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The frequency with which the treatment is given will de¬pend upon whether it is general or local, light or heavy, and on the condition of the patient from day to day. A general treatment is usually given three times per week, but a strong person could take it every other day, or four times per week. A light general treatment may be given five or six times a week for a limited period of time, if conditions seem to indicate it and little or no other treatment is being given. Very heavy of treatments including considerable exercise may have to be limited to two a -week, but as these are seldom given except to advanced patients, three a week should not be too much. If manipulation is especially needed it may be permissible to give a light general treatment three times a week and the heavier treatment with exercise twice a week. Local treat¬ment may be given once or twice a day, six days a M’eek. Xo matter what form of treatment is employed, a one-day rest-period each week should be strictly observed: and, if it is necessary to keep up treatment for a long period of time, a week of rest every four to six weeks is advisable. If one is always governed by the patient’s reactions, one will not go wrong. As long as the patient enjoys the treatment and feels better afterward, benefit will be assured.
The illustrations given herewith, with their accompanying captions, should be carefully studied, in order that the move¬ments may be correctly given. If the directions are followed exactly, not only will the patient react better to the treatment, but less exertion will be required on the part of the operator. Anyone who is really interested in learning to give this most effective treatment should have no difficulty in doing so if he will carefully study the instructions presented.
As regards the self-administered treatment, no additionaldirections will be needed, as all that has been said so far ap¬plies also to that form of treatment. The same method of applying the movements, using the little extra pressure at the end, is employed. It is comparatively easy to treat one’s own neck, arms, and legs, but, in the case of the trunk, treatment may have to be applied by pressing or pulling against some external object, or by using one set of muscles against an¬other. The illustrations will make this clear.
In giving a general treatment it is customary to begin with the neck, moving thence to the hands, arms, shoulders, feet, legs, hips, and spine. This applies to the face-up, face¬down, and sitting positions. In the last it is seldom that any parts other than the neck, spine, and shoulders are treated. If a movement is given in one position, it is not necessary to repeat it in another position, but it may he done if there is some special reason for doing so. Owe may start with the face-up reclining or the sitting positions, but as a rule it is well to finish with the face-down reclining position, in order that soothing and relaxing pressure may he applied to the spine as the finishing touch. Of course, if the treatment is
intended primarily for stimulation, one may use any position for starting and finishing. There are no hard and fast rules in the order of treatment, the variety of movements, or the length of the treatment; these are all adapted to the in¬dividual’s needs. It is always well, however, to avoid over-treatment. If in doubt, better give too little treatment than too much. If the patient feels very tired after a treatment, give less the next time. An exclusively manipulative treat¬ment should not last more than twenty minutes, and fifteen is generally sufficient. The amount given during a stated time will vary, of course, with the speed of the operator, but in most cases time is a fairly safe guide. If exercise is to be included with the manipulation, the latter should be shortened to ten minutes. The amount of exercise is governed strictly by the .strength and reactive powers of the patient. A period of rest should follow such a treatment, and preferably it should also follow simple manipulation. In giving exercise, follow the general rules which apply to all exercise and which are given in another volume of this work, Local treatment may he given instead of general treat¬ment whenever it is desired specially to affect a certain part, as in cases of flatfoot, knock-knee, and spinal curvature. If general treatment is to be given, with special attention to a certain part, the manipulation of the latter should be left until the last, or an extra local treatment to this part may be given at a different time of the day. In the case of a weak patient, it is usually necessary to confine the treatment to the parts needing it most.
Conditions may require two light treatments daily instead of one heavy treatment. If more than one part needs particu¬lar attention, but the patient is too weak to have theiy all worked on at onee, treatment of the parts may be altered on different days. It may seem strange that manipulation should be given to such a weak patient, but manipulation without the exercise will often be well borne when even massage woidd prove too exhausting. At the same time the effects are deeper and more lasting.
In giving these treatments, a suitable table is a great help. Treatment may be given on almost any kind of a table, or on a bed or couch, but the operator can always work more effect¬ively if he has a table of the proper height and width. The patient will also be more comfortable and will relax better. The table should be long and wide enough to hold the patient without any parts of his body projecting beyond its edges; but it should not be any wider than is necessary, because, in some of the movements, the patient straddles the table, and too wide a spread of the legs will be uncomfortable. The table should be well padded, but not so soft that the patient sinks into it.
