n k an d e x tremiti e s .We i n hibit v as o co n str i cto n -

o f s u rf ac e a rte r i e s .

The n e x t gre at co n s tri c t o r are a i s th e spl an ch n i c si x th ,

to e l eve n th d o r s al . Thi s an d th e p re c edi n g are a ar e th e tw o

p o i n t s o f v an t age fo r the o s te o p ath S i n c e th e S p lan ch n i c
.

n e rve s c o n tr o l a s y s tem o f b lo o d ve s s e l s wh o s e co mbi n e d

cap ac ity i s e q u al to th e e n ti re am o u n t o f th e b lo o d i n th e
b o dy we can q u i c k ly re aliz e wh at it m e an s to th e g e ner al
,

c i r cu l ati o n t o aff e ct thi s are a In all c ase s o f Co n g e st iv e

'

.
1 76 PR IN C I P LE S O F O S TE O PA TH Y

h e ad ach e s fev e r hyp e r aemi a o f vi sc er al o rg ans e tc we

, , , .
,
“ ”
i hibit th e p
n s l a n c h n i cs Why ? . The refle x e s b etw ee n
th e ski n o f th e b ac k an d th e m u sc l e s o f th e b ack ar e s o
i nte ns e th at th ey cau se v asc u lar co n s tri c ti o n o f th e c u
tan e o u s arterie s an d c o n tr acti o n o f th e d eep m u sc l e s o f

th e b ack th u s addi n g a m e ch an i c al o b str ucti o n to th e ci r

,

c u lati o n o f th e b lo o d i n an al re ady c o ns tri c te d are a IS .

it n o t p o s sibl e y e s p r o b abl e th at th i s s t ate o f th e s u rf ac e

, , ,

ti ssu e c au ses a c o n ge sti o n o f th e v aso m o t o r c e n te rs i n -

th e d o r sal are a o f th e co rd , th u s n u llifyi n g th ei r co n tr o l

o f th e S p lan ch n i c are a ? S u c h a c o n diti o n m igh t b e br o u ght
“

ab o u t by c o l d The e ati n g of i n d ig estibl e f o o d wh i c h r e

.

m ai n s a l o n g tim e i n th e dige stive tr act m ay al so b e a

c aus e .

The f act s ar e as we h ave s t ated them we i nhibit o ver ,

t he s pl an ch n i c are a to le s se n the i n te n sity o f th e refl e x e s

'

i n th at are a th ereby all o wi n g th e c e n ter s to reg ai n th ei r

,

c o n tr o l . R em emb er th at i nhibiti o n l e s se n s th e se n so ry
i mp re s si o n s re ac hi n g a c e nte r an d re lax e s m u s c l e b o th ‘

d i r e ct ly an d i n di re c t ly .

C ase I ll u s t r a t i o n s — An i llu s tr ati o n o f o s te o p

. ath i c

m eth o ds app li e d to hy pe r ae m 1a i s aff o rd ed by th e follo w m g

case z A ge n t l em an ab o u t fi fty ye ar s o f ag e w as i n sp e c ti n g

mi n e s in th e vi c i n ity o f Y u m a A riz o na H e was o f ple , .

th o ri c h abit an d h e n c e th e h e at o f th at l o c ality aff e c ted

h im q u i c kly Ab o u t eight p m wh i le i n his te nt p re
. . .
,
'

p ari ng to b ath e in o r de r to get so m e re li ef fr o m th e i n

te n s e h e at h e felt a w
,
ave o f we ak n e s s p ass u p hi s l eft s i d e

an d al m o s t i n st an t ly p o we r o f m o ti o n o n th at s id e w as

lo s t . P ar aly si s di d n o t e x te n d to th e f ac e The ge ntl e .

m an w as br o u ght to Lo s Ange l e s an d c am e u n de r th e be st
'

o f m edi c al tre atm e n t E l e c tri c ity an d m assage were tried

.

with f ai r s u c c e s s bu t th e l eft ar m an d h an d rem ai n e d

,

h elp le s s an d we re c arri e d i n a s li ng The h an d w as b ad ly .

s w o l le n an d w o u l d pit un der p re ssu re th us sh o wi n g a ,

marke d d e g r e e o f v aso co nst r i ct o r p araly si s -

The hand .

and arm had be e n t ho ro u ghly m as saged fo r two mo nt hs

1 78 PR I N C I PL E S O F O S TE O PA TH Y

Tre atm e n t w as dire cte d e cu ri n g re lax ati o n o f th e

to s

c o n tr ac ted c e rvi cal m u sc l e s an d t o b re aki n g u p adhe s i i o n s i n

th e sh o u l de r j o i nt wh i c h had be e n all o we d to s ti ff e n No .

t r e atm e n t w as give n to th e h an d o r ar m The p ati e n t w as .

i n str u cte d to str ai ghte n th e b e n t fi nger s with th e wel l h an d

m any tim e s p e r day to o ve r co m e th e sp as ti c co n diti o n .

Vaso m o t o r t o n e ret u r n e d to th e bl o o d ve ss el s o f th e h an d
-

i n p r o p o rti o n to th e am o u n t o f c e rvi cal rel ax ati o n ac

co mpl i sh e d At th e e n d o f o n e m o n th th e h an d w as al
.

lo we d to h an g n at u r ally an d s car c e ly any o edem a wa s

,

n o ti c e ab l e. M u s c u l ar c o n tr o l an d p o wer h ave s te adi ly

i n c re as ed
.

An o th e r ill u str ati o n i s affo rded by th e f o ll o wi n g cas e

A ge n tl em an su ff e ri n g with i n fl am m at o ry rh e u m ati sm i n
th e s e c o n d to e o f th e right f o o t so ught re li ef by me ans o f
o s te o p ath i c t re atm e n t H e had u s ed th e sali cyl ate s i n hi s
.

p revi o u s att ac k s bu t hi s st o m ach had b e co m e i nt o l er ant o f

,

th em The to e w as re d an d an gry l o o ki ng th r o b bi n g with

.
,

p ai n an d sw o lle n to th e s iz e o f th e gre at to e .

E x am i n ati o n of th e
pi n e reve al ed te n der n e s s b etwe e n
s

th e fifth lu mb ar an d th i rd sac r al spi n e s als o be tw e e n the

'

s e co n d an d th i rd lu m b ar spi n e s Why S h o u l d te n d er n e ss
.

e x i s t at th e se p o i n t s ? The an swer acc o rdi n g to anat o my

an d phy s i o l o gy i s th at th e s e sp i n al are as m ark th e p o i n t o f
:

em erge n c e fr o m th e s pi n al co l u m n o f the an teri o r c r u r al

an d gre at sc i ati c n e rve s whi c h ar e di strib u ted to e q u al
p art s o f th e aff e cte d toe ; th e s e n so ry n erve s bei n g i r
r itate d by th e d ep o sit o f f au lty k at ab o l i c p r o d u c t s i n th e

ti s su e s o f th e to e as th e re su lt o f a slo W blo o d stre am '

In th i s cas e th e p ati e n t w as c au gh t o u t i n th e r ai n an d
t h i feet wet T h e p eriph er al i rrit ati o n o f th e s e n so ry
“

g o s .

n erve s c au s ed dil at ati o n o f th e arteri o l e s an d c api ll ari e s .

The b lo o d ve s s e l s a r o u n d th e r o o ts o f o th er s e nso ry
n e rve s whi ch were br an c h e s o f th e sam e n e rve tr u n k s al s o
dil ate d i n re s p o n se to th i s i rrit ati o n i e hyp e r aemi a i n
, . .
,

th e S pi nal co rd w as br o u ght ab o ut at th e p o i nt o f o rigi n

 PRI N C I PL E S O F O S TE O PA TH Y 1 79

of th e an teri o r c r u r al an d gre at sc i ati c n erve s h e n c e th e

,

s e n so ry n erve s to th e ski n an d m u sc l es o f th e b ac k wh i ch

ar e i n n e rv ated fr o m th e s am e ar e a o f th e c o rd as th e s e

gre at n e rve tr u n k s wi ll a l so b e te n der to i n c re ase d t e ns i o n

s u ch as th at s e c u re d by th e digit al p re ss u re .

“
In a cas e su c h as thi s we do n o t de si r e to h ave the
‘

dep o s it i n th e to e t ake n u p u n ti l th e e li m i n ati n g o rgan s

To f o r c e it i n t o th e c i r cu la
'

of t he bo dy ar e ac ti n g fre e ly .

ti on b e fo re s u ch tim e as it c an b e elimi n ate d m ay re s u l t i n

i n fl am i n g an o th er p ar t .I t i s q u ite n e c e s sary th at th e
th r o bbi n g p ai n be s ubdu e d so t hat S l e ep m ay b e ha d The
'

p ati e n t s o o n le ar n s to t ake adv an t age o f ve n o u s c i r cu l a

ti o n by e l ev ati n g th e f o o t If pre ssu r e u p o n an d a ge n t l e
.
,

r el ax i n g m ove m e n t o f th e m u s c le s i n t he s pi n al ar e a i s
"

m ade th e r e wi ll q u i ckly b e n o te d a d e cr e as e i n s pi n al
,

s e n s itive n e ss fo l l o wed by l e s se n ed c o n s c i o u s p ai n i n th e

to e It i s q u it e p r o b abl e th at p ai n i n th e to e i s du e to
’

hyp er aemi a ; s e n sitive n e s s l n th e s pi nal are a i s due to th e

sam e S o rt o f c o n diti o n ,
th e di ff ere n c e b ei n g i n degree I t .

IS i mp o ss ibl e to p r o v e th e pr ese n c e o f th e s e tr an s it o ry
hyp er aemia s by any d ir e c t o b s erv ati o ns any m o r e than it
-
.

i s p o s s ibl e to p r o ve by p o s t m o rte m e x am i n ati o n th at hy

p e r a e m ia o r an aemi a o f th e br ai n i s p r e se n t as a fi x ed

p ath o l o gi c al le s i o n i n f au lty f u n cti o n i n g o f the br ai n .

P re s su re an d rel ax ati o n i n th e spi n al ar e a dr aw s th e

b lo o d aw ay fr o m i ts p o si ti o n aro u n d th e n erve tr u n k r o o t s
an d th u s s t o p s m a ny o f t he imp u l s e s wh i ch w o u ld o rigi n ate
c e n tr ally a s a re s u lt o f th e i rrit ati o n o f th e s e n s o r y r o o t s o f
.

th e n erve tr u n k .

We u su ally thi n k o f th e s e refle x se n sitive ar eas o f the

s pi n e a s b e 1 n g evi de n c e o f th e abi l ity o f all th e br an c h e s o f

a n erve tr u n k to e x p re ss s o m e degree o f th e irrit ati o n b e

i n g b r o u gh t to b e ar o n an y o n e o f t he b r an ch e s I t s eem s.

to m e th at in th e li ght o f wh at is k n o wn to h app e n i n th e
are a o f an i r r it a ted n erve hype raemi a th at th e s am e
, ,

ch an ge i n c i r c u l ati o n m ay o cc u r ar o u n d th e r o o t s o f i ts
18 0 PR I NC I PL E S o r O S TE O PA TH Y

p are n t n erve tr u n k an d b e th e so l e re aso n fo r wh at we d e

n o mi n ate a refl e x p ai n.

B y givi n g th e h e avy m o vem e n t re q u ired to rep lac e a

s u bl ux ated ve rtebr a o r eve n to re lax te n s e m u sc l e s ar o u n d

an o th erwi se n o rm al arti c u lati o n it i s q u ite p r o b ab le th at

,

i n e x p li cab le ch an ge s ar e wr o u ght i n th e c i r c u lati o n at

th es e p o i nt s wh i ch imm e di at ely c h an ge th e c h ar act er o f
th e n e rv e i mp u l se s o rigi nati n g o r r e fl e x ing fr o m thi s po r
'

ti o n o f th e S pi nal c o rd
.
18 2 PRI N C I PL E S O F O S TE O PA TH Y

bi u m
'

a b pm al Co r d La rv al wCa n co u a
5
'
c

b po st
e r i or mu mu r
r
!,
d u ru n ca
8 . R ec u r r ent br a n c h
C In fi r nu l br m
.
o h ( ,
c u tan e o u s ) h Ve n n ( o wn In fer i o r
, .

d E xfi m ul br cm o hJ M u sc u l ar ) 3 A ta
or»
b mpnfl he b c gan
p h on S amp lfl h e ttc br un c h
a h .

6 e cf to n a l :Dtunr a m
f
o H m an :3 o u

Bit the
“
W i de r an e M i n fi m a fé i
r e l a tori s
ch -
tu
g g

fl me Di slttbwtwm an d Co nn e c ti on s
‘
’

a . .

F IG . 30 . D r aw n b y D r J E . . . t rt
S ua .
 PR I N C I PL E S OF OS TE O PA TH Y 18 3

M e t hods of S tu dy i n g Anato m y — Th e se
t tem e nt s . s a

l e ad u S to a c los er st u dy o f e ac h j o i n t an d i ts c o n tr o lli n g
m u s c le s an d g o ver n i n g n erve o r n erve s W e m ay s t u dy .

an at o my u n de r artifi c i al divi s i o n s s u c h as O ste o l o gy S y n «

d e s m o lo gy M y o lo gy e tc an d sti ll afte r s e cu ri n g an
, ,
.
, ,

acc u r at e te c h n i c al k n o w l edge o f det ail s w e have n o th i n g

'

o f p r ac ti c al v al u e I t i s i n th e co rre lati o n o f th e s e ti s su e s
.

with th e i r i n te rd ep e n d e n c e q u ite f u lly u n d er st o o d th at we

h ave a W Or ki ng k n o w l e dge With thi s th o u ght o f th e i n
I

fl u e n ce o f o n e ti ssu e o n an o the r an d the harm o n i o u s ac

ti o n se c u re d by th e co mp ar ative ly v ari e d di s trib u ti o n o f
th e n e r ve tr u n k s, we fi n d a n e w an d vit al i n te r e s t i n
an at o my .

Thi s law i s b as ed u p o n the fac t s o f an at o my an d phy si

o l o gy ,
an d m ake s o u r c o n c ret e k n o wl edge o f th e s e s u b

t p r ac ti c al v al u e i n b o th di ag n o si s an d
j e c ts o f c on sta n
“ ”
th er ape u ti cs Thi s law sh o w s u s the w hy o f Ce r t ai n vital
an d m e c h an i c al m an ife s t ati o ns and t eache s u s p r ac ti c al
,

m et ho ds o f t r e atm e n t .

E x am ple o f H i lto n s Law — An e x amp l e o f H i lt o n s

’
.
’

law i s the édi str i buti o n o f th e sc i ati c n e r ve to th e an k l e

' '

~
.

The m u sc le s m o vi n g the j o i n t the sy n o vi al m emb r an e an d

,

m o st o f the s ki n o v e r th e j o i n t ar e all i nn e r v ated by it .

The —
K n e e The k n ee
. erve s E ach o n e has
has th re e n .

a m o t o r an d s e n s o r y c o n t r o l The e x te n so r m u sc l e s an d
.

the s ki n o ve r them is i nn erv ated by th e an teri o r c r u r al .

The fl e x o r m u s c l e s an d th e ski n o v er t hem i s i nn erv ate d

by th e sci ati c The o bt u r at o r i n additi o n to th e se n e r ve s
.
, ,

f u r n i sh e s s e n so ry fi lame n t s to th e s y no vi al m embr an e All .

th e j o i n t s o f th e b o dy m ay b e e x ami n e d in th e li ght o f thi s '

law . The sam e s egm e n t o f the c e nt r al n e r v o u s sy s tem

wh i c h give s o ff a p ur e ly mo t o r n erve tr u n k give s o ff als o ,

a s e n so ry n e rve wh o s e fi lam e nt s ar e di s trib u te d o ver th e

sam e are a Th u s it i s so m etim e s n e c e s s ary to g o to th e

.

c e n tr al n erv o u s s ys te m to di sc o ve r thi s as so c i ati o n o f

"

m o t o r an d s e n so ry di st r ib u ti o n In pr acti c e we alw ay s do
.
18 4 PR I N C I PL E S O F O S TE O PA TH Y

th i s be c au se it is e as i e r to w o rk fr o m th e c e nter o f th e
,

are as o f di strib u ti o n .

The O bj e ct o f S u ch a D i s t r i bu ti o n—H ilt o n say s : The

o bj e c t o f s u ch a di strib u ti o n o f n e rve s t o th e m u sc u l ar an d

arti c u l ar str u ct u re s o f t he j o i n t s in acc u r ate ass o c iati o n i s

, ,

to i n su re m e ch an i c al and phy s i o lo gi c al c o ns e n t betwee n

th e e x te r n al m u sc u lar o r m o vi n g f o r c e an d th e vit al e m
, ,
,

d u r an c e o f th e p art s m o ve d n am e ly o f th e j o i n t s th u s
, , ,

s e c u ri n g i n h e alth a tr u e b alan c e o f f o r c e an d fri c ti o n u n ti l

'

dete ri o r ati o n o cc u r s .

“
With o u t th i s n erv o u s a s so c i ati o n i n th e m u sc u lar
an d arti c u lar str u c t u re s ,
th e re co u l d b e n o i n tim ati o n by
” “
th e i nter n al p art s o f th ei r e x h au ste d c o n diti o n A g ai n , .

th r o u gh th e m edi u m o f the m u s c u lar and c u t an e ou s n erv o u s

'

as so c i ati o n gre at s e c u rity i s give n to th e j o i n t it s e lf by

th o s e m u scle s b ei n g m ad e aw are o f th e p o i n to f co n t ac t
“

o f any e x tr an e o us f o r c e o r vi o l e nc e Th e i r I nv o lu n t ary
.

co n tr ac ti o n i n sti n c t iv ely m ake s th e su rr o u n di n g s t r u ct u re s

te n s e an d rigi d an d th u s bri n g s ab o u t an i mp r o ve d de
‘
,

”
fe n c e fo r th e s u bj ac e n t str u c t u re s .

The U n if o r m ity of the Law Thi s ar ticu lar m u s e u

.
t

lar an d c u t an e o u s di strib u ti o n o f th e n erve s i s i n: my

-
,

Opi n i o n a u n if o rm arr an gem e nt i n every j o in t i n th e b o dy

,
.

We m ay fi n d n u m er o u s i llu st rati o n s o f the s am e m eth o d

o f di s trib u ti o n i n o th e r p art s o f th e b o dy whi c h h ave th e
'

sam e d efi n ite re lati o n s to e ach o th e r an d i n th i s re sp e c t

,

p re s e n t the sam e phy si o lo gi c al an d m e ch an i c al arr an ge

Thi s s am e pri n
i

*
m e n t o b se rv ab l e in j o i nt s .
'

c i pl e of arr an gem e n t ,
an at o m i c ally phy s i o lo gi c ally an d
,

p ath o lo gi cal ly c on si d ered is to b e o b s e r ved with an eq ual

,

d egree o f acc u r acy i n th e s e r o u s an d i n th e m u c o u s m em

br an e Th u s co ns i de re d it p re se n t s a p ri nc ip l e wh i c h if
.
, ,

it has any app li c ati o n i n p r ac ti c e m u st b e o n e c ert ai nly

,

”
o f l arge e x t e n t .

P r e ci si o n o f Ne rv o u s D i st r ib u ti o n to M l
u sc e s —7
T h e . -

gre at p re c i si o n with wh i ch m u sc l e s ar e s u pp li ed by th ei r
n erve s i s w o rthy o f rem ark ; a n d i s s u c h th at if we h ave
 18 6 PR I N C I PL E S O F O S TE O PA TH Y

lu s to th e n erve s co n tr o lli n g a j o i n t o r o th er str u ct u re ,

b e li evi n g th at it i s o f litt l e v alu e to anae sth etize n e rve

e n di ng s an d giv e re s t so lo n g as thi s stim u l u s is all o wed
to ar o u s e i mp u l se s i n the n e rve fiber s .

C o m par i so n M e t ho ds —To c omp are m eth o d s

of . o f uS

H i lt o n s
i ng Law we wil l n o te on e o f hi s c as e s an d a sim
’

, ,

“
i lar o n e tre ate d o ste O pathi cally In Ch apte r V I I I o f R e st
.

an d P ai n
”
h e d e sc rib e s a case o f i n fl amm ati o n o f th e sh o ul .

d e r j o i n t an d m e nt i o ns th at th e j o i nt i s fi x e d i n a p o siti o n
,

o f re s t as a re s u l t o f th e ass o c i ati o n o f n erve s t o th e sy n o

vi al m embr an e th e m u scl e s o f th e j o i n t an d th e s ki n o ve r
,

th e j o i n t An ae sth e si a re le as e s th e fi x e dn e ss o f th e j o i n t
.
,

be cau s e th e m uscle s do n o t co n tr act afte r th e se n so ry i m

'

“
p u ls e s ar e d e ade n ed by th e an ae sth eti c H e s ay s Ther a .
,

p e u ti c s m ay c ert a i n ly re ac h th e i n te ri o r o f thi s j o i n t an d
i ts m u s c l e s thr o u gh th e m edi u m o f th e n erve s u p o n th e
su rf ac e o f th e s ki n an d so i n d u c e phy si o l o gi c al re st to all
,

p art s c o n c er n ed i n m o vi n g th e j o i nt I m e an to s ay th at .

th e s e n erve s u p o n th e su rf ac e o f th e S ki n b ei n g i n dire ct
ass o c i ati o n with the i n teri o r o f th e j o i n t it s e lf w e m ay ,

re d u c e th e m u scu lar sp asm as we ll as th e se n sibi li ty o f

i '

th e i n teri o r p o rti o n o f th e j o i n t by applyi n g o u r an ae s ,

th eti c s with accu racy an d with s u ffi c ie n t i n te n si ty u p o n

th e e x teri o r o f th e de lt o i d m u sc le o ver th e di strib u ti o n o f ,

th e s e se n s itive fi lam e n t s The th o ught wi ll o ccu r to y o u

.

at o n c e th at th ere i s n o thi n g v ery rem ark ab l e i n th i s o p i n

i o n and th at i s q u ite tr u e
,
The embr o cati o n s h o wever
.
, ,

wh i ch w o u l d o rdi n ari ly b e S u gge s ted fo r th i s p u rp o se ar e

.
“

n o t o f a c h ar ac te r suffi c i e n t ly p o te n t to all evi ate th e p ai n

o f th e p atie n t an d ar e
,
I b e li eve s e l d o m emp lo ye d with a
, ,

defi nite i de a i n th e mi n d o f th e pre sc riber I wo u l d sug .

ge st th at we sh o u l d emp lo y o ur f o m e nt ati o n s s tr o n g ly
m edi c ate d with b e llad o nn a w ith o pi u m o r wit h h em lo ck
, ,

i n ste ad o f u si n g m ere f o m e n t ati o n o f ho t w ate r S o m e wi ll .

O h ho t w ater i s q u i t e as g o o d but I can assu re y o u

‘
say , ,

”
pr ac ti cal ly th at it i s n o t s o .
 PRI N C I PL E S O F O S TE O PA TH Y

Yo u wi l l te th at h e make s u s e o f th e cu t an e o u s r e
no

fl e x e s to aff e c t th e i n ter i o r o f th e j o i n t .

A re c e n t c as e c o r r e sp on di n g we b e li ev e w as tre ated
, ,

o s te o p athi c ally wit h m arked s u c c ess The i n fl amm ati o n .

i n the s h o u l de r j o i nt w as n ot tr au m ati c in o r igi n n o r did

i i

it app e ar to b e r he u m ati c in characte r H o t fo m e n tatio n s

'

w o u l d give gre at r e li ef but di d n

'

o t give su ffi c i e n t re s t to
,

th e j o i n t to pe r m it o f a c u re The fe ar w as e ntert ai n ed .

th at lo nger re s t of the arti c u l ati o n w o u l d r e su lt i n adh e

s i o n an d l o ss o f f u n c ti o n i n th e j o i n t S i n c e th e c ir cu m
.
.

fl e x n e rve app e ar e d to b e the o n e i n v o lved a car ef u l e x ,

ami n ati o n w as m ade o f th e arti c u lati o n s b etwee n th e s i x t h

an d s eve n t h c ervi c a l vertebr ae The c i r c u mfl e x n e r ve i s

'

m ad e u p large ly o f fib er s fr o m th e S i x t h c ervi cal n erve

tru n k Te ns i o n and te n der n e s s t o get he r Wit h s light r o
.
,

tati o n o f th e s i x t h c ervi cal we r e n o te d at t hi s p o i n t The .

o s te o path i ns te ad o f w o rki n g o ve r th e ar e a o f di st r ib u ti o n
,

o f th e c ir c u mfl e x c e ntered hi s w o rk u p o n t hi s arti c u lati o n

,

to b r in g ab o u t r i ght r e lati o n s be tw e e n the si x t h an d se v r

enth c ervi c al vertebrae Ten s i o n an d i rrit ati o n were r e

.
'

mo ve d Th e c ir cu mfl e x n e r ve c e as ed to m an ife s t any u m
”

. -

du e i r r it ati o n The o ste o p at h al m ost i nv ar i ab ly w o r k s

.

fr o m th e c e n te r to p eriph ery i ns te ad o f the r eve r se .

H e r pe s Z o ste r — Ah e x amp l e o f the o s te o p ath s u se o r

’
.
,

r at he r re co g n iti o n o f H ilt o n s law : A cas e o f H e rp e s Z o s te r

’ -

l o c ated al o n g th e c o u r s e o f the l eft fift h i n te r co s t al n erve

w as give n a g r ave pro g n o si s by a ho m e opath i c phy s IC Ian .

The p ati e n t v i sited an o s te op a t h i mm edi ate ly ho p i n g th at

'

s o m e rel i ef mi ght b e f o u n d fo r t he i n t o l e r ab l e p ai n The .

e ru pti o n e x te n de d fr o m the s pi n e to th e m e di an l i n e i n
‘
-
.

f r o n t f o rmi ng a band a bo u t o ne i n ch wide The fift h rib

,
.

w as f o u n d r o t ate d do a ar d th u s le s s e n i n g the fifth i n te r

,

c o s t al s p ac e an d pr e ss i n g o n th e n erve at s o m e p o i n t i n

i ts co u r s e Th i s rib w as r ai s ed eve n t ho u g h th e o ste o

.
,

p ath s fi n ge r s re ste d dire c t ly u p o n the er upti o n i n o r der

’
,

to f o r c e th e rib u pw ard The re s u lt w as m o s t gr atifyi n g

P ai n de c re as ed alm o st i m
. .

m edi ately an d th ere w as a r api d ,

18 8 PRI N C I PLE S O F O S TE O PA TH Y

F IG 31 S enso r y d e r m a to m e s on t
an e r i orrf a
su ce
b dy D r aw n b y Joh n Com s t k ( a ft r
.

of tn e o .
oc e

H e ad ) .
190 P RI N C I P LE S O F O S TE O PA TH Y

C YI
~

F IG 32 S e n so r y d e rm t
a o mes on
’

t
pos e r i o r rfsu ace
b y D raw n C om sto k ( aft r
. .

e
o f th e od . by J oh n c

H e ad ) .
 PR I N C I PLE S O F O S TE O PA TH Y 19 1

pl e m e n te d by hi s st atem e n t th at every f as c i a o f the b o dy

has a m u s c l e att ach ed to i t, an d eve ry f asc i a th r o u gh o u t
'

th e b o dy m u st be co n s i de re d as th e i n s ert i o n o f a m u scl e ”
.

Thi s carri e s th e i n fl ue nc e o f m o t o r n erve s to p o i n t s c o vered

by th eir s e nso r y co mp an i o n s .

H e adl s
’
Law —An o th er
. law , in
th i s c ase a c o mp re
‘

or

he n s iv e s t atem e n t has be e n m ade by H e ad i n hi s writi n g s

,

“
i n Br ai n .
”
Thi s i s a s t atem e n t o f phy s i o lo gi cal tran sfe r e n c e
o f p ai n fr o m i ts p o i n t o f o rigi n t o a p o i n t o f c o n sc i o u s

s e n s ati o n
. Thi s phy si o l o gi cal law i s st ated as f o llo w s
“
. Whe n a p ai n f u l s tim u l u s i s app l ie d to a p art o f low s e n
si bili ty i n c l o se c e ntr al co n n e cti o n with a p ar t o f m u ch
high er s e n s ibi li ty the p ai n p r o d u c e d is felt i n the p art o f
,

h igh er se n sib i lity r ath er th an i n th e p art o f lo wer s e n sibi l

”
ity to whi ch th e stim u l u s w as app li e d .

Appl i cati o n o f the Law —Thi s phy s i o l o gi cal law can

.

b e app l ie d i n tw o w ay s F i r st we m ay co n s i der th e re la
.
,

tive s e nsibility o f di ff ere n t p o r ti o n s o f a n erve tr u n k I f a .

stim u l u s i s appli e d t o a n erve tr u n k at s o m e p o i n t i n i ts

c o u r s e b e twe e n i ts o r 1g 1n an d di strib u ti o n th e p ai n c au s ed,

by th e s tim u lu s will b e felt in th e are a o f di s trib u ti o n o f

th e fib er s o f thi s n erve tr u n k r ath er th an at the p o i n t wh ere
th e stim u l u s i s app li ed The S k in m u co u s o r s er o u s m em
.
,

br an e an d m u s c l e i n wh i ch s e n so ry n erve s e n d ar e are as o f
high se n s ibil it y c o mp are d wi th th e tr u n k o f th e n erve .

The b r ai n i s c o n sc i o u s o f o n ly th e are as o f di strib u ti o n o f

th e se n so ry n e r ve s h e n c e s tim u li appli ed at th e p o i nt s o f
,

lo w s e n s ibi lity ar e referre d to th e are as o f h igh s en s ibi l ity .

Th us all l e s i o n s cau si n g pre ss u re u p o n n erve tr u n k s c au s e

p ai n co ntr acti o n o r p erv er s i o n o f se c reti o n i n the are as
, ,

o f di s trib u ti o n . The p ati e n t i s no t th o r o u gh ly co ns c i o u s

o f an y lo cati o n bu t th e are a o f di strib u ti o n whi c h i s an
are a o f hi g h s e n s ib i l ity
'

The cas e s de sc rib ed u n der Hi lto n s law ar e app l i c ab l e

’

h e re In th e c as e o f i n fl am ed sh o u ld e r j o i n t th e p ati e nt
.

w as n o t co n sc i o u s o f the i rrit ati o n at th e S p i n al c o lu m n

19 2 PR I N C I PL E S O F O S TE O PA TH Y

th e r o t ated ve rteb r a—th i s w as an are a o f l o w s e n sibil ity

i n th e c o u r s e o f th e n e rve tr u nk The br ai n attrib u ted all
.

th e tr o u b le to th e term i n ati o n s o f th e n erve s i n th e ti s su e s

o f th e j o i n t All o f the refle x e s ac te d acco rdi n g ly
. .

The
e c o n d app li c ati o n o f th i s law is to th e rel ative i n
s

te n sity o f are as o f h igh s e n s ibi lity The are as i n wh i ch

.

s e n so ry n e rve s e n d ar e al l are as o f h igh s e n s ibi lity bu t ,

s o m e ar e high e r th an o th er s We n o te in p r acti c e th at
.

so m eti m e s a n e rve tr u n k whi c h s u pplie s s ever al s tr u c t u re s

wi ll m anife st p ai n i n a po rti o n o f i ts a re a o f d i strib u ti o n

wh i ch i s n o t th e p art in w h i c h the i rrit ati o n i s l o c ated .

Fo r e x am pl e th e s e n so ry p o rti o n o f th e o bt u r at o r n er ve
,

i s di s trib u te d to th e hIp j o i n t an d ski n o n th e i nn er s i de

o f th e k n e e The s ki n s eem s to b e an are a o f high er se n
.
'

s i bi l i ty th an th e i n te ri o r o f th e h ip j o i n t b e cau se i n di se as e
,

o f th e h ip j o i n t th e p ati e n t fre q u e n tly c o mpl ai n s o f p ai n

i n th e c u t an e o u s are a r ath er th an i n th e j o i n t wh ere th e

ac t u al di se as e i s l o c ated .

The Vi — The vi sc e r a ar e n o rm al ly no n s e n sitive

sc e r a -

i e we ar e no t c on sc i o u s of p o ss e ss i n g vi sc er a The pre s
. .
,
.

su re o f f o o d i n th e st o m ac h an d th e b e at o f th e h e art m ake

n o i mp re s s i o n o n o u r Co n s c i o u s n e ss ; an d s o it i s with al l

p art s o f th e b o dy go ver n ed by sym p ath eti c n erve s The ;

v i s c e r a ar e are as o f lo w s e n s ibility n o t lo w i rrit abi lity

, ,

fo r th ey ar e ri ch ly su ppli ed with s e n so ry n er ve s u p o n ,

th e sti m u lati o n o f whi c h active f u n c ti o n i n g dep e n d s The .

re sp o n se to s ti m u li o f s e n so ry n erve s i n vi sc e r a i s r api d
"

b u t n o rm ally th i s re s p o nse t ake s p lac e e ntire ly o u t s id e o f

o u r c o n sc i o u sn e s s th e i mp re s s i o n i s n o t re c o g n iz e d as c o m
,
:

i ng fr o m th e vi s c e r a bu t fr o m a rem o te are a o f h i gh S e n
,

s i bi li ty i n c l o s e c e n tr al c o nn e c ti o n with th e l e s s s e n sitive

are a A s an e x ampl e p ai n i s fe lt i n th e right s h o u l der as

.
, ,

a re su lt o f hyp er aem i a o f th e liver The p re ssu re u p o n

.

se n so ry n erve s i n th e l iver d o e s n o t cau s e p ai n In t h e l i ve r

‘

—
bu t refer s it to a m o re se n s itive are a th e ski n an d m u sc l e s
o f th e right sh o u ld er .
19 4 PR I N C I PL E S O F O S TE O PA TH Y

C H A P TE R X I .

O S TE O P ATIIIC C E NTE R S-

C ert ai n p o i nt s o n th e s u rfac e o f th e b o dy ar e sp o ke n
“ ”
o f as C e nte r s
. Thi s w o rd has b e co m e a p art o f th e o s te o
I t d o e s n o t c o nvey to th e
’
p ath s t e ch n i cal v o c ab u lary .
‘

mi n d o f th e o ste o p ath th e sam e m e an i n g wh i ch att ach e s

to it wh e n u s ed i n phy s i o lo gi cal te x t b o o k s -
.

A phy si o l o gi c al f u n c ti o nal c e nte r i n th e c e n tr al n erv o u s

s y s tem i s th at p o i n t wh ere th e ac t l o n o f a c ert ai n vi sc us o r

o th e r str u c t u re is g o ver n ed .

A n o s te o p ath i c c e n ter i s th at p o i n t o n th e s u rf ac e o f
th e b o dy whi ch has be e n dem o n s tr ated to b e i n c lo se st
c e n tr al co nn e c ti o n with a phy s i o l o gi c al c e n te r o r o ve r th e
,

c o u r s e o f a go ve r ni n g n erve b u n d l e .

In Ch apte r II,
I n —
u de r th e su b h e adi n g S egme n t a ti o n,

refe re n c e i s m ad e to th e divi si o n o f th e c e n tr al n erv o u s

sy s tem i n t o se c ti o ns whi c h m ay to a m o d e r at e d egre e
, ,

f u n c ti o n ate i n d ep e n de n t ly No p o rti o n o f th e n erv o us sy s

.

te m ever f u nc ti o nate s ab s o lu te ly i n dep e n de n t ly The ac .

ti o n o f every p o rti o n aff e ct s all o the r p o rti o n s bu t c er tai n ,

are as i n th e b rai n an d S p i n al co r d s eem to b e s o m ewh at

\

se t ap art t o g o ve r n o r c o o rdi n ate th e phy s i o l o gi c al ac tivity

o f c ert ai n o rg an s . P hy s i o lo gy has d em o n str ated a large

n u mb e r o f th e s e c e n t er s .

P hy s i o lo gy sh o w s ho w no t o n ly th e i n divid u al g an
gl i a wh i ch l ie in th e i nte sti n e s f u n cti o n with rel ative i n
depe n de nc e bu t ho w eve n str u ct u re s l ike th e sp i nal g an
,

gl i a fre q u e ntly re ck o ne d in with th e c e ntr al sy stem still

”
e nj o y r el ative i nd ep e nd e n ce f ro m it f uncti o nally .

Wh at we k no w o f th e an at o mi cal str u ct u re and o f

 PRI N C I PL E S O F O S TE O PA TH Y 19 5

th e f u n cti o n s o f th e c e n tr al n erv o u s sy stem o f vertebr ate s

f o r c e s u S m o r e an d m o re to the c o n c lu s i o n s ( 1 ) th at eve n
‘

i n div id ual p art s o f th e c e n tr al sy s tem ar e th e m s e lve s i n a

p o siti o n to f u n c ti o n to a c ert ai n e x te n t i n dep e n de n t ly an d ,

( )
2 th a t eve th e br i n an d s p i n al c o rd o f v e r te b r ate s ar e
'

n a

co mp o s ed o f a s eri e s o f c e n ter s Wh eth er the o n e o r th e

.

o th e r o f th e s e i s m o re h igh ly deve l o p ed wh eth er th ey ,

ar e i n c o nn e c ti o n with de ep er c e n ter s wh eth e r th ey h ave ,

c o nn e c ti ons am o n g th em s e lve s an d with highe r c e n ter s

'

det erm i n e th e m e as u re o f th e high er o r lo wer deve lo pm e n t

o f th e c e n tr al sy s tem We wi ll fi n d later th at i n th e c o u r s e
.
,

o f th e d eve l o pm e n t o f a c la ss i n divi d u al c e n ter s c o nn e cted

,

w ith th e c e ntr al n erv o u s sy ste m h ave re ac h e d a h igh d e

v e lo p m e n t wh i l e o th er s h av e arrive d at a c ert ai n s t age
,

( o r re ac h ed a c ert a i n typ e ) wh e r e th ey r em ai n s t ati o n ar y ,

an d thr o u gh o u t a ll s u b s e q u e n t p o sterity r em ai n everywh e re

al ike .

“
O n e can c o n c eive th at i n i ts e s s e n ti als every n erv o u s
.

s y ste m i s c o m o s e d o f aff ere n t tr ac ts an d e ff ere n t tr ac t s

.

p ,

an d o f tr ac t s w h i c h f o rm th e c o n n e c tl o n o f th e e l eme n t s
'

”
am o n g t h em s e lve s .

An at o my an d P hy s i o lo gy de m o n str ate th at fr om a
c ert ain s egm e n t o f th e spi n al c o rd n erve fib er s ar e di s

t rib u t e d to ski n s ke l et al m u s cl e s i n v o l u n t ary m u sc le s an d

, ,
-

m u co u s m em br an e o f vi sc er a an d to th e m u sc u lar c o at s ,

o f th e arte ri es s u pp ly i n g al l t h e s e st r u c t u re s .

P hy s i o lo gy an d P ath o lo gy dem o n s tr ate th at i mp re s

“

sio n s m ad e u p o n s e n s o ry e l em e n t s i n s ki n m u co u s m em
'

b ran e m u s cl e o r o th er Str u c t u re s ar e carrie d to a c e n ter

, ,
-

i n th e c e n tr al n erv o u s s y stem Th e s e i mp re ss i o n s ar e c o
.

o rdi n ated i n th i s c e n ter an d aff e c t th e phy s i o l o gi c al ac t io n

o f all str u c t u re s i nn erv ate d fr o mth e sam e c e n ter

,

Wh e n .

we s p e ak o f tw o o r m o re str u c t u r e s b ei n g i n c lo s e c e n tr al
co nn e c ti o n we m e an th at th ey ar e i nn erv at
, e d fr o m th e sam e -

segm e n t o f t he c e n tr al n e r v o u s sy s tem .

D i agno si s — In di ag no si s th e s e segm e n ts se r ve th e pu r
p o s e o f calli n g th e o ste o path s atte nti o n to the co nditi o n
v
’
19 6 PRI N C I PLE S O F O S TE O PA TH Y

F IG . 33 . f
S u r ac e m ar k i ng of th e b r a c h i al pl e xu s .
19 8 PR I N C I PL E S O F O S TE O PA TH Y

a rti c u l ati o n th e m u scl e s wh i ch g o ver n m o vem e nt s o f th e

,

j o i n t an d th e ski n o ve r th e j o i n t ar e all i nn erv ated by thi s

,

fir st c ervi cal n erve .

The m u scl e s m o vi n g th e o cc ip it o atl an t al arti c u lati o n

-

ac t acc o rdi n g to i mp u l s e s re ach i n g th e p o i n t o f o r 1g 1n o f

F IG 34 F r o n t vi e w of t
p a r i al p ar al ysi s of th e
b
. .

r a c h i al p l e x u s
.

th e fir st c e rvi cal n e rve o ve r s e n so ry fiber s e n di ng In th e

s ki n c o veri n g th e b ac k o f th e h e ad an d th i s arti c u lati o n ,

al s o fr o m th o s e e n di n g i n th e sy n o vi al m emb r an e o f th e
j o i n t Th e s e i mp u l se s
. ar e co o rdi n at ed i n h igh er c e n ter s
 PR I N C I PL E S O F O S TE O PA TH Y 19 9

of th e br ai n wh i ch g o ver n e q u i libr ati o n The m u sc le s o f .

th i s j o i n t ac t also acc o rdi n g to o u r wi ll .

The P n e u m o g as tr i c Ne r v e — F u rth erm o re th e an teri o r ,

divi si o n o f th i s n erve c o mm u n i cate s with th e pn e u m o g as

tri c hyp o g lo ssal an d th e s u p eri o r symp ath eti c g an g li o n
, , .

F IG . 35 . S i de v i e w of sa me c as e as F i g . 34 .

The p n e u m o ga stri c has h

wid e di s trib u ti o n th at we
su c a

c ann o t aff o rd t o f o l l o w all o f i ts p ath s o f i n fl u e n c e at thi s

ti me The st u de n t i s referred to any e x te n ded w o rk o n

.

an ato m y fo r th e det ai ls The m u sc l e s an d m u c o u s m em

.

br an e s o f th e lary nx ar e i nn erv ate d by th e p n e u m o g astri c ,

he n Ce an y i rrit ati o n o f th e lary nx m ay r efle x i mp u ls e s to

th e c e n ter o f o rigi n o f th e fir st c ervi cal n erve an d c au s e
u n d u e c o n tr ac ti o n o f th e m u s cl e s i n n erv ate d by it Thi s .
2 00 PR I N C I PL E S O F O S TE O PA TH Y

m u s cu lar c o n tr ac ti o n c an re s u lt i n ch an gi ng th e rel ati o n

o f th e b o n e s f o rm i n g th e o c c i pi tO atlan tal arti c u l ati o n u n ti l
L

a c o n d iti o n e x i st s wh i c h we c all a s u b lu x ati o n o f th e at las .

H avi n g f o llo we d th e i mp u l s e s fr o m th e lary nx to th e

c e n ter o f co o rdi n ati o n an d o u t ag ai n t o th e m u s c le s o f

F IG . 36 . R e ar vi e w o f sam e cas e as F i g .

th e o cc ipit o at lan t al arti c u lati o n with c o n s e q u e n t s ublu x a

‘

ti o n we m ay p r o fit ab ly n o te th e f ac t th at s u dde n t empe r
,

at u re c h an ge s m ay aff e c t th e ski n o v e r th e s e m u s c l e s ,

ar o u s i n g i mp u l s e s wh i ch ar e c ar r i e d to th e c e n ter o f c o
'

o rdi n ati o n,
th e n c e to th e m u scl e s c au s i n g th e m to c o n
.
,

t ract with re su lti ng s u b lu xati o n S o m e o f th e refl e x i m

.
2 02 P RI N C I P LE S O F O S TE O PA TH Y

F IG . 38 . P o s te ri o r f
su r a ce m ar k i n g of th e lu n g s .
 PR I N C IPL E S O F O S TE O PA TH Y 203

p u l s e s m ay fi n d th ei r w ay to th e lary nx an d cau s e c o n
ge s ti o n o f i ts m u c o sa The atlas m ay b e sub lu x ated by
.

vi o l e n c e th e n th e s e nso ry imp u l s e s o rigi n ate i n th e sy mo

,

vi al m em br an e o f th e j o i n t an d i n th e m u s c l e s m o vi n g th e
j oin t Th e s e imp u l se s m ay be refl e c te d i n su ch m an n er as
.
=
.

to aff e c t th e lary n x ph ary nx an d o th er str u c t u r es i nn er

,

v ate d by th e p n e u m o gas tri c The refl e x i n fl u e n c e s e x i s t

.

i n g b etwee n th e fir s t c ervi c al n erve s an d th e pn e u m o g as

tri c ar e c hi efly co n fi n e d to th e lary nx an d th e ph ary n x ,

be c au s e spi nal n erve s u s u ally r e ce l v e symp ath eti c refl e x es

fr o m th e s egm e n t o f th e b o dy whi c h th ey co ver I f w e .

S h o u l d f o ll o w al l o f t he div is i o n s o f th e p n e u m o g astri c s ,

we w ou l d fi n d a w o n de rf u l diver sity o f di strib u ti o n W e .

do n o t e x p e c t th at refl e x e s fr o m the h e art lu n g s s t o m ach , , ,

et c.
,
ar e g o i n g to b e s u bj e c t to co o rdi n ati o n i n th e are a

o f o rigi n o f th e fir s t c ervi c al n erve j u s t b e c au s e th ere i s

,

c o m mu n i c ati o n b etwee n th e p n e u m o g as tri c an d th i s n erve .

The ph ary n x an d lary nx ar e i n p art s tr u c t u re s g o ver n ed , ,

i nv o lu n t ari ly an d h e n c e th ey ar e i n large p art rem o ve d

, .

fr o m th e i n fl u e n c e o f n erve s c arryi n g v o lu n t ary i mp u l s e s ,

i e s pi n al nerve s The p n e u m o g as tri c i s e ss e n ti ally s y m

. .
,
.

p ath eti c i n c h ar acter The ti ss u e s o f th e lary n x and ph ar

-
.

y n x a r e p r ac ti c all y u n der th e i n fl u e n c e o f th e fir s t c ervi

"
cal n e rve Y ou r atte n ti o n i s c alled to H i lt o n s law as h e
.
’
.

has s t ated it i n re lati o n to m u c o u s an d s er o u s s u rf ac e s .

“
Thi s same pri n c ip l e o f arr an geme n t ; an at o m i c ally phy s i o ! ,

lo gi cally an d p ath o lo gi c ally co n si dered i s to be o b s erved , ,

with an eq u al degre e o f ac c u r acy i n th e s er o u s an d m u

'

co us m emb r an e s Th u s co n s i dered it p re s e n t s a p ri n
.
,

c i pl e whi ch if it has any app li cati o n i n p r acti c e m u st b e

, ,

o n e c ert ai n ly o f large e x te n t .

S i n c e th e s pi n al acc e s s o ry f o rm s p art o f th e p n e u m o
g astri c ab ov e th e p o i n t o f c o m m u n i c ati o n b etwe e n th at
n erve and th e fir st c ervi c al we c an p er c eive th e re as o n
,

fo r th e gre at i n fl u e n c e whi c h temp er at u re c h an ge s aff e c t ,

—
i ng th e ski n o ver th e s te r n o c l ei d o m as t o i d an d tr ap ezi u s
-

m u scl e s h ave o n th e acti o n o f th e m u sc le s f o rm i n g th e

,
2 04 PR I N C I P LE S O F O S TE O PA TH Y
'

F IG . 39 . Th e l u n g t
ce n e r .
2 06 P R I N C I PL E S O F O S TE O PA TH Y

F IG . 40 . C i li o - s p i nal an d h e ar t c e nte rs .
in e of th e h e ar t .
2 10 PR I N C I PL E S O F O S TE O PA TH Y

FIG . Th e s to ma c h c e n te r .
 PRI N C I PLE S O F O S TE O PA TH Y 2 11

Ce r vi cal P l e x u s —The fir st f o u r c er vi c al n erve s ar e i n

te r w o v e n to f orm a p l e x u s E ac h di strib u t iv e br an c h
.

fr o m thi s p le x u s p r o b ab ly c o n t ai n s so m e c o mm u n i c at in g
,

fiber s fr o m th e f o u r p ri m ary n erve trun k s Vi ewi n g th e .

p l e x u s as a wh o l e w e fi n d th at i ts br an
,
-
c h e s ar e di strib u te d

acco rdi n g to H i lt on s law Th ey i nn erv at e the S ki n o f

’ ‘

“
.

'

th e n e c k as lo w as the fi fth c ervi c al spi n e p o st er i o r ly th e n ,

o b li q u e ly f o rw ard as l o w as th e ster n o c l avi c u l ar arti c u la -

ti n a te riorly
o n an d —
th e ac r o mi o clavi c u lar arti cu lati o n
,

later ally . The s ki n o f the p o s t eri o r s u rf ac e o f the c r an i u m

an d th e e ar re c eive s s e n so ry fib er s fr o m thi s p l e x u s Th e s e .

a r e th e gr o ss p o i n t s to b e rem emb ere d c o nc er n i n g c utan

e o u s s e n s o ry di strib u ti o n fr o m th i s p l e x u s The m usc l e s .

.

u n d er thi s c u t an e o u s are a al l re c eive m o t o r fi be r s f r o m th e

‘

fir s t f o u r c ervi c al n erve s .

A n at o m i st s divi de th e c ervi c al n e rve s i n t o an te r i o r

'
an d p o steri o r d ivi s i o n s th e n de sdr i be th e s e
,
e ly
-
.

Th i s i s an artifi c i al d ivi s i o n wh i ch d o e s n o t s e rve an y u s e

fu l p u rp o s e fo r u s I t m u ltip l ie s de tai l with o u t givi ng
.

an adeq u ate c o n c epti o n o f th e re al Ch ar acter o f th e wh o l e

n erve Whe n y o u st u dy th e u ltim ate di stri bu ti o n o f th e

'

an te r l o r divi si o n o f a n erve f o rm i n g th e c er vi c al p l e x u s
‘

do n o t f ai l to rem emb e r th at the u ltim ate d i strib u ti o n o f i

'

the p o s teri o r divi s i o n i s a p art o f th e s am e n erv e I f th e .

an teri o r d ivi s i o n co mm u n i c at es with a symp ath eti c g an

g l i o n th e p o s teri o r divi s i o n re c e ive s i mp u l ses fro m”

,
an d

s e n d s i mp u ls e s t o th i s gan gl i o n I f the an te r l o r divi si o n

.

co mm u n i c ate s with th e v ag u s an d hyp o g l o ss al n er ve s; th e

p osteri o r divi si o n i s a party to th i s c o mm u n ic atio n an d
’ '

i n all w ay s be n efit s o r s uff er s by it acco rdi n g to th e n u m

ber an d i n t en sity o f th e sti mu l i app lie d at any p o i n t alo ng
th e c o u r s e o f eith er n erve .

"
Thi s u pp er po rti o n o f th e n e c k i s th e m o st fl e x ibl e
'

p art o f th e wh o l e S p i n al c o lu m n I t i s su bj e c te d to m o re
.

c h an ge s o f temp er at u re an d m o re str ai n s o r twi st s th an

o th er p o rti o n s o f th e s pi n e The co n st an t e ffo rt to sav e

.

th e he ad f r o m i nj u ry p ut s a severe tax u p o n th e activi t y

2 12 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 44 . Th e s p l a n ch n i c ar ea .
 PR I N C I P LE S O F O S TE O PA TH Y 2 15

c al vertebr ae as a s o l id l eve r to s e cu re r o t ati o n an d r e

, ,

lax at io n b etwe e n th e t hird an d f o urth c ervi cal verteb r ae

m ay give g o o d re su lt s S i n c e hi cc o u gh i s a refl e x du e to
.

s tim u l ati o n o f s e n s o r y n erve s e sp e c i al ly th e pn e u m o g as

,
'

tri c it sh o u l d n o t b e e x p e c ted th at i n h ibiti o n o f th e m o t o r

ph re n i c w
,

n erve ,
o u ld ,
e n ti re ly s t o p h i c c o u ghs whi l e th e
s e n s o r y s tim u lati o n i s co n ti n u ed C l i n i c ally we fi n d th at.
,

i n h ibiti o n o f th e ph re n i c n e rve i s su ffi c i e n t to s t o p th e
or di n ar y c ase o f hi cc o u ghs Th eref o re we call th e are a .
,

o ver th e c o u r s e o f the phre n i c n erve as i t c r o ss e s th e sca ,

l e mu s an ti cu s m u sc l e Opp o s ite th e fifth c ervi cal tr an s ver s e

“ ”
p r o c e s s th e c e n ter fo r h i c co u gh s
, S e e F i g 2 66 . . .

The Tr apez i u s an d S pl e n i u s Capi ti s et C o ll i M u s cl e s

—Th
.

e erv i cal p l e x u s c o m m u n i c ate s wit h th e br ach i al

c

p l e x u s ; th e r ef o re we e x p e ct th at th o s e large m u sc le s s u ch ,

as th e tr ap ezi u s an d s p l e n i u s whi ch ar e i nn erv ated by ,

—
n e r ve s fr o m s egm e n t s o f th e spi n al c o rd at v ar i o u s l eve ls , ,

wi ll t r an sm it by th ei r acti o n th e i n fl u e n c e r e fl e x e d to th em
at the p o i n t o f th eir s eri al i nn erv ati o n The s p i n al acc e s .

s o ry i nn e rv ate s a l arge p art o f th e c ervi c al fibe rs o f th e

thi rd an d f o u rth c e rvi c al n erve s s e n d

br an ch e s to th i s m u s c l e Th eref o re an y di s t u rb an c e alo n g
‘

th e c o u r s e o f th e se n erve s o r alo n g th e c o u r s e o f o th er
,

n e rve s i n c l o s e c e n tr al co n n e c ti o n With th em whi c h m ay

c au s e ab n o rm al c o n tr ac ti o n o f th e tr ap e z i u s w i l l i n fl u e n c e ,
.

m o re o r l e s s all the p o i n t s o f att ach m e n t o f th at m u scl e

,
.

The tr ape z i u s i s se l d o m ab n o rm al ly c o n tr ac ted A n y le s .

s e n i n g i n th e n o rm al r an ge o f i t s ac ti o n i s q u i c k ly n o te d
”

by th e p ati e n t The co n tr ac t u re d co n diti o n i s e asi ly r e

.

m o ved by a wi lle d ac ti o n We u se th e tr ap ezi u s m u sc l e .

as a m e an s o f tr an s mitti n g p o wer to v ari o u s p o rti o n s o f

th e spi n al c o lu m n i e i n o u r e ff o rt s to m o ve o n e Or m o re
, . .
,

verteb r ae .

V as o m o ti o n -
,
H e ad, su p eri o r
F ac e an d Ne ck —The .

c ervi c al g an g l i o n c o m m u n i c ate s with th e fir s t f o u r c ervi cal

n erve s th eref o re th e are a o ve r th e s p i n e s o f th e fir s t f o u r

,
2 16 P R I N C I PL E S O F O S TE O PA TH Y

F IG . 46 .
An t e r ior su r fa ce ou t li n e of th e l i v e r an d l a r g e t
i n te s i n e .
2 18 PRI N C I P L E S O F O S TE O PA TH Y

F IG 47 C e n te r for g t
l a r e i n e s ti n e k
Th e a r r o w ma r s p o i n t o f
b t g t
.

c o n n e c ti o n o f c e r e r o S p i n a l n e r v e s w i h th e h p o a s r i c
y
. .

c lo se
-

p le x u s .
 PRI N C I PL E S O F O S TE O PA TH Y 2 19

Vertebr ae . The
h i l d w as n o t v ery s tr o n g at th e tim e o f
c

th e i nj u ry A s light f all wh i l e p layi n g s ub lu x ate d th e

.
, ,

fifth c ervi cal NO n o ti c e w as t ake n o f thi s s light f all The

. .

n e x t day ,
wh i le b ath i n g th e ch i l d th e m o the r no te d a pe,

c u liar i ty i n th e p o s iti o n o f th e sh o u l der Th e ar m c o u ld

.

n o t b e r ai s e d ab o ve th e h e ad The au th o r e xami n ed thi s

.

c as e th e day th e m o the r di sc o vered th e c h an ge i n th e

s h o u l der. Ar fir s t g lan c e fr o m th e s i de it app e ared to be
-

a s u b Spi n o u s di s lo c ati o n o f th e h u m er u s bu t p alp ati o n

"
-

di sp r o ve d th i s Caref u l e x am i n at i o n sh o we d a he m i par e
.

si s o i th e wh o l e l eft s i de b e lo w th e f o u rth c ervi c al n erve .

No n e o f th e n o rm al m o vem e n t s w ere lo st bu t i t re q u ired ,

the u tm o st e ff o rt o f th e p ati e n t to m ake th em No w an d .

the n th e left to e w o u l d strike th e fl o o r too s o o n an d s l ight

ly trip h er P alp ati o n Of th e fifth c ervi cal v erteb r a
.

The sl igh te s t p re ss u re at
'

s h o wed a lat e r al s u bl u x ati o n .

thi s po i n t cau s e d th e p ati e n t to c r y o u t with p ai n .

After o u r e x ami n ati o n ( th e s e ph o t o gr aph s were t ake n

at th at tim e ) th e ch i l d w as t ake n to a su rge o n w ho p re ,

s c ribed a Su rgi c al Op er ati o n t o s tit c h th e lati s s i m u s d o r s i

to i ts p r o per po siti o n o n th e l o we r an g l e o f th e sc ap u l a .

H e di d n o t re co g n iz e th e p areti c c o n diti o n o f th e wh o l e
l ef t s ide . A fter a sh o rt tim e th e c hi l d w as br o u ght to u s
,

fo r tre at me n t O u r s o l e e ff o rt w as to red u c e th e s u blu x a

.

ti o n o f th e fif th c ervi c al vertebr a The te n der n e ss w as so .

gre at th at thi s w as m an ife s t ly o u t o f th e r an ge o f p o s si

bi li ti e s with a de l i cate ch i l d A fter tw o we ek s o f re lax i n g
.

ar o u n d th is arti c u lati o n a dire c t m o vem e n t w as m ade to

re d u c e th e s u b lu x ati o n The ali g n m e n t w as p erfe c te d

.
,

bu t n o imm e di ate g o o d re s u lt s were n o te d A c o n ti n u e d .

i n c re as e i n n erve p o wer has gr ad u ally i n large m e asu re , ,

i
o v e r co m e t he def o rm ity .

x i
S u b lu at o n o f t e S capu
h l a —The def o rm ity i s th e e f
.

fe ct o f u n eve n co n tr acti o n o f m u sc l e s The lati ss im u s .

d o r s i , rh o mb o id s an d s err at u s m ag n u s ar e we ake n e d whil e

th e l ev at o r an g u li s c apu li an d c ervi cal fiber s o f th e tr ap e
ar e co n tr ac ti n g with th ei r c u s t o m ary p o wer The
'

z i us .
22 0 PR I N C I PLE S O F O S TE O PA TH Y

m u s c le s i n n e rv ate d by n e rve s fr o m / abo v e th e l e s i o n ar e

acti n g n o rm ally bu t th ei r acti o n i s n o t re s i s ted Thi s
'

.
,

re su lt s i n s u bl u x ati o n o f th e scap u la .

The Ne r v e of W ri s b erg .
— A divi s i o n
th e fi rst d o r sal of

n erv e f o rm s th e fir s t i nter c o s t al n erve The i nn er s ide .

.

an d b ac k o f th e ar m re c eive c u t an e o u s br an ch e s fr o m th e

fi r s t d o r sal n e rve Th ere is c o mm u n i c ati o n betwe e n th e

.

c u t an e o u s n erve s t o th i s are a an d th e s e c o n d i n ter c o s t al

n e rve by m e an s o f th e n erve o f Wri sb erg h e n c e p ai n i s ,

freq u e n t ly fe lt alo n g th e i nn er s u rf ac e Of th e ar m i n c as e s
o f h e art tr o u b l e i n te r c o st al n e u ralgi a i h th e s e c o n d s p ac e
,
'

o r p l e u ri sy .

The I nte r scapu l ar R e g i o n .

—The divi s i o n
th e spi nal o f
c o l u m n b etwe e n th e fir s t an d s e v e n t h d o r s al vertebr ae i s
'

c o m m o n ly c all e d th e i n te r scap u lar regi o n I t i s an e x

i

-
.

c e e di n g ly i mp o rt an t o n e I t i s so m etim e s c alle d th e pul

.
,

m o n ar y regi o n b e c au s e it i s th e are a fr o m wh i ch t
, he lu n g s
de rive m an y n erv e s S e nso ry i mp u ls e s fr o m the l u n g s ar e
.

c o o rdi n ate d i n thi s are a .

F ig u re 3 7 i l lus tr ate s th e an teri o r su rf ac e o u t l i n e o f

th e l u n g s wh i le F i g 3 8 sh o w s th e o u tl i n e o n th e p o steri o r
,
.

s u rf ac e o f th e th o r ax Th e s e m arki n g s were m ad e o n the

.

s u rf ac e ac c o rdi n g t o phy s i cal m eth o d s o f di ag n o si s Th ey .

rep re s e n t th e aver age p o s iti o n o f th e lu n g s i n a h e althy

m an .

L u n g C e n t e r — F ig u re 3 9 i llu str ate s th e lu n g c e n te r

.

withi n wh i ch s e n s o ry imp u l s e s fr o m th e lu n g s ar e c o
o rd i n ate d . A large p r o p o rti o n o f case s o f br o n c hiti s ,

p u l m o n iti s o r p l e u riti s o f e it her th e s i mp l e o r b acte ri al

typ e s ar e acc o mp an i e d by gr e at s e n sitive n e ss i n thi s are a
,
.

Th i s s e n s itive n e s s i s i n the co n tr ac te d m u sc l e s o r , ,

wh e n th e sh ap e o f th e th o r ax i s gre at ly c h an ge d at th e ,

an g l e s o f th e rib s S u b lu x ati o n s o f rib s o r vertebr ae i n

.

thi s are a ar e so m etim e s f o u n d i n co nn e cti o n with the i n

fl am m ati o n s ab o ve n am ed Wh eth e r th ey are th e c aus e
.

o r th e e ff e c t o f th e i n fl amm ati o n c an o n ly b e t o l d by th e
222 PR I N C I PL E S O F O S TE O PA TH Y

The co n diti o n m ight b e j u st th e o pp o site We do n o t de .

si re t o c o n f u s e o u r re ad e r s i n th e l e as t bu t it sh o u l d b e
,

re m emb ere d th at b ef o re m aki n g a d o gm ati c st atem e nt

“
s u c h as di se as e i s th e re s u lt o f anat o mi c al ab no rm al iti e s
”
f o llo wed by phy si o lo gi cal d i sc o rd we S h o u ld b e c e rt ai n
,

F IG . 49 . Cen t er f o r th e g al l b l ad d er .
 PR I N C I PL E S O F O S TE O PA TH Y 22 3

th at o u r s t atem e n t i s n o t b ase d o n a s eri e s o f s e l e cte d co

‘

“
i n c i de n c e s The o ld saw : Its a p oo r r u l e th at d o e s n o t
.
’

w o rk b o th w ays i s d e c i ded ly app li cab l e to n erv e refl e x e s

,
.

C i l i o S pi n al C e n t e r
-
Te n der n e ss i n thi s are a i s n o t
.
-

n e c e ssari ly i n di c ativ e o f phy s i o lo g i c al di s t u rb an c e in an y

F i g 40 i n d i c at e s tw o c e nte r s: Th e o n e
~

th o r ac i c vi s c u s . .

betwee n th e seco n d an d thi rd d or s al i s call ed th e c i l i o

S pi n al c e n t er D et ai l c o n c e r n i n g th i s c e n ter wi ll b e f o u n d
;

i n the Cha -"

pt er o n t he S ymp ath eti c Nerv o u s S y s tem .

—
The f ac t th at th e v aso c o n s tri c t o r fib er s to th e c e rvi cal
symp ath eti c g an g l i a l e ave th e s pi n al c o rd b el o w th e s e c o n d

d o r sal vertebr a sh o w s th at s o m e refl e x e s fr o m th e h e ad ,

f ac e an d n e ck m ay b e c o o rd i nated i n th e i n te r s cap u lar

regi o n .

—
H e art Ce nt e r The p o i n t b etwe e n th e f o u rth an d fifth
.

d o r s al spi n e s i s n o te d as a h e art c e n ter W e h ave n o t f o u n d .

te x t b o o k au th o rity fo r th i s s t ate m e n t Cli n i cal e x

’

an y -
.

p e r i e n c e l e ad s .
th e a u th o r t o l o c ate a h e a rt c e n ter a t thi s

p o i n t Wh at th e ab s o lu t e i n fl u e n c e o f thi s c e n ter i s we do
.

no t k n o w F r o m o b s erv ati o n o f c as e s o f an gi n a p e c t o ri s
.

it app e ar s to b e a se n s o ry an d v as o m o t o r c e n te r fo r t
-
‘

he -

h e art S tim u lati o n o f th i s c e n ter by a q u i c k p er c u s si o n

.
“

str o ke o f th e fi n gers wi ll bri n g o n an im m edi ate att ac k o f .

p ai n i n th e h e art b lu e n e s s o f lip s an d fi n ger tip s H e avy

.

,
’
.

digit al pre s su re at thi s p o i n t re li eve s the p ai n S te ady e x .

te ns i o n o f th e wh o l e s p i n al co lu m n d o e s n o t s ti m u lat e s u ch
c as e s b u t a s th e p u ll i s red u c ed an d th e vertebr ae ar e d r aw n
,

c lo s er t o geth e r thi s p oi n t i s fre q u e n t ly stim u late d In o r

,

der to av o id an att ac k afte r e x te n si o n it i s ne c e s s ary to ,

l e iss e n th e f o r c e o f th e p u ll very gra d u ally an d ev enl y

F i g 4 1 i llu str ate s th e s u rf ac e m arki n g s O f th e h e art
‘

. .

Thi s o rgan has th ree c e n ter s ( 1 ) The p n e u m o g astri c n e rve .

e x ert s an i n hibit o ry i n fl u e n c e Th i s n erve can b e stim u .

l ate d i n th e n e c k S e e F ig 2 67 ( )
2 . T h e a cc e l er at o r
. ce n .

ter i n clu de s s e c o n d th ird an d f o u rth d o r sal S e e Ch apter , .

V I O n th e S ymp ath et i c Nerv o u s S ys tem

\ ( )
3 V a so m o t o r .
-

an d s e n so ry c e nter i s f o un d b etwee n f o u rth an d fifth d o r sal .

224 P R I N C I PLE S O F O S TE O PA TH Y

F IG 50 t
C e n e r f o r th e o v a r i e s fl “
f
R e e x e s r o m th e O v a r i e s m ay
b
. . .

f o l l o w th e o v a r i an p l e x u s to th e a o r ti c a n d r e a c h th e c e r e r o
y t
s p i n al s s e m a t t t
hi s poi n . Th i s i s tr u e f o r th e te s te s a l s o
’

.
2 26 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 51 . P os t e r i or su rf ace ou tl i ne of th e k i dn e y s .
 P RI N C I PL E S O F O S TE O PA TH Y 22 7

whe n m aki n g a phy s i cal e x am i n ati o n The . s pi n al c e n ter

o f th e l arge i n tes ti n e i s i n di cated by F i g 4 7
‘

—The fir st p o rti o n o f th e s m all i n te s

S m all In t e sti n e
ti n e d u o de n u m i s i nn erv ate d fr o m ab o u t th e s am e are a
, ,

as th e liver Fi g 4 5
. I t m u st b e b o r n e in m i n d th at the
. .

S p lan c h n i c are a i s a large o n e an d c o mp re hen d s th e s e

s m all er c e n ter s M any o f th e s e p o i nt s i ndi cate d as ce n

.

t e rs ar e the are as wh i c h c li n i c al e x p eri e n c e has n o te d i n

'

c o nne c t io n w 1 th vi s c er al di st u rb an c e The rep e ate d e x .

p e r i e n c e o f m a n y c as e s giv e s th em v a lu e fo r di ag n o sti c

an d th er ap e u ti c p u rp o s e s .

C e nte r —W ith i n th e are a i n di cated by F i g

f o r Chi ll s .

