OMM3 # 16

Sidebending Rotation
Not yet reviewed
Chad McCormick for Jerry Ignatius
Thomas J. Fortopoulos, D.O.
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General Information: Dr. Fotopoulus followed his ppts., and stressed on certain points
that we should know for the exam and for future practicals. I have bolded everything
that he stressed on and that he alluded to following class. I have also added a pic that
Dr. Fotopoulus created and presented at the beginning of the 3rd hour lecture.

I.

Case Presentation (Remember this Case!!!)

A 26 y/o male presents to your clinic with severe headache not relieved by over
the counter medication for past 1-2 weeks. His family doctor referred him to a
neurologist, who found no neurological deficits. Both CT and MRI are negative for
fracture, mass lesion, AVM, or hemorrhage. Exhausting all consideration, the
neurologist refers the patient to your specialty OMM clinic. During your history,
the patient remembers a baseball game he recently played at, during which time he
suffered a blow to the left inferolateral aspect of the cranium, just behind the
mandible. You palpate the cranium and soon begin to distinguish the following
motion preference:
Right sphenoid greater wing moves inferior and anterior
Right occipital squama moves inferior and posterior
Left sphenoid greater wing moves superior and posterior
Left occipital squama moves superior and anterior
Differential Diagnosis
Right sidebending rotation (correct diagnosis)
Tension headache
Cluster headache
Vascular headache
II. Sidebending Rotation
Physiological Cranial Dysfunction (Remember that sidebending
rotation is a Physiological dysfunction)
Deviation from normal SBS Flexion and Extension

Diagnosed and described by cranial bone motion

Results from tension or trauma which restricts or diverts the arc of

SBS

A physiological adaptation to a lateral trauma exactly at the level of

the SBS inducing sidebending at the SBS with convexity to the opposite
side (eg. Force from right, convexity on left)
Can occur from birthing process

Sphenoid and occiput sidebend and rotate

For sidebending= there are TWO vertical axes
one through the foramen magnum of occiput
one through the body of the sphenoid

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Sidebending Rotation
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For rotation= there is ONE anteroposterior axis from opisthion to
nasion
For sidebending= the sphenoid and occiput rotate in opposite
directions about the vertical axes
creates convex and concave sides
For rotation= the sphenoid and occiput rotate in same direction

The rotation drops inferiorly on the side of the convexity of sidebending

The temporals follow the occiput.
Side of low occiput= temporal relatively externally rotated
Left Sidebending Rotation= left externally rotated temporal bone (relative)

Right Sidebending Rotation= right externally rotated temporal bone

(relative)

Named for the direction of rotation (the side of the

convexity). That is, for the side that drops
may be from trauma to the head or just other pulls on the body
motion of the head may alternate between neutral and the strain pattern, or
the strain pattern may be present through inhalation and exhalation phases of
primary respiration
III. Sidebending Rotation Palpatory Findings
Vault Hold

Sidebending experienced by approximating or narrowing the index and

little fingers of hand on side of concavity
Simultaneously, the other hand experiences a spreading or widening on the
side of convexity
Rotation is represented by an inferior (caudad) movement of the whole
spread hand and superior (cephalad) movement of the whole
approximated hand
In left sidebending rotation the left hand is spread wider, moves
inferior, and has an externally rotated temporal bone. The left head feels
fuller in the left hand
In right sidebending rotation the right hand is spread wider, moves
inferior, and has an externally rotated temporal bone. The right head feels
fuller in the right hand
IV. Gross Anatomical Features
All positions are relative

Anterior quadrant with superior (cephalad) greater wing of sphenoid=

external rotation

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Sidebending Rotation
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Anterior quadrant with inferior (caudad) greater wing of sphenoid=
internal rotation
Posterior quadrant with superior (cephalad) occiput= internal rotation

Posterior quadrant with inferior (caudad) occiput= external rotation

V. Specific Findings
Right Sidebending/Rotation
Right orbit narrow
Right globe retracted
Right frontal bone is flat, less full due to relative internal rotation

Right ear away from head

Right mastoid tip posteriomedial, due to right temporal bone in relative
external rotation
What your fingers will feel is:
1. Right hand will dip away and widen
2. Left hand will narrow and come up
Left Sidebending/Rotation
Left orbit narrow
Left globe retracted
Left frontal bone is flat, less full due to relative internal rotation
Left ear away from head
Left mastoid tip posteriomedial, due to left temporal bone in relative
external rotation
What your fingers will feel is:
1. Left hand will dip away and widen
2. Right hand will narrow and come up
At the beginning of the 3:00 hour Dr. Fotopoulos presented this drawing to explain the
ideas of Sidebending rotation.

Normal

Left

Right Side-bending

Right

Left
concave

Right
convex

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Sidebending Rotation
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