The best position is to have the patient prone on the examination table with the thoracic spine preferably in slight flexion. This is achieved by lowering the top of the table.

Test passive extension of each joint with firm pressure from the pad of the thumbs or the bony hand (either the pisiform prominence or the lateral border of the fifth metacarpal). Spring up and down with a few firm oscillations, keeping the elbows straight, but being well above the patient. Ask the patient if the pressure reproduces the pain. Apart from asking the patient 'Is that the pain?' note:

• the distribution of pain and its change with movement

• the range of movement

• the type of resistance in the joint

• any muscle spasm

Palpation must follow a set plan in order to reproduce the patient's pain. The sequence is as follows:

1. Central—over spinous processes

2. Unilateral—over apophyseal joints (2-3 cm from midline)

3. Transverse—on side of spinous processes

4. Unilateral—costotransverse junctions (4-5 cm from midline)

5. Unilateral—over ribs (spring over posterior rib curve with ulnar border of hand, along axis of rib)

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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