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TABLE OF CONTENTS
IFORWARD	
PREFACE	II
SIMPLIFIED LISTINGS DERIVED FROM MUSCULAR TENSION	1
Listening in on Inside Information	3
THE WORKING MUSCLE	5
THE MUSCLE LAYERS OF THE SPINAL COLUMN	6
PRACTICAL PROCEDURES	7
THE PHYSIOLOGY AND PROPOSED HYPOTHESIS OF WORKING MUSCLES	9
WORKSHEET (Supplemental to Lecture)	14
RECTUS CAPITIS POSTERIOR MINOR	17
OBLIQUUS CAPITIS SUPERIOR	18
FIRST BRANCH OF THE LEVATOR	20
ELEMENTARY PHYSIOLOGY OF THE JOINTS	22
OBLIQUUS CAPITIS INFERIOR	23
RECTUS CAPITIS POSTERIOR MAJOR	25
SECOND BRANCH OF THE LEVATOR	27
FIRST BRANCH SCALENUS MEDIUS	28
SEMISPINALIS CERVICIS	29
KINETIC MUSCLE CHECKS	30
THE LOWER CERVIGAL REGION	31
MULTIFIDUS C-3 - L-5	33
LEGEND FOR PATIENT'S TRAVEL CARDS	34
GLUTEUS MAXIMUS	35
GLUTEUS MEDIUS	36
POSTERIOR SACRO-ILIAC LIGAMENT	37
ILIO-COSTALIS LUMBORUM	38
LONGISSIMUS DORSI	38
ERECTOR SPINAE GROUP	38
"PALMER/GONSTEAD" LISTINGS AND THEIR POSSIBLE MUSCULAR ASSOCIATIONS	40
Questions and Answers	42
MUSCULAR INSIGHT FROM THE SCOLIOSIS	45
NOTES	52
IN CONCLUSION	53
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FORWARD
The muscles of the spine have been an enigma for the Chiropractor for these last 100 years.  Muscle palpation has been used more or less intuitively by the field clinician throughout our history.  Only within the past 20 years has there been a serious attempt to document the relationship between muscular patterns of activity and the vertebral subluxation. 
Dr. Spano has here shared invaluable information concerning the art of analyzing the subluxation complex "What we do" in our offices everyday has been further described, allowing for more accuracy.  It is no longer necessary to use a hit or miss approach for the correction of misalignments of the spine.  The result is a method of analyzing the spine that has surpassed other forms of spinal examination in its specificity, safety and simplicity.  No one is suggesting that we replace x-ray examination or newer and promising methods of imaging technologies; only that the muscles may give us the day to day feedback necessary to administer a specific Chiropractic adjustment for the needs of ongoing care. 
My personal experience with muscle palpation has been one of increasing satisfaction.  Clearing out the spine is fun and easy.  Misalignments are easily detectable with this work.  The basics should be listing a subluxation; it should be like catching a fly ball in baseball for the whole profession.  Unfortunately, this has not been so. . . until now!  Dr. Spano gives you the basics. 
Move over motion palpation - Advanced Muscle Palpation is simpler, reliable and does not depend on the complexities of segmental movement patterns or patient cooperation. 
The fixation implicit in subluxation produces an inability for the vertebral motor units to keep in step with surrounding vertebrae.  Movement produces posture.  Posture infers position.  Misalignment is a clinical reality that represents this inability of the vertebra to come to rest naturally in any given posture.  Muscles, as stated by Dr Spano, are the only active defenders of proper joint position . . and the muscles are our greatest allies in locating the vertebral subluxation. 
Until you have used Advanced Muscle Palpation and therefore this manual, I have a feeling that you probably don’t yet appreciate what you have in your hands. 
  <DIV ALIGN=right>- Dr. Edward Hartey
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PREFACE
  
Muscle palpation is an art for use as an analytical tool within Chiropractic. It is a beneficial indicator by which to establish a criterion for the adjustment of vertebral subluxations. 
