Osteopathic 
Strap Technic 
-BY- 
JOSEPH SWART, D.O., LL.B. 
Professor of 
Physical Diagnosis and Strap Technic in the 
Kansas City College of Osteopathy and Sur- 
gery; Author of “Analysis of Words 
Pertaining to Anatomy, Physiology, 
Diseases and Surgery, for Stud- 
ents and Physicians.” 
Second Edition, Revised and Enlarged. 
PUBLISHED BY 
JOSEPH SWART 
627 Ann Avenue, 
Kansas City, Kansas Copyright, 1923, 
By JOSEPH SWART; D. 0. PREFACE 
The use of straps in giving osteopathic 
treatments proved to be so agreeable to 
patients, so effective in operation and such 
a saving of energy to the operator that it 
seemed worth while to the author to pass 
the method on to other osteopaths. Strap 
technic is not a complete system nor is it 
expected to revolutionize osteopathic meth- 
ods of treatment; yet it is an aid of inesti- 
mable value to the osteopathic profession. 
The continued favor with which Osteo- 
pathic Strap Technic has been received has 
given opportunity for a second edition. This 
enables the addition of important new mat- 
ter. Foot troubles and their correction have 
attracted the attention of the general prac- 
titioner increasingly since the issue of Os- 
teopathic Strap Technic. A large section of 
the revised edition is devoted to the diag- 
nosis of foot ailments and the proper spec- 
ific treatment with the use of a specially 
constructed strap which aids very materially 
in the work of adjustment. 
Inasmuch as foot troubles are so often 
associated with lack of tone or develop- 
ment of muscles of the foot and leg, a 
chapter has been devoted to physical exer- 
cises. 
3 In addition, the revised edition contains 
descriptions of the spine and rib fixer and 
a spinal brace both of which are valuable 
adjuncts in the correction of a distorted 
spinal column. 
The text has been revised throughout 
and a number of new diagrams and cuts 
have been added. 
4 EQUIPMENT FOR OSTEOPATHIC STRAP 
TECHNIC. 
The necessary equipment for osteopathic 
strap technic is five handles, four straps, 
with two short straps attached to one of the 
four, and one harness snap, in addition to 
one ordinary treatment table and a pillow. 
The five handles can be secured at any 
good hardware store. They are the kind 
used on screen doors or for raising heavy 
windows. 
One handle should be placed at the front 
of the table. For convenience, this should 
be placed on the center and at the highest 
available point on the front end of the 
table. (Not on top.) 
On either side of the table there should be 
two handles; one about fifteen inches and 
the other about thirty, from the head end. 
It is advisable to use one leather strap 
about eight feet long, one and one-quarter 
inches wide, made of thick leather. This 
strap will do for all the heavy work and 
will last years. A weaker strap will soon 
be torn to pieces. 
The webbing straps needed are the follow- 
ing : One, one and one-half inches wide, 
eight feet long. One, one inch wide, four- 
teen feet long. Each of these webbing 
5 straps should have a buckle at one end and 
a tip piece at the other. 
On the fourteen-foot strap, about four 
feet from the buckle, fasten, at right angles, 
a webbing strap six inches long with a 
buckle on its free end. About seven feet 
from the buckle end of this fourteen-foot 
strap, fasten, at right angles, a webbing 
strap forty inches long, with a metal tip 
piece on the free end of it. 
There should be one strap, one inch wide 
by four and one-half feet long. About four 
inches from the buckle attach a five and 
one-half inch strap with a loop at the other 
end for the strap to pass through. This 
strap is for treating the foot. 
A pad for giving foot treatments is also 
required. It should be about one inch by 
three-fourths of an inch square. 
The harness snap should be put on the 
fourteen-foot strap; then the ends of the 
strap should be buckled together. The snap 
is for hooking into the handle at the end of 
the table, while the strap is put over the 
patient’s shoulders, as shown in Figures 
16 and 17. 
6 OSTEOPATHIC STRAP TECHNIC. 
Fig, 1—TECHNIC FOR CORRECTING A POS- 
TERIOR INNOMINATE LESION 
Note, in Figure 1, that the strap is buck- 
led short enough to flex slightly the pa- 
tient’s knee; and, that it passes across the 
patient’s hip just below the crest of the 
ilium on the lesioned side and just above 
the crest of the ilium on the normal side. 
Instruct the patient to push hard with his 
7 foot against the strap. The strap pulls the 
crest of the ilium forward and the head of 
the femur pushes the acetabulum backward, 
thus correcting the lesion. 
If the patient is a child or an adult too 
feeble to push hard against the strap, the 
operator should press downward on the pa- 
tient’s knee to straighten the leg. That will 
do the work just as well as when the patient 
does the pushing. This operation should be 
painless and agreeable to the patient. 
By this strap method, innominate lesions 
can be corrected for women while they are 
fully dressed for the street. 
It is just as easy to correct a big man’s 
innominate lesion as it is to correct one for 
a little patient; the patient does the work. 
An anterior lesion can be set in the same 
manner by moving the strap down, from the 
crest of the ilium to the ischium, and having 
the patient push as before. 
8 Fig. 2—TECHNIC FOR CORRECTING ANTER- 
IOR INNOMINATE LESIONS 
FIG. 2—TECHNIC FOR CORRECTING 
ANTERIOR INNOMINATE LESIONS. 
As shown in Figure 2, the strap is put 
through the handle at the front end of the 
table and looped over the patient’s knee. 
The strap should be buckled up to the proper 
length to reach over the knee when the 
thigh is perpendicular. Then instruct the 
patient to push with his knee, as hard as 
he can against the strap. By so doing he 
corrects the lesion. The hamstring muscles 
draw the ischium anteriorly and the gluteus 
maximus opens the sacro-iliac articulation, 
while the head of the femur pushes the 
acetabulum posteriorly, thus correcting the 
lesion. 
9 Fig. 3—TECHNIC FOR CORRECTING AN AN- 
TERIOR INNOMINATE LESION WITH- 
OUT USING A STRAP 
fig. 3—TECHNIC FOR CORRECTING 
AN ANTERIOR INNOMINATE LESION 
WITHOUT USING A STRAP. 
The patient interlocks the fingers of his 
hands and puts them over the knee to take 
the place of the strap. The patient should 
pull with both hands and push with his 
knee, with all his strength. He should not 
bend his elbows, as by doing so he draws 
the knee too far forward. This method can 
be used when the operator has no strap to 
work with. If he has a strap, it is best to 
use it, as the patient will push harder on 
the strap than he will on his hands. 
10 Fig. 4—TECHNIC FOR CORRECTING AN AN- 
TERIOR INNOMINATE LESION ON A 
BED OR SOFA 
11 FIG. 4—TECHNIC FOR CORRECTING 
AN ANTERIOR INNOMINATE LESION 
ON A BED OR SOFA. 
Sometimes a treatment is given at the 
patient’s home, with the patient on a bed 
or sofa. In such cases, there may be noth- 
ing to fasten a strap to. A broom handle, 
or any old stick, can be used as shown in 
this Figure. I usually put the strap over 
my wrist and grasp the head of the sofa or 
bed with my hand and let the patient push 
with all his might. Since I should consider 
that method dangerous for an operator who 
has an arm smaller than mine, I am advis- 
ing the use of a stick, as shown in Figure 4. 
12 Fig. 5—TECHNIC FOR CORRECTING AN AN- 
TERIOR INNOMINATE LESION WHEN 
THE PATIENT HAS A SORE KNEE 
13 FIG. 5—TECHNIC FOR CORRECTING 
AN ANTERIOR INNOMINATE LESION, 
WHEN THE PATIENT HAS A 
SORE KNEE. 
Synovitis of a knee joint is a common re- 
sult of an innominate lesion; therefore, it is 
quite common to find a sore knee associated 
with this lesion. On account of the soreness, 
place the strap on the thigh just above the 
knee. It is usually necessary to put a small 
pillow between the patient’s thigh and the 
strap, as the pressure against the strap may 
cause pain. 
Sometimes a patient will complain of pain 
between the sacrum and the posterior super- 
ior spine of the ilium. This can be removed 
by hooking the strap over the front corner 
of the table, opposite the affected side and 
over the patient’s knee while he lies, in the 
dorsal position on the table. Then let the 
patient push, as he would for correcting an 
anterior innominate lesion. By this method, 
the pull will be in proper direction for open- 
ing the joint at the point of pain and for re- 
moving the cause of the pain. 
No preparatory treatments are necessary 
before making innominate correction. Cor- 
rect the lesion, and then, if desirable, treat 
the muscles. 
14 The innominate lesion is very common. 
Some osteopaths say that eighty per cent of 
their chronic cases have innominate lesions. 
I do not keep case records, but I should judge 
that eighty per cent is not far out of the 
way. Every one of these lesions causes 
trouble—trouble that an osteopath can re- 
move by correcting them. If he successfully 
treats every innominate lesion that comes to 
him, he will make a sufficient number of 
cures to build a reputation for successful 
practice. 
It will not be necessary to enumerate the 
various diseases and ailments that have been 
cured by correcting innominate lesions; but, 
in a general way, it is well to know that such 
lesions cause congestion and pain anywhere 
in the legs, feet, pelvis or lower abdominal 
region. They also interfere with the circu- 
lation of the blood in all the parts just men- 
tioned, and gradually or suddenly, develop 
trouble of various natures, from varicose 
veins to neoplasms. 
A double innominate lesion often exists, 
that is, a lesion of both innominate bones. In 
such cases, the legs are of equal length. If 
there is pelvic trouble or trouble anywhere in 
the legs, feet or lower abdominal region, not 
otherwise accounted for, it is well to suspect 
a double innominate lesion. To test for such 
a lesion, give treatment for an anterior in- 
15 nominate lesion, and then measure the legs. 
If the leg so treated is shorter than the other, 
there was a double lesion. Treat the other 
lesion in the same manner and measure again. 
The legs will again be of equal length. Don’t 
be afraid to make this test; there is no danger 
of producing an innominate lesion by this 
treatment. Theoretically, one might fear 
that such treatment of a normal articulation 
would lesion it; but, experience of over five 
years has proven that there is no danger of 
so producing a lesion. 
Instead of calling this a double lesion, some 
osteopaths may argue that it is a slipped 
sacrum. If so, let them call it that. It makes 
no difference in the treatment and no differ- 
ence in the results. 
Why do patients travel many miles to get 
their innominate lesions corrected by the 
strap method ? To answer this question, it is 
necessary only to hear them relate their ex- 
periences with osteopaths trying to correct 
such lesions by the old methods. It is diffi- 
cult to understand why any osteopath should 
stick to his old methods of manipulation, 
when he knows that such methods are often 
unsuccessful and usually very unpleasant to 
the patient. The old methods lose business; 
the strap method gets it, always making the 
corrections and producing good results. 
16 Fig. 6—TECHNIC FOR CORRECTING A LUM- 
BAR LORDOSIS, OR FOR TREATING A 
RIGID LUMBAR 
17 FIG. 6—TECHNIC FOR CORRECTING 
LUMBAR LORDOSIS, OR FOR TREAT- 
ING A RIGID LUMBAR. 
In this process, there is but one strap used. 
It passes around the table, through one han- 
dle at the side of the table and over the 
patient’s knees. When the patient pushes 
with his knees against the strap, it places a 
strain on the erector spinae muscles. For 
each pound of pressure exerted by the knees 
there is about seven pounds strain put on 
the erector spinae and quadratus lumborum 
muscles. Most of it is put on the erector 
spinae muscles. Any average man can easily 
in this position raise three or four hundred 
pounds on his knees. That would mean a 
strain of 2,100 to 2,800 pounds on the erector 
spinae muscles. The treatment stretches 
these muscles; hence, it is especially good 
for correcting lumbar lordosis. Such a spine 
throws extra weight on the anterior portion 
of the base of the sacrum and tilts the pelvic 
girdle. This abnormally tilted condition in- 
terferes with the circulation of blood through 
the pelvic basin and impedes circulation of 
blood and lymph throughout the legs and 
feet. 
18 By this treatment, I have cured varicose 
veins of both legs after they were bad enough 
to necessitate the patient’s wearing rubber 
bandages to prevent the veins from breaking 
out. 
For years I sought for a successful treat- 
ment of lumbar lordosis, but I did not find it 
until I learned the technic shown in Figure 
6. When I was in college, I was shown how 
to treat such cases by laying the patient on 
his side, flexing his knees and pressing them 
with my chest while I reached over the pa- 
tient’s side and pulled on the erector spinae 
muscles. That was hard work for me; but 
it was easy on the erector spinae muscles. 
The treatment was practically worthless. The 
erector spinae muscles are probably the most 
powerful in the human body and it requires 
great force to affect them. 
Next to the correction of innominate les- 
ions to normalize the blood circulation in the 
pelvis and legs, the most important thing is 
the correction of a lumbar lordosis. 
These cases of lumbar lordosis are very 
common, as they are found in most portly 
people and in many slim ones. They are pro- 
ductive of much trouble. It is very necessary 
that this condition should be corrected. 
If the patient’s hips do not rise from the 
19 table when he pushes on the strap, the strap 
should be slipped from his knees and he 
should be asked to slide about three inches 
toward the foot of the table. Put the strap 
over his knees and let him push again. The 
further the patient moves toward the foot of 
the table, the higher the strain will be on 
his back when he pushes on the strap. Don’t 
allow the patient to push against his knees 
with his hands, for that does the spinal mus- 
cles no good. 
This treatment can be used very success- 
fully to loosen up a stiffened lumbar spine, 
but I would not recommend it for use on a 
posterior condition of the lumbar spine, be- 
cause, in such cases, it is detrimental. 
Don’t try this treatment with a weak strap, 
for, if you do, the strap will break and the 
erector spinae muscles will receive no benefit. 
Since the time required for correcting a 
lumbar lordosis is often more than the pa- 
tient feels he can devote to it if it requires 
two or more visits to the physician’s office 
each week, it encourages him to know that 
he can do part of the work himself at home. 
Instruct him as to the method of helping 
himself by this exercise. He can use a strong- 
ly built kitchen table or a wide board across 
a couple of stools. His shoulders must rest 
on the board above one of the stools and the 
strap must pass under the seat of the same 
stool; otherwise the strain will split the 
board when he pushes on the strap. This 
daily exercise will do much to aid the phy- 
sican’s work of correction. 
20 Fig. 7—TECHNIC FOR TREATING HEMOR- 
RHOIDS OR REPLACING FALLEN PEL- 
VIC ORGANS 
21 FIG. 7—TECHNIC FOR TREATING HEM- 
ORRHOIDS OR FOR REPLACING 
FALLEN PELVIC ORGANS. 
No strap is used in this treatment. The 
patient is lying on two pillows, so that her 
body can be rocked back and forth longitud- 
inally with ease. The operator pushes on 
the patient’s feet to rock her body toward 
the head of the table; then he pulls and 
pushes again to get it under good motion, 
After pushing the second time, the operator 
holds back on the feet to stop suddenly the 
forward movement of the body. As he makes 
this sudden stop, the momentum carries the 
abdominal and pelvic contents upward. 
This treatment requires a little practice, 
but after the operator becomes familiar with 
it, he can do great good with it. 
Whenever I have told osteopaths that this 
treatment would cure hemorrhoids in from 
one to five treatments, they looked at me 
doubtfully. Years of experience, however, 
have led me to believe that this treatment 
will cure ninety-five per cent of hemorrhoid 
cases in from one to five treatments. In 
some cases of hemorrhoids, there is an accu- 
mulation of dried blood in the tumor. This 
treatment cannot remove that dried blood. 
22 Long standing cases are not necessarily 
difficult to cure. I cured one case of hemor- 
rhoids of nineteen years’ standing in a single 
treatment. 
The question naturally arises, Why is this 
treatment so effective? It is because it re- 
moves the cause of hemorrhoids, folds in the 
bowel. The bowel becomes jammed and 
pressed down at the rectum, putting short 
folds in its walls. These short folds shut off 
the circulation of blood and the blood is held 
back, causing the veins to fill and enlarge. 
This enlargement is a hemorrhoid. Whenever 
the bowel is raised up by this treatment, the 
short folds are straightened out, and the 
blood is allowed to circulate freely. The hem- 
orrhoid drains and disappears. This is a 
simple technic easily understood. The cures 
are just as easily made. 
By this same treatment we can raise the 
fallen, flexed or verted uterus. If the uterus 
is tipped backward against the sacrum, the 
patient should be treated while she lies face 
downward. In that position gravitation aids 
the uterus in its replacement by drawing it 
away from the sacrum. When giving the 
treatment with the patient lying face down- 
ward, it will be necessary for her to keep the 
knees perfectly rigid. If the knees are 
23 springy, the treatment will be useless, as 
the body must be stopped suddenly, for the 
momentum to carry the uterus upward to 
its normal position, and this cannot be done 
if the knees are not rigid. 
