In the former method after one has worked on one side he is obliged to
change to the other side and go through the same process. Movements may
also be given to stretch the contracted muscles, thus overcoming the
contraction and producing relaxation of the muscles.
After having relaxed the muscles over the field of operation,
correcting the vertebræ will generally be easier to accomplish. In
readjusting an atlas it matters but little whether the patient is
sitting up or lying down. A firm hold of the atlas can be gotten in
either instance. In correcting the middle and lower cervical vertebræ
it is best to place the patient upon the back.
In correcting dislocations, as heretofore suggested, two general rules
should be followed: (1) Exaggerate or increase the dislocation. This is
to relax the tissues about the dislocated articulation and to disengage
the articular points that have become locked. (2) Reduce the lesion
by retracing the path along which the parts were dislocated. One can
readily see that a dislocated ball and socket joint could be reduced
only by the dislocated bone retracing the path by which it left its
socket, for the capsular ligament would at once prevent its returning
to the socket by any path other than that taken when dislocated. This
applies to all dislocations to a greater or less extent.
After locating the exact position of the abnormal vertebra the first
rule is applied, i. e., exaggerating the lesion by flexing the head
in the opposite direction to which the vertebra is dislocated.
Then with one or two fingers placed firmly upon the side of the
vertebra in the direction dislocated, so that when the proper time
comes the vertebra may be pushed or slightly rotated back into its
normal position, with the other hand produce flexion of the neck,
so that the angle of flexion is exactly over the involved vertebra;
next produce slight traction, so as to be sure that the articular
points will be disengaged; and then with rotation and extension of
the head to a normal or upright posture, at the same time pushing
in on the disordered vertebra, are the movements to be executed in
reducing a dislocated vertebra. It takes considerable practice to
be able to correct a vertebra and to know when it is corrected. The
amount of force applied varies greatly in different cases. Cases of
recent subdislocation require but little force unless there is marked
spasticity of tissue, while in long standing cases many times the
amount of force required is about all that one wishes to exert. As a
rule in many chronic cases it is better to give a series of preparatory
treatments in order to reduce muscle fibrosis and thickening of
capsular ligament. Remember that often it is a slight rotary movement
or twist given that aids the most in executing rule second. No matter
to what position a vertebra is rotated or side-bent the principles
applied are the same in each case.
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