For the operator’s sake the table should be about as high as his hips, as most of the movements can then be administered without much bending or stretching. An adjustable table is convenient, but not necessary. If the operator wishes to get well above the patient, lie can stand on a box or stool. Both operator and patient, especially the latter, should be loosely and comfortably dressed. Whenever possible, it is well for the patient to be stripped, so as to permit the greatest freedom of motion, and so that the direct spinal manipulation may be applied to the bare skin. If something must be worn, a one-piece bathing-suit will do very “ell. Treatment can be given to a patient wearing a gymnasium costume, or stripped to the waist, or when fully clothed if necessary, but unless the feet are not to lie treated, the shoes should always lie removed. Doctors applying these corrective movements to female pa¬tients usually have them wear pajamas or a kimono which opens down the back. When exercise as well as manipulation is to be given, a minimum of clothing is essential. In this case, also, it is particularly important that there be plenty of fresh air in the room.
Vigorous corrective movements should not be used when great pain is present, as is often the case in neuritis and some¬times in arthritis. If there is only moderate pain, the move¬ments can be given lightly, increasing the pressure very gradually when stretching the joints. In all acute conditions rest is more important than exercise, and any manipulation given should be limited to the lighter spinal movements. Gen¬erally it is well not to use any such treatment until the acute symptoms subside. During pregnancy it is well to avoid any very strenuous stretching of the abdominal region or heavy exercise of this part. A light general treatment may be given to great advantage, however, as it maintains the flexibility of the joints, muscles, and ligaments about the pelvis. The same precautions should be taken during the menstrual period. If there is a profuse flow, however, no treatment, except possibly pressure on the spinal nerve-centers, should be given.
The extent of the movements and the amount of force employed in their application can be graduated to meet the needs of the young, the old, the weak, the strong, the sick, and the well. The movements may be given slowly when it is de¬sired to relax, or rapidly when it is desired to stimulate. Pres¬sure may be applied gradually or quickly. The amount of resistance offered when giving the exercises may be graduated to a nicety for each part and for each person. The treatment may be made long or short, general or local. By modifying the severity of treatments they may be used to assist the over¬weight person in reducing or the person below normal weight in building up.
F’or example we select the neck, as movements of this part are important. Generally, it is best for the patient to be in the reclining position, especially at first. The movements can be given in the sitting position, but it is much easier for the oatient to relax when lying down. The movements used con¬sist of lifting the head as high as possible, so that the chin touches the chest; lifting the head diagonally left and right :;o that the chin touches the shoulder; bending the head to the sides, left and right, until the ear touches or nearly touches the shoulder; twisting the head to the left and right; stretch¬ing the neck by pulling directly backward on the head; stretching the neck while bending and twisting it at the same time; and pressing downward on the head while it is in a lifted position. In other words, the neck is bent, twisted, and stretched in every possible direction.
corrective Movements for thje Neck It is seldom necessary for the patient to relax before the treatment, as the movements themselves are relaxing as well as stimulating. The patient may be told to relax, and if he is inclined to help the operator by using his muscles, he should bn told to take his mind from the part being treated. If there is great difficulty in relaxing or if there is some pain, a little massage may be applied to the muscles before beginning the Movement manipulation. The latter should be given lightly and slowly at first. Kach movement is executed several times, and the amount of force can be increased slightly at each repetition. The movements must be made smoothly and with a firm touch, as an indecisive touch or jerky movement will cause the patient
to tense his muscles.
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A number of the movements for the foot will be found very helpful for weak or fallen arches, and those for the knee may be used in cases of knock-knee, or in bow-legs where the joint is chiefly affected. The manipulation applied to the toe is helpful for bunions. Cases of chronic arthritis, in which the joints can be moved without unbearable pain, are often greatly helped by proper movements. If the patient is not able to take active exercise, manipulation without the resistive movements will soon bring about such improvement that the latter may be added, and this will hasten the time when more active exercise may be employed.
Proper movements are of value even in paralysis. Here the stretching of the joints intensifies the good effects of exer¬cise. As soon as active exercise is possible, the resistive move-ments will hasten results, for they require the patient to use mental concentration on the muscles. Then the stimulation of the spinal nerves brought about by the manipulation of the back helps further in restoring normal nerve action.
