Chiropractic Philosophy and Practice

From: Review Course of FUNDAMENTAL SUBJECTS
combined with CHIROPRACTIC LAWS AND
STATE BOARD QUESTIONS AND ANSWERS
Fourth Edition, 1939
P.E. Gardner, D.C., M.S.C.

DEFINE CHIROPRACTIC.

Chiropractice is the art and science of treating disease by the adjustment of misplaced vertebrae, thereby relieving impingement of the nerves passing through the intervertebral foramina.

WHAT DOES THE WORD CHIROPRACTIC MEAN?

Chiropractic means "done by hand." Derived from the words "chiro" meaning "hand" and "praxis" to do.

WHO DISCOVERED CHIROPRACTIC?

D. D. Palmer in 1895.

HOW WAS CHIROPRACTIC DISCOVERED?

D. D. Palmer learned of its merit when he successfully cured a case of deafness by adjusting a misplaced vertebra.

WHAT IS THE THEORETICAL BASIS OF CHIROPRACTIC?

As a consequence of a subluxation there is produced an impingement upon the nerves which pass through the intervertebral foramina corresponding to the vertebrae involved in the displacement.

WHAT IS THE ANATOMICAL BASIS OF CHIROPRACTIC?

In direct contrast with the opinions of anatomists who continually taught that while a certain motion between vertebrae exists, a misplacement of a vertebra is impossible; we find that the ligaments and muscles of one side of the spine may at times be more contracted than those on the other side. This would naturally tend to draw the vertebrae with which these ligaments are connected toward the side on which the contracted condition of the ligaments exists. Were the ligaments of each side equally contracted, there would be a perfectly balanced condition and misplacements of the vertebrae would be impossible. It is because of this lack of balance that subluxations may be produced, anti it is this fact that the anatomists failed to take into consideration.

WHAT IS THE PHYSIOLOGICAL BASIS OF CHIROPRACTIC?

The functional activities of all parts of the body depend upon the amount of strength of the nerve-impulses received by them. If, therefore, anything interferes with the power of conduction of the nerve, the impulses which it normally conveys to the parts which it supplies are not forthcoming, and these parts will suffer; there will be either functional derangement, or a change in its structure.

HOW IS THE SYMPATHETIC NERVOUS SYSTEM CONNECTED WITH THE CEREBRO-SPINAL NERVOUS SYSTEM?

The efferent or white branches of communication between the ganglia of the sympathetic system and the cerebro-spinal nerves arise in the spinal con]: they pass out in the anterior root, and then into the spinal nerve. Here they join the afferent fibers which originate in the spinal ganglion. The united fibres then pass on into the anterior primary division of the spinal nerve. They leave this, and now known as the white remi communicantes, they pass to the ganglion of the sympathetic cord of the corresponding situation.

The afferent or gray branches pass from the ganglion of the sympathetic cord to the spinal nerve, and are called the gray rami communicantes. They pass through the anterior primary division of the spinal nerve to the spinal nerve proper, and then accompany it throughout all its divisions.

HOW IS THE SYMPATHETIC NERVOUS SYSTEM CONNECTED WITH THE CRANIAL NERVES?

The superior cervical ganglion communicates with all the cranial nerves through the following branches of the ganglion. The superior branch, the carotid plexus, the cavernous plexus, the external and internal branches and the anterior branches.

WHAT ARE THE FUNCTIONS OF THE EFFERENT AND AFFERENT NERVE FIBERS?

The functional activity and the organic integrity of every -part of the body are governed and maintained by the efferent impulses, which originate in the brain, and are transmitted along the course of the nerve-fibers to their proper destination. The proper relationship of all parts of the body, individually and collectively, to their environment, is maintained by the flow of afferent impulses from the periphery to the brain.

WHAT ARE THE EFFECTS OF STIMULATION OF AN EFFERENT NERVE?

Contraction of muscle (motor nerve). Influence on nutrition (trophic nerve). Influence on secretion (secretory nerve). Inhibition, augmentation, or stoppage of another efferent action.

WHAT ARE THE FUNCTIONS OF THE SYMPATHETIC NERVOUS SYSTEM?

Influence on movement and sensibility.

Influence on nutrition.

Influence on heat production.

Influence on metabolism.

Influence on circulation.

Influence on secretion and excretion.

Influence on the special senses.

Influence on reflex action.

Influence on the organs.

NAME SOME CAUSES THAT DISTURB' NERVE FUNCTION OTHER THAN VERTEBRAL LESIONS.

Fatigue, malnutrition, traumatism, extremes of temperature, chemicals and drugs, mechanical conditions.

STATE WHAT HAPPENS WHEN MISPLACEMENT OF VERTEBRA OCCURS.