4 8 th er e i s a c e n ter u s u al ly de s c rib ed as th e eighth do r

,

s al whi ch has re c eive d th e n am e o f

,
“
th e c e n ter fo r c hi lls ”
.

O u r fi r st o b s erv ati o n o f th e ac ti o n Of th i s c e n ter w as i n

c o nn e c ti o n with a c as e o f m alari al fever H e av y i n hi bi . .

'

ti o n o f th i s are a l e ss e n e d the s everity o f the chill W e .

h ave o b s erve d th e e ff e ct s o f i n hibiti o n o f th i s ce n ter i n

m any cas e s o f ch i ll du e to n erv o u s n e s s o n s et o f La ,

G ripp e o r o th er i n fe c ti o u s di s e as e s an d to ab sc e ss f o rm a ,

ti o n In all cas e s th e tre atm e n t w as di s ti n c t ly h e lp fu l

.
-

to th e p atie n t .

The Lan g u age

of P ai n —H o m e o p athi c m edi c al p r ae .

ti c e n o te s v ari ati o n s i n th e c h ar ac ter o f p ai n an d u se s ,

th e s e ch ar ac teri s ti c s as i n d i cati o n s f o r th e admi n i s tr a ‘

ti o n o f sp e c i al dr u g s as th o u gh a n erve fib er e x p re ss e d a ,

l an g u age o f p ai n To th e o ste O pathi c phy S 1 c 1an i t i s su f

.
,

fi c i e nt th at a n er ve e x p re s s a di s t u rb an c e at s o m e p o i n t
’

o f i ts c o u r s e Th is c ry o f th e ne rve s c al l s fo r j u st o n e
.

thi n g rem o ve th e c au s e S e ar ch i s m a de for thi s c au se

,
;

alo n g i ts e n tl r e c o u r s e an d th e c o u r s e o f i ts co n n e c ti o n s
.

,
.

Vi e w o f P at ho l o gy —
Anot
he r p arti cular
. ‘

O s t e o pat hi c
'

.
_

i n wh i ch th e o s te o p ath i c p ath o lo gy di ff er s fr o m o th e r
s ch o o l s o f m edi c i n e i s i n th e w ay we vi ew v ar yi n g co n di
ti on s o f a vi scus To th e m edi cal . p r actiti o n e r S i mpl e ,
 22 8 PR I N C I PL E S O F O S TE O PA TH Y

F IG 52. r
E n d o f th e s p i nal c o d . Ph y s i olo g i cal ce nt er rturi ti
f or p a o n,
t t rt
.

d e f e ca i on and m i c u i i on .
2 30

F IG . 53 .
r
A r e a s o f th e l u m b a and s a c r al pl ex u se s .
 PRI N C I PL E S O F O S TE O PA TH Y 231

at time s s e n d refle x e s h ere The u ter u s m o re th an any .

_

o th er p e lvi c o rg an m anife s t s i t s di s t u rbe d co n dit 1o n by ,

te n der n e s s at th i s p o i n t .

The u ter u s is s u ch a c h an ge ab l e o rg an th at it i s th e
c h i ef di st u rbe r o f s ymp ath eti c rhythm i n a w o m an s b o dy
’
.

A c h an ge i n i ts p o s iti o n cau s e s a c h an ge i n i ts b lo o d su p
pyl ,
f o l l o we d by c o n ge s ti o n o f i ts m u c o sa T hi s c o n .

ge s ted co n d iti o n s et s u p a s erie s o f i mp u ls e s i n th e symp a

the ti c Sy ste m whi c h m ay n eve r re ac h th e c erebr o s p i n al
/
-

sy s tem They s p e n d th e ir f o r c e o n th e v ari o u s o rgan s

.

g o ver n ed by the sy m pathe ti c n erv o u s sy s tem th e h e art

‘
, ,

s t o m ac h b o we ls e tc
,
F i g 5 5 i llu str ate s th e d i ff ere n c e
, . .

i n th e he ar ts rhythm i n th e sam e p atie nt The fir st

i
.

s phygm o gr am w as t a ke n wh i l e th e p atie n t had c o n s i der a

"

bl e di ffi c u lty i n m o vi n g ab o u t o n acc o u n t o f th e h e art s

’

very i rreg u lar acti o n The u te r u s i s p r o lap s ed P ati e n t

. . .

ha s w o r n a stem p e s sary fo r ye ar s
'

W h e n th e p ati e nt .

t ake s th e ge n u p e c t o r al p os iti o n an d i n h ale s str o n gly

-

whi l e p u lli n g u pw ard o n the abd o mi n al m u s c le s th ere i s

gre at re l i e f bu t wh e n th e h e art b e c o m e s as i rreg u lar as
,

th i s sphygm o gr am i n di c ate s she i s afr aid to t ake th i s po ,

s i ti o u .
—
A fter t we n ty f o u r to s eve n ty tw o h o u r s o f ir -

reg u lar ac ti o n th e h e art reg ai n s i ts r hythm The p o s iti o n

,
.

o f th e u ter u s be c o m e s ch an ge d by th e m o vi n g o f th e pa

ti e n t in b ed The p eri n e u m i s b ad ly t o r n an d th e u teri n e

.

lig am e nts ar e gre atly l e n gth e n ed h e n c e th e o rg an can n o t ,

b e kept i n o ne p o s iti o n S he has ref u s ed o p er ati o n . .

M any di ff ere n t p o i n t s ar e n ame d as c e n ter s fo r th e

u te ru s bu t th ey al l r e s t o n th e f ac t th at after th e o rg an
,

has i n iti ate d a large n u mbe r o f i mp u l s e s i n th e symp a

th eti c sy s t em th e y m ay b e p as se d to th e c erebr o spi n al

,
’
e

s y stem at any p o i n t o f u n i o n o f th e t w o sy stem s

—
.

O v a y an d
r T e st s
e The s e o rg an s re c eive th eir sy m
p atheti c i nn erv ati o n fr o m th e p l e x u s wh i ch li es On th ei r
art e rie s The o v ari an p l e x u s i s give n o ff fr o m th e ao r ti c
.

p l e x u s wh i ch re c eive s fi be r s fr o m as h igh as th e el eve n th

.

an d twelfth d o r s al g an gli a Th erefo re a l e si o n i n th e .

2 32 P RI N C I PL E S O F O S TE O PA TH Y

n
'

F IG . 54 . Ce t f
er or th e b ladd er .
2 34 PR I N C I PL E S O F O S TE O PA TH Y

ti vi ty ofth e re ct u m b lad der o r u ter u s D i st u rb anc e s in

, , .

th e s e vi sc er a ar e n o t n e c e ss ari ly m an ife ste d to th e o ste o

p ath by te n d er n e ss ar o u n d th e s e c o n d l u mb ar vert ebr a .

Any p o i n t alo n g the s pi n al c o lu m n b e lo w th e s e co n d

‘

lu mb ar m ay b e se n s itive as a re su lt o f di s t u rb an c e in th e
p e lvi c vi s c e r a F ig 52 . . .

D u ri n g p art u riti o n th ere i s co n sc i o u s ach i n g alo n g

th e wh o l e lu mb ar are a th u s de m o n str ati n g th at th e s e n
,

so ry n e rve s o f th e u ter u s c an refl e x th ei r irrit ati o n t o al l

th e l u mb ar n e rve s I nj u ry o f th e s pi nal c o l u m n at th e
.

j u ncti o n o f th e d o rs al an d lu mb ar po rti o n s may aff e c t m o

ti o n s e n sati o n an d n u triti o n o f all th e str u ct u re s i n n er
,

v ate d by th e c au d a e q u i n a A n i n j u ry b e lo w th e s e c o n d
.

l mb r v erteb r wi l o t h ave as f ar re ach i n g e ff e ct as

u a a l n — '

an i n j u ry o f th e s am e c h ar ac ter ab o v e th at p o i n t .

P ar apl e g i a Whe n th e b ac k i s b r o ke n at th e d o r s o
.
-

l u mb ar arti cu lati o n p ar ap l egi a re su lt s I t i s n o t n e c e s sary

,
.

to ac t u al ly bre ak t he b ac k i n o r der to c au s e p ar ap l egi a .

A s evere s tr ai n c au s ed bly a f all m ay i n d u c e s u ch an

ex u d at e ar o u n d thi s arti c u lati o n th at p re ss u re i s e x erted
o n th e l u mb a r e hlar g e m e n t o f th e c o rd M an y o f the so .

c al l ed b r o ke n b ac k s wh i ch ar e s p o ke n o f as c au sative o f
,

p ar apl egi a ar e n o t br o ke n at all bu t th e lig am e nt s ar e

, ,

b adly spr ai n ed The sam e co n diti o n e x i st s h ere as i n

.

o th e r s p r ai n e d j o i n t s Th ere m ay b e m arke d kyph o s i s

.
,

b u t th i s d o e s n o t n e c e ssari ly i n di c ate di s lo c ati o n The .

p ar aplegi c co n diti o n m ay b e p erp et u ate d by th e p re ssu re

of c o nn e ctive ti s su e f orm ed i n th e rep ai r o f th e i nj u ry .

Thi s is e sp e c i ally l i ab l e to f o llo w i f so m e f o rm o f m an i pu

lative tre atm e n t i s n o t p er s i s ted i n fo r fr o m o n e to thr e e
'

ye ar s The au th o r has f o rt un ate ly be e n able to o b s erve

.

th e s l o w rege n er ati o n o f n erve ti s su e f o llo wi n g c o mp lete

p ar apl egi a as a re su lt o f i nj u ry o f th e d o r so lu mb ar ar
’

ti c u lati o n . Thi s c as e has b ee n o b s erved by u s d u ri n g

n e ar ly f o u r ye ar s D u ri n g all o f th i s tim e she has r e
.
,

c e i v e d o s te o p ath i c tre atm e n t Thi s m eth o d o f tre atm e nt

.

w as n o t b eg un u n ti l te n m o n th s after th e acc id e n t th ere ,

 PR I N C I P LE S O F O S TE O PA TH Y 2 35

f o re sy n o vi al a dhe s i o ns had fo r me d to s u c h an e x ten t i n

,

th e j o i n ts o f the l im bs th at m u ch p ai n f u l m an ip u lati o n
o f th e s e j o i n t s has b e e n n e c e ssary .

F o llo wi n g th e ac c i d e nt th ere w as m o t o r an d s e n so r y
,

p ar aly s i s o f the e x t r em iti e s b ladd e r an d r e ctprn Co ntr o l

,
.

wo m
,

o f th e b ladder an d r e c t u m ret u r n e d aft er t o n th s o f

’
”

o s te o p athi c tre atm e n t S e n s ati on an d m o ti o n h ave re

.

t u rn ed to the e x t r em iti e s Th e r e i s def o rmity as a r e s u lt

.

F IG 55 S p h y g m o g r am s i l l u s tr ati n g th e e ff e c t o f u te r i n e re fl exe s on th e
he a£ t.

of th e adh esi o n s fo r m ed d u ri n g the te n m o n th s p r evi o u s

to th e fir st o s te o p athi c man i p u lati o n
—

'
The patl e n t had . .

be e n m as sage d du ri n g the te n m o n th s m e n ti o ne d .

u ar n r Pl x
'

—
L mb a d S ac al e u se s F r o m th e n erve s of the -

c au d a e q u i n a a r e f o rm ed t w o lar ge p l e x u s e s th e l u mb ar ,

an d s ac r al i n di c ated i n F ig 53 The b r an c he s of the se

, . . .

p l e x u s e s i nn e rv ate th e m u sc le s o f th e lo we r e x tremitie s .

The spi nal are a fr o m whi c h t he s e p l e x u se s r ec e i ve t

.

hei r
fib er s sh o u ld b e c aref u lly e x ami n ed w he n e v er any di ffi ‘

"

c u lty o f m o vem e n t o r se n sati o n i n th e l o wer e x tremitie s

i s p re s e n ted .

The s t u de n t sho u l d l e ar n th e s e n so ry an d m o t o r di s .

tr i bu tio n o f e ac h br an c h o f th e s e p le x u s e s so that; pe r
'
'

i phe r al di st u rb an c e c an b e imm e di ate ly as so c i ate d Q w i th

th e p o i n t o f em erge nc e fr o m th e S pi n al co lu m n o f the
affect e d n erve o r n e r ve s .

The Bladde r —F i g 54 i n di cate s th e s u p e r fi c i al are a

. .

i n whi ch refle x e s f ro m th e b ladde r ar e m o s t fre q u e n tly

 S O F O S TE O PA TH Y
2 36 PR I N C I PL E
2 38 P RI N C I PL E S O F O S TE O PA TH Y

S i ti v e wh e n th e p r o st at e i s e n l arged ; i n f act al m o st any ,

di so r de r o f th e m al e se x u al o rg an i sm i s acco mp an ie d by
thi s se n sitive co n diti o n;
I n h ib it o ry m o vem e n t s o ve r th e b ac k o f th e s ac r u m
an d i s ch i ati c s pi n e will re s u lt i n re lax ati o n o f th e p eri n e al

m u scl e s I t aff e ct s s p asm o di c stri ct u re o f th e u rethr a i n

.

a w o n derf u l m an n e r The lo cal an ae s th eti c e ff e c t o f i n

.

hi b iti o n i s n o t s o e asi ly dem o n str ate d i n any o th er po r

.

ti o n o f th e b o dy as i n th i s sac r al are a .

Wh e n th e u ter u s i s t u r n e d eith e r b ac kw ard o r fo r

w ard o r p r o lap s ed th ere ar e 1m pu ls e s ar o u se d i n s e ns o ry
,

n e rv e fib er s i n th e re c t u m o r bl add er Th e s e i mp u l s e s
‘

—
.

ar e r e fl e x e d to th e sac r al are a W h il e th o s e ar o u se d in th e
,

u te r u s p as s to h igh er p o i n t s i n th e s p i n al co l u m n In .

hi bi ti o n o f th i s s acr al are a wi ll h ave a temp o r ary e ff e c t .

The o n ly tre atm e n t w o rth whi l e 1 8 th e co rre cti ng o f th e

p o s iti o n o f th e u ter u s .

C o n cl u si o n s — Th ere ar e m any m o r e so c alle d ce n -

ter s m e n ti o n e d by o s te o p ath i c writ er s : We h ave n o t

‘

attempte d to eve n re c apit u l ate th o s e o th er c e nter s whi ch

s eem t o us t o b e qu ite to o f an c if u l fo r pr acti c al u se The .

‘

c e n te r s m e n ti o n ed i n thi s ch apter ar e th o s e whi c h c an

.

be dem o n s tr ate d i n d ai ly p r ac ti c e an d h e n c e ar e us ed
,
,

c o n ti n ual ly,
b o th as g u ide s fo r d i ag n o si s an d as i n di ca
ti o ns fo r th e app li cati o n o f m an ip u lative th er ap e u ti cs No
“ ” “
symp ath eti c s p i n al c e n ter s fo r s e n sati o n m o ti o n o r
,

“
n u triti o n
”
c an b e dem o n s tr ated Th e s e ar e c har acte r i s
.

t i c s o f n erve fibe r s i n ge n er al an d it i s e nti re ly mi s le ad

,

i n g to l im it th e s e ch ar ac teri s ti c s to any o n e po r ti o n o f n

t he sp i n al c o l u m n . E very o s te o p athi c c e n ter s h o u l d b e

c ap abl e of d em o ns tr ati o n an at o mi cally phy si o l o gi cal ly
,

an d c li n i c ally . O n ly th o se whi c h c an p ass th i s te st sati s

facto r ily ar e w o fthy o f o u r co ns i de rati o n .
 PR I N C I PL E S O F O S TE O PA TH Y

C H A P TE R X I I
‘

TH E BA C K .

The S pi nal C o lum n. The b ac k i s -

h ar acterized by tht c

s pi n al c o lu m n wh i ch c o n stit u te s th e lo ng ax i s o f th e b o dy
, .

Thi s c o lu m n c o n si st s o f twe n ty f o u r m o v abl e verteb r ae

-
,

th e s ac r u m an d c o ccyx The m o v ab l e b o n y s eg me n t s ar e
.

s ep ar ated —
‘

-
fr o m e ach o th er by fi br o c ar tilag in o u s di s cs -
.

E ac h ve r tebr a i s ch ar ac teriz e d by a b o d y an d an ar ch whi ch

e x te n d s fr o m th e p o s te ri o r later al p o r ti o n s o f th e b o dy .

The bo dy s erve s to give stre n gth , st abi lity an d weight

ca rryi n g c ap ac ity to th e co lu m n The ar c h e s s erve tC
“

f o rm an i n c o mp l ete b o ny c anal fo r th e p r o te cti o n o f th<

,

s pi n al co r d an d i t s m embr an e s A lth o u gh th e s e ar c h e
.
s

f o rm a fai r ly co mp l ete p r o te c ti o n to th e co n te n t s o f th e
ca n al i n th e u pp e r d o r s al regi o n th e appr o x im ati o n o f th e
,

l ami n ae i s n o t n e ar ly so p erfe c t i n th e lu mb ar regi o n I t is .

t hr o u gh th e g ap s b etwe e n the l am i n ae i n th e l u mb ar regi o n

th at p u n ct u re c an m o st e a si ly b e m ade .

S pi nal L i g am e n t s — —
The di s c s o f fi br o carti lage ar e
.

very str o n g ly att ach e d to the b o di e s o f th e ve rtebr ae an d

th e fi b r o u s ti ss u e o f th e se di sc s i n terwe ave s with th e fib er s
'

o f th e co mm o n l ig am e n t s whi ch e x te n d fr o m e n d to e n d o f

th e spi n al co lu m n o n th e an teri o r an d p o steri o r s u rfac e s

’

o f th e b o d ie s. A fter c u tti n g th e n e u r al ar ch e s at th eir ,

j u n cti o n with th e b o die s we h ave l eft a str o n g co l u m n o f

,

b o ny s egme n t s s e par ate d by fi bro c arti lagi n o u s di sc s wh i ch

,
-

ar e st r o n gly adh ere nt .B o th b o n e s an d cartil age s ar e ve ry

st r o n gly b o un d t o et he r by t he a n te r i o r and po ste r i or co m
g
mo n li gaments .
2 40 P R I N C I PL E S O F O S TE O PA TH Y

of r otatton
lo cated in

he
t cu r ves in
Cer vi cal

r
D awn by t
J ohn C oms ock .
2 42 PR I N C I PL E S O F O S TE O PA TH Y

—Thi s co l u m n i s ch ar acterize d by m o der

F l e x ibi l ity .

ate fl e x ibil ity an d c ert ai n c u rve s The el as ti c ity i s du e to

.

th e st r u ct u re o f th e fi br o carti lagi n o u s d i scs The c e nte r

-
.

o f th e d i sc s i s a very s o ft m as s o f fi b r o c arti lage th i c ke r -

,

th an th e m argi ns an d c o nt ai n i n g th e rem ai n s o f th e ch o rd a
d o r sali s o f th e emb ry o .

F IG . C u r v e s o f th e v e r e r a l t b
k t
.

c o lu m n (F ic ) A w i h i n te r
b
.

t t
,

v e r te r a l d i s c s ; B w i hou t i n e r
t b
,

v e r e r a l d i s cs .

No r m al S pi n al Cu r v e s —The rve s ar e du e to th e
. cu

e q u al th i c k n e s s o f th e an teri o r an d p o st eri o r p o rti o n s o f

th e di s c s The di s c s ar e thi c ker an ter i o r ly i n th e c ervi cal
.

an d l u mb ar regi o n s th i c ke r p o s teri o rly i n th e d o r sal regi o n

, ,

th u s p r o d u ci n g anter i o r cu rve s i n th e c ervi cal an d lu mb ar ,

an d a p o steri o r c u rve i n th e d o r s al The b o die s o f th e v e r

.

te br ae also v ary s lightly i n th i c k n e s s an teri o rly an d po s

te r i o r ly
,
i e th e an te ri o r d epth o f th e b o di e s i s l e s s th an
. .
,

th e p o ste ri o r so th at with o u t th e di sc s the wh o l e co l u m n

'

p re s e n t s a p o steri o r c u rve with a l o s s o f th e anteri o r c u rve s

i n th e c ervi c al an d l u mb ar regi o n s Th e s e c u rve s and th e . .

ch ar acteri s ti c s o f th e c e n te r s o f th e i nter vertebr al di scs -

 PR I N C I PL E S O F O S TE O PA TH Y 2 43

give th e co l u m n its re s i l ie n c e In b en di n g thi s co lu m n to .

th e si de r o t ati o n o f th e v erteb r al b o die s i s i n evit ab l e

,
.

L im itati o n o f F l e x bi l it y
i — The an teri o r an d p o s teri o r .

c o mm o n l ig am e n t s o f th i s c o lu m n o f vertebr al b o di e s an d
.

i n ter vertebr al di s cs te n d by th eir i n e las ti c fibr ou s ti s su e

-
, ,

to limit fl e x ibi lity B y addi n g th e n eur al ar ch es with th ei r

.
,

l ig am e n t s th e fl e x ibi l ity o f th e c o lu m n i s sti ll f u rth e r l i m

i te d . Be si de s the co m m o n l ig ame n t s bi n di n g th e b o die s
the r e i s o n e o th e r l ig am e n t whi ch e x te n d s th e wh o l e l e n gth
o f th e c o l u m n i e th e su p r aspi n al ligam e n t co ns i sti n g o f
, . .
, ,

i n e lasti c fib r o u s ti ssu e e x te n di n g o ve r th e sp i n o u s p r o
‘

c e s s e s fr o m t he s ac r u m to th e s eve n th c ervi c al wh ere i ts ,

s t r u c t u re c h an ge s to ye l l o w e lasti c fib er an d i s k n o wn as

th e l igam e n t u m n u ch ae th r o u gh i ts co n ti n u ati o n to th e
c ervi c al s pi n o u s p r o c e s s e s an d th e o cc i p i t al b on e Th i s
'

li g ame n t l imit s fl e x ib i l ity i n th e d o r s al an d l u mb ar regi o n s .

The rem ai n de r o f th e S p i n al l igam e n t s ar e i n tervertebr al ,

i e e x te n d betwee n tw o verteb r ae Th ey ar e i n el as ti c
. .
, .

with On e e x c epti o n th e l ig ame n t a s u bfl av a co n n e c ti n g th e

,

Th ere ar e m an y o t her th i n g s
'

lami n ae o f t he n e u r al ar c h e s .

—
wh i c h ar e facto r s i n l imiti n g th e i n h ere n t fl e x ibi l ity o f th e
‘
‘

Sp i n al co lu m n viz th e arti cu lati o n with the r ib s to f o rm

‘

, .
,
‘

th e th o r ax th e arti c u lati o n with p e lvi c b o n e s th e co n te n t s

,
.
,

o f abd o m e n an d th o r ax an d th e b u lk o f th e so ft ti ss u e s

wh i ch r o u n d o u t th e b o dy .

P r o c e ss e s — Alth o u gh th e S pi n al lig ame n t s

Ar ti cu lar .

and o th e r s tr u c t u re s l imit th e fl e x ibi lity o f th e s pi n al

c o lu m n th e ch aracter o f i ts evi de nt fl e x ibi lity i s l argely
,

go ver n ed i n th e v ari o u s regi o ns by th e sh ap e an d p o siti o n

o f arti c u l ar pr o c e s s e s wh i c h f o rm a s erie s o f glid i n g j o i n t s
,

b etwee n th e n e u r al ar ch e s The arti c u lar pr o c e ss e s ar e .

l o cated at the j u n cti o n s o f th e p edi c l e s an d lami nae Th ey .

co n si s t o f tw o s 11 p e r i o r an d tw o i n feri o r fo r e ach vertebr a

'

Ce r vi cal R e g i o n — In th e c ervi cal regi o n th e arti c u lar

.

pr o c e ss es ar e pl ac ed very o b l iq u e ly The su rfac e s o f th e .

su p e r i o r l o o k u pw ar d an d b ac kw ard an d ar e so m ewh at
2 44 PR I N C I PLE S O F O S TE O PA TH Y

F IG . 61 . R ad i og rap h of th e ce rvi cal r g i

e on t
i n p os i i o n f o r b al an c i n g th e
h e ad e r ct
e .
2 46 PR I N C I PL E S O F O S TE O PA TH Y

r h ed to fit th e s light co ncavity o f th e i n feri o r wh i ch l o o k

a c

d o w nw ard an d f o rw ard Thi s arr an gem e n t p ermit s fl e x 10 n

.
,

e x te ns i o n an d sid e b e n di n g ac co mp an i ed by sl ight r o t ati o n .

Th e s e ar e re co g n ize d as th e phy si o l o gi cal m o vem e nt s fo r

thi s regi o n o f th e c o lum n The h ighly sp e c i alize d arti cu
.

'

lati o ns b etwe e n th e o c c ipit al b o n e an d at las th e ax i s an d

_
,

F IG . 63 . R ad i o gra p h i ll u s trati n g n o r m al fl e x i on i n th e c e rv i c al re gi on .
 P RI N C I PL E S O F O S TE O PA TH Y 2 47 .

F IG . 64 . R ad i o g r ap h of th e c e r v i c al re gi on in t ti
ro a on .
2 48 PR I N C I P LE S O F O S TE O PA TH Y

a tl as ar e w o rthy o f m o re d et ai led c o n sid e r ati o n ( S e e .

Ch ap X I V )
. .

D o r sal R e g i o n —The s u rfac e s o f th e d o r sal arti c u l ar

.

p r o c e ss e s ar e verti cal th e su p e ri o r f ac i n g b ac kw ard th e

, ,

i n fe ri o r f o rw ard The s u rf ace s ar e slight ly c u rved fr o m

.

s id e to si d e th u s f o rmi n g p art s o f t he su rf ac e o f a th e o
ret i c al c y li n d er h avi n g i ts ax i s l o cated i n fr o n t o f th e b o dy .

The m o vem e nt s p e rm itte d by thi s str u c t u r al arr an ge me nt

ar e th e phy s i o lo gi cal o n e s k n o w n as fl e x i o n e x te n s i o n an d ,

s i de b e n di n g r o t ati o n R o t ati o n i s th e m o st c h ar ac teri s ti c

.

o f the m o vem e n t s i n thi s regi o n I t i s gre ate st i n th e u pp er

.

d o r sal arti c u lati o n s an d d e c re as e s as th e arti c u lar p r o c e s se s

b egi n to t ake o n lu mb ar ch ar ac teri sti cs The el eve n th .
,

so m eti m e s th e te n th d o r s al v e r te r br a m ark s th e limit o f

,

th i s ch ar ac teri sti c d o r sal m o vem e n t All m o vem e nt s ar e .

lim ite d i n th e d o r sal regi o n n o t o n ly by th e i nhere n t f o rm

,

o f th e vertebr al arti c u lati o n s b u t als o by th e att achm e n t

o f th e rib s . The typi cal c o st o vertebr al ar ti cu lati o n i s ch ar

ac te r i z e d by th e h e ad o f th e ri b arti c u l ati n g with th e b o di e s

of tw o vertebr ae wh il e th e t u b er c l e o f th e rib u n i te s
with th e arti c u lar -f ac et o n th e tr an sver s e p r o c e s s o f th e
,
.
.

lo we r o f th e s e tw o vertebr ae The fir s t e l eve n th an d

.
,

le ftl ate ral mem .

F IG . 65 . D ra w n b y J o h n C om s t k
oc .
2 50 PR I N C I PL E S O F . O S TE O P ATH Y

F l exi on an d E x t e ns i o n .
-
S i nc e th e
rr an ge me nt o f th e a

arti c u l ar p r o c e s se s i s an i n d ex to c h ar acte r o f m o v e:
th e
m e n t no rm ally p e rmitted b etwee n the vertebr ae i n the
'

v ari o u s regi ons o f the s pi nal c ol u m n it i s advi sabl e th at ,

we cal l atte nti o n to a few p o i n t s c o n c e r n i n g th em I t is .

re adily se e n th at fl e x i o n i s a f ai rly free m o vem e n t i n all

p o rti o n s o f th e co l u m n with th e e x c epti o n o f th at p o rti o n
,

o f th e d o r s al wh i ch arti c u l ate s with th e s eve n tr u e rib s .

E x te n s i o n is li kewi s e fre e i n th e s e s ame s e c t i o n s i e ,

'

. .

wh e re fl e x io n i s fre e it i s m et by f ai r ly fre e e x te n s i o n .

S i de B e di g R t
n n o a i on
t — S id e b e ndi n g o f a c o lu m n ,

h vi g
a n a n o —
te r p o s teri o r c u rve s i s ch ar ac teriz ed by r o t a
,

r o ta twn .

F IG . D rawn J oh n C om s t k
oc .
 P R I N C I PL E S O F O S TE O PA TH Y 2 51

ti o n Th i s i n h ere n t r o t ati o n o f the segm e n t s o f th e spi n al

.

c o l u m n wi ll n at u r ally t ak e p l ac e with a c e n te r o f r o t ati o n

the o reti cally lo cate d o n a l i n e e x te n di n g dire ct ly f r o m e n d

to e n d Thi s l i n e w o u l d p ass o n th e co nc av e sid e o f th e
.

c u r ve s 1 e ,
b e p o steri o r to th e b o die s in th e c ervi cal r egi o n
. .
, ,

an teri o r to th e b o di e s i n th e d o r sal an d p o ster i o r to th e

b odi e s i n th e lu mb ar A s t u dy o f th e arti cu lar p r o c e ss e s

.

wi ll S h o w ho w thi s acti o n i s f av o re d by the f ac in g o f th eir

art ic u lar s u rf aces L i n e s dr aw n p erp e n di c u lar to th e sur
"

f ac e s o f th e s u p eri o r art i c u lar p r o c e s s e s o f a typi cal c erv

i c al i e th e f o u rth o r fifth c e rvi cal wi ll m eet at a p o i n t
, . .
, ,

beh i n d th e S p i n o u s p ro c e sse s an d ab o u t th re e i n ch e s ab o ve

h dor sal
7t su er io r su r fa ce
p .

F IG . D r aw n b y J o h n C om s t k
oc .
2 52 PR I N C I PL E S O F O S TE O PA TH Y

F IG . D r aw n J oh n C oms t k
oc (a ft T
er old t) .

S TO CK .

F IG . 70 .
 2 54 PR I N C I P LE S O F O S TE O PA TH Y

also di m i n ish e s as th e n e c k i s e x te n de df In e i th er fl e x i On
'

o r e x te n s i o n a s erie s o f l ig am
,
e nt s b e co m e s te n s e an d h e n ce
l imit s th e e x te n t o f ano th er m o vem e n t whi ch r eq u ire s free
‘

do m o f thi s t en s e l ig am e n t The er e ct po s iti o n o f th e n e ck

.
-

F IG . 72 . L e ft
d o r s a l- fi r l g h t l u m a r b F IG 7 a B
o di e s o f t b
h e l u m ar v e r
r ty t t
. .
,

c u v a tu r e , p r o g r e s s 1v e ln pe te b r a e ar e rot a ed i n o p r o pe r
”

f
an d th e r e o r e p a i n u l f B
o di e s o f g
a li n m e n t by
e l e v a ti n g r i gh bu t t
b k
.

th e d o r s a l v e r te r a e r o a e d to t t to c
ft B b r
.

th e l e o di e s of th e l u m a
b g t
.

t t
v e r te r a e r o a e d to th e r i h .

sig n ifi e s ligam e nt o u s re lax ati o n an d i s th eref o re th e p o si ,

ti o n o f e l e cti o n fo r r e du cm g subl ux at i o ns i n th e c e rvi cal

regi o n The sev e nth c ervi cal m ark s the chan g e i n dire cti o n
.

o f th e f ac i n g o f th e arti cu l ar p r o c e ss e s Its su p e r i o r s ur .
 PRI N C I PL E S O F O S TE O PA TH Y 2 55

f ac e s adhere to c ervi cal ch ar acteri sti c s whi l e i ts i n fe r i o r

be co m e m o re v erti cal an d li n e s p erp e n di cu lar to th em m eet
at a p o i n t i n fr o n t o f th e c o lu m n There i s fre q u e n t ly a
.

g r ad u al ch an ge in th e f ac i n g o f th e c ervi c al arti cu lar pr o

F IG .74 . S h ows g r ea t t
es ri gh tla t F IG 75 . S h o ws gr at t l eft
e es l at
n av i ty Of
.

e r al fl e x 10 n i h y
c o n c av i t of th e e r al fl e x i on i n co c th e
d o r s al c u r v e . lu m ba
r cu r v e .

e e whi ch begi n s at th e s i x th c ervi cal; The i nf e r i o r

c ss s

p r o c e ss e s o f th e s i x th m ay fac e so as to b r i n g th ei r p er

pe n di cu lar l i n e s t o geth er i n fr o n t o f an d b e lo w the b o dy .

R o tat i o n i n the D o r sal R e gi o n — The arti c u lar pro

c e ss e s i n th e d o r s al ar e c h ar acte ri sti c ally verti cal an d th e o

ret i c ally m o ve i n l i n e with th e s u rf ac e o f a cy l i n d er hav i n g

its ax i s an teri o r to th e b o die s o f th e ve r teb r ae Th u s to .

tatio n in th e d o r s al app e ar s to m o v e o n a fi x ed p o i n t j u s t ,

anteri o r to the b o die s o f th e ve rteb r ae an d he n c e th e sp in o us

.
 2 56 PR I N C I PL E S O F O S TE O PA TH Y

p r o c es ses m ake an ac t u ally as we ll as app are nt ly gre ate r

.

e x c u r s i o n to right o r left The sam e r ul e with rel ati o n to .

freed o m o f m o vem e n t b ei n g gre ate s t i n th e n o rm al p o i sed

p o siti o n app lie s h ere ,
R o t ati o n i s gre ate r i n th e u pp er
.

F IG 76 I ll u str ate s g
th e d e r e e o f F IG 77 I t g
l l u s r a te s th e d e r e e o f
b b
. . . .

ro t a ti o n of th e o di e s of th e r ot a ti o n o f th e o d i e s o f th e d o r
lu m b a r ver t b a e r e in t h i s case o f b
s a l v e r te r a e i n th i s c a s e o f l e t f
l ft d
e ors al i ght
-
r b
lu m ar la e r al t g b t
d o r s al - r i h t l u m ar l a e r a l c u r v
v at
’

cu r ure . a tu r e .

d or sa l an d de c re ase s d o w n w ard di sapp e ari n g at the v ari ,

abl e p o i n t wh e re l u mb ar c h ar ac teri s ti c s b egi n to i n fl ue n c e

.

th e fo rm o f th e arti c u lar p r o c e ss e s Th i s v ar iab le p o i n t i s .

'

f o u n d fr o m th e n i n th to el eve n th d o r sal R o t ati o n with .

th e ax i s o f m o veme n t an teri o r to th e verteb r al b o dy u s u

ally ce ase s at th e arti c u lati o n b etwe e n t h e eighth an d n i n th
d o r sal ; The late r al fl e x i o n b etwe e n th e n i n th an d te nth ,
.

te nth an d el e ve n th an d el eve nth and twelft h i s ch ar act er

‘

iz e d by ve ry littl e ro t ati o n o f eit he r the d o rsal o r l umb ar

 2 58 PR I N C I PL E S O F O S TE O PA TH Y

an d th e ir i n te r o v e r te br al d i sc it i s app are nt th at th i s w o ul d
,

te n d to b lo c k th e m o vem e n t o f o n e verte br a o n th e o the r

an d h e n c e gre atly lim it r o t ati o n A lth o u gh a st u dy o f th e
.

m e ch ani c s o f th i s p o rti o n o f th e co l u m n s eem s to sh o w a

F IG 7 9 f
F l e x i o n to th e l e t, i n c a s e F IG 80 gh t i n
F le x i on to th e ri
g ding il
.

t
. . .
,

s how n i n p r e c e di n i l l u s r a ti o n ca h wn i n
se s po th e rece
g t a ti n Th p i n t f g at
.

Th e p o i n t o f t
r e a e s t fi e x i on is l
'

us r o e o o re
i ght i ab u t
.

t
l o c a e d i n th e c o n c av i t y of th e es t fl i n t th
ex o o e r s o
rg t
i h b
lu m a r cu r ve th en i n th d al i a b u t th
ors e , o e
nt n av i ty
. . .
,

ce f th
er o f th
e co c o e
l f t lat al p a t
e f th
er v a tu
r o e cu r re .

very so li d an d u n yieldi n g c o n str u c ti o n the fac t e x i s t s th at ,

we h ave a c o ns i de r abl e am o u nt o f m o vem e n t i n th e u ppe r

d o r sal arti c u l ati o n s R o t ati on is pr o b ably th e m o s t pr o
.
,

n o u n c e d o f th e u pp e r d o r s al m o v m e n t s an d it i s i n thi s
e
regi o n o f th e co l u m n l ate ral subl ux ati o ns ar e f o un d
“

Fl e x i o n an d e x te n si o n ar e re adily dem o nstr ate d fr o m fi r st

to f o u rth an d fr o m eighth to twelfth d o r sal i th e se , .

regi o n s th ey ar e m o re p r o no u nc e d th an i n th e mi d d o r sal -
.
 PRI N C I PLE S O F O S TE O PA TH Y 2 59

Char acte r i s ti c M o v e m e nt i n the L u m b ar R e g i o n —The

lu mb ar a rti c u lar p ro c e ss e s ar e verti c al an d f ac e s o th at
t hey m o v e in l i n e with th e su rfac e o f a th e o reti c al cy l i n der
h avi n g i ts ax i s r u nn i n g i n th e tip s o f th e sp i n o u s p r o c e ss e s
'

F IG . 81 . g t t
S li h r
l a e r a l c u v a tu r e
r t ty
o f th e s t u c u r a l p e a s i s e vi
by t t b
,

d e nce d r o a i o n o f th e o di e s
o f th e t b
l o w e r d o r s a l v e r e r a e to
th e l eft b
th e o d i e s o f th e l u m a b r
g t
,

to th e r i h .

Th ere i s m u ch v ari ati o n i n th e f o rm th e lu mb ar ar ti cu

of

lar su rfac e s . S i n c e th ey h ave m u ch gre ater weight fo r th eir

b e ari ng s u rf ace s to su pp o rt th ey ar e h e avi ly deve lo ped .

E x ag ger ati o n o f th e n o rm al lu mb ar c u rve d u ri n g the de

 PRI N C I PL E S O F O S TE O PA TH Y
'

O pi n g
ve I p e ri o d cau se s th em to t ake o n a gre ater weight
c arryi n g f u n c ti o n th an n o rm al an d h e n c e c h an ge s th e b e ar

i ng m o v abl e s u rf ac e so as to d e c re as e th e r an ge o f m o ve
m e nt The m o r e n e arly the b o di e s o f th e verteb r ae te n d
.
.

F IG . 82 t
L a e r al fl e x i o n to th e F IG 83 t
L a e r al fl e x i o n to th e l eft
g g ty t g t t
.
,

ri h t, Is r e a te s t i n c o n c a v i of in h i s case , i s rea es i n con

th e t
d o r s a l cu r v a u r e . cav i ty b
o f th e l u m a r c u rv e.

to pp o rt th e su p e ri n cu mb e n t weigh t th e gre ater free d o m

su

o f m o vem e n t wi l l n at u r ally e x i st i n th e ar thro di als betwee n

th e a rti c u lar p ro c e ss e s The ch ar acteri sti c f o rm o f the
.
‘

l u mb ar arti c u lar s u rfac e s i s n o t c o n d u c ive to r o t ati o n as ,

a we l l d efi n e d m o vem e n t su ch as we fi n d i n th e u pp er
,

d o r sal an d c e rvi cal bu t n everth el e s s si d e b e n di n g in thi s

, ,

regi o n i s ch ar acterize d by r o t ati o n h avi n g i ts c e nter i n a '

l i n e dr aw n v erti cally th r o ugh th e spino us pr o ce sse s Th us .

w e no te t hat r o t ati o n in the t hr e e r egi o ns o f the co l umn

2 62 PR I N C I PL E S O F O S TE O PA TH Y

th an th e rever s e M o vem e n t i n th e o pp o s ite di re cti o n co m

.

pre s se s th e i n te rve rteb r al di sk s an d h e n c e l e s s e ns th e 1 r re si

l ie n ce .

Ad apt abi l it y P o s iti o n to Bo dy W e i ght Fle x i o n an d

of .
-

e x t e n si o n in th e lu mb ar ar e n o rm ally q u ite fre e h e n c e th ere ,

F IG 85 I g
ll u s tr a ti n r
th e p e s e n c e
g
. .

of rot a ti o n i n th e d o r s a l r e i o n ,

t t
co e x i s e n t t
w i h l a te r a l c u r v a u r e
.

is gre at ad apt abi lity to th e p o s iti o n o f th e b o dy we igh t .

A de c i de d d evi ati o n o f a s i n g l e s pi no u s pr o c e ss i s s e l d o m
f o u n d i n th i s regi o n The di re c ti o n o f th e ar ti cu lar s u r
.

'

fac e s te n d s to p reve n t s u ch d evi ati o n .

 PR I N C I PL E S O F O S TE O PA TH Y 2 63

C H A P TE R X I I I .

TH E P E L V I S .

The F ift h L u m bar . The fifth lu mb ar verteb r a p re

-

e t s o m e p o i n t s o f i mp o rt an c e
S n s Its m as s ive n e ss i s an
.
‘

—
evi de n c e o f i ts weight c arryi n g c ap ac ity The d epth o f i ts .

an teri o r m arg i n i s m arked ly gre a te r th an th at o f the po s

te r i o r p o rti o n o f i ts b o dy T he i n t ervertebr al di s c b etwe e n

.

th e fifth an d th e s ac r u m s ti ll f u rth er ac c e n t u ate s by th e ,

re lative ly gre at thi c k n e ss o f i ts an te ri o r m argi n th e an g l e ,

f o rme d by th e arti c u lati o n o f th e fi fth with th e sacr u m The .

in feri o r arti c u lar p r o c e s s e s ar e wi der ap art th an th o s e o f

F IG 86 D ra w i n g of p e lv i s , sh o win g sacr o - v e r t b ra l
e an gl e
D r aw n b y J o h n t k ft
. . .

C om s oc (a er H olde n) .
2 64 PR I N C I PL E S O F O S TE O PA TH Y

o th er lu mb ar s . The tr an sv er s e p r o c e s se s ar e u s u ally
h e avily d evel o p ed bu t th e spi n o u s pr o c e s s is apt to b e
,

s m all er th an th o s e o f th e o th er l u mb ar s Thi s vertebr a .

j o i n s th e sacr u m at a r at he r abr u pt angl e f o rm i n g a de

c i de d pr o j e cti o n ,
th e Sac r o —
ve rtebr al an gl e A li n e draw n .

'

th r o ugh th e i nte rvertebr al d i sc be tw e e n the fifth l u m bar

an d th e sac r u m w o u l d f o rm an an gl e with th e h o riz o n t al

o f ab o u t 30 degree s I t is evid e n t th at t
. he i n feri o r ar ti cu
lar p r o c e s se s o f thi s vertebr a h ave a co n si d er abl e f u n c ti o n
o f weight carryi n g I f it were n o t fo r th e br ac i n g acti o n
.

o f th e s e p r o c e s s e s th e s u p eri n c u mb e n t w eight w o u l d t e n d
,

to sli de th e b o dy o f th e fifth f o rw a rd o n th e b as e o f th e
sac r u m .

L o ss v s . o f No r m al C u r v e
E x agg e rat i o n s a g en s —A
”

er al pr o p o s iti o n it m ay b e st ated th at th e l o s s o f a n o rm al
,
,
,

c u rve i n th e S p i n al co l u m n i s apt t o c au s e m o re di sco mf o rt

th an w o u ld th e e x aggerati o n o f a n o rm al c u rve Th ere i s , .

pr o b ab ly n o b ett er e x ampl e o f th i s th an th e e ff e ct s n o t ed
,

i n ch an ge s o f th e l u m b o s acr al arti c u l ati o n

-
I t is m an i .

fe s t th at e x te n si o n in th e ar thr o di al arti c u l ati o n s b etw ee n ,

th e arti c u l ar p r o ces s e s o f th e s e tw o b o n e s s erve s to ho ld ,

"

th em m o re fi rm ly t o geth er an d m ake the sac r o vertebr al -

an g le m o r e pr o mi n e n t Th i s s erve s to m ak e the l o wer ab

’

d o m e n m o re p r o m i n e n t and m ake s th e li n e o f divi s i o n b e

twee n abd o m e n an d p elvi s m o r e m arked .

M o t i o n i n L u m b o S acr al Arti cu latio n

- — F l e xi o n of th e ,

fifth o n th e s ac r u m co mpre ss e s th e th i ck ant eri o r m argi n

,

o f th e i n te rverteb r al d i s c a n d s l i de s i ts arti c u lar p r o c e s s e s .

u pw ard o n th o s e o f th e sac r u m th u s te n di n g to gre at ly de

,

c re as e th e sac r o ve rtebr al an gl e an d m ake th e s p i n o u s pr o

-

c e s s o f th e fifth b e c o m e m o re p r o mi n e n t I t i s co n c e iv.

abl e th at f o r c ed fl e x i o n i n th i s arti c u l ati o n c o u l d cau s e a

co mpl ete d i s lo c ati o n o f th e arti cu lar su rfac e s Fl ex i on .

an d e x te n s i o n ar e s o fre e i n thi s arti c u lati o n th at m u ch o f

th e m o vem e n t asc ribe d to th e l u mb ar regi o n as a wh o l e

, ,

i s co n trib u te d by it L o ss o f m o ti o n h ere as i n l u mb ag o
.
, ,
2 66 PR I N C I PLE S O F O S TE O PA TH Y

is h ar acte riz e d by a rigi dity wh i ch cau se s th e st rid e i n

c

w alki n g to b e gre atly sh o rte n ed .

Adapt ati o n i n L u m b o S acr al Ar ti cu lat i o n — In cas e s o f

-

—
u n eq u al l e n th o f l eg s as a re su lt o f i n j u ry fl at f o o t s l i gh t
g .

, ,

be n d o f an i nflam ed k n e e o r h ip th ere i s a tilti ng o f th e

,

,
i
fifth o n th e b as e o th e s ac r u m in o rd er to b al an c e the
2
,

weight o f th e b o dy Th e re i s u n eq ual m o ve m e nt i n th e
.

F IG 8 8 N o r m al p o i s e o f th e b o d y
b y J o h n C o m s to ck ( a fte r
. .

D r aw n
H o l de n )

ar thro dials f o rm e d by th e arti cu lar p r o c e ss e s i e th e j oi n t

, . .
,
-

o n th e s id e o f th e s h o rt er l eg e x te n d s whi l e th e o p posite
,

o n e fl e x e s th u s pr o d u c i n g a te n de n c y t
,
o r o t ate Thi s r o c k.

i ng ac ti o n p e rm it s a gre at r an ge o f ad apt ati o n i n th i s j o i nt ,

an ac ti o n wh i c h i s a b so l u tely e ss e n ti al to th e m ai n te nan c e

o f b al an c e i n th e u p right p o siti o n .

St abi l i t y o f the L u m b o S ac r al A
-
r ti cu l ati o n —T he an .

te r i o r co mm o n lig am e n t i s s o pl ac ed as to l e n d s u pp o rt to
 P R I N C I PL E S O F O S TE O PA TH Y

F IG 89 P l an ta r i m p r e s s i on of a cas e th a t sou gh t
f o r a s ac r o
r e li e f
b t rt t
. .

i l i a c s u lu x a i o n Th e u s e o f a n a r c h s u p p o c o r r e c e d th e s u p p o s e d
H

ff t mb t t
.

le s i o n Th e e o r t a t a d a p a ti o n i n t h e l u o -
sa cr al a r i c u la i o n
f tg
.

c au s e d a a i u e p ai n .
2 68 P RI N C I PL E S O F O S TE O PA TH Y

th i s rti c u lati o n i n th e e x te n de d p o siti o n L ig am e n t s o r

a .

di n ar i ly l im i t m o ti o n bu t ar e e x te n s ibl e ti s su e s wh e n u n der
.

c o nti n u ou s s tr ai n h e n c e th e weight o f th e b o dy te n d s
,

alw ay s to b e tr an s mitte d fr o m b o n e to b o n e To change .

thi s arr angem e n t an d th us pu t th e str ai n co nti n u o us ly o n

i

l ig am e n t o u s ti s s u e l e ad s to rel ax ati o n in th e j o i n t
,
Th e r e .

ar e m an y j o i n t s i n th e b o dy whi c h so far as th e ad apt a ,

ti o n o f th e arti cu l ati n g su rf ac e s o f th e b on e s whi ch f o rm

th e m ar e co nc e r n ed f u r n i sh n o s t ability The k n e e j o i n t
, .

i s a g o o d e x ampl e o f thi s I t has si x tee n ligam e n t s wh i ch

.

s erve to f u r n i sh i t a s t abi l ity n o t w arr an ted by th e f o rm

o f th e arti c u lati n g su rfa c e s o f tibi a a n d fem u r The l u mb o .

s ac r al arti c u lati o n has a st abi l ity i n i t s n o rm al an gl e du e t o

th e l o cki ng o f its arti cu l ar p r o c e ss e s The mo re th e se pr o .

c e ss e s ar e lo c ke d as i n hy pe r e x te n s i o n th e gre ater th e te n
-
, ,

de ne y to tr an s mit weight th r o u gh th em Thi s i s u nnat .

u r al an d h e n c e pr o d u c e s f atig u e b o th by co n ti n u o u s p re s ,

s u re o u th e arti c u l ar su rf ac e s an d b y str et chi n g o f t he an

te r i o r c o mm o n l ig am e n t Thi s i s th e co n diti o n cau s ed by
.

a p e n d u lo u s ab do m e n
‘
-
.

D e c o m pe nsat i o n o f the L u m b o S acr al Ar ti cul ati o n -

.

F l ex i o n o f th e lu mb o sac r al arti c u l ati o n c au s e s a s tr aigh t

'

c u i n g o f th e l u mb ar th u s bri n gi n g th e W e ight o f th e b o dy

m o re co mpl ete ly o n th e co l u m n o f b o di e s an d ch angi n g

th e lu mb o s ac r al angle s o th at th e ax i s o f the p elvi c c avity
-
,

i s b r o u ght m o re n e arly i n l i n e with th at o f the ab d o m e n .

The o bl iter ati o n o f th e n o rm al lu mb ar cu rve p r o d u c e s a

ge n er al c u rve i e co i nc id e s with th e d o r s al an d th u s be
,
.
,

c o m e s p art o f a ge n er al p o steri o r c u rve Thi s p u t s a gre at .

s tr ai n o n th e p os teri o r sp i n al lig am e n t s Th i s i s a s t at e o f .

de co mp e n sati o n o f th e no rm al spi n al cu rve s wh i c h n ece SS i ,

t ate s a de c i de d e ffo rt to b al anc e th e b o dy .

P art o f the P e lv i s O b s tetri ci an s c o u n t th e fifth lu m

.
-

bar as a p art o f th e p elvi s s i n c e it i s b ou n d to th e i n no m i

,

—
n ate s by ili o l u mb ar lig am e nt s whi c h e x te n d fr o m the tip s ,

o f i ts tr an sver s e p r o c e ss e s t o th e c re st s o f th e i l i a Th e s e .

ili o lu mb ar lig am e n t s te n d to co mp el th e fifth l u mb ar ve rte

-
2 70 P R I N C I PL E S O F O S TE O PA TH Y

do reg ai n co mp ar ativ e im m o b i lity f o llo wi n g par tu r i

no t ,

ti o n a co nd iti o n o f i n st ab i lity wi ll e x i st wh i c h wi ll e x pre ss

, ,

it s el f i n a dis tu r ban ce o f th e st at ic s o f th e b o dy Bal an c i ng

‘

an d weight c arryi n g fu n c ti o n s wi ll b e i nj u re d
-
.

P hy si o l o g i cal R e lax ati o n —The m e ns tr u al p eri o d s in

.

m an y w o m e n ar e ch ar acterize d by r e lax ati o n o f th e p e lvi c

l ig am e n t s with c o n s e q u e n t d i st u rb an c e o f the weight carry
,
-

i n g p o we r o f th e s ac r o i li ac arti c u lati o n s
‘

-
.

The M al e P e lv i s —The m al e p e lvi s eve r e x hibit s any n

f o rm o f n o rm al re lax ati o n o f lig am e n t s th eref o re th e e x ,

i ste n c e o f any i n st abi lity i n th e s ac r o i l i ac arti c u lati o n s i s -

p ath o l ogi cal i e du e to debi lity o r tr au m a The traum a

,
. .
, .

m ay b e di re ct an d f o r c ef u l e no u gh to str ai n the lig am e n t s

’

'

s u dd e n ly o r it m ay c o n s i s t i n a f o rm o f f atig u e whi ch '

, ,

eve nt u ally allo w s th e l ig am e nt s e n g aged in th e w eight ,

c arryi n g f u n c ti o n s Of th e s e j o i n t s to b e c o m e s tr ai n ed , .

F IG 91 D ra wi n g of t
pos e r io r
as p e ct of p e lv i s , sh o w i n el a i on g r
of t
by J
. .

t
th e p o s e r i o r s u p e r i o r i li a c S p i n e s
.

r aw n D
gk
s e c on s ac r a l to . oh n
C om s oc .
 PRI N C I PL E S O F O S TE O PA TH Y 2 71

L o ss of S t ab i li ty —It
i m ati c th at lo ss o f s ta is ax o

b il ity in th e pe lv i c g i r dle wi ll w e ak e n i ts w eight c arryi n g

‘

-
, ,

c ap ac ity an d h e n c e di s t u r b th e n o rm al s t ati c c o n diti o n o f

th e w ho l e bo dy‘

In v i e w o f th i s f act we m u s t m ak e a
.
e

.
,

r ath e r c ar ef u l st u dy o f th e st r u c t u re o f the s e j o i n t s an d ~

n o te an y evid e n c e s o f i n h ere n t we ak n e ss i at ,
.

wh at p o i n t s u n u sual f o r c e m ight m o st e as i ly p r o d u c e a
le si o n .

F IG . 92 . N o r m al r e la ti on s of s a c ru m an d i l i u m .

Analy si s of S acr o Il i ac Ar ti cu l ati o ns

- — D i ss e cti o n of

the s e j o i n t s di sc l o s e s the e x i s te n c e o f the sam e s tr u c t u re s

f o u n d in o t her j o i n t s i e b o n e car ti lage sy n o vi al m em
,
. .
, , ,
e

b r an e an d ligam e n t s The fact th at th e s e s tr u ct u re s do

e x i s t in th e s ac r o —
.

i l i ac ar ti cu lati o n s nat u r ally class ifie s ,

th e se j o i n t s as h avi n g p o ss ib l e m o bility
\
The se j oi n t s .

serv e t o ab so r b sho c k s tr an s mitted t hr o u g h t he l eg s to the

pelvi c gird l e The sli ght m o vem e nt no rm ally p o ss ib l e in
.
,

th em su bj e ct s th em to m u c h th e s am e co n d it i o ns wh i ch
,

s erve to i n j u re o t he r jo i n ts
'

.
2 72 PR I N C I P LE S O F O sTE O P ATH y

F IG . 93 . I li u m f o r c e d u p w ar d a nd fo r w ar d .

F IG . 94 . I l i u m f o rc e d u p wa rd an d k
b ac war d .
2 74 PR I N C I PLE S O F O S TE O P ATH Y

F IG . 96 . N o r m al su r fa ce mar k i n gs of th e
'

ti
r e la on s of th e sa cr u m a nd
i li a .
 PR I N C I PL E S O F O S TE O PA TH Y 2 75

s ac s . pp o s i ng au ri cu lar s u rf ac e s ar e re c ipr o c ally

The a ,

s l ight ly u n eve n but n o t e n o u gh so to s u s t ai n an y we ight

,

with o u t lig am e n t s The i l lu s trati o n .F ig 90 sh o w s ,

.
,

c l e ar ly th e re lat i o n o f th e f o rm o f th e sac r u m to th e di r e c
.

ti o n o f the wei ght it su st ai n s The s tr u c t u re o f th e s ac r o

.

i li ac syn ch o n dr o s e s i n di c ate s that m o v e m e nt i s p o s sib l e '

‘

an d i n f ac t
,
p r o b ab l e The p rim ary o bj e ct o f th e m o ve
,
.

m e n t i s to p r o d u c e e last i c ity i n th e p e lvi c gi rd l e an d i n t er

r u pt Sho c k S w
T

hi ch w o u ld b e tr an smitte d fr o m th e l eg s to
’

th e tr u n k A f u rth er o bj e c t w o u l d b e i n th e fem al e ad apt a

.
, ,

ti o n o f th e bi rt h c anal to i ts c o n te n t s .

Cau s e s of S u blu x ati o n sé—C l i n i c ally

we re co gn ize th e
e xi ste n c e o f dis tu r banc e s i n th e s e j o i n t s as du e to re lax a
'

ti o n o f lig am e n t s du e to p reg n an cy m e n s tr u ati on ge n er al , ,

d ebi l ity o r tr au m a F u n c ti o n al ad apt abi lity i n the fem ale

, .

p e lvi s m ake s w o m e n e asi ly su bj e c t to ch an ge s i n the se

j o i n t s an d l ikewi s e p erm it s e as i er c o rre cti o n The m al e
, .
-

pe lvi s i s p ra c ti c ally n ever di s t u rb e d e x c ept as re s u lt o f

d ebi lit y o r tr au m a an d i s th eref o re m o re d i ffi cu lt to c o rre ct
, .

R o tati o m— The m oti o n i n th e se j o i n t s i s d e s c ribe d by

v ar i o u s au th o r s J u dgi n g fr o m c li n i c al e x p e rie n c e th e m o
.

ti o n s eem s to b e i n th e n at u re o f r o t ati o n Thi s r o t ati o n .

t ake s p lac e o n an ax is whi c h p as se s th r o u gh th e ar ti c u lat

i n g s u rf ac e s o f th e s ac r u m an d i li a o n a l eve l wit h th e po s
te r i o r s u p eri o r S pi n e s o f th e i li a an d th e s e co n d s ac r al

s pi n e Thi s m ake s th e s e c o n d s ac r al spi n e an d th e po s

.

te r i o r s u pe ri o r S p i n e s o f th e i li a th e b o n y lan dm a rk s i n di

c ati n g th e p o si ti o n o f th e j o i n t su rf ac e s R o t ati o n o f th e .

i li u m f o rw ard w o u l d m ake th e p o ste ri o r su p eri o r s p i n e l e s s

pr o m i n e n t an d s light ly high er s o th at a li n e dr aw n ac r o s s
,

th e sac r u m thr o u gh i ts s e co n d s pi n o u s p r o c e s s w o u l d p ass

thr o u gh th e lo wer b o rder o f th e p o st eri o r s u p eri o r s pi n e ,

i n ste ad o f i ts ap e x R o t ati o n o f th e c re st o f th e i li u m b ac k
.

w ard m ake s th e p o steri o r su p eri o r s pi n e m o re pr o mi n e n t

an d slight ly lo wer th an n o rm al A ll th e p o s iti o n s de sc rib ed
.

by v ari o u s au th o r s can b e red u c e d by an aly s i s to th e tw o

2 76 PR I N C I PLE S O F O S TE OP A TH Y

F IG . 97 . R o tat i o n of th e i li um f o r w ard
,
.
2 78 PR I N C I PL E S O F O S TE O PA TH Y

r o t ati o n s j u st d e sc rib ed S i nc e th e se r o t ati o n s ar e u nilat

.

e r al th e p elvi c di st o rti o n re su lt s i n a sl ight app are nt dif

,

fere nc e i n th e l e ngth o f th e leg s s o th at wh e n th e p ati e nt

l ie s o n th e b ack o n a h ard s u rf ac e w ith th e l eg s s tret ch ed
, ,

o u t as eve n ly as p o s sibl e th e h ee ls wi ll b e f o u n d n o t to be
,

e q u al In o rd er to c o mp e nsate fo r th i s app are n t i n e q u ality

.

i n l e n gth th e p e lvi s wil l b e f o u n d to b e t i lt ed with re l ati o n

,
.
,

Thi s c o mp e n sat o ry ti lt i s th e sam e

'

to th e spi n al c o lu m n .

ph e n o m e n o n th at i s p re se n t i n every c as e h avi n g u n eq ual

F IG 99 r g t
A c a s e o f p o s te r i o ri h
r z by
. .

i l i a c w h i c h w a s c h a a c te r i e d
t g t
p e r s i s e n t p a i n i n th e r i h s a c r o
t b
i li a c a n d th e s a c r o - v e r e r a l a r
ti c u l a ti o n s .
 PR I N C I PLE S O F O S TE O PA TH Y 2 79

l e n gth of pp o rt In o rd er to m ake s u re whi ch j o i n t

le g su .

i s th e o n e at f au l t on e m u s t u s e th o s e b o n y l an dm ark s
,

whi c h ar e a p art o f th e p e lvi s i e p o s t eri o r su p eri o r i l i ac

,
. .
,

sp i n e s an d th e s e c o n d s ac r al s p i n e A n app are n t d i ff er en c e
.

in th e l e n gth o f th e l eg s m ight b e du e to a lu mb ar c o n di
ti o n i rre s p e c tive o f any c h an ge in th e r e l ati o n of the b o n e s
i '

x
,

o f th e p e lvi s .

C o m pe ns at o r y P e lv i c Ti l t—It sh o u l d b e rem embere d

—
th at n o ch an ge i n a s ac r o i li ac s y n ch o n dr o s i s i s ever u n ac
”

co mp an i ed by a c o mp e n s at o ry e ff o rt o f th e b o dy to tr an s
m it th e b o dy weight th r o u gh th e n o rm al h al f o f th e p e lvi s .

Thi s p r o d u c e s a s l ight s pi n al c u rv at u re wh i c h i s p art o f ,

the c o mp e n sat o ry ti l t o f th e p e lvi s to av o id tr an s mitti n g

-

b o dy weight thr o u gh th e we ake n e d j o i n t o f th e p e lvi c gird l e .

C as se s o C as e s
l f — Tw o c lass e s o f cas e s c o mp l ai n o f
'

p ai n wh i ch m ay b e tr ac e d to d i s t u rb an c e i n th e se j o i n t s .

The fi rs t gr o u p c o mp ri s e s th o s e o f b o th s e x e s w ho ar e ,

d eb i l it ate d an d h e n c e do n o t h av e n o rm al t o n e i n m u s cl e s
,

an d l ig am e n t s Th e s e cas e s e ith er ar e b ed f ast o r i n c li n e d

.
-

to as su m e th e re c u mb e n t p o siti o n Ca s e s co mp e ll e d to l i e
.

—
o n th e b ac k f o r a lon g p eri o d f o ll o wi n g su rgi c al o p er ati o n s

ar e apt to s u ff er di s tre ss i n th e se j o i n t s The s e co n d gr o u p .

c o mpri s e s t ho s e w ho ar e o v e r we ighte d i n th e ab d o m e n
-
,

an d he n c e te n d to l o rd o s i s i n th e l u mb ar regi o n Bo th o f .

the se clas se s ar e gre at ly h e lp e d by co rre ctive m an ip u la .

I
ti o n an d b an d age s .

The debi lit ated i n divi d u al i s t o n ed by c o rre c tive m an

ipu lati o n an d th e we ake n ed l ig am e n t s rei n f o r c ed by So m e
,

si mp l e f o rm o f gird l e whi c h h e lp s to h o l d th e p e l vi s firm .

The i n divid u al with th e o ve r weighte d abd o m e n i s phy si o

-

l o gi c ally re s ted by co rre c tive m an ip u lati o n an d the u se o f

a s u pp o rt wh i ch wi ll ass i s t the b ac k i n ca rryi n g th e e x

ce s si v e weight whi c h l i e s an teri o r t o it s n o rm al weight

c arryi n g str u c t u r e .

The re ally d i ffi cu lt s ac r o i l i ac l e s i o n to co rre ct i s th e

-

t r au m ati c S u ch a l e si o n has all th e el em e n t s whi c h m ake

.

p erfe ct re c uper ati o n pr o b l em ati cal in any j o i n t . .

280 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 100 . E l e v a ti on of th e inf oo t
a cas e of t
p o s e r i o r r o ta ti o n o f
g
th e r i h t i l i u m . T
h i s i s n o t su f
fi c i e n t, i n s u c h c a s e s , to c o r r e c t
th e c o m p e n s a to r y g
c h a n e s i n th e
lu mb t t
a r a r i cu l a i o n s .
282 PRI N C I PL E S O F O S TE O PA TH Y

su bl u x at i o n s th e c au s e IS th e co ntr o ll i n g f act o r as to th e
,

m e an s to b e emp lo ye d i e d ebi lity m us t b e co ntr o l led

,
. .
,

by ge ner al m e an s so th at l o c al re i n f o r c em e n t o f w e ake n e d
,

lig am e nt s wil l n o t b e co n ti n u o u sly n e c e ss ary . I t i s usu

ally e asy to m ake a s p e c ifi c co rre c ti o n o f th e l e s i o n i n a

d eb i l it ate d c as e bu t no t e asy to m ai nt ai n th e co rre cti o n

,
.

I t i s di ffi cu lt to c o rr e c t a tr au m ati c l e s i o n , bu t wh e n o nc e
co rre c ted th e vit ality o f th e ti ss u e s te n d s t o m ake th e co r

re cti o n p e r m
,

an e n t In all d ebi lit ate d cas e s v o lu nt ary e x e r

.

c i s e m u s t f o rm an imp o rt an t p ar t o f th e tre atm e n t C limb

.

i n g o n r o u gh gr o u n d is th e b e st ai d i n s u ch c as e s b e c au s e
,

n o tw o s t ep s ar e al ike ,an d h e n c e th e ti ss u e s ar e n o t

f atig u ed by repetiti o n s o f sim i lar m o v em e n t s .

 PR I N C I PL E S O F O S TE O PA TH Y 283

C H A P TE R XIV .

S U BLU X ATI O NS .

D e fi n i ti o n — The w o rd s u b lux ati o n w as s o n e w to th e ,

ge n e r al m edi c al p r ofe s si o n th at m u ch ri di c u l e w as h e ap e d
,

u p o n th e o s te o p ath s b e c au s e th ey adv o c ate d s u c h a r i di c u

“
lo u s th e o ry a s th at all di s e as e s ar e c au s ed by di s lo cati o n o f
bone . We ar e n o t so su re bu t th at thi s ridi cu le w as to a ,

large e x te n t we ll m erit ed by th e o ste o p ath s The l o o s e w ay

,
.

i n whi c h th e w o rd s lu x ati o n di slo c ati o n an d s u b l u x ati o n ar e

,

u s ed in s o m e o f o u r l ite r at u re sh o w s th at th ey do n o t alw ay s

c o ver a defi n ite i d e a i n th e m i n d o f th e writer Th ey can .

n o t b e u s ed i n ter c h an ge ab ly The w o rd su b lu x ati o n s h o u l d

.

b e u s e d to d en o te a d efi n ite co n diti o n S u b lux ati o n i s de

.

fi n ed as a p ar ti al di slo c ati o n i n whi c h th e n o rm al re lati o n s

"

of t he arti c u lati n g s u rf ac e s ar e b u t s l ight ly ch an ged .

D a C o s t a d e sc rib e s s u b lu x ati o n o f th e sh ou l der al so o f ,

th e h e ad o f th e r adi u s F o r th e latte r co n diti o n h e has c o l

.

le c te d eight di ff ere n t e x p l an ati o n s We h ave n o t b ee n ab l e

.

to fi n d th e term u s ed i n refere n ce to any o th er arti c u l a ti o ns .

The o s te o p ath u s e s th e term to defi n e c ert ai n i n eq u alitie s i n

the arr an gem e n t o f verteb r ae an d rib s s ac r o i l i ac an d o th e r
,
-

arti c u l ati o n s . P erh ap s we h e ar th e ter mu s ed in c o n n e c ti o n

with th e at las m o re th an with any o th er b o n e .