This form of treatment is very valuable in spinal curva¬ture for the reason that it combines manipulation with exer¬cise, and develops the muscles which hold the spine in normal position. Other forms of spinal manipulation do not do this. The movement required to force the spine into its normal position will, if resisted by the patient, develop the muscles which hold the hones in place. Full instructions for the treat¬ment of spinal curvature will be found in Volumes VII and VIII.
The purposes of these treatments are to improve the blood and nerve supply to all parts of the body and to de¬velop the strength and tone of the tissues necessary to retain this improved function. These effects are brought about in various ways. The manipulation of the joints increases their mobility, and this always improves the blood and nerve supply to the surrounding parts. The blood-vessels and nerves which pass a joint lie close to the hones and to the surface, and any stiffness or abnormal deposits about the joint will cause some pressure upon them. Manipulation of the joints not only helps to overcome and prevent this abnormal pressure, but through the stretching of the nerves greatly stimulates their action. Increasing the mobility of a joint involves stretching any tightened ligaments and also strengthening and restoring tone to relaxed and shortened ligaments. A joint, works normally when its supporting ligaments are normal, so that movement can he free hut controlled. It is possible for a joint to he so movable that it tends to dislocate easily but with proper manipulation this should not result, because the tonic effects of the treatment, especially the exercise, make the liga¬ments strong as well as flexible.
A joint which is in normal condition is not easily dis¬placed. If displacement occurs, the elasticity of the ligaments tends to draw it hack into place, especially if a little assistance is given in the form of stretching. Many people have had the experience of dislocating a ringer joint and replacing it by merely pulling upon it. Tims it will be seen that proper move¬ments help greatly in replacing any bones, ligaments, or muscles which may be slightly out of position. This is espec¬ially true of the spinal vertebrae.
Normal functioning of the organs depends upon their receiving a normal blood and nerve supply, and by manipu¬lating and exercising the parts adjacent to affected organsand to the nerve-centers in the spine which govern these or¬gans, great improvement can he brought about. The right sort of movements particularly are valuable for the heart, liver, and intestines, but all the organs are favorably in¬fluenced. There is not a part of the body that will not be benefited, including the brain, which is, of course, dependent upon a good blood supply.
It is also necessary, if the best results are to be secured, to combine the corrective exercises with every phase of right living. Manv people, having; heard that certain exercises are good for a spinal curvature, take the exercises, but neglect to correct their diet and to get more fresh air and sleep. Then they wonder why they do not get satisfactory results. Exer¬cise educates the muscles and creates a demand for their de¬velopment, but this development can take place only when the proper conditions are created through general right habits of living. Those who expect to recover from any abnormal condition by exercise alone will be disappointed. If lack of exercise has been one of the chief causes of their trouble, the addition of the proper muscular activity may make a marked change, but the effects will not be complete and perma¬nent unless all the laws of health and right living receive due attention.
For exercises to overcome specific deformities see Bow legs; Club-foot; Flatfoot; Parah/si.v; Rupture; Sight, Dis¬turbances of; Spinal Curvature (under Spine, Diseases of) in Volumes VII and VIII; also discussion on Increasing Height under Traction in Section 7 of this volume.
SPECIAL EXERCISE TREATMENTS.—The treatments here discussed are illustrated and described in detail throughout this section.
This mode of treatment is a combination of general bodily manipulation and resistive exercise. It includes a great variety of movements designed to reach all parts of the body. Sometimes manipulation may he administered without exer¬cise, sometimes it is given locally instead of generally, and there are always variations which may he utilized to meet special needs. The full description accompanying the many illustra¬tions will reveal the possibilities of this form of manipulation.
The importance of rest and relaxation in securing results from exercise has been fully discussed elsewhere, but it will lie well to emphasize their importance still more in relation to corrective exercise. In practically all cases requiring such treatment there is a lowered vitality, and so the nerve-energy must be conserved and every opportunity given the body to build more. When certain muscles are abnormally contracted, results will be poor until they have been relaxed. In such cases conscious relaxation of the part affected will then be in¬dicated, as well as general rest and relaxation. The subjects of relaxation and recuperation from muscular effort are treated at length in Volume III, Section 1. The statements made in the description cited on the general constitutional effects of exercise apply with equal force to corrective exer¬cise, as discussed in the present section and elsewhere.
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