The lumen of the intervertebral foramen is encroached upon by the displaced portions, and its opening narrowed. The contents of the lumen are compressed or displaced. In vertebral sUbluxations, hard bone presses on soft nerve, blood-vessels, and lymphatics.

DEFINE VERTEBRAL SUBLUXATION.

A displacement of a vertebra, resulting in an impingement of the structures in the intervertebral foramen by the displaced margins of the foramen.

WHAT IS MEANT BY SPONTANEOUS ADJUSTMENT?

A great majority of the subluxations which are sustained during the day are corrected during sleep. When we are relaxed in sleep, those vertebral subluxations which are not too severe are adjusted in this way.

NAME THE CHIEF EXTERNAL CAUSES OF SUBLUXATIONS.

Occupation, habits, injuries, age, and exhaustion.

HOW DO INTERNAL CAUSES PRODUCE SUBLUXATIONS?

It is a proven fact that pre-existing diseases may produce vertebral mal-alignment reflexly. Any disease which produces sufficient irritation at the periphery to stimulate the nerve-endings and produce a reflex act will produce a subluxation in the same segment of the vertebral column whose muscles are innervated by the efferent nerves from the corresponding segment of the spinal cord which receives the sensory nerves that have been stimulated.

WHAT ARE THE LOCAL EFFECTS OF VERTEBRAL SUBLUXATIONS?

When a vertebra is shifted from its normal position, its relative position to the vertebra above and below is altered in all its parts. A change in the position of the margins of the intervertebral foramen occurs, and the displaced wall presses on the following structures:

Afferent and efferent spinal nerves,

White and gray rami communicantes,

Arteries and veins,

Lymphatics.

NAME THE MOVEMENTS OF WHICH THE SPINE IS CAPABLE.

Flexion, extension, rotation, lateral motion, and mixed motion.

NAME THE SURFACE LANDMARKS OF THE DIFFERENT VERTEBRAE.

1st cervical:	Has no spinous process. The transverse processes are just below and in front of the tips of the mastoid processes.
2nd cervical:	Has the first spinous process below the occiput.
3d. cervical:	The spinous process is very difficult to palpate, since it lies beneath the overlapping spinous process of the axis, and can be felt only when the neck is flexed.
4th cervical:	The spinous process is the third that can be palpated when the neck is flexed.
5th cervical:	The fourth palpated when the neck is flexed.
6th cervical:	The spinous process is directly above the vertebra prominens.
7th cervical:	Easily recognized by the great length of its spinous process.
1st dorsal:	The spinous process is in line with the superior portion of the spine of the scapula.
2nd dorsal:	The spinous process corresponds with the head of the third rib.
4th dorsal:	The spinous process is opposite the junction of the first and second parts of the sternum.
5th dorsal	Easily determined by counting upward from the 7th D.
6th dorsal:	Directly above the sevent h.
7th dorsal:	The spinous process corresponds to the inferior angle of the scapula when the subject is sitting with the arms hanging at the sides, and half an inch above when the subject is lying prone.
8th dorsal:	Directly below the 7th dorsal.
9th dorsal:	The second from the 7th dorsal.
10th dorsal:	The spinous process is on the level of the ensiform cartilage of the sternum.
11th dorsal:	First below the 10th dorsal.
12th dorsal:	The spinous process corresponds to the head of the last rib.
1st lumbar	Recognized by counting upward from the 4th lumbar.
2nd lumbar	Recognized by counting upward from the 4th lumbar.
3rd lumbar	Directly above the 4th lumbar.
4th lumbar	The spinous process is situated at the level of a line drawn between the iliac crests.
5th lumbar	Directly below the 4th lumbar and above the sacrum.

DEFINE AND DESCRIBE A SPINAL SEGMENT.

A spinal segment is that part of the cord contained between two sets of roots. Each segment must be regarded as a unit endowed with motor, sensory, trophic, vasomotor, and reflex functions in respect to the parts supplied by the roots of the nerves which emerge from and enter it. A segment is named from the nerve-roots which take their origin from it, and not from the vertebra with which it corresponds.

NAME THE SYMPTOMS AND SIGNS OF VERTEBRAL

SUBLUXATION.

Malalignment of the vertebra.

Contraction of the spinal muscles and ligaments.

Diminished mobility of the back.

Pain and tenderness.

Symptoms referable to certain organs or parts of the body.

Local zones of increased temperature.

NAME THE VARIOUS FORMS OF SUBLUXATIONS.

Kyphosis Lordosis Scoliosis Anterior Posterior Inferior Right lateral

Left lateral Right posterior Left posterior Right inferior Left inferior Antero-inferior Postero-inferior

These are classed as simple subluxations. In addition there may exist combinations of two or more simple subluxations, constituting compound subluxations.

