Order of general Treatment
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.