C a ct i ti cs o
h r a e r s f S u b u ati o ns
l x — .S u bl u x ati o ns all o w
co n s i der ab l e m o vem e nt i n th e arti c u lati o n bu t to th e tr ai n ed
,

h an d th ere ar e evi d e n c e s o f m alp o s iti o n P ai n is deve lo p ed

.

wh e n th e c omp l ete n o rm al m o vem e n t i s attempted by th e

o p e r at o r. D igit al p re ss u re ar o u n d th e j o i n t cau se s d eep
p ai n Th ere is u su ally a hi st o ry o f acc ide n t e x p o s u re o r
.
,

vi s c er al di so rder .
284 PR I N C I PL E S O F O S TE O PA TH Y

F IG
’
102 N o r m al su r fa ce m ar k i ng of th e tr an s v e r s e p r o ce s s of th e
t
. .

A la s .
28 6 PR I N C I PL E S O F O S TE O PA TH Y

p o rt an t n e rve s an d bl o o d ve ss el s wh o se s lighte st m al adj u st

m e n t cau s e s i ns t an t di s t u rb an c e at th e very f o u nt ai n s o f
life . No phy s i cal e x ami n ati o n is co n sid ere d c o mp l ete with
o u t n o ti n g ac c u r ate ly th e p o siti o n o f th e at las Th ere b ei n g .

n o s pi n o u s pr o c e s s all re c k o n i n g m u s t b e m ade fr o m the

tr an sver s e p r o c e ss e s .

O cc i pit o At l an t al Ar ti cu ati o n
- l — Acc o rdi n g to G r ay s
.
’

“
A n at o my : The m o v em e n t s p e rmitte d i n th i s j o i nt ar e
fl e x i o n an d e x te n s i o n whi c h give ri s e to th e o rdi n ary for
,

F IG . 1 03
. Abno rm a l f
s ur ace m ark i ng s of th e tran sv e r se p r o c e ss of
t
th e A la s .
 PR I N C I PLE S O F O S TE O PATH Y 28 7

w ard an d b ac kw ard n o ddi n g o f th e h e ad b e s ide s slight lat ,

er al m o ti o n to o n e o r th e o th er s i de The .

R e cti L ateral es ar e m ai n ly c o n c er n e d i n th e s light later al

m o vem e n t A c co rd i n g to C r u v ei lh ie r th e re i s a sl ight m o
.

ti o n o f r o t ati o n in th e j o i n t A c c o rdi n g to G erri sh

.

F IG 1 04 N o r m al r e la ti ons b e tw e e n th e a tl a s an d
t b
.

o c ci p i al on e .

“
S o m e later algi ldi n g i s also allo wed by w hi ch th e'
,
'

o ute r edge o f th e c o n dy l e o n th e o n e s i de i s depre s s ed an d

o n th e o th er i s e l ev ated i n re lati o n t o i ts so c ket O r the .

m o vem e n t m ay b e o b li q u e ly later al o n e c o n dy l e adv an c i n g ,

s l ight ly at th e s am e tim e th at it i s d epre s s e d t o w ard th e

m e di an li n e wh i l e th e o pp o s it e c o n dy l e t ake s th e reve r s e po
,
-

s i ti o n
. Thi s i s th e p o siti o n o f gre ate st st abi l ity an d i s as ,

s u med i n th e m o s t e asy an d n at u r al atti t u de s L ater al m o ve

‘

m e n t s ar e re strai n e d by th e ch e c k lig am e n t s an d th e later al

p art s o f th e cap sul e s No tr u e r o t ati o n i s allo wed
. .
288 P R I N CI P L ES O F O S TE O PA TH Y

F IG 105 . N or m a l r e la ti on s be
tw tal
.

e en th e a tl a s an d o c ci p i
b n
o e .

F IG 106 Ri h g t tr a n sv e s e r
pr o
r r
. .

ce ss o f th e a tl a s to o f a r p o s te io .
2 90 P R I N CI P L ES O F O S TE O PA TH Y

The p s u l ar lig am e n t s ar e very lo o s e he n c e th e

ca ,

stre n gth o f th e j o i n t li e s i n th e an teri o r p o steri o r an d l at ,

e r al lig am e n t s Th ere i s n o c arti lagi n o u s di s k b etwee n th e

.

atlas an d o c c ip u t h e n c e m o t i o n 1 8 li mite d o n ly by th e l ig a
‘

m e nt s nam e d .

F IG . 109 . T wi t
s ed a tla t ti
s-ro a on .

I f o n e sh o u ld j u dge o f th e p rev al e n c e o f di s l o c ati o n s o f

th e at las by th e n u mb er o f tim e s s u c h a co n diti o n is m e n
ti o n e d i n o ste o p athi c l it er at u re we w o u ld dr aw th e c o n c lu
,
i

The term di slo ca

’
s i o n th at every o n e s at las i s di s l o c ated .

ti o n i s a s tr on g o n e an d o u ght n o t to b e u s ed 1n co nn e c ti o n
with th e at las Its di sl o cati o n w o u ld c au s e d e ath i ns t ant ly
. .

S u b lu x ati o n i s th e p r o per term to u s e S u bl u x ati o ns can b e

.

re adi ly di ag n o s e d ; th e f ac t th at th ey e x i st can n o t b e
d o u bted ; all p o siti on s betwee n th e no rm al re lati o n s an d
c o mp l ete di sl o c ati o n ar e p o ss ib l e The c o mpl ete di sl o c ati o n
.

o f th i s b o n e fr o m th e o cc ip u t m e an s de ath ; i n term edi ate po

s i tio n s,
s u bl u x ati o n s m e an i rrit ati o n o f n erve s dire ct
,
 PR I N CI PL E S O F O S TE O PA TH Y 29 1

an d b o th dire c t an d i n dire c t di st u rb an c e s o f c ir c u lati o n di

re c t di st u r b an c e by p re s su re ex erte d o n arteri e s an d ve in s ,

i n di re ct di s t urb an c e by e x c it ati o n o f v as o m o t o r n e r V e s .

The Cau s e s p f S u blu xat i o ns

-
— It i s di ffi c u lt to acc o unt
fo r th e se s u b lux ati o n s o f th e at las with o u t b rin gi n g in th e
" i

c o n tr a cti o n o f m u s c l e s Thi s s eem s to u s to be the m o st

‘

'

p rev ale n t cau se o f mi s p lac em e n t o f th e at las E ve n th ou gh .

we r e c o g n i z e the n u mber l e ss j ar s twi s t s an d s tr ai n s o f thi s

‘ ,

arti c ula ti o n st i ll th e; re su lt an t bad e ff e c t s ar e m ai n t ai n e d by

,

'

th e u n eq u al co n tr ac ti o n o f Opp o si n g gr o u p s o f m u scl e s
whi ch i s br o u gh t on by th e s e ac c ide nt s Take fo r i n s t an c e
.
, ,

th e v ari o u s twi s t s o f th e at las f o u n d by o ste o p athi c m eth o d s

o f phy s i c al di ag n 0 5 1 s G r ay s ay s : The R e c ti L ater al e s ar e
.
.

”
m ai n ly c o n c e r n ed i n th e s light later al m o vem e n t s Thi s i s .

th e m o vem e n t co n c er n ed i n a later al s u b lux ati o n The po .

-

S i ti o n i n whi ch we u s u ally fi n d th e at las i s an o b l iq u e o n e ,

h avi ng th e right tr an sver s e p r o c e s s h u ggi n g th e an g l e o f

th e jaw w hi l e th e l eft i s to o c lo s e to th e m as t o i d pr o c e s s .

G e rri sh de sc rib e s thi s p o siti o n as th e o b li q u e ly la

”
ter al a ,

n o r m al m ov e m e n t We als o co ns i der it no rm al i f it po s
.

s e ss e s t
—
he a bi li ty to slip b ac k i n t o a p o siti o n h avi n g s i mi lar
re lati o n s o n b oth si de s I t is a s u bl u x ati o n wh e n it can n o t
.

get o u t o f th at p o siti o n with o u t assi st an c e I f th ere i s fre e

.

m o vem e n t in th e o cc ipit o — a tl an t al art i c u lati o n eve ry chan ge

,

o f th e p o s it i o n o f th e h e ad wi l l c h an g e th e re lati o n s i n thi s

j o i n t O u r b o di e s ar e c o n st r u cted so th at wh e n th e b o n e s
.
,

f o rm i n g a j o i n t ar e mo v e d to th ei r f u lle s t e x te n t p re ssu re
, ,

i s u su ally e x e rte d o n th e s o ft ti s s u e s ar o u n d th e j o i n t Th i s .

i s n o rm al bu t wh e n t he se n o rm al re lati o n s ar e ret ai n ed to o
,

lo n g an d th e b o n e s do n o t r e su m e th eir e asy re s ti n g p o s i ti o n
th e c o n diti o n b e c o me s ab n o rm al ; it i s th e n a s u b lux ated
j o i nt
.

Th ere i s no arti c u lati o n i n the b o dy wh o s e b o ny p art s

ar e ab n o rm ally rel ated wh e n th e e x tr em e m o vem e n t i n th e

j o i nt i s m ade ( We wi ll e x c ept th e s ac r o i li ac arti cu l at i o n

.
-

be cau se it i s no t o rdi n ari ly co n s id ered a m o v ab l e jo i n t )

.
.

The su bl u x ati o n co ns i st s i n th e re lati o n o f th e b o ny su r

2 92 PR I N C I PL E S O F O S TE OP A TH Y

fac e s i n a p o s iti o n o th er th anth at wh i ch th ey sh o u l d h o l d

d u ri n g rel ax ati o n o r e q ual te n si o n o f all th e m u scl e s The .

n o rm al p o s iti o n o f th e tr ans ve r s e p r o c e ss e s o f th e atl as i s

p i c t u red i n F i g 10 2 The s ubl ux ati o n s ar e pi ct u red i n Fig

. . .

10 3
—Th
.

No r mal R e l ati o ns of the Atl as

rm al rel ati o n se no

o f th e atl as ar e i ll u s tr ated by ph o t o gr aph s o f th e s k u l l an d

fi r s t vertebra i n F i g 10 4 F ig 10 5 sh o w s an o b li q u e s ide
. . .

view In F i g 10 6 th e atl as i s slight ly twi sted so th at th e

. .
,

right tr an sver se p r o c e s s i s p o steri o r Thi s re ar vi ew sh o w s .

th e di st an c e b etwe e n th e l e ft m as t o i d an d left tr ansver se

p r o c e ss i nc re as ed The righ ttr an sver s e p r o c e ss i s p r o mi
.

n e nt The sam e rel ati o n s viewed fr o m b el o w ar e sh o w n 1n

.

F i g 10 7
. The right tr ans ver s e p r o c e ss i s s light ly p o steri o r
.

to th e m ast o i d .

Abno rm al P os i ti on s o f the Atl as —F ig 10 8 an d F i g 10 9 .

.
.

sh o w s i d e an d l ater al vi ew s o f a twi s te d atl as In p rep ar i ng .

th e s e b o n e s fo r ph o t o g r aphi n g i t has b ee n b o r n e ih m i nd
,

th at th e ar ti c u l ati n g su rfac e s m u st be k e pt in cl o se app o si ‘

ti o n The rel ati ons i l lu s tr ated ar e n o rm al to th e arti c u l a

.

ti o n bu t abno r m al w he n ret ai n ed i n th e s e p o s iti o n safter re

‘
'

l ax ati o n o f o pp o si n g m u sc l e s .

The E ff e ct o f M u s cl e C o n t r acti o n — If as C r u vei lhi er ,

s ay s th ere i s a sl ight r o t ati o n i n th i s j o i n t

,
— an d Oste o p athi c
’
p r ac ti c e p r o ve s Cr u v e 1lhi e r s st atem e n t tr u e th e n wh at
m u scl e c o u l d by i ts p er s i s te n t co n tr acti o n cau s e th i s r o t a .

ti o n to b e m ai n t ai n e d ? The R e c t u s C ap iti s An ti c u s M i n o r i s
so p lac e d as t o cau s e th i s m o ve me n t I t ari se s fr o m th e ah .

te r i o r s u rf ac e o f th e late r al m as s an d r o o t o f tr ansver s e pr o
c e s s o f th e atl as an d p ass e s o b l iq u e l u pw ar d an d i n w ard
‘ '

y .

I t i s i n s e rted i n t o th e bas i lar p r oc e ss o f th e o ccipit al bOn e .

Thi s m u scl e has as i ts e x ter n al rel ati o n th e su p e r i o r c e rvi

cal g an g li o n o f th e symp ath et ic an d a s a co n tr ac te d m u s
,

c l e i s th i c ke r th an an u n co n tr ac te d o n e pre s su re m ay be ,

e x erte d o n thi s gan g li o n whi ch m ay al so be i rrit ate d by the

t ransve r se p ro c e ss o f the atl as b ei ng pull e d t o w ar d it t he r e ,

by l e sse ni ng its no r mal spa ce i n mo r e t han o ne d irecti on .

2 94 PR I N C I PL E S O F O S TE O PA TH Y

At l oaxi al A rti cu lati o n —The arti c u l ati o n betwee n th e

-
.

at las an d ax i s i s th e m o s t i n tri c ate i n th e wh o l e s p i n al c ol

u m n co n s i s t
,
.
i n g o f f o u r di s ti n c t j o i n t s R o t ati o n t ake s pl ac e
.

be tw e e n the s e b o n e s b u t th i s m o ti o n i s l im ite d by th e ch e ck
,

ligam e n t s D i slo cati o no f th e o d o n t o i d p r o c e s s c au se s ih

.

st an t de ath by p re s s u re o n th e l o wer p ar t o f th e m ed u ll a
'

o b lo n g at a The ar ti c u lati o n s betwee n th e arti cu lar pr o

.

c e ss e s o f th e s e b o n e s ar e arth r o di al The arti culati o n b e

.

twe e n th e o d o nt o i d p r o c e ss o f th e ax i s an d ante r io r ar ch o f ‘

th e at las h o ld s th e b o n e s fi r mly t o gethe r M o s t o f th e r o t a .

‘

ti o n i n th e c ervi c al regi o n is i n th i s j o i nt Alth o u gh th er e .

i s so m u c h m o vem e n t allo wed by th e se ar ti c u l ati o n s w e se l ‘

,
'

do m fi n d th e ax i s su b l ux ated .

U n e q u al D e v e l o pm e nt— D evi ati o n o f th e s pi n e o f th e ’

ax i s fr o m th e m edi an l i n e i s a fre q u e n t c o n d iti o n b u t in th e ,

m aj o rity o f case s i s i ts n o rm al re lati o n o n ac c o u n t o f u n

eve n deve lo pm e n t .

Car i e s — H i lt o n d e sc rib e s cas e s o f di s eas e o f th e arti cul a

ti o n b etwe e n th e atl as an d ax i s sh o wi n g ho w de str ucti o n o f
,

th e tr an sve r se l i gam e n t s all o w s th e h e ad to tip f o rw ard ,

th ereby cau s i n g the _o do nto i d p r o c e ss to i mp al e th e m e d ull a .

D i sl o cati o n ¥ — We m ay s afe ly say th at di slo cati o n o f th e

.

at lo ax i al arti c u lati o n s i s p ro b ably th e r are st c o n d iti o n w e

-

wi ll eve r m eet V ari o u s degre e s o f r o t ati o n m ay b e m et

.

with wh i ch ar e i n th e n at u re o f s u b lu x ati o n s du e to m u scu lar

c o n tr ac ti o n s .

S po n t an e o u s R e du c ti o n —
S i n c e th e ab o ve p ar agr aph
.

w as writte n an arti c l e in th e M e di c al R e co rd M ar ch
, ,

19 00 has c o m e u n der my o b s erv ati o n

,
The arti cl e i s e n .

“ —
tit l e d S pi n al F r act u re P ar ap legi a
-
”
The au th o r D r R o b
.
, .

er t A bb e e x h ibit s a r adi o gr aph i llu s tr ati n g a c as e o f di s lo

,

The di sl o c at ion i s be tw e e n the arti c ular

‘ ‘

c at i o n o f th e n e c k .

pr o c e s s e s o f the at las an d ax i s The m o st i ntere s ti n g fe at u re

.

o f th e c as e i s th e s p o n t an e o u s red u c ti o n o f th e di s l o c ati o n

wh i le th e p ati e n t w as asl e ep The au th o r th i n k s th at the

.

rel ax ati o n o f sleep an d th e re s t le ssn e ss o f the p ati e n t co m

bi n e d to red u c e it .
 PR I N C I PLE S O F O S TE O PA TH Y 295
'

C e r v i c al V e r t e br ae — The r em ai n i n g c ervi c al vert eb r ae

.

ar e o c c as i o n all y f o r c ed fr o m th ei r p r o p er re lati o n s by v i o

le n ce Q u ite a n u mbe r o f c as e s ar e o n r e co rd whi ch sh o w

.

ho w gre at th e di st u rb an c e i s i n s u ch c o n d iti o n s Th o se .

c as e s re c o rd ed i n m e di c al l iter at u re ar e c o mp l ete di sl o ca

F IG 111 Thi r d c e r v i c al
t b ra b l u x at
. .

ver e su ed to
F IG 110 N o rm a l r e la th e _ r i gh t . Th e s u p e r i or
t
. .

ions or th e c e r v i c al a r tl c u l a r p r o c e s s o f th e
ve r e t b r ae fO rth c e r v i c al i s vi s
p
.

ih e .

ti o n s ,
h e n c e c an n o t b e c la s s e d with su b lux at i o n s s u ch
an d

as ar e m et with i n o s te o p athi c p r ac ti c e In o rd er fo r co m .

p l e te di s l o c ati o n to t ake p l ac e i e so th at th e arti c,

u l.ar p
. r o
,

c e ss e s ar e b o th lo c ke d th e i n te rvertebr al di s k s w o u l d h av e
,

to b e t o r n an d w o u l d p r o b ab l y bri n g gre at p re ss u r e o n th e
Co rd .

A ll gr ade s o f su b lu x ati o n ar e f o u n d b e tw e e n c e r v i cal _

vertebr ae W here th e vi o l e n c e has n o t b ee n su ffi c i e n t to

‘

c au s e lo c ki n g o f th e arti c u lar p r o c e s s e s it has e x agger ated ,

th e n o rm al m o vem e n t su ffi c i e n t ly to i n j u re th e l ig am e n t s
o r m u s c l e s whi c h th eref o re m ai n t ai n th e s u b lu x ated p o s i
,

ti o n.

D i spr o por ti o n Be tw e e n C au s e an d E —
ff e ct W e c an n o t
e stim ate th e e x te n t of th e sy stemi c e ff e ct s of a le si o n i n th e
296 PR I N C I P LE S O F O S TE O PA TH Y

spi n e Wh at migh t app e ar to u s to b e a very slight l e s i o n

.

m ight b e th e cau s e o f a very p r o f o u n d n erv o u s di so rd er .

The p o s iti o n o f th e l e s i o n i s th e ch ief m e an s o f e s tim ati n g

re s ul t s .

E x am pl e —T
i llu s tr at e th i s po m t we m ay m e n ti o n th e
o ,

cas e o f M r No rt o n R u ss e ll
. A l e s i o n o f th e s i x th c e rvi cal
.

v erteb r a w as f o u n d The verteb r a w as s lightly twi ste d

. .

M r R u s se ll had n o t sl ept d u ri n g o n e h u n dre d n ight s an d

.

d ay s with o ut th e u se o f s u lpho n o l o r m o rph i n e The fi r s t .

o s te o p ath i c tre atm e n t app l i e d to th e s i x th c e rvi c al v ertebr a

m ad e it di ffi c u lt fo r hi m to ke ep aw ake u n ti l h e re ach e d his

h o m e and th e n h e fe ll i nt o a p r o f o u n d s l e ep Th er e w as a .

h i st o ry o f s evere acc i de n t M u s cu lar c o n tr acti o n w as very

.

evi de nt .

U n e q u al D e v e l o pm e n t o f S pi n o u s P r oc e s se s i n Ce r v i cal
V e rte br ae —F ig 1 10 i ll u s tr ate s th e app e ar an c e o f th e p o ster
. .

i o r su rfac e s o f th e c ervi c al vertebr ae s e co n d to thes eve n th

, ,

wh e n all th e verteb r ae ar e i n n o rm al po s iti o n i e arti c u lar ,

. .
,

s u rf ac e s eve n ly O pp o s e d t o e ac h o th e r The ch an gi n g ch ar
.

ac t er o f th e s p i n o u
s p r o c e s s e s i s re adily n o te d N e arly all.

o f th e s e p r o c e s s e s ar e u n eve n ly d eve lo p e d sh o w i n g t ,
h at pal
p a ti o n o f th e s e p r o m i n e n t p o i n t s c an n o t h elp b ei n g u n s ati s

f act o ry The t u b er c l e s o h th e b ac k an d o u te r su r f ac e s o f th e
.

i n feri o r arti c u l ar p r o c e ss e s p re s e n t a m u ch m o re u n if o rm
d eve lo p m e n t an d th ey c an b e e as i ly p alp ate d after o n e has
be co m e accu s t o m e d to th e fee l o f th e c e rvi c al m u sc le s Fig . .

11 1 sh o w s th e th ird c e rvi cal su b lu x ate d to th e right The tu .

be r cle o n th e l eft i n feri o r arti c u l ar p r o c e s s i s m ade m o re

pr o mi n e n t The m u scl e s o ver th i s p o i n t will be f o u n d co n
.

tr acte d .

P alpati o n o f D o r sal S pi no u s P r o ce ss e s — Whe n th e

. .

S pi n e s o f th e d o r s al ve rteb r ae ar e p alp ated th e tr ai n ed

,

fi n ger s m ay fi nd i n divi d u al s pi n e s whi ch ar e n o t i n li n e with

th o s e ab o v e an d b el o w o r th at the s pac m g s b etwe e n th e
,
.

spi ne s ar e n o t e q u al The devi ati o n s fr o m the n o rm al ar e

.

i n di cative o f ch ange d rel ati o n s b etwe e n th e vertebrae .

2 98 P RI N C I PL E S O F O S TE O PA TH Y

Spi n o u s p r o c e s s S u ch a defl e cti o n fr o m th e m edi an l i n e

.

w o u ld b e n o te d by the u ns ki lle d t o u ch o f a laym an Thi s .

defl e cti o n has n o di ag no sti c s ig n ifi can c e u n le s s th ere is pr o ,

n o u n c e d s e n s itive n e s s ar o u n d it an d th e n it i s th e hy pe r ae s
,
.

the s i a an d n o t th e o s se o u s f o rm ati o n th at m u st b e n o te d ;

F IG 116 t
E x e n s i o n i n th e
g g
. .

d o r sa l r e i o n s h o w i n ap
t
p r o x i m a i o n o f th e s p i n o u s
.

p r o ce sses .

very ski llf u l o s te opathi c di ag n o s ti c i an might b e m l sle d by

thi s l e s i o n Th e re d o e s n o t appe ar to b e any w ay to pr o
'

l
.

te e t ag ai n st a wr o n g i nterp ret ati o n i n a cas e l i ke thi s e x cept

th e e x p eri e n c e o f th e phy s i c i an i n weigh i n g all th e evid enc e .

L at e r al S u blu x ati o n —Fig 1 13 i llu s tr ate s a ge nu i n e lat

. .

er al s u bl u x ati o n o f a d o r sal ve rtebr a The arr an gem e n t o f .

th e R o t at o re s S pi n ae acc ou n t fo r su ch a le si o n as thi s Th ey .

ari s e fr o m th e u pp er s u rf ace s o f th e tr an sver s e p r o c e s s e s an d

i ns ert i n t o th e l ami n ae ab o ve The s ubl ux ated vertebr a in

.

thi s gr o u p i s th e fifth The digit ati o n o f the R o t at o re s

.

S pi n ae b etwe e n th e right tr an s ver s e pr o c e s s o f th e s i x th an d

l ami n a o f th e fifth m u st c o n tr ac t i n o rder to p r o d u c e th i s
c o n diti o n
. Th i s digit at i on may re sp o n d to a s evere vi s c er al
refl e x an d c au s e a su bl u x ati o n o f thi s ch ar ac ter Di re ct .

vi o le n c e m ay cau s e it also a c u t an e o us r e fl e x i n iti ated by

,
:

temper at u re ch an ge i n th e atm o s ph ere .

 PR I N C I PLE S O F O S TE O PA THY .
299

M u scu lar C o n t r acti o n —M u s cle s c o n tr ac t a s a re s u lt o f

.

e x c e s sive str ai n i n g o r wr enc hi n g o r e x p o su re to co ld an d ,

o f refl e x i rr i t a t i o n I f O pp o s i n g m u s c l e s u n de r all c o n di
.
'

ti o ns o f tem per at u re m e ch an i cal an d refl e x irrit ati o n w o u l d

,

c o n ti n u e t o e x er t eq u al i n fl u e n c e o n a j o i n t the n n o th i n g ,
"
bu t a c o mp l ete di sl o c ati o n w o u l d b e p o s s ib l e A m o v ab l e .

j o i n t i s e n c lo s e d i n a s y n o vi al m embr a n e wh i c h f ac i l it ate s

th e r api d retu rn to a n o rm al p o s iti o n A ll th e me ch an i cal .

c o n dit i o n s i n an d a r o u n d a j o i n t ar e c o n d u c ive to th e q u i c k

ret u r n to n o rm al I t i s th e vit al an d n o t th e m e ch an i cal

.

p ri n c ip le wh i ch ke ep s u p a conditi o n o f m aladj u stm e n t No .

i n te rm edi ate p o s iti o n i s p o s s ib l e th ere b e i n g n o un eve n n e ss

,

o f s u rf ac e to b e co m e lo c ked u n l e ss we t ake i n t o c o n s ide r a

,

ti O n the vit al ac tivity as m an ife s ted i n a c o n tr ac te d m u sc l e

—
.

Co pm a r i s o n o f E ff e c t s O f M u s cu l ar C o n t r a c ti o n J E . . .

S t u art D O has m ad e an apt c o mp ari so n b etwe e n th e p u ll

o f th e m
.

.
,
.
,

u s c l e s o f th e b ac k o n th e i n divi d u al ve rtebr ae an d

th e we ll re c o g n i zed in su ffi c i e n ci e s o f th e o cu lar m u s cl e s All .

phy si c i ans re co gn iz e th e s e r i o u s e ff e c t s Of lo n g co n ti n u e d
i n s u ffi c i e n cy o f an o cu lar m u sc l e bu t few i n de e d hav e give n , , ,

any tho u g ht to the p oss ibi l ity o f a s imi lar c o n diti o n aff e c t
’
.

i n g s tr u c t u re s l e s s m o v ab l e o r l e s s s e n s itive th an the eye

, ,

b all The re lati o n o f a ve rtebr a wit h i ts fe llo w s i s o f gre at

.

imp o rt an c e to the de li c ate n erv o u s ti ss u e wh i ch it su r

r o u n d s It i s n o t n e c e ss ary fo r a vertebr a to p r e s s u p o n th e
.

spi n al c o rd o r n e rve fib er s c o m i n g f r o m o r g o i n g to it
, in ,

o rder t o p r o d u c e irrit ati o n Th ere i s a n erve s tr ai n i n c o n

.

n e cti o n with th e s e l e s i o n s whi c h i s n o t th e r e s u lt o f di r e c t

p re ss u re bu t o f th e e ffo r t s o f th e c e n tr al n erv o u s sy s tem to

b alan c e an d co o rdi n at e th e co n tr acti o n o f th e m u scl e s p u ll
i n g o n th e verteb r a I t i s n o t n e c e s sary fo r d iverge n t o r
.

c o n verge n t s q u i n t to b e s o m arked th at th e e x pre s si o n o f

th e eye s i s i n st an t ly n o ted by all o b s erver s befo re any sy m p

t o m s o f eye s tr ai n ar e fe lt by th e p atie n t Neith er i s it n e c e s
'

s ary fo r a vertebr a t o b e di s lo c ated i n o rde r t o c re ate a di s

tu r ban c e I t i s co n c eiv ab l e th at a co mp l ete ly di sl o cate d

.

verte b r a m ight after a t im e c au s e as l itt l e i r r it ati o n as an

, ,
3 00 PR I N C I P L E S O F O S TE O PA TH Y

eyeb all wh i c h i s so diverge n t th at n o e ff o rt i s m ad e to u se

bi no c u l ar vi s i o n . The b o dy b e c o m e s acc o m m o d ate d to th e
ch an ge .

S e par a ti o n o f S pi P nou s — F i g s 1 14 an d 11 5 give

r o c e s ses .

tw o vi ew s o f th e fifth s i x th an d s eve nth ve rteb r ae i llu str at

, ,

i n g th e s ep ar ati o n o f th e s pi n e s as i n e x trem e fl e x i o n No te
, .

th at th e s u p eri o r arti c u l ar f ac et s ar e un c o ve re d by the m o ve

m e nt The v ert eb r ae assu m e thi s p o s iti o n i n kyph o si s We
. .

freq u e nt ly fi n d th at th ere i s a g ap b etwee n tw o spi n e s whil e

th e sp ac i n g ab o v e an d b e lo w is q u ite eve n E ith e r th e sp ac e .

d ire c tly ab o ve o r th at b el o w thi s g ap i s l e s se n ed F ig 1 16 .

-

sh o w s th e s p i n e o f th e fifth s i x th an d s eve n th d o r s al ve rte

,

b r ae i n th e p o siti o n o f e x trem e e x te n si o n The sp i n e s c r o wd .

,

h ard u p o n e ach o th er Th e s e i llu str at

. i o ns all S h o w n o rm al
p o siti o n s bu t th ey ar e th e o n e s wh i ch o u r fi n ger s d i sc o ve r
,

as l e s i o n s o f th e ve rtebr ae .

Appr o x i m ati o n o f S pi n u s P ces s s Wh e n t

o r o e — w o spi n e s
ar e c l o s e ly appr o x im ated as i n Fi g ,
1 16 th e r e i s n e ce s
.
,

Sar ily a wi de n i n g o f th e n e x t s p ac e ab o ve o r b e lo w dep e nd ,

i n g u p o n wh i ch verteb r a i s aff e c ted The c o ntrac ted sp ac e

.

wil l u s u ally b e s e n s itive to digit al p re s su re Th ere i s a c o n .

tractu r e d c o n diti o n o f th e m u sc l e s c au s i n g thi s e x trem e

m o vem e n t o f e x te n si o n Thi s co n tr ac t u re di st u rb s th e
.

rhyth m o f n erve mp u l se s fr o m th at s e cti o n o f th e s p i n al

i

co rd i n c lo s e s t re lati o n with th e di st u rb ed v e t te br a Th ere .

i s lac k o f co o rdi n ati o n o f m o ve m e n t i n th e aff e c te d j o i n t s .

Wh e n sever al v ertebr ae ar e tight ly b o u n d t og eth e r a

s tr aight ,
—
n o n fl e x i bl e s p i n al c o lu m n i s th e re s u lt The m u s .

c l e s ar e tight ly c o n tr ac te d an d m o re o r l e ss se n s itive t o digi

tal p re s su re .

P r i m ar y S u b lu x ati o ns —Th e s e c o n diti o n s as h ere il lu s ,

tr ate d ar e wh at o ste o p ath s u su ally de sig n ate as s pi n al su b

,

l ux ati o ns whi c h ar e c au sative f act o r s i n di se as e Th ey ar e .

so u r c e s o f i rrit ati o n to th e spi n al n erve s i n dire c t c e n tr al

rel ati o n with th em an d th e s e n erve s co n vey di s t u rb ed o r

,

aryth mi c al i mp u l s e s to th e vi sc er a an d bl o o d ve s s el s th u s
.

,
3 02 PRI N C I PLE S O F O S TE O PA TH Y

v e rteb r ae t ake o n th e ch ar act e r o f th e lu mb ar h e n c e r o t a ,

ti o n i s p r ac ti cally i mp o ss ib l e Th e re is a digit ati o n Of th e

.

R o t at o re s S p i n ae betwee n th e e l eve n th an d twe lfth d o r sal

v ert ebr ae .

L ow e r D o r sal V e rte b r ae — F ig s 1 17 an d 1 18 give a po s

. .

te r i o r and l ate r al vi ew o f th e five lo wer d o r sal Vertebr ae .

The c h an gi n g c h ar ac teri sti cs o f th e s pi n o u s pr o c e ss e s o f

th e se ve rtebr ae sh o u l d be caref u lly n o ted so th at th e stu ,

de n t m ay n o t b e m i sle d as to th e s ig nifi c anc e o f th at whi ch

his p alp ati o n m ay di s c o ver The e l eve n th d o r sal s pi n e t ake s
’

a h o riz o n t al di re c ti o n an d i n so m e case s thi s m ake s eith e r

'

»
,

a ve ry n arr o w s p ac e b etwe e n it an d th e t e n th o r a very wid e

s p ac e betwe e n it an d th e tw e lfth .

D L
o rs o - u m bar Ar ti cu l at i o n —The
j u n ct i o n o f th e do r
sal an d l u mb ar r egi o n s i s very fl e x ib l e A large p o rti o n o f .

fl e x i o n an d e x te n si o n o f th e S pi n al c o lu m n is m ade i n thi s
arti c u l ati o n The m o st c o mm o n c o n diti o n no ti c e abl e i n th e
.

l o wer d o r s al regi o n i s i n c r e ased p r o m i n e nc e o f the spi n e s

'

an d i n c ip i e n t ky ph o s i s Th i s c o n d iti on fre q u e n tly aff e c t s

.

th e j u n c t io n o f the d o r sal an d l u mb ar regi o n s .

Ky phos i s—L ow e r Do r sal —A slight kyph o s i s i n th e

'

l o we r d o r sal regi o n i s i n di c ative Of lo ss o f t o n e i n th e ex te n

so r m u sc l e s g o ve r n i n g th e arti c u lar s u rf ac e s The sp i n e s .

ar e s ep a r ated f arthe r th an n o rm al an d th e i n feri o r ar t i c u lat

i n g s u rf ac e s ar e p art ly u n co vered by th e su p e r i o r o n e s .

Thi s we ak en ed co n d iti o n o f th e b ac k m ay b e br ou ght o n

by i n j u ry , o r refl e x e s fr o m th e b o we ls o r kid n ey s C o nti n .

u al vib r ati o n o f th e S pi n al c o l u m n a s i n c as e s o f s tre et c ar

,

m e n we ake n th e b ac k an d the n f u n c ti o n al di st u rb anc e s o f

,

th e kid n ey s ar e n o ted .

L um
b R gi e
ar o n — F ig s 119 an d 12 0 i llu str ate th e l ater al
. .

an d p o ste ri o r app ear an c e o f th e n o rm al lu mb ar vertebr ae .

The s pi no u s p r o c e s se s ar e e as i ly p alp ated i n thi s r egi o n .

The i r de v e lo pm e n t Vari e s e no rm o u s ly i n di ff e re n t i n divi d

nal s .The f o rm ati o n o f the arti c u l ar pr o c e ss e s preve nt s
 PRI N C I PLE S O F O S TE O PA TH Y 30 3

an y r o t ati o n h e n c e we do n o t fi n d any later al su b lux at io n s

,

i n th i s regi o n The po s i ti On o f i n divi d u al v ertebr ae i s r are

.

”
ly aff e c ted Bre ak s th at i s s ep ar ati o n s o f th e spi n e s
.
, , ,

ar e so m etim e s n ote d bu t n o t o fte n Vi o l e n c e i s th e ch i ef

,
.

c au s e o f th e s e s ep ar ati o n s The m u scl e s i n thi s r e g i o n ar e

.
'

F IG 12 0 Lu m b ar re gi on,
—n o r m al
. .

vi ew
—L
r e ar .

FIG
— . 119
n or mal
.

.
u mb ar r e g i on . S i de Vi e w

th i c k an d p o we rf u l h e n c e th eir i n fl u e n c e i s no t e x erte d so
,

m u ch o n i n divid u al verteb r ae as u p o n th e wh o l e s er i e s o f
vertebr ae The r ef o re we fi n d c u rve s i n ste ad o f s u bl u x ati o ns
.

i n thi s regi o n E x agger ati o n o f th e n o rm al m o vem e n t s i s

.

re s p o n s ib le fo r kyph o si s lo rd o s i s o r sc o l i o si s E x trem e
,
.

we a ri n e s s as a re s u lt o f m ai n t ai n i n g a s itti n g o r st an di n g
,

p o s iti o n le ad s the i n divid u al to shift th e weight o f th e b o dy

,

so as t o t ake som e adv an t age o f th e l ig ame n t s wh i c h l im it a

m o vem e n t The stre n gth an d fl e x ibi l ity o f th e lu mb ar

.

region i s fre q u e n t ly a very g o o d c rite ri o n o f th e p ati e n t s ’

b o di ly vig o r I t i s e asi er to aff e c t th i s p o rti o n o f the spi nal

.

c o l u m n by, l ever age m o vem e n t s th an any o th e r regi o n , .

3 04 P R I N C I PL E S O F O S TE O PA TH Y

E x am i nati o n R ib s —The p o s iti o n o f th e rib s i s al

of the

w ay s n o te d by th e o ste o p ath i c phy s i c i an I t i s n o te d i n .

,

m e di c al t e x t b o o k s o n di ag no si s th at th e ge n er al co n f o rm a
-
,

ti o n o f th e th o r ax i s in di c ative to a v ari abl e de g re e o f eith er , ,

th e p ast m ed i cal h i st o ry o f th e i n divi d u al o r i s evi d e nc e o f

th e p re s e nt e x i ste n c e o f p re di sp o s iti o n to c ert ai n di s e ase s .

A f u ll r o u n d n o n fl e x i ble c h e st d e n o te s as thm a o r e m phy

, ,

s e m a ; fl at c h e st d e n
‘

o te s te n de n c y to t u b er c u l o si s e tc The se , .

s t atem e n t s ar e ge n er al iz ati o n s b a s ed o n l o n g o b s erv ati o n ,

an d ar e u s u al ly v ery n e ar th e tr u th The r e spir at o ry m o ve .

m e n ts sh o u ld b e no ted w he the r fu ll an d fre e co mp are d

,
>
,
.

with th e cap ac ity o f th e th o r ax The o ste o p ath i c phy s i c i an .

go e s f arth e r th an th e se e x c e lle n t ge n er al iz ati o n s i n his di ag

n o si s The re lati o n an d p o siti o n o f e ach i ndiv i du al r i b ar e
“

. ,

e x trem ely imp o rt an t The c o n diti o n o f the wh o l e th o r ax

.

an d i ts c o n te n t s i s dep e n den t o n th e re lati o n s o f th e b o n e s '

whi ch f o r m it With th is i de a i n mi n d a caref u l e x am i na

.
,

ti o n o f e ach rib i s m ade .

Th eir spi nal

I

The rib s ar e n o rm ally qu i te m o v abl e

, ,
.

arti c u l ati o n s ar e so arr an ged th at an e asy ri s e an d f all o f th e

s h aft o f th e rib is p erm itted The r i s e an d f al l is th e r es u lt

.

o f r o t ati o n o f th e rib o n a n ax i s p as s i n g th ro u gh th e c o st o
'
‘

c e n tr al an d c o st o tr ansver s e arti c u lati o n s

-
.

C o st o ce n t r al Ar ti cu ti o s
- l a n — The co s t o c e n tr al ar ti c u -

lati o n s o f th e fir s t te n th e l ev e n th an d twe lfth rib s h av e n o

, ,

i n ter arti c u lar l igam e n t The m o vem e n t o f th e h e ad s o f th e s e

.

rib s i s limited by th e c ap su lar l ig ame nt s The h e ad s o f all .

th e o th e r rib s ar e h e ld i n p lac e by i n ter arti c u lar ligam e n t s

att ac h ed to ridge s o n th e h e ad s o f th e rib s an d to th e i n te r

verteb r al di sk s .

C o s t o t r an s v e r se Ar ti cu l ati o n s
- — The t u b er c le s o f th e
”

rib s arti cu late with th e tr an s ver s e p r o c e ss e s o f th e verte

'

br ae f o rm i n g arth r o di al j o i n t s The s u p eri o r c o s t o tr ans .

-

v er se lig am e nt s p re ve n t : th e dr o pp i n g d o w n o f th e co st o .

tr an sver s e arti c u lati o n The re i s very li m ited g lidi n g m o ve

.

m e nt in t hi s arti cul ati o n As be fo r e state d th e m o v em e nt

.
,

i n the co st o c e nt ral and co sto t r ansv e r s e ar ti cul ati o ns i s to

- -
306 PR I N C I PL E S O F O S TE O PA TH Y

C o o r di n ati o n —F ig . 12 1 i ll u str at e s
th e no rm al o bl i q u ity
o f th e fifth an d si x th rib s Wh en th e c o ntr acti o n o f all th e
.

m u s cle s o f re s pi r ati o n i s p r o p e rly co o rdi nated th e i nte r ,

c o s t al s p ac e s ar e all e q u al i n width The re s p ir at o ry rhyth m .

sh o u l d b e e q u al i n all p art s o f th e th o r ax .

F IG 123 S e p a r a ti o n of th e fifth an d
b
. .

s i x th r i s .

—Wh e n th r o u gh so m e n erv o u s refle x

In c o o r di n ati e n .

i n spi r ati o n i s m ade di ffi c u lt th e i n sp i rat o ry m u scle s e x p an d

,

the tho r ax to i ts fu l le st e x te n t an d ret ai n th e e x pan s i o n

'
'

, .

Th e n th e di am eter s o f th e th o r ax ar e i n c re a sed Thi s p o si .

ti o n o f e x trem e i n spir ati o n i s typ i c al o f th e asth m ati c ch e st .

Th ere m ay b e lac k o f coo rdi n ati o n o f th e m u sc l e s i n any

i n te r c o st al sp ac e Thi s i n c o o rdi nati o n m ay b e m an ife sted
.

by to o m u ch c o n tr ac ti o n o r re lax a ti o n The re s u lt i s a .
-

c h an ge i n th e n o rm al width o f an i n ter c o s t al s p ac e .

Ne r vo u s C o nt o o R sp at o
r l f e i r i n — R e s pi r ati o n i s car .

ri e d o n by a c o mpli c ated m e ch an i sm Its c hi ef c e nter o f n o r .

m al co n tr o l i s i n th e m ed u lla b u t s u b s idi ary c e nter s i n lin

, ,

e ar s eri e s e x i s t i h th e s pi n al c o rd
,
E ac h spi nal n e rve whi ch
.

i nn erv ate s i n ter co st al m u sc l e s o r o the r m u scle s o f i n spi r a

,
4

ti o n ari s e s fr o m a s ub sidi ary r e spir at o ry c e nter On e o f

, .

th e s e sub sidi ary c e nte r s may be co m e to o active o r p assiv e

.

as a re su lt o f l oc al i rrit ati o n du e to ci r c u l at o ry ch ang s,

e .
 PRI N C I PLE S O F O S TE O PA TH Y 307

The m u scl e s go v e r n e d by th i s di stu rb ed e n ter wi ll

c n o t ac t

h arm o n i o u sly h e n c e th e rhyth mi c al

, all th e m o vemen t o f
rib s i s i n terfere d with .

W e have no te d th at s p i n al m u scle s c o n tr act u n eve nly

‘ '

as a re s u lt o f dire c t s p i n al i n j u ry e x p o su re o f th e s ki n o ver ,

th em to c o ld o r fr o m vi s c er al refl e x es The res p ir at o ry

, .

m u s cl e s ar e s u bj e cted to th e s am e c o n diti o n s A lat er al su b .

~

lu x ati o n i n the do r sal re g i o n c arri e s i ts arti cu lated rib with

-
L

it P alpati o n wi ll di s c o ver th eir c h an ged re lati o n s A k y

’

. .

ph o si s i n th e do r sal r egi o n cau se s th e rib s to r o t ate u pw ard s

-

th u s i n c re as i n g th e di am eter s o f th e th o r ax L o rd o si s i n .

thi s regi o n has the Opp o site e ff e ct .

C os tal S u b l u x ati o n s—F ig s . i llu str ate the

!
. 12 2 an d 12 3
'

c h an ge s i n s p ac i n g o f t he r i b s du e to i n c o o rdi n ati o n o f m u s
c u lar c o n tr ac ti o n The se po si ti o n s o f th e rib s ar e sp o ke n o f
'

as c o s t al s u b lu x ati o n In Fi g 12 2 th e u pp er rib i s r o t ate d

. .

d o w n w ard as a re su lt o f a c o n tr ac ti o n o f th e i nter c o st al
m u s c le s i n th e sp ac e b e lo w i t o r th e re lax ati o n o f th o se ,

ab o ve it P alp ati o n e li c it s s e n sitive n e ss at th e lo we r b o rder

.

o f thi s fi ft h r ib The s e n s itive n e ss i s u s u ally f o u n d wh ere

.

th ere i s c om p re ss i o n du e to th e dr o ppi n g o f th e rib an d th e

c o n tr ac ti o n o f th e m u sc l e s Th i s rib might h ave b e co m e .
,

d i sp lac ed as a re s u lt o f vi o l e n c e o r th e p ati e n t m i ght h ave ,

b ee n e x p o s ed to c o l d ai r whi l e s we aty o r so m e di s e as e o f ,

an o th er p art o f th e b o dy m ight h ave c au s e d s u ffi c i e n t we ak

n e s s to allo w thi s rib to dr o p as a re su lt o f p re ss u re o c c a

s i o n e d by th e p o s iti o n i n be d o r o th erwi s e .

Wh atever the c au se o f th e s e su b lu xati on s th ey c ert ai n ,

ly be c o m e so u r c e s o f gre at irrit ati o n to th e n erv o u s sy s tem .

S o m etime s th e b o dy be c o m e s acco mm o d ate d to th e s e s ub

lu x ati o n s bu t th e f ac t th at cas e s o f asthm a h ave b ee n c u red
‘

after ye ar s o f s u ff eri n g by red u c i n g th e s e m alp os iti o n s i s

,

p ri m
,

a fac i e e vid e n c e th at acc o mm o d ati o n i s so m eth i n th at

g
c an n o t alw ay s b e dep e n de d o n .

The h e ad s of the e
s co n d to n i nt h rib s canno t be di slo
c ated with o ut ru pt ur e of th e i nte rarti cu l ar l ig am e nt s Co n .
30 8 PR I N C I PL E S O F O S TE O PA TH Y

s i de r abl e c h an ge in th e p o s iti on o f th e s h aft o f th e rib o cca

i
s o ns ve ry littl e ch an ge i n th e p o s iti o n o f th e h e ad o f th e
rib .

F i r st —
R ib The fir t rib d o e s
. t m o ve i n the same
s
q
no

m ann e r as th o s e bel o w The att ach m e n t o f th e scale n u s an

.

ti c u s ke ep s th e s h aft alw ay s r ai s ed No m atte r ho w fl at th e .

rem ai n der o f th e th o r ax m ay b e th e fir s t rib s t an d s o u t ,

p r o mi n e nt ly The ch i ef ch an ge in i ts p o s iti o n i s du e to th e
.

c o n trac ti o n o f th e s c al e n u s an ti c u s th eref o re it n eed s to be ,

d ep re s s ed r ath er th an el ev ated .

—The he ad o f the te nth rib i s arti cu l ated

Te n t h R ib . a

with th e b o dy o f th e te n th vertebr a ; th e re i s no i nte r ar ti cu

lar l ig am e n t Thi s allo w s fre er m ov em e nt Its an teri o r
'

. .

e x tremity is i n s e c u re ly arti c u lated to th e c arti lage o f th e

-

n i n th rib Th i s co nn e c ti o n i s freq u e ntly b r o ke n th u s m ak

.
,

i n g an a dd e d fl o ati n g rib .

E l e v e nth R ib s —The e le v
an d e n th an d twe lfth
Tw el f t h
rib s ar e very lo o s e ly arti c u late d to th e v e r t ebr ae They .

have n o c o s t o tr n s ver s e lig am e n t s h e n c e d e p e n d o n the ac

a
-
,

ti o n o f m u sc le s to h o ld th em i n p lac e Th ey ar e fre qu e ntly .

fo u n d r o t ate d u p ward o r d o w n w ard .

We h ave e nd e av o re d to S h o wth at th e n o rm al m o ve
m e n t s o f th e rib s as a wh o l e m ay be c o m e very ab n o rm al
, ,
. .

wh e n m ade i n d ivi d u ally or o u t o f rhyth m with e ac h o th e r

,
.

The d epre s si o ns o r e l ev ati o n s o f i n divi d u al rib s h ave n o t di s

l o c ated th ei r arti c u lati on s ; th e y h ave m ere ly carri e d an d r e
tai n e d th em i n p o s iti o n s o u t o f har m n o y with th e rem ai n der
o f th e rib s Th ey h ave be c o m e di sc o rd an t m ember s o f a
. .

h arm o n i o u s b o dy an d u n le s s m ad e to c o op e r ate fo r the g e n

,

er al we lfare th ey wi ll r api d ly m ake o ther m emb er s i nhar

,

mo n io u s .

E ff e ct o f
P o si ti o n of V e r t ebr ae o n P os i ti o n o f R ibs .

L ack o f symm etry in th e d o r sal vertebr ae cause s ach ange i n ’

the p os iti o n o f the rib s B o th co nditi o n s can be co r re cted

'

by red u cti o n o f th e vertebr al subl ux ati o ns .

3 10 PR I N C I PLE S O F O S TE O PA TH Y

whi ch we call a le si o n m ay b e o n ly evid e nc e o f a l e s i o n

,

whi ch li e s i n th e e x c e ss ive ly ac tive m u s c l e o r at so m e o ther

p o i n t in c lo s e n e rv o u s c o nn e cti o n .

A su bl ux ati o n m ay be call ed a p rim ary l e s i o n wh e n it

re su lt s fr o m acc i de n t It i s s e c o n d ary wh e n du e to refl e x
.

acti o n. I t i s n o t alw ays p o ss ibl e to d eterm i n e wh ethe r a

l e s i o n i s p rim ary o r s e co n d ary , bu t i n ge n e r al i t i s b e st to
]

re d u c e th e m wh ereve r f o u n d i f any d i s t u rb an c e c an be
,

tr ac e d to th em .

In r are i n st an c e s on e tre atm e n t has be e n f o u n d s u ffi

,

c i e n t to red u c e a s u b l u x ati o n
. The fac t th at the m aj o rity o f
c as e s m u st be tre ated t w o o r th re e m o n th s p r ove s th at th ey
ar e n o t e as i ly kept red u c ed
.
.
 PRI N C I PL E S O F O S T E O PA TH Y 311

C H A P TE R X V .

TH E D IA GNO S TI C V A LUE O F BA C K A C H E .

E l asti c i ty —It i s fre qu e n t ly sai d th at a m an is as o ld

.

as hi s arte ri e s .Itm ay with e q u al sig n ifi can c e b e s ai d th at

a m an i s as o l d as hi s s pi n al c o lu m n In eith er c as e a l o s s o f
.

e lasti c ity l e ss e n s o n e s y o u thfu ln e ss o u t o f all p r o p o rti o n to

’

’
o n e s act u al ye ar s .

A F i e l d fo r S t u dy —The u se Of th e b ac k an d th e s pi n al
.

c o l u m n as a fi e l d fo r i n iti ati n g an e ff o rt t o di ag n o s e th e

phy s i cal c o n diti o n o f h u m an b ei n g s has m an y adv an t age s , ,

b o th fo r e li c iti n g o bj e ctive an d s u bj e ctive i n f o rm ati o n .

P r o b ab ly few phy s i c i an s re aliz e ho w m u c h o f phy si cal di s

tre ss i s m i r r dr e d i n s ympt o m s co n s c i o u sly o r u nco n sc i o u sly
referre d to th e b ac k
O bj e ctiv e an d S u bje ctiv e S y m pt o m s — In o rde r th at we
m ay h ave s o m eth i n g fo r refere n c e we wi ll p ass a few fac t s
i n r evi ew .As diag n o sti c i an s we ar e alw ay s de s i r o u s o f
k no wi n g wh eth er th e s tr u ct u re o f th e b ac k i s n o rm al an d
wh ethe r th e r e i s any di stre ss i e p ai n o f any ch ar acter i n
,
. .
, ,

the ti ssu e s o f th e b ac k H e re we h ave th e o ld d ivi s i o n o f

.

o bj e ctive an d su bj e c tive sympt o m s .

P ai n —P ai n i s th e sympt o m whi ch u s u ally l e ad s a pa

.

tie n t to s eek re li ef o r advi c e h e n c e we ar e i n tere s te d i n seek

,

i n g th e c au s e o f th e p ai n The s imp l e s t p o s s ibl e c au s e o f

.

th e p ai n Sh o u ld n at u r ally b e th e fir s t th i n g c o n s idered S i n c e .

m any lo cal ized p eriph e ral an d vi sc er al p ai n s eith e r ar e

cau se d by c o n diti o ns i n th e str u ct u re s o f th e b ac k o r at l e as t ,

reflexl p r o d u e a re a f as o i ate d hyp e r ae sthe si a th ere we

y c s o s c ,

s eek t o di s c o ver wh at s tr u c t u r al f au l t o r referred s e n s itive

n e ss m ay e x i s t .
3 12 PRI N C I PLE S O F O S TE O PA TH Y

P i —
o se The fir s t o b s erv ati o n sh o u ld be addre s se d to d e
te r m in i n g th e p o i s e o f th e b o dy i e st ati c s I t i s very i m
,
. .
,
.

p o rt ant to n o t e th e p o i se o f th e b o dy Th ere ar e m any d ev .

i ati o n s fr o m n o rm al wh i c h ar e o n ly s light ly app are n t bu t

‘

n everth el e s s give ri s e to b o di ly di s tre ss P o s t u r al f au lt s in .

ad u lt s l e ad to di stre s s du e to f atig u e o f th e ti s su e s an d as ,

th e b o n e s ar e n o t p lasti c p ai n i s fe lt The ch i ld s b o n e s ar e
, .
’

p las ti c h e n c e th e s am e f o r c e th at p r od u c e s di stre s s i n m a
,
.

t u re p er s o n s c au s e s str u ct u r al d i s t o rti o n i n c hi ldre n i e , . .

,

th e st ati c co n diti o n s whi ch i n c hi ldre n p r o d u c e spi n al d e

fo rmity p r o d u c e i n m at u re p e r so n s spi nal d i stre s s .

S t r u ct u r al D e fe ct s — P ai n in th e b ac k i s o f su ch fr e
q u e n t o c c u rre n c e th at it i s advi sab le fo r u s to co n s ider so m e
o f th e ge n e r al an d s p e c i al co n diti o n s wh i c h m a be m o re or
y
l e s s c h ar ac teriz ed by b ac k ach e S i n c e we ar e e x p o n e n t s o f
.

a sy stem o f c o rre c tive m an ip u lati o n we n at u r ally lo o k fir st

fo r p o s s ib l e str u c t u r al defe c t s The simp l e st str u ct u r al d e

fe e t w o u ld b e a bad p o st u re with its c o n s eq u e n t i m
.

b alan c e
i n the m u s c le gr o u ps wh i c h m ai n t ai n th e b ody ere c t .

S t ati cs — 1 S t U n de r thi s h e ad we mu s t c o n s i de r
‘

ati c s. .

b ac k ach e as a p o ssi b l e re su lt o f any ch an ge in str u c tu r al s up

p o r t The m u sc l e s o f th e b ac k m u s t c o m pe n sate y altere d
.

te n s i o n fo r an y ch an ge i n th e le n gth o f a le g s u ch as th at
, ,

p re s e n t i n fl at f o o t sl ight ly fle x e d k n ee k n o c k k n e e o r a s a
-
, ,
-

cr o i li ac l e s i o n
-
.
- —
The p ai n du e to fl at f o o t i s o n e o f th e m ost
co m m o n c o mp lai n t s M any cas e s o f s o called i nn o mi n ate
.
“ -

”
l e s i o n s ar e n o th i n g m o re th an b ac k ach e c au s ed by th e e f
f o rt to co mp e n sate fo r a we ak ar ch M an ip u lati o n o f the .

m u sc l e s o f th e b ack give s re li ef bu t d o e s n o t rem o ve th e

c au s e .The lo n ger s u c h a c o n diti o n e x i st s i e fl at f o o t the , . .
,
-
,

m o re wi de s p re ad wi ll b e th e b ac k p ai n s S egm e n t s above .

th e lu mb ar ar e gr ad u ally i n v o lved u n ti l it i s h ard to re c o g

n ize wh ere th e v i c i o u s c y c l e beg a n Bac k ach e du e to di s .

tu r be d s t ati c s i s a f atig u e p ai n i e i s evid e nc e Of ti re d m u s

, . .
,

c l e s o r s tr ai n ed lig am e n t s A ll s u c h b ac k ac h e s ar e rel i eved

.

by m an ip u lati o n Th ey di sapp e ar u n d e r th e i n fl u e n c e o f
. .

t o n i c e x er c i se su ch as m o u nt ai n climbi n g be cau se th e u n
, ,
3 14 PR I N C I PL E S O F O S TE O PA TH Y

eve n n e ss o f th e gr o u n d n e c e s sit ate s c o nst an t v ari ati o n i n

m u sc u lar t e n si o n W alki ng o n p avem e n t r api d ly pr o d uc e s
.

f atig u e b e cau s e e ach m o v em e n t is a rep l i c a o f th e p re c edi ng

,

o ne .

G e n e r al D e bi l it y
.
— G e n er al d ebi lity m ay l e ad t ti c to s a

err o r s with c o n se q u e n t di stre ss M any st ati c err o r s m ake

.

th ei r app e ar an c e d u ri n g a slo w c o n v ale sc en c e an d th e n p e r

F IG 1 2 6 P
o si t by
i o n w h i ch sh o w s ,
t t b
. .

th e o u l i n e s o f th e v e r e r a l b Or
r
d e s o f th e s c a p u l a e , th at t
ro a
b
ti o n o f th e v e r te r a l b odi e s e x
g t
i s ts a s h i h a s th e s i x h d o r s al .
P R I N C I PL E S O F O S TE O PA TH Y 3 15

F IG 127 t
C o r re c i on o f
'

th e l u m
by g ft
. .

b ar cu r v e r ai si n th e le
b t
u to c k .
 3 16 PR I N C I PL E S O F O S TE O PA TH Y

i t
s s in
pit e o f i mp r o ve d m u s cl e t o n e ;
s in f ac t ar e n ever r e c
o g n i z e d u n ti l s u c h tim e as th ey f o r c e s p e c i al atte n ti o n be

cau s e o f th e di stre s s they c au s e .

S acr o -
i l i ac S u b lu x ati o n .
—S i n c e b ack ach e i s o n e o f th e
m o st p r o m i n e n t sympt om s i n cas e s o f sac r o i li ac s u b lu x a
-

F IG 1 2 8 f t r t t
Th e e f e c o f o a i o n o f F IG 12 9 . S am e c as e b e n di n g to
b t b ft
. . .

th e o di e s of th e v e r e r a e in th e l e .

t t
,

s p i na l c u r v a u r e o n th e l o c a i o n
b g
,

an d e x e n t t o f si d e e nd i n .

ti o n n o e x am i n ati o n w o u ld b e c o mpl ete with o u t t aki n g th e

,

p o s sibi lity o f su c h a l e s i o n u nd e r c o n s i der ati o n .

R o t ati
S pi n al — P r ac ti cally all s t ati c co n diti o n s o f
on

l o n g s t an di n g ar e ch ar ac terize d by slight s pi n al r o t ati o n .

Th i s i s th e n at u r al re su lt o f th e b o dy s e ffo rt to tr an smit i ts
’

weigh t th r o u gh its str o n ge st s ide Thi s c o mp e n sat o ry r ot a

.

ti o n c an n o t b e co rre cte d with o u t t aki n g i n t o c o ns id er ati o n

th at co n diti o n fo r wh i ch th e r o t ati o n i s it se lf a co rre cti o n .
 3 18 PR I N C I PL E S O F O S TE O PA TH Y

S pi n al C u rv at u r e — C u rvat u re th e s pi n al c o lu m n is
of

n o t alw ay s c h ar acte riz ed by l o c al o r ge n e r al b ac k ach e As .

a ge n e r al r u l e str u c t u r al sc o l i o s e s ar e n o t p ain f u l Th i s i s
‘

-
.

p r o b ab ly b e cau se th e sh ap e o f th e b o n e s has b e com e a d apte d

to th e weight o f th e b o dy i n th e n e w p os iti o n P ai n i s apt .

F IG 1 32 . G g y f
r e at i r r e u l a r i t O th e F IG 133 ff t f
C o r r e c ti v e e ec o ex
f
.

t
. .

c o lu m n ,
,

s p i na l i n a c a s e o f te e n si o n o f l e t ar m a t so s o ih
f ty
al o u s c o n v al e s c e n c e , a te r ph oid fi u e nc e th e i g u la i t y f
rr e r o th e
feve r
S h o w s th e e e c ff t of re s p i n al co u l m n du t w ak n
e o e e ss
g t y
.

m ai ni n a lm o s t c o n s a n tl on
g
th e r i h t s i d e .

to b e ass o c i ate d with a f u n c ti on al cu rve be c au s e su ch a

:

.
,

c u rve p u t s m u sc l e s an d l ig am e n t s o n a s tr t ch A s th e b on e s
e .

and i n terve rt ebr al di sc s gr ad u ally yiel d to th e un e q u al p re s

su re o i a f u n c ti o n al c u rve r o t ati o n t ake s pl ac e acco rdi n g t

'

,
o ,
 PR I N C I PL E S O F O S TE O PA TH Y 3 19

the law s whi c h g o ver n r o t ati o n i n the fdo r s al an d lu mb ar

regi o n s an d a c o mp e n s at o ry c o n diti o n re s u lt s whi c h we r e c
, ,

o g n i z e as a right d o r sal l eft lu mb ar s co l i o s i s o r th e rever s e , .

Car —
i es 2 . A c t u al di s e ase o f vertebr ae m ay b e th e “

c au s e of b ac k ach e . S u ch a co n diti o n i s u s u ally a l o calized -

F IG 134 t t
S r u c u r al t al u v a
la er c r
t kyp h g a t i g i d i ty
. .

ure an d i
os s, re r
mf t
,

no p ai n or di s c o or .

ca ri e s du e to t u b er c u lo si s C arie s i s ch ar ac terize d by an g u
.

lar def o rm ity gre at s e n s itive n e ss to digit al p re ss u re an d

,

e sp e c i ally to verti cal p re ss u re ; 1 e any additi o n to th e . .

,

W e i ght o f the b o dy ab o ve the i nv o lved vertebr ae L o calize d .

b ack ache as so c i ated with a pr o mi n e nt sp i n o u s p r o c e s s and

32 0 P RI N C I PL E S O F O S TE O PA TH Y

s e n sitive n e ss to ve rti cal p re ssu re S h o u ld b e su f fi c ie n t to

c au s e any phy s i c i an to s u sp i c i o n th e e x i s te n c e of c ari e s .

R i g i dit y —E ve n th e s e c o n diti o n s with o u t app are nt de

.

f o rmity sh o u ld m ake o ne h e sit ate b efo re u s i n g any l ever age

th r o u gh th at are a O n e o f th e ch ar acteri sti cs o f l o calized
.
_
‘

b ack ach e i n di se ase o f th e str u ct u re o f the sp in al c o l u m n

i s rigi dity i e th e b o dy p r o te c t s it s e lf by m u s c u l ar te n
, . .
,

s i o n su ffi c ie n t to lim it o r p reve n t m o ve m e n t i n th e i n
fl am ed are a Wh e n ever thi s p r o t e ctive ph e no m e n o n i s
.

o b s e rved i t s h o u l d b e a w ar n i n g ag ai n st i n te rfe re n c e u n ti l

o n e i s c o nvi n c e d th at m o re i s t o b e g ai n ed t h an l o st by ,

’
i nterferi n g with n at u re s p r o te c tive m e chan i s m .

Ar t hr o pat hi e s —C as e s of
p are si s an d t ab e s d o r sal i s ar e
.

su bj e c t t o arth r o p ath i e s an d h e n c e h e avy m an ip u lati o n o f a ,

l ever age o r th r u sti n g typ e sh o u l d b e av o i ded Th ere i s dan , .

ge r th at an arth r o p athy m ay e x i st an d as s u ch c o nditi o n s ,

ar e n o t ch ar ac te rized by pai n th e n o rm al p r o te c ti ve m e c h an
~
,

i sm d o e s n o t as se rt it s e lf F ig 13 5 s h o w s an an g u lar de
. .

f o rmity i n a c ase o f p are s i s The d ef o rmity w as cau sed by .

,

i
s eve re m an ip u lat o n by o n e w ho had n o k n o wl edge o f p ath

Thi s
' I

o lo gy o r ,
i n f act any o f th e b as i c m e di c al s c i e n c e s
, . ,

w o m an had a c o mp ar ative ly s traight S pi n al c o lu m n whi ch

e xhi bi ted so m e sti ff n e ss an d s e n sitive n e ss eighth to twel fth ,

d o r s al The w o m an w as pl ac ed o n he r b ack k n ee s d o u bled

.

_
,

u n d e r h er c h i n th e n r o ll e d o n to h e r s h o u ld er s an d a h e av y
,

d o w nw ard thr u st give n s o a s to str o ng ly fl e x th e lo we r do r

s al. The sh arp kyph o si s w as i n st ant ly p r o d u c ed with r e ,

s u lti n g p re ss u re o n th e s pi n al c o rd .

S po n dy li ti sD e fo r m an s — A ge n er al p o steri o r c u rve with

.

an ky lo s i s o r di mi n i s h ed fl e x ib i lity thi c ke n e d s pi n o u s p ro
, ,

c e ss e s ,
te n de r n e ss to digit al p re s s u re l o c alize d p ai n s no t , ,

m arkedly s e n sitive to verti c al pre s su re i s re co g n ized as ,

sp o n dyl iti s d ef o rm an s O th er j o i nt s o f th e b o dy ar e u su ally

.

s i mi l arly aff e cted

—Th
.

R achiti s . ge s due to m al nut r iti o n r achi ti s

e chan , ,

ar e f r e q u e ntly re co g niz ed The f act th at ch ange s el s ew he re

.
3 22 P R I N C I PL E S O F O S TE O PA TH Y

ar e apt to m o re p o sitively i n di cate th e p revi o u s e x i s te n c e of

r ach iti s m ake s di ag n o s i s co mp ar ative ly e asy .

M al i g nan t G r o w ths .
—
Wh e n l o cali ze d b ack ach e is co m
p l a i n e d o f an d n o def o rm ity i s evi de n t th o r o u gh te st s s h o u ld ,

b e m ade to determ i n e th e e ff e ct s o f p o s iti o n s an d m o ve

m e n t s The p r o te ctive co n tr acti o n o f the m u sc le s sh ou ld
.

b e caref u lly analyz ed so as to j u dge wh eth er th e p ai n i s du e

,

to any i n fl am m at o ry p r o c e s s i n v o lvi n g th e vertebr ae ,o r any

o f th ei r j o i n t s Ne ar ly all p ai n s i n th e l u mb ar regi o n ar e
.

“
c all ed l u mb ag o bu t o n e m u st alw ay s b e o n g u ard l e s t a
,

s u o —
p er i ste t l mb ag l ike p ai n b e no t give n i ts tr u e v al u e
n .

P ai n s o f a sh arp lanc i n ati n g c h ar acte r wh i ch p er s i ste n tly

,

app e ar i n a d efi n ite s p i n a l are a o r alo n g n e rve tr u n k s o r i g

i n ati n g fr o m th at are a u s u ally h ave a s i n i ster s ig n ifi can c e
, .

A d efi n ite di ag no si s i s p r ac ti cal ly imp o s sib l e but th e p er ,

s i s te n c e o f th e p ai n s i n s pite o f all e ff o rt s t
, o reliev e with -

h eat p o siti o n s o f re s t o r m an ip u lati o n s i s p retty g o o d evi

, , ,

de n c e th at so m e m al ig nan t p r o c e ss i s atw o rk whi c h i nv o lve s

th e se S pi n al ti ss u e s I f no feve r e x i sts o r o th e r co n s ti tu
.
,

ti o n al sig n it m ay b e th at th e p ai n i s du e to i n v olve m
,
e nt o f
th e s pi nal co lu m n by a gr o wth with i n th e b o dy A s e x am .
t

pl e a m an 44 ye ar s o ld c o mp lai n e d bitter ly o f sh arp lan

,
.
, ,

c i n at i n g p ai n s i n th e lu mb ar regi o n an d e x te n di n g d o w n
br an ch e s o f th e lu mb ar an d sac r al p l e x u s e s Al l e ff o rt s at .

rel i ef we re u nav ai li n g Th ere w as n o def o rm ity o f th e

.

