The usual method, if only a single vertebra is anterior, is to make contact with the vertebrae immediately adjacent, crossing the hands and having fingers of upper hand pointing toward head and of lower hand toward Sacrum. But some adjusters use this move differently, making contact with Sacrum and with the mid-dorsal region in general and applying a slow force with both hands. Contact is with heel of hand upon spinous process. SACRAL ADJUSTMENTS The adjustment of the comparatively fixed sacrum is difficult at best and requires a very considerable force, violently applied. It is probable that nine-tenths of all attempts to move sacra fail. In children, when sacrum does not articulate properly with the ilia, and in adults in whom the sacrum has been loosened by trauma and remains in an abnormal relation to surrounding structures, it can be moved. The sacrum is described as being posterior at the base or at the apex, and its axis for rotation is believed to be a transverse line through the sacroiliac articulations. Force for its adjustment is applied at right angles to the curve of the sacrum at the point of contact. The best contact is with the heel of the hand against a part of the sacrum, the wrist of the adjusting hand being gripped and reinforced by the other hand. If standing on patient’s left, the right hand becomes adjusting hand for sacrum as for the last two Lumbars, if on the right, the left hand. Another contact is with the pisiform and adjacent soft part of hand upon the sacral base, the pisiform hooking against the first sacral spinous process. Do not mistake an anterior fifth Lumbar for a posterior sacral base. Discriminate between iliac and sacral subluxations by noting that with the latter both sacroiliac articulations, and with the former only one seems abnormal. [Illustration: Fig. 29. “Bohemian Move” for correction of anterior fifth Lumbar by transmitting shock through spine.] ILIAC ADJUSTMENTS Palpation With patient sitting erect on flat surface, feet on floor, stand behind and examine both sacroiliac articulations at once with the palmar surfaces of the fingers of both hands. If the two articulations are similar in every line neither ilium is subluxated, though the _sacrum_ may be rotated on its transverse axis between the ilia, so as to be posterior or anterior at base or apex. But no examination of the ilia is complete without investigating also the lumbosacral articulation. It sometimes happens that though the first sacral spinous process naturally completes the lumbar curve and there is no lumbosacral subluxation the crests of both ilia appear much posterior to their normal relation to the upper part of sacrum: this is a double iliac displacement.