The McManis table is convenient for this 
treatment, as the patient can be put on it 
with her head lower than her hips, making 
the treatment more effective. 
24 Fig. 8—TECHNIC FOR TREATING LEUCOR- 
RHEA OF MENORRHAGIA 
25 FIG. 8—TECHNIC FOR TREATING 
LEUCORRHEA OR MENORRHAGIA. 
The strap is placed across the lower lumbar 
region. The operator raises the patient’s 
knees as high as she will tolerate. The knees 
should be raised, in this manner, three times 
for a treatment. 
The results thus obtained for leucorrhea 
are very satisfactory, and if continued, will 
cure most cases. One treatment will stop 
any normal menses, although more than one 
may be required for abnormal conditions. 
The treatment is quickly given, and is too 
valuable to be omitted when needed. 
26 Fig. 9—TECHNIC FOR TREATING THE AN- 
TERIOR ABDOMINAL AND CHEST WALLS 
27 FIG. 9—TECHNIC FOR TREATING THE 
ANTERIOR ABDOMINAL AND 
CHEST WALLS. 
No strap is used in this treatment. A pillow 
is laid at the center of the table. The patient 
lies across it as shown in this figure. His 
feet do not touch the floor. 
The patient’s arms are raised above the 
head to draw on the pectoralis muscles and 
raise the chest walls. After a patient has 
had this treatment several times, a weight 
can be held in his hands to make the stretch 
greater. 
This treatment is especially good for cases 
of thoracic kyphosis. In such cases the ribs 
are slanted too far downward, anteriorly. 
The abdominal muscles are contracted and 
shortened. Contractured intercostal and ab- 
dominal muscles make it impossible to 
straighten the spinal column. They must 
be stretched and relaxed. This treatment 
will do the work. 
Stooped shoulders, with their accompany- 
ing distorted chest, make a suitable place for 
a multitude of diseases, affecting especially 
the nervous system, heart, lungs, and bron- 
chial tubes. This treatment shown in Figure 
9 is good for a multitude of cases. It is not 
28 hard on the operator. At first it is very 
severe on the patient. Later he can take 
it with pleasure. 
The length of time a patient should lie 
across the table depends on his toleration. 
Some patients do not wish to lie there more 
than ten seconds. They often breathe heav- 
ily after this treatment, as though they had 
tried to lift a ton. Some patients can lie 
there a minute and repeat the exercise three 
or four times for a treatment. Some patients, 
after practice, can lie five minutes and hold 
a ten-pound weight in their hands. Each 
operator should try this treatment before he 
gives it to any of his patients; then he will 
know what to expect of the patient. Put a 
patient across the table as shown in Figure 
9, palpate the muscles of the chest and ab- 
domen and note how taut they are. You 
will decide that this is a powerful treatment. 
These cases of thoracic kyphosis with their 
accompanying distorted chest are the out- 
growth of many years of faulty position due 
to habit or spinal lesion. They necessarily 
require a considerable time for a proper res- 
toration. The patient can well afford to 
take this treatment daily at home. The 
results will justify the efforts even though 
the treatments are continued for six months 
29 or more. After one patient had used this 
treatment his friend slapped him on the back 
and said, “What has become of the hump 
on your back” ? This patient was over forty 
years of age; yet, his spinal column and 
chest improved perceptibly in the eyes of 
the layman; also his health improved accord- 
ingly. 
30 Fig. 10—TECHNIC TO PREVENT VOMITING 
OR TO STOP A STOMACH HEADACHE 
31 FIG. 10—technic to prevent vomit- 
ing OR TO STOP A STOMACH 
HEADACHE. 
When a patient complains of a headache 
that affects the eyes and forehead, place one 
finger on the right side of the spine, at the 
fourth thoracic nerve, to see if the spot is 
hypersensitive. If so, the stomach is the 
cause of the headache. Hold one finger on 
this spot to inhibit the nerve from one to 
three minutes and the headache will have 
cleared up. It is not necessary to count the 
vertebrae to locate this hypersensitive nerve. 
Guess at the spot and press. If that spot is 
not hypersensitive, try the one above or the 
one below. The patient will tell you when 
you hit the right spot. 
If the stomach is in bad condition, this 
treatment may not give permanent relief. 
In practically all of these cases of stomach 
headache, there is too much acid in the 
stomach. This can be readily neutralized by 
letting the patient drink half a glass of water 
containing half a teaspoonful of common 
baking soda. No, this is not medicine. If 
your patient spilled hydrochloric acid on his 
hands, would you not apply anything you 
could get to neutralize the acid? Of course 
32 you would. Then, why not neutralize the 
acid in the stomach, when it is burning up 
the lining of the stomach and causing the 
headache ? 
Inhibition of the same nerve will stop vom- 
iting. If a patient gets sick while riding on 
the cars, this nerve will be hypersensitive 
before he is sick enough to vomit. Inhibit 
the nerve to stop the headache and to stop 
the vomiting. 
Very often when a patient desires to vomit, 
it is best to let him do so, for that will clean 
out his stomach. Then give him some hot 
water to drink. Even if he throws it up, it 
will wash the stomach. Give him more hot 
water. 
Sometimes, however, it is desirable to have 
the patient keep some food in his stomach. 
This can be done by inhibiting the fourth 
thoracic nerve on the right hand side. Hold 
one finger on the nerve, while the patient 
eats or drinks some liquid food. After the 
food has been in the stomach for a few min- 
utes the disturbance calms to such a degree 
that it is no longer necessary to inhibit the 
nerve. 
33 Fig. 11—TECHNIC FOR STOPPING HIC- 
COUGHS 
34 FIG. 11—TECHNIC FOR STOPPING 
HICCOUGHS. 
Hiccoughs are due to spasms of the dia- 
phragm, brought about by inflammation of 
the phrenic nerves. This inflammation often 
spreads from the stomach to the lower side 
of the diaphragm where the terminal branch- 
es of the phrenic nerves are numerous. 
Figure 11 shows the thumb on the right 
phrenic nerve and the index finger on the 
left one. The thumb and finger are on each 
side of the trachea, but they do not touch 
the trachea. The thumb and finger, after 
pushing the sternocleido mastoid muscles 
laterally, press the phrenic nerves against 
the anterior side of the transverse processes 
of the vertebrae. A steady pressure on these 
nerves from thirty seconds to two minutes 
should stop any case of hiccoughs, unless it 
is due to continued use of morphine or hic- 
coughs denoting approaching death. Hic- 
coughs due to use of morphine can be stopped, 
though sometimes they are stubborn. 
After the hiccoughs have been stopped in 
this manner, treatment should be given for 
the stomach trouble or other cause, to pre- 
vent their return. 
35 Fig. 12—THE PROPER WAY FOR A PATIENT 
TO GET ASTRIDE THE TABLE 
36 FIG. 12—THE PROPER WAY FOR A 
PATIENT TO GET ASTRIDE THE 
TABLE. 
The patient should sit on the table as shown 
in Figure 12; then, raising the right foot, 
swing it across the table to the position 
shown in Figure 13. Sometimes the adductor 
muscles of the thigh are so contractured that 
it is difficult and uncomfortable for the pa- 
tient to spread the knees as wide as the 
table. In such a case, place a stool under 
one heel to give support and relieve the 
muscles. If that is not sufficient to over- 
come the trouble, let the patient place both 
feet on the table. Sitting astride on the end 
of the treatment table is a comfortable posi- 
tion for most patients. It is also convenient 
for the operator as it allows him to stand 
erect while working on the patient, as shown 
in Figures 14 to 23. 
37 Fig. 13—A CONVENIENT WAY OF THROWING 
THE STRAP ACROSS THE TABLE AND 
BACK UNDER IT TO THE 
OPERATOR’S FEET 
38 FIG. 13—A CONVENIENT WAY OF 
THROWING THE STRAP ACROSS 
THE TABLE AND BACK UNDER 
IT TO THE OPERATOR’S FEET. 
Hold the strap as shown in Figure 13, 
swing the buckle out as far beyond the table 
as is necessary and, as it swings back toward 
the table, lower the hand so that the buckle 
will pass under the table and light near your 
feet. Pick up the strap and buckle it firmly 
across the patient’s thighs, as shown in Fig- 
ure 14. The strap will hold the patient’s 
hips firmly on the table and make the spinal 
movements, as shown in Figures 14 and 15, 
more effective. 
39 Fig. 14—TECHNIC FOR TORTION TREATMENT 
OF THE SPINAL COLUMN 
40 FIG. 14—TECHNIC FOR TORTION 
TREATMENT OF THE SPINAL 
COLUMN. 
The patient’s hands are interlocked over 
the back of her neck. The operator’s right 
arm passes below the patient’s right arm and 
his hand grasps her left arm just below her 
shoulder. With this hold, he turns her 
shoulders toward the right several times to 
produce the desired tortion movements of 
the spinal column. 
After turning the patient’s shoulders a 
few times toward the right, as shown in 
Figure 14, the operator changes hands, and 
turns her shoulders toward the left several 
times. By varying the flexure of the spinal 
column, while giving this treatment, desired 
points may be affected. 
This technic is too well known to require 
detailed explanation, however, it might be in 
order to say that the main object is to relax 
the deep muscles and ligaments along the 
spinal column. This relaxation is very im- 
portant, as it is the soft tissue near the 
lesioned vertebrae that suffers first and most 
from the lesion, and becomes abnormally 
contracted. Chronic inflammatory processes 
at the vertebral lesions are bound to cause 
41 some hyperplasia, which interferes with 
nerve functioning and blood movement. 
In many cases, there are hypertonia of the 
spinal muscles and shortening of spinal liga- 
ments without specific vertebral lesions. 
Such conditions interfere with nerve action 
and blood movements, in and about the spinal 
canal, and are necessarily detrimental to 
health. This spinal treatment is very bene- 
ficial, if properly given. 
When treating large patients the operator 
can do this work very easily by using the 
half-Nelson hold, i. e., by putting one arm 
under the patient’s arm and putting the 
palm of the hand on the back of the patient’s 
neck as shown in Figure 15. With this hold 
it is easy to turn the patient’s shoulders to 
produce spinal tortion for loosening the deep 
spinal muscles and ligaments. 
42 Fig. 15—TECHNIC FOR GIVING TORTION 
TREATMENT OF THE SPINAL COL- 
UMN BY HALF NELSON HOLD 
43 FIG. 15—TECHNIC FOR GIVING TORTION 
TREATMENT OF THE SPINAL COL- 
UMN BY HALF NELSON HOLD. 
In this treatment, the operator’s right arm 
passes under and in front of the patient’s 
right arm, and his hand rests on the back of 
her neck. 
The patient should lean forward and to the 
right, while her head and shoulders are 
turned toward the right several times. This 
movement permits of greater head and shoul- 
der circumduction than the technic under 
Figure 14; therefore, it gets better spinal 
action. It also relaxes some of the ventral 
and lateral muscles of the abdominal and 
chest parites. The quadratus lumborum, 
over the crest of the ilium, where it so often 
pulls the twelfth rib down, can be relaxed 
effectively by this movement. 
Try this movement without the strap; then 
try it with the strap buckled across the pa- 
tient’s thighs and note the difference. You 
will discover that the strap is a great aid and 
that the results obtained, by treatment with 
the strap, are better than those obtained 
without the use of it. 
44 FIGS. 16, 18, 21 AND 22—SHOWING HOW 
THE SHOULDER STRAPS SHOULD 
BE PUT ON THE PATIENT. 
Buckle the ends of the fourteen-foot strap 
together. Hook the snap on this strap into 
the handle at the front of the table; then put 
the strap over the patient’s head and shoul- 
ders to her back and just below the axilia, 
as shown in Figure 16. The forty-inch strap 
attached to this fourteen-foot strap, should 
be at the patient’s right and just in front of 
her axilla, as shown in Figure 18. Put this 
Strap over the patient’s right shoulder and 
downward between the patient’s back and 
the fourteen-foot strap, as shown in Figure 
21; then raise the free end of it and put it 
pver the patient’s left shoulder and buckle 
it to the six-inch strap, fastened on the four- 
teen-foot strap, as shown in Figures 18 and 
22, 
i The object of the strap over the patient’s 
shoulders is to hold the fourteen-foot strap 
at any desired position on the patient’s back. 
45 Fig. 16—TECHNIC FOR TREATING THE 
SHOULDER AND COSTAL REGION 
46 FIG. 16—TECHNIC FOR TREATING THE 
SHOULDER AND COSTAL REGION. 
Beginning with the patient as shown in 
Figure 16, take hold of her elbow with the 
right hand and with the left hand hold her 
hand on top of her shoulder. Raise her el- 
bow as high as possible in a line directly in 
front of her shoulder. (This pulls on the pec- 
toralis major muscle, raises the ribs and re- 
laxes the intercostal muscles.) Raise as high 
as possible and lower the elbow a few times 
in this position. Then lower it and swing it 
a little toward the right. Raise and lower it 
a few times from that position. Next swing 
the elbow out directly lateral to the shoulder 
joint and raise and lower it a few times 
from that position. Repeat this movement 
with the elbow thrown farther backward. 
Draw the arms backward, as shown in Figure 
20. Treat the left shoulder and costal region 
in the same manner. Finally, take both arms 
and treat them as shown in Figure 17. 
These various movements relax every 
muscle and ligament about the shoulders, 
expand the chest and free intercostal circu- 
lation and nerve action. The technic is very 
forceful, yet it is easy on the operator, for 
he stands erect and works with a long lever- 
age. (For other chest technic, see Figures 
28, 29 and 30.) 
47 Fig. 17—SHOULDER TECHNIC 
48 Fig. 18—TECHNIC FOR EXPANDING THE 
CHEST 
49 FIG. 18—TECHNIC FOR EXPANDING 
THE CHEST. 
This treatment is usually given with the 
operator’s knee in the patient’s back, while 
the patient sits on a stool. By this method 
shown in Figure 18, the strap takes the 
place of the knee. 
The patient’s arms should be raised, with 
the elbows close together, and the elbows, 
flexed as the hands are lowered directly to 
the shoulders. 
This treatment is valuable for treating 
patients suffering from lung, broncial or 
heart trouble. It uses the pectoralis muscles 
to raise the ribs and expand the chest. This 
expansion relaxes the intercostal muscles 
and frees the intercostal circulation. It 
gives more freedom of action to the thoracic 
viscera and frees the circulation of its blood 
and lymph. 
50 Fig. 19—TECHNIC FOR CORRECTING A FIRST 
RIB LESION 
51 FIG. 19—TECHNIC FOR CORRECTING A 
FIRST RIB LESION. 
Dr. Ashmore, in her “Osteopathic Mechan- 
ics,” on page 171, says: “Depression lesions 
of the first rib are rare,” and I find this to be 
true. The upward lesion, however, is fre- 
quently found. It may cause pain at the 
head of the rib, and frequently causes pain 
in the arm or hand. 
The strap is placed under the right-hand 
corner of the table and over the lesioned left 
rib, as shown in Figure 19. The strap over 
the patient’s thighs is not necessary for this 
operation. Buckle the strap snugly, but not 
very tightly, over the patient’s shoulder. 
Have the patient lean toward the left to 
tighten the strap, and forward to make the 
strap pull backward and downward. The 
downward and backward pull corrects the 
lesion. 
Be careful to have the strap close enough 
to the patient’s neck to be on the first rib. 
This rib technic is easy on the operator, 
easy on the patient and very effective. I have 
never known it to fail. I usually have the 
patient lean forward against the pull of the 
strap two or three times to make certain 
that the correction is complete. 
Before I learned this strap method for cor- 
52 recting the first rib lesion, I pressed on the 
rib with my thumb, while I flexed the pa- 
tient’s head laterally toward the lesioned side 
to spring the first thoracic vertebra away 
f rom the head of the rib. I learned that the 
thumb pressure often produced soreness. I 
have had no such complaint from the use of 
the strap. 
This treatment can be given while the pa- 
tient is sitting on an ordinary chair, as well 
as on a treatment table. The only difference 
in the technic is that the strap must be plac- 
ed under the corner of the chair bottom in- 
stead of under the corner of the treatment 
table. Frequently it becomes necessary to 
give the treatment at the patient’s home 
where no treatment table is used. The chair 
will do just as well for this first rib technic. 
A lesioned second rib can be treated in the 
same manner as the first one with the ex- 
ception that a small pad like one of those1 
used on my spine and rib fixer, should be, 
placed under the strap and on the second rib 
so that the second rib will get most of the 
pressure of the strap. After the strap and 
pad is properly adjusted, direct the patient 
to lift with his shoulder on the strap and 
lean forward to produce the downward and 
backward pull on the lesioned rib. 