S pi n al c o lu m n bu t th e p ati e n t h e ld him se lf rigi d

,
M any .

attempt s we re m ade by m an y phy s i c i an s to m ake a di ag

no si s O n e o f th em u s e d h e avy m an ip u lati o n o f a l ever age

.

ch ar ac ter In o rd er to te st th e e ff e ct Of ve r ti c al pre s su re h e
.

u s e d a co ncus s i n g b lo w o n th e to p o f th e h e ad an d th e n o n
th e h e e ls Th i s latte r p r o d u c ed ag o n izi ng p ai n whi c h w as
.

f o llo we d rap i d ly by p ar apl egi a The case r an a tedi o u s .

c o u r s e o f m an y m o n th s Au t o p sy S h o we d c anc e r i n v o lvi ng
.

l eft kid n ey an d th e s pi n al are a u n d er it The p r o gre ss o f .

th e di se as e w a s e x c ee di n g ly s lo w an d h e nc e hi s b o dy w as ,

abl e to bri n g m an y co mp e n s at o ry m e c h an i s m s i n t o ac ti o n ,
 PR I N C I PLE S O F O S TE O PA TH Y 32 3

wh i ch m ade it di ffi c u lt fo r eve n th e m o st s ki llf u l to re co g

n ize th e tr u e c o n diti o n .

Ty pho i d S pi ne — The s o c all ed typh o i d spi n e i s an -

o th er f o r m o f spi nal tr o u b l e with o u t def o rm i ty whi ch m ay

, ,

b e a sp o n dy liti s bu t p r o b ab ly i s a pu r e n e u ro s is
'

L u m b ago 3 U n der th i s h e ad we m ay c o ll e c t a v a
. .

rie t y o f c o n diti o n s whi c h ar e c h ar ac terized by p ai n whi c h

i s par tfcu
'

lar ly aggr av ate d by v o lu n t ary m o vem e n t It is .

Ofttim e s di ffi c u lt to determ i n e wh at th e str u ct u r al ch an ge

'

i s wh i c h give s r i s e to t hi s p ai n .
E ach c as e will S h o w p e cu l i .

ar i ti e s as to th e e x ac t lo c ati o n o f th e p ai n an d th e am o u n t

o f p o s s ib l e v o l u n t ary m o ve m e n t Th ere may b e i nv o lv .

m e n t o f m u sc l e lig am e n t f as c i a o r p eri o ste u m The caus e

, , , .

o f the tr o u b l e m ay b e f atigu e as re s u lt o f p o st u re st r ai n ,

fr o m l ifti n g o r m ay b e du e to a to x em i a
, .

P o s t u r e — Bac k ache ,
mm o nly pr o
du e to p o st u re ,
is co

du c e d i n an y o n e w ho attempt s to do w o rk wh i ch c o m
p e ls b e n di n g o f th e b ac k f o rw ard ‘

U n ti l s u c h ti m e as .

th e i n divi d u al d eve lo p s ad apt ati o n to thi s p o s iti o n th ere

wi ll be s e n s itive n e s s at th os e p o i n t s i n th e s pi n al co lu m n
.

wh i ch e n d u re th e gre ate st str ai n The s tr ai n th u s pr o .

du c e d m ay aff e c t th e e x te n s o r m u sc l e s o f th e b ac k o r i n ,

c as e th e p o s t u re i s s u c h as p u t s s tr ai n o n l ig ame n t s
.

[
th ere ,

wi ll b e hyp ere s th eti c p o i n t s dire ct ly o n th e ve rtebr al sp i n o u s

p r o c e s se s wh ere th e su pr aspi n o u s ligame n ts att ac h Back .

ach e du e to s tr ai n i s n o t c h ar ac terize d by fever The r e .

c umb e n t p o s iti o n give s reli ef .

To x e m i a .
—Bac k ach e du e to t o x e mi a i s n e ar ly alw ay s
o f s u dde n app e ar an c e The f ac t th at th e p ati e n t fir s t be
.

c o m e s co n s c i o u s o f i ts e x i s te n c e wh e n so m e m o vem e n t is

m ade su ch as q u i c k ly s itti n g u p i n b ed o r be n di n g fo r ,

w ard to pi c k u p s om eth i n g o r p u tti n g o n c lo thi n g alw ay s

, ,

l e ad s to th e be li ef th at th e p ai n i s du e to str ai n Ne ar ly .

all s u c h cas e s s h o w a c o ated t o n g u e bad bre ath c o n s tip a , ,

ti o n h e ad ach e an d g e n er al phy s i c al dep re ss i o n The pain

‘

, , .
32 4 PR I N C I PLE S O F O S TE O PA TH Y

F IG 1 36 A s w e ll i ng u n d e r th e s h e a t h o f th e
f
.

l e t e r e c to r S p i n a e m u s c l e , w h i c h w a s c o i n
.

e ide n t t k
w i th a n a t a c of
“
b g
lu m a o ,
”
f o llow
i n g a h e av y t s r ai n.
32 6 PRI N C I PL E S O F O S TE O PA TH Y

cert ai n c o n diti o n s o f th e atm o s ph e re e sp e c i ally c o ld dry , , ,

el e ctri cal wi n d s Alth o u gh th e se c as e s S h o w so m e sig ns

.

o f i n dige sti o n th ey do n o t s ee m to be o f th e sa m e ch ar
ac ter as th o s e we h ave p revi o u sly m e n ti o n ed .

I nv o lve m e n t o f the S pi nal C o r d 4 P ai n i n th e b ac k . . .

m ay b e du e to so m e i nv o lvem e n t o f th e S pi n al c o rd o r i ts
m emb r an e s As a ge n er al r u l e th ere ar e e no u gh o th er
.

s ympt o m s s u ch as m o t o r o r s e n s o ry ph e n o m e na t o d i re c t

The p ai n i n
’
o n e s atte nti o n to th e re al s e at o f di s e as e .

th e se cas e s i s like ly to b e sym m etri c al o r at l e ast defi n ite ly

lo c ated with re s p e c t to c ert ai n sp i n al n erve tr u n k s F ur .

the r m o r e p ai n du e to i n v o lve m e n t o f th e c o rd o r i ts m e n
, ,

i n ge s d o e s n o t c al l f o rth th e p r o te c tive r e fl e x e s w hi ch ar e
,

so evi de n t wh e n any str u c t u r al ti s su e o f th e s p i nal c ol u m n

i s i n v o lved Th ere i s n o n e c e s sity fo r rigidity to p r o te c t

.

su pp o rti n g ti ss u e s ( We ar e.n o t i n c l u di n g s p i n al m e n i n

giti s i n thi s gr o u p ) Wh e n th e n erve r o o ts ar e i n v o lved

. - ~

th e p ai n i s i n te n s e an d d efi n ite ly l ocated . Wh en th e r o o t
gan gli a ar e i n v o lve d w e h ave th e we ll k no w n c on diti o n
c all ed h erp e s z o s e r
t .

Inf e cti o u s F e v M any o f th e acu te in fe cti o u s

‘

er s . 5 .

feve r s ar e c har ac terized i n p art by s evere b ack ach e Ih

, ,
.

fl u e n z a t o n s i l iti s s m allp o x typh o id diphth eri a an d de n g u e

, , , ,

all h av e s eve re b ack ac h e s as an i n c i de n t i n th ei r c o u r s e It .

i s n o t k n o w n wh at pr o d u c e s th e p ai n i n th e s e feve r s .

R e f er r e d Vi sc e r al P ai ns 6 P r o b ably th e gre at pr o. .

p o rt i o n o f back ac h e s ar e referred p ai ns du e to i nv olve me n t

o f th o r ac i c abd o m i n al o r p elvi c vi s c er a
,
A tte n ti o n has .

al re ady b ee n c all e d to H e ad s law o f referre d p ai n ’

’

an d to th e e x i s te n c e o f th e re c ept o r field s f o r s e n s o ry

i mp re s si o ns fo r c ert ai n segm e n t s o f th e s pi nal co rd The .

'

i n ter o ce pti ve fiel d i s an ar e a o f lo w s e n sibil ity so far as

-
,
'

o ur c o n sc i o u s re co g n iti o n o f th i s fiel d i s co n c er n e d No t .

all s egm e n t s o f th e s pi n al c o rd re c eive s e ns o ry fib er s fr o m

th i s fie ld h e nc e vi s c e r al refl e x e s ar e f o un d o nly i n th o se
,

p o rti o ns o f th e b ac k asso ci ate d wi th th o s e segm e nt s h avi n g

 PRI N C I PL E S O F O S TE O PA TH Y 32 7

F IG 1 37 t
A n o c cu p a i o n c u r v e w i h t fl tta g enin in
g P t t
. .

th e u p p e r d o r s a l. T
e l e r aph e r . a ien com
p la i n e d of p ai n an d te n d e r n e s s , se con d to
f t
o u r h d o r s al o n t f
h e l e t si d e D y
i e d s i x t da s y
ft t g t
.

a e r th e p h o o w a s m a d e , a n i n a p e c o r i s .
32 8 PR I N C I PL E S O F O S TE O PA TH Y

i nter o ce ptiv e s e n so ry c o mm u n i cati o n

-
D i st u rb an c e s i n .

h o llo w vi s c er a su ch as th e s t o m ach and i n te sti n e s ar e du e

to o verl o adi n g th e dige s tive app ar at u s F atig u e an d co n .

s e q u e n t f ai l u re o f dige s ti o n l e ad s t o di s te n ti o n with g as ,

ab s o rpti o n o f to x 1 n s fau lty el i mi n ati o n ,

D i ste nti o n cau s e s .

p re ssu re o n n erv e e n di n g s i n th e w all s o f th e vi s c era an d

'

th u s i n iti ate s refl e x b ac k ach e E x agger ati o n o f phy si o

.

lo gi c al ac tivity o f th e l ive r o r sp l e e n cau s e s te n si o n o n th e

, ,

c ap su l e s o f th o s e o rg an s an d h e n c e i rrit ati o n o f th eir s e n so ry

n erve s with refl e x b ac k p a i n s The sam e i s tr u e o f th e ki d

.

ney . D i st u rb an c e s i n th e b lo o d su pp ly to any o rg an s uc h ,

as o cc u r s i n arteri o sc l er o s i s, o r as re su lt o f an e u ri s m u su
-
,

al ly c au s e referre d p ai n s The referre d p ai ns th at ar e du e

.

to f u n c ti o n al f atig u e ar e u s u ally o f a so m ewh at d iff ere nt

c h ar ac ter fr o m th o s e du e t o i n fl amm ati o n i n vi sc er al o r

g ans A cu te i n fl amm at o ry s t ate s in th e vi sc er a give ri s e

.

i n m any i n st an c e s to c u t an e o u s hyp er s e n s itive n e ss i n th eir

,

s egm e n t ally ass o c i ate d are as Th e s e cu tan e o u s ar eas ar e

‘

hyp er s e n s itive to a s light t o uc h bu t n o t e sp e c i al ly so to

p re ss u re S t ate s o f f u n cti o nal strai n an d f atig u e wh eth e r
.
,

ac u te o r m o re apt to p r o d u c e a refl e x i n th e ,

sp i n al are a wh i c h i s ch ar ac teriz ed by te n d er n e s s t
, o p re s

su re o ve r th e e x te ns o r m u s cl e s at so m e p o i n t bet we e n th e
S p i n o us p r o c e s s e s o f th e vertebr ae an d th e an gl e s of th e

rib s Cu t an e o u s an d de ep ti s su e hyp er s e ns ibi lity m ay b e

.

as s o c i ate d i n th e sam e c as e The de ep hyp er s e n sibility

.

i s th e m o re c o n st ant f o rm di sco vered by p alp ati o n .

In fl amm at i o n o f S e r o u s M e b an s m r e — Wh e rever th e
n e c e ss ity fo r fri c ti o n o f o n e o rg an o r s tr u c t u re o n an o th er , ,

is n e c e s sary we fi n d s er o u s ti ss u e i n th e f o rm o f a b u rsa
, ,

te n d o n sh e ath sy n o vi al m embr an e t u n i ca v agi n ali s testi s

, , , ,

p l e u r a
ib p eri c ardi u m o r p erit o n e u m I n fl am m ati o n o f a .

s e ro u s m e mbr an e i s acc o mp an i e d by m u s c u lar fi x ati o n o f

th e s tr u ct u re s wh i ch d ep e n d o n th at m embr ane fo r fre e

m o vem e n t Th i s is a p r o te c tive acti o n re q u ire d to p reve nt
.

fri c ti o n o f th e i n fl am e d s u rfac e s I nfl am m ati o n o f a pl e u r al.

s u rf ac e calls f o rth a p r o te c tive c o n tr ac ti o n o f al l th e m u scl e s

330 PRI N C I PL E S o F O S TE O PA TH Y

of th e fifth laye r o f th e b ac k i s co mp l etely i nn erv ated fr o m

,

a si n gl e s egm e n t o f th e co rd we fi nd also th at n o vi scu s ,

is wh o l ly co ntr o lled by fib e r s fr o m o n e s egm e n t .

R fl e ex — The c o nti nu o u s ac ti o n o f a r e
S u b lu x ati on s .

fl e x s u ch as th at du e to i n fl am m ati o n o f a s er o u s s u rf ac e
'

, ,

o r to l o n g c o n ti n u e d f u n cti o n al s tr ai n o r t o c o n ti n u e d c i r ,

c u lat o ry di s t u rb an c e u s u ally re su lt s i n a ch an ge i n th e
,

ch ar ac t er o f th e b ac k i e a c ert ai n d egre e o f s t ati c alter a

, . .
,

ti o n t ake s pl ac e as a c o mp e nsat o ry ad apt ati o n t o v aryi n g

deg r e e s o f m u scu l ar an ky lo s i s Th i s m u scu l ar an kyl o si s .

i s th e e x p re s s i o n o f th e vi sc e ral refl ex I t p r o d u c e s ch an ge s .

i n b o ny alig n m e n t wh i ch we re co g n iz e as s u bl u x ati o n s
wh e n o nly thre e o r f o u r v ertebr ae ar e aff e cte d ; o r as c u rv a
t u re s wh e n gre ater n u mb er s ar e i n v o lved
‘

.
,

Int e nsi ty R of e e actio n —Th e x te n t

an d c o mp l e x ity o r
.
,

i n te ns ity o f a refl e x o r co Ordi nated se ri e s o f refl e x e s i s

, ,
-

n o t a c ri t eri o n by wh i ch to e stim at e th e e x te n t o f p at ho
lo gi cal ch an ge i h a vi scu s o r vi sc er a Very s eri o us p ath o .

l ogi cal ch an ge s m ay b e p re s e n t i n a vi scu s with o u t pr o

du c i n g i n te n s e o r eve n dete rm i nab l e sp i n al refl e x e s Th e s e
"
.

ch an ge s m ay h av e p r o gre ss ed so sl o wly an d i nv o lv e d su c h
s m all are as th at n o i n te n s e p r o te c tive re ac ti o n w as c all e d ,

f o rth .

L o cat i o n o f R e fl ex e s —B as ed u p o n cli n i c al
. an d e x pe r i

m e n t al o b s e rv ati o n s a c on s id er ab l e am o u n t o f d at a has b ee n
,

s e c u re d b e ari n g u p o n th e l o c ati o n o f refl e x e s i n co n n e c ti on

with v ari o u s vi sc er al di s e a se s The d at a with re sp e c t to .

th e lo cati o n o f c u t an e o u s hyp er ae sth e si a has b ee n we ll " '

m app ed o u t but u n ti l o ste o p ath s b eg an to p l an th ei r m

, an ip
u lati v e tre atm e n t acc o rdi n g to th e str u c t u r al ch ange s i n

s p i n al a l ig n m e n t du e to m us c u l ar hyp erte n si o n t
,
h ere w as ,

practi cal ly n o atte n ti o n p ai d to th e ph e no m e no n o f r efl e x

hyp erte n si o n The refe rre d vi sc er al p ai n s an d th e hyp e r
.

te nsi o n o f th e spi nal m u scl e s ar e e x p r e ss i o n s o f a di st u r bed

s egm e n t o r s egm e n t s o f th e s pi n al c o rd .
 PRI N C I PLE S O F O S TE O PA TH Y 33 1

R e fl ex —
P att e rns Bas ed o n c l i n i c al an d e x p eri m e n t al

d at a it i s p o ss ibl e to o u t li n e a s erie s o f refl e x p atter n s whi ch

,

ar e c h a r ac teri s ti c of c ert ai n vi sc er al i nv o lv m e n ts The

.

c o mp l e x ity o f t h e p atter n s dep e n d s large ly o n ho w gre at

an e ff o rt i s req u ire d by th e b o dy to o v e r c o m e th e di s e ase .

S o m e di s e as e s h ave a s p i n al refle x p atter n ap p are n t ly o u t

o f all pr o p o rti o n to th e gr avity o f th e i lln e s s Thi s is e s p e
.

c i ally mar k e d w he n au t o t o x emi a i s a ch ar ac teri sti c o f th e

‘

i lln es s Un der s u ch ci r c u m s t an c e s mu s c u lar te n s i o n an d

’

”
(

te n der n e s s e x te n d far o u t s i d e th e limit s o f th e n o rm al s e g

m e n t al i n n erv ati o n
3 32 PR I N C I PL E S O F O S TE O PA TH Y

C H A P TE R X V I .

A D A P TATI O N A ND C O M P E NS ATI O N .

E x ami n ati o n p ati e nt s fre q u e n t ly reve al s th e re s ult s

of

o f acc i de n t s o r di s e as e wh i c h do n o t app e ar to h ave an

y I

p re s e nt de l ete ri o u s i n fl u e n ce o n th ei r h e alth I t i s alw ay s .

n e c e s sary fo r th e phy s i c i an to e s ti m at e th e rel ati o n s whi ch

th e s e ch ange s h ave i h th e p as t b o r n e to th e ge n er al
‘
'

, ,

h e alth o r m ay at p re s e nt b e l i abl e to e x ert un de r k n ow n

‘

, , ,

co n diti o n s o f c li m ate di et an d e nvir o n m e nt

, .

D e fi niti o n .
—In sp e aki n g tr u ct u r al an d f un c ti o n al
of s

c h an ge s ,
w e u s e th e w o rd s ad apt ati on o r c o mp e ns a ti o n .

A d apt ati o n m e an s i n bi o l o gy f av o r abl e o rgan i c m o di fi ca

, ,

ti o n s su iti ng a pl an t o r an im al to i ts e nvi r o n m e nt Co m
‘

“ ” “ ”
n at i n m e an s to m ake u p fo r t o c o u n te rb alan c e
p e s o ! , ,

t hat wh i ch m ake s g o o d the lack o r v ari ati o n o f som e

'

”
th i n g el s e . The e x ampl e s o f ad apt ati o n an d c o mp e n sa
ti o n ar e very n u m er o u s an d it i s n e c e ssary fo r th e phy s i
o re c o g n ize th e c as e s i n wh i c h th e b o dy
'

c i an t o b e abl e t

has e x er c i sed o r m a
, y with p r o p er
, a ss i s t an c e e x e rci se ,

th i s p o we r to a g re at degre e I t i s so m eti m e s sai d th at .

-

di s e as e i s an e ff o rt o f th e b o dy to acc o m m odate it s el f to
‘

ne w c o n diti o n s th at i s ch an ge s in th e q u antity and

, ,

q uality o f s tim u l i o ccas i o n ed by v ari ati o n s i n c l im ate , d ie t ~

,

e nvir o n m e n t o r acc id e nt .

O ste o p athy app are n tly o rigi n ate d fr o m th e f ac t th at

s tr uc t u re aff e c t s f u nc ti o n With thi s as a b asi s all e x am
.
,

in atio n s ar e m ade fr o m th e s tr u c t u r al st an dp o i n t an d
th eref o re if we f o l l o w th i s meth o d to o liter ally we ar e
, ,

apt to o verl o o k th e f ac t th at th e c e l l s o f o u r b o die s have

'

th e p o wer o f ad apti ng th em s e lve s to ve ry p r o no unc ed

‘

3 34 P RI N C I PL E S O F O S TE O PA TH Y

F IG 1 38 . t t
A d a p a i o n o f th e b o d yto th e s ta te o f i ts
g
.

t
E n l ar e m e n o f th e s p l e e n w h i c h c a u s e s
.

c o n te n ts
b g g b
.

a ul in o f th e r i s a n d a c o i n c i d e n t s p i na l l e s i o n
.
 PR I N C I PL E S O F O S TE O PA TH Y 33 5

s tr aighte n i n g o f th e sp i n e o r e n d u r e de fo r m i ty w i th f ai r ‘

he alth D ef o rmity i s alw ay s a w o u n d i n th e s e l f e steem

.
~

o f th e i n divi d u al M an y w o u ld ri s k life tim e an d ag ai n

.

to be rid o f it I t i s th i s wh i ch give s th e e x p e ri me n ti n g
.

phy si c i an o r s u rge o n amp l e o pp o rt u n ity to try hi s s ki ll

o r hi s ig n o r an c e I t i s all o n e to th e p ati e n t; a ch an c e
.

to b e ri d o f def o rm ity .

C o m pe nsat o r y Cu r v at u r e — A later al c u rv at u re o f th e
.

spi n e usu ally ha s t w o p art s th e p rim ary an d the c o mp e n

”

s at o ry c u rve The c o mp e n sat o ry c u rve i s th e e ffo rt to

.

m ai n t ai n th e ere c t p o siti o n th at i s ke ep th e weigh t o f , ,

th e b o dy p r o p er ly b alan c ed The phy s i c i an m u s t determi n e

.

wh i ch c u rve IS pr l m ar y an d whi ch i s c o mpen sat o ry .

Wh e n th e hip i s d i s lo c ated o r any c on d iti o n e x i st s ,

whi ch sh o rte n s o n e l eg th e sp i n al co lu m n i s Cu rved to

,

c o mp e n s ate fo r thi s red u c e d le n gth ; I t w o u l d b e u s e l e ss

to tre at a c o mp e n sat o ry s p i n al c u rv at u re with o u t l e n gth ,

e n i n g th e l eg by re d u c i n g a h ip d i slo cati o n o r p u tti n g

an e x ten s i o n o n th e s h o e Wh e n th e fem u r is di sl o cated
.
,

all th e th i gh an d hip m u sc l e s ac co mm o d ate th em s elve s

to a n e W po s i ti o n the n th e s pi n al c o lu m n c u rve s b e c au s e
. ;
,

th e p e lvi s tilt s e n o u gh to co mp e n sate fo r th e lac k o f

l e n gth i n th e e x tremity The lo n ge r th e di slo cati o n has
.

e x ist ed t he m o r e p erfe c t i s th e ad apt ati o n an d c o mp e n s a

ti o n To red u c e th e di slo cati o n we m u s t u n d o th e w o rk
.

o f ad apt ati o n th at i s le n g the n th e m u sc l e s an d f o r c e th e

, ,
.

h e ad o f th e fem u r i n t o th e ac et ab u lu m .

All i n divid u al sp i n al l e si o n s m u s t be j u dged caref u l

ly as to th ei r r e lati o n s to f u n c ti o n al di s t u rb an c e The .

f act th at s p i n e s d evel o p u n eve nly i n m an y c ase s m ake s it , ,

h ard to defi n e th eir e x act co n diti o n A late r al s ublux a .

ti o n m ay e x i s t to whi ch th e b o dy has b e co m e acco m m o

d ated To red u c e th i s s u b lux ati o n might ag ai n su bj e ct
.

th e i n divid u al to di s t u rb ed f u n cti o n .

The Tho rax — D r o o p i n g o f th e rib s l e s s e n s th e an

.

ter o p o st eri o r di am e te r bu t i n c re ase s th e verti c al di am

-

I
,

ete r The fu ll r o u n d ch e s t o f large cap ac ity i s u su ally

.
.
33 8 PR I N C I P LE S O F O S TE O PA TH Y

is an i nc re as e i n th e si ze o f o n e o r m o re o f i ts ch amber s .

Thi s i n c re as e i s at th e e x p e n se o f th e th i c k n e ss o f i ts
w al l s th u s re su lti n g in di spr o p o rti o n b etwe e n th e size o f
,

th e cavity o f th e v e n tri c l e o r au ri cl e an d th e am o u nt o f ,

m u sc u lar ti s su e req u i red to empty th em o f th ei r c o nte n t s .

Wh e n th e p r o p o rti o n b etwe e n th e cavity an d i ts w alls

is so far re st o re d th at th e h e art i s abl e to o ver co m e th e
s t as i s o f th e b lo o d i n th at p o rti o n o f th e c ir c u l at o ry a
p
ar at u s b eh i n d th e l e s i o n we s ay th at o mp e n sati o n e x
p c ,

i sts . The abi l ity to re c o gn ize th e s t at u s of a h e art l e s i o n

i s o f gre at v alu e to a phy si c i an .

S ki n an d i n e —
K d ys A
p i nal l e s i o n might c au s e a di s
s

tu r ban ce i n th e f u n cti o n i n g o f th e kid n ey s de c re as e o f ,

.

ac tivity w hi c h i n t u r n i s c o mp e n sate d fo r by i n c re as ed
’

,
-

ac tivity o f th e ski n wh i ch in tim e i s c o mp e nsate d fo r by

,

i nc re as e d activity o f th e b o we ls The diarrh o e a i n thi s .

c ase w o u l d b e c o mp e n s at o ry an d y et it i s v ery di ffi c u lt
,

fo r th e phy s i ci an to n o te th i s f act
‘

I f th er ap e u ti c m e ans .

we re u se d to sto p th e d i arrh o e a an d th e ki d n ey s o r s ki n
‘

di d n o t i mm edi ately t ake u p th e w o rk o f elimi n ati o n , th e

b o dy w o u l d cal l u p o n th e s er o u s m emb ran e s an d are o lar
ti s su e , to t ake care o f th e su rp lu s li q u id i n th e c 1r c u lati o n .

As a re s u lt th ere w o u l d b e e dem a o f th e e xtrem iti e s as .

c ite s p l e u riti c e ff u s i o n
,
.

The mp e n s ati n g acti o n wh i c h m ay t ak e pl ac e be

co

twe e n th e kid n ey s s ki n m u co u s an d s er o u s m emb r an e s i s

, , ,

o n e wh i c h 15 m o re freq u e n t ly re c o g n ize d an d m ade u se

o f by phy s i c i an s th an an y o th e r e x amp l e o f th e s am e po w

e r m an ife sted i n th e b o dy The fac t th at th e s ki n an d kid

.

’
n ey s re s p o n d to e ac h o th er s n ee d s f o rm s th e b asi s fo r ,

m any th e r ap e u ti c p r o ced u re s M u co u s memb r an e s be .

co m e ac tive wh e n th e s ki n f ai l s P e r s p ir ati o n red u c e s .

ac tivity o f th e m u c o u s m embr an e s S e r o us m embr an e s

e x c e ssive activity wh e n m u c o u s m e m
.

c e as e th eir b r an e s
elimi nate freely The o edem a o f are o lar ti s s u e give s w ay
.

to ac tivity o f m uc o u s m emb r an e s The phy s i c i an m u s t .

 PR I N C I PL E S O F O S TE O PA TH Y 3 39

re c o g n ize wh i ch i s th e di s e as e d ti s s u e an d wh i ch i s th e
,

c o mp e n s ati n g o n e The f ai lu re o f th e ki d n ey to e x c rete

.

might n o t b e the f au lt o f i ts o w n str u c t u re bu t re su lt ,

fr o m the v is a terg o give n th e c ir cu lati o n by a di s e as e d

'

h e art
.

P ow e r o f E n cy ti g
s n — In th1 s we ster n co u n try C ali
.
,

fo r n i a we h av e amp l e Opp o rt u n ity to wit n e ss th e abi l ity

,

F IG 1 41 k g
S i d e V i e w o f ca s e o f l e u e m i a , sh ow i n re
b
. .

su lt t t
o f a d a p a i o n o f th e s p i n a l c o l u m n an d ri s
t t b y
.

to th e c o n e n s o f th e od .
3 40 PR I N C I P L E S O F O S TE O PA TH Y

F IG 1 42 Pl a n ta r i m p r e s s i o n o f a l m o s t c o m
t g g
. .

p l e te l e ti n d o w n o f th e l o n i tu d i na l a r c h .
34 2 P RI N C I PL E S O F O S TE O PA TH Y

F IG 1 43 P la n ta r i m pr e s si on of ca se of a b lu t fl a t
so e
f t gt r t ly b r k n
. .

oo . Th e l o n i u d i n al a ch is co m p le e o e

down .
 PR IN C I PL E S O F O S TE O PA TH Y 343

F IG . 1 44 . P l an ta r
i m p r e s si o n o f lo ss of t r an s
v e r s e a r ch an d c o n s e q u e n t i n c r e a s e o f p r e s
t
,

s u r e o n th e h e a d o f t h e s e c on d , h i r d an d
fou r ht t t r
m e a a s al b
on e s, a s e vi d e n c e d b y
th e c al l o u s .
3 44 PR I N C I PLE S O F O S TE O PA TH Y

i nj u ri e s to o r lo s se s o f th ei r o wn s tr u ct u re A d apt ati o n
, .

to e x te r n al co n diti o n s c alls fo r th e Op er ati o n o f c o m pe n -v

s ati n g o r b alan c i n g devi c e s with i n th e o r an l s m th ere

g ,

f o re th e lo gi c al s t u dy o f th i s s u bj e ct w o u ld nat u r ally gr o u p
th e ph e n o m e n a u n d er th re e h e ad s F ir s t th e st u dy o f.
‘

s tr u c t u re ,
with a vi ew to dete rmi n i n g th e e x i ste n c e o f
b alan c i n g d evi c e s i n th e arr angem e n t o f b o n e s l ig am e nt s , ,

m u sc l e s b lo o d v e ss e ls vi s c er a an d n erve s The s e c o m
,
'

, .

n t m ha n i m m t b e n ide red i n every e ff rt

'

p e s a o r y e c s s u s c o s o

at ad apt ati o n .Th i s fi rs t divi s i o n de als with i n te r n al

s tr u c t u r al co n diti o n s an d th eir f u n c ti o n s
,
i e an at o my , . .
,

an d phy s i o l o gy S e c o n d the S t u dy o f c o n diti o ns u n der

.
,

whi ch livi n g str u c t u re s ar e e x i sti n g Thi s divi si o n d eal s .

W ith all th o s e th i n g s whi ch c o ns tit u te e n vi ro n me n t s u ch ,

as f o od te mp er at u re atm o sphe r i c pr e s s u r e ; re lati o n to

'

, ,

o th er l ivi n g th i n g s s u c h as i n s e c t s p r o t o z o a a n d bac
, ,

teri a ; an i m al an d veget ab l e p o i so n s Thi 1 d a lo gi c al o u t .

,

gr o wth o f th e fi r st an d s ec on d divi s i o ns i e a s t u dy o f , . .
,

th e artifi c i al c o n diti o n s u s ed by phy s i c i ans to i n fl u e n c e

th e n at u r al c o n diti on s o f th e fir s t an d s e co n d d ivi s i o n s .

S i n c e m an s po s i ti o n i s u p right it app e ar s th at all

’ '

u
,

p art s o f his b o dy ar e c o n str u cte d with th e e n d i n vi e w

o f m aki n g th at p o s iti o n e asy t o m ai n t ai n A b ew i ld er .

i n g s erie s o f c o mp e n sati n g devi c e s serv e to b alan c e th e

b o dy in th e u pright p o siti o n An y de vi ati o n o f any p art .
,

as the re s u lt o f ac c i d e n t o r n e c e s s ity 1 5 i mmed i ate ly m e t ,

by an o pp o si ng co u n terb alanc i n g e ffo rt o f i ts n at u r al

c o mp e n s at o ry o pp o s i n g str u c t u re I f thi s c o mp e n sat o ry
‘
.

e ffo rt i s n o t pre s e nt th ere i s lo s s of b alance betwee n r e

,

c i pr o c at i n g p art s re s u l ti n g i n s tr ai n an d di sc o m fo 1 t As
,
.

a ge n e r al p r o p o s iti o n th e fO 1 e g o in g i s re c o g n ized by all ,

bu t to ac tu ally re c o g n ize th e f ai lu re o f c o mp e n sati o n

.

th e p re s e n c e o f s tr ai n i mb al an c e re q u i re s k n o w ledge o f
, ,

th e s tr u ct u re o f re c ip r o cati n g p art s .

The fe et p re sent so m e i n tere sti n g m e c hani s m s fo r

’
'

re sp o n di n g to th e n e ed s o f th e b o dy i n balanc i ng i n th e
‘

u p ri ght p o s iti o n E very c h an ge i n s h o e las t c all s fo r a

.
 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 1 45.
An t e r i or Vi ew of old f r ac u r e t F IG
'

. 1 46 . S i de Vi ew of ol d
, f t
r ac u r e
'

of

s cap h o i d the s c ap h o i d
o f th e
”
.
.

th i s gr o o v e w as de c i d edly app are n t F i g 146 P alp ati o n . . . ,

whi le th e we igh t w as o n th e ar ch se em e d to i n di c ate th at ,

th e tibi a an d fib u l a h e ld a re lati o n to th e astr ag alas sim

i lar to th a t wh i c h i s n o rm a l wh e n th e f o o t i s e x te n d ed .

on th e l eg i e ,
th e . p ,
o s ter i o r p o rti o n o f th e s u p eri o r s u r

f ac e o f th e as tr ag al u s w as b e ari n g th e weight The sh o rt .

l
"

e nin g o f th e f o o t h eight ,
o f th e i n s tep i n a bi l ity t o p
,
a

at r f e c t co n nu ti ity o f th e i n ter n a l s id e o f th e l o n gi
p e p ez .

tu di n al a c r h an d e x i s te n c e o f gr o o ve j u st i n fr o n t o f th e '

an l k e j i
o nt t o geth -
e r with s l igh t s w e ll i n g b u t n o e dem a ,

dil ate d ve i n s an d d u l l p ai n i n th e arc h an d l e g but no

'

f
lo s s o f u n c o n ( ti i e ,
m o bi l.ity .e x
,
i ste d i n a ll t a r s a l a n d
m et at ar s al arti c u l ati o n s ) we re i n di cative o f so m e de c i ded
r t
st u c u a r l c h a n ge s T h e p ri
.
n c ip al p o i n t n o ted a b o u t th e
 PR I N C I P LE S O F O S T E O PA TH Y 34 7

F IG 1 47 Rad i o g r aph of an Ol d f t
r ac u r e of th e s c ap h o i d an d c o n s e q u e n t
t a g al
.

t
.

d i s p la c e m e n of th e a s r us .

m o vem e n t s w as th at i n v er s i o n an d ever si o n o f th e f o o t
t o o k p lac e with th e f o o t i n th e n o rm al re lati o n to th e le g ,

as th o u gh it w as e x te n d ed th u s dem o n str ati n g th at th e

,

astr ag alu s w as i n f ac t i n a p os iti o n o f e x te n si o n ev en ,

th o u gh th e f o o t app e are d n o t to b e s o .

The c o n diti o n o f thi s f o o t i s e x c eedi n g ly i n tere sti n g ,

wh e n th e hi st o ry i s c o n s idered M r C s ay s hi s f oo t was . . .

i nj u re d by a large r o c k whi c h a fe llo w w o rkm an acc i

, .

de n t ally dr o ppe d Th i s acc i d e n t t o o k p la c e f o ur ye ar s

.

ag o wh i l e h e w as w o rki n g i n a m i n e
,
The f o o t s we ll ed .

s light ly i e to ab o u t i ts p re s e n t s iz e an d w as p ai n f u l
,
. .
, ,

bu t di d n o t i n c ap ac it ate h i m fo r w o rk C l aim s h e n ever .

348 P RI N C I P LE S O F O S T E O PA TH Y

'

l o st a day on i ts acc o u n t , an d it w as n o t e x am i n e d by a

phy si c i an The s we lli n g gr ad ually s u b si de d an d th e f o o t

.

g ave h im n o i n c o n ve n ie n c e fo r th re e ye ar s e x c ept i n th e ,

m atte r o f fitti n g a sh o e R e c e n t ly s we lli n g an d p ai n h ave

.

d eve lo p ed .

F IG 1 48 gr
R a d i o a p h o f an o l d fr t
ac u r e of th e
g t y t
. .

s cap h o i d s ho w i n c o m p e n sa or r ot a i on of
f t g
.

th e oo o n to i ts o u te r m a r i n , to a v o i d tr a n s
t g
m i t in th e b y
od g g
w e i h t th r o u h th e l o n i g
tu d i nal a r c h
.
350 PR I N C I PL E S O F O S TE O PA TH Y

ph o i,d i n ter n al c u n eif rm fir sot m et at ar

an ds al — i s b ad ly
di st o rted The re lati o n s o f th e m et at ar s al s as sh o w n i n
.
,

th i s il lu s tr ati o n i n di c ate th e t e n de n cy to thr o w th e

,

weight o n th e o u t e r edge o f th e f o o t The s ide vi e w .

,

sh o w n i n F i g . 149 dem o n str ate s ag ai n the d i s lo cati o n o f

th e h e ad o f th e astr ag alus d o w n w ard to a p o s iti o n u n d er
th e s caph o id The scaph o id sh o w s an i rreg u lar o u t li ne
.
,

F IG 150 P l a n ta r
i m p r e ss i o n s h o w
ff f
. .

i ng e e ct of o ld r act ure of
s ca p h o i d a n d conse qu e n t
d o w n w ar d
m o v e m e n t o f th e h e ad o f th e a s
tr a g al u s .
 PR I N C I PLE S O F O S TE O PA TH Y 3 51
‘

as th o u gh h avi n g b e e n fr ac t u re d an d rep ai red le avi n g i r ,

reg u lar m as s e s o f callo u s .

A n imp re ss i on o f th e p lan t ar su rf ac e o f th e f o o t w as
t ake n Fi g 150 Th i s sho w s the gre at i nc re as e i n c o n
‘

. . .

t ac t su rfac e e s p e c i ally u n der th e he ad o f the astr ag alu s

, r
.

An o th er i n tere s ti n g th i n g d em o n str ate d by thi s i mp re s

si o n i s th e c h an ge th at has t ake n p l ac e i n th e s e co n d m et a

t ar sal and s e co n d to e Bo th h ave b ee n e l ev ated so th at

,
-

they n o l o n ger be ar m u ch di re c t weight The thi rd an d .

f o u rth m e t at ar s al s ar e b e ari n g th e di re c t app l i c ati o n o f

th e weight o f the b o dy .

In o rde r to m o re c l ear ly an alyz e thi s c as e we wil l ,

c o n s i de r s o m e g e n e r al fu n dam e n tal i de as co n c er n i n g t
. he
s t r u c t u re an d f u n cti o n o f th e fo ot The f o o t act s p ri .
,

m ari ly as a p as sive su pp o rt o f the b o dy weight ; s e c o n

,

dar i ly as an ac tive l eve r to m o ve th i s weight as i n r u n

, ,

n ing In o rder to p erf o rm the s e fu n cti o n s i t m u st h ave

’

.
,

stre n g th e lasti c ity an d ad apt abi li ty th u s p e r m itti n g it

, ,

t o as su m e v ari o u s attit u de s n e c e ss ary t o p r o te c t it fr o m

'

i nj u ry S i n c e th e p rim ary f u n c ti o n o f th e f o o t i s to act

.

as a s u p port t he i n tegrity o f the l ig am e n t s i s e s s e n ti al

, .

Wh e n th e f oo t i s p ass ive u n der weight th e ar ch e s s ett l e ,

s l i ght ly The ar ch as a wh o le i s e lasti c bu t th e l igam e n t s

.
‘

ar e n o t The el asti c ity o f th e ar c h i s th e re s u lt o f th e

.

m o vem e n t o f th e b o n e s i n t o a p o s iti o n wh ere th e lig a

m e n t s re c eive th e weight M u scle s l ig am e n t s an d th e
.
,

p lan t ar fasci a all s erve to s u pp o rt th e f o o t bu t wh e n ,

p ass ively be ari n g th e weight o f th e b o dy th e lig am e n t s ,

b e ar th e s tr ai n L o ss o f e lasti c ity 1n th e f o o t cau se s i n

.

c re a s e d p re ss u re o h p o i n t s o f c o n t ac t o n th e so l e o f th e
f o o t al so o n th e t o e s The s k in th i c ke ns o v er th e se b o ny
, .

co n t ac t p o i n t s i n an e ffo rt to co mp e n s ate fo r lo ss o f e las

ti c ity ,th u s co r n s an d call o u s e s ar e evide n c e s i n m an y ,

”

c ase s o f c o mp e n sati o n an d s h o u l d i n di c ate th e n ec e s s ity

,

fo r a c aref u l e x am i n ati o n o f th e s tr u c t u re o f th e f o o t .

In th e attit u de o f re s t th e astr ag alu s r o t ate s s l igh t ly

i n w ard an d d o w n w ard o n th e o s calc i s th u s m aki ng th e ,
3 52 PRI N C I PLE S O F O S TE O PA TH Y

h e ad o f th e astr ag alu s s o m ewh at p r omi n e n t o n th e i nn e r

s id e o f th e fo o t Thi s m o v e m e n t i s c h e c ke d by lig a
.
-

m e nt s an d thi s p o siti o n o f fi x ati o n rem o ve s all s tr ai n fr o m

,

th e m u s c le s In th e c as e we ar e st u dyi n g the c alc an e o

.
,

s c aph o i d lig am e n t w as t o r n h e n ce th e r o t at io n o f th e
,

astr ag al u s i s li mite d o n ly by c o mp re ss i n g th e s o ft ti ss u e s

o f th e so l e ag ai n s t th e fl o o r as i s evide n c ed by th e i m
,

pr ess i o n alo n g th e i n n er b o rder o f th e f o o t i n F ig 150 . .

The p o siti o n o f th e h e ad o f th e as tr agal u s u n d er th e

s c aph o id r ai s e s th e i n n er b o rde r o f th e f o o t an d th r o w s

th e weigh t o n th e o u ter b o rd e r a n at u r al c o mp e n sat ory ,

p o s iti o n F r o m th e f o reg o i n g w e j u dge th at thi s f o o t i s

.

a p oor p as sive s u pp o rt Alth o u gh it ha s d o n e g o o d

.

s ervi c e fo r n e ar ly f o u r ye ar s i t ha s n ever b ee n ca ll e d ii po n
'

, ,
'

u n ti l withi n th e p re s e n t ye ar to ac t fo r lo n g p e r i o ds o f
,
”

tim e as a p a ss ive s u pp o r t H e ret o f o re thi s f o o t has

.

ad apte d it se l f to u n eve n su rf ac e s p r o d u c i n g! co nst ant ,

v ari ati o n o f p re ss u re No w th at c o n t ac t wit h s m oo th

.

h ard p avem e n t give s n o o pp o rt u n ity fo r sh ifti n g o f weight

and alte rn ati n g co n tr ac ti o n o f m u s c l e s i t f ai l s a s a S up ,
'
p o rti ng m e ch an i s m S te ady pre ssu re o f th e h e ad of th e
.

as tr ag al u s o n th e s o ft ti ss u e s o f th e pl an t ar su rf ac e 1n t e r

fe r e s w i th c ir c u lati o n c au s e s edem a an d p ai n
‘

.
,

The s e c o n d ary f u n c ti o n o f th e f o o t i s as a l eve r i n .

ac tive ly r ai s i n g an d p r o p e lli n g th e b o dy We d ivid e the s e .

f u nc ti o ns i n t o prim ary an d s e co n d ary be c au s e a f o o t th at ,

m ight se rve as a g o o d p as sive S u pp o rt might p o s s e ss n on e ,

e lem e n t s req u i re d i n r u n n i n g A WO o de n
'

o f th e ac tiv e .

f o o t w o u ld s e rve as a s u pp o rt bu t n o t a s an active l e ver

,
.

The h e ad s o f th e m et at ar s al b o n e s act as a f u lc r u m , th e
‘

c al f m u sc l e s f u r n i sh th e p o we r th e weight re s t s o n th e,
.

as tr ag alu s Wh e n th e f o ot is u sed n o rm ally th e li n e o f

.
,

weight p as s e s d o w n w ard th r o u gh th e c e n ter o f the k n e e

an d an k l e j o i n t s h e n c e f o rw ard alo n g th e li n e o f th e
,

s e co n d t oe The f ac t th at th e i n n er sid e Of th e f o o t i s
.

l o nge r th an th e o u ter cau s e s th e s tr ai n re s u lti n g fr o m

,

l ifti ng th e weight Of th e b o dy o ver th e f ul cr u m to b e car ,

3 54 P R I N C I PL E S O F O S TE O PA TH Y

C H A P TE R X V I I .

I NH I BI TI O N .

Acce l e r ati o n —I i biti

nh —
We h av e n o te d in a fo rm er
on .

c h apt er th at th e attrib u te s o f n erv o u s ti ssu e ar e i rrit abil it y

co n d u c tivity an d tr o phi c ity We m ay add to th e s e ac

.

c e le r ati o n an d i n h ibiti o n We do n o t u s e th e term s sti m u

.

l ati o n an d i nhibiti o n as de n o ti n g Opp o site Co n diti o n s be ,

c au s e s t i m u l ati o n app l i e s t o th e i n iti ati o n o f an i mp ul s e .

Th i s i mp u ls e m ay b e acc el er at ory o r i nhibit o ry i n ch ar ac

te r We m ay sti m u late a n erve wh o s e c h ief f u n c ti o n i s
.

i n h ibiti o n A n imp u ls e wh eth er accl e rato r y o r i n h ibi to ry

.
,

i n c h ar acte r i s th e re su lt o f st
,
im u l ati o n .

A ll b o d i ly fu n cti o n s re q u ire stim u l ati o n i n th e s e n se ,

we h ave u s e d the term i e s o m ethi n g m u st i n iti ate an

, . .
,

i mp u l s e wh i c h i s d e s ig n e d to e x c ite ac tivity After thi s .

activi ty i s st arte d it m u s t b e go ver n e d I t i s th e m e an s

, .

o f g o ve r n i n g t h e s e ac tiviti e s we ar e i n tere ste d i n s t u dyi n g

, .

M u s cu lar i
C o ntr act o n — M u scl e m ayb e s i m u l ate d to
c o n tr ac ti o n . Thi s c o n tr ac ti o n m ay b e i n c re ased o r de
c re as ed ,
th u s s ho w i n g that afte r i n i tiato ry i m pu ls e st art s
~

o n i ts w ay to th e p o i nt o f co nver s i o n i n t o w o rk d o n e by
th e m u scl e it i s acc el e r ated i n c re as e d o r i n h ibited r e
, , , ,

s tr ai n e d by c ert ai n i n fl u e n c e s whi ch we c an n o t e as ily

an alyz e . The co n tr ac ti o n and rel ax ati o n ph e no me n a o f
m u sc l e ar e eq u al ly i mp o rt an t V aso c o n stri cti o n an d v aso
.
-

di lati o n ar e e x ampl e s o f th e s e ph e no m e na .

S e cr e ti o n — The ac tivity o f s e c ret o ry ti ss u e s i s reg u

lated by so m e arr an gem e n t si mil a r to th at c o n tr o l li n g m u s
c u lar ac ti o n Afte r a c ell be c o m e s ac tive i t i s s ti ll u n der
.
,
 PR I N C I PLE S O F O S TE O PA TH Y 3 55

th e c o n tr o l o f a g o ver n i n g c e n ter wh i ch acc e l er ate s o r

,

i n h ibit s acc o rdi n g to th e ne c e s siti e s o f th e c ase

, .

Acce l e r at i o n an d Inhi b iti o n as Att r i b u t e s o f Ne r v e

Ti ssu e —C e lls ar e f u ll o f p o te n ti al e n ergy whi ch n e ed s a
‘

.
,

stim u l u s to s t art i ts c o n ve r s i o n i n t o k in e t i c e nergy

, We .

m ay as k o u r s elve s th e q u e s ti o n ; Why i sn t all of th e po

’

te n ti al e n ergy co n verte d i n t o ki n eti c at o n e tim e o r in ,

re sp o n se to a s m g le stim u lu s ? I f th e e x pl o sive m ateri al

-
'
P
K -

—
i n a m agazi n e i s i gn ited it all e x p lo de s th ere i s c o mp l ete
,

c o n ver s i o n o f p o te n ti al i n t o ki n eti c e n ergy The re i s n o .

r e str ai n i n g or acc e ler ati n g i n thi s c as e The el em e n t

.
,

nit r o ge n wh o s e l ib er ati o n in th i s ca se c au s e s su ch dire

re s u lt s i s th e sam e e l em e nt i n th e c e ll s w
-
,

,
h o s e lib er ati o n
“ ” ’
i s n o te d as w o rk d o n e by m u s c l e o r glan d Why i sn t .

all the n it r o ge n i n th e c ell s l ib er ated by a s i n gl e s tim u l u s ,

as n t e m ag az i n e
i h ? We c an th i n k o f n o e x pl an ati o n e x
"

c ept th at i mp u l se s p ass i n g o ver n erve s ar e q u al ifie d by

o the r imp u ls e s p as si n g o ver o th er n erve s th e tw o sti m u l i
,

o f Opp o s ite c h ar ac ter th u s m o difyi n g e ac h o th er o r i n ,

so m e c as e ad di n g th ei r f o r c e s wh e n o f like ch ar ac ter
s , .

I nhi bi t io n as an attrib u te o f th e n erv o u s sy stem d o e s ,

n o t s eem to b e e x er ci s ed i n s h o rt refl e x ar c s n eith er d o e s ,

it app e ar to b e e x er c i s ed by c e nter s in th e S pi n al c o rd .

It m ay b e th a t a c ert ai n a m o u n t o f i n hibit o ry i n fl u e n c e
i s e x erted i n th e s e s u b s i di ary c e n ter s bu t th u s far i h
'

v e s ti g ati o n s d em o n str ate thi s attrib u t e to b e p o ss e s se d by

th e br ai n c ell s .

Inhi bit i o n a No r m al Att r i bu te o f the C e n t r al Ne r v o u s

S y ste m —I n h ibiti o n i s a n o rm al re str ai n i n g i n fl u e n c e po s
.

s e s s ed by th e c e n tr al n e rv o u s s y s tem Wh e n th e o s te o
"
.

p ath i c phy s i c i an sp e ak s o f i nh ibiti o n h e m e an s a th er a

,
.

p e u ti c pr o c ed u re wh i ch e x er ci se s a re str ai n i n g i n fl u e n c e
o ver so m e f u n c ti o n th i s re str ai n i n g i n fl u e n c e b ei n g i n d e
,

p e n den t o f th at i n hibiti o n wh i c h i s an attrib u te o f th e

c e n tr al n erv o u s sy s tem .

A n ythi n g wh i ch de c re as e s th e n u mb e r o r s tre n gth o f

s e ns o ry imp u l s e s r e achi n g a refl e x ce nt e r i s i nh ibit o ry i n
,
3 56 P RI N C I PL E S O F O S TE O PA TH Y

c h ar acter The m e di cal p r o fe s si o n has m ade u se o f a large

.

n u mbe r o f ag en t s fo r th i s p u rp o s e o p i u m fo r e x ampl e
, , .

H i s t o r y — I n h ibiti o n i s a w o rd f o u n d i n l ite r at u re
.

b e ari n g o n th e ph e n o m e n a o f th e n erv o u s sy s tem It i s .

we ll fo r u s to i nve stig ate th e h i s t o ry o f th i s w o rd an d ,

th e ph e n o m e n o n wh i ch it i n di c ate s The ph e n o m e no n .

whi ch o c cas i o n e d the u se o f th i s w o rd w as fir st o b served

by th e br o th e r s W eb e r ( 18 4 5 ) an d m any i nve s tig at o r s
h ave s i n c e c o nfirm e d it Th ey n o te d th at e x c it ati o n o f
.

fib er s o f th e p n e u m o g astri c n e rve o cc asi o n e d sl o wi n g o r

s t o pp age o f th e co n tr ac ti o n s o f the he ar t Thi s n e w ph e
n o m e n o n m u s t h av e a d e s ig n ative te r m h e n c e th e w o rd
.
.

“ ”
s t o pp age w as u s e d m e an i n g th e arre st o f ac ti vity o f
,

an o rg an by ar o u s i n g ac tivit y i n a n erve su pp lyi n g it

,
The .

“ ”
w o rd i nh ibiti o n w as p r o po se d later by Br o w n S e q uard —
an d has rem ai n e d i n u se to th e e x c l u s i o n o f th e e arl i er
,

t erm s .

A fte r o b s ervi n g th e ph e n o m e n o n o f n erve arre st i n

th e h e art o th e r ph e no m e n a o f a so m ewh at s i mi lar ch ar ac
,

ter were gr o u p e d u n de r the sam e h e ad Th u s we fi n d th e .

_
l ”

term i nhibiti o n c o n fu se d with s u ch ph e no m e n a as th e

p ar aly s i s o f m o t o r n erve s by c u r are l o ss o f s e ns ati o n f o l
’
’

lo wi n g th e i n h alat i o n o f c h lo r o f o rm sh oc k an d f atig u e , .

We c an th u s re aliz e th e gre at co nf u s i o n o f m e an i n g s
att ac h e d to thi s t erm Late r i nve s tig at o r s re alized th e
.

e sse nti al di ff e re n c e s i n th e s e ph e n o m e na an d drew atte n ,

ti o n to th e f ac t th at p ar aly si s s h o c k an d f atig u e were n o t

,

c o mp ar ab l e t o th e ph e n o m e n o n o f arre st o f c ardi ac co n

tr act i o n f o llo wi n g stim u lati o n o f th e p n e u m o g astri c

.
.

M o ro t s ay s In o rd er to p reve n t th i s co n f u si o n it i s n e c e s
,
“
,

s ary t o ret u r n to th e e x p e rim e n t al d at u m wh i c h l i e s at th e

f o u n d ati o n o f th e c o n c epti o n o f i n h ibiti o n Thi s app e lla .

ti o n wi ll b e give n to every ph e n o m e n o n rep r o d u ci n g th e

ch ar ac ter s an d th e e ss e n ti al c o n diti o n s Of st o pp age o f th e
”
h e art by th e stim u lati o n o f th e v ag u s n e r v e s .

Ar r e s t o f Acti v i t y — P ar aly si s sh o c k f atig u e an d i n

.
, ,

hi bi ti o n all s ig n ify arre st o f activity bu t ar e n o t sy n o ny ,

 ‘

3 58 P RI N C I PL E S O F O S TE O PA TH Y

th at wh i ch c all s f o rth co ntr ac ti o n M u sc u lar rep o se . is th e

re s u lt o f n erve activ ity Th i s is th e i mp o rt an t p o i nt
.
,
in th e
pr acti cal c o n si de r ati o n o f i nh ibiti o n .

Thr e e Char ac ter i sti cs of the Ne r v o u s S y s t e m .

—
The
n e rv o u s sy stem d u ri n g i ts d eve lo pi n g p eri o d S h o w s th re e ,

s p e c i al ch ar ac teri s ti c s i e it eith er app r o p ri at e s o r pr o

, . .
,

—
d u c e s e ergy i t i s u n d eterm i n e d ho w th e e n e rgy i s se
n

cu r e du

tr an s m i ts e n ergy an d las t ly ret ai n s th e di sc harge

,

o f e n ergy . The las t c h ar acteri s ti c i s i nh ib iti o n .

D e v e lo pm e n t o f I n hi biti o n — Wh e n w at chi n g th e m o ve
m e n t s o f a y o u n g b ab e we ar e am u sed by th e i n c o o rdi nat e
,

ac tivit y o f i ts e x trem iti e s A t th i s s t age i n i ts devel o p

.
i

m e nt i n hibiti o n is n o t an acc o m plishe d fu n cti o n o f i ts

'

n erv o u s sy ste m The b l adder an d b o we ls act r e fl e x ly If

‘

. .

i nh ibiti o n d eve lo p s n o rm ally the c h il d so o n c o n tr o l s de

,

fe c ati o n a n d m i c t u riti o n ; if n o t a c as e o f e n u re s i s e x i st s
, ,

u n til su c h ti m e as th e i n h ibit o ry f u n c ti o n i s devel o p e d i n

th e c e n tr al n erv o u s sy stem .

Ne u r o ti c D i at he s i s Cho r e a —The we ll re c o g n ize d f act

, .

th at m any c hil dre n ar e e as ily pre c i pit ated i n t o th e co n

v u l si v e s t ate i s an evi d en c e o f th e p o o rly de v
,
el o p e d co n di
ti o n o f thi s thi rd attrib u te o f n erv o u s ti s su e s The so .

cal l e d n e u r o ti c di ath e s i s s e em s t o m e an l ittl e m o re th an

f au lty d ev el o p m e n t o f i n h ibiti o n I n hib i ti o n m ay deve lop .

i n a fairly n o rm al m an n er b u t o n ac c o u n t o f n u triti o n al
,

co n diti o n s e n v i r o n m e n to r acc i d e n t
,
b e i n p art i mp aired ,
.

An e x ampl e o f th i s i s e x h ibite d by th e we ll k n o w n u n
c o n tr o ll e d m o vem e n t s i n c h o re a I mp ai rm e n t o f the i n .
,
~

hi bi to r y fu n c ti o n o f th e c e n tr al n erv o u s s ys tem w o ul d
s e em to b e s u ffi c ie n t c au s e fo r c h o re a .

—
P ar alys i s A git ans To c arry o u r th e o ry i n t o l ater life
.

we m ay t ake p aralys i s agit an s as an e x amp le o f th e i m

p ai rm e n t o f th e i nhibit o ry f u n c ti o n o f th e c e n tr al n e r vo u s
sy s tem .Thi s f u n c ti o nal n e u r o n i c di s e ase p re s e n t s n o l e s i o n
o f th e n erv o u s ti s su e wh i ch has be e n det ected u p to th e
,
 PR I N C I PL E S O F O S TE O PA TH Y
,

3 59

p re s e n t tim e . I t m ay b e th at f u t u re s t u dy o f n erv e ti ss u e
wi ll di s co ve r a d e l i cate m e c h an i s m w ho s e p u rp o se i s i n
,

hi biti o n .

D e v e lo pi n g In hib i ti o n by Tr ai ni n g —The f u n cti o n al

ac tivity o f n erve ti ss u e i s au gm e n te d by u se j u st as m u sc u ,
i

lar p o we r i s e n h an c ed by p r o p e r tr ai n i n g K n o wi n g thi s .

fac t i s evi de n c e d eve r ywhere i n th e fie l d o f e d u cati o n al

e n d eav o r ; we feel th at i n hibiti o n as an i mp o rt an t f u n c ti o n
,

of t he n erv o u s s y stem ( i n f ac t we m ay call it a pr o te c

'

tive f u n c ti o n ) sh o ul d b e r e c o g n ize d an d c u ltiv ated e ar ly

i n l ife . The we ll tr ai n e d c hi l d i s th e o n e p o s s e ss i n g a
-

we ll b alan c e d ne rv o u s s ys tem S u ch a chi ld do e s n o t h ave

'

s p as m s b e c au s e ap petite an d d e s ire h ave b ee n tr ai n ed

, an d ,

t he s e vi rt u e s o f se lf co n t r o l m an ife s t th em s e lve s i n n erve

p o we r an d Co n tr o l Th u s do we fi n d th e co n s i de r ati o n o f
.

a p u re ly s c ie n tifi c asp e c t o f th e d eve l o p m e n t o f th e n e r v o u s

s y stem l e a d s u s i n t o th o u ght s co n c e r n i n g m o r al d evel o p

-

m e n t o f th e u n it s o f h u m an so c iety Thr o u gh su ch s t u die s .

a s th i s th e phy s i c i an b e co m e s an imp o r t an t fac t o r i n th e

,

de v e lOpm e n t of a p r op e r an d he alth f u l s o c i al life

_
.
.

Inhi bi to r y P
E ff e ct of—
No w to ret u r n to an
r e s su r e .
,

o th er vi ew o f o u r su bj e c t
.
we call y o u r atte n ti o n to a few
,

o f th e re c o g n iz e d ph e n o m e n a co n s t an t ly p r e s e n ted to u s
-

by o u r e ffo rt s to all evi ate di s e as e co n diti o n s W e k n o w

'

by m an y e x p eri e n c e s th at by p re s su re o n th e su rf ac e o f
th e b o dy o ver th e c o u r s e o f a n erve b u n d l e a re str ai n i n g
, ,

i n fl u e n c e i s o fte n e x er c i s ed Over th e f u n c ti o n o f th e ti s su e
r e ce 1v 1n g th e termi n al s o f th at n erve b u n d l e E ve n m o re .

i n tere s ti n g i s th e o b s erved f ac t th at a re s tr ai n i n g i n fl u e n c e
i s o fte n e x er t e d o n ti ss u e s rem o te fr o m th e p o i n t o f p re s
s u re,
wh i ch do n o t re c eive any o f th e term i n als o f th e
n e r v e whi c h i s pre s s ed u p o n bu t re c eive term i n als o f
,

o the r ne rve s fr o m th e sam e s egm e n t o f th e c e n tr al n erv o u s

s y s tem . W e m ay eve n g o f arth er an d say th at i t i s n o t

an u n o b s erve d ph e n o m e n o n to h ave f u n c ti o nal ac tivity

re s tr ai n e d in very re m o te ti s su e s wh i ch do n o t seem ,
360 PR I N C I P LE S O F O S TE O PA TH Y

o rdi nari ly to b e i m me di ate ly c o n n e cte d with th e s egm e n t

o f n erve ti ssu e dire ctly aff e cted Thi s di ffu si o n o f r e
.

str ai n i n g i n fl u e n c e s f o ll o wi n g e x ter n al p re ss u re w o ul d
, , .

s e em t o p o i nt t o th e p r o b abi lity th at th e pr es su re ac t s as

a s tim u l u s to an i n hibit o ry m e chan 1 s m 1n th e c e n tr al ‘

n e rv o u s sy stem I f thi s we re no t s o w e co u ld n o t e x p e ct
.
,

an y refl e x re str ai n i n g e ff e ct s su c h as we ar e c o nst an t ly

, .

s e eki n g A s e x amp l e s o f p re ss u re e ff e ct s l et u s cal l at

.
,

te nti o n to p re s su re o f th e s u b o cc ip it al n e rve s i n cas e s o f

h e ad ac h e Th e se n erv e s ar e i n p o s iti o n to b e c o mpre s s e d
.

ag ai n s t b o n e The e ff e c t o f co mp re s s i o n s e em s to b e
.

man ife ste d p e riph er ally by a de cr eas e i n p ai n P ai n i n ’

th e abd o m i nal vi sc er a can freq u e n t ly b e l e ss e n e d to a , .

very app re ci ab l e e x te nt by e x ter n al pre ssure m ade o ve r

,

th e p r o p er ass o ci ate d S p i n al are a In thi s we h ave a g o o d .

e x amp l e o f th e refl e x e ff e c t o f p re ssu re w hi ch s ee m s to

“ '

u ph o l d th e i d e a th at p re ssu r e i s re ally s tim u lat i on of a

f u n c ti o n re si di n g i n th e c e ntral n erv o u s ti ss u e s P re s .
.

s u re Over th e sacral n erve s i n a wo m an p a ss i n g th r o u gh

th e m e n o p au s e an d tr o u bl e d by irreg u l ar h e art actio n has

, ,

b e e n k no wn to b e al m o s t im m ed i ate ly fo ll o we d by reg .
.

u l ar h e art rhyth m S i n c e the c ardi ac i rreg ul arity w as a

.

refl e x, o c c as i o n ed by di st u rb an c e o f th e sac r al pl e x u s th ere ,

m u s t h ave b ee n a r e adj u s tm e n t o f n erv o u s ac tivity du e to

'

so m e f o rm o f s ti m u lati o n I t s eem s very p r o b abl e th at a

.

m o ve m e n t whi ch we n am e i n hib iti o n m ay i n re ality b e

, ,

a f o rm o f stim u lati o n wh i c h c alls f o rth a f u n c ti o n o f th e

c e n tr al n erv o u s sy s t em , th e re s u lt an t ac ti o n o f th e c e n !

tr al n erv o us sy stem b ei n g m erely evi de n c e o f th e f act th at

r e adj u s tm e n t t ake s p lac e as a se lf p re serv ative activ ity ,
i e a m an i fe st ati o n t o w ard th e n o rm al
. .
, .

D os ag e —W e ar e l ike ly to b e mi sled i n t o th e f at u o u s:
b e li ef th at i f we give j u st e no u gh stl m u lati o n o r i nhibi ,

ti o n i n a give n c ase i e if o u r d o sage is j u st right We

'

.
, ,
.
, ,

wi ll get p erfe ct re s u lt s Th i s i s th e o l d s t u mb li n g b l o c k
'

o f h o m e o p athy an d al l o p athy D ev o te e s o f the s e sy stem s

.

beg u i le th e mse lve s with th e i de a th at sp e c ifi c ity o f d o sage

3 62 PR I N C I P L E S O F O S TE O PA TH Y

i nc re ase d w o rk i n m u s cle an d gl an d s o m etime s to th e p o i nt ,

o f e x h au stio n To d e c re ase th e am o u n t o f w o rk we m u st
.
,

de c re as e th e n u mb er o f st i m u li The stim u l i o rigi nate at th e .

p eriph e ry o f s e n so ry n erve s S e nso ry n erve s ar e m o st .

n u m e r o u s 1 n th e ski n m u c o u s m embr an e an d m u s cl e
,
Inhi b .

i to r y i n fl u e n c e s m u st b e appl ie d to o n e o r m o re o f th e s e
str u c t u re s S ki n i s th e su rf ac e ti s su e ri chly s u ppli ed by
.

s e n s o ry n e rve s an d u n de r it ar e m u sc l e s
, al so wel l su p ,

pl i ed by s e ns o ry n erve s .

l L
’
—
H i to n s aw H ilt o n by sh o wi n g th at th e s ki n m u s
.
, ,

c l e s an d sy n o v i al m embr an e o f a j o i n t o r th e ski n mu s , ,

cl e s o f th e abdo m e n an d c o n te n t s c o vered by p erit o n e u m ,

ar e i n n erv ated fr o m th e s am e s egm e n t o f th e c ord laid a ,

f o un d ati o n fo r th e r ati o n al u se o f i nhibiti o n i n o s te o p ath i c

”

p r acti c e
I nhi b iti o n—
.

The r ape u ti c — I n h ibiti o n as a te rape uti c

'

.
,

p r o c e d u re c o ns i st s i n a ste ady d igit al p re s su re m ad e o ver

,

s o m e n erv e tr u n k o r o ver an are a whi c h i s c l o s ely c o n

,
.

n e c te d with a spi nal s egm e n t fr o m w hi ch n e rve s p ass to

'

an i n ter nal v 1sCu s whi c h we de s ire to aff e c t ,

.

In o rde r to e x pl ai n th e n e c e ss ity fo r th i s m o vem e nt

an d i ts b e n efi c i al e ff e c t s we m u s t n o te th e ph e n o me n a o f
,

v aso m o ti o n
-
.

H OW V aso m o to r C nt s e e r A ct—
- —
V aso m o t o r c e nte r s .

act acc o rdi n g to th e s u m o f th e stim u l i r e achi ng the m

'

fr o m s ki n m u scl e g lan d s e tc I f th e se nso ry n erve s o f

,
‘
, ,
.

o n e l ater al h al f o f th e b o dy a r e stim u l ated as by p ri c ki n g ,

with n eed l e s th e te mp e r at u re o f th at h alf Of th e b o dy

,

wi ll b e high er th an th e o th e r thu s d em on str ati ng t hat ,

'

e x c e ss ive s tim u l ati o n o f se n s o ry n erve s e n d s i n vaso '

dil ati o n i e 10 5 5 o f t o n e o f th e m u scu l ar c oat o f the bl o o d

,
. .
,
.

ve ss el s S i n c e e x c e ssive i e o ve r s tim ul ati o n o f s e n so ry

.
, . .
,
-

n erve s i n thi s e x p erim e n t c au se s i n hibiti o n o f v asc u l ar .

t o n e an d hyp er aemi a re s u lt s we arg u e th at any p r o c ed u re , ,

wh i ch l e ss e ns th e e x c e ssive am o u n t o f stim u l ati o n p ass

i n g to a v aso m o t o r c e n te r wi ll f av o r th e r et u r n o f th e
-
,

v ascu l ar t o n e Theref o re S i n c e it i s e asily dem o nstr ate d

.
,
 PRI N C I PL E S O F O S TE O PA TH Y 3 63

th at di g it al p re ss u re l e s s e n s p ai n an d s e n s itive n ess i n th e
are a pre ss e d u p o n we k n o w th at th e regi s te ri n g p o wer o f
,

th e s e p eriph er al nerve s i s de c re a se d an d th e re re su lt s a ,

better v asc u lar t o n e i n th at are a .