Here I have attempted to capture a basis of ideas and description for a fundamental understanding from where the student may radiate. This collection of material may serve only to invest a "feeling" or primary understanding of muscle palpation and cannot credibly be used to substantiate a working knowledge for practical use. Only empirical training and "hands on" diligence can properly embody an operative and effective (most of all safe) knowledge for analysis. 
Each framework is unique, each muscle is unique, each subluxation is unique and each palpation must be unique and with relative impression by the student doctor. 
Build stability within your frame of reference to the patient; use your imagination to picture the following myology (and the sensation descriptions of the muscles), and then give that picture dimension with practice, practice, practice!!!  
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 SIMPLIFIED LISTINGS DERIVED FROM MUSCULAR TENSION
PRIVATE "TYPE=PICT;ALT=Suboccipital muscles"Integration of paravertebral muscular reflex action into your assessment of the misalignment should allow you more consistent, and accurate analytical conclusions.  Conversely, muscles that "present" themselves for analytical interpretation, while offering a listing derived from an inherent biomechanical vantage, often produce a simplified directional listing code.  Serving as examples below are hypothetical muscular findings that would be extrapolated into the subsequent listings.  For example, perhaps only one major muscle is accessible. Note that these muscles only yield a partial listing; but one that still allows a more precise line of drive than is often possible without such information. 
Examples of Working Muscles and Subsequent Listings
- Among the upper cervical muscles only the left Superior Oblique and the First Branch Levator Scapula on the right are established as working. 
Indications - right laterality of the atlas while the left superior articulating facet is displaced anteriorward, relative to the matching left occipital condyle, which is posterior. 
- After any C-1 involvement has been ruled out or corrected let us assume your findings include left Rectus Capitis Posterior Major working action.  Perhaps the Second Branch Levator Scapula does not give any sure indications, but the S.C.M. is also subtly active on the left. 
Indications - posterior misalignment of the axis vertebra with spinous deviation to the right; possible posterior mastoid on the left due to head rotation subsequent to the axis misalignment. 
- A Multifidus is displaying an increase in tension and interpreted as working at the T-2 level on the right. 
Indications - possible posterior misalignment of T-2 with spinous displacement to the left. 
- A working Erector Spinae band is apparent over the left Illiac crest.  The sacrum may be involved, as attached guarding muscles are also palpated, consistent with a shift of the Sacral apex to the right. 
Indications - the Pelvic misalignment would be addressed first as it may also be the cause of the seeming Sacral activity. The working Erector Spinae would indicate possible posterity and inferiority of the posterior superior Illiac spine. Once the Pelvis has been adjusted, the Sacrum can be reevaluated.  
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Listening in on Inside Information
PRIVATE "TYPE=PICT;ALT=Lateral Suboccipital muscles"The protection of the central nervous system by osseous strutuces such as the skull and vertebrae suggest its importance to the organism. It is no surprise then that the vertebrae are knit together by many tough ligamentous structures and stabilized by hundreds of small muscles. 
The muscles which attach directly to the vertebral processes are stretch sensitive due to their inherent muscle spindles and sensory innervation. The mechanism which causes the muscle to respond is called the stretch reflex, i.e. misalignment occurs, the central nervous is system informed and consequently commands contraction of the stretched muscle or muscles. These muscles are attempting then to correct the misalignment by pulling toward the proper positioning of the joints. The method of analysis of these muscles is palpation. Palpation is both natural and convenient as the Chiropractor uses his hands for survey and evaluation of the musculature. 
Here a muscle is said to be working if it exhibits increased tension
comparable to the muscles surrounding the vertebra, (particularly identical muscles). There is no sound pathological explanation for a muscle to "spasm" on segmental level while other surrounding muscles are not similarly affected. 
There are those that simplictically propose that the subluxated vertebra causes the "spastic" muscle and it is this which in turn holds the vertebra out of place. Now spasm can and does occur in the postural muscles and can affect vertebral placement but does not occur segmentally. In fact, muscular tension (above that of normal tone), can be due to a number of things, such as emotional strain, guarding spasm the torticollis of whiplash), fatigue, etc., but all of these things, including Vertebral Subluxation, cause increased muscular tension in more than just one tiny muscle. A region of muscles could be affected or a relay of muscle bands; but the independent action of one muscle band upon the individual process of a vertebra is a phenomenon which is clearly physiologic in nature and should be interpreted by the Chiropractor as a healthy or positive action or defense mechanism (at least). The purely mechanical imbalance of muscle lengths (due to a long standing Vertebral Subluxation), may contribute to the chronic fixation, only in that the apparent "adapted:" length of the fibers may cause instability upon correction of the misalignment. 