53 Fig. 20—TECHNIC FOR TREATMENT OF THE 
STERNOCLAVICULAR ARTICULATION 
54 FIG. 20—TECHNIC FOR TREATMENT OF 
THE STERNOCLAVICULAR 
ARTICULATION. 
The operator passes his right hand over 
the patient’s right shoulder and puts his 
thumb and fingers at her left sternoclavicu- 
lar articulation to feel the movements of the 
clavicle produced by backward and circum- 
duction movements of the patient’s left arm, 
as shown in Figure 20. 
By raising and lowering the patient’s left 
arm, while it is extended backward, the clav- 
icle can be rotated on its longitudinal axis; 
and by pulling the patient’s arm downward 
and backward, the clavicle can be drawn 
from the sternum, thus stretching the liga- 
ments of this articulation. 
This technic is especially beneficial in the 
treatment of bronchitis, asthma or in affec- 
tion of the throat and vocal cords due to ir- 
ritation of the recurrent laryngeal nerve. 
Obstinate coughs, due to this irritation, may 
be cured by this treatment. 
The technic gives the operator such power- 
ful leverage, that he should work carefully 
until he is quite familiar with it. 
55 Fig. 21—TECHNIC FOR CORRECTING AN 
ACROMIOCLAVICULAR SUBLUXATION 
56 Fig. 22—TECHNIC FOR CORRECTING AN 
ACROMIOCLAVICULAR SUBLUXATION 
57 FIGS. 21 AND 22—TECHNIC FOR COR- 
RECTING AN ACROMIOCLAVIC- 
ULAR SUBLUXATION. 
The usual subluxation of this articulation is 
an upward or upward and forward one of the 
clavicle. 
To test for this subluxation, raise the pa- 
tient’s elbow laterally from the body. If the 
lesion is present, he cannot raise the elbow in 
that direction high enough to put his hand on 
top of his head, neither can the operator do it 
for him. 
This movement may be impossible also, in 
cases of soreness in and about the shoulder 
joint from rheumatism, neuritis, or synovitis, 
or in case of ankylosis; but, these conditions 
can be readily differentiated by any osteo- 
path. 
The ligaments of this articulation, to be 
taken into consideration, are the superior 
acromioclavicular and the inferior acromio- 
clavicular. 
When the acromium is drawn from the end 
of the clavicle, the ligaments, if normal, guide 
the clavicle to its proper place; so, when the 
acromium is allowed to return, the articular 
surfaces naturally meet in proper relation to 
each other. 
The treatment is given as shown in Figure 
21. The palm of the patient’s hand is turned 
outward to stiffen the elbow joint; then the 
patient’s arm is drawn downward and back- 
ward so the humerus pries across the ribs and 
forces the acromium away from the clavicle. 
58 When the patient’s arm is released, the lesion- 
ed articular surfaces should come together in 
proper relation. Test it by raising the arm, 
with the elbow laterally to the shoulder. 
When the articulation is correct, it will go up 
with ease. 
In some cases the operator will find it nec- 
essary to press downward and backward on 
the end of the clavicle, while the articulation 
is being separated by the arm movement as 
above described. 
If hyperplastic tissue has been formed by 
long standing irritation and inflammation at 
this articulation, or exostosis has developed, 
more force is required than above described. 
In that event, use the method shown in Fig- 
ure 22, in which a strap is passed under one 
corner of the table and over the patient’s 
shoulder to hold down the end of the clavicle; 
then raise the patient’s elbow, as shown in 
Figure 22, to raise the acromial process. 
This is a powerful treatment and it should 
be handled carefully, as the end of the clavicle 
might be forced too far downward. 
In some cases the diseased process may 
have made complete correction impossible 
without several treatments. In such cases, 
after giving the treatment, raise the patient’s 
elbow laterally to the body and see if it goes 
higher than it did before treatment. If it 
59 does, some progress has been made. If the 
patient’s hand goes up to the top of his head, 
with the elbow raised laterally from the 
shoulder, the reduction is complete. 
There is no other joint in the body so dif- 
ficult to keep in proper place after it has 
been lesioned. It is well to warn the patient 
that it may be necessary to correct this lesion 
several times before it will stay corrected. 
Sleeping on the affected side often pro- 
duces this subluxation, especially if a small 
pillow is used under the head, as that puts 
more weight on the shoulder. Throwing a ball 
or other object, may produce such a subluxa- 
tion. Gymnasium work is likely to produce 
it. 
Such a subluxation usually causes pain in 
the shoulder and arm, especially at the del- 
toid insertion on the humerus. This pain 
will usually leave at once on reduction of the 
subluxation. 
In many cases the patient can correct his 
acromioclavicular subluxation by turning his 
palm outward and forcibly swinging his arm 
backward to the position shown in Figure 21. 
In this manner the patient accomplishes the 
same results, as the operator does for him, 
as shown in Figure 21. 
60 Fig. 23—TECHNIC FOR TREATING THE UPPER 
DORSAL AND CERVICAL VERTEBRAE 
61 FIG. 23—TECHNIC FOR TREATING THE 
UPPER DORSAL AND CERVI- 
CAL VERTEBRAE. 
• With the patient as shown in Figure 23, 
place one hand on top of her head to move 
her head as desired. The other hand is used 
to make fixation at the proper vertebra. 
This position permits freely of anterior, 
posterior, lateral and circumduction move- 
ments of the head. Any desired movement of 
the vertebrae can be secured and the adjust- 
ment is comparatively easy to make. 
In order to get the most favorable move- 
ments of the upper dorsal vertebrae, turn the 
patient’s face somewhat laterally to stiffen 
the neck, and then make forward and back- 
ward movements as desired. In that manner 
movements of the first, second, or third dor- 
sal vertebra can be produced readily; and, if 
the patient is slim, good movements can be 
obtained on the fourth dorsal vertebra. 
The second cervical vertebra is aften les- 
ioned to the right or left. If it is lesioned to 
the right, tip the patient’s head to the left; 
then the right lateral side of its spinous pro- 
cess can be easily palpated and the patient 
will admit that it is very sensitive at that 
62 point. Then tip the patient’s head to the 
right and palpate the left side of the same 
process. If it is just as prominent and as 
sensitive to palpation as it was on the right 
side, the vertebra is in normal position or 
lesioned posteriorly. If it is not as easily 
palpated on the left side as on the right, it 
is lesioned to the right. This lesion often 
produces pain in the levator anguli scapulae 
muscle. This muscle is innervated by the 
third cervical nerve which is usually irritated 
by this lesion. 
This vertebral lesion can be corrected by 
tipping the patient’s head to the left and 
slightly backward, then giving it a little 
chug to move the lesioned bone. If, when the 
patient turns his face as far as he can to 
the right and to the left, pain is produced in 
the levator anguli scapalae muscle the lesion 
is not fully corrected. Try the correcting 
technic again, if necessary, until no pain is 
produced in said muscle when the patient 
turns his face as far as possible to the right 
or to the left. 
The principles of this method of examinna- 
tion and treatment apply the same to a left 
lesion of the same bone. 
63 Fig. 24—TECHNIC FOR CORRECTING A POS- 
TERIOR OCCIPUT 
64 FIG. 24—TECHNIC FOR CORRECTING A 
POSTERIOR OCCIPUT. 
The patient is pulling backward on the 
strap as shown in this plate. The occiput 
cannot go backward, on account of the strap; 
but the cervical vertebrae will move back- 
ward as the muscles of the neck pull on 
them. 
The patient should raise and lower her 
chin, in various positions, and pull again, to 
permit movement of the occiput on the atlas. 
An osteopath can correct his own posterior 
occiput by this technic. 
The posterior occiput lesion is a very com- 
mon one. It forces the transverse processes 
of the upper cervical vertebrae against the 
superior cervical ganglion and irritates it so 
as to cause trouble in the throat, ear or cer- 
ebral meninges. For more on this subject 
and on this lesson, see Figure 25 and its ex- 
planation. 
This technic is intended for an osteopath 
who has to correct his own posterior occiput. 
The method shown in Figure 25 is the 
treatment that should be used on patients. 
65 Fig. 25—TECHNIC FOR TREATING THE NECK 
WITH CHEST STRAPPED 
66 FIG. 25.—TECHNIC FOR TREATING THE 
NECK WITH CHEST STRAPPED. 
In this Figure, there is but one strap used, 
and that is placed across the patient’s should- 
ers and chest. It should be buckled snugly, 
but not tightly enough to be uncomfortable 
for the patient. 
In order to crack me joints of the neck, 
take hold of the patient as shown in the fig- 
ure, but do not raise her head from the pillow. 
Turn the patient’s head to the right or left, 
as desired, and wait until the neck muscles 
are properly relaxed. Give a quick turn of 
the head and note how easy it is to make the 
joints crack. Usually two or three pounds’ 
force is all that is necessary to make the 
joints pop. 
The strap is especially beneficial in treat- 
ing a posterior occiput. As shown in the 
figure, the head should be raised so that the 
neck is at an angle of about 45 degrees. 
While the head is so raised, give extension 
and slight lateral rotation. This movement 
not only stretches the ligaments of the neck, 
but it moves the head forward on the atlas. 
Special effort should be made to have the 
patient relax the muscles of the back of the 
neck. 
67 My experience has led me to believe that 
the posterior occiput is the most common 
lesion of the neck and it is especially produc- 
tive of trouble in the ear, throat, tonsils and 
cerebral meninges. I have never treated a 
case of otitis media that was not due to a 
posterior occiput. This lesion forces the 
transverse processes of the upper cervical 
vertebrae against the superior cervical gang- 
lion, causing irritation which incapacitates 
these nerves for normal functioning. All 
branches from the superior cervical ganglion 
are affected by irritation of this ganglion. 
I have treated children, partially paralyzed 
in the throat and all the exteremities by a 
posterior occiput evidently produced at birth. 
In case of a posterior occiput, the upper 
end of the ligamentum nuchae is moved 
backwards with the occiput and it will be 
farther away from the spinous process of the 
second cervical vertebra than it would be in 
normal conditions. To test for this condition, 
while the patient lies on her back, raise her 
head to tighten the ligamentum nuchae and 
press on the ligament, near its upper end, to 
see if it springs against the spinous process 
of the vertebra. If it springs, there is a pos- 
terior occiput. In normal conditions, the lig- 
ament is against the spinous process of the 
68 vertebra, and there is no spring to it. Give 
the treatment as above described and test 
again. If the ligament then lies against the 
spinous process, the lesion has been corrected. 
If an operator is not familiar with this test, 
he may lack confidence in it, and he should 
palpate the transverse processes of the atlas 
to satisfy himself of his diagnosis. In many 
cases, I have found it difficult to palpate the 
transverse processes, so I have examined, in 
a few seconds, by the ligamentum nuchae. 
When the strap is not used for this treat- 
ment, the patient usually raises one or both 
shoulders and tightens the cervical muscles. 
Relaxation of the cervical muscles is much 
better when the strap is used; the treatment 
is more effective, especially when an upward 
pull is desired for correcting a posterior occi- 
put or for stretching the posterior ligaments 
and muscles of the neck. 
69 Fig. 26—TECHNIC FOR TREATING THE NECK 
WITH CHEST AND FEET STRAPPED 
70 FIG. 26—TECHNIC FOR TREATING THE 
NECK WITH CHEST AND FEET 
STRAPPED. 
In this treatment, there are two straps 
used, one as shown in Figure 25, over the 
patient’s shoulders and chest, the other 
around the table and around both feet. The 
strap at the patient’s feet prevents the body 
from sliding towards the foot of the table 
when pressure is applied to the top of her 
head. 
In giving this treatment, the operator 
places the pillow between his body and the 
patient’s head to enable him to push easily 
on top of her head. While pressure is applied 
to the top of the head, the operator can give 
any movement he desires to head and neck. 
He can raise and lower the base of the skull 
to get good movements at the atlanto-occip- 
ital articulation. He may give lateral move- 
ments of the neck and, by moving his body 
to the right or left, may swing the patient’s 
head to get any desired lateral movement of 
the neck. 
By the aid of these movements and the use 
of the hands, as shown in Figure 26, cor- 
rective work can be accomplished of lesions 
of the upper cervical vertebrae. 
71 Fig. 27—TECHNIC FOR ROTATING THE LUM- 
BAR AND LOWER DORSAL REGION 
72 FIG. 27—TECHNIC FOR TREATING THE 
LUMBAR AND LOWER DORSAL 
REGION. 
The strap extends around the table and 
over the patient’s hips. It is tightly drawn 
and buckled to prevent her hips from rotat- 
ing. If the upper hip is directly over the 
lower one, the strap will not hold it firmly. 
The patient must lie in such position that 
the upper hip is farther forward than the 
lower, before the strap is tightened. 
The operator holds one hand on the lumbar 
region to note the spinal movements, as he 
pushes the patient’s shoulder backward with 
the other hand. The patient’s shoulder should 
be pushed back and forth several times to 
loosen the lumbar muscles and ligaments. 
To reach the fifth lumbar by this method, 
place the patient’s head and shoulders back 
farther on the table, and rotate the spinal col- 
umn as shown in Figure 27; also, put one el- 
bow and forearm on the patient’s hip and 
force it downward suddenly to rotate the pel- 
vis forward, when the patient’s shoulder is 
rotated backward as far as possible. This act 
usually elicits from one to half a dozen 
“pops” of the joints in the lumbar region. 
When the movement is desired especially 
73 in the upper lumbar and lower dorsal re- 
gions, slide the patient’s head and shoulders 
forward on the table, before rotating the 
spinal column as shown in Figure 27. 
The direction of the force applied by the 
operator on the patient’s shoulder deter- 
mines where the greatest spinal movement 
takes place. If the operator stands near the 
head of the table and pushes on the patient’s 
shoulder, the force will be centered in the 
lower lumbar region. 
After treating one side as above explained, 
the patient should turn over and have the 
other side treated in like manner. 
This treatment is a continuation of the 
spinal rotation treatment begun in Figures 
14 and 15 with the patient sitting on the end 
of the table. 
If the patient is a large person or one who 
does not relax well, have her or him hold the 
upper hand on the back of the head while 
you take hold of the elbow and use the arm 
as a lever to rotate the shoulders backward. 
This is a powerful leverage and should be 
used carefully. See Figure 30. 
74 Fig. 28—TECHNIC FOR RAISING THE RIBS, 
AND RELAXING THE INTERCOSTAL 
MUSCLES 
75 FIG. 28.—TECHNIC FOR RAISING THE 
RIBS AND RELAXING THE INTER- 
COSTAL MUSCLES. 
See Figure 28 and note that the patient is 
in the same position as shown in Figure 27 
for rotation of the spinal column. The strap 
holds the hips firm, while the arm is used 
as a lever to raise the ribs and stretch the 
intercostal muscles. 
As in Figure 16, the arm should be raised 
from different positions to pull on different 
muscles. If the operator wishes, he can as- 
sist in stretching the intercostal muscles by 
pressing downward on the ribs, while the 
patient’s elbow is raised, and pulling upward 
on them. 
This in another powerful treatment, which 
should be handled carefully until the operator 
is familiar with it. 
The value of this treatment can be better 
understood by thinking over the various ail- 
ments that are the result of contractions 
about the chest such as intercostal neuralgia, 
heart trouble, etc., as well as anemic condi- 
tions due to interference with the normal cir- 
culation of blood, into and out of the ribs, 
where millions of blood cells should be man- 
ufactured and put into the general circula- 
tion. 
76 Fig. 29—TECHNIC FOR TREATING THE 
SHOULDER AND PECTORAL 
MUSCLES 
77 FIG. 29.—TECHNIC FOR TREATING THE 
SHOULDER AND PECTORAL 
MUSCLES. 
This treatment is a continuation of the 
work started in Figures 17 and 28. The same 
explanation applies here as was given under 
those figures. 
78 Fig. 30—TECHNIC FOR TREATING THE RIBS 
AND SPINAL COLUMN 
79 FIG. 30.—TECHNIC FOR TREATING RIBS 
AND SPINAL COLUMN. 
As shown in this figure, the patient’s hand 
is on the back of her head, while force is 
applied to her elbow to throw her shoulder 
backward and to rotate the spinal column. 
While the patient’s shoulder is forced back- 
ward, her ribs are drawn forward by the 
operator; or the operator may stand behind 
the patient and push on the ribs, while he 
pulls backward on the elbow. 
This movement can be used for correcting 
lesioned ribs or for expanding the chest and 
relaxing the intercostal muscles. 
80 Fig:. 31—TECHNIC FOR TREATING ELEVENTH 
OR TWELFTH RIB LESIONS 
81 FIG. 31.—'TECHNIC FOR TREATING 
ELEVENTH OR TWELFTH RIB 
LESIONS. 
