Operator draws back slightly. The pull on the pectoral muscles lifts the ribs in front. Operator assists this action by reaching forward, slipping his fingers under the posterior angles of the ribs, his thumbs under the anterior borders, pushing down on the posterior angles and lifting up on the ribs anteriorly. While the patient is still on his back, palpate for the liver, and, if necessary, do abdominal work. Patient turns on side.
Patient lies on right side.
Operator stands facing him. Operator slips left hand under patient's head. The thumb of operator's right hand is placed against the spinous process of each vertebra in turn in order to localize the movement, while the fingers of the same hand feel for movement between that spinous process and the one below. Operator rotates patient's head slightly toward left then sidebends toward left slowly, until tension is overcome. The addition of a quick jerk now elicits a pop.