O v e r sti m u l ati o n E qu als I nhibiti o n

- — —
If o ver s ti m u la .

ti o n re su lt s i n i n hibiti o n o f v as c u lar t one a s the ab o ve e x ,

p e r i m e n t s eem s to dem o n s tr ate the n it a pp ,

e ar s r ati o n a l to

de c re ase th e— sti m u lati o n to a p o i n t wh ere v asc u lar t o n e

“
\

i s ri o t di s t u rb ed Digit al p re s su re d o e s de cre as e th e ir
.

r it abi li t y ; th eref o re w e m a y e x pre s s o u r s e l ve s a s f o l l o w s

I n hibiti o n o f s e n so ry n erve s i n s ki n an d m u s cle whi ch

, ,

ar e o ver s tim u lated

-
wi ll f av o r th e ret u r n o f v as cu lar t o n e
,

i n all are as whi ch ar e S u pp l ie d with n e r v e s fr o m th e s am e

'

s e m e n t o f th e co rd
g .

O ver stim u lati o n o f s e n s o ry n erve s c au s e s v ascu lar

-

di lat ati o n I n h ibiti o n l e ss e n s th e irrit abi lity o f s e n so ry

.

'

n e r v e s an d h e n c e d e c re as e s th e n u mb er o f s ti m u l i re ach

i n g th e v aso m o t o r c e n ter s
-
th u s allo wi n g a ret u r n o f v as
,

c u lar t o n e
—
.

The G uide f o r t e U s e f nhi biti o n

h o I K n o wi n g th e
co mp l et e di strib u ti o n o f any n erve tr u n k we m ay j u dge ,

th e c o n diti o n o f th e i n ter n al str u ct ure s su pp l i e d by o n e ,

o f i ts br an ch e s by the phy s i o lo gi c al ac tivity o f su rfac e

,

ti ssu e s su ppl i ed by o th er s o f i ts b r an ch e s In thi s w ay

,
.

we ar e g u i ded as to o u r u se o f i n h ibiti o n .

P atho l o gi c al Chan g e s W hi ch Acc om pany O v e r sti m u -

l ati o n — If an i n divi d u al e at s a h e arty m e al an d b ef o re it i s ,

dige sted e at s an o th e r an d co n ti n u e s th e p r o c e s s th e sti m u

‘

, ,

lati o n o f th e s e n so ry n erve s i n th e m u co s a o f hi s dige s tiv e

vi sc er a r e su lt s i n a phys i o lo gi c al hyp er aemi a w hi ch u n de r ,
.

th e c e as e l e ss stim u lati o n o f th e p re s e n c e o f f o o d fi n al ly ,

b e co m e s c hr o n i c The l iver be c o m e s hyp er aem i c an d i ts

.
,

s e n so ry n erve s a r e s tim u late d by th e i nc re as e d am o u n t o f

bl o o d pre s e n t i n th e cap i llarie s

.
Th e s e s e n s o ry n erve s
.

do n o t re gi ste r th ei r i mp re s si o n s o n th e s e nso ri u m o f th e
'

'

b r ai n bu t do e x c ite th at are a o f th e S pi n al co rd w ith whi ch

,

th ey ar e c o n n e c te d by m e an s o f th e r am i co mm u n i can te s -
.
364 PRI N C IPL E S O F O S TE O PA TH Y

Thi s re a o f th e spi n al co rd lie s betwee n the s i x th an d

a

te nth d o r sal s pi n e s F r o m th i s are a n erve s p ass to th e

.
,

d ee p m u sc le s o f th e b ac k The s e m u scl e s ar e e x c ited to .

u n d u e c o n tr ac ti o n an d th ei r s e n so ry n e rve s ar e th ereby
, ,

m ade s e n sitive The capi llary c ir c u lati o n i n th e s e m u scl e s

.
‘

is poo r th ereby i n c re asi n g th e m u scu lar se ns itive n e s s

, .

Thi s m u s c u lar se n s itive n e ss o r r ath er i n c re as e d stim u la ,

ti o n o f th e s e nso ry e n di n g s i n th e m u sc l e s s e n d s a n e w
se t o f i m
,

p u ls e s to th e sam e are a o f th e spi nal c o rd s i x th ,

to th e te n th d o r sal an d th e c o rd refl e x e s th e m b ac k to th e
‘

symp ath eti c s y s te m Th u s a fig u re 8 i s f o rm ed with th e

.

u n i o n o f th e c i r c l e s repre s e n ti n g the spi n al co rd W ith .

imp u ls e s e n t eri n g th e co rd fr o m b o th lo o p s symp ath eti c ,

an d c e reb r o s p i n al -
th e c o rd it s e lf b e co me s hyp er aem i c
, .

The c o n st an t i n ter c h an ge o f refl e x e s wh i c h were o r 1g 1n ate d

by e x c e s s ive dem an d s o n th e phy si o lo gi cal activity o f th e
ti s su e s i nv o lve d either e n d s i n a s p asm o di c eff o rt o f n a
,

t u re to ri d it s e lf o f th e i n t o l er abl e c o n diti o n by m e an s o f ,

“
a bi l i o u s s p e ll o r th e hyp er ae mi a c au se s e x c e s sive s e c re
,

ti o n o f m u c o us hyp ertr o phy o f c o n n e c tive ti ss u e an d

, ,

atr o phy o f p are n chym at o u s ti ss u e The bi li o u s s p e ll i s .

’
n at u re s safety v alve .

R ati onal Tr e atm e n t —

.

Afte r su c h a co n d iti o n a s we
.

h ave de sc rib ed i s wel l e st ab li sh ed di eti n g m ere ly l e ss e n s ,

th e refle x e s in th e symp ath eti c p o rti o n o f o u r fig u re 8 .

The refl e x e s i n th e c erebr o spi n al p o rti o n ar e s ti ll ac tive -

,

be c au s e th e d eep m u scle s o f th e b ack h ave b e c o m e c h r o n

i c ally c o n tr ac te d an d c o n ti n u e to o ve r s ti m u late th e se n
,
-

s o ry n erve s Th e s e c erebr o spi nal refl e x e s sti ll he lp to

‘
-
.

m ai n t ai n th e hyp e r aemi a o f th e s pi nal c o rd wh i c h co n ,

ti n ne s to d i st u rb th e rhyth m o f th e symp ath eti c M an i

'

fe stly th e tre atm e n t m u st co n sid e r b o th p o rti o ns o f th e

,

fig u re 8 Di eteti cs wi ll l e s se n to s o m e e x te n t the hype r

.

activity o f th e symp ath eti c lo o p D igit al p re s s u re i nhibi .

,

ti o n wi ll re lax th e spi n al m u scle s an d le ss e n th e hyp e r

, ,

ac tivity o f th e c ereb r o s pi nal lo o p The tw o li n e s o f tre at

-
.
'

m e nt wi ll d e c re as e th e n u mber o f s ti m u li e n teri n g th e
3 66 PR I N C I P LE S O F O S TE O PA TH Y

co n n e cti o n with it Th eref o re if we aff e ct th e t o n us o f

.
,

b o th s ke let al an d i nv o l u nt ary m u s c le s s e n sati o n i n th e

‘

"
c e reb r o s pi n al an d symp ath eti c s y s tem s
-
we c e rt ai n ly af ,

fe c t th e c alibe r o f blo o d ve s se l s an d th e activity o f s e c re

‘

t o ry an d e x c ret o ry g lan d s .

I t is n o t to o m u ch to say th at i nh ibiti o n d o e s n o t de
c e i v e c o n sc i o u s n e ss by l e s s e n i n g the p o wer o f regi s teri n g
n e rve s b u t d o e s st o p a s t o rm o f refl e x e s wh i ch h ave n o
,

rep arative te n de n cy an d th at it d o e s aff e ct th e are a o f lo w

,

s e n s ibil ity as i s evi d e n c e d by a c h an ge i n th e c o n diti o n

,

o f i ts m u s c u lat u re bl o o d s u pp ly a n d se cret o ry activity

, .

Th e re ar e m an y o s te o p ath s w ho c o n te n d th at th e key
n o te o f all m an ip u lative w o rk ac co rd i n g to o ste o p a th i c ,

p ri n cip l e s i s the di sco v ery an d rem o v al o f a l e s i o n

,
“ ”
,

o ss e o u s i n c h ar ac te r With thi s i de a c arri e d to e x trem e

.
,

th e au th o r has n o symp athy In co nn e cti o n with th i s .

i de a th e s t u de n t i s referre d to th e ch apte r o n S u bl ux ati o n ,

p age 2 8 3
—
.

The P hr ase R e m o v e Le s i o ns The ph r as e R em o ve .

”
L e s i o ns i s a g o o d o n e an d yet it i s i n e x act i n m any
I ,

c as e s . I t i s ah e las ti c ph r as e an d c ap ab l e o f many an d ,

v ari e d i n te rp ret ati o n s E ach ye ar o f active p r acti c e add s .

to th e o s te o p athi c id e a o f wh at l e si o n s ar e O u r l iter a .

t u re c o n t ai n s m any refe re n c e s to l e si o n s wh i c h ar e n o t
m e nti o n e d i n D r S ti ll s writi n g s an d yet D r S til l s b as i c
.
’
,
.
’

w o rk has m ad e th e l ate r co nc epti o n p o ss ibl e

. Oss e o us .

l e s i o n s h ave alw ay s b ee n p ar am o u n t i n o u r w o rk an d
tho u ght bu t m u s c u l ar l e s i o n s no w h o ld an eq u al p lac e
, ,

an d bi d f ai r to l e ad wh e n we se e m o re cle arl y i n t o th e
,

s u bj e ct .

The H um an B o dy Is a Vit a l M e c an i s
h m — W e say .

th at wh e n th e anat o mi c al i s ab so lu te ly co rre c t th e phy s i ,

”
o l o gi c al p o t e n ti ate s Thi s c o n c epti o n is b as ed o n th e
.

st atem e n t th at th e h u m an b o dy i s a m ac hi n e The h u m an .

b o dy i s v ast ly m o re th an a m ach i n e I t i s a vit al m e ch .

~

an i sm an d th e f ac t th at it i s v it al re n d er s it su s c eptibl e
, ,

to o th er i n fl u e n c e s be s i de s m e ch an i c al s u ch as f all s twi st s , , , .
 PR I N C I PL E S O F O S TE O PA TH Y 36 7

t i
s ra n s , et c We m ay tr u th f u lly s ay th at wh e n th e
.

phys i o lo gi c al i s o ver ac tive th e an at o mi c al alig n m e n t is

-
,

di sarr an ged The p ri n c ip le s o f o s te o p athy as th ey were

.
,

fir s t p r o m u lg ated d e c lared th at a str u ct u r al defe c t i s at

,

th e b o tt o m o f every phy si o l o g i c al d efe ct S tr u c t u r e al .

w ay s aff e ct s f u n cti o n A s u ffi c i e n t n u mb er o f c as e s were

.

fo u n d to give a f o u n d ati o n o f f ac t to th i s s t atem e n t .

H asty re aso ni n g tri ed to m ake thi s an all emb r ac i n g pri n -

"
c ipl e, a p p li c abl e to ev e ry c as e o f di s e a s e O th e r s c h o o l s .

o f m e di c i n e hav e m ade s imi lar mi st ake s

'
'

The al lo p at hi c .

“
s c h o o l p r o m u lg ate d th e law o f co n tr ari e s The h o m e o
‘

Neit her
“ ”
p athi c s ch o o l h o ld s alo ft th e law o f si m i lar s .

o f th e s e ar e l aw s A law i s ab so l u te n o e x c epti o n s ar e
.
,

.
—
t o ler ated I f th ere ar e any e x c epti o n s to a so c all ed law
‘

it c e ase s to be a law .
.
.

O steo pathi c M e ani n g — By th e term in o f Inhi b it i o n .

hibi ti o n we do n o t attempt to c o n vey any o the r m e an i n g

,

th an th at o f pre s su re app l i ed at s o me p ar ti c u lar p o i n t o n

,

the su rf ac e o f th e b o dy fo r th e p u rp o s e o f l e ss e n i n g th e ,

hy pe r ac tiv ity o r hyp er ae s th e s i a o f th e imm e di ate o r s o m e

,
_ .

, ,

di st an t p art o f the b o dy The i n h ibiti o n it se lf d o e s i n so m e

‘

c as e s rem o ve wh at we m ay ch o o s e t
r

o c al l a l e mo n l n o th er ,

ca s e s it m ay make th e re m o v al o f a l e s i o n p o ss ib l e bu t
'

i n th e m aj o rity o f c as e s, i ts e ff e ct i s p u re ly o n th e n erve s ,

th e r eby acti ng On b o th th e m o t o r an d s e ns o ry p o rti o ns

o f th e refle x ar c l e s s e n i n g mus c u lar c o n tr ac ti o n an d p ai n
, .

T he S ci e nti fi c Us e Of I nhi bi ti o n . .
—It has b e e n p r o ve n
m any time s th at th e o s t e o p ath i s cap abl e o f ch e c ki n g e x .

c e ss w e f u n c ti o n al ac tivity i n vi s c er a by th e s imp l e m e an s

o f i n h ib iti o n S o m e w o u l d q u ibb l e as to th e c au s e o f th i s
.

ac tivi ty . The o rigi n al s tim u lu s m ay h ave di sapp e ar e d ,

bu t the refl e x e s whi c h it i n iti ate d m ay b e p erp et uati n g

"

th e c o n di ti o n M any c as e s h ave b ee n tre ate d in wh i ch n o

.

d efin ite c au s e o r o s se o us le s i o n c o u l d b e di s co ve r ed S o m e
’

o f th e s e c as e s c am e u n der th e h e adi n g I n di sc reti o n s o th e rs

u n de r p u re ly m e n t al c o n diti on s Th e s e ca s e s were tre ated .

368 PR I N C I PL E S O F O S TE O PA TH Y

by i nh ibiti o n b as ed o n a k no wl edge o f th e an at o my an d
,

phy si o lo gy o f th e p art s i nv olve d The tre atm e n t w as.

s u cc e s s f u l
. We ar e su re th at su ch su cc e ss e s ar e j u s t as
gr atifyi n g j u s t as sc ie n tifi c as ar e th o s e in wh i ch th e fi n d
, ,

i n g an d red u c i n g o f a s u bl u x ati o n bri n g s th e g lo w o f tri

u mph to th e eye o f p ati e n t an d phy s i c i an alike .

I nhibiti o n as a L o cal An ae s t he ti c —I nh ibiti o n i s a lo c al .

anae sth eti c ,

an d as s u c h i s b ei n g u s ed u n iver sally i n the
,

o ste O pat hi c p r o fe ss i o n t o d ay Tr u e it i s n o t a tre atm ent

.
,

wh i c h wi ll s e c u re re s u lt s i n a mi n u te We c an h o t i n
'

hi bi t fo r five m i n u t e s at th e eighth do r s al s pi n e i n a cas e ,

o f m alari al feve r an d e x p e c t to ch e c k th e c hi ll
,
The chill .

c an s o m eti m e s b e co n tr o l l ed as l o n g as t he i n h ibiti o n i s
m ai nt ai n ed The i n fl u e n c e th u s g ai n e d o ver th e m u sc u lar
.

to i n c re a
’
c o n tr ac ti o n s s e em s se th e p ati e n t s re si st an c e .

The o n s et o f th e n e x t ch i ll u s u ally sh o w s a de c re as e i n
th e i n te n s ity o f m u s c u lar c o n tr ac ti o n an d th e d u r ati o n ,

i s sh o rte n e d . NO o n e w o u l d say th at we rem o ve a phy s i cal

l e s i o n by th i s tre atm e n t o r th e cau se o f th e chill M u s
, .

c u l ar co n tr ac t i on o f th e d eep d o r sal m u sc le s co m e s o n
with the ch i ll bu t d o es n o t cau s e it S u rely i n h ibit io n i n
, .

th i s c as e w o rk s a n erv o u s ch an ge o f a p r o n o u n c ed c h ar
ac te r.

A n e x amp l e o f the g o o d re s u lt s o f i n h ibiti o n is af

’
f o rde d by o n e o f th e au th o r s c as e s W o m an fifty ye ar s .
,

’
o f ag e ,
s u ff ered fr o m di arrh o e a t w o ye ar s d u r ati o n
, F ive .

to s eve n b o we l m o vem e nt s d ai ly No f o rm ed fe c e s . .

U su ally th e st o o l s we re typh o i d i n ch ar ac te r U teri n e .

fibr o id rem o ve d p ri o r to deve lo pm e n t Of di arrh o e a H i s .

t o ry o f co n ti n u o u s d r u g tre atm e n t O ste O pathi c e x am i na

.

ti o n di d n o t reve al any o ss e o u s le si o n Th ere s e emed to .

b e n o th i n g to lay th e b lam e u p o n e x c ept th e o n c e e x i ste nt

,

fib r o id o r th e re su lt o f th e o p er ati o n S i n c e n o d efi n ite
,
.

l e s i o n e x i sted th e tre atm e n t w as pl ann ed as a te st o f i n

,

hibi ti o n with o u t any o th e r m eth o d At th e e n d o f th ree

.

m o nth s th e p ati e nt had bu t o ne m o vem e n t d aily an d th e ,

3 70 PRI N C I PL E S O F O S TE O PA TH Y

e x c r u ci ati n g p ai n in th e sid e I t w as a case o f dry pl e u

.

r i sy . S te ady i nh ibiti o n w as give n fo r fifte e n m i n ute s be ,

twe e n th e tran sve r s e p r o c e s se s o h th e right s i de i n th e ,

are a b etwee n th e th i rd an d th e s eve n th d o r s al vertebr a e .

A fte r thi s l e ngth o f ti m e th e p atie nt co u l d r ai s e the righ t

ar m ab o ve th e h e ad an d t ake m u ch b ette r i n spir ati o n As .

a re su lt o f thi s tre atm e n t give n twi c e p er da th e p ati e nt

y ,

m ad e a g o o d re co v ery th o u gh all th e m et ab o li c p r o c e sse s

,

we re carri ed o n in a ve ry u n sati s f act o ry w ay .

In hi biti o n P r e par ato r y Tr e at m e nt—There i s s ti ll

as a

an o th er tim e wh e n i n h ibiti o n i s O f i n c al c u l ab l e v al u e : In
’

m aki n g e x ami n ati o n o f th e v agi n a o r re ct u m e s p e ci ally ,

th e f o rme r S ev eral ti me s in th e au th o r s pr acti c e e x am

.
,
’
,
,

i n ati o n o f th e v agi n a s e em ed i mp o s s ib l e with o u t g re at dis

,

tre ss to th e p ati en t The irrit ability o f th e m uco u s m em

.

br an e o f th e v agi na cau s e d i n te n s e sp asm o d i c c o ntr acti o n

o f th e sph i n c te r bu t ste ady i nhi bi ti o n i o v e r th e third an d
,
. .

f o u rth s ac r al f o r ami n a fo r ab o ut five m i n u te s c au s e d co m ,

p l e te re l ax ati o n an d
,
th e e x am i n ati o n c o u l d th e n be m ade

with o u t any t ro u bl e C as e s h ave b ee n rep o rted to th e

.

au th o r by m an y o s teo p ath s d e sc rib i n g th e g o o d re s u lt s o f

,

i n h ibiti o n i n gy n e c o l o gi c al c as e s Th e s e c ase s h ave r an ged

I

fr o m s i mp l e n erv o u s v agi n i s m u s to c u rettem e n t

'

S i nc e .
»

th e sac r al n erve s ar e so n e ar th e s urf ac e an d ar e no t i n ,

te r r u pte d i n th e ir c o u r s e to th e p elvi c vi sc er a th ey aff o rd ,

e xc el le n t Opp o rt u n ity fo r th e g o od e ff e ct s o f i nhibiti o n to

b e dem o n str ated .
 PR I N C I PL E S O F O S TE O PA TH Y 37 1
.

C H A P TE R XVI I I .

S OU NDS PR O D U C E D IN J O I NTS BY M ANI P UL A

TI O N .

No r mal S o u nds .
—
It im m o n to he ar p ecu li ar
s n o t u n co

so u n d s ac c o mpan yi n g th e no rm a l m o vem e nt o f j o i nt s The s e .

“ ”
so u n d s ar e i n di c at e d by p o p u l ar terms s u ch as c r ac ki n g
, ,

”
“
s n app i n g a n d T h ey a r e s o co m m o n th at eve ry
o ne has h e ar d th em eith er i n th eir o w n bo di e s o r th o se o f
,
-
,

fr ie nd s P u l li n g the fi n ger s is th e b e s t k n o w n m eth o d I t Is

. .

co m m o n ly s u pp o s e d th at s u ch a m eth o d i f p e r s i s te d , _

e n l ar g e the j o i n t s I t i s d o u btf u l wh eth er th e r e i s any pr o o f

.

o f thi s . D o ubt l e ss th e fe ar o f it o rigi nate d as an e ffo r t to

f r ight e n s o me o n e i n wh o m the p he no m e n o n w as e asily pr o
du c e d . L o o s e j o i nte d p eo pl e ar e abl e to p r o d u c e so u n d s in
m any j o i nt s by ec arryi n g n o rm al m o v em e n t s to th e li mit .

S c ar c e ly any m o v abl e j o i n t i n whi ch the lig am e n t s an d

,

m u scl e s ar e n o r m ally r e lax ed i s fre e f r o m th e p o ss ibilit y o f

,

p r o d u c i n g s o u n d w he n th e o pp o si n g m u sc le s ar e c o n trac ted
,

u n eve n ly 1 e , . eith er th e fl e x o r s o r e x te n so r s p red o m i n ati n g

.
,
.

The j o i n t s u rf ac e s wi ll sl i p u p o n e ach o t he r su d de n ly t hu s
.
,

pr o d u ci n g the s o u n d After ithas b ee n o n c e m ade i t is

.
,

r arely rep e ated wit ho u t th ere has b ee n an i n terv al o f re st ,

d u ri ng whi ch the m u s cl e s ch an ge th ei r te ns i o n The c rack .

i ng i n th e temp e r o m ax i llary arti c u l ati o n can be r e pe ate d

-

u n ti l the s t r u c t u re s ac h e b e c au s e it i s oc ca
,
s i o n e d by th e sli d ~

mg o f th e i nte r arti c u l ar carti lage o n to the emi n e n ti a ar ti cu

lar i s f The wri st an d sh o u l de r ar e ca p abl e o f pr o du cm g fr e
q u e nt so u n d s o n acco u n t o f the i i free m o vem e n t an d th e
, ,

many di r e cti o n s in w hi ch th e f o r c e i s appli ed .

3 72 PR I N C I PLE S O F O S TE O PA TH Y

A b no r m al S o u n d s — A large n u mbe r o f so u n d s wh i ch
o rigi n ate i n j o i n t s ar e ab n o rm al ; i e th e j o i n t s ar e n o t
. .
,

n o rm al o r e ls e th e s e p arti c u lar s o u n d s w o u ld n o t b e pro

,

du c e d S o m e o f th e se s o u n d s ar e f ami li ar to all phy si c i an s

. .

Th ey re s u lt fr o m f o r c e d m o ti o n ac tive ly o r p as sive ly m ade , ,

i n a j o i n t h avi n g li mite d m o vem e nt as a re su lt o f i n j u ry ; o r

‘

i ntr acap su l ar dep o sit s du e to d i s e ase ,

An o th e r c lass o f .

so u n d s i s p r o d u ced by f o r c e d m o vem e n t
. p ass ive i n j o i n t s , ,

h avi n g lo St s o m e o f th e n o rm al re lati o ns o f th ei r s u rf ac e s .

P at o o gy
h l o f J o i nt s P r o d u c i n g b n o r m al S o u n d s It
A — .

m ay b e we ll to re c ou n t sy s te m ati cal ly th e c o n diti o n s i n

whi chp ass i ve m o vem e n t o f j o i nt s p ro d uc e s so u n d s In th i s .

w ay we c an n o te th e di ff ere n c e b etwe e n th e c h ar acter s o f

s o u n d s u s u ally re c o g n ize d by phy s i c i an s and th o s e e s p ec i al ,

ly p e c u li ar to m an ip u lative tre at me n to f s u b lu x at i o ns .

S y n o vi al Adhe s i o ns — The br e ak in g o f adh e s i o ns be

.
’

twee n arti c u lar su rfac e s p r o d u c e s a so u n d c o mpar able t

'

o
th at o c c as i o n ed by th e b re aki n g o f a gre e n s ti ck i n whi ch ,

th e fiber s b re ak i n divi d u ally as th e f o r c e b ecom e s gre ater

'

"

an d gre ate r Sy n o vi al adhe s i o n s ar e du e to m any cau se s

.
,

th e s imp le st o f hzvhi ch ar e S light i nj u r y an d n o n u se o f a 1

. .
-

j o m t . A n i nj u ry s u ffi c i e n t to Cau s e Sl igh t eff o rt s at rep a i r -

,

wh e n acc o mp an i ed by re s t wi ll re su lt i n a few adhe si On s

‘

, .

V o lu nt ary m o v em e n t o f th e j o m t i s arre ste d by th e se adh e

si o n s S u c h co n diti o n s fre q u e n t ly f o llo w a S pr ai n o r th e
.
,

sp l i n ti n g o f a j o i n t j u s t ab o v e o r b e lo w a fr ac t u re The j o i n t .

m ay b e q u ite we ll but by ke epi n g it p erfe c t ly fi x ed d u ri n g

,

th e rep ai r o f th e fr actu re th e p eri arti c u lar s tr u ct u r es lOS e

,
'

th ei r el asti c ity an d a few adhe si o n s may f o rm with i n

,

No n u s e Of a S ig t y S pr i d J i t S o m etimes a
-
l h l a n e o n —
tim i d p er so n m ay be so fe arf u l o f m o vi n g a slight ly s prai n e d
'

j o i n t th at adh e si o n s f o rm an d c o n tr o l o f th e j o i n t i s l o st I
, .

w as re c e n t ly c alle d to e x ami n e a f o o t whi c h w as v ery p ai n ,

S eve n m o n th s p revi o u s ly th e an k le w as
'

fu l an d u s e le ss
'

.
_

s p r ai n ed The f o o t had n o t b e e n u s ed s i n c e th at i n j ur y I
. .

fou n d th e f o o t sti ff co l d an d re sti n g o n api ll o w E x ami n a

,
.

ti o n r e v e ale d slight m o ti o n wh i ch se em ed to be limit ed by

3 74 PR I N C I PLE S O F O S TE O PA TH Y

s on of
i th e j o i nt By t aki n g th e le g betwe e n my k n ee s an d
.

m aki ng th u mb pre s su re o n th e p ai n f u l pr o mi n e nt sp o t the n ,

ge n tly fl e x i n g an d s light ly r o t ati ng th e tibi a o n th e co n dyl e s

o f th e fem u r f o llo we d by q u i c k e x te n s i o n a di s ti n c t so u n d
, ,

w as e l i c ited an d th e acti o n o f th e j o i n t w as r es t o re d
, The .

so u n d i n di c ate d rep lac em e n t o f th e c arti lage

Bo n e S etti n g —It has b e e n s u pp o s e d th at m u c h o f

.

“ ”
.

th e w o rk o f o st eo p ath s co n s i ste d i n br e ak i ng a dhe sio n s ,

wh i c h we re si mp l e e n o u gh bu t h app e n e d n o t to h ave b ee n ,

s tri c t ly atte n d e d to by th e su rge o ns Th e re i s m u ch ch an c e .

to m i s i n te rp ret th e w o rk o f th e o ste o p ath s i n red u c i n g s ub

l u x ati o n s M e di cal m e n o f e stabli she d s cho o ls o f m edi c i n e
i

h ave fai le d to c l o s ely an alyze th e str u ct u r al c o n diti o n o f

.

j o i nt s b ef o re an d after m an ip ul ati o n he n c e th ey h ave j u mp ed ,

to th e c o n c lu s i o n th at all o f o u r w o rk w as o f th at ki n d c all e d
“
b o n e setti n g fo r Wan t o f a b e t
”
ter de scriptive te rm Thi s .

app el lati o n ,b o n e setti n g i s a p o p u l ar o n e fir s t u se d i n

, ,

E n gl an d to de sc rib e t he w o rk o f i n divid u al s u su all y u n ,

ed u cated w ho tre ate d p ati e n t s by m an ip u l ati o n o f j o i nt s

, ,

wh i c h th ey sai d we re o u t Q u i c k f o r c ef u l m o ve me nt s in th e
.

di re cti o n o f n o rmal j o i n t acti o ns u su al ly re su lte d i n a po p ‘ f‘

” “ ”
pi n g s o u n d Wh e n th i s o ccu rre d th e b o n e sette r c o ns i d
.

e re d hi s w o rk ac co mp li sh e d .

H i st o r i cal R e fe r e nce —As id e fr o m adhe s i o n s th e c o n di

.

ti o ns W hi ch we fi n d lim iti n g th e m o ve m e n t s of j o i n t s ar e
su bl u x ati o n s Wh art o n P H o o d M D
. . f u r n i sh e d
,
. .
,

th e L anc et a de s cripti o n o f wh at w as co m m o n ly call ed

“
b o n e setti ng H i s arti c l e s were p u b li sh e d i n th at j o u r n al
.

M ar ch an d April 18 7 1 The arti cl e s were p u bli sh e d i n b o o k

, .
“

f o rm th e sam e ye ar e n titl e d O n B o n e S et ti n g ( S o Ca
“
, l l ed )
an d Its R el ati o n to th e Tre atm e n t o f J o i n t s C ripp l e d by In
”
j u ry R h e u m at i sm I n fl amm at io n E tc D r H o o d m ade
b o n e s etter —
. .
, , ,

c lo s e o b s erv ati o n s o f th e w o rk o f a
“
M r H ut .

to n Thi s ge n t l em an s o u ght to te ac h D r ; H o o d hi s art as a

.
h

m atte r o f gratit u de fo r p r o fe s si o nal atte nti o n give n hi m by

D r P ete r H o o d In th e p age s o f thi s b o o k I fi n d a c l e ar
. .
,

’
c o n c i s e e x p o s iti o n o f th e b o n e setter s ar t t o geth er wit h a ,
 PR I N C I PLE S O F O S TE O PA TH Y 3 75

re co r d o f th e o b serv ati o n s o f th e au th o r w ho has th e adv an ,

t age o f e x c e lle n t tr ai n i n g in th e m edi cal art s Th ere i s n o .

d o u bt i n my mi nd as to th e s im il arity e x i sti n g b etwe e n th e

”
co n diti o n s whi c h were re c o g n ized by s o call e d b o n e s etter s -

an d th o s e w ho h ave f o rm e d th e b as i s f o r th e su c c e ss f u l ad

van c em e n t o f o ste o p athy The di ff ere n c e l ie s p ri n c ip ally i n

.

th e ed u cati o n al q u alifi cati o n s D r H o o d n o te s th at th e m an

. .

i pu lati o ns w e r e m ad e with o u t any k n o w l edge o f anat o my an d

phy si olo gy bu t were n everth e l e s s ast o n i sh i n g ly su cc e ss f u l
,
.

and h e c al ls atte n ti o n t o th e f ac t th at m u c h gre ate r su cc e s s ,

with l e s s p r o b abi l it y o f 1 nj u r y o u ght to re su lt fr o m th e s e

,

m an ip u lati o n s wh e n the tr u e p ath o lo gy o f th e j o i n t i s u n der

,

st o o d ; i
. e wh e n th e o p erat o r is i n f ac t a tr ai n e d s u rge o n
.
, ,

th o r o ugh ly ver s ed i n th e det ai l s o f anat o my D r H o o d e vi . .

de ntly di d n o t u n d er st an d th e co n diti o n s whi ch we re c o g

n ize as su bl u x ati o n s o f th e rib s an d ver tebr ae alth o u gh he ,

came very n e ar t o it as y o u wil l o b s e r ve here afte r

, H i s at .

te nti o n w as pr 1n c1pally fi x e d o n th e c o n diti o n s f o ll o wi ng

‘

gre ate r o r l e s s er d egre e s o f j o i n t i n fl amm ati o n re s u lti n g i n ,

i n tr a¥ar ti cu lar adhe s i o n s o r e x tr a—arti c u l ar co n tr ac ti o ns In .

th e cas e o f adhe si o ns bre aki n g th em caus e s a so u n d w hi ch

‘

can n o t be re pe ated bu t su bl ux ati o n s may o cc u r r ep e ated ly

,

i n the sam e j o i n t e ach r e du cti o n cau s m g a so u n d

, .

Tar sal and Car pal S u blux ati o ns —In D r H o o d s ch ap

‘
’
.

ter o n p ath o lo gy I fi n d th e fo llo w m g : S u b lux ati o ns o f tar

,

sal an d c arp al b o n es m u s t o cc u r I thi n k i n a c o n s ider abl e , ,

n u mb er o f i n s t an c e s I m e an by s u b lux ati o n s so m e dis

.

.
,

tu r ban ce o f th e p r o pe r rel ati o n s of a b o n e with o u t ab so l u te

di spl ac eme n t an d I b e l i eve th at s u ch di st u rb an ce m ay b e
,

p r o d u c e d eithe r by th e tr acti o n o f a b an d o f adh e si o n ab o u t

th e j o i n t s or by a twi st o r o th er dire c t vi o l e nc e
, G r an t the .

p o ss ibi lity o f su b lu x ati o n i n th e arthr o d i al j o i n t s o f th e c ar

pu s an d t ar s u s it i s n o t imp r o b ab l e to c o n c eive o f th em i n
,

“ ”
any o th er j o i n t As a p u re e x amp l e o f b o n e s etti n g
. o ne ,

o f my re c e n t c as e s i s ap r o p o s A lady stepp e d o n s o m e small

.

h ard o bj e ct th e p o i n t o f co nt act bei n g j u st u n d er t

, he i n step .

S h arp p ai n lo c alized o n to p o f th e i n step beg an at o n c e an d

, , ,
3 76 PR I N C I PL E S O F O S TE O PA TH Y

w as no t rel ieve d by h e at o r o th e r antiphl o gi s ti c m e as u re s .

F o rty eigh t h o u r s afte r th e o n set o f p ai n I w as c al led to

-
,

e x ami n e th e f o ot
'

F o u n d s o m e swel li n g o ve r th e i n step
.
,

bu t p alp ati o n l o cali z e d th e pa1n 1n th e arti cu l ati o n b etw ee n

th e scaph o i d an d i n ter n al c u n eif o rm Any attempt at l o c al .

m o vem e nt o f th i s j o i nt cau sed sh arp p ai n The p ati e nt co u l d .

n o t s t an d o n th e f o o t o n a cc o u n t o f th e p ai n wh i c h w as i n
, .
,

c re as e d th ereby . E x te n si o n o f th e f o o t with firm pre s su re

'

o n th e u pp e r si de o f th e arti c u l ati o n c au s e d a very l o u d

,

so u n d th e p r o mi n e n c e o f th e s c aph o i d w as n o t so app are n t

, ,

an d th e p ati e n t co u l d pu t h er weigh t o n th e f o o t im m edi ate

ly. Thi s w as a c as e o f t ar sal su bl ux ati o n I f th e sam e d e .

gre e o f di spl acem e nt had e x i ste d in a ve rtebr al arti c u l ati o n

.

th e e ff e c t o n c ir cu l ati o n i n th e n erve c e n ter s o f the co rd

m ight h ave c au s e d very wid e sp re ad sympt o m s .

The s u bl u x ati o n s tre ate d by b o n e s ette r s h ave u su al

“ ”

ly b e e n t ho s e whi ch o ccas i o n ed p ai n i n th e j o i n t The o s te o .

p ath d o e s no t dep e n d u p o n p ai n as a sympt o m o f su bl ux a

ti o n but m ake s p alp ati o n th e tr u e g u i de
—
, .

E nar t hr o di al an d A r thr o di al J o i n t s Wh e n th e h e ad
of th e fem u r i s f or c e d o u t o f the a s c e tabulu m th ere i s m o re ,

o r l e s s te ari n g o f lig am e n t s with c o n s e qu e n t i n fl am m ati o n

,
.

R ep lac em e n t o f th e h e ad i s n o t acco mpl i she d with o u t a di s

ti n ct so u n d The so u n d i s c o n si dered as au dibl e evi de nc e o f
.

s u c c e ss f u l op e r ati o n The sam e i s tr u e o f the sh o ul d er j o i nt

. .

The gre at r ange o f m o vem e nt i n th e se j oi n t s n e c es sarily r e

q ui re s lax lig am e n t s th eref o re gre at sep ar ati o n o f th e j o i n t
,

The arth r o di al j o i n t s i nall p art s o f

-

s u rf a c e s i s po ssib l e .
,

the b o dy ar e co n s tr u c ted o n a diffe r e n t p ri n c ip l e The r an ge

'

.
,

o f m o ve m e n t i s n o t gre at i n th em an d th eir lig am e nt s ar e

,

co mp ar atively sh o r t The f o rm o f th e b o dy s u rf ac e s o f th e
.

arth r o di al j o i n t s d o e s n o t l imi t m o ti o n , as i n th e c as e o f e n

arthr o di al j o i n t s .

R ep lac em e nt o f th e h e ad o f th e fem u r o r hu m er u s re
ire it m ve ve r ri dge f b on e o r c artil age an d w h e
q u s t o o o a o n ,

it s i nk s su d d e n ly i n t o i ts p r o p e r pl ac e a so u n d i s h e ard . ,

P r o b ably th e s o u n d whi ch ac co mp an ie s th e red u c ti o n o f a

 P R I N C I PLE S O F O S TE O PA TH Y
‘

3 78

’
ve n t o f o ste o p athy we q u o te a p o rti o n o f D r H o od s ch ap
, .

te r o n Affe cti o ns o f th e S pi n e .

“ ”
Aff e c ti o ns o f the S pi ne D r H o od I fe ar it m u st
, . .

b e adm itted that th e gre at i mp o rt an c e o f th e spi nal co rd ,

an d th e gr avity o f i ts di se as e s h ave r ath er te n de d to m ake

,

p r o fe ssi o nal m e n o verl o o k th e o sse o u s an d l ig am e n t o u s cas e

by whi ch it i s e nc l o s e d an d wh i ch is li abl e to all th e m ala
,

di e s that bef al l b o n e s an d l i g am e n t s el s ewh ere The q u ac k

'

.
,

o n th e o th er h an d w ho pr o b ably n ever h e ard o f th e s pi nal

,

c o rd re c o g n ize s th e p re s e n c e o f str u c t u re s with whi c h h e i s

,

fami li ar an d de al s with th e m as h e d o e s i n o th er s it u ati o n s

, , .

The re su lt i s m u ch the s am e as in th e hi p j o i n t The q uac k .

every n o w an d th e n c u re s co n diti o n s wh i ch th e au th o riz ed

p r actiti o n er had reg arded with a so rt o f rev ere nc e be c aus e
“ ”
th ey were s pi nal ; and h e every n o w an d th e n kill s a pa
ti e n t be cau se thi s reve re n c e di d no t e x i s t fo r hi s pr o te cti o n .

I f th e p r o fe s si o n ge n e r al ly wo u l d s o s t u dy th e di s e ase s o f th e
s pi n al co rd a s to re sc u e th em fr o m s p e c i al i st s th e fi r st s t
'

ep ,

w o u l d b e t ake n to w ard s re scu i n g th e di se as e o f th e verteb r al

c ol u m n fr o m q u ac k s
’

-
.

'
“ ” “
Cr i ck i n the Back H o wever th e m atte r m ay b e e x
.
,

pl ai n ed it i s q u ite c ert ai n th at m any p e o p l e n o w re sort to

,
“ ”
b o n e setter s co mpl ai n i n g o f a c r i ck o r p ai n o r we ak n e ss
,

i n th e b ac k u s ual ly co nse q u e n t u p o n so m e i nj u r y o r u n d u e
,

e x erti o n an d th at th e s e app li can t s ar e cur ed by m o vem e nt s

,

o f fl e x i o n an d e x te n s i o n c ou pl e d with p re ssu re u p o n any

,

p ai nf u l sp o t .

M an i pu l ati o n o f the Ne ck In a few cas e s M r H u

. t , .

to n w as c o n su lted o n acc o u n t o f s ti ff n e ss ab o u t th e n e c k o r
c ervi c al vert eb r ae an d h e th e n w as ac cu st o med t
, o s tr ai ghte n

th em . H is l eft f o re arm w o u l d b e pl ac ed u m
de r th e l o were d chi n o f th e p ati e n t with th e h an d co m i n g ,

r o u n d to th e b as e o f th e o cc ip it al b o n e The right th u mb .

wo u ld th e n b e pl ac ed o n any p ai n f u l spo t o n th e c ervi cal

'

s i ne an d th e chi n s u dd e n ly el ev ated a m u c h as s eem e d

p , s

to b e re q u i red A s far as my o b serv ati o n e x t

. e nd s the i h ,

s t an c e s o i thi s ki n d were n o t b o n a fi de e x ampl e s o f adh e

 PRI N C I PLE S O F O S TE O PA TH Y 3 79

F IG 1 51 . I ll u str ati o n f r o m O n B o n e Se tti ng b y W h a r

to n P H o o d 1 8 7 1
.

. .
,

i bu t g e n e r ally su ch as m ight b e attrib u te d to s light

'

s o n s,

m u scu lar r igi dity o r e v e n to so m e f o rm of i m agi nary m al

, s
;

ady . The b en efit g ai n ed w as pr o b ab ly r ath er du e to the

f the Op er ti d th e e ff e c t p r o d u c ed by it u po n th e
‘

p a 1 n o a o n an

m i n d Of th e p ati ent th an to any act u al ch an ge i n th e phy si

c al c o n diti o n c on c er n ed .

M an i pu lati o n o f the Back F o r th e lo wer regi o n s Of

.

th e sp i n e h e had tw o m eth o d s o f tre atm e n t di ff eri n g i n de

t ail but n o t in pr 1nc1ple In th e fir s t wh e n th e p ai n f ul sp o t
.
,

w as f o u n d th e p ati e n t w as m ad e to get o u t o f b e d an d to
.

s t an d f ac i n g i ts s i de with th e fr o n t o f th e l eg s o r p erh ap s
th e k n ee s—ac co rdi n g to th e h eight o f th e p atie nt an d th e
,

—
b ed ste ad p re s se d ag ai n st it S he w as th e n t o ld to b e n d
.

f o rw ard u n ti l th e b e d w as t o u c h e d by th e e lb o w s H i s left .

ar m w as th e n pl aced ac r o s s th e ch e s t an d th e th u mb o f ,

th e right han d u p o n th e p ai n f u l sp o t F irm p re s sure w as .

the n m ade with th e th um b an d as s o o n as he fe lt th at h e

,

had s ettl e d h im s elf i nt o s u c h a p o s iti o n th at h e cou l d o bt ai n

3 80 PR I N C I PL E S O F O S TE O PA TH Y

th e f u ll p o wer o f th e left ar m th e p ati e nt w as t o l d to assu m e

,

th e ere c t p o st u re with as m u ch r ap idity an d vig o r as she

co u l d c o m m an d . Th i s m o ve m e nt w as f ac i lit ate d an d e x
'

p e d i te d by th e th r o wi n g u p o f hi s l eft ar m an d th e Opp o s i n g
f o r c e o f th e right th u mb A s a r u le th ere se em e d to b e tw o
.

p ai n f u l s p o t s an swe ri n g to th e u pp er an d l o wer b o rd er o f
,

th e aff e c ted ve rtebr ae so th at th e m ano e u vre w o u l d re q u i re

,

to b e repe ated .

“
In th e s e c o n d m eth o d th e p ati e n t w as s e ate d i n a ch ai r
pl ac ed a sh o rt di st an c e fr o m th e w all s o th at th e fe et co u ld ,

b e firmly p re s sed ag ai ns t it S he w as t o l d to be n d f o rw ard

.
.

an d pl ac e h e r arm s b etwe e n h er l eg s with th e e lb o w s re st ,

i n g ag ai n st th e i nn er s i d e o f th e k n e e ; to si t firm ly o n th e
c h ai r an d at a giv e n sig n al to th r o w h er s e l f u p right
,
The .

Op er at o r p ass ed his l eft ar m u n de r th e ch e s t p lac ed hi s right ,

th u mb o n th e p ai n f u l s p o t an d i n o rde r to Obt ai n firm an d

, ,

re s i sti n g pre ss u re re s ted hi s e lb ow ag ai n st th e back o f the

‘
‘

c h ai r . The sig nal be in g give n th e o p e r at o r keep i ng hi s fi st

, ,

c l e n c h ed so as to s u pp o rt hi s th u mb s an d th e elb o w bei n g

h e l d firm i n i ts p os iti o n wh e n th e p ati e n t thr o w s h e r self

,

u p right re s i st s t
,
he app r o ac h o f h er b ac k to th e chair an d
be n d s h er h e ad an d sh o u l d er s as far b ac kw ard s as p o s sib l e ,

th e p o siti o n o f th e feet p reve nti n g any f o rw ard m o ve m e nt .

Tr e atm e nt o f U ppe r D o r sa l — “
Th e s e tw o m eth o d s ar e
.

u s ed fo r c as e s i n wh i c h p ai n i s p re s e n t i n th e d o r s al verte

br ae b e lo w th e eighth o r i n any o f th e lu mb ar The tre at

,
.

m e n t u se d fo r th e u pp er d o r sal an d lo we r c ervi cal verteb r ae

w as to plac e th e o p e r at o r s k n e e ag ai n st the p ai n f u l s p ot
’

'

an d with th e h an d s plac e d u po n th e s h o u l der s to draw th e

, ,

u pp er p art o f th e b o dy as far b ac k as p o s sib l e .

“
In cas e s wh e n p ai n w as c o mpl ai n ed o f i n th e d o r sal
an d l u mb ar regi o n an d th e b ac kw ard m o vem e n t s did n o t

affo rd th e req u ire d re l ief th e p atie n t w as m ade t

, o be n d sid e

w ay s an d a s imi lar p r o ce s s w as g o ne th r o ugh as i n the

,

o th e r m an ip u l ati o n s .

Comm e n t.
— “
A s a co m me n t ary o n all thi s th ere i s ,

m an ife st ly litt le to say e x c ept th at th e size o f th e vertebr al

,
 38 2 PR I N C I PL E S O F O S TE O PA TH Y

h o u r ; th e n h e felt a s ti ff n e ss an d n u mb n e ss at th e si de s an d
b ac k o f hi s h e ad and the b ack o f hi s n e ck with a f u ll n e ss in ,

th e th r o at an d di ffi c u lty o f sw al lo wi n g At fir s t h e had no
'

. .

l o ss o f p o we r o ver his l imb s o nly s ligh t p ai n d o w n h1s r i ght

,

ar m ; so m e d ay s after admi s si o n h o wever h e had p arti al , ,

l o ss o f p o we r i n th e right ar m whi ch sh o rtly re co vered ,

it s el f O n admi ss i on h e car r i e s hi s h e ad fi xed an d has p ai n

.
'

o n sl ighte s t att empt t o r o t ate fl e x o r e x te n d th e h e ad ; hi s

,
.

i p rti ly fi xed n d h e can n o t o p e n hi s m o u th wid e

j a w s a a l a ,

e n o u gh to ad mit o f a fi n ge r bei n g p asse d to th e b ack o f th e

p h a ry n x hi s ,
v o 1 c e 1 8 thi c k an d g u ttu r a1 ; d e g l u ti ti o n n o t at
te nd ed by any gre at u n e as i n e ss Co mpl ai n s o f all sympt o m s .

bef o re e n u m er ate d E x te r n ally o ver the spi n e o f th e se co nd

.
,

c e rvi c al ve r tebr a th ere i s a t u m o r h ard and re si sti n g bu t

, ,

te n de r o n p re s su re ; thi s i s evi d e n t ly f o r m ed by th e u n d u e
p r o m i n e n c e o f th e spi n e o f the ax i s it s elf ; the te n d er n e ss
i s n o t ge n e r al bu t c i r cu m s c rib e d ; th e p art s all ar o u nd ar e
,

n u mb .H e w as pu t o n hi s b ac k o n a h ard b e d hi s h e ad ,

w as s l ightly e l ev ated an d a s m al l san d bag w as p l ac ed

b e n e ath th e pr o j e c ti n g S pi n e and th e wh o l e h e ad m a1n ,

tai n e d i n a fi x é
-

H e w as
'

d p o s iti o n by large r san d b ag s .

o r dered p u lv D o v gr V ; hydr c c ret a ;

. . .
-

b i s d ie
. . .

Th is w as c o n ti n u ed fo r ab o u t te n d a ys Wh e n hi s gu m s ,

b e cam e aff e cted s light ly an d it w as th e n o mitted M arke d

“

,
.

1 m pr o v e m e n t ha s t ak e n p lac e i n hi s ge n er al app e ar an c e

an d m o re p arti c u l ar ly i n hi s sp e c i al s ympt om s H e co n '

. .

ti n u e d u n ti l J u ly 3 g r adu ally an d ste ad i ly imp r o vi n g He

‘

m
.
,

th e n had ac u te rh e u ati c i n fl am m ati o n o f the right k ne e

an d e lb o w j o i n t f o ll o we d i n a day o r tw o by a simil ar
,

s t ate i n th e l eft k n e e j o i n t Th ere w as n o evi de n c e o f a

.

py aem i c s t ate The j o i n t s were b li stere d ; h e has bee n

.
‘

tre ate d with po t n itr an d le m o n j u i c e an d i s n o w f as t r e

'

. .

co v eri n g The te n d er n e s s an d all th e sympt o m s h ave di sap

.

e ar e d th e p r o j e c ti o n s til l r e m a1n 1 n g an d h e e x pre s se s h im

p , ,

s el f m u c h re l ieved by t
’
he c o n ti nu ed re st i n b ed .

S iz e o f the V e r t e b r al C anal H ilt o n i n rem ark

.
.
,

i n g o n th i s c ase o b serve d th at it had b ee n dem o ns t rated t hat

,
 PRI N C I PL E S O F O S TE O PA TH Y 38 3

th e are a o f th e vertebr al canal might be dimi n i sh e d by o n e

th ird ,
p r o vi d e d th at th e dim i n u ti o n w as S l o w ly e ff e cte d ,

w ith o u t givi n g r is e to an y alarmi n g o r i n de e d m arked sy mp

to m s o f co mp re ss i o n o f th e c o rd .

C on se r vat iv e vs R adi cal Tr e at

. m e nt No w th ere can
.
,

be n o d o u bt th at m o s t s u rge o n s w o u l d agree th at Mr H i lt o n .

e x er c i s e d a so u n d di sc reti o n i n S imp ly p lac i n g th i s m an i n

c o n di t i on s fav o r abl e to re c o ve ry o r i n ke ep i n g hi m at re st
'

u n t il th e ax i s w as fi x e d i n i ts n e w p o s iti o n an d th e S pi n al

c o rd acc u s t o m e d t o th e ch an ge i n i ts re lati o n s Th ere can

.

be l itt l e d o u bt th at M r H u tt o n w o u l d h ave m ade th u mb

.

p re s s u re o n th e p r o m i ne n t s pi n e wh il e he s h arp l y r ai s e d
the h e ad . The p r o b abi lity i s th at h e w o u l d by thi s m ano e u
w e h ave c u red hi s p atie n t ; th e p o ss ibil ity i s th at h e m ight
h ave ki lle d h im Thi s so r t o f m ake a sp o o n o r s p o i l a h o r n
.
‘ ’

p r acti c e we m ay co n te n te dly l e ave to q u ack s an d with o u t ,

ri ski n g rep u t ati o n i n d o u btf u l c as e s I t

,
hi n k we m ay fi n d
.

a c o n s i d er ab l e n u mb er wh i c h ar e n o t d o u btf u l i n whi ch
,

S ki ll e d o b s erv ati o n m ay e x c lu de all el em e n t s o f d an ger ,

an d i n wh i c h th e r e c tifi cati o n o f di s pl ac em e n t o r th e r u p

t u re o f adh esi o n s wi ll b e c ert ai n ly f o llo we d by th e m o st

f av o r ab l e re s u lt s F o r th e di sc o very o f th e s e c as e s n o s e t
.

tle d r u l e s c an b e l ai d d o w n S i n c e th ey c an o n ly b e k n o w n
,

—
by n eg ati o n s by th e ab s e n c e o f th e sympt o m s th at w o u ld
give w ar n i n g o f d an ger The di ag n o si s m u st b e m ad e in
.

e ach i n st an c e fo r it s e lf an d i n e ach m u st d ep e n d u p o n th e
,

”
sag ac ity an d ski ll o f th e p r ac titi o n er .
38 4 PR I N C I PLE S O F O S TE O PA TH Y

C H A PTE R X IX .

P O S I TI O NS FO R E X AM I NATI O N

— The m eth o d o f e x ami n ati o n sho uld be

l

O b s e r v ati o n
'

'

s o m ewh at aff e c te d by o n e s getti n g a s e n s e Of th e i n divid u

’

al ity o f th e p ati e n t Th e re ar e
. m
an y th i n g s wh i c h o n e
s h o u l d be tr ai n e d to O b s e rve q u i c kly s u c h as th e p o s e an ,
d
m o vem e n t o f th e p ati e n t n u triti o n ch ar acte r o f the Ski n
, ,
’

Al l o f th e s e th i n g s give a s e n s e o f d ire c ti on to t he
'

et c .

e x ami nati o n i e O dd po se s c omp e ns at o r y m o v e m e n ts o r

'

, , , g
. .

c ach e x i as l e ad o n e to try t o dete rmi n e th e c au s e s o f t he se

‘.
very app are n t ab n o rm aliti e s M i n o r ph as e s o f th e se th i n g s
.

m ay e s c ap e o u r c u r s o ry g lan c e bu t i t i s u n wi s e to c o m
,

m e n c e any e xam i n ati o n with o u t fi r st d etermi n i ng th e

'

p r o b abl e r e g io n o r regi o n s e sp e c i ally re qu iri n g e xami n a

‘

ti o n Thi s do e s n o t m e an b ei n g p arti cu l arly g u id e d by

.

th e p ati e n t s o w n st atem e n t bu t r ath e r s e eki n

’
g to e xe n
’
c i s e o n e s p o wer s o f o b s e rv ati o n an d ded u c ti o n

We wi sh it d i sti n c t ly u n d er st o o d that w e ar e s tr iv .

h ere to e x p lai n a S p e c i al f o r m o f e x am i n ati o n w h i ch -

1n
-

g
i s o nl y a p art o f ge n er al d i ag n o sti c w o r k
‘
A n ex ami n a .

ti o n whi ch c o mp reh e n ds m ere ly th e u s e Of p alp ati o n w o ul d

’
give a lim ited u n d er s tan di n g o f a p ati e n t s ai lm e n t , bu t
si n ce thi s b o ok i s co n c e r n e d with e lu c id ati n g g r o u ps o f
ph e n o m e n a wh i ch c an q u ite c l e ar ly b e re c o g n ize d by pal
p a t i o n we
,
wi ll n o t u s e ti m e o r sp ac e t o de s c ribe o th er
.

c o o rdi n ate m eth o d s whi c h ar e ab ly t au gh t i n o th e r t e x t s .

In o rder t o be sy s te m ati c i n th e e x am m ati o n o f

p ati e n t s it i s we ll to ad o pt th e u s e o f a c ert ai n r o u ti n e o f
,

p o s iti o n s whi ch will be st sho w th e det ail s o f o ss e o u s str uc

t ur e .
38 6 PR I N C I PL E S O F O S TE O PA TH Y

l ate r al devi ati o n I f th e am o u n t O f fl e sh o ver the sp i n e s

. .

as i n fat p e o p l e p re c lu de s th e u s e o f th e s e n se o f s ight
, ,

y o u c an as c e rt ai n th e re lati o n by th e s e n s e o f t o u c h .

S e n se of To u ch — W e wi sh emph asize th e n e c e s sity

to
'

’
o f th e st u d e n t s acq u i ri n g th e h abit o f d ep e n d i n g o n th e

s e n s e Of t o u c h r ath e r th an o f S ight In all o ste o p ath i c

, .

e x am i n ati o n s th e s e n s e o f t o u ch sh o u l d b e u s e d to o bt ai n
,

th o s e d at a c on c er n i ng str u c t u re wh i c h f o rm th e b asi s o f all

di ag n o s i s R em emb e r th at y o u c an n o t se e b o n e m u s cl e s
.
,

an d g lan d s bu t y o u c an fe e l th em
,
.

I n sp e cti o n —Wh i l e th e p ati e n t i s sitti n g ere c t asce r

'

t ai n th e fl e x ibi lity o f th e S pi n al c o lu m n No te th e p o siti o n .

o f th e s c ap u lae wh eth er n e ar Or far fr o m the s p i n al c o l

,

umn wh eth e r u n eve n ly p lac ed

,
No te th e dev e lo pm e n t
.

Of th e tr ap ezi u s lati ss im u s d o r si an d e re ct o r spi n ae i e

, , ,
. .
,

Ob s erve th ei r s u rf ac e m arki n g s I f the p ati e n t d o e s n o t

.

v o lu n t ari ly re lax whi l e i n th e er ec t p o siti o n as k hi m to ,

as s u m e hi s n o rm al p o st u re Th i s w 111 i llu str ate th e p o i n t s

.

o f gre ate s t S p1n al s tre s s an d S h o w ho w th e s p i n al c o lu mn

act s i n i ts n o rm a
'
l wei ght c arryi n g cap ac ity .

ti o n o f the R ib s — Fi g 1 53 i llu str ate s a m eth o d

P al pa .

o f b r i n g i n g th e r i b s pr o mi n e n tly i n t o vi ew o r i n c as e o f ,

fl e shy p e r s o n s m aki n g it e asy to p alp ate th em By p ull

,
.
'

i n g th e ar m u p an d ac r o s s th e c h e s t th e lati s s i m u s d o r si ,

i s s tret ch ed wh i c h b ri n g s th e f o u r lo we r rib s i n t o a g o o d
p o siti o n fo r e x ami nati o n The m o vem e n t Of th e s c ap u l a
.

aw ay fr o m th e ve rteb r ae m ake s it e a si er fo r th e e x ami n er

to fe e l th e an g l e s Of the f o u rth an d fifth rib s I t i s n o t we ll .

‘

to d epe n d o n thi s p o s iti o n f o r evi d e n c e o f rib s u b l u x ati o n s .

b e c au se th e te n si o n Of th e lati s si m u s d o r si bri n g s at le ast

th e f o u r lo wer rib s i n t o p r o pe r alig n m e n t The S p aci n g .

o f th e se rib s wi ll th e n b e eq u al .

The ch i ef v alue o f th i s p o smo n i s to give th e e x am .,

i n er b ette r o pp o rt u n ity to p alp ate th e an g le s o f th e rib s

ab o ve th e n i n th an d to n o te th e c h an ge d re lati o n s whi ch
 PR I N C I PL E S O F O S TE O PA TH Y 387

F IG . 153 .
'

P o s i ti o n to t
a c c e n u a te th e p r om i n e n ce of th e ri b s .

m ay t ake p lac e at the an teri o r e nd Of th e . n In th . t e n th

e leve n th an d twe lfth rib s .

P alpati o n o f the S pi n e A fter g athe ri n g as m u ch i n

— .

fo rm ati o n as p o ss ib l e by Ob s ervi n g the f o rm Of th e b ac k ,

p o s iti o n Of th e s c ap u l ae an d c o n to u r Of th e m u sc le s e x ,
.

am in e the sp i n e by m e an s Of y o u r s e n s e Of t o u c h TO do .

thi s have th e p ati e n t si t ere c t b ei n g c aref u l no t to e x ag

, ,

g e r ate th e n o rm al p o s t u re i e b e n d the s,p 1 n.e f ar f

. o r
,

w ard O r b ac kw ar d i n t he lu m bar regi o n A m arke d te n

'

.
38 8 P R I N C I PL E S O F O S TE O PA TH Y

F IG . 154 . P a l p a ti o n oi th e Sp i n e i n th e t t
v e r i c al p o s i i o n .

de n cy to eith er p o siti o n i s i n di c ative o f we ak m u sc l e s .

U se th e i n d e x an d m i dd l e fi n ger o f eith er h an d to c are

f u l ly n o t e th e re lati o n s o i th e i n divi d u al vertebr ae as i n ,

F i g 1 54
. . Begi n at th e fi rst d o r s al an d w o rk d o w n w ard
to th e sac r u m L ater al s u b lux ati o n s ar e e as i ly n o ted with
.

th e p ati e n t i n th i s p o s iti o n G e n t le digit al pr es su re m ay

.

b e m ade at th e p r o m i n e n t side o f any su b lu x ated v ertebr a

to d etermi n e th e degre e o f s e n s i tive n e s s Thi s i n f o rm a .
390 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 156 . D i ag ra m of d o r s al m u s c le s , fi r s t, s e c o nd, thi r d a n d fifth

la ye r s .
 P R I N C I PL E S O F O S TE O PA TH Y 39 1

F IG 1 57 D i ag r am of d o r s al m u s c l e s— o u r th
f la ye r A dap t ed
fr g g
. . .

m m i n C u nni n h am s A n at o m y
’
o a di a ra .
392 PRI N C I PL E S O F O S TE O PA TH Y

wi ll b e ab le to di sti ng u i sh e asi ly betwee n th e s e ns e o f

m ere p re ssu re an d a p ai n f u l o r hyp er s e n sitive fe e li ng -
.

B egi n o nc e m o re at th e fir st d o r s al an d e x am i n e alo n g
th e si de s Of th e spi n e s and ab o u t th re e i nche s fr o m th em
'

Th i s s p ac e b ri n g s th e i n te r nal an d mi dd le gr o u p s o f i n
tr i n s i c m u s c l e s u n der y o u r fi n ger s .

E x tr i nsi c I t i i M
an d n r ns c . of the —
u s cl e sIn Back
'

sp e aki n g Of e x tr i n s i c an d i n tri n s i c m u s c l e s o f th e b ac k ,
.

we de s ire y o u to b e ar i n m i n d th e di ff ere n t gr o u p s as th ey
ar e n o te d i n G r ay s A n at o my
’
G r ay divi d e s th em i n t o
.

fi v e l aye r s The fi rs t th re e layer s ar e e x tri n si c i e ari s e

.
,
. .
,

fr o m ve rtebr ae an d i ns ert i n t o th e h u m er us scap u l ae o r , ,

rib s . Th ey d ep e n d u p o n th e i ntri n s i c m u sc l e s o f th e
f o u rth an d fifth layer s to fi x th e S pi n e s o that Op er ati n g
fr o m th e sp i n al co lu m n as a fi x ed p o i nt th ey c an m o ve ,

th e u pp er e x trem iti e s an d rib s .

Wh il e p alp ati n g a b ac k wh i c h is mo d er ately wel l m u s

c l ed, y o u wi l l b e abl e to fe e l th r o u gh th e u pp e r thre e
layer s an d di sti n g u i sh th e co n diti o n o f th e m u s c l e s o f th e
f o urth l aye r I t i s i mp o rt an t th at th e s t u de nt S h o u ld l e ar n
.

to fe el th r o u gh th e so ft ti s su e s to h arde r o n e s bel o w S ki l l .
!

i n dete c ti n g v aryi n g degree s o f de n sity an d h ard n e s s i s an

ab s o l u tely e ss e n ti al q u al ifi c ati o n o f th e di ag n o s ti c i an .

A c aref u l di ss e c ti o n o f th e f o u rth layer wi ll di sc l o s e

th e f ac t th at th ere ar e th ree p ar allel gr o u p s o f m u s c l e s .
‘

The fir st i s th e s p i nali s d o r s i wh i ch l i e s o n th e s i de o f th e
spi n e s . The s e c o n d gr o u p li e s m o re o n th e tr ans ver se
p r o c e ss e s The l o n gi ss i m u s d o r s i an d i ts c on ti n uati o n s
‘

m ake u p thi s gr o u p The s ac r o lu mb ali s an d c o n ti nu ati o n s

.
-

m ake u p the th ird gr o u p whi ch l i e s o n th e an g le s o f th e

rib s C aref u l p alp ati o n wi ll d i s ti n g u i sh th e se divi s i o n s
. .

The D i ag no sti c V alu e H y pe r ae st he si a —D i ff e re n t

of

p o i n t s alo n g th e li n e o f th e fir s t gr o up , whi ch ar e hyp er

,
i

s e n s itive m ay b e evi de n c e Of dire c t s t rai n o f a S i ng l e v e r

,

te br al arti c u lati o n o r th e re s u lt o f a vi sc er al refl e x o r eve n

, ,

i n symp athy with a rib s u b lu x ati o n whi ch aff e ct s se n so ry

39 4 PR I N C I PLE S O F O S TE O PA TH Y

re lated The o rigi n al i rrit ati o n might h ave b ee n an e x c e s

.

sive d em an d o n th e abi lity o f th e vi s c u s as i n th e c as e o f ,

.

th e s t o m ach b ei n g o ver lo ade d .

In an y c ase th e di sc o ve ry o f wh at app e ar s to b e an
,

o ss e o u s l e s i o n l e ad s u s to te st th e co n d iti o n o f i ts re lated
,

n e rve s .I f th ey do n o t sh o w u n d u e e x c it abi lity th e l e s i o n ,

i s d o u btf u l as a cau sative f ac t o r A c aref u l e x ami n ati o n o f

.

v erteb r al sp i n o u s p r o c e s se s m ay S h o w m any d evi ati o n s fr o m

s ym m etri c al deve lo p m e n t an d th e di ag n o sti c i an sh o u l d
,

g u ard ag ai n st th e f als e evi d e n c e o f th e s e di st o rted s pi n e s .

I f a s pi n e has b ee n di s t o rte d by u n e q ual deve lo pm e n t th ere ,

S h o u l d b e n o s e n s it i ve n e ss ar o u n d it e x c e pt as t he re su lt
o f a vi s c er al refl e x In c as e o f s u ch vi sc er al refl e x th e e x
.
,

am i ne r c an n o t h e lp b ei n g mi s l ed a s to th e v alu e O i th e ap
'
'

p are n t o s s e o u s m alfo rm ati o n H i s fi nger s c an no t i n f o rm

.
-

hi m th at wh at h e c o n s i der s an os s e o u s le s i o n i s i n re ality
bad d eve lo pm e n t The o n ly w
. ay he c an e s c ap e fr o m m ak

i n g a m i st ak e i s by c o n ti n u i n g hi s e xam i n ati o n with o u t h o ld

i n g a p o sitiv e i de a th at h e has f o u n d th e cau s e The hi s t o ry
-
.

an d d e ve lo pm e nt Of th e c ase m ay ar o u s e s tr o n g d o u bt s as
to th e v alu e o f hi s di s co vered S pi n al l e s i o n .

Y o u r atte n t i o n i s c alle d to thi s p o ss ib l e m i st ake i n v al

uat i o n o f a l e s i o n s o th at y o u m ay n o t b e c o m e we dded to
,

th e i de a th at wh e n y o u h ave f o u n d wh at ap pe ar s to b e a
,

mi sp lac em e n t y o u ar e free to e nd y o u r e x ami nati o n an d

,

p r o n o u n c e a co mp ete n t j u dgm e n t .

Te s t M u scu l ar Te n s i o n — Whi le th e p ati e n t i s o n hi s '

s id e e x ami ne c aref u l ly th e am o u n t o f te n s i o n i n th e s e t hre e

,

gr o u p s c o n stit u ti n g th e f o u rth layer A fter c o n s id er ab l e

.

ed u cati o n o f th e s e n s e o f t o u ch it wi ll be p o ss ib l e fo r y o u
,

to determi n e th at th e p o i n t s u n d er y o u r fi n ger s ar e p r o b ab ly
'

to o se n sitive . Wh e n th e s e m u s cle s fe e l h ar d an d u ny i e l d
i n g th ey ar e u s ually so re to p re ss u re
,
The c on tr ac t u re d
.

co n diti o n o f th e mu sc l e has aff e c te d th e s e n so ry n erve fi la

m e n t s i n tw o w ay s : F i r st by di re c t pre s su re betwe e n the

,

c o n tr ac ted m u s c l e b u n dl e s ; s e c o n d by rete nti o n o f m et a

,

ho li c w a ste p r o d u c t s whi ch re s u lt i n c h em i c al p o i so n i n g .
 PR I N C I PLE S O F O S TE O PA TH Y 39 5

F IG . Te s i n t g th e b y
p l i a i li t of th e i n te r s c ap u l a r t
p or i o n of .

th e s p i n al co lu m n .