These cases, which are very common, usu- 
ally reach an osteopath, since the medical 
doctors fail to diagnose or treat them cor- 
rectly. 
I treated one case of over ten years’ stand- 
ing. Several medical doctors had treated the 
case, and when they insisted on operating to 
find the cause of the pain, the patient came 
to me for examination and treatment. That 
was about) three years ago. The patient 
weighed 114 pounds. I corrected the rib les- 
ion and cured the trouble. The patient now 
weighs 150 pounds and is in the best of 
health. 
The usual cause of this lesion is a contrac- 
tion of the quadratus lumborum muscle, 
which draws the anterior end of the twelfth 
rib downward and causes it to irritate the 
soft tissues. Sometimes the transverse ab- 
dominal muscles are also at fault. 
In some cases, the pain remains almost con- 
stant; in others it comes on suddenly and is 
severe; it lasts a few hours or a few days, 
when it gradually disappears. 
The irritation is usually at the end of the 
82 rib; but the pain that the patient complains 
of is usually in the abdomen. The patient 
does not suspect that the trouble is at the 
rib, though, sometimes, the pain is severe 
enough to cause a fever. 
On examination, the patient recognizes the 
hypersensitiveness at the anterior end of the 
rib, as soon as the examiner’s finger presses 
gently at that point. In some cases, the rib 
is drawn down far enough to irritate the soft 
tissue at the crest of the ilium and cause it 
to become hypersensitive. In this class of 
cases, the only pain may be between the end 
of the rib and the crest of the ilium. 
As shown in Figure 31, the patient’s upper 
hip is directly over the lower one and firmly 
held by the strap. The operator puts his 
elbow in front of the patient’s arm and 
shoulder to press them backward, while, with 
both hands, he pulls upward and forward on 
the lower ribs and the quadratus lumborum 
muscle. The strap holds the hip so firmly 
that the operator can exert a very strong pull, 
in this manner, on the quadratus lumborum 
muscle. 
If there is a considerable hypersensitive- 
ness at or near the tip of the rib, or where 
the rib irritates the crest of the ilium, let 
83 the patient lie on her back and buckle the 
strap firmly over the hips, then, while sitting 
on a stool, reach across the patient’s body 
and pull on the quadratus lumborum muscle. 
In this manner, the operator can work 
around the sore spots without producing 
much pain. The pull on these muscles should 
be upward and forward. With the patient 
lying on her back, the muscles may be worked 
with either hand or with both hands, as the 
operator may wish. The operator can do this 
work standing; but he can do it more effec- 
tively sitting. Try it and note the direction 
of the pull. 
In some cases the anterior end of the 
twelfth rib is lesioned upward to such an ex- 
tent that it rests inside, i. e., in front of, the 
eleventh rib. To correct this lesion, while 
the patient lies on the table with the lesioned 
rib uppermost, put a strap across the hips 
as shown in Figure 31. Rotate the upper 
hip backward then buckle the strap tightly to 
prevent the hip from rotating forward. Then 
put another strap around the table and across 
the patient’s shoulder. Rotate the top 
shoulder as far forward as possible; then 
buckle the strap tightly to hold the shoulder 
forward. Now examine the twelfth rib and 
notice that its free end is separated from 
84 the eleventh rib. With the palm of the hand 
press the eleventh and twelfth ribs inward 
several times to relax the muscles about 
them as much as possible. 
85 Fig. 32—TECHNIC FOR RELAXING THE 
QUADRICEPS EXTENSOR MUSCLES 
86 FIG. 32.—TECHNIC FOR RELAXING THE 
QUADRICEPS EXTENSOR MUSCLES. 
The strap is buckled snugly over the pa- 
tient’s hips to keep them down. The opera- 
tor raises the patient’s foot, as shown in this 
figure, and forces it to the hip, or as near it 
as the patient will permit. This produces a 
forceful stretch on the quadriceps extensors. 
The operator then lets that foot down and 
raises the other in like manner. It is well to 
treat both legs alternately three or four 
times. It is advisable, after the heel touches 
the hip readily, to move the foot laterally, 
six or eight inches, on the patient’s hip to 
put special strain on the vastus internus and 
externus muscles. 
This treatment frees the arterial and ven- 
ous circulation of the legs; hence, it is bene- 
ficial in any case of impeded circulation of 
the legs and feet. Such cases are very num- 
erous. 
This treatment also permits the patient to 
raise his knees freely; thus, it aids him in 
walking. When these quadriceps extensors 
are shortened, they shorten and retard each 
step. Patients often remark that, after tak- 
ing this treatment, they find themselves 
87 walking faster than usual without extra ef- 
fort. 
If, by this treatment, the quadriceps ex- 
tensors are found to be abnormally shorten- 
ed, the second, third and fourth lumbar ver- 
tebrae should be treated to remove the irri- 
tation, at that point, from the anterior crural 
nerve, which supplies these muscles. 
Very often these muscles are contracted in 
one thigh, while they are normal in the other. 
The spinal treatment should be given accord- 
ingly. 
If the operator desires to stretch the exten- 
sors of the foot, he can extend the patient’s 
foot, by pulling gently on the toe portion of 
the shoe, while the heel of the shoe is near 
the patient’s hip. 
When the quadriceps extensors are stretch- 
ed in this manner, it may be discovered that 
they are hypersensitive and the operation 
quite painful. The operator should work 
gently, until he learns the condition of these 
muscles. 
88 Fig. 33—TECHNIC FOR TREATING THE SPINAL 
MUSCLES 
89 FIG. 33.—TECHNIC FOR TREATING THE 
SPINAL MUSCLES. 
The strap is buckled snugly over the pa- 
tient’s hips to hold the body firmly and pre- 
vent longitudinal movement. While the body 
is so anchored, deep treatment of the spinal 
muscles can be effectively given. Of course, 
this treatment can be given without anchor- 
ing the body; but, in that event, there is a 
considerable waste energy, as the patient’s 
body moves with each forceable upward or 
upward and outward movement. 
If it is desired to treat these muscles while 
they are in a fully relaxed condition, it 
should be done with the patient lying on her 
side. In that manner of working, the opera- 
tor’s force is usually exerted principally out- 
ward from the spinal column. When the 
muscles are treated as shown in Figure 33, 
the force is exerted principally upward, i. e., 
toward the patient’s head. If a thorough 
loosening of the spinal muscles is desired, 
they should be treated with the patient first 
in one position, then in the other. 
90 Fig. 34—TECHNIC FOR TREATING THE HIP- 
JOINT AND MUSCLES OF THAT REGION 
91 FIG. 34.—TECHNIC FOR TREATING THE 
HIP JOINT AND MUSCLES OF 
THAT REGION. 
In this treatment there is but one strap 
used. It is placed around the table and over 
the patient’s thigh just above the knee. The 
strap holds the right pelvis firmly on the 
table and permits of but little movement of 
the left pelvis. 
This treatment is especially beneficial in 
the treatment of fibrous ankylosis of the 
hip-joint. It is a forceful treatment for such 
cases. The foot may be raised or swung lat- 
erally as desired and a powerful strain can be 
put on the ankylosing fibers. 
Treatment of this kind can be given to re- 
lax the pectineus muscles and the various 
groups of muscles passing from the sacrum 
and innominate bone to the femur. The lev- 
erage is great and the operator should work 
carefully until he learns how much force the 
patient is willing to tolerate. 
92 Pig. 35—TECHNIC FOR TREATING A KNEE 
OR A DISLOCATED ANKLE 
93 FIG. 35.—TECHNIC FOR TREATING A 
KNEE. 
In this treatment, a short strap is put 
around the patient’s thigh just above her 
knee, and a strap is attached to this strap 
and to the handle at the head of the table. 
The operator grasps the patient’s knee with 
one hand and her foot with the other hand, 
as shown in this figure. In this manner, any 
desired movement can be produced at the 
knee. By the foot hold, the leg can be ro- 
tated on its longitudinal axis and can be 
raised, lowered or given lateral motion to 
suit the operator. 
This treatment is good for correcting a 
slipped semilunar cartilage, or for treating a 
fibrous ankylosis. It is not advisable to use 
this method for treating synovitis of the 
knee-joint, as such cases get along better if 
the knee is left alone. They are sometims 
due to traumatism, but more often due to an 
innominate lesion or a lesion in the lumbar 
region affecting the anterior crural nerve. 
For best results, treat the lesions and leave 
the knee alone. 
94 Yia. 36—TECHNIC FOR TREATING A LATERAL 
SPINAL CURVATURE 
95 FIG. 36.—TECHNIC FOR TREATING A 
LATERAL SPINAL CURVATURE. 
A strap is laid across the table with the 
buckle near the operator, while the tip-end 
of it is put through the handle on the side of 
the table as shown in this cut. A pillow is 
laid on top of the strap. The patient lies face 
down across the pillow. The strap, buckled 
across her back, does not extend around the 
table, but goes down through the handle at 
the side of the table, and up over the patient,. 
The pillow should be adjusted to protect thtj- 
patient’s right side from the strap. 
i 
The strap, over the patient’s shoulders, if 
through the handle at the right-hand side of 
the table. The operator draws the patient’s 
legs towards him and so straightens the paj- 
tient’s spine. This treatment thoroughly 
stretches the tissue on the concave side of 
the curve. The patient’s legs should b4 
moved from time to time during this treat- 
ment; but a steady strain can be put on the 
tissues of the concave side of the curve and 
allowed to remain until they relax. 
Pressure with the palm of the hands over 
the ribs and spine, while the stretch is on, will 
aid materially, if intelligently applied. 
96 Fig. 37—RESISTANCE TECHNIC FOR TREAT- 
ING A NECK 
97 FIG. 37.—RESISTANCE TECHNIC FOR 
TREATING A NECK. 
When one or mere vertebrae are lesioned 
laterally, they can usually be replaced by this 
resistance technic. The operator pulls on the 
patient’s head. The patient resists with all 
her might; her muscles, pulling on the lesion- 
ed vertebrae, draw them into normal position. 
This method works well for correcting the 
second or third cervical vertebra, which often 
is lesioned laterally and irritates the third 
cervical nerve. This irritation produces, in 
the levator anguli scapulae muscle, the pain 
of which the patient complains in the side 
of his neck. Every time he attempts to turn 
his face to the right or left, the pain is in- 
creased. 
In some cases, on account of so much 
hypesensitiveness over the lesioned verte- 
brae, the patient cannot permit pressure on 
the vertebrae to correct the lesion. For such 
cases, this resistance technic is very conven- 
ient. 
98 Fig. 38—TECHNIC FOR TREATING CHRONIC 
STIFF NECKS 
99 FIG. 38.—TECHNIC FOR TREATING 
CHRONIC STIFF NECKS. 
The strap is put around the patient’s neck. 
The other end of the strap is fastened to the 
handle at the end of the table. The patient’s 
foot is against one leg of the table to prevent 
the table from moving. The head can be 
given any movement desired while the strap 
is holding the cervical vertebrae. 
If a stiff neck cannot be worked out by 
this method, there is not much to be done 
for it. 
The treatment is not dangerous, and no 
harm should come from its use, if ordinary 
judgment is exercised by the operator. 
100 GENERAL OSTEOPATHIC TREATMENT. 
Who needs a general osteopathic treat- 
ment? If one hundred osteopaths answered 
this question, they would express a great 
variety of opinions. Some osteopaths believe 
in specific treatments exclusively. Others 
believe that the bony lesion should be cor- 
rected and the soft tissue, adjacent to and 
directly affected by the lesion, should be 
treated. 
Other osteopaths believe in giving general 
treatments because they know that the whole 
system is affected by local troubles. They 
know that a chill, a fever and other constitu- 
tional symptoms, arise from acute nephritis; 
that chronic interstitial nephritis produces 
high blood pressure, throwing an extra bur- 
den on every organ of the body; that, as the 
kidneys are eliminating organs, if they fail 
to perform their work, the liver will be over- 
worked in its efforts to eliminate the waste 
products of the body; that, if the waste pro- 
ducts are not eliminated by the kidneys and 
the liver, the sweat glands will be overwork- 
ed, and will become laden with waste pro- 
ducts endeavoring to escape; that, if the 
waste products are not eliminated, the blood 
becomes laden with them and the tissues of 
101 the body become saturated with them; and 
that there is no end to this chain of troubles 
until the grave is reached, unless general 
treatments are given to aid in the elimina- 
tion of the waste products from all parts of 
the body and to restore normal organic func- 
tioning. 
Another osteopath says that general treat- 
ments are advisable, for even the intellect and 
disposition of a patient are governed largely 
by the condition of the body. He says the 
reason so many children possess disagreeable 
dispositions and fail to make their grades in 
school, is defective nutrition of the brain 
substance. Howell says, “Vasomotor nerves 
to regulate the blood supply to the brain 
have not been demonstrated.” Therefore, 
general treatments with special attention to 
the cervical and upper dorsal regions are nec- 
essary to purify the blood and supply the 
brain tissue with good nutrition. Children, 
so treated, grow alert, make their grades at 
school, and become happy and agreeable. 
Another osteopath believes that any man 
who works hard and constantly puts a strain 
on his nervous system, which, if continued, 
will result in neurasthenia, with its accom- 
panying symptoms of headache, backache, 
gastro-intestinal disturbances and a fatigued 
102 feeling on slight exertion, and that such a 
condition, not marked by a specific lesion, 
must be reached by a general treatment to 
free the circulation and provide good nutri- 
tion to the weakened nerve cells. 
Another osteopath believes that if his pa- 
tient’s heart musculature is weakened, he 
must give not only specific treatment to in- 
sure good blood supply through the coronary 
arteries, and thus furnish the heart muscles 
with good nutrition and plenty of it, but also 
a general treatment to free the circulation of 
blood throughout the entire body, for, by do- 
ing so, he lessens the demand on the heart’s 
strength. Thus, he would give a general 
treatment in all cases of heart weakness, even 
though dropsy of the limbs or ascites has not 
set in. 
Is a general treatment detrimental to any 
one? No, it can harm no one, unless he is 
very feeble or has great soreness or extreme 
pain. As a rule, ninety per cent of the office 
patients can be benefitted materially by gen- 
eral treatments. 
There is no tonic that can purify the blood 
as general treatments can do it. How are 
beef, iron and wine going to purify the blood ? 
I don’t know. Who does ? Chemists say that 
all the iron so taken, passes through the body. 
103 None of it is assimilated. Wine stimulates 
the heart’s action if enough is taken. If too 
much is taken, it stimulates the tongue. As 
for beef, why not buy it from the butcher, 
rather than from the druggist? 
On the other hand, any one can understand 
how general treatments purify the blood. 
They stimulate the eliminating organs to 
such activity, that, as the blood is brought to 
the kidneys, liver or sweat glands, the impuri- 
ties are taken out of it. General treatments 
stimulate cell activities, increase metabolism 
and throw out waste products, like overhaul- 
ing an old house, tearing out the defective 
parts and rebuilding with new material. Aft- 
er completing such a job, there is a great 
heap of trash to be hauled away or burned. 
The general treatment stimulates the circu- 
lation of blood and thus hauls the trash to 
the eliminating organs to be disposed of. By 
the general treatment, the various glands of 
the body are stimulated to better work, ac- 
cordingly, the whole process of digestion is 
improved ,and the waste products of the ali- 
mentary tract are eliminated, preventing ab- 
sorption of their toxins. 
A general treatment should prevent the ab- 
sorption of toxic products. It should increase 
cell metabolism, making every cell as nearly 
104 perfect as possible. It should normalize all 
glandular activity in the body, thus improv- 
ing, not only the action of the digestive 
glands, but the functioning of the ductless 
glands as well. It should free the circulation 
of blood, so as to lessen the work of the heart 
and to carry all waste products to the elimin- 
ating organs where they are disposed of. 
Thus, the blood and all tissues of the body 
become purified, normalized and made 
healthy. 
If a man is perfectly healthy, a general 
treatment would do him no good; but who 
ever saw a perfectly healthy man? Perfect 
health is dependent on a perfect diet, perfect 
exercise of every part of the body, perfect 
ventilation, regular rest and sleep, freedom 
from worry, fear, jealousy or anxiety, etc., 
etc. 
There has been so much said in our maga- 
zines about specific treatments, I fear that 
many osteopaths are failing to give their 
patients the benefit of general treatments as 
they should. It is all right to conserve en- 
ergy when it can be done without detriment 
or loss to the patient; otherwise the work 
should be done. 
For a good general treatment, I would 
recommend the manipulations described un- 
105 der the following Figures, to be given in the 
order indicated, Figures 14, 15, 16, 17, 18, 23, 
25, 26, 27, 28, 29, 30, 32 and 33, and followed 
by massage of the abdomen. This full treat- 
ment can be given in twenty minutes. It is 
well for any osteopath who is not familiar 
with strap technic to let someone give him 
this general treatment before he gives it to 
his patients. By doing so, he will know bet- 
ter how to give the treatment himself. 