GIVE A METHOD OF PALPATION OF THE SPINOUS PROCESS.

In palpating the tips of the spinous processes one may commence either in the lumbar region and pass upward, or begin with the first thoracic vertebra and pass downward. In palpating the spinous processes each one should be felt and the exact point of position of its tip marked on the skin overlying it.

GIVE METHOD OF PALPATION OF THE TRANSVERSE PROCESSES.

In palpating the transverse processes it is advised to use the tips of the first three fingers of each hand; one finger being placed on a transverse process in such a manner as to enable the palpator to make comparison between three vertebrae.

NAME THE VARIOUS POSITIONS FOR THE PURPOSE OF MAKING SPINAL ANALYSIS.

The erect position, the prone position, the dorsal position, and the Adams position.

DESCRIBE THE METHODS USED TO DETERMINE THE EXACT NATURE OF SUBLUXATIONS.

Inspection: By this we note the following points:

1. Malalignment of the spinous processes.
2. Diminished mobility of the back.
3. Undue prominence of the angle of a rib or ribs.
4. Tilting of the pelvis.

Palpation: By which we note the following points:

1. Local zone of increased temperature.
2. Contraction of the spinal muscles and ligaments.
3. Tenderness. .
4. Thickening of the nerve-trunk.
5. Malalignment of the spinous and transverse processes.

X-Ray: To verify the findings of inspection and palpation.

GIVE THE POSITIONS OF THE SPINOUS AND TRANSVERSE PROCESSES IN EACH FORM OF SUBLUXATION.

Antero-Inferior subluxation: The spinous process is displaced upward and backward. The transverse processes are displaced forward and upward to the same degree on each side.

Postero-inferior subluxation: The spinous process is displaced downward and forward. The transverse processes are displaced backward and downward to the same extent on either side.

Posterior subluxation: The spinous process is displaced backward. The transverse processes are displaced backward to the same extent on each side.

Anterior subluxation: The spinous process is displaced forward. The transverse processes are displaced forward equally on each side. Inferior subluxation: The spinous processes of two vertebrae are approximated, that of the subluxated vertebra downward upon the vertebra below. The transverse processes on both sides of two vertebrae are approximated.

Right and left inferior subluxation: The spinous process is displaced toward the side away from the side compressed. The transverse process is displaced downward on the compressed side, while that of the other side is raised.

Lateral subluxation: The spinous process is displaced to one side. The transverse process projects laterally in the cervical region, and in the thoracic region the transverse processes on one side is drawn away from the line of the spinous processes, while on the other side it approaches this line.

Right or left posterior subluxation: The spinous process is displaced slightly to one side. The transverse process of one side is forward, while on the side on which the subluxation exists it is displaced posteriorly.

Kyphotic subluxation: The spinous processes are displaced and the distance between them increased. The transverse processes are displaced posteriorly and separated.

Lordotic subluxation: The spinous processes are displaced anteriorly and set close to each other. The transverse processes on both sides are displaced forward and approximated.

Scoliotic subluxation: The spinous processes are displaced laterally. The transverse processes are displaced to the side, and rotation of the vertebrae is frequently present.

DEFINE SPINAL ADJUSTING.

The replacement to their normal position of subluxated vertebrae for the purpose of relieving pressure upon the nerves, and thus restoring to the parts supplied by these nerves their proper innervation.

HOW IS A CHIROPRACTIC ADJUSTMENT ACCOMPLISHED?

By the application of a: definite thrust by the hands of the operator in contact with the affected vertebra.

WHAT IS THE IMMEDIATE EFFECT OF A CHIROPRACTIC THRUST?

A momentary relaxation of the ligaments of one side, permitting the ligaments of the opposite side which had been stretched beyond the limit of their elasticity, to return to their original condition.

DEFINE VERTEBRAL PALPATION.

Vertebral palpation consists in the use of the tactile sense to determine the number, position, relation, size, shape, and as far as possible the condition of, the segments of the spinal column, in order to discover the primary causes indicative of disease.

DEFINE NERVE TRACING.

Nerve tracing is that branch of palpation by which the tendernessof irritated spinal nerves is discovered and their paths demonstrated.

DEFINE ORGAN TRACING.

Organ tracing is that branch of palpation which deals with the outlining of the boundaries and surface markings of a tender organ or part.

WHAT NERVES ARE TRACEABLE?