Tho rac i c F l e x ibi l it y — F ig i llu s tr ate s a m eth o d o f 1 58

'

as c ert ai n i n g th e e lasti c ity Of th e d o r s al s p i n e an d th o r ax .

Thi s p r o c ed u re as s i s t s i n e s tim ati n g th e ge n er a l Co n diti o n

Of th e b o dy I f th e th o r ax i s fi x ed i n e las ti c re s p ir ati o n
.
, ,

c an n o t b e c arrie d o n p r o p er ly O x y g e n ati o n o f th e b l o o d
will b e imp erfe ct I f de s i re d we m ay p alp ate th e spi n o u s
.

p r o c e s s e s an d th e m u sc u lat u r e whi l e th e pati e n t i s i n thi s

p r o n e p o s iti o n .

E x ami n at i on of th e A b do m e n
h o w s th e — F ig . 1 59 S

p r o p e r p o s iti o n o f th e p ati e n t fo r e x am m atl o n Of th e abd o

men The k n e e s b ei n g dr aw n u p allo w s re lax ati o n o f ab
”
“
‘

do m i n al m u s c l e s W h ere th e abdo m e n i s very s e n sitive to

' '

th e t o u ch eith e r b e c au s e o f p ai n o r ti c k li sh n e s s us e the
, ,

wh o le h an d u n ti l th e p ati e n t b e c o m e s so m ewh at acc u st o m ed

to th e t o u c h S o m eti m e s it i s n e c e s s ary fo r th e phy si c i an
.
396 PR I N C I P LE S O F O S TE O PA TH Y

F IG . 1 59 . P a l p at i o n of th e a bd o men .

lift th e feet fr o m the tabl e an d fl e x th e k n e e s q u ite c lo s e

'

to

to t he abd o m e n . A ste ady eve n pre ss u re o f th e h an d o n

,

th e ab d o m e n wil l so o n b e co m e n o n i rrit ati n g to th e p atie nt

-
,

an d deep e r p alp ati o n c an be m ade .

I f th e e x ami n ati o n i s a ge n er al o n e c o m m e n c e y o u r ,

w o rk w ,
ith th e p ati e n t i n th i s p o s iti o n by p alp ati n g th e ,

th o rax No te f o rm an d fl e x ibi lity e s p e c i ally th e fl e x i bility

.
,

o f th e five l o wer rib s The fre e m o vem e n t o f th e s e rib s i s

.

e sse n ti al to m any f u n cti o n s ch i efly re sp irati o n bu t i tal so

, ,

aff o rd s a s o rt o f rh t
y h m 1 c al m as s age to th e l iver a n d
st o m ach .

S u c h o b s erv ati o n s o f f o rm an d fl e x ibi lity ar e very g e n

e r al bu t th ey le ad i nv ar i ably to so m e clu e o f e sp e c i al v alu e
'

i n th e s e ar c h fo r e ff e c t s an d th ei r cau s e s .

E l e vati o n o r D e pr e s s 1o n o f R ib s — No te th e sp ac i n g o f
th e rib s to d etermi n e wh eth er any rib i s el ev ated o r d e
398 PR I N C I PL E S O F O S TE O PA TH Y

b o o k s o n di ag n o s i s By th e u se o f all th e s e phy s i cal meth

.

o ds it i s p o s s ib l e t o arriv e at a ve ry defi n ite c o n c lu s IOn o f

th e s t at e o f th e th o r aci c vi s c e r a .

The ab d o m e n sh o u l d b e p alp ated th e n p er c u ss e d

-
, .

Th e s e tw o m eth o d s sh o u l d m ake evi de n t a ny o rg an i c ch an ge

i n th e abd o m i n al vi s c er a .

E x am i n ati o n o f the R e ctu m an d P r o s t ate G l an d: — F ig :

'

160 i llu str ate s a p o s iti o n fo r e x am i n i ng th e re c t u m an d po s

t ate g land .F ig 16 1 i s «
. the we ll— k n o w n S i m m s p o s iti o n ’

whi ch m ay b e u s e d fo r th e s am e p u rp o s e as the pr e ce di ng
'

O th e r p o s iti o n s u s ed by th e o s te o p ath fo r e x ami n ati o n

an d tre atm e n t ar e th e we ll k n o w n gy n e co lo gi c al p o siti o n s
-

—
ge n u p e c t o r al an d Tre n d el e n b u rg
-
.

E x am i n ati o n o f the Ne c k — F o r e asy ex am i n ati o n o f .

th e n e c k th e pati e n t sh o u l d be re c u mb e nt
, , as i n F i g 1 59 . .

The m u sc l e s o f th e n e c k m u st h ave all te n si o n rem o ve d

'

’
S O th at th e e x a mi n er s fi n ger s c an fe e l th e p r o c e s s e s o f th e
"

c ervi c al ve rteb r ae .

A fl at t ab l e i n s te ad o f t he m o d e l sh o w n i n the illu s
'

tr ati o n i s b ette r
-
.A h ard s m all pi l lo w m ay b e u s ed to Su p
-

p o rt th e h e ad .

F IG . 1 61 . S imm s
’
t
p o s i i on .
 PRI N C I PLE S O F O S TE O PA TH Y 39 9

S i nce th e
pi n o u s p r o c e ss e s i n th e c ervi cal regi o n ar e
S

sh o rt an d bi fi d an d o fte n ti m e s deve l o p ed u n eve n ly an d

,

are c o vere d with s ever al layer s o f m u s c l e s an d l ig am e n t s ,

it i s n o t sati sf ac t o ry to u se th em as l an dm ark s fo r re lati o n s

o f c ervi c al ve rtebr ae

The t u be r c l e s o n th e tr an s ver se pr o c e ss e s ar e e as i ly
” ‘

p alp ated h e n c e th e s e s erve as g u i d e s in th e d ete c ti o n o f

,

S l ight m i sp la c m e n t s o f c ervi cal v ertebr ae

e .

The t r an sv
‘

e r s e p r o c e s s e s o f th e at las ar e u s u ally l arge

I
’

an d s u ffi c i e n t ly p r o mi n e n t to e n ab l e th e e x ami n er to asc e r

t ai n acc u r ate ly i ts po s iti o n Wh e n th e at las i s i n i ts tr u e .

p o siti o n i ts tr an sver s e ! p r o c e sse s wi ll b e f o u n d ab o u t mi d

,

w ay betwee n th e m as t o i d p r o c e s s e s O i the temp o r al b o n e s

an d th e an g l e s Of th e jaw Thi s re lati o n sh ip m ay app e ar
.

u n tr u e wh e n th e m as t o i d p r o c e s s e s ar e q u ite l arge o r s m al l ,

o r th e an g l e s o f th e jaw ar e m o re o r l e s s o bt u s e I t is .

n e c e s sary to s t u dy th e re lative deve lo p m e n t an d p o s iti o n s

i n every c as e o n b o th s ide s i n o rde r to di s c o ver wh eth e r

, ,

a su b lu x ati o n ex i s t s The f ac t th at n e ar ly all su b lu x ati o ns

.

'

of t he at las ar e t wi s t s i n s te ad o f di re c t f o rw ard o r b ac k w ar d
'

s it c o mp ar ative ly e asy to d ete c t th e

'
-

i n e q u al iti e s an d u n der st an d th e f au lty p o s iti o n S e n sitive .

n e ss wi ll b e f o u n d i n th e ti s s u e s o n th e si d e wh o s e tr an s

ver s e p r o c e ss i s po ste r i o r In c as e th ere i s m arked S e ns i

_ .

ti v e n e s s o n b oth s ide s th at i s o n th e p o s teri o r su rf ac e s o f

=
, ,

b o th tr an sver s e p r o c e ss e s th e at las i s pr o b ab ly d r awn,

!

S lightly p o s te ri o r o n b o th S id e s by th e s ev ere c o n tr ac ti o n
'
-

o f i ts a t ta c he d m u s c l e s
,
.
,
_

The th i rd c ervi c al v ertebr a s e em s to b e e asi ly su b l u x

'

ated I t i s u su ally twi sted n o t su ffi c i e n t ly to lo c k i ts ar

.
,

ti c u lar pr o c e s s e s bu t j u s t e n o u gh to m
,
ake th e d o r s al s u r

f ac e O f i ts i n feri o r arti cu lar p r o c e s s e as i ly p alp ab le thr o u gh

th e m u sc l e s wh i ch li e Over it Thi s p r o mi n e n t p o i n t wi ll .

be se n sitive be cau s e th e m u sc l e s o ver it ar e alw ay s te n s e '

S o meti m e sth e s i x th c ervi c al verteb r a i s twi sted Wh e n

thi s c o n diti o n e x i s t s th ere i s m arked di st u rb an c e o f c i r c u
,

lati o n i n th e h e ad The p ati e n t i s u s u ally w akef u l and

.
4 00 PRI N C I PL E S O F O S TE O PA TH Y
O

e x cit abl e o n acco u n t o f th e c o n ge ste d co nd iti o n o f th e c ere

b r al b lo o d ve ssel s c au sed by th e p re ssu re o n th e verteb ral
,

vei n s.

No te th e t o n e o f all th e c e rvi cal m u s c l e s th e fl e x ibi lity ,

o f th e n e c k ,
th e temp er at u re o f th e S ki n o n di ff er en t p art s
Pa lp ate th e ch ai n s O i lym phati c gl an
'

o f th e n e c k . d s th e ,

thyr o id an d th e su bm ax il lary s al iv ary gl an d s .

A fter a th o r o u gh p alp ati o n o f th e n e c k lo o k caref u lly ,

fo r any evi d e n c e s o f di s t u rbe d c ir c u l ati on i n th e h e ad as

m ay b e evi de n c e d by th e app e ar an c e o f the S ki n m uco us ,

m e mb r an e o f th e m o u th th e t o n s i ls c o n j u n c tiv a O r the
, , .
'

we ari n g o f g lasse s Y o u r k n o w l edge o f o pti cs sh o ul d e n

.

ab l e y o u to j u dge th e ge n e r al c o n diti o n o f th e eye s by In

spe c t i o n o f th e g las se s w o r n .

S u c h an e x am i n ati o n o f th e h e ad an d n e c k as h erei n
o u t li n e d S h o u l d give th e exami n e r a g o o d u n der s t an di n g

o f th e s tr u c t u r al an d f u n cti o n al co n diti o n e x i sti n g at th e

tim e o f e x am i n ati o n an d ev e n g u i de hi m to wh at o th er
,
'

p art s o f th e b o dy m ay n e e d S p e c i al atte n ti o n .

The H i st or y o f L e s i o n s — A ll f act s as t o str u c t u re and

f u n c ti o n de tei m i n e d by y o u r e x ami n ati o n ar e hi st o ri cal

,
'

t hat i s th ey h ave d ate s an d c i r c u m st an c e s whi c h g 1v e th em

,

mu c h o r littl e v alu e The e x p e ri e nc ed di ag no sti c i an de

.

light s i n fi lli n g i n th e l ife h i s t o ry o f th e p ati e n t to fit th e

s tr u c t u r al an d f u n c ti o n al c h an ge s : H erei n li e s th e o ppo r
tu n i ty fo r th e phy s i c i an to b ri n g to hi s aid all hi s re s o u r c e
'

o f e x p eri e n c e an d e du c at l o n l n j u dgi n g ho w the s e l e si o n s

h ave b ee n b r o u ght abo u t and ho w th ey ar e n o w i n fl u e nc ing

o th e r t i ss u e s .

m
The E x t r e iti s e — Whil e the p ati e nt i s in th e re c u m
.

b e n t d o r s al p o siti o n Fig 1 59 th e lo wer e x trem iti es can b e

, .
,

e x ami n ed No te the c o mp ar ative le ngth o f the l egs but

m
.
’
,

b e c aref u l to e li m i nate all p o ss ibi lity o f i s t ake by O bse r v .

i n g wh eth er th e p ati e n t i s lyi n g eve n ly o n the b ac k i l i a ,

s am e h ei ght an d m u sc l e s o f b o th l eg s e q u ally re lax ed A

"

, .

me asu rem e n t fr o m th e anteri o r su p e ri o r ili ac S pi n e to th e

i nter nal m all e o l us determ i n e s th e l e n gth o f th e l eg .
 40 2 PR I N C I PL E S O F O S TE O PA TH Y
‘

C H A P TE R XX .

M A NI PUL ATI O N .

Th ere has b ee n ve ry rap id ev o lu ti o nary d eve lo p

a

m e n t Of m an ip u lati o n as a th e r ap e u ti c m eth o d ,
I t has .

b ee n f o u n d to be a w o n de rf u lly ad apt ab l e m e an s o f al
l e v i ati n g h u m an su ff eri n g U n d o u b te d ly th e p ri n c ip l e s
.

u n de r lyi n g a n y m eth o d o f m an ip u lati o n c on trib u te s o m e

th i n g to all o th er so — c all ed sy s tem s o f m o vem e n t cu re s .

M an ip u lati o n i s h and p r ac ti c e i n th e s u rgi cal s e n se It .

i s app l i c ab l e i n a treme n d o u s ly wi de r ang e o f di so rd e r s ,

fo r e x amp l e th e tre atm e n t Of fr ac t u re s s pr ai n s b re aki n g , ,

adh e s i o n s re d u c i n g di slo cat i o n s as si sti n g v e n o u s cir cu l a

, ,

ti o n stim u l ating p eri st al s i s re d u c i n g c o n ge sti o n s q u i et

, , ,

i n g refl e x e s s ti m u lati n g n erve c e n ter s an d m any o th er

, ,

th i n gs o f a h elp f u l char acte r .

The f o rm Of m an ip u lati o n m o st ge n er ally u n der s t o o d

i s m as sage Th i s term i s u s ed by so m e to m e an any
.

m eth o d o f m an ual m an ip u lati o n M as sage i s a m eth o d o f.

m an ip u lati o n wh i c h has b e e n e x te n s ive ly p r acti c ed an d

writte n ab o u t h e n c e th ere is n o e x c u se fo r th e prev ai li ng
,

Of the te r m to co ve r all f o rm s o f h an d
‘

s lo ve n ly u se

m an ip u lati o n The c h ar ac teri s ti c m o vem e nt s o f m as sage

.

ar e fri c ti o n an d k n e adi n g They h ave p r o ve n w o n de rf u lly

.

s ati s f ac t o ry a s adj u v an t s i n o ve r c o m i n g ve n o u s s t as i s an d

t o n i n g th e n e u r o m u sc u lar m e ch an i s m o f th e b o dy NO
-
.

o n e w ho IS at all c o n ver san t with th e ph e n o me n a o f n at

u r al re c o ve ry f ai ls to re co g n iz e th e gre at ass i st an c e whi ch

—
eve n th e c r u de st u se O f m ass age f u r n i s h e s .

The n e x t step o f a sc i e n tifi c c h ar ac te r i n th e d eve l

o pm e n t o f m an ip u lative m eth o d s w as S we di sh m o v e
 PR I N C I PLE S O F O S TE O PA TH Y 40 3

m e nts . The s e i n tr o d u c e d l ever age

v o lu n t ary re s i st an c e an d
—
as n e w f ac t o r s i n i n c re as i n g th e t o n e o f th e n e u r O m u s

cu lar app ar at u s A very l imite d fie l d w as acco rde d to

‘

m ass age an d S wed i s h m o vem e n t s Bo t h th e s e m eth o d s .

w e r e pr acti c ally n eve r u s ed e x c ept as p re sc rib e d by a

(

phy si c i an P racti c ally n o di ag n o sti c ab i l ity o r 1n 1t1at1v e

.

i s c redite d to th o s e w ho app ly th e m eth o d s S u rgery w as .

“
F o rm er ly t hat br an c h Of m edi c i n e c o n c er n e d wit h m an
”
u al o per ati o n s u n der th e dire c ti o n Of th e phy s i c i an If .

th e ev o lu ti o n Of su rgery c an b e u s ed as a c riteri o n fo r
j u dgi n g th e f u t u re o f m an u al m an ip u lati o n th ere can be ,

n o d o u bt as to th e c o m m an d in g p o s iti o n th at wi l l b e at

tai n e d .

O ste o p athy has i n tr o d u c e d a n e w f ac t o r i n m an ipu

lative th er ap e u ti cs i e th e adj u s tm e n t o f j o i n t lu x ati o n s
,
. .
,

an d s u b l ux ati o n s
.

It i s i n tere sti n g to n o te th at th e ar t
.

Of m an ip u lati o n app li c ab l e to th i s c o rre ctive w o rk w as

deve lo p ed i n d ep e n de n t ly Of m ass age an d S wedi sh m o ve
m e nts O s te o p ath i c m o vem e n t s c o u l d n o t h ave ev o lve d
‘

n at u r ally fr om m as s age an d S we di sh m o vem e n t s b e c au se ,

o ste o p athi c te chn i q ue i s th e di re c t re s u l t o f th e th e o ry

"

st u rdi ly ass erte d an d d efe n d ed by D r A T S ti ll th at

,
. . .
,

“
s tr u c t u r e g o ver n s f u n c ti o n H i s re c o g n iti o n an d tre at
.

“ ”
m e n t o f j o i n t l e si o n s s u b lu x ati o n s l e d to th e d eve l o p
, ,

m e n t o f a sys tem o f m o vem e n t s p rim ari ly s u r g i cal i n

c h ar ac ter NO m atter ho w m u c h any o ste o p ath i c phy si
.

c i an may t ake i ss u e with h i m i n m atter s o f th e o ry th e , _

f ac t e x i st s th at n o t o n e o f th e m b e li eve s th at h e has ever

_

b ee n app r o ache d in s ki ll i n th e ar t o f co rre c tiv e m an ipu

lati o n .

P re s en t day o s te o pathi c phy s i c i an s ar e b e n efi c i ari e s

o f al l th e su c c e s s e s c redited to m as sage
.
S we di sh m o ve ,

m e n t s D r A T S ti ll s o rigi n al w o rk sp e c i al o p er ati o n s
,
. . .
’
.

d evi sed by o r th o p aedi st s all o ve r th e w o r l d an d th e ,

bri lli an t w o rk o f P r o fe sso r L u cas Cham po n i e r e i n th e

— ”
tre atm e n t o f fr ac t u re s by g lu c o ki n e si s an d m o b i l i s a
ti o n W e ar e b e n efi ciari e s o f all th e s e b e cau s e D r S ti ll
. .
4 04 PR I N C I PL E S O F O S TE O PA TH Y

b e li eve d f u n d am e nt al m e di cal e d u c ati o n an d th e e s

in
tabls hm e n t Of a s ch o o l o f m edi c i n e an d su rge ry p rim ari ly
d ev o te d to th e sc i e ntifi c d eve lo pm e n t o f m an ip u lative
th e r ap e u ti c s S i n c e at th e tim e o f hi s m o st active w o rk
.

i n p r ac ti c e an d te ac hi n g th e ab u s e o f d r u g s an d s u rgery
,

w as at i ts h eight it i s n o w o n der th at h e de s i re d to e st ab
,

li sh a sy s tem o f p r acti c e wh i c h w o u l d n o t b e b u rd e n ed
by i n h erit anc e Of th e f o ib le s an d f ai lu re s o f dr u g th er apy -
.

A S a re s u l t o f th e s u cc e ss o f o st e o p athi c th e o ry an d
p r ac ti c e th ere has b ee n th e i n evit ab le p lagi arizi n g o f i ts
,
'

lite r at u re an d m eth o d s by tho s e w ho fi n d it pr o fit ab l e to

im p o s e o n an ig n o r an t p u b li c Thi s plag i ar l z i n g has b e e n
.

d o n e u n der s ever al n am e s bu t e sp e c i ally u n d er th at o f

,

c hi r o p r ac ti c The h i st o ry Of th i s attemp t to app r o p ri ate

.

th e p ri n c ip l e s an d m eth o d s Of O ste o pathy t with ou t r e ,

‘

q u i ri n g any c re dit ab l e e d u cati o nal w o rk to m ake th em

s afe m e an s o f tre ati n g ai l i n g h u m an b ei ng s i s a sad tr av ,

e st y o n .
th e s ta n d ard s o f m edi c al ed u c ati o n i n th i s c o u n -

try . U n de r o u r pre s e nt law s n e w sch oo ls o f m e di c i n e

m ay be st arted as sh o rt c u t s to av o i d th e m o der at ely
s evere re q u i re me n t s o f e st abl i sh ed sch o o ls S o lo n g as
”
thi s i s p o s sib l e th ere wi ll c o n ti n u e to app e ar n e w s ch o o l s
,
'

e x p lo iti n g so m e ph as e Of e s tab li shed m eth o d s u n d e r n e w

n am e s .
’

M e t ho ds o f P r oc e du r e — O ste o p athi c phys i c i an s f r e

.

q u e n t ly di ff er as to m eth o d s o f p r o c e d u re but th ey all ,

w o rk ac co rdi n g to th e sam e p ri n c ip le F o r i n s t an c e a
.
,

s u b lu x ati o n o f a ve t te br a might b e di s co ve re d by tw o
o ste o p ath s The fir st o n e m ight u nd ert ake to re du c e th e
.

s u b lu x ati o n with o u t any p re lim i n ary w o rk o n th e m u s .

c le s b e li evi n g th at it i s be st to g o ri ght to th e S e at o f
,

tr o u b l e an d rem o ve i t H i s tre atm e nt w o u l d b e s e v ere

.

b e c au s e m u ch stre n gth w o u ld b e re q u i re d to o ve r co m e
th e re s i st an c e o f th e m u sc l e s g o ver n i n g th e arti c u lati o n .

The se co n d o n e m i ght s p e n d c o n s ider ab l e ti m e o n th e

p re lim i n ary w o rk o f re lax i n g th e m u scle s Of th e arti cu la ~

ti o n i nc re asi n g fl e xibi lity red u ci n g se n s itive n e ss e tc

, , , .
,
406 PR I N C I PLE S O F O S TE O PA TH Y

The m o vem e n t s h ere afte r p i ct u re d an d d e sc rib e d ar e

all m ad e with refere n c e to s tr u ct u re r ath e r th an f u nc ti o n .

F e w refere n c e s ar e m ad e c o n c e r n i n g th eir app li c abi l ity to

s pe c i al di s e as e s We do n o t c are wh at th e nam e o f th e
.

di s e as e i s The gr o u p s o f sympt o m s whi ch m ake u p th e

.

pi ct u re s d e sc ribe d i n sym pt o m at o lo gy h ave very litt le ,

s ig n ifi c an c e to th e o s te o p ath H i s m o vem e n t s ar e n o t
'

m ad e with ref ere nc e to a n am ed di s eas e b u t to a fau lty ,

str u c t u r al co n diti o n The s tr u c t u r al c o n diti o n m ay b e

.

th e b as i s fo r th e phy s i o lo gi c al Fu n c ti o n d o e s aff e c t str u ct

.

ure . W e ar e n o t to lo s e s i gh t o f th i s f act F u n c ti o n .

m ay b e p erverte d by bad h abit s h e n c e o u r th er ap e u ti c s ,

m u s t c o mp reh e n d th e hygie n i c an d diet eti c s i de Of life as

w e ll as s tr u ct u r al
'

E very m o vem e n t h ere i n o u t li n ed s e c u re s a d efi n ite

e ff e c t o n a m u sc l e o r i s us e d to aff e ct th e re lati o n o f b o ny
'

p art s .

The m o vem e n t s m ad e to aff e c t th e m u s c le s o f the

b ac k an d S pi nal c o lu m n ar e b ased u p o n th e att ach m e n t o f
th e m u scl e s an d th e l ever age th ey e x ert o n th e s p i nal -

c o lu m n .

R e l ax ati o n o f the Lati ss i mu s D o

”

r si — The arr an ge .

m en t o f th e b ac k m u s c l e s has b ee n n o t e d i n th e ch apter
o n P o s iti o n s fo r E x am i n ati o n In o rd er to rel ax th e se .

m usc l e s in th eir nat u r al rel ati o n s i e fr o m s u p erfi c i al , . .

,

to d eep gr o u p s we b egi n with su c h a m o veme n t as wi ll

,

s ep ar ate th e e x trem iti e s o f th e m os t s u p erfi c i al m u scl e s

to th ei r f u lle st e x te n t F i g 162 i ll u str ate s th e m eth o d O i

. .

re lax i n g th e lati s sim u s d o r s i O n e h an d e x te n d s th e ar m

.

to i ts f u l l e s t e x t e n t th e o th er h an d an ch o r s th e i li u m
,
It -
.

wi ll b e n o ted th at th e lo we r d o r s al an d l u mb ar p o rti o n s
o f th e sp i n al c o lu m n ar e l ifte d by th e p u ll o f thi s m u sc l e,
‘

A l s o th e f o u r lo we r rib s ar e r ai s e d The i n tri n si c e ff e ct .

o f thi s s tret chi n g m o vem e n t i s t o t ake m o s t o f th e te n

s i o n o u t o f th e m u sc l e it s e l f an d i n c re as e th e am o u n t o f

m et ab o li c ch an ge t aki n g p lac e withi n it Bu t th at is n o t .

wh at i s p rim ari ly i n te n ded The i ntri n si c e ffe ct s ar e m ere

.
 PRI N C I PL E S O F O S TE O PA TH Y 40 7

F IG .
163 . R e l ax ati o n of th e t r ap e ziu s .

I n c i de n t s i n the phy s i o lo g ic al life Of th e m u sc l e an d a s ,

su c h are f o un d f o llo w i n g a l l ki n d s Of m u sc u l a r m o vem e n t s .

e tri
The x n s c eff c s i e t a r e wh a t c o n c er n u s m o s t ; th e e ff e c t
p
u on th e verteb r a e an d r ib s th e ,
c h a n ge i n th e f o rm o f

th e ch e s t .

T here ar e thre e u s e s f o r thi s m o vem e n t F ir s t .a s ,

p rep ar at o ry to w o rk u p o n m u sc l e s lyi n g be n e ath it i e ,

. .
,

p u re ly r e lax i n g S e co n d i n cas e o f o ver lappi n g by any

.
,

Of th e f r we rib I t i mm diti t
'

one ou l o r s . s a c o o n c o n o n o

"
fi nd t e h twe l fth r i b u n d e r th e e l eve n th o r te n, th u n der
e leve n th The p u ll o f th e lati s s im u s d o r s i i s e x e r te d o n
.

ike h e e th e i divid l ib b h t i t th eir

‘

all al
.
n c n u a r s a r e r o u g n o
,

p r o p er re lati o n s .
R e lax ati o n u s u ally allo w s a re tu r n o f
.

th e f au lty p o s iti o n bu t if th e rib s ar e h e l d at th ei r e x

,

tr e m i ti e s by th e Op erat o r fo r a few s e c o n d s after re l ax a

ti o n the i n ter c o st al m u scl e s an d q u adr at u s lu mb o r u m wi ll
,
40 8 PR I N C I P L E S O F O S TE O PA TH Y

'
F IG . 1 64 . R e l ax at i o n of th e rho m b oi de u s m aj o r an d mi nor .

b e fi ll e d with arte ri al b lo o d wh i ch t o n e s th em The .

p ati e n t sh o u ld b e di re cted to h an g by th e h an d s sever al

ti m e s p e r day s o as to get a go o d e ff e c t o n th e p o s iti o n o f
th e lo wer rib s Th ir d to aff e c t later al cu rv at u re o f th e
.
, .

S pi n e i n th e l u mb ar o r lo wer d o r s al p o r t
i on .

h r —
R e lax ati o n o f t e T ape zi u s The tr ap ezi u s i s ah
o th e r O i th e s u p e rfi c i al gr o up o f b ac k m u s c l e s Its fib er s
'

ar e s o v ari o u s ly att ac h ed th at s ever al m o v e m e n t s ar e re

q u i red to re lax all i ts divi si o n s F ig 163 i llu str ate s th e

.
. .

m eth o d Of gr aspi n g an d ho ldi n g th e s cap u l a wh i l e re lax

i n g th e tr ap ezi u s The sc ap u la i s r o t ated o n the th o rax
‘

as far as p o ss ib l e t o w ard th e h e ad s o as to stret c h th o se

fib er s e x te n di n g fr o m th e spi n e Of th e s c ap u l a to the S i x th
M0 P R H M HP LE S CHI O S TE O P ATH Y

FIG . 1 65 . R e l a x at i o n of th e p e c to r al i s m aj o r t
an d s e r r a u s ma gnu s .

e x erte d o n a later al c u rve In th e 1 n te r s capu lar regi o n I t .

i s ge n er ally u s e d as p rep ar at o ry to w o rk o n deep e r str u e

t u re s
—
.

The P e ct o r al i s M ajo r an d S e r r at u s M ag nu s F o llo w

i n g th e s e m o vem e n t s wh ere ge n eral th o r ac i c an d spi n al
,

re lax ati o n ar e d e si re d th e m o vem e nt illu str ated 111 Fig

, .

16 5 m ay b e u s ed I t aff e ct s th e P e c t o r ali s M aj o r an d
.

S err at u s M ag n u s f By p u shi n g th e p atie n t s e lb o w as far

’
,

b ack as p o s s ib le th e scap u la is appr o x im ated to th e s p i n al

,

co l u m n h e n c e th e serr at u s m ag n u s i s pu t u p o n a te n
,
'

si o n wh i c h l ift s th e eight u pp er ribs The pect o r al i s .

m aj o r al so aff e c t s th e u pp e r rib s The phy s i c i an s h an d .

’

o n th e an g l e o f th e rib s ac c e n t u ate s th e e x p an s i o n o f th e
 PR I N C I PL E S O F O S TE O PA TH Y 41 1

F IG 166 R e l ax at i o n of th e s e r r a tu s ma gn us an d me
so fi bres of th e
f
.

t
. .

ou r h la
. ye r of d o r s al m u s cle s .

ch e st Thi s is a ge n er al m o vem e n t bu t o n e wh i c h has far

.
,

reach i n g e ffe ct s u p o n r e sp1r ati o n an d c ir c u lati o n

‘
It is .

ad apt ab l e to m an y sp e c ifi c s tr u c t u r al defe c t s o f the rib s .

In F i g 166 th e phy s i c i an ag ai n u s e s the h u m er u s an d

.

s c ap u l a a s m e an s by wh i c h to aff e c t th e s pi n al c o lu m n .

The l eft h an d e x ert s tr ac ti o n o n th e m u s c l e s ab o ve the

s pi n e wh i le th e right h an d an d ar m f o r c e s th e p ati e n t s
, . .
’

sca p u la t o w ard th e h e ad an d s pi n e The m o vem e n t i s .

m ade to e n ab le th e phy s 1c 1an to re lax th e s err at u s m ag

n u s an d s o m e Of th e fib er s o f th e f o u rth l ayer o f th e b ac k
'
‘

S light t o r s i o n o f th e d o r s al S pi n al c o lu m n i s al so s e c u re d .
.

Q u adr at u s Lu m b o r u m — The
re lax ati o n o f th e q u ad
.

r at u s lu mb o r u m i s se c u red acc o rdi n g to F i g 167 In all -

. .

di sp lac em e n t s o f th e twe lfth rib it i s n e c e s sary to s e c u re ,

a free c ir c u l ati o n i n th e m u s c l e s att ac he d to th at rib The .

f ac t th at it i s a fl o ati n g rib m ake s i ts p o siti o n dep e n de nt

4 12 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 1 67 . R e l ax at i o n of t
th e q u a d r a us lu m b o ru m .

on th e t o n e o f th e m u sc le s att ac h ed to it I t i s fre q u e n t .

ly sl ipp e d u n de r th e el eve n th Thi s m o ve m e n t s ep ar ate s

.

th em
F i g 16 8 i s i n s o m
.

. e re sp e ct s si mi lar to th e m o vem e n t
il l u str ate d i n F i g 166 e x c ept th at t
.
,
he s c ap u la i s f o r c ed
d o w nw ard an d th e left h an d is ab le to w o rk t hr o u gh th e
,

re lax ed su p erfi c i al m u s cl e s After th e u s e o f th e m o ve

.

m e nt s alre ady i llu str ated it 1 s ast o n i shi n g ho w e asily o n e

,

c an w o rk u p o n th e f o u rth laye r o r e x ami n e th e c o n diti o n

o f d e ep s tr u c t u re s .

E r e ct o r S pi — The w o rk u p o n th e f o u rth layer

n ae

sh o u ld b e d o n e ac co rdi ng to F ig 1 5 5 The fi nger s ar e . .

p lac ed b etwe e n th e m u sc le s an d th e sp i n e s o f th e verte

4 14 PR I N C I PLE S O F O S TE O PA TH Y

F IG . 1 69 . S p r i ng i ng
-
a d or so - lu m ba kyph
r o si s .

FIG . 170 . A me tho d of s p r i ng i n g a b kyph

l u m ar os i s .
 PR I N C I PLE S O F O S TE O PA TH Y 4 15

F IG . 171 . S pr in gi n g an upper d o r sal l o r d o si s

ky pho s e d atth e j u n cti o n o f th e d o r s al an d lu mb ar The .

’
h
p y S 1 c 1an s
’
f o r e arm s ar e p lac e d ag ai n st th e p atie n t s
S h o u l de r an d i l i u m wh i l e th e fi n ge r s re s t o ver th e ky
p h o se d p o rti o n o f th e s pi n al c o l u m n T he h a n d.s dr a w fo r

w ard wh i l e th e f o re arm s p u sh aw ay C o n sider ab le f o r c e .

c an be e x erted i n thi s w ay o n S l en der p ati e n t s .

G r eat f o r c e c an b e e x erte d o n a p o steri o r c u rve Of th e

l o wer d o r s al an d lu mb ar p o rt 1o n s by th e m o vem e n t S h o w n
i n F i g 17 0
. .Th i s m o vem e n t i s als o u s ed fo r p u rp o s e s o th er
th an c o r re ctive o f s tr u ct u r al defe c t s S i n c e th e l ever age .

i s S O gre at it i s q u ite e as y fo r th e phy si c i an to carry it

,

to o far The re s u lt i s an active c o n ge s ti o n Of th e lo wer

"

p o rti o n o f th e S p i n a l co rd f o l l o wed
,
by e x c e ss iv e a c tivity
Of th e n erve c e n ter s l o c ated th ere In givi n g thi s m o ve .

m e n t to w o m e n as c ert ai n wh ethe r preg n an cy e x i s t s I f

, .
4 16 PR I N C I P L E S O F O S TE O PA TH Y

S O, do der any co n si der ati o n u s e it The c e nter fo r

no t u n .

p art u riti o n m ight b e e x cite d by it eve n th o ugh th e m o ve

,

m e n t m ad e is slight .

Th ere i s p r acti c al ly n o d an ge r i n thi s m o ve me n t wh e n

i n te llige n t ly u s ed e x c ept in th e case o f p reg nan cy A
,
'

S lo w , s te ady li ft m ad e whi le th e phy s i c i an i s w at ch i n g

c aref u lly th e am o u nt o f re s i s t an c e o ff ere d by th e b ac k

wi ll u su ally i n h ibit th e e x c item en t o f th e c e n ter s lo c ated

i n th e l u mb ar e n l argem e n t o f th e spi n al c o rd The s lo w . .

n e s s an d ste adi n e s s o f the m o vem e n t re lax e s th e m u sc l e s

o f th e fifth l ayer an d s e c u re s b e t te r dr am ag e fo r b l o o d i n
th e sp i n al can al No active c o n g estl o n 1 8 br o u ght o n
.
,

h e nc e a s e d ativ e e ff e c t 18 g am e d Q u i c k i n te n s e e xe cu
.
,

ti o n o f thi s m o vem e n t has fr e q u e ntly a r eve rs e e ff e ct be ,

c au s e th e s h arp str ai n pu t u p o n th e m u s c l e s re su lt s i n

ad ded c o n tr ac ti o n ac tive c o n ge s ti o n an d Ob s tr u c ti o n to
,

g o o d d r ai n age o f th e sp i n al can al Th e s e c o n dit i o n s r e

.
.
-

s u lt i n f u n c ti o n al ac tivity o f th o se o rg an s g o ver ne d by
th e n e rve c e lls i n th e lu mb ar e n l argem e nt Ac tiv e co n .
‘ ‘

ge s ti o n o f a g e n te r r es u lt s i n i n c re as ed f u n cti o n o f t he
o ve r ne d by
"
o rg an th a t c e n ter
g .

AS age n e r al r u le , th i s m o v em e n t i s co n tr a I n di c ated -

fo r any p u rp o s e b u t th at o f c o rre c ti n g a str u c t u r al d efe c t .

The re ac ti o n Of m any pati e n ts i s an u n c ert ai n q u an tity ,

h e n c e it is n o t wi s e to u s e th i s tre atm en t f o r p u re ly f u n c
”

ti o n al e ff e c t s .

As a re s u lt o f th e ig n o r an t u s e o f thi s m o veme n t by
th o s e w ho ar e p alm i n g th em s e lve s o ff as o ste o p ath s th e ,

au th o r k n o w s o f s ever al c as e s wh ere d a n ger o u s c o n dit i o n s

we re br o u ght o n .

L or d o si s —U pper D o r sal — An an teri o r c u r ve

. or ,

str aighte n ed c o n diti o n of t he s p i n e i n th e i n ter s cap u l ar

regi o n is r ath er di ffi cu lt to tre at o n acc o u n t o f i n abi lity
'

o f th e phy si c i an to u se th e e x trem iti e s a s l ever s .

i llu str ate s a m eth o d o f applyi n g lever age by m e an s o f th e

c e rvi c al ve rteb r ae The p o s iti o n o f the k n e e o n th e sp inal
‘

.
4 18 PR I N C I PL E S O F O S TE O PA TH Y

co ul m n reg u late s th e e x te n to f th e f o r c e o f th e m o vem e nt .

The k n e e i s th e weight to b e l ifte d th e spi n al co l u m n i s ,

a fl e x ib l e l eve r The phy s i c i an s f o re ar ms ar e th e f u lc r u m

’
.
.
,

wh il e his h an d s app ly th e f o r c e to l ift the weight ( th e

k n ee ) wh i ch b e n d s th e l eve r at t he p o i n t g o ve r n ed by -

the p o s iti o n o f th e we ight an d f u l c r u m The p o s iti o n o f .

’
th e phy si c i an s h an d s i s i mp o rt an t b ecau s e th e c ervi cal ,
"
i s n o t th e p o rti o n o f th e S p i n al co l u m n we de s 1 r e to b e n d .

I f th e h an d s ar e all o we d to re s t c l o se to the he ad th e ,

f o r c e e x e rte d i s n e arly all sp en t o n th e n e c k ; the m o st

‘

fl e x ib l e p art o f th e s pi n al c o lu m n i s aff e c t ed— a re su lt n o t

de s ire d P l ac e th e h an d s as n e ar ly Over th e c e rvi cal a
.
nd

fi rs t d o r sal s p i n e s as p o s sible S i n c e tht u n cti o n o f th e .

d o r sal an d l u mb ar s egm e n t s is a very fl e x ib l e p oi n t th e ,

k n e e sh o u l d b e l o c ate d h igh er .

F ig 172
i ll u str ate s ano th e r m eth o d o f p r o d u c i n g “

fl e x i o n i n th e u pp er do r s al r e g i o n The l eve r age l n th i s

. .

p o s iti o n i s s o gre at th at th e Op er at o r m u st e x er c i se c au
ti o n i n i ts u se The O perat o r S h o uld n eve r aim to o ver
.
\

i e rits re sis tan c e by e x erti n g a g r e até

’

c o m e th e pat r f o r ce
’
.

The p ati e n t wi ll u s u ally rel ax un der th e i n fl u e n c e o f a

‘

tete r i n g m o vem e n t i e sh o rt,

ge nt l e app li c at io n o f th e
. .
, ,
.

le v e i ag e
‘

The Po s sib l e va r i ety o f M o v e m e n t s W h i c h W i l l S e

cu r e t e S a
h m e R t
es u l s — A ll o f th e e ff e c t s de s cribe d m ay
.

be s e c ur e d by m ov em e n t s di ff eri n g fr o m th o se o ut li n ed .

The au th o r de si re s to i llu s tr ate th e a p p l i c ati o n o f o ste o

"
'

p ath i c p ri n c i pl e s I t i s b el i eve d by him th at th e S erie s o f

.
.
“

m o vem e n t s i ll u str ate d h ave th e V 1 r tu e o f dir ectly an d

f o r c ib ly aff e cti n g th e p art d e si red with o u t u s i n g u p to o
m u c h Of th e phy si c i an s stre n g t h i n th ei r app li cati o n
’
.

‘ Nhe r e m u c h w o rk i s d o n e by a ph s i c i an it b e m e
-
y c o s a ,

vit al p r o b lem with h im ho w to c o n se rve hi s o w n stre n gth ;

B y th e s e le cti o n o f th o s e m o vem e n t s wh i ch giv e the gre at
e st l ever age h e s ave s h im s el f
,
.
 PR I N C I PL E S O F O S TE O PA TH Y 4 19

The H e ad an d L e ve r — Ii th e an teri o r o r
Ne c k as a .

s tr aighte n ed co n diti o n o f th e sp i n e i s very m arke d i n th e

upp e r d or sa l it i s p o ss ib l e fo r th e phy s i c i an to u s e th e
,

h e ad an d n e c k i n s e c u ri n g hi s l ever age Wh e n th e p osi .

ti o n o f th e sp i n e i s as de s c ribed th e S p i n al m uscl e s i n th at
,

are a wi ll b e very c o n tr ac te d
)
Th e verteb r ae wi ll b e h e l d
.

tight ly t o geth e r th u s l e s se n i n g th e fl e x ibi lit y

,
Lo s s o f .

fl e x ibi li ty o f the s pi n al c o lu m n re su lt s i n p o o r c ir c u l ati o n

f

i n th e s pi n al c o rd wit h co n s e q u e n t p erver si o n o f th e ac
ti v i ty of th e ph y si o lo gi c al n erve c e n ter s l o cated th ere .

C o n ge sti o n p as s iv e typ e u s u ally e x i s t s ar o u n d th e s e ce n

, ,

ter s wh e n dr ai n age is i n terfer ed with by th e s e c o n tr acte d

'

m u scl e s.

L o r do si s o r Ky phos i s M ay Aff e ct a F u ncti o n S i m i lar ly .

—A ch an ge in th e co n t o u r o f th e sp i n e eith er an te ri o r o r ,

p os terio r m ay re su lt i n th e s am e di st u rb an c e s In th e
,

p eriph er al di st r ib u ti o n o f th e n erve s fr o m th e dis

to r te d s e c ti o n The an teri o r c u rve i n th e i nte r s c ap u l ar
’

regi o n u s u ally cau se s th e rib s to dr o o p whi ch o c c asi o ns ,

a fla t th o r aci c c avity i s l e s s e n e d h e n c e re sp ir a ,

FIG 1 73
. . Vol un tar y tr e atme nt of an u pp e r do r sal l o r do si s .
42 0 PR I N C I PLE S O F O S TE O PA TH Y

t ion fe ebl e P e o p l e with fl at ch e st s m ay d evel o p w o n

is .
,

de r fu l b re ath i n g c ap ac ity by p er si s t e n t e x er c i s e The .

re sp i r at o ry m u sc le s l ift th e rib s E x er c i se o f the s e m u s .

c le s wil l i n c re as e th e ante r o p o ste ri o r di am ete r o f th e

-
-

c h e st .

Wh e n di re c ti n g a p ati e n t ab o u t th e d et ail s Of e x er c i s e
to i n c re as e th e bre ath i n g c ap ac ity do n o t f ail to i mpre s s
“

th e f act th at a f u ll r o u n d ch e st with o u t fl e x ib il ity i s j u st

“

a s bad a c o n diti o n as an ab n o rm al ly fl at c h e st F l e x ibility .

i s th e key n o te o f h e alth Th ose e x ei c i se s wh i ch m ere ly

.

i n c re as e th e c o ntr acti n g p o wer o f m u s c l es With o u t at th e ,

s am e tim e i n c r e as m g th eir rel ax i n g p o wer ar e n o t h e alth

fu l .

h o w s th at w heth er we h ave an te ri o r o r
E x am i n ati o n s

p o steri o r con diti o ns i n th e i n ter sc ap u l ar regi o n , th e s pi nal

m u scl e s ar e c o n tr acted The p ati e n t s p o we r to rel ax th em
.
’

i s lo st The p ati e n t m ay fe e l tire d an

. d we ak but th e s e ,

m u sc l e s wi ll n o t c e ase th ei r c o n tr acti o n The rigi dity has

.

’
p as se d b ey o n d th e p ati e nt s c o n tr o l .

The p ati e n
t m ethi n g t
c ano w ard re st
do so o ri n g fl e x i

bi li ty to an an te r l o r ly c u rved o r s tr aight s pi n al c o l u m n
i n th e u pp e r d o r sa l regi o n Fi g 17 3 i ll u s tr ate s th e eff e c t
. .

o f fl ex i ng th e n e c k f o r c ibly by pu ll1ng d o w n with th e

h an d s Th e s e S p i n e s ar e gre at ly s ep ar ated an d h e n c e th e
.
,

m u sc l e s Of the f o u rth an d fifth laye r s ar e re lax ed .

F ig 174
i llu s tr at es ho w th e phy s i c i an c an u s e th e do r
.

s al an d c e rvi c al vertebr ae as a fl e x ib l e l ever an d by S hift ,

i n g th e p o s iti o n o f th e h an d u p o n th e s p i n e app ly th e
m o vem e n t s p e c ifi cally to an y p arti c u lar v ertebr a NO .

m o vem e n t whi c h u s e s th e arm s as leve r s wi ll aff e ct th e

p o siti o n o f th e s e ve rtebr ae b e c au se th e fir s t an d se co n d,

layer s o f m u scle s w hi ch ar e aff e cted by ar m m o vem e n t s

'

do n o t c o n tr o l th e i n tr i n s Ic m o bi l ity Of thi s p o rti o n o f th e

S p i n al c o l u m n The f o u rth an d fifth layer s o f b ac k m u s

.

c l e s ar e th e gr o u p s wh i c h cau s e th e m al p o siti o n o f ve rte -

b r ae i n th i s regi o n .
42 2 PR I N C I PL E S O F O S TE O PA TH Y

F IG 1 75 A m e th o d of a ff e ctin g kyph o si s in th e u ppe r d o r s al

g
. . . .

re i on .

Th ey ar e no t
'
w el l a d apte d to tre atm e n t of an i n d ivi dual
ve rteb r a .

K y pho s i s—U ppe r D o r sal — A p o steri o r cu rve i n th e

’
.

u pp e r do r s al regi o n c an b e tre ate d by th e m eth o d i ll u s

17 5 The p hy s i c i an s right ar m i s p l ac ed
’
tr ate d i n F i g . .

ab o ve th e p ati e n t s right S h o u ld er an d u n de r th e che s t s o

’
,

th at th e h an d can b e p lac e d in th e p atie n t s l eft ax i lla

‘ ’
.

The p atie nt s h e ad s h o u l d b e t u r n e d aw ay f ro m th e phy s 1

’

c i an s o th at th e u pw ard p re s su re o f hi s ar m wi ll n o t i nter
,

fere with th e trach e a The phy si c i an s l eft h an d m ay be

.
’

m o ved fr o m p lac e to pl ac e alo n g th e sp i n al c olu m n The .

f arthe r th e h an d s ar e sep ar ate d th e m o re l ever ag e i s ,

g ai n ed Co n sid e r abl e f o r c e c an b e e x e r te d i n th i s m o ve
'

m e n t with o u t any d an ger to th e p ati e nt i n f act to b e o f , ,

any v al u e it m u s t be m ad e f o r c ef u lly The p ri m ary use .

o f thi s p r o c ed u re i s to red u c e th e e x c e s s o f p o s teri o r c u rve .

 PR I N C IPL E S O F O S TE O PA TH Y 42 3

Th at whi ch has b ee n writte n Co n c er ni n g th e erve n

c e n t er s i n th e i n ter sc ap u la r r e gi o n wh e n s tr aighte n i n g o r
"

an teri o r c u rv at u re Of th e s p i n e e x i s t s app l i e s e q u ally to ,

th e p o s te r i o r c u rv at u re .

F IG . 176 . A me th od of -
t g k yp h
aff e c i n o si s in th e d o r s o - lu m ba r
r e g l on .
42 4 PRI N C I PL E S O F O S TE O PA TH Y

P o ste ri o r cu rv at u r e i s acc o mp an i e d by i n c re ase d ah

t e r o p o ste ri o r di am ete r o f th e ch e s t an d lo ss o f fl e x ibi l
-
,

ity Thi s m o vem e n t i nc re as es fl e x ib i lity I t c an e asi ly b e

. .

ad apted to th e t re atm e n t Of th e fifth o r s i x th r ib s .

F IG 177 A m e th o d of a ff ti ng k y p h
ec o si s in th e l o we r d o r s al
r g on
. .

e i .
42 6 PR I N C I PL E S O F O S TE O PA TH Y

gr avi d u te r u s co n tr a i n di c ate th e u s e o f any m o vem e nt

,
~

wh i c h co mp re ss e s th e abd o m i nal co nte n t s an d al so i n th e ,

Case o f a gr avid u ter u s any m o vem e n t w hi ch i s li abl e to

c au s e ac tive c o n ge sti o n o f th e l u mb ar e n largem e n t o f th e

S pi n al c o rd .

O the r M o v e m e nt s —Fi g 17 7 il lu str ate s

. an o th er m eth
od Of e x e rti n g p re ssu re o n th e p r o m i n e n t p art o f a ky pho
s is . The l ever age i s n o t s o gre at as i n th e pre c ed i n g
m eth o d bu t wh ere th e kyph o si s i s s light it i s th e b etter
, ,

m o ve m e n t .

S til l an o th e r s i mpl e m eth o d o f sp ri n gi n g th e lu mb ar

p o rti o n o f th e sp i n al c o lu m n i s sh o w n i n F i g 178 The
-

. .

’
p ati e n t s k n e e s ar e h e l d ag ai n st th e phy si c i an s abd o m e n
’

,
’
whi le the phy s i c i an s h an d s m ake co u n te r p re ss u re o ver
th e ap e x O f th e kyph o s i s The bu tt o c k s ar e f o r c ed b ac k
. .

w ard by th e p re s su re o n th e patl e n ts k n e e s S o m e o ste o ’

.

p ath s o bj e c t to th i s m o vem e n t o r any o th e r whic h n e ce s

F IG 179 A m e th o d of a ff ti n g
ec ei th er k y ph o si s or l o r d o s i s i n th e
l u m b ar gi
. .

re on .
1
 PR I N C I PL E S O F O S TE O PA TH Y 42 7

S it a te s pre ssu re O i the p ati e n t s k n e e s o r e lb o w s ag ai n s t

-
’

Th ere i s an e l em e n t o f d an ge r to th e
"

th e abd o m e n .

o s te o p ath .

Thi s p o s iti o n F i g 178 i s u s e d freq u e n t ly wh ere

‘

, .
,

s tr o n g i n h ibit o ry p re ssu re i n th e l u mb ar r e g i o n i s re q u ire d

‘
.

F o r e x amp le i n cas e s o f di arr ho e a o r c r amp s

,
An y hyp er .

ac tivity O f s tr u c t u re s g o ver n ed by c e ll s i n th e l u mb ar e u

largem e nt m ay be i n hibite d i n t hi s reg i o n

e

Wh e n l o rd o si s o f th e lu mb ar r egi o n ex i st s i t is n e ce s
s ary to fl e x th at reg i o n i n o r de r t o c o u n ter act it F i g 179 . .

i llu str ate s an e asy m eth o d o f acco mp li shi ng t hi s r e sult .

Th i s s am e m o v e m e nt with th e phy s i ci a n s r i ght h an d

‘ ’

u n der th e sp i n e can b e m ade t o do d u ty i n co rre ct ing a

p o s teri o r cu rve Wh e n th e h an d i s p lac e d dire ct ly u n der
.

th e kyph o s i s th e b ac k i s l if ted ; th e n i f th e b u tt o c k s b e
,

f o r c e d to th e t abl e the S p i n e wi ll b e spr u n g i n th e di r e c

,

ti o n de si r e d .

F u n cti o n al h i —
Ky p o s s A l arge p r o p o r ti o n o f p ati e n t s
.

wh o se S p i n al c o lu m n s e x hib it a te n de n c y to kyph o s i s in ,

th e sp lan ch ni c are a S u ff e r fr o m eith er vi s c er al refle x e s o r

"

a hyp o t o n i c co n diti o n o f the e r e cto r spi n ae m u s cl e s Th e r e .

i s s car c e ly a cas e Of vi sc er al pt o s i s t hat d o e s n o t pre s e nt

a hyp o t o n i c c o nd i t i o n o f th e se e x te n s o r m u s c l e s The .

f u n c ti o n al kyph o si s so fre q u e nt ly app are n t i n thi s regi o n

i s trem e n d o u s ly b e n efited by r ath e r f o r c ef u l l ever age
m o vem e n t s whi ch ar e acc o mp an ie d by co u n ter p re ss u re at
the ape x o f th e kyph o si s I f thi s c o u n ter p re s su re i s ap
.

p li e d s u dde nly bu t n o t s everely it u su ally p r o d u c e s a

, ,

s o u n d i n the arth r o di al ar ti c u l ati o n s o f th e s p i n al co l u m n

-

un de r th e p o i n t o f c o u n ter p re s su re Thi s p o ppi n g s o u n d .

c an b e p r o d u c ed by a v ari ety o f m e t ho ds m an y o f w hi ch , _

ar e i ll u s tr at ed i n thi s ch apte r The p ati e n t p r acti cally

'

alw ay s f e e l s a n i n c re as e o f m u sc l e t o n e after th e p o pp i n g
-

s o u n d i s e l i c ited Th i s i s evi de n c e d by a fee l i n g o f gre ate r

.

abi l ity to h o l d th e b o dy ere c t Th ere i s a g en u i n e fee l i n g

.

o f i n c re as e d p o wer asi de f r o m any p sy ch o l o gi cal e ff e ct

,
42 8 PR I N C I PL E S O F O S TE O PA TH Y

F IG . 180 .
A m
e th o d
'

of s e cu r i n g ‘

g e n e r al d o r sal ro t at i on .

th at m ay ac c o mp an y ph e n o m e n o n As a s imp l e
the .
ex“

i
’

p e r i m e nt ,
o ne m ay v o l u n t a ri ly e x te n d o n e s fi n ger s n

o p e i
n n g th e h an d to i ts f u l l es t e x te n t a fter h a v i n g,
h a d it
fl e x e d fo r a c o n s i derab l e ti m e Th ere is a fe eli n g o f li m
.

i tati o n Of th e e x te n s o r m o vem e n t wh i c h i s d o n e a w a y w ith

'

i f w e p assively e x te n d th e fi n ger s with the o t he r h an d .

A fter thi s p as s ive e x te n s i o n by m a n ip u l a ti o n we a r e a b l e

to v t
o lu n a lri y e x te n d t h e fi n ger s with gre a ter p o wer an d

to a gre a ter e x te n t th a n b ef o re .
T hi s e q.u a liz i n g o f th e _

f o r c e s o f e x te ns i o n an d fl e x i o n is p r o b ably wh at tak es
p lac e wh e n w e h e ar th e s o u n d i n c id e nt al to m o vem e n t s
,
,

whi ch pr o d u c e su dd e n p ass iv e e x te n s i o n i n a j o i ntwh i ch ,

i s in a s a t te o f i mb a l a n c e o n a c c o u n t o f a s t a ti c err o r o r ,

vi sc e r al refl e x .
43 0 P R I N C I PL E S O F O S TE O PA TH Y

The eff o rt p r o d u c e such a so u n d i n all so call ed sub

to -

l ux ati o ns wi ll su re ly re s u lt i n s tr ai n o f th e p e ri arti cul ar -

ti ssu e s The Op e r at o r m u st h ave a tr ai n e d s e n se o f ti s su e

.

re s i st an c e an d b e g o ver n e d acco rdi n gly L ever age an d

"

co u nte r p re s s u re s h o u l d n eve r b e u se d i n t he tre atm e n t

o f an y j o i n t wh i ch e x h ib it s sympt o m s o f i n fl amm ati o n .

In cas e o f i nfl amm ati o n i n a j o i n t i ts p o s iti o n i s p r o b ably

‘

s el f p r o te c tive an d h e nc e sh o u l d n o t be r o u ghly tre ated “

-
.

The l ac k o f abil ity to di ag n o s e th e tr u e c o n diti o n o f a

j o i nt l e ad s to fre q u e n t mi s u se o f m an ip u lative m eth o d s .

Ne w S cho o ls — It i s t i hi n g ho w v ari e d a cl as s
as o n s

o f p ati e n t s i s b e n efited by r ath er h e avy c o u n t er pre ss u re

m o vem e n t s Th i s f act has l e d to th e r ap id ex p l o it i n g o i so

.

ca ll e d
“
ne w S ch o o l s whi ch c lai m th eir m et ho d s ar e di ffer
”

e n t fr o m an d f ar su p eri o r t o o ste o ath i c m et ho d s

p I t i s an .

i nt e re sti n g f act te s tifie d to by m any pati e n t s w ho h av e b ee n

,

tre at ed by ma n y o ste o p ath i c phys i c i an s th at n o tw o o f ,

th ei r phy si c i an s o p e r ate d al ike Thi s i s ch ar acteri sti c i n

.
,

th at th e o st eo p ath i c c o lle ge s h ave n o t co n c e ntr ate d s o

.

m u ch o n a p a rti c u lar m eth o d as o n te ach i n g p ri n c ipl e s

whi ch ar e c ap abl e o f m any m eth o d s o f app li cati o n
.
.

F IG 182 S i m pl e s t f m
or of m ov e m e n t to ove r co me a fu n ti o nal
c
kyp h i gi
.

r
.

os s i n th e do s al re on .
 PR I N C I PLE S O F O S TE O PA TH Y 43 1

V ar i o u s Appl i cati o ns o f a P r i n c i pl e p atie n t with .

—
Ii a

a f u n cti o n al kyph o s i s, i n th e s p lan ch n i c a re a l ie s pr o n e o n ,

th e fl oo r o r any o th er u n yie l di n g s u rf ac e as i n F ig s 18 2 ,
.

'

an d 18 3
. i t o fte n su ffi c e s to m e re ly m ake su d de n d o w n
,

w ard p re s su re o n th e ap e x o f th e k y pho se d af e a with th e ‘

p alm o f th e h an d O n e o r s ever al p o pp i n g so u n d s wi ll b e
.
, ,

h e ard if th e p ati e n t re lax e s an d th e f o r c e o f th e su dde n

p re s s u r e i s p r op er ly p r o p o rti o n e d to th e p a ss ive re s i st an ce

o f th e S p i n al ti ss u e s I t m ay b e n e c e ssary to c o n c e n tr at e
.

th e p o i n t o f p re s sure i e u se a th u mb o r h eel o f th e h an d
,
. .
, ,

rei n f o r c ed with th e o pp o s ite h an d The r e aso n so m e o p .

e r ato r s u se lo w t ab l e s IS m e re ly to al l ow th em to u s e
th ei r o w n weight to th e b es t adv an t age i n u si n g d o w n
w ard p re ss u re . A c c o rdi n g to th e e x te n t o f th e l e si o n e d
“

”
are a ,
i e th e kyph o si s an d acc o rdi n g to th e v o lu n t ary
. .
, ,

p o wer o f re lax ati o n ch ar act eri sti c o f th e p ati e n t th e 0 p

.
'

e r ato r c an u s e a large o r s m all c o n t ac t are a i e th e he el , . .

, .

o f th e han d hyp o th e n ar em i n e n c e o r th e th u mb
,
The , .

am o u n t o f p re ss u re m u s t b e p r o p o rti o n e d to th e p ass ive

re si st an c e o f th e ti s su e s No e ff o rt sh o u l d b e m ad e to .

F IG 183 ‘

To k y p h i i n th up p d al
ove r co me a f t
u n c i o n al os s e er or s
a t w l a t f f l m w h i l m ak i n g u dd n
. .

w m ay
e a u se o e s so r o u cr u e s e
d wnwa d p
o v th r t an v r e s su r e
p f th
o v ter e r s e r se r o ce s se s o e er e
b a w i th th th m b T h i m v m nt
r e e al l y
u a s a n ap s o e e u su c u se s s
pi ng m t a ff t d b y th th u m b
.

n d i n th a ti
s ou l ati n e r cu o s os ec e e
pr e ssu r e .
4 32 P RI N C I PL E S O F O S TE O PA TH Y

o ve r c o m e any activ e re s i st an c e o n th e p art o f th e p ati e n t .

The Op er at o r m u s t co n trive to u s e th e p re s su re b ef o re th e
p ati e n t c an b ri n g hi s m u sc l e s i nt o active co ntr ac ti o n .

H e re i n li e s th e n e ce s sity fo r th e e x e r c i se o f c o n sid er abl e

d i sc reti o n as to wh e n th e adv ant age o f th e p ati e n t s O ff ’

g u ard m o m e nt sh o u ld b e t ake n .

T e Us e o
h f a F u l c r u m — Adv an t age o ve r a p ati e n t s
.
’

n at u r al spi n al re s i s t an c e i s g ai n ed by u s i n g a f u lc r u m at

so m e c h o s e n p o i n t o n th e an teri o r su rf ac e o f th e b o dy A .

very si mpl e u se o f th i s p ri n c ipl e i s i ll u str ate d by F i g 18 4 .

,

’
wh e rei n th e o p e r at o r s f o r earm s e rve s th e p u rp o se o f a fu l
cru m .

Fi gs 18 5 an d 18 6 il lu str at e th e appl i c ati o n o f th e

.

s am e p ri n c ipl e with th e p ati e n t s itti n g Th i s i s p r o b ab ly .

th e e as i e st p o siti o n fo r th e o p er at o r to u s e co u n ter p re ss u re .

H i s k n ee s s erve as a f u l c r u m H i s h an d s gr asp i n g th e pa.

,

ti e nts elb o w s h ave a s e c u re h o l d s o th at a Su dde n p u ll

’
‘

, ,

b ackw ard s erv e s to f o r c e th e weight o f th e u pp er p o rti o n

o f th e p ati e n t s b o dy o ve r th e f u lc r u m an d th u s f u lfi ll th e
‘

co n d iti o n s o f exte n si o n an d c o u n te r p re ss u re re q u i re d fo r

c o rre c ti o n o f th e kyph o si s By v aryi n g th e p o s iti o n o f th e

.

F IG 184 To co r r e c t a fu n ti
c o n al kyph osis in th e g
d o r sal r e i o n
g i ght f f
. .

t
.

O p e r a o r u si n his r o r e ar m as a u l c r um S u dd e n d o w n
.

r
w a d p r e s s u r e i s m ad e w i th th e r f
O p p o s i te h an d , e i n o r c e d by
r ’
th e p r e s s u e o f th e o p e r ato r s c h e s t .
4 34 PR I N C I PLE S O F O S TE O PA TH Y

’
Op e r at o r k n e e s an d i nter lo cki n g his fi n ger s o ver th e pa
s

ti e n ts c h e s t as i n F i g 18 5 th e m o vem e n t c an b e m ade
’

, .
,

ve ry sp e c ifi c as to a s i n g le sp i n al segm e nt .

A m o vem e n t o f gre at ad apt abi l ity i s i ll u str ate d by

Fi g 18 7
. The p ati e n t p lac e s hi s h an d s o n Opp o s ite sh o u l
.

d er s an d th e n allo w s his weight to re s t On th e o p er at o r s ’

f o re arm In th i s m an n er th e o p e r at o r m ay u s e hi s l eft
.

o r righ t h an d a cco rdi n g to c o n ve n i e n c e

,
as a f u l c r u m to ,

b e app li ed at any se le cte d p o i n t i n th e d o r s al o r lu mb ar

are a By lifti n g th e p ati e n t s b o dy ag ai n s t th e f u lc r um
’
.
,

e ith e r s u dd e n ly o r gr ad u ally the o p er at o r is ab l e to c o n ,

c e n tr ate c o rre c tive l ev er age an d p re ss u re at an y de s i red .

p o i n t R o t ati o n o f th e sp i n al c o lu m n c an b e s e cu red by
.

th i s m o vem e n t an d h e n c e it s e rve s as o ne o f th e m o st
ad apt ab l e m o vem e n t s fo r a ll s o rt s o f c o r re ctive w o rk The .

o p er at o r d o e s n o t ac t u ally c arry m u c h o f th e p ati e n t s

'
’

weight o n hi s ar m .

The fir s t f o u r d o r s al vertebr ae ar e r ather d i ffi c u lt to

m an ip u late The p o s iti o n i llu s tr ated by F i g 2 3 0 sh o w s
. .

h o w th e hyp o t
’
h e na r em i n e n c e o f th e Op er at o r s l eft h an d
s erve s as a f u lcru m whi l e th e r e st o f th e h an d rei n f o r c e s
,

th e n e c k s o th at th e h e ad an d n e c k th u s r ei n f o r c e d c an
,

b e u s ed as a l ever wh i c h i s f o r c ed b ac kw ard by th e right

-
,

h an d on th e p ati e n t s c h i n F ig 18 9 sh o w s ho w m o re po w
’
. .

e r fu l l eve r age m ay b e ap p l i ed by o n e w ho ha s a ke e n s e n s e , _

of ti s s u e re si s t an c e A n y m o vem e n t emb o dy i n g gre at

.
,

l ever age m u st b e u s e d with e x trem e c au ti o n

,
.

C o o r na o n o C
di ti f o r r ec tiv e M o v e m e n t s — The su cc e s s
o f any o f th e s e m o vem e n t s dep e n d s e n tire ly o n th e o p er

ato r s abi l ity to c o o rdi n ate hi s m o vem e n t s so as to aff e c t

’

th e sp e c i al p o i n t i n th e s p i nal ti s s u e s r e q u l r m g adj u s t
m e n t J u s t as o n e s eye s c o o rdi n ate to pr o d u c e bi n o cu lar
’
'

vi si on o n e s h an d s m u s t w o rk harm o n i o u sly to s e c u re g o o d
,
’

re su lt s The ski ll f u l o p e r at o r cau s e s p r ac ti c ally n o p ai n

.

by hi s m o vem e n t s Th ey ar e ti med an d gr ad u ate d to s u it

.

t he n ee d s o f hi s c as e .

F ig 19 1 i llu str ate s a m eth o d o f e x e rti n g l ever age

.

an d p re ss u re to c o rre c t a later al su bl u x ati o n i n th e u pp er

 PR I N C I P L E S O F O S TE O PA TH Y 43 5

F IG 186 To c o r r e c t a f y
u n c ti o n a l k p h o s i s i n th e d o r s al
g g
. .

r e i on P
r a c ti c a l ly th e s am e m o v e m e n t a s i n p r e c e d i n
t By t t g t g
.

i ll u s tr a i o n r an s m i t in th e p u ll h r o u h th e p a
t t g
.

ti e n t s a r m s , th e p a i e n t s p e c o r a l a n d s e r r a tu s m a n u s
’ ’

m u s cl e s l i ft t t
th e a n e r i o r e x r e m i ti e s o f th e r i s b T hi s
gy by
.

i s an e x c e e di n l t
e fh c i e n t m o v e m e n wh en e x e cu te d
k f
a s i ll u l Op e r a or t .
436 PR I N C I PL E S O F O S TE O PA TH Y

F IG 187 An e x c e ll e n t m ov e m e n t by w h i c h to exer t l v ag
e er e
m b ar r g i n
. .

an d c o u n te r p r e ss u r e i n th e d o r s al a n d l u e o s . .
438 PR I N C I PLE S O F O S TE O PA TH Y

F IG 18 9 g
U si n th e h e a d a n d n e c k as a le ve r w h i l e th e
g
. .

y
h p o th e na r e m i n e n c e o f th e r i h t h a n d i s u s e d a s a
f g
u l c r u m i n th e u p p e r d o r s a l r e i o n o rby g
u si n th e th u m b
an d f r fi g r
o e n e a s th e f u l c r u m th e f o r c e o f th e m o v e
t t
m e n m ay b e e x e r e d to c o r r e c t a c e r v i c al l e s i o n .
 PRI N C I PLE S O F O S TE O PA TH Y 439

F IG 190 A v ar i a ti on of th e m ov e m e n t t
p i c u r e d i n th e p r e
g t a ti
. .

c e di n i llu s r on .
 PRI N C I P L E S O F O S TE O PA TH Y

d o r sal The Op e r at o r s right h an d s e rve s to f o r c e th e h e ad

.
’
-

an d n e c k i n a di re cti o n to b e n d th e c o l u m n o ver th e th u mb
”

o f th e l eft h an d as a f u lc r u m The p ati e n t s fac e i s i n cl i n ed

’
.