While giving a general treatment, add any 
specific treatment that may be indicated, for 
that, too, is essential. On the other hand, 
don’t neglect the general treatment, when it 
is indicated, just because some specific treat- 
ment has been given. Do all for your pa- 
tient that can be done. Then and not until 
then have you done your duty to your patient 
and to the profession you represent. 
106 Fig. 39—SHOULDER BRACE' AND SPINAL 
SUPPORT 
SHOULDER BRACE AND SPINAL 
SUPPORT. 
For several years past I have been using 
on patients a shoulder brace and spinal sup- 
port like the one shown in Figure 39. It 
is light, cool and comfortable. After wear- 
ing it a few days, the patient feels more 
comfortable with it on than with it off. 
It holds the shoulders in proper position 
and supports the spinal column. It is easily 
taken off at night and put on next morn- 
ing. It corrects anterior-posterior spinal 
defects, also lateral curvatures in the early 
stages. 
107 It is made of heavy wire connected, where 
the two ends meet, by a piece of brass tub- 
ing1. It is shaped in proper form to fit the 
patient’s spinal column. The upright pieces 
are covered with adhesive tape, then the 
front side of the tape is covered with a 
cotton padding which is held in position 
by a covering of cotton bandage. A belt 
is made and attached as shown in Figure 
39. Two soft cotton strips are made to 
pass through the top of the upright part 
and over each shoulder to support the top 
of the brace. 
Any person who has the time and the 
desire can make up this brace. I have made 
many of them for my patients during the 
past few years. I will make them up for 
any osteopath, who will send me the pa- 
tient’s belt measure and height from the 
belt line to the fifth thoracic spinous process. 
I usually treat the patients who are wear- 
ing the braces, once or twice a week; how- 
ever, many of them can get splendid im- 
provements by wearing the brace even 
though no treatments are given. 
108 Pig. 40—SPINE AND RIB FIXER ADJUSTED 
FOR USE 
THE SPINE AND RIB FIXER. 
The spine and rib fixer is very conve- 
nient for rib lesions anywhere below the fifth 
rib. It will not work well on ribs between 
the scapulae. It is also valuable for treat- 
ing a rigid or posterior lumbar or lower 
thoracic spine. A patient with average 
strength can push from two to four hun- 
dred pounds on the strap over his feet. 
While this pressure is maintained on the 
vertebra with the spine fixer, the patient 
can produce movements of the spine by 
moving his shoulders forward and back- 
ward. 
109 In case of lumbago due to a posterior 
lumbar, the spine fixer is especially useful. 
In such cases the patient is usually unable 
to sit on the table and put his feet upon it 
also; so it is best to allow him to sit on 
the middle of the table and put his feet on 
a stool. Then adjust the spine fixer as 
shown in Figure 40. While the patient is 
using the spine fixer with his feet lower 
than his hips, the pull on the bar of the 
spine fixer will be too much downward. 
This trouble is readily overcome by the 
patient putting one arm on either side un- 
der the strap and allowing his hands to rest 
on his thighs. This will hold the strap up 
high enough to make the pull on the bar 
just what it should be to make the pads 
press squarely on the transverse processes 
of the vertebra. 
An osteopath can treat his own spine with 
the spine and rib fixer. He can easily move 
the bar up or down as he desires by putting 
one hand on either end of it. While press- 
ing hard with his feet on the strap to pro- 
duce the desired pressure on the vertebra, 
he can move his shoulders forward and 
backward to produce the desired move- 
ments of the vertebra. In this manner he 
110 can give his own spinal column a good treat- 
ment. 
If a vertebra is lesioned to the right or 
left, it can be corrected by setting one pad 
on the more posterior transverse process 
and adjusting the end of the bar nearest 
this pad a little farther forward than the 
other end of the bar. This will put most 
of the pressure on this pad. While the 
pressure is so maintained, the patient by 
moving his shoulders forward and back- 
ward, produces movement in the vertebral 
articulations so that the vertebra can move 
into its normal position. 
Fig. 41—ILLUSTRATION OF THE ACTION OF 
THE STRAP 
The above drawing represents the prin- 
ciple on which the strap operates in giving 
111 foot, treatments. Two arcs are shown pass- 
ing through Pf the point of contact between 
the pad and the foot. Arc cc has for its 
center the knee joint and represents ap- 
proximately the line of motion of the point 
Pf when the knee is extended by a pull on 
the foot. Arc c’c’ has the strap for its radius 
and the point of contact between the strap 
and thigh for the centre. It will be noticed 
that when the knee is extended the arc cc 
falls outside the arc c’c’. The distance be- 
tween these two arcs indicates the amount 
of pressure upon the point of contact be- 
tween pad and foot as the position of the 
foot is changed by forcible extension of the 
knee. 
The little pad used on the plantar surface 
of the foot is for the purpose of centralizing 
the force of pressure on the desired point. 
The strap produces a very forcible press- 
ure on the pad when the knee is extended; 
and that pressure can be easily maintained 
by holding the foot at the desired position. 
While the pressure is maintained on the 
pad, motion in the articulations about the 
lesioned bone can be produced by proper 
movements of the metatarsal and phalangeal 
bones. For instance, when correcting le- 
sions of the cuneiform bones or the anterior 
112 articulation of the cuboid bone, the move- 
ments of the metatarsal bones should be 
flexion, extension and inversion. When 
treating the reciprocal reception articula- 
tion the movements should be abduction 
or adduction principally, with more or less 
extension and flexion. For instance, if the 
scaphoid is lesioned downward on the as- 
tragalus, the pad should be placed on the 
plantar surface of the scaphoid bone and 
while pressure is maintained on it by means 
of the strap, the foot should be abducted, 
flexed and extended to open up the lesioned 
articulation, so the pressure of the pad can 
force the scaphoid into its normal position. 
If the cuboid is lesioned downward on the 
os calcis, the pad should be placed on the 
plantar surface of the cuboid and pressure 
should be produced on the pad by means of 
the strap, as above described. While said 
pressure is so maintained, the foot should 
be adducted, flexed and extended to open 
up the lesioned articulation while the pad 
presses the bone into its normal position. 
Further explanations will be given under 
the descriptions of specific treatments. 
In some cases the patient’s muscles and 
other soft tissues are hypersensitive. Some 
such patients may complain that the strap 
113 hurts their thigh. To avoid this trouble 
fold a towel to several thicknesses and put 
it between the thigh and strap. Some pa- 
tients may complain of the pressure of the 
strap on the sides of the foot. To avoid 
this trouble use a thicker pad on the sole 
of the foot, as it will reduce the pressure 
on the sides of the foot. Some patients 
will complain that the short strap which 
passes around the front of the instep pro- 
duces some discomfort. To avoid this trou- 
ble fold a small cloth and put it between 
the strap and the ankle. 
The short strap which passes in front of 
the ankle is for the purpose of preventing 
the other strap from slipping off the pa- 
tient’s heel when his foot is extended. This 
strap has a loop at one end of it to allow for 
adjustments for feet of different sizes. 
Perhaps the most convenient way to ad- 
just the strap and the pad is as follows: 
Put the strap on as shown in Figure 42; 
then press down on the distal end of the 
metatarsal bones and push the foot back so 
as to flex the knee a little more to lessen 
the pressure of the strap on the sole of the 
foot; then slip the little pad under the 
strap on the sole of the foot and place it 
where the pressure is desired. 
114 THE RECIPROCAL RECEPTION ARTIC- 
ULATION OF THE FOOT. 
(Chopart’s Joint) 
It should be borne in mind that the later- 
al movements of the foot are produced prin- 
cipally in the astragalo-scaphoid articulation 
and in the calcaneo-cuboid articulation. These 
two articulations taken together form a 
reciprocal reception articulation. They per- 
mit of extension, flexion, inversion, ever- 
sion, adduction and abduction of the foot. 
When the os calcis and astragalus are firm- 
ly held and the balance of the foot is ad- 
ducted or turned towards the median line, 
the calcaneo-cuboid articulation is separated 
while the astragalo-scaphoid articulation is 
held tightly together. Bear this point in 
mind for it will be necessary to open the 
calcaneo-cuboid articulation when adjusting 
the cuboid bone. When the os calcis and 
the astragalus bones are firmly held and 
the balance of the foot is abducted, or 
turned from the median line, the bones of 
the astragalo-scaphoid articulation are sep- 
arated and the calcaneo-cuboid articulation 
is tightly pressed together. This is impor- 
tant because when the scaphoid bone is to 
be adjusted it should be separated from 
the astragalus. 
115 The astragalo-scaphoid articulation can be 
examined best for sensitiveness at the dor- 
sum on the inner edge of the foot. The 
calcaneo-cuboid articulation can be examined 
best for sensitiveness at the dorsum on the 
outer edge of the foot. 
Inasmuch as these two articulations op- 
erate together as a reciprocal reception 
joint, I prefer to consider them as such. The 
two articulations form a compound curve 
like the articulation at the base of the meta- 
carpal bone of the thumb which is known 
as the only reciprocal reception articulation 
of the whole human skeleton. In a foot mis- 
shapen by wearing high heeled shoes this 
articulation is always lesioned downward 
on the astragalus and on the os calcis. 
For treatment, see chapter on correction 
of lesions due to high heeled shoes. 
116 Fig. 42—FOOT WITH STRAP PROPERLY 
ADJUSTED 
TREATMENT FOR A LESIONED SCAPH- 
OID BONE. 
The scaphoid bone is a very important 
one. It is the keystone of the longitudinal 
arch and it bears much of the burden of 
the weight bearing section of the foot. It 
is the highest point of the longitudinal arch 
and its position is maintained by the liga- 
ments and the longitudinal muscles below it. 
Its articulation with the astragalus is of 
the condyloid type which permits motion in 
many directions. Practically all of the 
movements produced by adduction and ab- 
duction of the foot take place in this artic- 
ulation. Flexion, extension and rotation may 
also be produced in it. Articulations pos- 
sessing the greatest variety of movements 
117 are the ones most often lesioned, such as 
the condyloid articulation formed by the 
occiput and atlas. This astragalo-scaphoid 
articulation is frequently lesioned. The le- 
sions are of a great variety, as upward, 
downward, lateral, torsional, etc. As we 
study the anatomy of this articulation and 
its diversified movements we can readily 
understand why it should be subject to 
frequent lesions due to trauma and strains 
or to a weakened condition of the muscles 
of the foot. 
The anterior portion of this bone artic- 
ulates with the three cuneiform bones. The 
articular surfaces of these bones are nearly 
flat. However, there is some concavity of 
this bone where it articulates with the in- 
ternal cuneiform bone. It might be expected 
that such an articulation would be readily 
subject to lesions and experience in treat- 
ing feet has shown that these joints are 
frequently lesioned. Their lesions are like 
the lesions of any other condyloid joint, in 
that they may be lesioned in any one of 
many directions. The most common lesion 
of the scaphoid bone is downward with ro- 
tation on the astragalar articulation. There 
may be the same kind of a lesion in relation 
to the cuneiform bones. Sometimes the cune- 
118 iform bones are lesioned downward on the 
scaphoid. In case of flat foot the scaph- 
oid lesion is usually one of tortion down- 
ward and inward toward the median line 
of the body. This gives a fullness or bulged 
appearance of the inside of the foot. The 
bulge is also produced, to some extent, 
by the internal cuneiform bone when it is 
pushed out by a lesion of the other two 
cuneiform bones. In case the patient has 
worn high heeled shoes for a long period 
of time, the scaphoid bone will be badly 
lesioned downward in relation to the as- 
tragalus. Fortunately this bone can be 
easily palpated to detect its exact position. 
It should be palpated on top of the foot and 
on the inner side of the foot, as well as on 
the plantar surface. Not only the bony 
prominences should be palpated, but the hy- 
persensitive points should be noted. Le- 
sioned bones produce more or less hyper- 
sensitiveness by pressure and irritation on 
the adjacent soft tissues. This point should 
not be forgotten when palpating a foot for 
bony lesions. 
Treat a downward or a downward rotation 
lesion of the scaphoid bone, at its articula- 
tion with the astragalus, as follows: 
While the patient lies face downward on 
119 the treatment table, adjust the strap on 
the .foot and thigh as shown in Figure 42. 
Then slip the pad beneath the strap and 
adjust it on the scaphoid bone. Standing 
at the foot of the treatment table and fac- 
ing the head grasp the heel of the foot with 
the fingers in such a manner that the heel 
of the hand presses against the lateral side 
of the cuboid bone and produces there a 
fixed point. Now with the hand in this 
position, pull the foot to extend the knee 
thereby producing pressure on the pad over 
the scaphoid bone. While maintaining this 
pressure, grasp the foot with the other 
hand about the metatarsal bones and hold- 
ing the cuboid as a fixed point, by abduc- 
tion, flexion jtnd extension, loosen the artic- 
ulations of the scaphoid bone, thus allowing 
the pad to force the scaphoid bone into its 
normal position. After this lesion is cor- 
rected, the other bones, especially the 
cuneiform bones, should be carefully exam- 
ined and treated according to the indica- 
tions. 
The scaphoid bone may be lesioned by a 
sprain. Correction of the lesion and rest 
of the foot is usually all the treatment that 
is necessary. If the lesion is a part of a 
flat foot condition, the innominates and the 
120 lumbar area should be carefully examined 
and treated according to the conditions 
found. The patient should be instructed to 
take some foot and leg exercises to develop 
the muscles. 
It should not be expected that this ar- 
ticulation will invariably remain normal 
after the first correction. It should be un- 
der observation from time to time for sev- 
eral weeks, during which time the longitud- 
inal muscles of the foot are being developed 
by special exercises. If it does not maintain 
its proper position it should be reset. The 
exercises to develop the muscles of the foot 
should be continued for a period of at least 
one month, as no muscle can be well devel- 
oped by exercise in a shorter time. 
121 TREATMENT FOR A LESIONED CUBOID 
BONE. 
The cuboid bone belongs to the outer 
longitudinal set of bones. To some extent 
they support the weight of the body, but 
their principal function is that of maintain- 
ing the equilibrium of the body. The cu- 
boid bone contains three articular surfaces, 
all of which are very smooth and easily dis- 
located. Its dislocation is usually down- 
ward or downward with rotation. It is well 
supported by ligaments, and by the tendon 
of the peroneus longus muscle when in ac- 
tion. 
To correct this lesion, operate as follows: 
While the patient lies face downward on 
the treatment table, adjust the strap on the 
foot and thigh as shown in Figure 42. Then 
slip the pad beneath the strap and adjust 
it on the cuboid bone. Standing at the 
foot of the treatment table and facing the 
head, grasp the heel of the foot with the 
fingers in such a manner that the heel of 
the hand presses against the inside of the 
scaphoid bone and produces there, a fixed 
point. Now with the hand in this position, 
pull the foot to extend the knee thereby 
producing pressure on the pad over the 
122 cuboid bone. While maintaining this pres- 
sure, grasp the foot with the other hand 
about the metatarsal bones and holding the 
scaphoid bone as a fixed point, by adduc- 
tion, flexion and extension, loosen the ar- 
ticulations of the cuboid bone, thus allow- 
ing the pad to force the cuboid bone into 
its normal position. 
123 TREATMENT FOR A LESIONED 
INTERNAL CUNEIFORM BONE. 
This bone is probably lesioned more often 
than any other bone of the foot. It forms 
an important part in the weight supporting 
portion of the longitudinal arch of the foot. 
It must be remembered that the bones of 
the foot are arranged in an inner longitud- 
inal set and an outer longitudinal set of 
bones. The outer set is composed of the os 
calcis, cuboid, fourth and fifth metatarsal 
bones and the fourth and fifth toes. The 
function of this set is principally that of 
maintaining the body equilibrium. The 
weight of the body is principally supported 
by the astragalus, scaphoid, three cuneiform 
bones and the first three toes. The articu- 
lation of the tibia with the astragalus is 
broad and powerful to support the weight 
of the body on the astragalus. While stand- 
ing or walking the main portion of the body 
weight is thrown on the muscles and liga- 
ments supporting the articulations between 
the astragalus, scaphoid, cuneiform bones 
and the first three metatarsal bones. When 
this arch breaks down, the scaphoid and 
cuneiform bones are the ones displaced; 
or at least one or more of said bones will 
124 be lesioned. The internal cuneiform bone is 
usually lesioned before the scaphoid, and 
that is usually followed by lesion of the 
middle and external cuneiform bones. 
