Position

The patient is lying on his face, without the head-rest; the arms should be kept at the sides.

I. Stroking with both hands, one on each side of the spinal column, from the base of the skull down to the sacrum. If on a large person, the operator had better divide the back into three parts, in such a manner as to first work next to the spinal column, then over the center of the back, and finally over the sides, remembering that by the last manipulation he may conveniently reach the liver or spleen, if desirable in certain cases. In the case of an infant, and especially in infantile paralysis, we often use in the stroking only the index and the middle fingers, one on each side of the spinal column.

Fig. 15. - Kneading of the Back.

2. Friction with the hand or with the last two phalanges of the one hand, from the upper part of the trapezius down to the glutei, one side at a time.

3. Stroking as previously described.

4. Kneading with the two thumbs, one on each side of the spine, so as to act upon the spinal nerves. The hands should be spread over the back, supporting the sides if possible. (See Fig. 15.)

5. Pinching on the sides so as to act upon the sympathetic ganglia.

6. Hacking with one hand on each side of the spine, up and down, from the sacrum to the neck.

7. Clapping on both sides, lengthwise, one at the time.

8. Stroking repeated; performed very quickly if we wish to stimulate; very slowly and firmly if we wish the manipulation to have a soothing effect.