, .

t o w ard the l e sio n s id e s o as to acc e nt u ate r o tati o n wh i ch

'
‘

-
-
, ,

i s th e ac t u al co rre c tive p art o f th e m o vem e n t .

o r —
D s a R o t ati o n F i g 18 1 i s a s imp l e m eth o d o f s e
l .

c u ri n g fl e x i bi li t y i n th e l o we r d o r s al p o rti o n o f th e b ac k .

R o t ati o n i s p o s si b le i n th e d o r s al bu t n o t i n the l u mb ar
regi o n h e n c e by h o l di n g th e sh o u ld er s d o w n an d li fti n g
, ,
.

r o t ati o n i s s e c u red i n th e d o r s al regi o n Thi s

'

o n e h ip
‘

, .

m o vem e n t f o r c e s th e n o rm al ac ti o n betw e e n i n divid u al v e r

'

te b r ae o f th e lo we r d or s al reg i o n I f any p arti c u lar ar tic u .

lati o n is at f au lt it wi ll n o t yie l d to s u c h a g e n er al m o ve
,

m e nt as th i s The o n ly g ai n m ade by it i n th at c ase i s to

.
, ,

p rep are th e s u rr o u n di n g ti ss u e s fo r m o re sp e c ifi c w o rk .

—
L at e r al C u r v at u r e Th i s ki n d o f d ef o rm ity i s fr e
.

q u e n t ly f o u n d an d a large p r o p o rti o n o f su c h c as e s ar e be n ‘

e fi te d by o ste o p athi c m an ip u lati o n A we ake n ed c o n .

d iti o n o f th e wh o l e b o dy predi s p o s e s to th e f o rm ati o n o f

'

a l at er al c u rv e \ F ig 19 2 i l lu str ate s an u n c o mp e n sated

.

late r al c u rv e th a ,
t is th e c u rv at u re is all i n o n e di f ecti o n
,
.

In s u c h a c a se th e m u sc l e s o n th e c o n ve x si de ar e n o t d o i n g
th ei r f u ll d u ty The p ati e n t i s allo wi n g th e weight o f the
.

u pp er p o rti o n o f th e tr u n k to b e h e l d by th e lig am e n t s i n

st ead o f th e m u sc l e s Th i s si mp l e c u rv at u re c an b e re adi ly
.

o ve r c o m e by e x er c i s e s wh i c h wi ll d eve lo p th e we ak s p i n al
'

m u scle s .

F i g 13 4 i ll u str ate s a c o mp e n sated c u rve th at i s a

"

.
, ,

The p ri m ary c u rv e i s i n the i n te r sc apu lar

'

l ette r S c u rve .
.

regi o n an d i s co mp en s ate d fo r by a c u rve i n th e o pp o s ite

di re c ti o n i n th e l u mb ar regi o n
—
.

K n ow H o w to A pply P r i n c i ple s The o s te o p ath .

s h o u ld k n o w ho w t o app ly his p ri n c ipl e s so th o r o u gh ly th at

th e p o siti o n o f hi s p ati e n t wh eth e r ly in g s itti n g o r st an d , ,

in
g, W ill n o t c o n f u s e h im S o m e o ste o p ath s de si re t . o give

th ei r m an ip u l ati o n s to th e p ati e n t s itti n g o th er s l ike th e ,

re cli n i n g p o siti o n b ette r O n th e wh o l e it s e em s b e st to .

,

s el e c t th e p o siti o n su ited to th e s p e c i al w o rk req u ire d .

442 PR I N C I PL E S O F O S TE O PA TH Y

D O No t C o py M o v e m e n t s —DO
py anyb o dy s n o t co
’

m o vem e nt s L e ar n th e p ri n c ip le s th e n apply th e m i n th e
.
,

m an n e r m o st sati s f act o ry to y o u r se lf an d h el pf u l to the

p atie nt . To u n d er s t an d th e p ri n c ip l e s an d apply th em
i n te llige n tly o n e c an n o t k n o w to o m u ch c o n c er n i n g all
, .

th e s u bj e ct s wh i c h ar e th e b as i s o f a b r o ad m edi c al e du
c ati o n
.

FIG 19 2 A c as e o f u n c o mp e n sate d l ate r al

b l i ty
. .

cu r vatur e , du e to d e i .
 PR I N C I PL E S O F O S TE O PA TH Y 443 ‘

C H A P TE R X XI .

R E D U CTI O N O F S U BLUX ATI O NS .

H avi n g n o ted a fe wm Ov e m e ri tS whi c h h ave a ge n er al

—
be n efi c i al e ff e c t o n g r o u p s o i s tr u c t u re s w e wi ll n o w e x ,

am i n e a few o f th e mo vem e n t s wh i c h ar e app l i c ab l e to

s p e c ifi c s u b l u x ati o n s .

In th e c h apte r o n S u b lu xati o n i n th e th e o reti c al s e c

'

“
ti o n o f th i s v o lu m e we call e d atte n ti o n to th e f act th at A
.

s u b l u x ati o n i s a sl ight ab n o rm al re lati o n b etwe e n b o n y

s u rf ac e s m ai n t ai n e d by u n eve n co n tr ac ti o n in Opp o s i n g
,

gr o u p s o f m u s cl e s wh i c h co n tr o l th e a rti c u lati o n The .

c au s e s of t he co n tr acti o n ar e vi o l e n c e temp er at u re c h ang e s

”

an d refle x irrit ati o n

.
A red u c ti o n i s s e c u re d by e q u al izi n g
.

vit al ac tivit y : With th i s st atem e n t i n mi n d we wi ll s t u dy ,

fir st th e lat e ral s u b lu xati on s i n th e d o r sal regi o n .

—
L at e r al S u bl u x ati o n A later al s u b lu x ati o n i s p o s sib l e
'

o n ly
'

in th o s e p o rti o n s Of th e s pi n al c o l u m n wh e re the
f o rm ati o n o f th e arti c u lar f ac et s allo w r o t ati o n The c e r .

vi c al an d d o r sal ar e the regi o n s i n wh i ch th i s o cc u r s Lat .

er al s u b lu x ati o n i s m o s t c o m m o n i n th e arti c u lati o n s o f

.

th e at las thi rd c ervi c al an d an ywh ere in th e d o r s al w itli

, ,

th e e xc epti o n o f th e twe lfth The i n feri o r arti c u lar fac et s

.

o f th e twe lfth ar e l u mb ar i n c h ar ac ter h e n c e allo w o n ly ,

fl e x i o n e x te n s i o n an d c i r c u m d u c ti o n
,
.

I t m ake s n o di ff ere n c e wh at th e cau s e o f th e l ate r al

s u b lu x ati o n m ay b e th e u n eve n c o n tr acti o n o f m u scl e s
,

i s the fi ri al re s u lt h e n c e all ar e tre ate d i n th e s am e m an n er

'

, .

Wh e n th e vertebr al S pi n e i s di sco vere d o u t o f li n e with

th o s e ab o ve an d b e lo w an d te n d er n e s s n o te d o n i ts p r o m
i n e nt S i de we ar e di sp o s ed to c o n s id er it a tr u e l e s i o n an
, ,

irrit an t to th e n erv o u s sy ste m Wh ethe r it i s th e re su l t o f .

44 4 P R I N C I PL E S O F O S TE O PA TH Y

F IG 1 9 3 . . f
S u r ac e i n d i c a ti o n of a la t e r al su b lu x at i on

ac c i de nt c o ld o r refl e x e s d o e s n o t n ee d to b e s eri o u s ly
,

c o n s i de red Wh il e it e xi s t s it i s a c o n ti n ual so u r c e o f i r
.
,

r itati o n to th e n er v o u s sy s te m he n c e sh o u ld be rem o ve d
,
.

with o u t d el ay I f it i s th e re su lt o f refl e x e s i ts red ucti o n

.
,

wi ll at l e as t re m o ve o n e di st u rb i n g f ac t o r fr o m th e cas e .

The p r o mi n e n t si d e o f th e sp i ne i s th e o n e o n whi ch
th e m u sc le s ar e co ntr acte d The c o n tr ac ted m u sc le s m u st
.

b e th o s e wh i ch ar e hOldi n g the b o n e i n i ts m al p o siti o n

'

-
.

In o rd e r to e x ert th i s i n fl u e n c e th ey m u s t b e att ach ed i n ,

s u c h a w ay as to m o ve th e b o n e i n thi s dire c ti o n wh en
'
'

th ey act n o rm al ly Th eir p re s e n t c o n diti o n i s o n e Of hyp er

.
“

ac tivity . With th i s l i n e o f re as o n i n g any arti c u l ati o n can ,

b e e x ami n e d th e p u ll o f its m u sc l e s d etermi n ed an d m o ve

,
446 PR I N C I PL E S O F O S TE O PA TH Y

blu
'

F IG . 1 95 . F lex i on of a l a te r a l su x a ti o n ..

p r om i n e n t S id e o f th e le s i o n as i n F i g Th i s p r o c ed u re .

s tret c h e s th e co n tracte d r o t at o re s S pi n ae an d al so s e p
ar ate s th e th re e verteb r ae i e th e s u bl u x ate d o n e an d
,
. .
,

th e s u p e ri o r an d i n feri o r o n e s th u s m aki n g it e as ier to

,

p u sh th e s u b lux ated v ertebr a i nt o i ts tr u e p o s i ti o n .

The s e c o n d m o vem e n t i s an an teri o r fl e x i o n to permit

o f gre ater free d o m o f m o vem e n t b etwe e n th e arti c u lar pr o

c e ss e s
. By f o r c i n g th e b o dy fir st i n t o th e p o siti o n o f later al
fl e x i o n th e n an te r 1o r fl e x i o n al l th e m u s cl e s o f th e fifth
, ,

gr o u p wh i ch affe ct th e s u b lux ate d vertebr a ar e re lax ed .

“ ”
D u ri n g th i s an te ri o r fl e x i o n a c li ck i s s o m etim e s h e ard
,

wh i ch is evi d e nc e o f re lax ati o n s u ffi c i e n t to allo w appr o x i

m ati o n o f th e su bl ux ated su rfac e s D u ri n g all th e tim e o f .
 PR I N C I PL E S O F O S TE O PA TH Y 44 7

F IG 196 Ex te n s i o n an d c o u n te r p r e s su r e O
t re
bl
.

ti
.

du ce a l a te r a l su uxa on .

m aki n g t he s e fl e x io n s th e phy si c i an s righ t th u mb S h o u ld

,
’

m ake s te ady pre s s u re ag ai n st the p r o m i n e n t S i de o f th e .

spi n e th u s t aki n g adv an t ag e o f th e re lax ati o n g ai n e d by

,

e ach fl e x i o n The an teri o r fl e x i o n i s i llu s tr ate d i n Fi g 19 5

. . .

The fi n al m o vem e n t i s later al fl e x i o n t o w ard th e l e s i o n

whi l e l ifti n g th e p ati e n t fr o m th e s t o o l i n s u c h a w ay th at
th e weight o f th e b o dy be lo w th e l e si o n e x ert s its i n fl u e n c e
to s ep ar ate th e verteb r ae F i g 19 6 C o u n te r p re s su re with
. . .

th e th u mb i s m ade vig o r o u sly d u ri n g thi s fi n al m o vem e nt .

The S u c c e s s f u l red u c ti o n o f thi s su b lu x ati o n m ay b e

“ ”
ac c o mp l i sh e d with o u t an y c li c k or o th er evi de n c e Of
move m e n t o f th e s u rf ac e s The vertebr a u s u ally m ove s
‘ ' '

i nt o its tr u e p o siti o n with o u t any au dib le sig n The phy s i .

44 8 PR I N C I PL E S O F O S TE O PA TH Y

c i an s
’
fi n ge r s c an d ete rm i n e th e su cce ss o r f ail u re o f th e
m o vem e n t I f th e su b lu x ati o n w as c au se d by ac c ide n t o r
.

c o ld ,
i ts re d u c ti o n i s all th at i s n ee de d bu t if it i s th e r e ,

s u lt o f refl e x i rr i t ati o n o r i gi nati n g i n a vi s cu s

,
th e phy si ,

c i an m u st di re c t su ch a m o d e o f l ivi n g th at re st m ay be
s e c u red fo r th e stim u lated vi s c u s H abit s o f life m u s t b e .

lo o ked i n t o .

F i g 19 7 i ll us tr ate s an o th er m eth o d of red u c i n g a sligh t

.

The phy s i c i an s left ar m p a ss e s u n de r

’
late r al s u b lu x ati o n .

the p ati e n t s l eft a la th e n th e h an d i s plac e d firm ly o n

l
’
,

th e b as e o f th e n e c k p o steri o r ly Thi s give s th e phy si c i an ,

The phy s i c i an s k n e e right o r l eft i s

’
gre at l ever age .
,
.

p lac ed ag ai n st th e S pi n al co lu m n at a p o i n t fo u r o r five

F IG 1 97 L e ve r a g e a pp li e d t ral
to a l a e su b lu x ati on in th e mid
g
. .

d o r s al r e i o n .
4 50 PR I N C I PLE S O F O S TE O PA TH Y

tai n e d as wh e n c o u n ter e x te n s i o n i s give n by tw o m e n

p u lli n g at th e h e ad an d fe et o f th e p at ie nt whi l e a thi rd ,

o ne d e vo te s his atte nt io n to f o r c i n g th e ve rtebr al spi n e

—
i nt o p lac e Wh e n th e p ati e n t i s S h o rt an d h e avily m u s cl ed
‘

.
,

it i s imp o s sib le to e x e cute this m o v e m e n t sati sf act o ri ly

.
.
.

L t
a e r al S u b u ati
l x on e r l —
L ow r D o sa A late r al le S IO n .
‘

o f th e n i n th te n th o r e leve n th d o r sal i s m o re e asi ly han

,

dle d th an th o s e high er u p b e c au s e the phy si c i an can

'
‘

gras p th e p ati e n t in a m u ch m o r e s ati s f act o ry m an n e r .

F i g 19 8 i llu str ate s th e m eth o d

. .

The se ri e s o f m o vem e nt s i s alw ay s th e s am e as al ,

re ady d e sc ribed th at i s lat e r al fl e x io n o r e x agger ati o n

, ,
'
,
-

an te ri o r fl e x i o n th e n lat er al fl e x i o n t o w ard th e le s i o n a s
,
s
,

i llu str ate d by th e c u t .

With th i s s am e p o s iti o n o th er f o rm s o f s u b lu x ati o n i n

,

th e lo we r d o r s al an d l u mb ar regi o n s c an b e co rre c ted ;

A D e pr e s s e d S pi n e — S ligh t depre s si on Of a d o r sal
s pi n e with s e n s itive n e s s o ve r it th at i s betwe e n its ap e x , ,

an d th e spi n e b e l o w
'

i n di cate s th at th e m u s c l e s in th at
,

S it u ati o n ar e s ffi c i e n tly co n tr ac te d t o dr aw the S pi n e o f

'

u
‘

th e u pp e r verte br a d o w n w ard The de pre S Se d s pi ne i ri di .

‘

c ate s th at th e b o dy o f th e verte b r a i s S l ight ly tipp ed b ac k

'

w ard an d d o w nw ard S e e c h apter o n S u b lux ati o n s!

.

To red u c e th i s l e s i o n a fl e xi o n o f th e spi n al Co lu m n
,

a s far as th e verteb r a b e lo w th e l e s i o n i s m ade an te ri o rly .

I f th e d epre s se d S p i n e i s any o n e o f th e u p pe r s ix d o r sal

”

u se th e p u ll o f th e S p l e n i u s c apiti s e t c o ll i
.
i e fle x th e , . .
,

h e ad an d n eck as i n F i g The phy si c i an s right han d

’
.

i s p lac e d o n the S p i n e Of th e vertebr a be lo w th e S ublux a

ti o n th u s allo w m g all th e f o r c e o f th e m o v e m e n tito ter
,

mi n ate i n a p u ll o n th e m u s c le s b etwee n th i s ve rtebr a an d

th e d ep re ss ed s pi ne Thi s s am e pri n c ip le can b e app li ed
.

to al l p o rti o n s o f th e S pi n al co lu m n .

Wh e n i n divid u al sp i n e s ar e p r o mi n e n t an d se n sitive
.

ne ss i s f o u n d ab o ve th e p r o c e ss i n ste ad o f be lo w w e h ave ,

a c o n diti o n th e rever s e o f th at j u s t d e s c rib ed Its tre at .

'

m e nt i s s i mi l ar to th at o f the pre c ed i n g e x c ept th at by

' ’

,
 PRI N C I PLE S O F O S TE O PA TH Y 4 51

c h an gi n g th e p o siti o n o f th e right h an d to re s t u p o n th e
p r o mi n e n t S p i n e o u r l e ver age aff e ct s th e c o ntr acte d m u s
,

c le s ab o ve th e S p i n e

K y pho s i s—P o tt s D i s e ase W h e n ever a k n u c k l e i s

'
.

’
—
f o u n d i n th e S pi n e i n q u i re c aref u lly as to th e p os sibi lity
,

o f di re ct i n j u ry p r e di s
, po s i ti o n to t u b er c u l o s i soe tc P o tt s , .
’

F ig . 199 . S p r e ad i n g th e l o w e r ri b s an d s tr e tc h i n g g
th e d i a p h r a m .
4 52 PR I N C I PL E S O F O S TE O PA TH Y

di se as e o f th e spi nal c o lu m n m ay c au se pr o m i n e nc e Of a

s i n g l e verteb r al S pi n e . A s o th er ve rtebr ae ar e aff e cted ,

a

kyph o si s is d eve lo p ed .

R ib S u b lu x ati o n s —
R ib
su b l u x ati o n s
. pre se n t m any
di ffi c u lti e s to th e o s te o p ath The m eth o d s u se d i n th eir
.

re d u cti o n ar e as v ari e d as can we ll b e i m agi n e d A fe w

'

o f th e m o st u s e f u l an d dire c t ar e give n here .

In F i g 199 th e phy s i c i an i s app lyi n g a m e th o d o f

.

s p re ad i n g th e lo wer rib s W he n th e te nth rib S i n k s u n der

.

th e n i nth and th e re i s a g en e r al j amm i n g o f th e f o u r lo wer

rib s t o geth er th e phy s i c i an st an d s b eh i nd th e p ati e n t w ho
,
.

r ai s e s hi s h an d s ab o ve hi s h e ad to s pre ad th e lo w e r rib s
.

by m e an s o f th e lati ssi m u s d o r s i Wh il e th e h an d s ar e
.
.
‘

e lev ated th e phy si c i an gr asp s the anteri o r e x tremiti e s o f

,
‘

th e rib s an d h o ld s th em u p wh i le the p ati e nt l o w er s hi s

h and s to hi s thigh s S u ch a m o v eme n t as thi s w ill rep lac e
.

th e rib s i n th ei r right re lati o n s b u t a fl e x i o n o f the p atie nts ’

' '

b o dy Wi ll u n d o th e w ork Co n ti n ual w e ll dire cte d tre at

.

m e n t an d v o lu n tary e x er c i s e ar e n e ede d to br i n g the m to

'
'

'
p lac e an d h o ld th e m th e re .

The f o u r l o we r rib s c an b e s ep ar ate d an d th e ante ro

p o ste ri o r di amete r o f the th o r ax i n c re as e d by th e m eth o d -

i llu s tr at ed i n F ig .

The l eft h an d lift s o n th e an g le s o f th e depre s sed rib s

.

wh i le th e p ati e n t s ar m i s e xte n d ed b e y o n d hi s h e ad , th u s
’

m aki ng u se o f th e l ever age g ai ne d th r o u gh th e att achm e n t

o f th e lati ss im u s do r s i Thi s m o vem e n
. t i n c re a s e s th e right
“

an d l eft hyp o c h o n d ri ac al s p ac e s .

-
The p o s iti o n o i an i n divid u al rib i s aff e c te d
'
-
th e
co n t r ac ti o n o f th e i n ter c o st al m u s c le s ab o ve and b e lo w i t -
.

The sp ac i n g determi n e s wh eth e r th e rib is e lev ate d o r de

p re ss e d The width o i an i n ter c o st al sp ac e wi ll n o t b e th e
.

sam e b etwee n t he an g le s an d an ter io r e x tremiti e s This .

i s c au s e d by th e f act th at th e h e ad o f th e rib i s fi x e d s o
th at it c an no t m o v e u p o r d o w n The mo vem e nt wh i ch .

t ake s pl ac e be twe e n the he ad o f the r ib and the ve rteb ra

'
4 54 PR I NC I PL E S O F O S TE O PA TH Y

The te n d e n cy i n th m ati c an d br o nchiti c pati e nt s is

as

to c au s e el ev ati o n o f th e rib s th u s d eve lo pi n g a b arrel

,

S h ap ed ch e s t Wh e n all th e i nter co st al m u s cle s act e q ual

.

ly th e rib s ar e e q u ally sp ac ed bu t i n a case o f b r o nc hiti s

'

, , ,

s o m e l o cal p o rti o n o f th e b r o n c h i al t u bi n g i s e sp e c i ally

F IG 2 01 . F irs t p o s i ti o n to r e du c e a su b l u x at ed fi f th
'

rib .
 PR I N C I PL E S O F O S TE O PA TH Y 4 55

i rri tated F r o m thi s are a irrit an t i mp u ls e s re ach th e s p i n al

.
,

c e n te r with whi c h it i s m o s t c lo s e ly as s o c i ated . The i n ter

co st al m u s cl e s i n dire c t re lati o n wi th thi s c e n ter re c e iv e

a gre ater n u mber o f i mp u ls e s h e n c e c o n tr a c t m o re vig o r
, ,

o u sl . A str ai n o r b l o w m ight c au s e th e S a m e re s u lt
y .

F IG . 2 02 . S e co n d t
p o si i on to r e du c e a su bl t
uxa ed fifth rib .
4 56 PR I N C I PL E S O F O S TE O PA TH Y

To bri n g th i s fifth rib d o w n to i ts p r o p er p o s iti o n th e ,

phy s i c i an may st an d b eh i n d hi s p atie nt as i s il lu str ated ,

"
by Fi g 2 0 1
. H is
l eft h an d gr asp s the p atie n t s right e lb o w
.

an d p u s h e s i t ab o ve t he S h o u ld er th u s c au si n g th e m u s ;

c l e s to l ift th e r ib s Thi s m o vem e n t wi ll p u ll o n all th e

.

rib s o f th e right s id e an d te n d to e qu aliz e th e s p ac i n g

, .

The phy si c i an pl ac e s hi s left k n e e dire c t ly o ve r th e an g le

o f th e fifth r i b hi s right h an d o n th e ante ri o r e x tremitie s
,
'

of t he fifth s i x th an d s eve n th rib s th e mi d dle fi n g e r o f

, ,

thi s h an d b e i n g app li ed aga i n st th e lo we r m argi n o f th e

fifth rib The rib b ei n g n o w i n r ig ht r e lat i o n w ith i ts fel
'

lo w s th e c riti cal p eri o d o i th e m o ve m e n t i s wh e n rel ax a

'

-v
,

ti o n i s allow ed by lo we ri n g th e ar m The k n ee ab 6v e an d
'

w
.

o v er th e ang le p re ss i n g f o r ward an d d ow nw ard

,
hi le ,

th e m i dd le fi n ger o f th e right h an d p reve n t s d ep re ss i o n

‘

o f th e
-
an te ri o r e x trem it y
'

Thi s l ever ag e f o r c e s th e rib

.

to ret ai n right re lati o ns with its fel lo w i n re lax a ti o n o f

th e ch e st The te rm i n at i o n o f th e m
. o vem e n t i s i l l u s tr ated

by F ig 2 0 2 . .

ge n er al “ dep re ss i on Of all th e an g le s o f th e rib s

A .

c au s e s th eir s u p eri o r m ar gi n s t A fl at c h e s t
’
o b e p r o mi n e n t :

i s th e re su lt Th i s co nditi o n fr equ e n tly f o llo w s p n e u m o

.
.

'

n ia o r s o m e di s e a s e wh i c h c au s e s the p atie n t to l i e o n the

b ac k d u ri n g a lo n g p eri o d of we ak n e s s .

Wh e n a S i ng l e d ep re ss e d rib is f o u n d it u su ally has

'

b e e n cau s e d by a s tr ai n wh i c h has we ake n ed th e i n ter .

T
.

c o s t al m u sc l e s i n th e s ac e ab o ve it re at i t whi l e s t an d
p .

i n g i n fr o n t o f th e p ati e n t P lac e th e mid dl e fi nger o f th e

.
.

The p ati e n t s right elb o w

’
l eft h an d u n de r th e an g l e .
!

m ay re st a g ai n s t th e phy si c i an s abd o m e n P re s s u re m ade ’

.

o n th e elb o w f o r c e s th e s cap u la b ac k an d bri n g s i n t o ac

-

ti o n th e se rr at u s m ag n u s whi c h lift s th e rib s A sk th e .

p ati e n t to i n sp i re an d th i s wi ll r ai s e all th e ribs W h e n .

.

rel ax ati o n c o m e s with e x pi r ati o n lift th e an gl e o f the rib ,

f o r c ef u l ly an d i t wil l reg ai n i ts pr o p er p o s iti o n F i g 2 0 3

,
. .

i l lu str ate s th i s m o vem e n t S o m e o ste o p ath s gr as p th e

.
4 58 P R IN C I PL E S O F O S TE O PA TH Y

F IG . 204 . t
F i r s t p o s i i o n i n li ft i n g a se r i e s o f d e p r e s s e d l ow e r ri b s .

F ig s 2 04 , 2 0 5
. i llu str ate th e meth o d o f r ai s m g
an d 2 06 .

an d S p re adi n g th e lo wer rib s With th e p ati e n t i n thi s

.

p o s iti o n th e phy si c i an c an m ake e x te n sive p as sive m o ve

,

m e n t s with o u t m u c h re si st an c e Th e se m o vem e n t s ar e
.

S imi lar to th at i llu s tr ate d by F i 199

g . .

“ ”
Wh e n th e rib s dr o o p to a m arked degree th e re i s a ,

de c id e d ch an ge i n th e sh ap e o f the di aph r ag m The e x te n t .

o f th e th o r ac i c fl o o r i s l e s s e n e d an d it m ay b e th at th e
,

s tr u c t u re s p as si n g th r o u gh th e di aph r agm are d etrime n t al

ly aff e cte d by it The m o vem e nt pi ct u re d in Fig 19 9 i s

. .
"

we ll c al c u lated to s pre ad th e lo we r rib s an d th e reby i n

c re as e re s pi r at o ry c ap ac ity .
 PR I N C I P L E S S
O F O TE O PA TH Y 459

The fi r st r i b i s
‘

tr o n g ly h e l d by the s cal e n u s anti

so s :

c u s th at it p r a c ti c ally n
ever i s dep re ss ed I t i s h o wever .
, ,
r qu n l
f e e t y e l ev ated to s u c h an e x te n t th at it i n fri n ge s o n
s tr u c t u re s ar o u n d th e fir s t th r
o ac i c s y mp ath eti c
gan g li o n ,

t hu s aff e cti n g h e art acti on .

"

To dep r e ss the fir s t rib to i ts p r o p e r p o s iti it i s

on ,

n e c e ssary to t ake th e e x tr a co n tr
ac ti o n o u t o f th e s c al e n u
s

F IG . 2 05 . S e co nd t
p o s i i on in lif ti n g a se r i e s of d e p r e ss e d low e r
rib s .
460 P R I N C I PLE S O F O S TE O PA T HY
an ti c u s Thi s i s d o n e by m aki n g th e fir s t rib a fi x ed i n
.
“

s te ad o i a m o v abl e att ach m e n t F i g 2 18 i llu s tr ate s th e

. .

m eth o d o f re lax i n g th e s c ale n u s an ti c u s The phy s i ci an s .

’

th u mb h o l d s th e fi r s t rib d o w n wh i le th e m u sc le i s stret ch e d
’
by f o r c i n g th e p ati e n t s h e ad dire ctly to th e o pp o site S i d e .

The sc al e n i m u scl e s c an b e e asi ly d ete c te d by p lac i ng

o n e s fi n ger s 0 11 th e S id e o f th e n e c k n e a r th e b as e
’
Th ey .

wi ll b e fe lt h ard en i n g d u ri n g i n s pi r ati o n .

F IG . 206 . Th e th i r d p o s i ti on f
i n l i ti n g a serie s of d e p r e s s e d l ow e r r ib s .
46 2 PR I N C I PL E S O F O S TE O PA TH Y

FIG . 2 07 . P o si ti o n f o r tr e a tm e n t o f a n u p w a d r an d f o r w ar d di s
l o c a ti o n o f th e i l i u m
'

The h o ck wh i c h i s tr an s mitte d to thi s arti c u lati o n i n

s

an ac c i de n t u s ually s trike s th e t u b er i s ch i i fr o m b e l o w o r ,

p o s teri o r ly o r s trike s th e k n e e an d th e f o r c e i s ex erted

,

ag ai n st th e a sc e tabu lu m Wh e n th e f o r c e i s ag ai nst the

.

t u be r i s ch ii fr o m b e lo w o r p o steri o r ly w e h ave an u v ar d
, ,

di sp lac em e n t o r a twi s t c au s i n g th e p o s teri o r su p eri o r

, ,

ili ac spi n e to b e c om e m o re p r o m i n e n t Whe n th e f o r c e .

\

s trike s th e asce t ab u lu m by m e an s o f th e fem u r th e twi st ,

i s i n th e o pp o site di re c ti o n an d the s pi n e i s l e s s p r o mi n e n t
,
.

H ave th e p ati e n t g ive det ai ls if p o ssib l e c o n c er n i n g

, ,

hi s p o s iti o n with refere n c e to th e dire c ti o n o f th e f or c e at

t h e tim e o f th e ac c id e n t o r if th e c o n,
diti o n ap p e a r s -t
; o b e
du e to Oth e r c au se s striv e to fi n d o u t wh at th ey ar e
,
.

H avi n g d eterm i n ed the di r e c ti o n o f th e twi st th e f o r c e ,

o f o u r m an ip u lati o n m u s t b e m ad e c o u n ter t o t hat ap p li ed

at th e tim e o f t he acc id e n t S i n c e th e . ve ry
m o v ab l e we c an n o t u se th e thigh as a sti ff lever th ere
,
.
,

f o re o u r f o r c e m u s t b e app lie d to eith er th e an te r io r o r pos

,
.

te r i o r su rf ac e o f th e t u b er i s ch ii a n d to the an teri o r o r
 PR I N C I PLE S O F O S TE O PA TH Y

p o ste ri o r s u p e r i o r S p i n e o f th e i l i u m i e p u s h an d p u ll ,
. .
, ,

s u c h as t u r n i n g a wh ee l o n i t s ax l e Thi s m o vem e n t i s
‘

i llu strated in F ig 2 0 7 The o rigi n a . l f o r c e whi c h thi s m o ve

.

m e n t i s tryi n g to o ver c o m e w as tr an smitt ed fr o m th e k n e e

"
by th e fem u r to th e ac et ab u lu m an d re su lte d in a twi st ,

Of th e i li u m wh i ch m ad e th e p o steri o r su p eri o r S p i n e l e ss
p r o m i n e n t th an its fe llo w o f th e Opp o s ite S i de In o rd er .

to make th i s n i oV e m e n t e ff e c t u al an ass i st an t m u st m ake

"
-

s te ady eve n pre ss u re o v er th e arti cu lati o n o f the sa c r u m

’

an d fifth lu mb ar verteb r a i e o ve r c o m e th e te n de n cy o f
,
. .
,

th e twi sti n g m o ve me n t to m ere ly aff e c t the m o v ab l e sac r o

vertebr al i n ste ad o f th e i mm o v ab l e s ac r o i li ac ar ti c u lati o n
,
-
.

By fl e x i n g th e p ati e n t s thi gh o n to his ab do m e n s u f

’

fi ci e n t Opp o rt u n it y i s give n th e phy s i c i an to m ake p re s

.
-

s u re o u th e an teri o r s u rf ac e o f th e t u b er i sch ii an d p u ll ,

fo rw ard o n th e p o steri o r S u p eri o r i li ac S p i n e th u s reve r s

,

i ng th e m o vem e n t i llu str ate d by F i g 2 0 7 i .

F i g 2 0 8 i llu str ate s an e ffo rt to u s e th e thigh as a l eve r

.

to aff e c t th e sac r o i l i ac arti c u lati o n wh e n th e p o s te ri o r

-

s u p eri o r s p ine is pr o mi n e n t Thi s i s a d an ger o u s m o ve .

m e n t an d sh o u l d n o t b e u s ed The f o r c e tr an smitted by
, .

th e th igh aS a l e v e r wi ll n o t re ach th e j o i n t de s ired an d

- -

,
—

wi ll o n ly re su lt i n str ai n i n g th e i li o fem o r al l ig am e n t -
.

.
—
A s ac r o i l i ac s u bl u x ati o ni s di ffi c u lt to c o rre c t b e c au s e ,

th e j o i n t i s p r ac ti cally with o u t n o rm al m o vem e n t The -

.

p elvi s te n d s alw ay s to re si st any app re c i ab l e m o vem e n t i n

i ts j o i n t s th eref o re th e phy s i c i an m u st d evi s e w ay s o f
-
,

s e c u ri n g lever age to d ire ct ly aff e c t th e s e j o i n t s with o u t

-

'~

tr an smitti n g hi s c o rre ctive l ever age th r o u gh th e very

_

—
m o v ab l e sac r o vertebr al j o i n t ab o ve o r th e hip j o i n t b e lo w
Thi s i s a di ffi c u lt c o n diti o n to f u lfi ll
.

An t e r io r R o t ati o n o t e I i u
f h l m — W h e n th e i li u m i s .

r o t ated f o r ward th e p o s teri o r su p e ri o r S pi n o u s p r o c e ss i s

,
-

l e ss p r o mi n e n t th an i ts fe llo w o f th e o pp o s ite s i d e Th i s .

c o n d iti o n c an b e m et by h avi n g th e p ati e n t p r o n e o n an

u n y ie l di n g s u rf ac e ; s light ly p adde d S O as n o t to br u i s e
th e an teri o r s u p eri o r sp i n e o f th e i li u m Si n c e the twi s t .
464 P R I N C I PL E S O F O S TE O PA TH Y

ge y i ng f o r c e S ac r o
’

FIG 2 08 A dan ro u s m e th o d of a ppl to th e

t
. .

i li a c ar i c u l a ti o n .

F IG 209 To c o r r e c t a n te r i o r r ta ti n f th i l i u m H a d p a d
o o o e . r

g t r u p ri o m
. .

din u n d e r th e a n e i o r s e p i n
r f th
s i l i u e S u
o d d n e . e ,

h e av , d o a y a r d p e ss e r ur o n th sacru m e b tw n i ts fi r t e ee s
r
s p i nou s p oce ss an d th e i li ac spi ne , on th e l e s i o n si d e .
 PR I N C I PL E S O F O S TE O PA TH Y

th e p ati e n t s l eg o n th e s i d e o f th e l e si o n to h an g o ff th e
’
, ,

t ab le so as to b e at a right angl e to th e s pi n al c o l u mn .

Th i s te n d s to ti lt th e p e lvi s b ac kw ard an d th u s p ermit a

gre ate r d o w nw ar d m o vem e n t i n re sp o n se to th e s u d d e n
p re ssu re S o m etim e s it i s advi sabl e to u s e s everal par
. .

ti al appli cati o n s o f th e p re s s u re b ef o re th e fi n al co rre ctive

eff o rt with o u t rem o vi n g th e c o n t ac t h an d
,
Thi s te n d s .

to p e rm it th e p at i e n t to rel ax by t aki n g aw ay th e fe e li n g
The o p e rat o r
.

th at p r o te c tive re s i s t an c e m u s t b e m ade .

m u st c re ate and r e co g n ize th e p sy c h o lo gi c al m o me n t fo r

'

th e appli c ati o n o f th e co rre c tive m o vem e n t .

The pr 1n ci ple un de r lyi n g th e Op er at i o n j u s t de sc ribed

'

c an b e app li ed if th e p atie n t l ie s o n hi s b ac k The l eg .

o n th e l e s i o n s id e sh ou l d b e fl e x ed o n t he thigh and th e '

th igh o n th e abd o m e n th u s t ilti n g th e p e lv i s bac kw ar d

, .

B y p lac i n g th e p elvi s s o th at th e i li u m o n th e le s i o n s id e '

i s j us t o ff th e p ad de d e dge o f th e t ab l e th e o p e r at o r can
.
,

p lac e his c h e st ag ai n st th e fl e x e d le g an d th igh whi l e hi s

h and s re st o n th e o pp o s ite an te ri o r su p eri o r S pi n e s o f th e
il i a A s u dderi d o w nward p re ss u re co o rdi nated with an
.
,

attempt to spr ead the i li a apar t w i ll b e me t by the r e

'

r
, l

s i stan c e o f th e p ad de d edge of the t abl e: ag ai n s t t he S i de

betwe e n i ts fir st spi no us p ro c e s s and the
‘

o f th e s acr u m ,

i li ac c re st Th e s e m o vem e n t s h av e th e advantag e o f ap
' '

p lyi n g co rre c tive f o r c e with o u t h avi n g any o f th at fo r c e

’
.

d i s sip ate d by p as s i n g it th r o u gh a m o vable l jo i nt b ef o re

'

re ac h i n g th e i n te n ded po i nt o f app li c ati o n Thi s i s a very

‘

i mp o rt an t f act o r if th e p ati e n t i s an ae s thetiz ed

—
P o ste r i o r R o t ati o n o f the Il iu m Wh e n th e po steri o r .

su p eri o r s p i n e o f o n e o f th e i l i a i s ap p ar en t ly to O p r o m
'

i n e n t c are S h o u l d b e t ake n to n o te wh eth e r the appar e nt

‘

p r o m i n e n c e i s n o t du e to a r o t ati o n an d ti ltin g of the p el

‘

v i s i n i ts re lati o n to th e s pi n al c o lu m n S inc e the fl e x i o n

“

o f th e tr u n k o n th e p elvi s i s c h ar ac t eri sti c i n th e S itti n g

'

, .

p o s t u re an d all p e o p l e te n d to re st th em s elve s whi l e st an d

,

i n g by tr an s mitti n g th e weight o f th e b o dy th r o u gh o n e
l eg co n ti n u ed m ai nte n anc e o f th e s e p o siti o ns ch ange s th e
,
 PR I N C I PL E S O F O S TE O PA TH Y 467

re lati o n o f th e p e lvi s to th e s p i n al c o lu m n i e c au se s a ,
. .
,

u n i later al —
l u mb o s ac r al S u b lu x ati o n S t ati c err o r s ar e .

c h ar ac te riz ed by a c o mp e n sat o ry ti l t o f th e p e l vi s h e n ce ,

all the fac to r s th at might p r o d u c e s u c h a c o n diti o n m u s t

‘

b e t ake n i n t o co n s i d er ati o n A S p revi o u s ly n oted th e o n e .

,

te st o f wh eth e r a s u b lu x ati o n e x i s t s i s a co mp ari so n o f th e

re lative p o s iti o n s o f th e p o s teri o r s u p eri o r sp i n e s with
re lati o n to the se c o n d S ac r al S p i n e
,
-
-

To c o rre c t a p o ste ri o r r o t ati o n we u se p r acti c ally th e

s am e p o s iti o n an d l ever ag e re q u ire d to c o rre c t a ti l t o f

th e p e lvi s o n th e S p i n al c o lu m n The p ati e n t s h o u l d r e .

c l i n e o n th e n o rm al s ide th u s p re se n ti n g th e s u b lu x ati o n
,

ar e a to th e Op er at o r F o r c e m u s t be a pp l ie d o n th e c re st
.

an d S id e o f th e i l i u m c lo s e to th e p o s teri o r su p eri o r s pi n e ,

so as to r o t ate th e i l i u m f o rw ard The b o dy m u st b e to .

tate d b ac kw ard th u s te n di n g to h o l d th e sac r u m fr o m r o

,

t ati n g i d ly with th e i l i u m The s e c o n d iti o n s c an b e fu l

'
.
.

fi ll e d i f the Op er at o r t ake s th e p o s iti o n i llu str ated i n F i g .

211 i e gr asp s th e p ati e n t s e lb o w with hi s h an d an d

, . .
,
’

’
p re ss e s hi s o w n elb o w agai n st th e p ati e n t s S h o u ld er th u s ,

F IG 211 t t
To c o r r e c p o s e r i o r r o a ti o n o f th e i l i u m t
a l a n ce p a B
b y t r b t t t t by
. . .

e cu m e n
’
ti e n t s od i n th e l a e r a l p o si i o n so ha , p u sh
t
i n g th e p a i e n s s h o u l d e r
’
t
a c w a r d th e o p e r a o r b k
c an ma e t k
effi ci e n t
p r e s s u r e a ai n s t th e p o m i n e n g r
i lia c Sp i ne w i h hi s t t
o p p o si e t f r
o e a r m a n d th u s s e c u r e a c o m i n a i o n e x t e n s i o n an d b t
t r
o s i on m ov e m e n , t t
c o n c e n tr a e d i n th e sac r o - i l i ac j o i n t .
468 PR I N C IP L E S O F O S TE O PA TH Y

s e cu ri ng an adv an t age o u s h o l d fo r f o r c i n g th e p ati e n t s ’

b o dy to r o t ate b ac kw ard The Op e r at o r pl ac e s hi S o the r

'

f o re arm s o li d ly ag ai n st th e c re s t Of th e il i u m an d gl u te al
“

ti s su e s j u s t ab o ve an d e x ter n al to th e p o steri or ili ac spi n e .

By r o c ki n g th e p e lvi s f o rw ard and th e b o dy b ac kw ard a

few ti m e s th e p ati e n t wi ll yi e ld to th e m o vem e n t an d th e
o p e r at o r S h o u l d s e l e c t th e m o m e n t o f th e p atie n t s gre ate s t
’

rel ax ati o n to S udd e n ly ac c e n t u ate th e s e Opp o si n g r o t a

ti o n s No atte mpt S h o u ld b e m ad e to m ake m o re th an a
.

m o d e r ate r o t ati o n u n ti l i t i s felt th at th e p atie n t i s p e r

m itti n g th e m o vem e n t to be m ad e with o u t i n te rp o s i ng any »

str o n g p r o te c tive m u s c l e te n s i o n I t IS q u ite i mp o ss ibl e .

to c o rre c t a s u b lu x ated i li u m i f th e p ati e n t e x ert s an y pr o

te c ti v e c o n tr ac ti o n o f hi s m u sc l e s The f o r c e o f th e r o t a .

ti o n m o ve m e n t mu s t g o th r o u gh th e m u s c le s with o u t r e
s is tan c e so as to re ac h th e lig am e n t s an d o th er de ep s tr u c
,

t u re s ar o u n d th e j o i n t The ar t o f getti n g su cc e s s f u lly

.

by th e m u sc u lar te n s i o n o f the p atie n t with o u t e x erti n g

a f o r c e ca p ab le o f p r o d u c i n g tr au m a re q u i re s n o s m all

degre e o f skil l NO gre at am o u n t o f f o r c e s ee ms eve r to

.

be req u ire d i f one has a fi n e s e n s e o f ti s s u e re s i s t an c e .

F IG 212 L e v e r ag e and c o u n te r p r e s su r e to r e du c e a t
pos e r ior
bl O p ra t ft f r k
. .

i liac su u x a ti o n e or s
’
le o m ma es
e ar p r e s su r e
g ai n g
.

a st pos e r ior t sup i r i l ia

er o c sp i n e S am e l e v e r a e as in
f da n g
.

F ig . 2 1 8 , th e r e o r e u ero s .
470 PR I N C I PL E S O F O S TE O PA TH Y

th e ti s s u e s is advi sab le I t m ay b e n e c e ssary to re pe at

.

th e c o rre ctive m o vem e nt s m any ti m e s if the cas e is o n e o f

lo w vit ality o r has a st ati c ar e a w hi c h d o e s n o t p erm it th e
'

p e lvi s to h o ld i ts n o rm al re lati o n to th e sp i n al c o lu m n .

F IG . 2 13. T t
hre e s r ips O f f
tw o a n d o n e - h a l - i n ch a d h e s i v e
f r g t t
a p p li e d to r e i n o c e th e p e l v i c l i a m e n s s o a s to r e a i n
b t t
a s u l u x a e d i li u m i n p o s i i o n a ft t
e r c or r e c i o n
.
 PR I N C I PL E S O F O S TE O PA TH Y 471

C H A P TE R X XI I .

I RE A TMENT O F TH E C E R V I C A L R E GI O N .

The tre atm e n t o f th e c lavi c l e m u s t b e co ns i dere d h ere

'

be cau s e i ts p ositi o n so fre q u e n t ly i n te r fere s With th e

dr ai n age o f th e ti ss u e s o f th e n e c k W h e n it i s h e ld d o w n
_

'

to o c l o s e ly to the fir s t rib by sh o rt e n i n g o f th e s u b c lavi u s

,

m u sc l e it i s q u ite su re to aff e ct ve n o u s c ir cu lati o n in th e

,

h e ad an d n e c k .

To R ai s e
'

the C lavi cl e — TO r ai s e it p lac e th e

. ight r

th u mb o n th e fir s t rib as i llu s tr ate d by F ig 2 14 th e n c arry .

,

th e p ati e n t s l eft f o re arm ac r o ss hi s f ac e ab o v e t

’
he h e ad
as i n F i g 2 15 Th e n as far o u tw ar d as th e p hy s i c i an s
’
. .

ar m . Thi s m o v e m e n t c au s e s th e c lavi c l e to p re ss d o w n
i
-

o n the phy s i c i an s th u mb
’
wh ere it re st s o n th e fir s t rib
, ,

an d th u s stret che s the su b c l avi u s .

S u bl u icati o n of Clav i cl e — A rti cu lati o n s s u c h as

the .
,

t he s te r no c l avi c u lar an d ac r o mi o c lavi c u lar wh i c h d ep e n d

- -

e n t ire ly o n th ei r ligam e n t s to keep th em t o geth e r an d to

l imi tth ei r m o ti o n c an n o t be ret ai n e d i n p lac e if th eir l ig a
,

me nt s h ave b e e n i n j u red I f th e li gam e n t s o f th e ster n o

.

c lavi c u l ar j o i n t b e co m e re lax ed th e p u ll o f th e s ter n o

,

cl ei d o —m ast o i d lift s it u pw ard S l ight irrit ati o n o f th e

.

p n e u m o g astri c n erve m ay b e o cc as i o n ed by thi s ch an ge o f

p o s iti o n .

P r e par ato r y Tr e atm e nt o f the Ne ck—Tr ape z iu s — The .

prep ar at o ry tre atm e n t o f th e n e c k co n si st s in m o vem e n t s

to re lax t he v ari o u s gr o u p s o f m u s c l e s F i g 2 16 i l lu s tr ate s . .

t he m e t h o d o f re lax i n g th e c ervi c al p o rti o n o f th e tr ap e

zi ns O n e h an d o n th e sh o u ld e r h o l d s it firm ly d o w n wh i l e
.
,
4 72 PR I N C I PL E S O F O S TE O PA TH Y

F IG
'
. 2 14 . F i rs t p o s i ti o n to r ai s e th e c l av i c l e .

th e o th er h an d f orc e s th e h e ad as far as p o s sib le i n th e

Opp o sit e dire c ti o n R e lax th e Opp o s ite m u s cl e i n a simi lar
.

m ann er .

t
S e r n-
l i
o c e d o m as t ~
o i d —Ne x t rel ax th e ster no c l e id o
.
,
-

m ast o id by s ep ar ati n g i ts att ac hm e nt s as far as p o s sib l e ,

as i n Fig 2 17 al so by d ire c t m anip u lati o n

.
, O b s erve .

wh eth e r b o th m u sc le s wi ll re lax eq u ally Th e s e large m u s .

c l e s ar e freq u e n t ly f o u n d u neve n ly c o n tr ac ted S i n c e th e .

S pi n al acc e s so ry n erve s c o n tr o l th e s e m u s c l e s any co n ,

trac ti o n S h o u l d le ad th e phy si c i an to e x am i n e all p art s

i n c o n n e c ti o n with th em A refl e x fr o m th e lary nge al
.

br an ch e s as wel l as p n e u m o gastri c b r an ch e s m ight ac

co u n t fo r it .
474 PR I N C I PL E S O F O S TE O PA TH Y

R e l ax a ti o n fib r e t ziu
‘

F IG . 216 . of th e c e r v i cal s of th e r ap e s .

E x t e ns i o n .
—D i re t e x te n s i
c th e n e c k m ake s an on of
’
e q u al p u l l o n all th e v erteb r ae Wh e n th e p ati e n t s feet .

ar e an c h o re d the i fo r c e o f th e p u ll i s fe lt i n th e we ake st
,

p o rti o n s o f th e S pi n al c o lu m n The aver age p ati e n t r e qu i r

.

i n g th i s tre atm e n t e nj o y s a d e li c i o u s s tim u l ati o n after r e

"

l ax ati o n o f th e e x te n s i o n A few w ho ar e e x trem e ly n e r

.

v o u s m ay giv e a b ad re acti o n The i n fl ux o f b lo o d i n th e .

S pi n al c o rd i s h igh ly b e n efi c i al t o th o s e w ho h av e s u ffi

c i e n t v a s o —
m o t o r t o n e to h o ld i t th ere bu t th o se w ho lack ,

th i s t o n e wi ll fe e l f ai n t o r eve n ab so lute ly lo s e co n sci o u s

n e ss . S imp ly allo wi n g th em to re st o n th e t ab l e u n ti l th e
v asc u lar sy stem re ac t s wi ll e nab le th em to re ap th e f u ll
,

be n efit o f th e tre atm e n t The e x te n si o n s h o u ld b e m ade

.

with ab so lu te ste a di n e s s The re lax ati o n p eri o d i s u su ally

.

th e o n e i n whi c h any v aso m o t o r ph e no m e n a ar e n o te d

-
.
 PR I N C I PL E S O F O S TE OP A TH Y 4 75

F IG . 2 17 . R e l a x a ti o n O f th e s t rn
e o - cl e i d o - m as t o i d .

The te n s i o n h o u l d b e l e ss e n ed very S lo w ly i n all

S c as es .

’
F ig . 220 s h o w s th e p o s iti o n o f the phy si c i an s h an d .

R o tat io n —The f o llo wi n g m o vem e n t i s o n e fo r wh i c h

l o n g p r acti c e i s re q u i re d i n o rder to get an yth i n g l ike a
,

s u cc e ss f u l re su l t f ro m i ts u s e I t co n s i s t s i n gr asp i n g th e
.

p ati e n t s n e c k with th e l eft h an d as i n F i g 2 2 1 The pa

’
. .

ti e n t s he ad re s t s ag ai n s t an d sl ight ly to th e right o f th e
’

phy s i c i an s f o re arm The right h an d gr as p s th e c hi n wh i l e

’
.

th e fo re arm re s t s firm ly ag ai n s t th e p atie n t s h e ad The ’

.

o bj e c t i s t o h o l d th e n e c k an d h e a d rigi d ab o ve th e p o i n t

gr as p ed by th e th u mb an d fi n ger s o f th e l eft h an d W h i l e .

h o l di n g th e h e ad an d n e c k rigi d th ey ar e m o ve d s o as to,

fo r c e c ir c u m d u cti o n i n th e j o i n t b e lo w th e gr as p o f th e
l eft h an d A fte r e ac h c i r cu m d u c ti o n th e l eft h an d i s sh ifted
.

th e depth o f On e v ertebr a n e arer th e h e ad Th u s all th e i n .

te r v e r te br al arti c u lati o n s i n th e c ervi c al regi o n ar e re l ax e d

476 PR I N C I P L E S O F O S TE O PA TH Y

F IG . 218 . R e l ax at i o n of th e s c a l e ni by d e p r e s si n g th e fi t
rs r ib .

an d s p e c ifi c w o rk o n a d efi n ite a rti c u l ati o n c an b e d o n e

m o re e as i ly .

The H y o i d Bo n e — W o rk o n th e an teri o r p o rti o n o f

th e n e c k c o ns i st s in aff e cti n g th e c o n diti o n o f gr o u p s o f
m u s c l e s f o rmi n g th e fl o o r o f th e m o u th an d e x tri n s i c m u s
c l e s o f th e l ary n x .

The H y o id b o n e i s th e m o v able par t w hi ch c an b e

'

’
gr asp e d by th e phy s i c i an s fi nger s D r awi n g it d o w n w ard .

an d to th e righ t as i n F i,g 2 22 re l ax e s th e
. s tl —
hy o
,
i d an d
p o steri o r b el ly o f th e d ig astri c A c o ntr ac t u re d c o n diti o n
.

o f th e s e m u sc le s may aff e c t th e p n e u m o g as tri c n erve .

-
n l o —
M y l o hy o i d a d H y o g ssus The my lo hy o id an d .
-

hy o g lo ssu s f o rmi n g th e fl o o r o f th e m o u th m ay b e tre at ed

as i n F i g 2 2 3 . Wh e n th e m ax i llary g lan d s ar e c o nge sted
.
,
4 78 PR I N C I PL E S O F O S TEO PA TH Y

F IG . 22 0 . Exte nsi on of th e ne c k .

I nt r i n s i c M u scl e s o f the L ar y nx —The i n tri nsi c m u s.

c le s o f th e l ary n x S o m etim e s n e ed atte n ti o n The c ri c o .

thyr o i d i s th e t u n i n g m u sc l e o f th e l ary nx Thi s m ay b e .

dem o n s tr ated by gr a sp i n g th e thyr o i d c arti lage with th e

t hu mb an d f o refi n ge r o f o n e h an d wh i le th e th u mb an d ,
~

f o refi n ger o f th e o th er h an d grasp s ligh tly th e c ri c o i d

c arti lage as i n F i g 2 2 4 I f th e carti lage s ar e sl ight ly se p
'

, . .

ar ate d wh i l e th e p ati e n t m ake s a v o we l s o u n d th e p it ch ,

o f th e v o i c e wil l b e p er c eptib ly l o were d Th i s i s o cc a

’

s i o n e d by re lax ati o n o f th e v o c al c o rd s by s ep ar ati n g th e

c arti lage s ,
w hi c h stret ch e s th e c ri c o thyr o i d Thi s m u s-
.

c le i s i n n e rv ated by t he e x ter n al b r an c h o f th e s u p eri o r

lary n ge al b r an c h o f th e p n e u m ogastri c The m o t o r fib er s
.

o f th e s u p e r i o r l ary n ge al c o m e fr o m th e s pi n al a cc e sso ry ,

h e n c e we fi n d l e si o ns i n th e c e rv i cal arti c ul ati o ns wh i ch ,

ar e p ri m ary c au se s o f l ary n ge al di so rd er s .
 '

PR I N C I PLE S O F O S TE O PA TH Y 4 79

F IG 221 Ci r cu m du c i o n t of th e n e c k to r e l ax th e m u s cl e s of th e
fif
. .

th l a e r y .

The Atlas r
e l
- i The at las p o s iti o n fre e
o n ac c o u n t of i ts
do mo f mo vem e nt n u m er o u s m u sc u lar att achm e n t s e tc
, ,

, , .
,

i s s u bj e c t to f r eq u e n t s u b l ux ati o n F i g 10 2 sh o w s th e . .

n o rm al re lati o n s o f th e m as t o id p r oce s s tr ans ver se pr o n

c e ss o f th e at las an d th e an g l e o f th e jaw
,
F i g 10 3 S h o w s . .

th e abn o r m al re lati o n s o f th e s e v ari o u s p r o mi n e n t p o i nt s

as th ey ar e fre q u e n t ly f o u n d by th e o s te o p ath Wh e n .

the right tr an s ver s e pr o c e ss i s n e a r th e m ast o i d th e l eft ,

i s to o c lo s e to th e an g l e o f th e jaw an d vi c e ver sa ,
-
.

In r ed u c i n g thi s twi st Of th e at las th e phy si c i an ,

S h o u ld w o rk o n th e S i d e wh i c h s h o w s th e tr an s ver s e p r o

c es s t o b e p o steri o r The sam e pri n c ip le i s app l i e d i n r e

.

du c i n g thi s s u b lu x ati o n as w as d e sc rib e d i n c o nn e c ti o n

with th e d o r s al later al s u b lu x ati o n s F i g 2 2 5 i ll us tr ate s . .

“ ”
e x aggerati o n F i g 2 2 6 s h o w s later al fl e x i o n to th e l eft
. .
,

’
wh i le th e phy s i c i an s fi nger s m ake firm pre ssu re b ack o f
th e p r om i n e n t tr an sver s e p r o c e s s th u s ste adily t aki ng ,
48 0 PR I N C I PL E S OF OS TE OPATH Y

F IG 2 22 R e lax a ti o n of th e s ty lo - h yo i d a nd pos t e r i or b lly

e of the
g t
. .

di a s r i c .

a dv an t age o f all th e re lax ati o n g ai n ed i n e ach p o rti o n o f

th e m o ve m e nt The termi n ati o n o f th e m o vem e n t i s i 1
.

lu str ate d i n Fi g 2 2 7 S o m etim e s th e at las sl ip s i n t o p lac e

. .

“
with an au dib le c li c k bu t m o re o fte n th e phy si c i an fe e l s
.

“
gritti n g s e n sati on as th e ar ti c u lar su rfac e s r ub o ve r
'

e ach o th e r Wh e n th e s u b lu x ati o n o f th e at las l s red u c ed

.

by th i s m o vem e nt it wi ll h o ld i ts tr u e p o s iti o n m o re firmly

,

th an wi ll any o th er ve rtebr al arti c u lati o n whi ch has b ee n

aff e cted i n a l ike m an n e r Thi s i S be cau se the c o n dyl e s
.
'

o f th e o c c ip u t fit m o re d e eply i n t o th e su p eri o r art i c u lat

i ng su rf ac e s o f th e atl as th an i s th e case b etwee n ar ti c u lat
i ng su rf ace s o f p ai r s o f verteb r ae F i g 2 2 9 il lu str ate s a . .
48 2 P R I N CI P L E S O F O S TE O PA TH Y

F IG 224 . R e l ax a ti o n of th e c r i co - th y r oid .

e x e rt m u c h p r e s su r e u p o n b o ny str u c t u re s fr o m the an
te r io r s u rf ac e o f th e n e c k The re a r e s o m an y glan d s
.
:
,
.

n e rve s,
a rte ri e s e t
,
c lyi n g o
. ve,
r th e tr a n s ver s e pr o c e s s e s ,

th at d ire c t p re s sure i s li ab l e to i nj u r e them

‘

Fi g 2 2 8 il lu s tr ate s a m eth o d o f red u c i n g a s u b lu x ati on

.

x t T i
’

of th e s i th c ervi c al v er ebr a he p a ti e n t.s c h i n re s t s n

th e phy s i ci an s h an d s wh i ch ar e p lac e d o n e ac h S i d e o f the

’
,

n e c k an d n e ar e n o u gh to th e c h i n to su pp o rt i t by th e u

litt l e fi n ger . The th u mb s ar e u s e d to aff e c t th e spi n e

d ire c t ly The c o m p re s s i o n o f th e h e ad and n e c k ab o ve
.
.

th e l e s i o n by b o th h an d s ke ep s th em rigi d a n d all ar e
, ,

m o v e d t o geth er fir s t to e x ag g e r ate th e le s i o n o f th e S i x th
, ,

th e n anteri o r fl e x i o n i s fo rc e d i n th e arti c u lat i o n aff e cted

'
~

t he n l ate r al fl e x io n wit h counter p ressur e by the t humb

on t he p r o m i n e n t sid e o f the spi ne .
 PR I N C I PLE S O F O S TE O PA TH Y 48 3

F IG
°

225 R e d u c ti o n of subl u xa ti on of th e a tl a s , ri gh t t r an s
.

ver se
.

pr o ce ss to o f ar p t
os e r i or —e x a gg e r ati o n m ov e m e n t .

hi
T s m o vem e n t c a n b e a pp l ie d t o s u b l u x a ti o n s o f th e
fir st an d s e c o n d d o r s al .

G e ne r al P r i n c i p l e s U n d e r l yi n g C o r r e c ti v e M o v e m e n t s .

The s a m e ge n er al p r i n C i p l e g o ver ,
n i n g th e c o rre c ti o n o f
b ti th er p rti f th e pi l l m n i
'

s u lu x a o n s i n u
o o o n s o s n a c o s ,

a pp i
l ca bl e i n th e c ervi c a l regi o n i e th
,
e. m .o vem
, e n t o r ,

e e
s ri s o f m o vem e n t s m u s t
,
b e m a d e s o a s t o o v e r c o m e th e
i nfl u e nce o f a d o mi nant muscl e gr o up As w e have pr e .
48 4 PR I N C I P L E S O F O S TE OPA TH Y

F IG . 226 . R e d u c ti o n of su b lu ati
x on of th e t
a las, t ral
la e fl e xi on .

v i o u s ly te d th e p o siti o n o f an arth r od i al j o i n t i s e x p re s
no ,

s iv e o f th e re lative te n s i o n o f th e m u sc l e s whi c h ac tiv ate it .

The S i m pl e st F o r m o f C o e cti o n
r r — The simpl e st f o rm
'

o f c o rre c tiv e m o vem e n t i s e x te n s i o n 1 e a di re c t p u l l i n

, . .
,

th e lo n g ax i s o f th e S p i n al co lu m n Th i s te n d s to put .
48 6 PR I N C I PL E S O F O S TE OPA TH Y

F IG 22 8 M an n e r of g
h o ld i n th e h e a d a n d n e c k in o r de r to r e du c e a
b t ba
. .

t r
s u l u x a te d s i x h c e v i c a l v e r e r .

To r s i o n an d t P r e s su r e — S i n c e th e c e rvi c al
Coun e r .

regi o n i s n o r mf lly ve ry fl e x ibl e c o n s i de r abl e ski ll i s r e

t
,

q u ire d if an o p er at o r m ake s us e o f r o t ati o n an d co u nter

,
“
!

p re ss u re fo r c o rre c ti o n o f j o i n t l e s i o n s The re su lt s s e .

c u re d by th e s e m e an s ar e v ery gr atifyi n g bu t th e re i s a ,

l arge r e l em e n t o f d an ge r th an i n th e u se o f e x te n s i o n The .

s ki l lf u l o p er at o r m u s t h ave a g o o d k n o w l edge o f th e an at

o my o f th e regi o n an d a s e n s e o f ti ss u e re s i s t an c e A to r .

si o n m o vem e n t i s a p o werf u l l ever an d s h o u ld b e u se d

ve ry c aref u lly Alth o u gh it is p o ssib l e to de sc rib e th e

.

r e lative p o s iti o n s o f th e o p e r at o r s h and s an d th e g e n er al

’

di re c ti o n o f th e m o veme n t s i t i s n o t p o s s ib l e to c o nvey to
-

th e re ad e r an i de a o f th e am o u n t o f f o r c e u s ed o r th e re la ,

tive am o u n t o f re s i st an c e to b e o ver c o m e I t i s thi s var .

i able e l em e n t whi ch m ake s th e d i ff ere n c e b etwe e n su cc e s s

an d f ail u re i n O p er ative w o rk No rm al m u sc l e t
. one is
e q u al to ab o u t six p o un d s p u ll h e n c e i f a pati e nt vo lu n
’

tar ily rel ax e s o r i s p l ac e d i n a p o s iti o n wh i ch d oes n o t

,
 PR I N C I P LE S O F O S TE O PA TH Y 48 7

F IG 229 P o s i ti o n f o r l o o se n i ng s tr u c t t
u r e s a r o u n d th e a l a s
f g f
. .

an d o r ci n i t o r w ar d.
48 8 PR I N C I P LE S O F O S TE O PA TH Y

F IG 2 30 . t
M o v e m e n t to se c u r e c o r r e c i o n o f a c e r v i c o
k g
.

d o r sal y p h o s i s M a n y va r i a ti o n s o f th i s l e v e r a e m ay
f
.

b e u se d Th e e f e c ti v e n e s s o f th e m o v e m e n t d e p e n d s o n
f b g r
.

th e u lc r u m e in p o p e r ly ap p l i e d
.
4 90 PRI N C I PL E S O F O S TE OPA TH Y

of th e co rre c tive m o vem e n t i n a c ert ai n j o i n t The . c or r e c

ti ve r o t ati o n m o vem e n t i s alw ay s as so c i ate d with a l itt le

fl e x i o n o r e x te n s i o n ac c o rdi n g to th e ch ar acter of th e
,

F IG . 2 31 . Th e u s e of r ota ti on to s e cu r e cor r e c ti on of c e r v i c al l e s i on s .
 PR I N C I PL E S O F O S TE O PA TH Y 49 1

le si o n . The h ead i s r o c ked ge n t ly i n th e dire c ti o n re q u i red

fo rth e co rre cti o n an d w he n th e r o t ati o n re ach e s a p o i nt
wh er e th e r e si st anc e in th e 1e 8 1o n i s fe lt F i g 2 3 1 th e o p , .
,

t
.

FIG 2 32
. . Le v e r ag e an d co u nt e r p r e ssu r e ap pl i e d to a r e cl i n i ng p atie nt. R o ati o n
i s se cu r e d i n th e u p p e r d o r sal o r any p o m t i n th e ce r vi cal
.

acco r di n g t o t f
he l ocati o n o f th e u l cr u m
.

.
49 2 PR I N C I PL E S O F O S T E O PA TH Y

e r ator trive s to c re at e a c o n d iti o n o f r e laXati o n by ad

s
'

m o n i sh i ng hi s p ati e n t n o t to re si s t S O th at by a s u d de n ,

bu t very S light i n c re ase i n r o t ati on th e le si o n w i ll re c eive

th e f u ll e ffe c t o f th e m ovem en t an d yie ld to it The yie ld .

in i s u su al ly a cc o mp an i ed by a l i ki n g o u n d i n th e
g c c s

j o i n t an d a fe e li n g o f c o mf o rt The r an ge o f v o l u n t ar y
.

m o vem e n t i n th e arti c u lati on i s i n c re as ed an d th e p atie n t

u s u ally e x p e ri e n c e s a fe e l i n g o f adde d p o wer .

The p o s iti o n o f th e f u lc r u m i n d ivi d u alize s th e ch ar ac

te r o f a m o v em e n t th e ref o re th e S h ift o f th e depth o f o n e
,

ve rteb r a eithe r m ake s o r m ar s th e su cce ss o f o n e s e ff o rt -

’

at c o r r e c tl o n In o rd e r to u s e th e f u l c ru m h an d with m o re
.

spe c ifi c ity or ,
f o r c e th e o p er at o r m ay re st th e p ati e nt s
,
’

c hi n i n th e be n d o f hi s e lb o w an d th en by anch o ri n g ,

th e h e ad with hi s b o dy f o re arm an d h an d F ig 18 9 e x
, , .
,

te n d th e p ati e n t s n e c k by a ge nt le lift Th i s e x te n si o n
’
.

fre q u e n t ly o ver c o m e s e n o u gh o f th e m u s c u lar te n s i on to

.

p ermit a S light ad diti o n al r o t ati o n m o vem e n t , with c o u n

ter p re s su re t o c o rre c t th e le s i o n
, .

S ever al i llu s tr ati on s ar e p re s e nted h e rewith to S h o w ,

th e m an n e r o f app lyi n g th e o s te o p ath i c pri n c ip l e o f c o r

r e c ti n g c ervi c al s u b l u x ati o n s by e x te n si on an d t o r s i o n
"
.