The great toe has but two phalanges, both 
of which are very heavy and strong. They 
are so constructed to meet the strenuous 
requirements of that part of the foot. The 
first metatarsal bone is more than twice 
as strong as any other metatarsal bone. 
Because of the anatomical relation of these 
bones with the internal cuneiform bone, it 
must support them in all of their function- 
ing. It can be plainly seen that great re- 
sponsibilities are placed on this bone and 
on the muscles and ligaments that support 
It. 
The peculiar concavity of the anterior 
and posterior articular surfaces of the in- 
ternal cuneiform bone makes it susceptible 
to lesioning when the longitudinal arch is 
settled or sprung down. When we take all 
of these facts into consideration it is not 
difficult to understand why this bone is so 
often lesioned. The lesion is usually down- 
ward, i. e., toward the plantar surface, or 
downward and inward, i. e., toward the 
median line of the body. If the middle and 
external cuneiform bones are lesioned down- 
125 ward the internal cuneiform bone is neces- 
sarily forced inward by the separating ef- 
fect of the wedge shaped middle and exter- 
nal cuneiform bones. When making the 
correction of these lesions, the above de- 
scribed conditions must be taken into con- 
sideration. The middle and external cunei- 
form bones must be adjusted first to allow 
the internal cuneiform bone to return to its 
proper longitudinal line; then the internal 
cuneiform bone should be raised to its 
proper height in the longitudinal arch. This 
can be done by using the little pad over 
this bone while the patient lies face down- 
ward and flexes his knee at about a right 
angle so the strap can be placed in position 
as shown in Figure 42. The desired amount 
of pressure on the pad can be produced, 
after the strap is properly adjusted, by pull- 
ing with one hand on the foot to extend the 
knee as far as necessary. While the pres- 
sure is maintained, movements should be 
produced in the articulations of the internal 
cuneiform bone so as to open the joints and 
coupled with the pressure of the pad, cor- 
rect the lesion. The necessary movements 
to open the joints can be readily made by 
flexion, extension and lateral movements 
cf the first and second metatarsal bones. 
126 It must be remembered that this internal 
cuneiform bone is held in proper position 
by the ligaments and longitudinal muscles 
beneath the longitudinal arch of the foot. 
In order that these muscles and ligaments 
may have normal nutrition they must have 
proper blood and nerve supply. The drain- 
age of blood and lymph from the foot, leg 
and thigh should be normal. The sciatic, 
anterior crural and obturator nerves, all of 
which supply muscles of the thigh, leg or 
foot should be in condition to function nor- 
mally. Of these three nerves, the func- 
tioning of the sciatic is the most important, 
for the nutrition of the muscles at the bot- 
tom of the foot is directly dependent on this 
nerve. In order that these nerves may be 
in good working condition the innominates 
should be normal, the pelvic girdle should 
have its normal tilt and the lumbar area 
should be as near normal as possible. 
If the sciatic nerve is in an inflamed con- 
dition, as shown by more or less pain and 
suffering, special foot exercises for devel- 
oping the longitudinal muscles of the feet 
would not be advisable. But if the sciatic 
nerve is not in an inflammatory stage 
exercises should be taken daily, or, better, 
twice daily, to develop said muscles as they 
127 are the main support for the longitudinal 
arch of the foot. A man who walks all day, 
like a mail carrier, will exercise the muscles 
beneath the longitudinal arch of his foot; 
but the retail clerk, who stands on his feet 
most of the time during the day, will fa- 
tigue these muscles by continued strain, but 
will not develop them. He needs exercises 
to dvelop these muscles. See “Physical Ex- 
ercises.” 
128 Fig. 43—STRAP ADJUSTED FOR TREATING 
THE ASTRAGALO-CALCANEAN LESION; 
ALSO, BANDAGE FOR TRANSVERSE 
ARCH 
TREATMENT FOR A LESIONED ASTRAG- 
ALO-CALCANEAN ARTICULATION 
These bones are very materially depend- 
ent on ligaments and muscles for support. 
They are bound together by four ligaments, 
the external, internal and posterior calcaneo- 
astragaloid ligaments and the interosseous 
ligament. The interosseous ligament forms 
the chief bond of union between these bones. 
It is a very thick and strong ligament, be- 
ing at least an inch in breadth from side 
to side, and serves to unite the astragalus 
and os calcis solidly together. 
These bones are also supported by the 
ligaments supporting the arch of the foot. 
129 The three principal ones are the calcaneo- 
scaphoid ligament, the long and short plan- 
tar ligaments, and the plantar fascia. The 
inferior calcaneo-scaphoid ligament is an 
extremely strong fibrocartilaginous band. 
Together with the posterior surface of the 
scaphoid it forms a socket for the head of 
the astragalus. This is one of the most 
important ligaments for supporting the lon- 
gitudinal arch of the foot. The long plantar 
ligament extending from the under surface 
of the os calcis to the base of the metatarsal 
bones assists in supporting the arch like 
the string of a bow. The plantar fascia is 
a thick strong band extending from the 
tuberosity of the os calcis to the metatarso- 
phalangeal articulations. This materially 
aids in maintaining the longitudinal bony 
arch of the foot. The importance of these 
longitudinal ligaments for maintaining the 
normal longitudinal arch must be admitted. 
However, these ligaments support the arch 
principally while the person is standing still. 
During locomotion the longitudinal muscles 
of the foot and some of the muscles of the 
leg support the arch before any material 
strain is brought to bear on the ligaments. 
Considering these facts, we can readily un- 
derstand the importance of keeping these 
130 muscles well developed. These longitudinal 
muscles not only support the arch by reason 
of the tension; but the belly of the mus- 
cles thickens by contraction and forms a 
padding that helps support the longitudinal 
arch of the foot. 
There are seven muscles of the leg that 
extend their tendons beneath one or more 
of the tarsal bones and materially assist in 
supporting the longitudinal arch of the foot 
during walking, running and jumping. Vari- 
ous foot and leg exercises should be used 
to develop these muscles and to develop the 
muscles at the bottom of the foot. 
Even though we are endowed with a won- 
derfully constructed foot and its bony frame- 
work is well supported by ligaments, mus- 
cles and tendons, a large multitude of peo- 
ple are afflicted with broken down arches. 
In case of broken down arches the astrag- 
alus is usually lesioned forward and in- 
ward towards the median body line. This 
throws extra weight on the sustentaculum 
tali and rotates the os calcis somewhat in- 
ward. To correct this lesion place the pad 
over the anterior end of the os calcis, while 
the patient is lying face downward with his 
knee flexed at about a right angle; adjust 
the strap over the pad as shown in Figure 
131 43; then, while the strap and pad are prop- 
erly adjusted as described, pull on the foot 
with one hand to extend the knee and to 
make sufficient pressure on the pad. While 
said pressure is so maintained grasp the 
patient’s heel and move it from side to side 
a few times to work the articular surfaces 
of the os calcis down in proper position with 
the articular surfaces of the astragalus. 
Also produce a make and break pressure on 
the pad by moving the foot repeatedly for- 
ward and backward. After this lesion and 
all the other bony lesions of the foot have 
been corrected, attention must be given to 
the proper development of the muscles of 
the leg and foot referred to above. We 
must not forget that these soft tissues 
should be developed. To accomplish this 
the pelvic and lumbar areas must be made 
as nearly normal as we can make them. As 
broken down arches are due to weakened 
muscles and ligaments of the foot and leg, 
we should not expect a cure without improv- 
ing the nutrition of these tissues. 
Physical exercise should also be taken to 
develop the muscles of the foot and leg. See 
“Physical Exercises.” 
132 TREATMENT FOR A FALLEN ANTER- 
IOR TRANSVERSE ARCH OF 
THE FOOT. 
In this case the transverse arch at the 
distal end of the metatarsal bones has flat- 
tened. If it has been of long standing there 
may be a callus on the plantar surface of 
the foot directly below the distal end of the 
second, third or fourth metatarsal bone. If 
the arch is not broken down badly enough 
to form such callus, there will be a hyper- 
sensitiveness at these points which can be 
detected readily by palpation. There will also 
be hpyersensitiveness at the plantar sur- 
face of the foot below the middle and ex- 
ternal cuneiform bones. One or both of 
these bones will be lesioned downward, i. e., 
toward the plantar surface of the foot. On 
account of the wedge shape of these two 
cuneiform bones this lesion spreads the 
internal cuneiform bone from the cuboid 
bone. It widens the foot at the proximal 
end of the metatarsal bones and lowers that 
end of the second and third metatarsal 
bones. It also produces a fallen condition 
of the anterior transverse arch. 
The treatment indicated is to replace the 
lesioned cuneiform bones. This is done bv 
133 placing the pad directly over the plantar 
surface of these bones while the strap is ad- 
justed over it as shown in Figure 42. Then 
by the use of one hand the patient’s foot 
is pulled so as to extend his knee as far as 
possible. With the other hand the metatar- 
sal bones can be moved about in different 
directions to produce movements of their 
articulations with the tarsal bones. This 
will open the articulations about the middle 
and internal cuneiform bones, and coupled 
with the pressure on the pads, will correct 
the lesion. 
After making corrections of the bony le- 
sions of such a foot, a tight fitting bandage 
should be adjusted around the distal end 
of the metatarsal bones, care being taken 
not to cover the articulation of the great or 
small toe. This bandage should be put on 
so as to force the distal end of the first 
and fifth metatarsal bones downward and 
the corresponding end of the second, third 
and fourth metatarsal bones upward. This 
can be done easily by using an adhesive 
plaster one and one-half or two inches wide 
as the bandage. Tear off the proper length 
so that the ends will lap one and one-half 
inches when placed in proper position around 
the foot. See Figure 43. As the bandage 
134 is being placed on the foot, draw down- 
ward, i. e., toward the plantar surface on 
the first and fifth metatarsal bones, and 
push upward on the plantar surface of the 
second, third and fourth metatarsal bones. 
The bandage should be put on as tightly as 
the patient can wear it without discomfort. 
After the bandage has been adjusted on 
the foot ask the patient to stand up. The 
weight of his body will spread the foot as 
far as the bandage will permit. If the 
bandage is too tight, it will cause pain when 
the patient stands on the foot. If it is too 
tight or not tight enough, it should be 
properly adjusted before the patient puts 
on his shoe. Such a bandage should not be 
worn more than three days, as in case of a 
sensitive skin the bandage may produce 
some soreness if left on too long. To pre- 
vent such soreness, change the bandages 
every two or three days and line them with 
a piece of gauze bandage to within about 
one inch of each end of the bandage. There 
will be enough of the adhesive passing 
through the gauze to hold the bandage in 
place on the foot. Some adhesive plaster 
does not stick well. It comes loose at the 
end as soon as the patient stands on the 
bandaged foot. In that event, stick it down 
135 again and put another piece of adhesive 
plaster about two inches long over the lap- 
ped ends to help hold them together. 
This bandage will give the patient a great 
deal of comfort. It will assist the foot to 
become readjusted and the arch to become 
normalized. In these cases the ligaments 
and muscles have to undergo corrective 
changes and some weeks will be required 
for the restoration. As soon as the foot 
is sufficiently improved, the bandaging 
should be discontinued. Adjustments of the 
bones will have to be repeated from time 
to time until they remain in their normal 
position; then the patient may be dis- 
charged as cured. 
It also must be remembered that, in ad- 
dition to this treatment, if there are any 
lumbar or innominate lesions, they must be 
properly treated, as a foot will not normal- 
ize when it has poor circulation and bad 
nutrition. 
Foot and leg exercises should be taken 
daily, or better, twice a day, for a period 
of at least thirty days, to develop the mus- 
cles of the foot and leg. 
In many of these cases the longitudinal 
arch is also broken down, and it must be 
136 treated so that the entire foot may be nor- 
malized by one course of treatments and 
exercises. 
137 FLAT FOOT. 
This is a common foot ailment. It is 
usually brought about by strain on weak- 
ened foot muscles. If the body is otherwise 
healthy and well nourished, there must be 
a local cause for the weakness of the foot 
muscles. In such a case we would natur- 
ally expect some lesion affecting the sciatic 
nerve, thereby impairing the nutrition to 
the foot and leg muscles. In some cases the 
foot muscles may be capable of supporting the 
longitudinal arch of the foot under ordinary 
conditions, but break down under heavy 
strain or fatigue. For instance, when a 
person who is accustomed to sitting during 
a great deal of his time takes a long walk, 
his foot muscles become fatigued easily and 
the arch sags. This sagging puts the liga- 
ments on strain and they sooner or later 
relax allowing the center of the arch to 
settle lower. Some of the tarsal bones sag 
more than others and become subluxated. 
When the feet are rested the muscles con- 
tract more or less acquiring their normal 
tone and raising the center of the arch to 
its former position. Sometimes when the 
arch settles and raises again in this manner 
138 some of the tarsal bones slip slightly out 
«of their normal position. 
It must be remembered that the longi- 
tudinal arch of the foot is supported like 
the arch of a bow. The longitudinal foot 
muscles, ligaments and fascia constitute 
the bow string. The arch is not self sup- 
porting, inasmuch as both ends of the arch 
are movable, easily spreading and allowing 
the center of the arch to settle down. The 
arch is not only supported by the pull or 
tension of the longitudinal muscles of the 
foot located beneath the arch, but also by 
the padding formed by these muscles. When 
a muscle is in action it not only shortens 
but thickens by the contraction of its fibers. 
This thickening of the muscles affords more 
padding beneath the longitudinal arch of 
the foot. If these muscles are undeveloped 
or somewhat emaciated, they are weaker 
and thinner than normal thus providing 
less support for the arch of the foot. 
It is also true that the tarsal bones are 
often somewhat displaced by climbing hills 
or mountains or by stepping on rough or nar- 
row surfaces. Such lesions are brought 
about more readily when the foot muscles 
are weakened by fatigue, partial paralysis 
or malnutrition. 
139 In some cases the tarsal bones become 
lesioned by strain or trauma even though 
the muscles of the foot are in good condi- 
tion, so we should not understand that 
weakened muscles of the feet are absolutely 
necessary for the production of flat foot. 
Flat foot causes more or less painful and 
aching sensations, which in many cases be- 
come very distressing; yet we must make 
our diagnosis of flat foot from other signs 
and symptoms. One method of making the 
diagnosis is to wet the soles of the patient's 
feet and look at the tracks he makes by 
walking over a bare floor. The track of 
a normal foot indicates that the hollow of 
the foot does not touch the floor. The wet 
track left on the floor by a normal foot 
indicates that the heel, the external side 
of the plantar surface of the foot and the 
ball of the foot touch the floor and wet it. 
If the longitudinal arch of the foot is bro- 
ken down the hollow of the foot will touch 
the floor and wet it. This test is not ab- 
solute, for some people who have normal 
short fat feet will make tracks like that of 
a flat foot. 
By inspecting feet we learn their normal 
shape and contour, just as we learn the nor- 
mal shape and contour of the chest. With 
140 this knowledge we readily recognize abnor- 
mal shapes, sizes and contours. By inspec- 
tion of a flat foot we note a flattening over 
the top of the instep; we note that the ankle 
is inverted and that the internal malleolus 
is unusually prominent; that the tarsal 
bones are protruding somewhat toward the 
median line, giving the inner edge of the 
foot an unnatural fullness. 
If the transverse arch is also broken 
down, which is usual in such cases, there 
will be an unusual flatness across the distal 
end of the metatarsal bones. In these cases 
very often a callus is to be found on the 
plantar surface of the foot beneath the dis- 
tal end of the second, third or fourth 
metatarsal bones. This callus is not al- 
ways present in cases of a broken down 
transverse arch; however, when it is pres- 
ent it is conclusive evidence of such a fallen 
arch. In some cases of a broken down trans- 
verse arch, when a callus has not yet form- 
ed, a considerable hypersensitiveness can be 
elicited by pressure on the plantar surface 
of the distal end of the second, third or 
fourth metatarsal bones. 
When the middle and external cuneiform 
bones are lesioned toward the plantar sur- 
face of the foot they spread the bones on 
141 either side of them to which they are artic- 
ulated. This spreading leaves the second 
and third metatarsal bones free to sag down 
and thus cause the transverse arch to be- 
come flattened. These two cuneiform 
bones are wedge shaped; so, when they set- 
tle down, the bones about them must separ- 
ate. In all of these cases pressure on the 
plantar surface of the foot beneath these 
cuneiform bones will reveal a hypersensi* 
tiveness which Is an important diagnostic 
point. 
Flat foot will usually cause a clumsy 
gait. The feet lack the normal spring, 
elasticity and strength that a normal foot 
should possess. 
In a case of flat foot an imaginary line 
drawn parallel with the front of the center 
of the tibia will extend to a point much 
nearer to the inside of the foot than it 
should normally. This deviation of the ti- 
bia causes the knees to come closer togeth- 
er, so it is often said that flat foot gives a 
tendency for knock-kneed condition, and 
this condition is used as a diagnostic point. 