As the body tries to accomplish the correction of a Vertebral Subluxation by the action of specific vertebral muscles, the tone of those same muscles will be increased above the "normal" tone of the surrounding musculature. The correction of the misalignment may occur, either by the natural introduction of force as the spine is moved through the normal range of motion during daily activity of the patient or as the result of an adjustive force introduced by the Chiropractor. In both circumstances it is ultimately the body of the patient which determines how normal juxtapositioning occurs. The muscles are only one gauge of correct joint position. Tendons, ligamentous structures, joint capsules, cartilage and osseous structure inherently determine juxtaposition by their size, position and anatomical construction. Structures such as the joint capsule, rich in sensory receptors, feed joint-position information to the brain. And it is the brain and spinal cord that ultimately decide where the vertebra was designed to be or what is the best position of the vertebra in relation to the surrounding vertebrae (with structural and functional (considerations). 
  PRIVATE "TYPE=PICT;ALT=Erector spinae"
Kinesthetic, proprioceptive and equilibrating receptors feed the necessary sensory information to the brain, which pools the data and then instantly determines the appropriate muscular response.  And it is the muscles that are actively utilized to perform and guard such positioning.  Using palpation we can "intercept" the resulting commands and be the beneficiaries of the brain’s knowledge of its own biomechanical needs. 
The tone of these muscles is available (by palpation) information about the position of the vertebrae and the intentions of the nervous system. The vertebral muscles are "working" for the correction of the subluxation and therefore telegraphing information to the Chiropractor.  Palpation reveals the location of the working muscles which in turn describe the position of the subluxated vertebra and subsequent line of correction, (surpassing our crude attempts to collect data concerning the Vertebral Subluxation without the information from muscle palpation).  The Chiropractor interprets the intentions of a working muscle, i.e. what direction can these muscles be pulling and what is the basic line of correction of the misalignment. 
THE WORKING MUSCLE
  
Generally stated, a working muscle is more "active" and maintains a subtle disposition of contracted fibers. The working muscle can often be discriminated by comparison to its counterpart, contralaterally. There can be noted an asymmetry and moderation of the tensile consistency; the working muscle being the more resilient or renitent in character.  It may not be a marked difference, and therefore difficult to discriminate. 
A simple illustration is that of the rubber band felt through a piece of paper (though this is far from accurate).  To the novice this sensation is more accurately felt by raising the corner of the mouth in a slight smile and palpating the teeth through the working muscles and succeedingly relaxing the mouth and palpating to differentiate the non-working sensation.  The working muscle is perceptible as a portion of its fibers having definition and tissue density within its slender bands.  Again, this is often a subtle sensation and palpation practice is essential to refine the tactile senses of the student.  
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 THE MUSCLE LAYERS OF THE SPINAL COLUMN
PRIVATE "TYPE=PICT;ALT=Muscle layers"There are five layers of overlying muscles covering the bones of the spine.  These interlacing and overlying muscles vary in size and direction, complicating our analysis.  Furthermore, the majority of muscles that are useful for listing interpretation are deep within the spinal muscles and relatively small and thin. 
This does not necessitate a heavy touch, on the contrary; a fine variation of fibers is indicative of the working muscle and a light palpation pressure on the surface of these layers yields the clearest touch perception.  Directly, this subtle "inconsistency" within the muscle layers is the means of recognition of a working muscle. 
In realizing the muscle stratification of the spine, it becomes evident that the student must be familiar with the sensation involved with each area of the spine to be studied.  Only his intimate acquaintance with the palpation of each region will allow the student to distinguish a variation in the issues or more specifically a contrasting working muscle. 
  
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