The p o siti o n o f th e p atie n t eith e r lyi n g o r S itti ng is p u re

, ,

ly a rbitr ary with th e o p e r at o r The p ri n c ip le s i n v o lve d i n

.

th e Op er ati o n ar e th e s am e i n eith e r p o s iti o n F i g 2 3 2 . .

sh o w s ho w t o r s i o n an d c o u n t er pre ss u re m ay b e us e d W h en
th e p atie n t i s re c u mb e nt The p o s iti o n o f th e right h an d
.

i llu str ate s ho w th e in flu e n c e o f th e l ever age m ay be c ar

ri e d i nt o th e u ppe r d o r s al regi o n F i g 19 1 i ll u str ate s th e. .

app li c ati o n o f th e s am e p ri n c ip l e wh e n th e p at i e n t 1 8 si t
'

ti n g A s we h ave prev i o u sly s t ated th e p o s iti o n o f th e

.
,

f u l c r u m i s th e p art o f any c o rre c tive m o vem e n t o f thi s ,

c h ar ac te r wh i ch lo cali ze s th e e ff e c t S i n ce w e ar e aimi ng
,
.

to ch an ge th e re lati o n s o f th e b o ny e le m e n ts i n a fl e x ib l e
l ever th e S pi n al c o lu m n at a c ert ai n p o i n t the f u lc r u m
, , ,

m u st b e u se d with refere n c e to the ki n d o f m o vem e nt

ch ar ac te ri s ti c at th at p o i n t .
49 4 PR I N C I PLE S O F O S TE O PA TH Y

to b e an kyl o s e d Th i s c o n diti o n m ay b e term e d b o ny

.

—
( c o m p l ete
) o r fib r o u s ( i n co mp l ete ) tr u e ( i n tr a arti,
c u lar )
—
o r f al s e ( e x tr a arti c u lar ) an ky lo s i s
”
.

“
Th e s e ar e th e te rm s u s ed by D a C o st a to defi n e
an ky lo s i s yet s o m e c lai m th at j o i n t sti ffn e s s c au se d by
,
-

—
e x tr a arti c u lar co n tr acti o n o r o b st r u c ti o n i s no t ankyl o s i s
, ,

i n th e co rre ct s e n s e ; bu t o n l o o ki n g at th e d eriv ati o n o f th e

w o rd ( an ( g ) k u lo s —c r o o ke d o r b e n t ) it s e em s th at th e ,
'

te rm an ky lo s i s w o u ld b e co rre ct wh e n app li ed to any f o rm

”
o f re s tri cte d j o i n t m o vem e n t .

“
The c au s e s o f an ky lo s i s are m an y F i r s t l et u s co n .
,

s id e r th o s e wh i c h re s u l t i n co mp l ete a n d i n c o mpl ete a n

ky lo s i s In fl amm ati o n s i n o r a r o u n d th e jo i n t fr o m wh at
.

(
,

eve r c au se i f co n t i n u ed l o n g e n o u gh fo r n e w ti ss u e f o rm a
,

ti o n wi ll c au se an ky lo si s A fte r as epti c i n fl amm atio n s we

,
.

F IG 233 M ann e r o f ap p l y i ng r g
l e v e a e to stre tch
'
th e t t
s r u c ur e s
f o rm i n g
. .

th e r
s c ap u l o - h u m e a l a rti c ul a ti o n .
 PR I N C I PL E S O F O S TE O P ATH Y 49 5

wi ll m o s t l ik ely fi n d fibr o u s bu t wh e n th ere i s i n fe c ti o n

,
,
”
b o ny an ky lo si s i s m o re p ro b ab le
, .

Thi s fib r o u s f o rm ati o n i s th e re s u lt o f i n fl am m ati o n .

fo r wh erever th e re i s i n fl am m ati o n th ere i s an i n c re as e o f

ti s su e S upp o s e a c as e o f di slo cati on with co n si der ab l e
.

t y m an i p u lat i on
“

F IG 234
'

. .
A p o si i on f or eas of th e s cap u l o - hu
m e r al a rti cu l a ti o n .
496 P R I N C I PL E S O F O S TE O PA TH Y

t
co n u s o n i ofth e ti ss u e s ar o u n d th e j o i nt i n fl amm ati o n r e ,

s u lts an d embry o n i c ti s s u e b egi n s to f o rm as a rep ar ati v

,
e
p r o c e s s ; th e embry on i c ti ssu e se n d s o u t s m all p r o c e s se s ,

wh i c h s t art fr o m n e w c e nter s an d S pre ad th r o ugh th e

ge lati n o u s m ass i n an d ar o u nd th e j oi n t u n ti l a v ery i r
, ,

reg u lar n etw o rk i s spre ad all ar o u n d th e j o i n t su rfac e ,

wh e n th e co n tr ac ti o n p r o c e s s b egi n s th e n e w t i ss u e i s ,

f o rm ed i n t o fib r o u s ti ss u e wh i c h u n ite s th e b o n e s clo se ly
,

t o geth e r ; by c i c atri c i al c o ntr acti o n th e b o n e s m ay b e dr aw n

”
s o c lo s e ly t o geth e r th at m o vem e n t i s al m o s t i mp o ss ib l e .

“
Bo n y u n i o n o f th e j o i n t s ur f ac e f o llo w s fibr o u s an ky
lo s i s ; it o c c u r s w he n th e b o n e it s e lf i s i n j u re d o r di s e as ed ,

an d th e su rf ac e Of th e b o n e er o d e d o r b r o ke n
-
O ss i fi c ati o n .

begi n s c hi efly i n th o s e layer s o f fibr o u s ti ss u e lyi n g n e x t

to th e b o n e .

“
F als e o r e x tr a arti c u lar an ky lo s i s i s c au s ed by th e
- -

c o n tr ac ti o n o f ti s su e s ar o u n d the j o i n t Th e s e c o n tr ac .

ti o n s e x ter n al to th e j oi n t m ay b e th e re s u lt o f m any
, ,

’
rem o te an d o b scu re cau se s .

F IG . 2 35 . R e l ax a t i o n of th e q u adr i c e p s ex t e nsor .
49 8 P R INC Il LE S o r O S TE O PA TH Y
’

by e x u d ed s e r u m an d w aste m ateri al n o t carri e d aw ay by

th e c i r c u lati o n s lu ggi sh th r o u gh i n activity o i th e m u scl e s
,
.

The t e n d o n s an d lig ament s ar o u n d th e j o i n t ar e

“

th i c ke n e d an d h ar d e n ed to th e le n gth th e l imb w as h el d
by th e ac tive co n tr acti o n bu t after th e m an n er o f all n e w
,

ly f o rm ed ti s s u e it co n ti n u e s to retr ac t an d dr aw th e limb
,

”
m o re o u t o f i ts n o rm al p o s iti o n .

“
Th i rd . C o n tr ac ti o n s m ay b e th e re s u lt o f c ert ai n
di s e as e s ( as rh e u m ati sm g o u t t u b er cu lo s i s syph i li s o r
, , , ,

any —
d i s e ase c au si n g n o n u se o f th e j oi n t o r m al n u triti o n
”
o f th e c o n tr o ll i n g m u s c l e s .

In e x am i n i n g an an kyl o s e dj o i n t we m u s t di sti n g u i s h
“
,

betwe e n b o ny an d fib r o u s an ky lo si s an d e x tr a arti c u lar co n

tr ac ti o n A j o i n t m ay b e i mm o v abl e and yet no t so be
.
,

c au s e o i b o n y an ky lo s i s .

D a C o st a s ay s th at a jo i n t i mm o v able fr o m fi br o u s
“ ‘ -
'

di s ti n g u i sh e d fr o m a j o i n t i mm o v ab l e fr o m
‘

an ky lo si s IS

b on y an ky lo s i s by th e f ac t th at i n th e f o rm e r attempt s , ,

at m o ti o n ar e p r o d u ctiv e o f p ai n an d su b s e q u e n t ly o f i n

fl am m ati o n ; th eref o re p ai n o n attempted m o ti o n e x clu de s

,
I

F IG . 2 37 . R e laxat i on of th e ad du c t or m u s cl e s of th e t hi g h .
 PR I N C I PLE S O F O S TE O PA TH Y 499

bo ny ky lo si s fr o m ou r di ag n o si s An appr o x i m ate ide a

an .

o f the e x t e n t o i th e sti ff ne ss may b e o bt ai n e d fr o m a hi s

-

t ory o f the cas e as to wh et her th e di s e as e has bee n s eve re

in c h ar acter an d lo n g i n d u r ati o n The n erve s o f th e j o i n t
.

s h o u l d b e e x am i n ed at th e ir p o i n t o f e x it fr o m th e spi n e
”
an d thr o u gh o u t th ei r c o u r s e to th e j o m t .

The s am e c o n diti o n s i n ge n er al whi c h c au s e p ai n i n

, ,

a j o i n t may c au s e an ky lo si s , wheth er th at p ai n b e du e t
'

lo cal i n j u r y o r referred fr o m so me o the r p art A c o n tr acte d

" '

. .

p so as m u scl e by i r ri tati o n to the b r an ch e s o f th e o bt u r a

.

to r
n erve c an c au s e p ai n c o n tr ac ti o n an d c o n s eq u e n t s ti ff n e ss
,

o f th e k n ee j o i n t .

“
What c an o ste o p at hy do fo r thi s c o nditi o n ? Fo r
bon y an ky lo si s n o th i n g s h o u ld be attempted fo r the tre at ,

me n t w ou ld o n ly re s u lt i n di sco u r agem e nt an d di sapp o i n t

m e n t to b o th phy s ic i an an d p atie n t ; bu t if th e j o i n t is i n an
/
'

al m o st u s e le ss p o s iti o n e x c i s i o n o r o s te o t o my m ay b e tri e d
,
-

with g o o d re s u lt s I f th e j o i n t has be c o m e an ky lo sed

.

t h r o u gh s epti c i n fl aim m ati o n it sh o u ld n o t b e f o r c ib ly

,

br o ke n u p b e c au se o f th e d ger
,
a n o f r e —i n fe c ti o n o f th e

F IG . 2 38 . M e th o d of t t
s re c hi n g th e s ci ati c r
n e ve .
50 0 PR I N C I PL E S O F O S TE O PA TH Y

wh o le j o i n t o r o th e r p art s o f th e b o dy th r o u gh th e c i r
, ,

”
c u lati o n .

“
1 11 c as e s o f fibr o u s an d e x tr a arti c u lar an ky lo si s o ste o
-

p athy c an refer to th e m os t e n c o u ragi n g re c ord s an d i s u n

”

d o u bted ly ah e ad o f any o th e r m eth o d o f tre atm e n t The , .

m ai n p o i n t i n th e tre atm e n t co n s i st s p ri n c ip ally i n m aki n g

ac tive th e ret arde d c ir c u lati o n gr a d u ally bre aki n g u p th e
,

adh e s i o n s th o ro u gh ly re lax i n g all th e m u s cl e s an d a

, ,

s ti m u lati n g tre atm e n t t o th e n erve s .

“
—
F o r e x tr a arti c u lar an ky lo si s th e tre atm e n t i s v arie d
ac c o rd i n g to th e c au s e O s te o pathy has a gre at m i s s i o n
.
.

to fi ll i n fi n di ng an d rem o vi n g the p rim ary cau s e o f m any .

c as e s o f an ky l o si s H i lt o n spe ak s o f a c as e o f di s e ase d
.

( t u ber c u l ar ) k n e e j o i n t c u re d by a n ky l os i s T r u e ! th e .

re st an d an ky lo si s w as n at u re s w ay o f re d u c i ng the i n ’

fl am m ati o n an d di s e ase wh e n it had p r o gre s s e d s o far .

Bu t th e w o rk o f th e o s te o path is to lo o k fo r th e c au s e s
‘‘ ”
wh i c h m ade th e k n e e j o i n t a p o i n t o f l e ast re si s t an c e fo r
_

th e t u b e r c l e bac 1111 to m u ltip ly i n

, E x ami n e the s p i n e .

th o r o u gh ly th e s ac r o i li ac arti c u lati o n an d th e h ip fo r di s
,

l o c ati o n s wh i ch c au s e p ai n i n th e k n e e j o i n t t hr o ugh irri

,

tati o n o f th e obt ur at o r n erve Bu t d o e s p ai n alo n e i n th e

.

j o i n t s le ad to the c on diti o n k n o w n as a po i n t o f l e as t r e ‘

s st
1 an c e ? ’
P ai n p reve nt s m u c h m o vem e n t i n the j o i n t ,

an d r e m embe ri n g th at co nti n u ed 1i on u se o f m u scl e s Cau s e s

’

m al n u triti o n s lu ggi sh c i r c u l ati o n an d d ege n er ati o n o f th e

,

mu scle we m ay s e e ho w the j o 1 n t m ay be co m e a p lac e fo r

,
-

”
germ s to m u ltip ly .

“
Is it to o lo n g a c o u r s e fr o m simp l e p ai n to d i s e as e ?
R em emb er th at p ai n i s u sually ac c o mpani e d by c o ntr acti o n
o f m u sc le .O u r tre atm e n t m u s t b e b o th p reve ntiv e an d
”
c u r ative ,

F ol lo wi ng i s a cas e o f fibr o u s anky lo s i s and p a

“
r aly si s
"

i llu str ating th e e ffi c i e n cy o f o ste o p athy to tre at thi s class

‘

o f su ff erer s Vi n c e nt P ete
. five ye ar s o f ag e had an an ky
, ,

l o sed e lb o w as a re s u lt o f a di s lo cati o n an d b re ak The .

j o i nt w as atte n de d to i mm edi ately after th e acc ide nt by a

50 2 PR I N C I PL E S O F O S TE O PA TH Y

h an d were p erfe ct ly n o rm al C o ntr as t th i s c ase with o n e .

tre ated by m e ch an i c al re st re s u lti n g i n a fi x ed elb o w jo i n t , ,

or p e rh ap s a m od e r ate ly u s ef u l j o i n t f o llowi n g f o r cib le

b re aki n g o f adh e s i on u n d e r anae sth e si a wh i c h i s a dan ,

g e ro u s tre atm e n t with v ery d o u btf u l re su lt s as th e o p er a

, ,

ti o n m ay h ave to be d o n e o ve r an d o ve r ag ai n b ef o re a u se
”
fu l j o i nt i s g ai n ed .

The S capu l o hu m e r al -
Arti cu lati o n — F ig . 2 33 il lu s
r te s a m eth od o f p ryi n g th e h e ad o f th e h u m er u s o u t o f
ta

th e g l e n o i d f o ss a i e sep ar ati n g th e arti c u lar s u rf ac e s

,
. .
, .

Thi s m o vem e n t c an b e u se d i n c as e s o f m u s c u lar rh e u ma

'
'
-

ti s m wh e n c o mp l et e abdu c t1o n o f th e ar m i s imp os sib l e It .

al s o allo w s an i n fl u x o f fre sh arteri al b lo od

'

Wh e n abd u c ti n g th e ar m th e sc ap u la m u s t b e h e l d by ,

the phy s i c i an s h an d s
’
P lac e th e fi n ger s o n the ve rtebr al
.
,

b o rd er o f th e s c ap u la whi l e th e ax i llary b o rd er i s c o m
,

p re s se d by th e th u mb By h oldi n g th e s cap u la s e cu re ly
.
,

th e phy s i c i an i s s u re th at all th e m o vem e n t h e f o r c e s is in

'

th e sh o u lder arti c u lati o n an d n o t th e gl idi ng o f th e s cap u l a

,

Ihe m u sc le s o f th e ar m m ay b e re lax
”

'
o n th e th o r ax . C e d by
‘

di re c t m an ip u lati o n The i n s ert i o n o f th e de lt o id i s i re

'

q u e n t ly te n der An y w astl n g o f th e m u s c l e s o f the e x

.

tr e m i t sh o u l d b e c aref u lly n o ted s o th att h e c o u r s e o f i ts

y ,

F IG 2 40 S t t
re ch i n g th e de e p an d su p e r fi c i al m u s cl e s on th e
ba k
. .

c of th e le g .
 P R I N C I PL E S O F O S TE OPA TH Y 50 3

go ver n i n g nerve m ay be s e ar ch ed .

fo r a p oint of co m
pre ss i o n .

E x am i n ati o n of P l e x u s — The p ri n c ip al
the Br achial
m o t o r divi s i o n s o f th e b r achi al p l e x u s m ay b e te s te d by
si m p l e m o vem e n t s m ad e by th e p ati e n t The p ati e n t s
’
.
,

gripp i n g p o wer i s an i n d e x to th e co n diti o n o f th e m edi an

n erv e ,
an d th e m u s c l e s it i n n erv ate s E x te n si o n o f th e .

an d fi n ge r s m ad e ag ai n s t re s i st an c e i s an

i n de x o f p o wer i n th e m u sc u lo S pi r al n erve tr act Ab du c -

.

ti o n an d add u c ti o n o f th e fi n ger s ar e c o n tr o l le d by th e u ln ar
n erv e . F l e x i o n o f th e f o re a rm by th e m u sc u l o c u t an e o u s
- -
.

O b s erve th e co n diti o n o f th e fi r st po s teri o r i n te r o s ~

s e o u s m u s c l e whi c h f o rm s th e l itt l e m u sc u lar s we ll i n g wh e n

th e th u mb is add u c te d to th e s e c o n d m et ac arp al b o n e I f .

h i s w asted th ere i s evid e n c e o f n erve c e ll d ege n er ati o n .

Thi s m u s c l e sh o u l d b e we ll d eve lo p ed i n thi n h an d s as ,

We ll as i n fat o ne s I f th e w as ti n g i s u n i later al lo o k fo r
.
,

i mp i n gem e n t o n th e u lnar n erve at so m e p o i n t i n i ts c o u r s e .

I f it i s bi later al th e c e ll s in th e s pi n al c o rd ar e p r o b ab l y
at f au lt .

The de lt o i d i s fre q u e n tly p ai n f u l as a re su lt o f p re s su re

o n the cu c u mfl e x n erve The p re ss u re is u su ally at th e
.

p o i n t o f e x it fr o m th e v erteb r al c an al R e lax ati o n o f th e .

s tr u c t u re s ar o u n d i ts p o i n t o f e x it u s u al ly give s re l i ef .

R e du c t io n o D i s c
f l o a ti o n s by T r a c ti o n — The ge n eral .

m eth o d ap pl i ed to di slo c ati o n s o f all j o i n t s o f th e e x tr e m i

ti e s i s di re c t tr acti o n Thi s i s so m etim e s aide d by p re s
.
_

su r e f o n th e p r o mi n e n t po m t o f th e di s l o c ated b o n e to ai d
’

it i n s l ipp i n g to i ts p lace A ll o f th e d islo c ati o n s o f th e

;

h u m e r u s s u b co r aco i d s u b c lavi c u lar s u bgl e n o i d an d su b

, , ,

S pi n o u s ,
c an b e red u c ed by u s i n g tr a c ti o n to s tret c h th e

m u s cl e s an d lig am e n t s o f th e j o i n t to th e e x te n t th at th e
h e ad o f the h u m er u s w s lip o ver th e rim o f th e g l e n o i d
f o s sa ThIS tr ac t i o n m a be m ade with th e p ati en t s itt in g
.
,

f he k n e e i n the ax illa sp ri ng s th e he ad
'

as i n F g i 2 3 4 .
i .
a

o f th e hu m e r u s o u t w ar d The s am e tre atm e n t m ay b e ap

'

p l ied with th e p ati e n t re c li n i n g The phy s i c i an sho u ld .

504 PR I N C I PL E S O F O S TE O PA TH Y

p lac e a b all o f w o o le n y ar n i n th e ax i lla th e n p lac e his ,

s t o c ki n ged f o o t u p o n it an d m ake tr ac ti o n o n th e ar m
, .

I t i s p o s sib le to app ly th e trac ti o n m eth o d in a s impl er

w ay A n o rdi n ary c an v as c o t with a h o l e c u t i n it so th at
.
, ,

th e ar m c an b e pu t th r o u gh whi le th e p ati e nt re st s e as i ly o n
hi s s id e sh o u ld b e e l ev ate d far e n o u gh fr o m th e fl o o r to al
,

lo w a si x p o u n d wei ght to b e att ach ed to th e wri st

-
Th i s .

s te ady W eight q u i c k ly re lax e s th e m u sc le s an d red u c e s th e

s u b lu x at i o n .

Tr ac ti o n alw ay s str ai n s th e m u sc l e s an d c au s e s so m e
h e at an d swe lli n g th eref ore c ar e s h o u ld b e t ake n to p re
, ,

ve n t e x u d ate s an d adh e s i o ns .

e r —
R e du c ti o n o f Di sl o c ati o n s by L v e ag e Th o s e w ho .

ar e e x p ert i n re d u c i n g sh o u l der di slo cati o n s u su ally m ake ,

u s e o f a s eri e s o f m o vem e n t s whi ch e x agge r at e th e l e s i o n ,

i e m ake th e h e ad o f th e di slo cat

. .
,
ed b o n e m o re pro m 1n e nt .

In s u bc o r ac o i d di slo c ati o n s o f th e h u m er u s abd u c ti o n of

-
,

th e ar m c au s e s e x agger ati on The phy s i c i an s t an d s at .

th e si de o f the p ati e n t w ho i s re c li n i n g o n a h ard su rf ac e

, .

As abd u c ti o n i s m ad e th e phy s i c i an s fre e h an d re st s u p o n

’
.
,

F IG . 2 41 . P o s i ti o nf o r e as y m a n i p u lati o n of th e s aph e n ou s open in g .

 506 PR I N C I P LE S O F O S TE O PA TH Y

th e u l na i nt o p lac e Thi s di sl o c ati on is u su ally co m

-
. pl i
c are d w ith fr ac t u re o f th e c o r o n o i d pr o c e s s .

The R adi u s —The r adi u s m ay b e di sl o cate d p o steri o r ly

o r an teri o r ly . L ater al di s lo c ati o n s o f eith er r adi u s o r u ln a
ca rry b o th b o n e s t o gethe r A p o s te r i o r di s l o cati o n o f th e
.

r adi u s can b e red u c e d by fl e x io n o f th e f o re arm th e n e x ,

te n s i on with c ou n ter p re ss u re o n th e p r o mi n e n t p o i n t o f
th e h e ad o f th e r ad i u s p o steri o rly A f or w ard di sl o cati o n .

req u i re s s u pi nati o n o f th e ar m an d add u cti o n o f th e h an d ,

t o gethe r with p re s su re o n th e anteri o r su rf ac e o f th e h ead

o f th e r adi u s .

Di slo cati o n s o f th e b o n e s o f th e wri st o r h an d are r e

du c e d by tr acti o n o r p re s su re .

O ld Di s o c ati
l o n s — All di s lo c ati o n s tw e n t y f o u r h o u r s ,
-

o ld ,
re q u ire co n si der ab l e r el ax i n g tre atm e n t The o l de r .

th ey ar e th e h ard er th ey ar e to red u c e
,
Nat u re beg i n s .

to ad apt h e r s e lf to n e w c o n d iti o n s alm o st im m edi ate ly .

'

A ll th e s lac k o f m u sc le s an d l ig am e n t s i s s wift ly t ake n u p

'

Th o s e ti ssu e s m o st c o mpre s s e d by th e n e w p o s iti o n o f the

b o n e ar e imp o ve ri sh e d by th e lac k o f n o u ri shm e n t Thi c k .

e n i n s an d adh e s i o n s qu i c kly f o rm s o th at o l d di sl o cat i o ns

g ,

ar e n o t e as i ly h an d l ed O l d di s lo c at
. i o n s ar e tre at ed i n
th e sam e m ann er as fre s h o n e s e x c ept th at m u ch rel ax i n g
,

an d re s t o ri n g o f vit al ity i s n e c e ssary

M u s cl e s o f the L o w e r E x t r e m i ty —The m u scle s o f th e

.

lo wer e x trem ity m ay b e re lax ed eith er by di re c t m an ipu ,

lati o n o r by t aki ng adv an t age o f th e m o vem e n t o f v ari o u s

j o i nt s to pu t th e m o n a s tret ch D i re ct m an ip u lati o n is .

lab o ri o us an d re q u i re s c o n sid er abl e ti m e :

The m u s c le s o f th e hi p j o i n t fre q u e n tly co n tr act s uf
fi c i e n tly to make w alki n g d i ffi c u lt Th ey c o n tr ac t a
. s a re .

s u lt o f s tr ai n b r u i se di se as e o f th e j o i nt s u blu x ati o n o f
m
, , ,

l u b ar verteb r ae o r lu x ati o n o f th e i li ac b o n e s
, The sub .

lu x ati o n s i rrit ate th e n erve s wh i ch i nn erv ate th e m u sc le s

‘

co n tr o l li n g th e j o i n t
.

The m o vem e n t s h e re after o u t li n ed m ay be u sed fo r

m any d i ff e re n t p u rp o se s bu t th ey ar e appli ed h e re to s pe
,
'
-
 PR I N C I P L E S O F O S TE O PATH Y 50 7

c ifi c gr o u p s o f m us c le s A ll th e m o veme n t s we h ave th u s
.

far o u t li n ed h ave b ee n de sc ribe d acc o rdi n g to th e w ay th ey

aff e c t s tr u c t u re n o t f u n cti o n
, .

F IG P o s i ti o n for r e du c ti on of sub l u a ti
x on of ex t e r n al
g kn
.

se m i lu n ar c a r ti l a e of th e ee .
50 8 P R I N C I PL E S O F O S TE O PA TH Y

F IG 2 44 S ho wi n g g f
p o s i ti o n f o r p r o d u c i n ree m ove m e n t
b
.

In th e a r th r o d i a l a r ti c u la ti o n e tw e e n u p p e r e n d s o f th e
fib u la b
a n d ti i a b
E x te r n a l p o p li te a l n e r v e l i e s e h i n d
fib
.

th e h e a d o f th e u la .
5 10 PR I N C I PL E S O F O S TE O PA TH Y

F IG 2 45 R a d i o g ra p h of f r actur ed ol e c r a n o n p r o c es s an d e x u d a te
ft r r m t M o v e m e nt r r ft m an y w e e k s
. .

a e e oval of s pl i n s . e co v e ed a er
n l mani pu i ati on to pr o m ot e ab so r p i on t and b r e ak adv
a
t e e
e s1g
onst
.

.
 PR IN C I PL E S O F O S TE O PA TH Y 5 11

The m o ve me
t m ade to re d u c e th e s e su b lu x ati o n s
n s

t ake i nt o con si d er ati o n th e fac t th at th e h e ad o f th e fem u r

must: be m ade to retr ac e its r o u te i n o rd er to regai n its
'

p pro e r p o s i t i o n
l
F o r e x a mp l e . a di s l o c a ti o n p o s teri o
,
r ly o n

to the sp i n e o f the i s ch i u m c au s e s the to e to t fi rp i n w ard ,

an d the re i s s li ght s h o rte n i n g o f th e l e g The phy s i c i an .

ta ke s a p o s iti o n as i n F i g 2 3 9 an d c arri e s th e k n e e u pw ard.

an d i n w ard H e f o rc e s th e k n ee as far as p o ss ib l e ac r o s s
.

the m edi an l i n e th e n fl e x e s th e thigh h ard o n th e abd o

,

men Thi s t u rn s th e h e ad o f t he fe m u r d o w n w ard an d

‘

i n w ard R em em ber th at th e h e ad p o i nt s alw ay s in th e

.
‘

Now f o rc ib ly ab
I

sam e di re cti o n a s th e i n ter n al c o nd y le .

,

d u c t i an d e x te n d th e th igh with a q u i c k e x te r n al r o tati o n .

Th e s e m o vem e n t s c ann o t b e m ade su cc e ss f u lly with o u t a ,

lo n g co u r s e o f p r e l imi n ar y re laxi n g tre atm e nt s th at i s if

“

, ,
.

the di s lo c a ti o n i s an ol d o n e
D i r e c t tr acti o n m ay b e u s e d fo r all di slo cati o n s o f th e
fem u r j u st as fo r th e sho u ld er bu t th e m usc l e s ar e so
"

'

, ,

s tr on g t hat it i s n o s m all m atter to o ver c o m e th em h e nc e ,

m o vem e n t s whi ch t ake adv an t age o f l e v e r ag e a r e m u c h

_ .
‘

m o re sati s f act o ry .

The f o rm u la fo r any di s lo c a ti o n o f the hip m ay b e

w o rke d o utby n o ti n g the p o s iti o n of t he h e ad of th e fem u r
and th e n c arryi n g th e i n ter n al c o n dy le s o as t o m ake th e -

h e ad retrac e i ts c o u r s e W he n sh o rte n i n g o r len gth e n i n g

.

of t he le g i s n o te d m ake s u re th at th e i li ac b o n e s ar e eve n
, .

A h alf i n c h di ff ere n c e i n th e l e n gth o f th e l eg s m ay e as i ly

-

b e ac co u n te d fo r by th e ac ti o n o f the hip m u scle s ,

.

The pyrif o rmi s m u sc l e m ay co n tr act an d co mp re ss th e

sc i ati c n e r v e i n i t s c o u r s e th r o u gh th e gre at s c i ati c f o r am e n .

Fi g 2 39 i llu s t r ate s th e m o veme n t to stret c h the p y r i fo r

.

m i s The phy s i c i an h o ld s th e p e lvi s to th e t ab l e by p re s s

.

The thigh
i
'

i n g o n th e an teri o r su pe ri o r spi n e o f th e i li u m .

i s th e n s t ro n gly add u c ted .

-
St tr e c h i n g the S c i ati c N '

e r v e s — S c i a t i c a i s freq u e n t ly

s u cc e ss f u lly t r e ated by r el ax i ng th e pyrif o r m i s »

but th e ,

majo r ity o f case s re q u i r e a st r et chi ng o f the sci ati c ne rv e ,

5 12 P R I N C I P LE S O F O S TE O PA TH Y

F IG . 2 46 . P o s i ti o n for r e du c i n g tar s a l su bl u x a ti o n s .
5 14 PR I N C I PL E S O F O S TE O PA TH Y

F IG 2 47 D i s te n s i o n o f v e i n s d u e to tr i c u s p i d i n s u f
b t
.

V
.

fi ci e n cy ar i c o s e u lc e r s o n o h sh i n s a n d u n d e r
b k by g
.

m a ll e o l i o f o th a n l e s w e r e h e a l e d s tr a p p i n
ov e r t r
th e u l c e r s w i h s t i p s o f a d h e s i v e p l a s te r .
 PR I N C I PLE S O F O S TE O PA TH Y 51 5

Op e ni n g The de ep an d s u p e rfi c i al vei n s o f th e l e g h ave

.

l itt l e o r n o c o mm u n i cat i o n ab o ve a p o i n t ab o ut th e j u n c ti o n
o f th e lo we r an d m i dd l e th ird of th e l e g Thi s ap pl i e s .

es p e c i ally to the l o n g saph e n o u s ve i n V ari co se ve i n s o n

'

th e fe et o r an k le s m ay b e dr ai n ed by b o th S uperfi c i al an d
'

deep vei n s th eref o re thei r e x i s te n c e in th e s e lo c ati o n s

, ,

m ay b e du e to V i sc er al cau s e s eve n wh e n th ere i s n o o b ,

s t u c ti o n t o the a ph e no u s O p e n i ng
r s .

P o pl it e al S pac e — The po pli te al s p ac e so m etim e s n eed s

t

re lax ati o n Th i s i s p erf o rm ed by dire c t m an i p u l ati o n a s

.
,

The p o s iti o n o f th e ph y s i c i an s
’
i llu str ated i n F ig .

"

h an d s i n th i s i llu str ati o n aff e ct th e u pper po r ti o n o f th e '

p o p l ite a l sp ac e By f ac i n g th e p ati e n t th e lo wer p o rti o n

.

c an b e e as i ly aff e c ted .

The sem i l u n ar Car ti lag e s o f the K n e e — The s e c arti .

,
.
—
lage s whi c h s e rve to f o rm c u p l ike d ep re ss i o n s fo r th e
c o n dy l e s o f th e f em u r to re s t i n o n th e s u p eri o r arti c u lar
,

s u rf ac e o f th e tibi a m ay b e c o m e s light ly di s p lac ed an d

,

h e n c e ac t as wedge s to lim it m o ti o n i n th e j o i n t S i n c e .

th ey n o rm a ly m o ve wi t h th e c o n dy l e s it i s p r ob ab le th at
l ,

s o m e s l ight l ig am e n t o u s s tr ai n i s p ri m a ri ly th e c au se o f th e
c h an ge i n p o s iti o n o f a s em i l u n ar c arti lage The e x ter n al
s em
.

i lu n e i s th e o n e m o st fre q u e n t ly aff e c te d The re aso n

.
.

fo r thi s p r o b ab ly i s du e to th e f ac t th at th e i n ter n al c o n
dy l e o f th e fem u r is lo ng e r th an th e e x ter nal h e n c e i n a ,

m o veme n t s u c h as p e d al i n g a b icy c le the e x te n s i o n o f

'
'

, ,

th e j o i n t i s m ad e with th e k n e e s r ath er wid e ap art Thi s .

te n d s to s tr ai n th e e x te r n al later al l ig am e nt The c arti lage .

s l ip s S light ly f o rw ard an d p reve n t s eith er fl e x i o n o r e x te n

si o n
.
—
The j o i n t rem ai n s i n a s em i fl e x e d p o s iti o n an d i s
e x q u i s ite ly p ai n f u l S o m e o f th e s e c as e s c an b e q u i c k ly
.
,

re li eved by h avi n g th e p ati e n t S it so th at th e o p er at o r can ,

gr asp th e k n e e with b o th h an d s as in F i g 2 4 3 The o p ,

. .

’
e r ato r s th u mb m ake s c aref u l pre s s u re o n th e p ai n f u l S p o t

wh e re th e e x ter n al s e mi lu n e c au s e s a l itt le tr an sve r s e

ri dge By g ent ly r o t a
. ti ng th e tibi a an d u s i n g a sli ght e f
fo r t to sl id e th e tibi a o n th e co n dyl e s with o u t p ro d uci n g ,
5 16 PR I N C I PL E S O F O S TE O PA TH Y

F IG 2 48 S am e case as the p r e ce di ng ill u str atio n No

t
. . .

cap u me du sae p r e s e nt thu s sh owi ng that p o rtal ci r

y b
,

cu l ati o n i s not s e r i o u sl o str u ct

. ed
5 18 PR I N C I PL E S O F O S TE O PA TH Y

F IG 250 M e th o d o f t
s r appi n g w i th adh e s i ve t
p la s e r to
’

t r
. .

su p p o r va i c os e u l ce r on th e s h i n.
 PR I N C I PL E S O F O S TE O PA TH Y

th at a S light edem a e x i st s i n th e s h e ath o f th e n erve at the

p o i n t wh i ch su ff ered th e tr au m ati c p re ssu re In th o s e .

c as e s du e to e x te n s i o n o f th e l e g re c o very i s alw ay s
'

p r o b l em ati c al b e c au s e th e tr au m ati c p re s su re m ay h av e
,

be e n p r o d u c ed by a f o l d o f f as c i a Thi s i s e s pEc i ally th e .

c as e wh e n th e a n teri o r t ibi al n erve i s th e o n ly br an c h o f

th e P er o n e al p ar alyzed Th e s e c ase s n ee d to b e tre ated

, .

by sem i fl ex in g th e k n e e s o th at d eep digit al m an ip u lati o n

-

, ,

Of all the s o ft ti ss u e s o f th e k n ee wi ll h aste n ab so rpti o n ,

o f th e edem a . J u dgi n g by so m e o f th e c ase s we h av e see n ,

th e p ati e n t s w o u l d h ave b e e n i n m o re c ap ab l e co n diti o n

with b o n y d ef o rm iti e s du e to fr ac t u re s th an with th e
, ,

p ar aly s e s re su lti n g fr o m the e ffo rt s to m ai n t ai n red ucti o n

,

o f th e fr ac t u re s Th e s e p ar aly s e s a r e h o wev e r u n av o i da
.
, ,

le i n so m e c as e s b u t re co very w o u l d b e m o re r a
i

b , p i d an d
c e rt ai n i f i n te ll ige n t m an ip u l ati o n w as u s ed al m o s t fr o m

th e b egi n n i n g o f th e c as e s .

“
i
G lu co k i n e s s an d M o bi i ati
l s o n — M an y e ff o rt s h ave .

b ee n m ad e to deve lo p a m eth o d o f tre ati n g fr ac t u re s th at ,

wi ll n o t o nly —i n s u re a re aso n ab ly p erfe c t u n i o n b u t wi ll

—

av o i d th e s eri o u s s e q u e lae i n c i de n t to th e u se o f cast s ,

S p li n t s an d e x te n s i o n app ar at u s No S i n g l e m eth o d o f
.

tre atm e n t i s app li cab l e to al l f o rm s o f fr ac t u re s bu t th ere

ar e c ert ai n p ri n c ip l e s u n d er lyi n g th e ar t o f m an ip u l ati o n
, ,

whi c h ar e app li cab l e i n the tre atm e n t o f c ert ai n fo rm s o f

i

fr act u re s The u se o f a f o rm o f m ass age by D r J u s t

.
, .

L u c as Ch ampi o nn i e re i n th e tre atm e n t o f fr act u re s i s a

-
, ,

n e w d eve l o p m e n t i n th e ar t o f m an ip u lati o n H e cal ls .

hi s meth o d g lu c o k i n e s i s
“
p ai n l e s s m as s age I t i s s o dif
, .

fe r e n t fr o m m ass age as ge n er ally u n de r s t o o d by m ass e u r s

, ,

th at n o n e bu t phy si c i an s w ho u n der st an d th e ph e n o m e na
,

i n ti ssu e s i n v o l ved i n fr ac t u re can u se it i n te l lige n tly

,
It .

c o n s i s ts i n str o ki n g th e i n j u re d p art very ge n t ly in th e ,

di re c ti o n o f v e n o u s c ir c u lati o n an d th e m u s c l e fib er s Thi s .

s tr o ki n g i s rhyth mi c al an d c o n ti n u o u s f o r ab o u t fiftee n o r

twe n ty mi n u te s The s tr o ki n g i s so ge n t l e as to s e em
.

q u ite i n e ff e ctive The fir st p ri n c ip l e i s : Never b e afrai d

.
“
52 0 PR I N C I PL E S O F O S TE O PA TH Y

of r u bbi n g to o ge n t ly o r o f givi n g to o sm al l a d o s e o f
,

m o bi li sati o n ; alw ay s fe ar th at th e m ass age i s to o h e avy

The re su lt o f thi s str o ki n g
”
an d th e m o vem e n t to o gre at .

i s th e rel i ef o f p ai n i n th e i nj u re d p art an d a co i n c id e n t
rel ax ati o n o f th e m u scl e s i n v o lve d i n th e fr act u re Thi s .

rel ax ati o n o f m u scl e s al l o w s rep lac em e n t o f th e fr agm e n t s .

“ ”
M o b ili s ati o n co n s i st s o f m i n u te d o s e s o f p as s ive m o ve
m e n t i n all o f th e j o i n t s ab o v e an d b el o w a fr act u r e The .

“
d o s e S h o u l d c au s e n o p ai n i n th e l imb The app li ca
”
.

ti o n o f P r o f L u c as C ham pi o nn i e r e s m eth o d s has be e n

.
-
’

e x c e ll e n t ly de sc rib e d by D r J am e s B M e nn ell i n hi s w o rk
. .

o n The Tre atm e n t o f F r ac t u re s by M o bili sati o n an d M as

sage M ac M i llan an d Co
,

P ai n i n the
L e g s an dc as e s co mpl ai n o f
F e et —M any
'

p ai n o f v ari ab l e ch ar acte r i n th e l eg s an d fe et I t i s g o o d .

p r acti c e to te st th e pl ant ar ar ch e s i n all s u ch case s We ak .

n e s s o f th e l o n git u di n al ar c h m ay n o t b e evide n t e x c ept

wh e n th e l eg m u s c l e s ar e fat i g u ed th eref o re a p l an t ar
‘
,

imp re ss i o n m ay n o t s h o w any saggi n g I f n o str u c t u r al .

d efe c t i s appafe n t i t i s s afe to as su m e th at we ak n e s s

,

e x i st s The app li c ati o n o f s trip s o f a dh e s ive to p ar all el

.
,

the su s p e c te d te n d o n s wil l give e n o u gh s u pp o r t to d em o n

‘

str ate wh eth e r th e di ag n o s i s i s re aso n ab ly c o rre ct .

Tar sal l ig am e n t s m ay b e str ai n ed o r a t ar sal b o n e ,

b e co m e s ub lu x at ed The pai n i n c id e n t to th e s e co n diti o n s

.
, ,

is very ac u te S u b lu x ati o n s ar e u s u ally red u c ed by pas

.

s iv e m o vem e n t s whi ch m ere ly t e n d to pr o d u c e m o b i l ity

,

i n th e t ar s u s as a wh o l e I f th i s d o e s n o t p r o d u c e r e du c
.

ti o n it wi ll b e n e c e s sary to u s e th u mb p re s su re o ver th e
,

p r o m i n e n t p ai n f u l s p o t an d th e n fl e x an d e x te n d th e tar
s u s with th e o th er h an d s o a s to al lo w th e p re ss u re to b e
,

c o m e e ff e c tive In any c as e o f we ak a r c h o r s ub l ux ated

.
,

t ar sal b o n e it i s advis abl e to u s e so m e m e an s o f p as sive

,

s u pp o rt u n til th e ac u te ph a s e s ar e p as t S o m e cas e s wil l .

re c o ve r c o mp l ete ly u n de r th e i n fl u e n c e o f v o l u nt ary e x e r
c i s e s wh i l e o th er s c an no t get al o n g with o u t su pp o rt
,
.
522 PR I N C I PL E S O F O S TE O PA TH Y

C H A P TE R X X I V .

M A NI PU LATI O N FOR V A S O M O TO R
-
NE R V E
E F F E CTS .

Th ere ti m e s wh e n th e phy si c i an de s i re s to aff e ct

‘

ar e

th e am o u n t o f b lo o d i n th e ti ss u e s o f th e h e ad Th e re m ay .

b e co n ge sti o n o f th e n as al ph ary n ge al an d l ary n ge al m u

,

“ ”
c o s a as d u ri n g a h ard
,
c o ld A fter m an ip u lati n g to r e
.

lax th e mu s c l e s o f th e n e c k an d o ve r co m e any e ff e ct s th e s e
m ay h ave had o n th e p o s iti o n o f th e c ervi c al vertebr ae it ,

i s we ll to try to c au s e v as o — co n st r i cto r a ct i o n by s ti m u lat

i n g n e r ve e ndi n g s F i g 2
. 5 1 i.l l u s tr a te s a m eth o d o f s ti m u

lati n g d e ep ly u n d er th e zyg o m a i n th e sigm o i d n o tch o f

th e i n feri o r m ax i llary b o n e Wh e n the pati e n t o p e ns hi s
.
‘

m o u th th e phy s i c i an p lace s hi s fi n ger o ver th e depre ssi o n

,

b e lo w the z y g o m a an d p re sse s i n ward at th e sam e tim e

'

m aki n g a vibr at o ry m o vem e n t o f th e fi n ge r Thi s aff e ct s .

th e b r an c h e s o f M e c kel s G an g li o n an d thr o ugh it the

’

, ,

n asal m u c o s a I t i s a p ai n f u l tre atm e n t but th e b l o od

.
,

wi ll o ft e n s u rge fr o m th e m u co u s ti ss u e s to th e s ki nas a
re s u lt o f it .

Ab o u t th e s am e e ff e c t i s se c u re d by u s i n g th e m o ve “

m e n t i llu str ate d i n Fi g 2 52 Whi l e th e p ati e n t s m o u th

. .
’

i s o p e n th e phy s i c i an pl ac e s his th u mb s o n th e bridg e

'

o f th e n o s e an d hi s fi n ger s a
, t th e an g le so f th e jaw The .

tip s o f th e l itt l e an d ri n g fi n ger s ar e p re s sed i n t o th e d e

p re s s i o n cau s e d by th e f o rw ard m o ve me n t o f th e c o n dy l e
o f th e jaw o n th e em i n e n ti a arti c u la ri s The p hy si c i an .

f o r c e s th e m o u th s h u t wh i l e the p ati e n t o pp o se s The .

p o siti o n o f th e tip s o f th e litt l e an d ri n g fi n ger s p reve nt s

the e asy s l i ppi n g o f th e c o n dyl e s i n t o th e g le n o i d f o s sa .
 P RI N CI PL E S O F O S TE O PA TH Y 52 3

The e n s o ry fiber s ar o u n d the c on dy le ar e i n te n s e ly stim

‘

s v

u l ate d an d fre q u e n t ly m an ife s t it by sp re adi n g a fl o o d o f

c o lo r o ver the f ac e i n fr o n t o f th e e ar Thi s i s al so a p ai n .

fu l s tim u lati o n I t i s h igh ly p r o b ab le th at all mo ve m e n t s

.

o f thi s c h ar ac te r W hi ch ar e p ai n f u l s e cu re re su lt s b y cau s
i n g ac tivity o f th e di lat o r n erve s to b lo o d ve s s e ls i n s u pe r
fi c i al ti ss u e s t hu s d ep l eti n g th e b lo o d i n th e c o n ge s te d
,

are a . A Sh arp pai n m ay cau s e a su dde n b lan c h i n g bu t i t ,

i s f o llo we d by v aso dil ati o n .

I f it i s di ffi c u lt fo r th e p ati e n t to bre ath e th r o u gh th e

n o s tri l s p
,
re ss o n th e n as al b o n e s fir s t o n th e right sid e
“

,
.

th e n l eft th e n m ake a h e avy p re s su re o ver th e j u n c ti o n o f

,

th e nas al an d fr o n t al b o n e w ith O n e th u mb ab o ve th e o th er . .

Thi s m o vem e nt i s very p l e as an t to th e p ati e nt o rdi nari ly , .

To c ar ry o ff th e ve n o u s b lo o d m ake a str o ke fr o m ,

F IG 2 51 t t
S i mu l a i o n b e tw e e n th e zyg o ma an d th e si gm oi d no t ch
f
. .

of th e in e r i or m ax i lla .
52 4 PR I N C I PL E S O F O S TE O PA TH Y

th e i n n e r c an th u s o f th e eye d o w n w ard o ve r th e j u ncti o n

o f th e m ass eter m u s c l e with th e lo wer jaw th e n c e to th e ,

s u p r acl avi c u lar f o ss ae .

The F ift h Cr an i al Ne v e r — The fifth c r an i al n erve can

.

b e t re ate d at i ts p o i n t s o f e x it th r o u gh th e b o n e s o f th e
f ac e F ig 2 53 i ll u str ate s th e po si tio n o f th e se p o i nt s A
‘

. . .

vib r at o ry p re ssu re o ver th e s e p o i nt s cau s e s a d ull bu t i n

I f th e m o vem e nt i s m ad e q u i ckly an d v ig
'

c r e as i n g pai n .

o r o u sly th ere wi ll b e evi de nc e o f a re acti o n i n a fl us h ed

,

app e ar an c e .

I nhi biti o n o f S u bo c ci pit al — LWhe n th ere i s a high .

bl o o d p re ss u re i n th e he ad an d th e p ati e n t i s su ff eri n g .

with h e ad ach e it is po s s ibl e to give gre at r eli ef by ste adi ly

'

i n h ibiti n g i n the Su b o c c ipit al f o s sae and te mpl e s as i ll u s ,

F IG . 2 52 . t
S i m u l a ti o n by f or ci bl e c l o su r e of th e m ou th a g ai n ts
’

res s i t an ce .
52 6 PR I N C I PL E S O F O S TE O PA TH Y

The ph re nic p u di c an d p n e u m o g astri c ar e th e o nly

,

n e rve tr u n k s di str ib u te d i n th e b o dy wh i c h c an b e e asi ly

c o m re ss e d th r o u gh s o ft ti s su e
p F i g 2 56 i l l u s tr ate s
. s ti m .

u lati o n o f th e p n e u m o gas tri c The phy si c i an s fi n ger s r o l l ’

.

o ve r th e n e rve tr u n k wh ere it l i e s alo n g th e i nn er e dge

o f th e ste r n o c l ei d o —
-
m as t o id .

The ge n e r al t e n d e n cy o f an o s te o p athi c tre atm e n t ,

whi ch aim s to re lax th e e x te n s o r m u sc l e s o f th e n e c k an d

-

tr u n k i s to red u c e b lo o d pre s su re C as e s whi ch ar e ch ar

,
.

ac te r i z e d by h igh b lo o d p re s su re ar e gre at ly be n efited by

r el ax ati o n o f m u scl e te n si o n by m e an s o f ge n t l e lever ag e

’

, .

The u s e o f h e avy p re ss u re m o vem e nt s i s c o n tr ai n di c ated ,

b e cau s e th ey m ight o cc as i o n i nv o lu nt ary r esi s t an c e by th e

p atie n t an d th u s s u dd e n ly r ai s e bl o o d p re ssu re to a dan
e r o u s d egre e
g .

I t i s very p r o b ab l e th at the e x te n s i o n and c o u nte r

p re s su re m o vem e nt s we use to re d u c e s ubl ux ati o n s act al so ,

F IG . 254 . I n h i b i ti o n in th e su b o cci p i tal f o s sa .

 P RI N C I PLE S O F O S TE O PA TH Y 52 7

as f ac t o r s in c h an gi n g b lo o d pre ss u re i n lo c al ized vi sc er al
are as .

Vaso m o t o r e ff e c t s c an b e s e c u re d by v ari o u s f o rm s
-

of s ti m u l ati o n a pp l ie d to s pi n a l a re as C o u n ter irrit a ti

.
o n ,

cu ppi n g h,
e a t o r c o l d c o n c u s s i o n
,
o r s u dde n p r e,
ss u re t o

F IG . 2 55 .
I n h i b i ti o n of th e ph r e ni c n e r ve s . C e n te r f or h i c co u gh .
52 8 PR I N C I PL E S O F O S T E O PA TH Y

th e p o i n t o f p r o d u c i n g a cli ck i n an arth r o di al j o i nt all ,

pr d e v
o u c a s o —
m o t o r e ff e ct s o f v ari o u s degre e s They all .

s erve a u s ef u l p u r o s e an d te n d t ei n f r a h t he r i n
p o r o ce e c o

s o m e c as e s .

F IG . 2 56 . t t
S i m u la i on of th e g t
pne u mo as ric n e r ve s .
53 0 PR I N C I P LE S O F O S TE O PA TH Y

P hy s i o lo gy of th e Ne rv o u s S y stem M o ro t
Te x t Bo o k of P hy s i o lo gy
Tre atm e n t of F r ac t u re s by M o b i l i s ati o n an d M ass age
M e nn el l
S p o n dy lo th er apy

H an d At las of H u m an A n at o m y .

Ey e S tr ai n i n H e alth an d D i se ase R ann ey

Abd o mi nal P ai n M ay lar d
The A bd o m i n al an d P e lv i c Br ai n - R o b i n son
D i s e as e s of th e Nerv o u s S y stem R e su lti n g fr o m Acc i
”

d e nt an d I n j u ry -Bai l ey

M o d er n ized C hir o pr acti c S m ith L an gw o rthy P ax so n

'

, ,

S u rgi c al An at o my ‘
:Cam pb e ll
-

C l i n i c al An at o my E i s e n dr ath

A M an u al of M ed i c i n e . Allchin

M an u al o f P h i l gy
s o o S t e wart
y
Ki r k e H an dbbo k P hy s i o lo gy K irk e
’
s of

Di s e as e s of th e Nerv o u s S y st e m M ett l er
Bi o lo gy ,
G e n er al an d M ed i c al Mc F ar lan d
App l ie d An at o my C larke

No rm al H i st o lo gy P i er s o l
C o mp ar ative P hy sio lo gy an d M o rph o lo gy of An im al s
Le C o nte

Ne u r o ti c D i so rd er s of C h i l dh o o d R ahfo
c r d

An at o my th e C e n tr al Nerv o u s
of S y s t em i n M an an d
in Verteb r at e s in G e n er al E d i n ger an d H all

Bier
’
s Hyper aemi c Tre atme nt M eyer S chmiede n
,

P hy s i o lo gi c an d P ath o lo gi c C he m i s try Bu nge

O rigi n of L ife Le D an te c

M anu al of O st e o p ath i c
 —
P RI N C I PLE S O F O S TE O PA TH Y

D efo rm itie s i n cl u di n g D i s e as e s of the Bo n e s an d

Jo i nts Tu bbv

The Tr e atm e n t o f F r actu r e S

e

L W

P ri nc ip l e s of S urgery _

Le ct re s R e st an d P ai n H i lt on
'

u oh

A R TI C L E S

R o t ar y L at er al C u rv at u re . No 7 \ .
,
v
ol . II of J . of A .

H . \ V F o rb e s
.

The Nat u re of a S u b l u x at
io n . NO . 5 . Vol . I J ,
. of

Tas ker

How th e H e ar t i s A ff e c te d by O s te o p athi c M an ip u l a
t i o n s No . . 11 Vol I I J
,
.
.
. of A O . . m

Verteb r al A r t i cu l ar L e s i o n s .
( S erie s b eg u n i n 190 8 )
J of A O F o rb e s
'

. . . _

Au t o P r o t
-
e ctiv e and R e c u p er ativ e M e c h an i s m o f th e
Bo d y No 4 V o l X I J o f A O A
. E S . . .
,
. . . . -_ . . W i llard
The O ste o p athi c L e si o n . No . 8 , V ol . IX, J . of A O . .

A . M c C o nn e l l

The I m m ed i at e E ff e c t s of Bo n y L e s i on s . No 1 1 V o l .

IX J ,
. of A O A . . . Bu r n s

E x amp l e s o f F u n c t i o n al L e si o n s . No ; 9 ,
Vol . X J ,

of A O A H F G o etz
‘

.
.

. . - _ . .

A d apt ati o n an d C o m p e n s ati o n . NO 3 V o l I I I \ V e s t

.
,
.
,

e r n O s t e o p ath Tas ker

Bac k ac h e C al if o r n i aS t ate
. J o u r n al of M edi c i n e J u n e ,

and J u ly 1 909 , - C ) . I . Coo per

A C o n sider ati o n o f the P e lvi c A r ti cu lati o n s fr o m an

An at o mi cal P ath o lo gi cal and Cl i n i cal S tan dp o i n t ,
.

Bo st o n M edi cal an d S u rgi cal J o u r nal M ay 18 an d

’

J u n e 1 190 5 , an d O s g o o d
 I N D EX

C o m p e n s at i o n cu rvat u r e F
C o n du ct ivit y F at i g u e, E ff e ct of
C o ntr act i o n ,
M us cu lar 3 54 Fe et
C o ntr o l ,
P lu r i s e g m e n tal 110 Fe e t P ai n i n .

C o
o -
r di nat i o n S e g m e nt al ,
50 F e m u r D i s lo c at i o n
, of

C u rvat u r e C o m p e n s at o r y
, 33 5 F ev e r
L at e r al 69 ,
408 , 440 F ev e r I n f e ct i o u s
,

F le x i o n, S p i n al
F r ac t u r e , M o bi li s at i o n 5
F u l c r u m , The us e of 4
'

D e v e lo p m e nt V ar i at i o n s i n
, 43 F u li c ti o n , Im p ai r m e n t
,
of 3
D i ag n o si s 1 9 5 38 1 38 6 3 9 2 4 93 an d s tr u c t u r e
, , , ,

D i ag n o si s B ac k ach e
, 3 11 V ar i at i o n s in n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n

E x tr e mit i e s 49 3
O st e o p ath i c 23 G
'

Ph y s i c al 2 3 18 5
G an g li a A ut o m
I I

at i c v is c e r al 1
, ‘
'

D i g astr i c 4 76 S y m p ath e t i c
D i s e ase C au s e s o f
,
27 G an g li o n M e c k e l s ,
’

I nt e rp r e t at i o n o f ph e n o m e n a S up e r i o r c e rvi c al 2 05 u u u u u u u u u u u u u u
u u

,
2
of
G lu c o k i n e s i s an d m o bili sat i o n
- -
51
Kn o w n c au s e s of

s y mp t o m s
D i slo c at i o n s
D i s lo c at i o n s E l bo w L
H e adach e
H e ad s l aw
-
, ’

Femu r
o f r adi u s
H e ali n g The tr u e ar t o f
,
'

H e alth
H e alth N o r mal ,
D o r s al r e g i o n I rr it at i o n ,
i n o7, 3 8 0
. .

H e art 1 53 , 3
H e r p e s Z o st e r 1
H i c co u gh 2
H ilt o n s law ’ '

E ffi c i e n cy H y o g lo ssu s 4
E lbo w D i slo cati o n s
,
H y o i d bo n e 4
E m br y o lo g y H yp e r ae m i a
E n c y st i n g P o w e r Of
,
H y p e r ae sth e s i a S p i nal ,

E nvir o n m e nt F avo r abl e ,

r e ac H y p o g astr i c p l e x u s n n n n n n n n n n n n n n n n n n n n n n n n 1

t i o n to
Er e ct o r sp i n ae
E x am i nat i o n P o sit i o n fo r
,
38 4 In e ffi ci e n cy

E x t e n si o n I n fl am m a ti o n , S ero us m em
E x t e n s i o n S p i nal
,
2 50 br an e s
E x tr e m it i e s 34 1 , 400 , 49 3 I nh i bit i o n
 I N D EX

'

I nh i bit i o n D o sag e ,
D e p th an d e x t e nt of u uuuuuu
Th e rap e u t i c E x p e r i me nt al o

Inn e rvati o n I n fl u e n e o n F al s e
'

,
c

I n sp e ct i o n F u n c t i o n al fat i g u e
I n t e grat i o n S e gm e n t al ,
G r o up
S y st e ms o f H i st o ry o f
Irr it abi lit y L ev e r ag e
Irrit at i o n Me ch ani c al,
L if e Te n ac it y o f
,

L o r do si s
L u m bag o
L u m bar r e gi o n I rr it at i o n
,
in -
68
K i dn ey s L u m bo s ac r al art i c u lati o n
-

Kn e e 1 8 3 , 51 5 12 6 4 , 2 66 , 2 68
K y ph o s i s L y m ph

K y ph o s i s L o w e r ,
do r s al 302
M
M ali g n an t g r o w ths
L
M an ip u lat i o n
L ar y n x I ntr i n s i c m u s c l e s o f 4 78
, M an ip ulati o n B ack u ,
n n n - b n u u n n u n n c u u -u - p uu n

L at i s s i m u s do r s i M an i p u l at i o n , Ch i r o pract i c
of Co n s e rvat iv e v s r adi c al .

Law of co m p eh gati o n _ C o rr e ctiv e

H e ad s ’
D i sl o c at i o n
'
H i lt o n s ’
18 1 ,
362 D i s l o c at i o n o i e lb o w
L e g s P ai n i n
,
_a D i slo cat i o n O l d
L esi o n an o bj ct iv e s y m pt o m
,

e 57 I) o r s al
as a c au s e 40 E x t e n si o n
4 1, 7 5 Ex t e r n a l p o p li t e al n e rv e 51 7
Ch ar ac t e r i st i c s of 40 F i fth c r an ial n e rv e 52 4
C l as s e s of 4 1 , 56_ G e n e r al p r i n c ip l e s 48 3
D i s e as e as s oc i a ti o n 31 G lu c o k i n e s i s
-
40 3
in di ag n o si s 76 G lu c o k i n e si s an d m o bili s at i o n5 19
-
-

int e g r at i o n H e ad and n e c k
'

12 0 3 78 4 19
.

t
p al p a i o n 44 K y pho s i s - -pu 4 1 3 4 22 4 2 5 42 7 , , ,

p att e r n s 58 L o r do s i s
P e r s i st e n c e of 43 Meth o ds o f p r o c e dur e
S e c o n dar y 41 ,
56 M o bi li s at i o n
S e q ue nc e of . 43 o f addu c t o r m u s c l e s o f th i gh 509

82, 9 1 4 50 o f an k y l o s i s
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Ch e m i c al c au s e s o f o f di g astr i c
 I N D EX

M an ip u lat i o n M e c k e l s g an g li o n
’

o f e r e ct o r s p i n ae M e di c i ne Pr act i c e of

o f e x t re m it i e s

o f f e mur di sl o c at i o n S ch o o l s of

Of li y o g l o s su s
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lar y n x
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of
se ro u s 32 8
of l at i s s i m u s do r s i i

of m y lo hy o id
- M o bili sat i o n an d g lu c o k i n e si s 5 19 -

of pe ct o r al i s m aj o r M o ti o n L o ss o f
, 54
of phr e n i c n e rv e M us cl e Cr i c o th y r o i d
,
-
4 78
of p o p lit e al sp ac e Di g astr i c
of p yrifo rm i s m u sc le 51 1 Er e ct o r sp i nae
of q u adr at u s lu m b o r u m 4 0 7 -
, 411 H y o g lo ssu s
of q u adr i c e p s e x t e n s o r 50 9 Irr it abilit y o f
of rh o m bo i ds 409 L at i s s i m u s do r si M an ip u la ,

of r ib s u bl ux at i o n s 4 52 tio n o f
of s ac r o ili ac s u blu x at i o n s 46 1
-

M y lo h y o i d
-

of s c al e n i 4 73 P e ct o r ali s m aj o r
of s c ap u l o - h u m e r al art i cu la P y rif o r m i s
t io n Q u adr at u s lu m b o r u m 40 7 4 1 1 ,

of s e rr at u s m ag nu s Q u adr i c e p s e x t e n so r 509

of S p l e niu s c ap i ti s xe t c o ll i R e ct u s c ap it i s ant i cu s m i no r 2 9 2
4 2 1 , 4 73
R e ctu s l at e r ali s .

Rh o m bo i ds
.

of t r
s e n o c l e i do -
m ast o i d 4 72 '

S c al e ni
o f st e r no hy o i d-
4 77
S e rr at u s m ag n u s
o f st e r n o th y r o i d
-
4 77
S ph i n ct e r vag i n ae 237
o f s t y l o hy o i d
- -

S p l e n i u s c ap it i s e t c o lli 2 1 5 42 1
o f s u blu x at i o n s
,

S te rno hy o id -
477
P o s it i o n f o r
S t e r n o th y r o i d
-
4 77
R i g i dit y c e rvi c al r e g i o n 48 9
S ty lo h y o i d
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R o tat i o n c e rvi c al r e g i o n 4 75
Tr ap e i u s
,
z 2 15 4 08
S aph e n o u s o p e n i n g 5 13 ,

S c i e nt i fi c 5 13 M u s cl e s A ddu c t o r o f the th i gh
, , 509
S e m ilu nar c art i l ag e s k n e e ,
515 A s so c i at i o n o f -
92
C e rvi c al 87
S tr e t ch i n g s c i at i c n e rv e 51 1
S u bo c c ip it al n e rv e
D e ve l o p m e nt al ch an g e s i n 93

S w e di sh
N e rvo u s di str i but i o n to 18 4
o f l o w e r e x tr e m i t y
Tar s al li g am e nt s .

of the bac k
To r s i o n an d c o u nt e r p r e s sur e 48 6
-

Tr act i o n M u scu lar c o ntr act i o n 2 9 9 , 3 54

V ar i c o s e ve i n s t e n si o n 59 , 73 ,
75 3 9 4
,

V aso m o t o r
- t o n e L o ss o f
,

M as sag e M y lo h y o i d
-
 I N D EX

P ag
S e g m e nt at i o n of the b o d y 7

R ach it i s of the S p i n al co rd 10
S e m ilu n ar ca rt ilag e s of k ne e 51
R adiu s D i slo cat i o n o f
,

S e n sat i o n
R e act i o n s Int e n sit y o f ,

S e n s at i o n R e c e pti o n of
Pr o t e ct iv e ,

S e n s o r y n e rv e s
R e c o v e ry N at u r al
S e ro us m e m b r an e s In fl am m a
I

R e ct u m E x am i n at i o n o f
, 39 8
tio n in
,

32
R e c u m b e n c y Eff e ct o f , 68
S e rr at u s m ag n u s 4]
R e c u p e r at ive p o we r In l e r e n t ,
i 38
S h o ck
R e fl e x p att e r n s 33 1
s u bl u x at i o n s
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Re fl ex e s S o lar p le x u s

R e fl e x e s I n t e n s it y o f S p i n al al i g n m e nt an d
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fl e x i b i l it y 3E
,

L o cat i o n o f a rthr o p ath i e s 32

c o lum n
1
2 39 , 3
V i sc e r al
co rd
R e g i o n C e rvi cal
,

c u rv at u r e
C e rvi c al e x t e n s i o n
c u rv e s
C e rvi c al r i g i dit y
c u rv e s N o r m al
I) o r s a1 ,

e x t en s i o n
I nt e r scap u lar
fl e x io n
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R e s i st e n c e A ch an g e o f , . 33
h y p e r ae sth e si a 59 64 , 3 7 ,

i rr it at i o n S y m pt o m s o f C
R e sp ir ati o n N e rvo u s c o ntr o l o f
, - 30 6 ,

li g am e nt s 2 1
R e st
n e rv e s Irr i t at i o n o f 6
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,
,

Rh o m bo i ds ri g i dit y
R i b s E x am i n at i o n o f
, 39 6
r o t at i o n 2 50 3 1 ,

R i g i dit y tr e at m e nt 6

R o t at i o n C e rvi c al r e g i o n S pl an c hn i c n e rv e s 13
,

D o r sal S p o n dy li t i s de f o rman s 32

S p i n al 250 261
S p l e n i u s cap it i s e t c o lli 42 1 4 7
. a .
,
,

S t at i c s
S t e r n o c l e i do m ast o i d
- -

S S te rno hy o i d
-

S t e r n o th y r o i d
-

S ac r al r e g i o n Irr it at i o n ,
in
S ac r o il i ac art i c u l at i o n
- S tr u c t u r e N e c e ssit y fo r st u dy
,
“

S aph e n o u s o p e n i n g of

S c al e n i V ar i at i o n s i n
S c ap u l a S ty lo —
hy o id
S c i at i c ne rv e ,
S tr e t ch i n g S u blux at i o n At las ,
u u u u u u u u u u u u u u u u u u u u u u u u u u

S e cr e t io n C arp al
S e g m e n t al co - o r di n at i o n C lav i cl e
S e g m e nt at i o n L at e r al 2 9 8 , 44 3 , 45
 I N D EX

S u blu x at i o n Tr ap e z i u S
R e du ct i o n o f
I

Tr au m a
S ac r o — il i ac Tr e at m e nt
Tar s al
'

Tr i an g le s S u b o c c i pi t al
,

S u blu x at i o n s Tr o ph i c it y
C o st al Tu m o r
I n n o m i nat e bo n e s Ty ph o i d S p i n e
Re flex
S u b oCCi p i tal tr i an g l e s
S u b s i di ary p l e x u s
S urge ry U l c e r V ar i c o s e
,

S y m p at he t i c G an g li a o f
,
70 U ni t y o f the bo dy
,

n e rv o u s s y st e m 12 5 of the n e rvo u s sy st e m n 99
n n
.
n n n n n

S y m p t o m s O bj e ct iv e
,
1 18
S u bj e ct iv e 59 ,
40 1

T
V as o - m o ti o n
Tar sal su blu x at i o n s 3 75 V as o m o t o r n e rv e s
-
16 0 3 62 , ,

Te n s i o n Art e r i al
,
1 52 V e i n s V ar i c o se
,

I ntr ac ellu lar 35 Ve rt e br a Fi fth lu m bar

,

M u s c u lar 59 S ix th c e rvi c al
Te st i n g ali g n m e nt an d fl e xi bi li ty V e rt e br ae C e rvi c al
'

38 4 ,

Th e r ap e u t i c s - l 73 ,
18 5 L o w e r do r s al
O st e o p ath i c
,
'

24 V i o l e nc e E ff e ct o f
,

S c i e nt ifi c 36 Vi s c e ra
Th o r ax 33 5 , 39 5 V i s c e r a P lu r i s e g m e n tal c o ntr o l
,

Ti s s u e r e l at i o n s D i st u r b e d
,
38 of

To r s i o n 48 6 V i s c e r al di st u r b an c e
To x em i a 32 3 g an g li a
Tr act i o n F e m u r di s l o c at i o n
,
50 9 p ai n , R e f e rr e d