The tarsal and metatarsal bones should 
all be carefully palpated to ascertain which 
are lesioned. As lesioned joints are usually 
hypersensitive, each articulation should be 
142 palpated for sensitiveness. In many cases 
the lesioned articulations can be correctly 
diagnosed by the sensitive tissue about 
them, even though they cannot be other- 
wise diagnosed. The articulations should 
he thoroughly examined by palpation from 
the plantar surface of the foot, from the 
dorsum of the foot and from the lateral sur- 
face of the foot. 
The treatment for flat foot is to correct 
the bony lesions in the foot, lumbar and pel- 
vic areas. This also should be followed by 
physical exercises to develop the muscles of 
the foot and leg. 
An explanation of how to correct the 
bony lesions of the foot can be found under 
proper titles. Foot and leg exercises are 
fully given under the heading, Physical 
Exercises. 
143 Fig. 44—STRAP ADJUSTED FOR STRETCHING 
THE TENDO ACHILLIS AND THE LONGI- 
TUDINAL MUSCLES AND LIGAMENTS 
BELOW THE LONGITUDINAL ARCH 
CORRECTION OF LESIONS DUE TO 
HIGH HEELED SHOES. 
A foot that has worn high heeled shoes 
for a considerable time flexes at the recip- 
rocal reception articulation until it remains 
permanently flexed. The scaphoid, cuboid, 
cuneiform bones and the metatarsal bones 
form a straight line slanting downward to- 
wards the toes, and the toes are materially 
extended. In such a case the muscles, ten- 
dons, ligaments and plantar fascia become 
adjusted accordingly, i. e., the tendo Achillis 
becomes shortened because of the elevated 
position of the heel; the plantar fascia, liga- 
ments and longitudinal muscles below the 
144 longitudinal arch of the foot become ab- 
normally shortened due to the flexed con- 
dition of the foot; and the extensor tendons 
of the toes become shortened due to the ex- 
tended condition of the toes and the exten- 
sion of the ankle joint. The whole foot 
takes on an abnormal contour. The scaph- 
oid and cuboid bones are lesioned toward 
the plantar surface of the foot. 
Treatment should be given to restore nor- 
mal contour of the foot by correcting the 
bony lesions and restoring normal length to 
the muscles, tendons and ligaments. 
Thoroughly loosen up all the articulations 
of the foot. Treat with the strap and pad 
as shown in Figure 44, to stretch the tendo 
Achillis and the longitudinal muscles and 
ligaments below the arch of the foot. In 
this treatment, extend the patient’s knee 
as far as possible by pulling on his foot. 
Hold it in this position long enough to give 
the muscles of the foot and leg an oppor- 
tunity to relax then let the knee flex again 
to rest the muscles. Repeat this operation 
several times for a treatment. This part 
of the treatment can be taken daily by the 
patient with the aid of an assistant. 
The reciprocal reception articulation 
should be adjusted as soon as the muscles 
145 and ligaments permit. To make this ad- 
justment, put on the foot strap and pad as 
shown in Figure 43. In this figure, note 
that the strap is as close to the heel as 
possible without slipping off during the 
treatment. Its purpose is to hold the os 
calcis and astragalus as firm as possible. 
The strap is tightened by pulling on the 
foot with one hand to extend the knee as 
far as desired while the other hand pro- 
duces as much movement as possible at the 
reciprocal reception articulation with a view 
to moving the scaphoid and cuboid bones as 
far as possible toward the dorsum of the 
foot to correct the lesion. 
Advise physical exercises to develop the 
muscles of the feet and legs. See “Physical 
Exercises.” 
It must be remembered that the high 
heels have changed the balance of the body 
and necessarily have had their evil effects 
on the pelvic and lumbar areas. The pel- 
vic girdle and the lumbar vertebrae and 
muscles should be carefully examined and 
treated according to the conditions found. 
In most of these cases a lumbar lordosis 
will be found. Raising the heels causes the 
body to be pitched forward and the should- 
ers must be pitched backward to maintain 
146 the equilibrium. This posture naturally 
produces a lumbar lordosis. 
The lumbar lordosis can be corrected by 
stretching the muscles of the lumbar region, 
giving special attention to the erector 
spinae and quadratus lumborum muscles. 
For this work I would recommend the treat- 
ment shown in Figure 6. After the treat- 
ment has been given the patient should be 
advised to keep it up daily at home. It can 
be done on a short table or on a board laid 
on two chairs as a substitute for a treat- 
ment table. In case the chairs are used, 
the strap should be placed under the bot- 
tom of one of them and up over the knees. 
If the strap is placed under the board and 
not under the bottom of the chair and then 
up over the knees, pushing with the knees 
against the strap will split the board. It 
should be remembered that a pressure of 
from one thousand to fifteen hundred 
pounds can be exerted with the knees 
against the strap and the pull on the 
erector spinae and other muscles of the lum- 
bar area will be about seven times that 
amount. Correction of the lumbar lordo- 
sis will normalize the pelvic tilt and im- 
prove the circulation of blood through the 
legs and feet. 
147 If the patient should have a posterior 
lumbar condition, which is possible when 
due to spinal lesions, it should be treated 
with my spine and rib fixer as that will 
give quick and satisfactory results. A pos- 
terior lumbar spine is capable of producing 
not onty a poor circulation of blood in the 
feet and legs, but it also causes many pel- 
vic disorders. It is also very important 
that the innominates should be kept normal- 
while the normal balance of the body is be- 
ing restored. 
It would not be advisable for a patient 
who has misshapen feet due to wearing high 
heeled shoes to wear a real low heeled 
shoe, as the change would be too great and 
would probably cause unnecessary suffering. 
She should wear a shoe with a common 
sense heel. She should wear the same 
height heel every day of the week including 
Sunday. The muscles will became accustom- 
ed to a certain height heel and the patient 
should be warned carefully about wearing 
shoes that would put extra strain on the 
muscles of the feet, legs and lumbar re- 
gion while she is under treatment for her 
troubles brought about by wearing high 
heeled shoes. She should be informed that 
it took years to bring about the troubles 
148 for which she seeks relief; that she should 
expect it to take months to cure them; 
and, that the cure, when produced in this 
manner, is of inestimable value. It not only 
relieves the suffering from the feet, but it 
normalizes the pelvic and lumbar areas 
which were destined to bring on more or 
less serious pelvic or nerve troubles pro- 
vided they were allowed to remain in their 
abnormal conditions. The far reaching ef- 
fects of wearing high heeled shoes can be 
traced to all parts of the body. A lumbar 
lordosis necessarily produces a thoracic 
kyphosis and a cervical lordosis as compen- 
satory curves. Hence, it will be seen that 
the entire spinal column will be affected by 
the prolonged use of high heeled shoes. A 
cervical lordosis will be followed by a pos- 
terior occiput and that combination will 
cause an irritation of the superior cervical 
ganglion. Branches from this ganglion 
supply the nasal tract, tonsils, throat, sin- 
uses, eustachian tubes, ears, etc. It can be 
plainly seen that irritation of this ganglion 
may produce a multitude of troubles in the 
throat, nose, and hearing apparatus. The 
thoracic kyphosis may affect the nerves 
supplying the bronchial tubes, lungs, heart, 
stomach, liver, spleen, etc. It could also 
149 affect the circulation of blood in any part 
of the body, as the vasomotor nerves leave 
the spinal column from the second thoracic 
to the second lumbar vertebrae. 
It is important that high heels should be 
discarded as early as possible and the evil 
effects treated before it is too late in life. 
After the bones become hardened and the 
ligaments shortened with age, the abnormal 
spinal curves cannot be corrected. The 
best that can be done then is to loosen the 
articulations as much as possible to free the 
blood and lymph streams, and to permit the 
nerves to function as freely as possible. 
150 TREATMENT OF MORTON’S DISEASE. 
This disease is a form of metatarsalgia 
due to the irritation of the superficial 
branch of the external plantar nerve and 
its two digital branches where they pass 
between the heads of the fourth and fifth 
metatarsal bones. The head of the fifth 
metatarsal bone presses on the neck of the 
fourth metatarsal bone. This pressure is 
usually brought about by a tight fitting 
shoe. Removal of the shoe soon gives re- 
lief. Walking increases the pain and suf- 
fering, which sometimes becomes very severe. 
The pain is usually confined to the 
region of the head of the fourth and fifth 
metatarsal bones and to the fourth and 
fifth toes. In many cases the pain does not 
reach the toes. The condition is a neural- 
gia brought about just as intercostal neu- 
ralgia is produced by irritation of an inter- 
costal nerve due to a lesioned rib. This con- 
dition is usually associated with flat foot, 
which may produce other pain in the foot. 
The treatment should be directed to a 
removal of said nerve irritation. The out- 
side edge of the fifth metatarsal bone 
should be rotated upward to prevent its 
head from rotating somewhat beneath the 
151 neck of the fourth metatarsal bone. A pad 
of cotton or some other soft substance 
should be worn between the fourth and 
fifth toes to cause the little toe to pull the 
head of the fifth metatarsal bone from the 
neck of the fourth metatarsal bone. The 
cuboid bone may be lesioned; if so, it must 
be corrected. If flat foot exists it also 
should be treated as described in this text. 
This disease probably has existed ever 
since people have worn tight fitting shoes. 
It was first discovered by Dr. Thomas G. 
Morton of Philadelphia in 1876. 
152 TREATMENT FOR A HAMMER TOE. 
This is a toe deformity with a more or 
less fixed flexion of the articulation at the 
distal end of the first phalange. The plan- 
tar ligaments below the toe are materially 
shortened by contraction, and this shorten- 
ing is given by many authors as the cause 
of the hammer condition of the toe. My 
observations of joint deformities have led 
me to believe that the ligaments on the 
flexor side of a joint do not contract and 
flex the joint; but that the flexion is due to 
one or more contractured muscles. The lig- 
aments then contract to meet the changed 
conditions of the joint. In the case of ham- 
mer toe, the ligaments become contracted 
after the toe joint is permanently flexed by 
the flexor brevis digitorum muscle. This 
muscle is innervated by the internal plantar 
nerve which crosses the plantar surface of 
the navicular bone and the internal cunei- 
form bone. A lesion of either of these 
bones may irritate the nerve and cause 
some abnormal contraction of the flexor 
brevis digitorum, thus producing one or 
more hammer toes. This muscle supplies the 
second, third and fourth toes. By correct- 
ing the lesion of the navicular bone or of 
153 the internal cuneiform bone as conditions de- 
mand, the irritation can be removed from 
the internal plantar nerve, thus permitting 
the flexor brevis digitorum to relax and al- 
low the toe joint to extend to its normal 
position. I have seen hammer toes normally 
extended within a few days after the bony 
lesions had been corrected. No treatment 
was applied directly to the affected toes. 
In curing hammer toes by simply correct- 
ing one or more bony lesions, the osteopath 
should feel highly pleased with his success 
as compared with the results of surgical 
operations performed in such cases. 
154 TREATMENT OF HALLUS VALGUS 
AND BUNION. 
This is a subluxation of the great toe 
outward, i. e., toward the other toes. This 
trouble is usually brought about by wearing 
shoes with narrow toes, shoes that are too 
short, or shoes with high heels. It may 
be due to gouty or rheumatic conditions. A 
bursa develops on the inner side of the head 
of the first metatarsal bone due to contin- 
ued irritation and congestion of the tissues. 
This bursa finally develops into a bunion. 
As the toe becomes displaced outward the 
extensor hallucis longus, by its contraction, 
tends to increase the deformity. 
The treatment in severe cases is surgical 
removal of a portion of the bones so that 
the toe may be brought back in proper 
alignment of the foot. But if treatment is 
begun in time surgery is not necessary. 
The treatment should be directed towards 
furnishing normal nerve action to the tis- 
sues about the joint. A lesion of the navi- 
cular bone or of the internal cuneiform 
bone may interfere with the nerve supply 
of the first metatarsal and great toe region; 
hence, they should be carefully examined, 
and, if lesioned, they should be properly 
155 adjusted. A padding should be worn be- 
tween the first and second toes to prevent 
the first toe from turning toward the second 
toe. Properly fitted shoes with wide toes 
or with a straight line last should be worn. 
Shoes with pointed toes and with high heels 
must be tabooed. 
Treatment of a bunion should be directed 
toward removal of the cause as above out- 
lined. Any external application to reduce 
inflammation of the bunion should prove 
beneficial. One Doctor says that much re- 
lief from the discomfort of a bunion may be 
secured by painting the bunion with a solu- 
tion of ten grains of permanganate of potas- 
sium in two drams of water. He also ad- 
vises a pad of cork and cotton between the 
first and second toes. 
156 SPRAIN OF THE ANKLE. 
The ankle joint is a hinge joint. Its 
movements are flexion and extension. Gray 
says, “The malleoli tightly embrace the as- 
tragalus in all positions of the joint, so that 
any slight degree of lateral movement which 
may exist is simply due to stretching of 
the inferior tibio-fibular ligaments and slight 
bending of the shaft of the fibula.” 
The ankle joint is well protected and sup- 
ported by numerous powerful ligaments, 
yet it is more subject to sprains than any 
other joint of the whole human framework. 
These sprains are usually the result of lat- 
eral force, either that of inversion or ever- 
sion of the foot. As the external ligaments 
are weaker than the internal ligaments, the 
sprain due to inversion of the foot is by far 
the more common. In such cases the tarsal 
articulations are usually moved laterally 
beyond their normal limits, as the ankle 
joint permits of practically no lateral move- 
ments. What is referred to as a sprained 
ankle is often a sprain of the articulation 
of the astragalus with the os calcis; and 
in some cases, the reciprocal reception artic- 
ulation is also sprained. 
157 When the foot is forcibly everted, the 
deltoid ligament supports the ankle joint 
with such great strength that it usually re- 
sults in fracture of the fibula. It also fre- 
quently fractures the internal malleolus. In 
some such cases the deltoid ligament rup- 
tures. 
A lesion of the ankle joint often sets up 
acute synovitis. This will materially in- 
crease the amount of synovial fluid and 
cause a considerable bulging in front of the 
joint and some bulging at the lateral sides 
of the joint. When the puffiness is prin- 
cipally below the ankle joint it indicates 
that the subastragaloid articulation is ma- 
terially affected. Very often the whole foot 
and a considerable part of the leg swells to 
such an extent that the ankle movements 
are practically impossible. In such cases 
the swelling should be reduced by the appli- 
cation of heat and cold or by massaging. To 
massage such a case, begin high on the 
swollen part of the leg. Free the circula- 
tion until the swelling reduces and massage 
down closer and closer toward the ankle un- 
til most of the swelling is reduced. No rough 
treatment should be used in treating a 
sprained articulation. If any manipulative 
treatment is used at all it should be very 
158 gentle and without strain on the already 
sprained tissues. The foot should be so 
bandaged as to support the ankle joint and 
prevent strain on the affected tissues. For 
instance, the most common sprain of the 
ankle joint is one due to a forced inversion 
of the foot. After a sufficient examination 
of such a sprain has been made to ascertain 
that there are no bony fractures nor bony 
subluxations, the bandage should be applied. 
All bony subluxations should be adjusted be- 
fore bandaging the ankle. An adhesive 
bandage is probably the most satisfactory to 
use at first. Use one inch adhesive tape. 
A good way to apply the bandages is to be- 
gin on the inside of the foot, about an inch 
in front of the heel; pass the bandage under 
the plantar surface of the foot and up on 
the outside of the leg to a point about four 
inches above the ankle. Then begin again 
on the back of the heel and pass the adhes- 
ive tape around the outside of the foot and 
up across the metatarsal bones. The first 
tape applied is for the purpose of prevent- 
ing inversion of the foot. The second one 
is for the purpose of preventing adduction 
of the foot. These two tapes are not suf- 
ficent to properly do the work. Two or 
three more pairs of tapes should be used 
159 by applying them parallel to the two tapes 
first applied. 
The ankle lesion due to a forcible inver- 
sion of the foot often becomes chronic by 
repeated sprains. In that event the foot 
should be kept bandag-ed to support the 
ankle and the shoe heel should be fixed to 
support the outside of the ankle. For 
further information on how to treat sprains, 
see McConnell and Teall, Fourth Edition. 
160 DISLOCATIONS OF THE ANKLE JOINT. 
This joint is frequently dislocated, and 
often fractures of the tibia or fibula ac- 
company the dislocation. All cases of an 
injured ankle should be carefully inspected 
and palpated for dislocations and fractures. 
In many cases the fractures are small pieces 
broken from the malleoli and the examina- 
tion for such breaks must be carefully made 
or they will be overlooked. The dislocated 
articulation can usually be corrected best 
while the patient’s knee is flexed so as to 
reduce the tension of the tendo Achillis. 