Any spinal nerve may be traceable for at least a part of its course. The cranial nerves are not traceable, except the spinal portion of the spinal accessory and the terminal portions of the nerves to the face. The sympathetic trunks are not traceable, except perhaps in the neck. Only such nerves are traceable that are irritated and consequently swollen and tender. If a nerve is very heavily impinged, especially if the impingement is chronic, it is partially or wholly paralyzed and not traceable. If the heavy impingement be acute or if the impingement be light, nerve tracing is a real aid to diagnosis.

STATE BRIEFLY THE TECHNIC OF NERVE TRACING.

The operator, having made his vertebral palpation, may begin at some point in the body indicated by the symptoms of disease and, finding tenderness, follow the path of a nerve back to the spinal column where it is presumed to enter the intervertebral foramen. Or he may use palpation as a guide and follow the tender nerves outward, to their periphery. This is a better method. Use second finger of either hand as the palpating finger, choosing the hand which can be most conveniently used, as determined by the position of patient and part of the body to be examined. Reinforce this second finger by the pressure upon it of the first and third fingers and also, if desired, by the pressure of the thumb against it. Apply the tip of the palpating finger to the nerve with a motion such that it crosses the path of the nerve at right angles back and forth. Meanwhile, the probable path of the nerve must be kept in mind. As the finger crosses the nerve-path it makes steady and even pressure upon any structures beneath it. The motion of the hand is a semi-rolling motion, the finger tip probing for the tender spot. These tender spots should be noted and marked at about one inch intervals.

STATE THE CHIROPRACTIC HYPOTHESIS.

Chiropractic has accepted, as a convenient working hypothesis, that all disease in the human body is primarily made possible by injury to (stimulation or inhibition of) some part of the nervous mechanism.

WHAT ARE THE SERIES OF EVENTS THAT TAKE PLACE IN PRODUCTION OF DISEASE?

Concussion of force.

Subluxation of vertebra.

Impingement of nerve.

Excitation or inhibition.

Disease -- Abnormal function.

NAME SOME CONDITIONS THAT ACT AS SECONDARY CAUSES IN THE PRODUCTION OF DISEASE.

Pathogenic germs.

Poisonous excretions from germs.

Tissue destruction by chemical action of such toxins. .

Reflex muscular tension tending to increase subluxation.

Dietetic error.

Tissue destruction or nerve irritation by chemical poisons.

Reflex motor disturbances.

Abnormal mental condition.

Waste of nerve energy with production of toxins.

General metabolic disturbances.

Increased disease wherever disease previously existed.

WHAT IS THE CHIROPRACTIC THEORY REGARDING SECONDARY CAUSES OF DISEASE?

None of the secondary causes can operate without previous subluxation. A subluxation may produce disease without the aid of any secondary cause.

WHAT IS THE CHIROPRACTIC CONCEPTION REGARDING THE CURE OF DISEASE?

That Nature is the only real curative agent and that we contain within our own bodies the possibilities of perfect normality. The Chiropractor assists the body by adjusting displaced structure and affording the body a free and unhindered opportunity for the exercise of its own healing powers.

STATE THE PROPER ORDER IN MAKING A CHIROPRACTIC EXAMINATION.

General observation.

Vertebral palpation.

Nerve tracing.

Special examination.

History of case.

Summary.

WOULD YOU ADJUST A CASE OF POTT'S DISEASE?

No, for fear that the affected vertebrae would fracture.

WOULD YOU ADJUST A PREGNANT WOMAN IN HER LAST TRIMESTER?

Absolutely. It will facilitate her labor by aiding the cervix to elax.

HOW CAN YOU DIAGNOSE AN ANKYLOSED VERTEBRA?

By moving the patient back and forth and sideways. If there is movement between the vertebra in question, and the one above and below; the vertebra is not ankylosed. If the interspaces between the vertebra are not changed by motion, ankylosis may be suspected.

HOW WOULD YOU DETERMINE A BENT SPINOUS?

If the vertebra in question is subluxated the transverse process on the opposite side will be palpable and appear higher than its fellows.

WHAT IS THE CHIROPRACTIC VIEW OF THE GERM THEORY AS THE CAUSE OF DISEASE?

That the germs are only capable of invading tissue void of proper nerve innervation. If the tissues are healthy, the germs will not be able to propogate and elaborate their toxins because healthy tissue is a poor culture media for their growth.

DEFINE A SPECIFIC ADJUSTMENT.

To adjust specifically the segment which enervates the organ diseased.

IS THE SEVENTH CERVICAL ALWAYS THE VERTEBRA PROMINENS?

Only in about 65% of the cases. The sixth cervical or the first dorsal may be vertebra prominens in the other 35% of the cases.

WHAT IS A MAL-ADJUSTMENT?

Is the driving of the vertebra in the wrong direction, increasing the already existing subluxation or causing subluxation of a properly aligned vertebra.