While the patient lies on his back- on the 
table, put a strap once around his leg just 
above the knee, then fasten the strap to 
the head of the table, so as to support the 
patient’s thigh in a perpendicular position. 
See Figure 35. Then stand at the foot of 
the table and take hold of the patient’s 
foot and use traction on it with careful 
movements to correct the dislocation. After 
correction of the dislocation, the joint 
should be cared for as any other joint that 
has been dislocated. 
161 CORNS. 
People who never wear shoes or boots are 
not troubled with corns or bunions. Corns 
originate with calluses due to ill fitting 
shoes or boots. The cause of corns must be 
removed. If the shoe cannot be made to 
fit the foot, it must be discarded. Tempo- 
rary relief may be had by paring off the 
hard horny layers of the corn after soak- 
ing it in warm soap suds for about one- 
half hour. However, this treatment will 
not give permanent relief. 
Soft corns develop between the toes and 
are due to sensitive skin with nutrition be- 
low par. The toes should be spread by 
wearing cotton between them. They should 
be carefully cleansed every night. A pa- 
tient with soft corns needs shoes with wide 
toes. The shoe must be longer than the 
foot so the toes will not be cramped. It 
must be borne in mind that the foot is 
longer and wider when walking than when 
at rest. A shoe should be selected accord- 
ingly. 
To cure soft corns apply a little formal- 
dehyde to the corn daily until cured. Or 
wet cotton with raw linseed oil and place 
162 it between the toes and renew it day by 
day until the corn is cured. 
To remove hard corns apply a drop of 
acetic acid, soak the foot and lift the corn 
out. 
A simple remedy said to cure in four or 
five treatments is to bind cotton on the corn 
before retiring and saturate it with tur- 
pentine. 
163 INGROWN TOE-NAILS. 
Frequently the cuticle adjacent to the 
edge of the nail becomes overgrown and 
causes this trouble. It may be pushed back 
away from the edge of the nail by inserting- 
a small roll of cotton under the edge of the 
nail. It may be held away by the use of a 
small piece of adhesive plaster. The nail 
should be carefully cut away. This can be 
done with very little inconvenience provided 
melted tallow has been previously poured on 
the affected part and allowed to remain a 
few days. 
An ingrown toe-nail may be the result of 
pressure by a tight fitting shoe or by a 
stocking that binds over the end of the toe. 
In such a case the cause of the trouble 
must be removed before any treatment can 
be expected to be effectual. 
In some cases granulations and pus may 
have formed and the toe should be treated 
accordingly. 
164 SOME CAUSES OF PAIN IN THE FOOT. 
Pain is our best friend. Were it not for 
its warning message many of us would un- 
necessarily allow our bodies to go to rack 
and ruin. It is this warning message that 
leads the patient to a doctor’s office, where 
he enters full of hope and with much con- 
fidence in his physician who is expected to 
definitely locate the pain, find its cause and 
remove it. 
If the patient complains of a burning sen- 
sation in his foot, his physician readily 
knows that it is due to irritation of the 
sciatic nerve. Said irritation may be at 
the fifth lumbar, due to a tilted pelvis, or 
it may be due to an innominate lesion, a 
lesion of the pelvic organs, a pelvic tumor 
or an inflamed psoas muscle. In some cases 
the lesion may be in the tarsal or metatarsal 
bones. Wherever the lesion is, it should 
be adjusted so that normal conditions may 
be restored. 
I once knew a case in which the little toe 
was badly twisted over the next toe to it. 
It continually irritated the nerves until the 
whole sciatic nerve was affected to the hip. 
Usually when a patient complains of pain 
or a burning sensation in the leg, thigh or 
165 hip, the point of irritation is at the fifth 
lumbar vertebra, the pelvic area or about 
the hip. 
A common location for pain is on the heel 
at the insertion of the tendo Achillis, known 
as achillodynia, or at the bottom of the 
heel, or at the plantar surface of the foot 
just in front of the heel. It may be almost 
instantly relieved by correcting the innom- 
inate lesion to remove the irritation of the 
sciatic nerve. 
In rheumatic conditions there may be a 
considerable pain and suffering due to dis- 
eased joints of the foot. It should be borne 
in mind that rheumatism is due to strep- 
tococcic infection in the blood. It arises from 
a focus of pus that has no drainage—such 
as pus in a tooth socket, in a sinus, in the ton- 
sil or imbedded in other tissues. The strep- 
tococci are carried in the blood stream to 
all parts of the body. Dr. Richard Cabot 
says that a rheumatic condition has a dis- 
tinct involvement of joints with evidence 
of acute infection. The same infected blood 
will be carried about to all parts of the 
body; hence, all joints are likewise attacked. 
The inflammation will not remain long in 
one joint without other joints showing man- 
ifestations of the same nature. In case of 
166 rheumatism affecting the feet, it would be 
useless to treat the feet. The focus of pus 
should be located and drained. The cause 
of the pus should be treated and a general 
treatment should be given to purify the 
patient’s blood. 
The joints of the toes may be affected 
by gout. Such a case would call for a con- 
stitutional treatment, an abundance of phy- 
sical exercise and a very rigid diet. 
The toes may be affected by Raynaud’s 
disease. At first the patient may complain 
of the toes having a dead feeling and of 
turning white for a few minutes or hours 
at a time, especially when exposed to a 
cooler atmosphere. In some cases the con- 
dition becomes serious, even fatal, as gan- 
grene may result from the vasomotor 
spasms. This disease is purely a vasomotor 
disorder and should be treated as such. It 
is characterized by spasmodic contractions 
of the arterioles. The fingers are more 
commonly attacked than the toes; however, 
in some cases the toes are attacked while 
the fingers are not. In all cases of Ray- 
naud’s disease the nervous system should 
be treated. The toes are not at fault; 
hence, treatment of the feet would not be 
curative. 
167 Traumatic synovitis might affect the 
joints of the feet; but it is not very likely 
to do so on account of the limited amount of 
synovial membrane in said joints. If such 
a case should appear in a foot, it should not 
be diagnosed as rheumatism, as the affection 
would not move from one foot to the other 
nor to the joints of the hands or wrists. 
Such a case calls for local treatment—prin- 
cipally rest of the affected joint and treat- 
ment for the reduction of the inflammation. 
Manipulation of a joint affected with syn- 
ovitis is detrimental. Manipulation above 
and below such a joint is quite beneficial 
to establish a good circulation through the 
j oint. 
Arthritis deformans often affects the feet 
and is seldom cured. This disease is clas- 
sified as rheumatism or rheumatoid, which 
means like rheumatism, yet its cause is not 
understood. Some writers express an opin- 
ion that these joint deformities are due to 
some specific germ. However, they have, as 
yet, been unable to prove the correctness of 
this theory. A correct diagnosis of these 
cases should not be difficult for when the 
joints of the feet are badly deformed the 
joints of the hands are usually affected in 
like manner. 
168 As the foot is frequently affected by 
trauma it is liable to have periostitis whUh 
is quite a painful affliction which some- 
times results in abscess or necrosis. These 
cases are not due to bony lesions of the 
feet. They should be treated just the same 
as they would be treated if appearing in any 
other part of the body. 
Ulcers may appear on the sole of the foot 
due to malnutrition caused by an irritated 
sciatic nerve. Such ulcers heal readily after 
said irritation is removed by correcting the 
innominate or other lesion responsible for 
the trouble. 
An ulcer will not develop in healthy tissue 
without some external irritant, and in that 
event, as soon as the irritant is removed the 
ulcer should readily heal. Wherever one or 
more ulcers appear spontaneously in any 
part of the body, we should look for de- 
fective nerve functioning to the affected 
tissue. For instance, if an ulcer should ap- 
pear on the lip, as herpes labialis, or com- 
mon cold sore, we always find a lesion of 
the Gasserian ganglion with resulting tro- 
phic disturbances of the regions supplied 
by the trigeminal nerve. If the tissue of 
the neck just back of the angle of the in- 
ferior maxillary is properly worked out and 
169 lesions in the upper cervical region are cor- 
rected the ulcers readily heal. 
In case of an ulcer in the stomach, verte- 
bral treatment to remove the cause of the 
irritation to the great splanchnic nerve will 
soon give desired results. If an ulcer on 
a finger is due to irritation of the brachial 
plexis by a first rib lesion, liniments applied 
to the finger will fail to cure said ulcer. 
The rib lesion should be corrected; then na- 
ture will do the rest. There is very little 
use for liniments for healing ulcers on the 
soles of the feet. The lesion that irritates 
the sciatic nerve should be corrected, so the 
foot may have normal nutrition through 
normal functioning of said nerve; then the 
ulcer will readily heal and the patient will 
feel grateful for what osteopathy has done 
for him. 
170 SYSTEMIC INFECTION VIA THE 
FEET. 
Perhaps more recognition should be given 
to the feet as an avenue of ingress of in- 
fection into the body. 
Occasionally patients complain of the skin 
between the toes cracking and bleeding and 
causing more or less annoyance. Whether 
coincidental or resultant, there is often as- 
sociated with this condition what the suf- 
ferer usually calls rheumatism. Lack of 
cleanliness may be the cause of this con- 
dition, but not necessarily so. In fact, 
daily bathing of the feet will not always be 
sufficient for a cure. In such cases some 
good antiseptic solution such as sodiphene 
should be applied morning and night and 
the patient should be instructed not to walk 
about in his bare feet. 
Doubtless these cases are due to the 
lower forms of plant life, probably fungus. 
The effect of the fungus growth is to pro- 
duce the raw and bleeding surface in an 
area well protected from the friction of 
the foot covering. Here the germs flourish 
without interference except at times when 
the feet are cleansed. For this reason 
these areas are fine avenues of ingress for 
any germs picked up by the feet. 
Associated with this condition will be 
found horny skin about the margins of the 
toes and on their under surfaces, especially 
where pressure has produced ridges. Also, 
it will be found that the skin tends to hard- 
171 en and proliferate along the margins of the 
nails. This condition will be corrected if 
the primary lesions between the toes are 
cured. 
In cases of so-called rheumatism, where 
the recognized causative factors are not 
found, I would suggest the examination of 
the feet for the above described conditions 
and application of the indicated treatment. 
172 PHYSICAL EXERCISES. 
Tee Exercises: 
Remove the shoes and stand on a book 
about two inches thick, with the toes ex- 
tending beyond the book. While in this po- 
sition, flex the toes to their extreme limit, 
then extend them as far as possible. Repeat 
these movements until the point of fatigue 
has been reached. 
Foot Exercises: 
Stand on a book about two inches thick 
with the heels entirely off the book. While 
in this position, raise the heels as high as 
possible by extending the ankle joints. Then 
let the heels down nearly to the. floor. Re- 
peat these movements until the point of 
fatigue has been reached. 
Leg Exercises: 
Stand erect, and raise the heels as high 
as possible above the floor while the weight 
of the body is supported on the ball of the 
feet. Then let the heels down to the floor 
and flex the knees and hips as far as possi- 
ble or until the hips are down to the heels. 
Then repeat these movements over and over 
again until the point of fatigue has been 
reached. 
173 Tibialis Anticus Exercise: 
Sit in a chair with both feet set squarely 
on the floor. While both heels are resting 
on the floor, raise the balls of the feet by 
flexing the ankle joints; then invert the 
feet as far as possible to put a strain on 
the tibialis anticus muscle. This exercise 
should be repeated over and over again 
until the point of fatigue has been reached. 
174 INDEX 
Page 
Abdomen, relaxing the walls.... 27, 28 
Achillodynia, treatment 166 
Acromioclavicular lesion, how to cor- 
rect 56, 57, 58 
Ankle joint, dislocations 161 
joint, dislocations, treatment. 93 
sprains, treatment 157 
Arch, longitudinal, support .139 
transverse, diagnosing ..141 
transverse, examination 133 
transverse, treatment 133 
Arthritis deformans 168 
Astragalo-calcanean lesion, treat- 
ment 129, 131 
Bandages for sprained ankle 159 
Bandage, how prepared for foot 135 
on foot, how adjusted ..134 
Blood, circulation in pelvis and legs 19 
Bones of the foot, the two sets.. 124 
Bunion, treatment 156 
Burning sensation in the foot 165 
Chest, distorted, treatment 28 
expansion 49, 50 
relaxing the walls ...27, 28 
Chopart’s joint 115 
Corns, treatment 162 
Costal region, treatment 46, 47, 48 
175 Page 
Cracks between the toes... 171 
Cuboid Bone, how to adjust—.113, 115. 122 
lesion — 122 
Cuneiform Bone, examination.. 133 
internal, lesion 125 
internal, treatment .124 
bones, lesions ' 119 
bones, treatment 134 
Curvature, lateral spinal, treatment-..-95, 96 
Dorsal, lower region, treatment 72, 73 
Equipment for strap technic 5 
Exercise, for feet, who need it... 128 
toe, foot, leg and tibialis anticus..._173 
Flat foot, etiology 138 
diagnosing 140 
inspection ....141 
treatment .143 
Foot, misshapen by high heels, treat- 
ment 145 
treatment, principal Ill 
strap, causing pain .114 
strap, how adjusted 114 
General treatment .....101 
Gout, treatment 167 
Hallus valgus, treatment ..155 
Hammer toe, treatment 153 
Handles for strap technic 5 
176 Page 
Headache, stomach, treatment. 31, 32 
treatment 33 
Hemorrhoids, treatment 21, 22 
Hiccoughs, treatment 34, 35 
Hip-joint, treatment 91, 92 
Ingrown toe nails, treatment.... ...164 
Innominate, anterior lesion, treatment 
8, 9, 10, 11, 12, 13, 14 
Innominate Lesion, double, treatment 15 
effects of 15 
posterior, treatment 7 
Knee, treatment 93, 94 
Kyphosis, thoracic, treatment 28 
Lumbago, treatment 110 
Lumbar, lesion, exercise for 20 
lordosis, treatment 17, 18 
rigid, treatment 18 
rotation, treatment 72, 73 
Leucorrhea treatment 25, 26 
Menorrhagia, treatment.... ..25, 26 
Metatarsalgia 151 
Morton’s disease, treatment.. ..151 
Muscles, hip region, treatment ....91, 92 
hypersensitive .113 
intercostal, treatment 75, 76 
foot, stretching 144 
of the leg supporting the foot..... 131 
pectoral, treatment 77, 78 
177 Page 
spinal treatment 89, 90 
quadriceps extensors, treatment_...86, 87 
Neck, chronic stiff, treatment.. .....99, 100 
Neck, resistance treatment 97, 98 
Neck treatment 68, 67, 70, 71- 
Nutrition to the foot, how improved........127 
Occiput, posterior, diagnosed 68 
posterior, treatment ...64, 65, 67 
Otitis media, treatment. 68 
Pad for foot treatment.. ....112 
Pain in the foot, causes.— 165 
Periostitis of the foot 169 
Physical exercises 173 
Raynaud’s disease ...167 
Reciprocal reception articulation of the 
foot 115 
Rheumatism of the feet 166 
Rib fixer, also spine fixer 109 
Rib lesion, 11th or 12th, treatment—81, 82 
1st or 2nd, treatment 51, 52 
Ribs, treatment 75, 76, 79, 80 
Scaphoid bone, treatment..113, 115, 117, 119 
Scaphoid lesion, most common 118 
Shoe heels, high, discard early in life....l50 
high, lesions caused 144, 149 
high, lesions, correction.... 144 
Shoes, high heeled .....119 
Shoulder brace .107 
178 Page 
Shoulder, treatment . ....77, 78 
region, treatment 46, 47, 48 
Shoulders, stooped, treatment 28 
Shoulder straps, how to adjust '... 45 
Spinal column, support .....407 
torsion treatment 40, 41, 43, 44 
treating ones own.. ....110 
treatment 79, 80 
Spine fixer ’. 109 
Sternoclavicular lesion, treatment 54, 55 
Stomach, acid, treatment. 32 
Stomach, headache, treatment. .31, 32 
Straps for strap technic.... 5 
Straps, how to adjust 38, 39 
Subastragaloid sprain, treatment 158 
Synovitis, treatment 168 
Systemic infection via feet.......... .171 
Table, how to get astride ....36, 37 
Tarsal bones, how misplaced .139 
Tendo Achillis, stretching ..144 
Toe-nails, ingrown, treatment ...164 
Treatment, general. • .101 
Ulcers on the soles of the feet .....169 
Uterus, replacing 21, 23 
Veins, varicose, treatment.. 19 
Vertebra, lesioned, treatment ..Ill 
Vertebrae, cervical, treatment 53, 61, 62 
upper dorsal, treatment 61, 62 
Vomiting, how to prevent 31, 32 
179