2014 UAAO Forum 10-18-11 Intro to Cranial Osteopathy

Vault Hold 1. Patient supine, physician seated at head of the table 2. Your patient should slide caudad enough so you can rest your forearms on the table 3. Place fingers as follows: A. Index fingers on greater wings of the sphenoid B. Middle fingers on zygomatic processes C. Ring fingers on mastoid processes D. Little fingers on the occiput

Fronto-occipital Hold 1. Patient supine and physician at head of table, seated towards corner if more comfortable 2. Caudad hand is placed under the occiput, allowing your forearm to rest on the table 3. Thumb and pointer finger (or middle finger if you cant reach) on the greater wings of the sphenoid

Using the Vault Hold, you will have to demonstrate physiologic (normal) and pathologic (abnormal) strain patterns. Practice these motions with your hands as much as possible, so when the test questions come youll have all the answers. Physiologic Strain Patterns (Flexion/Extension, Torsions, Side-bending/Rotation)

Flexion/Extension
Number of Axes Type of Axes Naming Finger motion Two axes Two parallel transverse axes Sphenoid motion into flexion (anterior rotation) or extension (posterior rotation) Flexion: both hands widen and drop/move inferior Extension: both hands approximate and move superior

Torsions
Number of Axes Type of Axes Naming Finger motion One AP axis (anterior to posterior) Side of higher greater wing of the sphenoid (left or right) Sphenoid and occiput rotate in opposite directions on single AP axis Index finger on same side of torsion moves superior (torsion named for side of more superior greater wing of sphenoid) as index finger on opposite side moves inferior Pinky finger on same side of torsion moves inferior (as occiput rotates opposite of sphenoid) and pinky finger on opposite side moves superior

Left Torsion R-GWS: Inferior R-O: Superior L-GWS:Superior L-O: Inferior

Right Torsion R-GWS: Superior R-O: Inferior L-GWS: Inferior L-O: Superior

Sidebending/Rotation
Number of Axes Three total Sidebending two axes Rotation one axis Sidebending two vertical axes (one through foramen magnum and one through body of sphenoid, sphenoid and occiput rotate opposite about the vertical axes) Rotation one AP axis (Sphenoid and occiput rotate in same direction on this one) Side of convexity (the side that drops, or feels fuller in your hand) One hand feels approximation of fingers while the other hand (on side of convexity) feels widening Rotation is felt as the approximated hand moves superior and the spread hand moves caudad Hand should feel fuller on side of convexity

Type of Axes

Naming Finger motion

LEFT SIDEBEN DING

RIGHT SIDEBEND ING

Pathologic Strain Patterns (Vertical Strains, Lateral Strains, Sphenobasilar Compression) Vertical Strains/Shears
Number of Axes Type of Axes Naming Finger motion Two Two parallel transverse axes Position of sphenoid base in relation to occiput (superior or inferior) Superior vertical strain (hands tip forward) forefingers of both hands move inferiorly (sphenoid base moves superior so greater wings move inferior) little fingers of both hands move superiorly Inferior vertical strain (hands tip backward) forefingers of both hands move superiorly (sphenoid base moves inferior so greater wings move superior) little fingers of both hands move inferiorly Superior Inferior
R-GWS: Inferior R-O: Superior L-GWS:Inferior L-O: Superior R-GWS: Superior R-O: Inferior L-GWS: Superior L-O: Inferior

Lateral Strains (Parallelogram)

Number of Axes Type of Axes Naming Two Two parallel vertical axes (one through sphenoid, one through foramen magnum; sphenoid and occiput rotate in same direction) BASE of sphenoid, so as the sphenoid base moves toward the lateral strain side your forefingers on the greater wing actually point to the OPPOSITE side!!! In left lateral strain: forefingers shift lateral to the right (sphenoid base turns to the left), and the little fingers shift to the left (occipital base turns to the right) In right lateral strain: forefingers shift lateral to the left (sphenoid base turns to the right), and the little fingers shift to the right (occipital base turns to the left)
Left Lateral Strain R-GWS: Post/Lat R-O: Post/Med L-GWS: Ant/Med L-O: Ant/Lat Right Lateral Strain R-GWS: Ant/Med R-O: Ant/Lat L-GWS: Post/Lat L-O: Post/Med

Finger motion (parallelogram)

Also hand on same side of strain moves slightly anterior

SBS Compression
Compression of the sphenoid and occiput at the SBS junction = Bowling Ball Head (Caused by Trauma or Severe Depression)

Questions for Thought:

Who came up with Osteopathy in the Cranial Field? William Garner Sutherland, DO What are the five body components of PRM (primary respiratory mechanism)? 1. The inherent motility of the brain and spinal cord 2. Fluctuation of the cerebrospinal fluid 3. Mobility of the intracranial and intraspinal membranes 4. Articular mobility of the cranial bones 5. The involuntary mobility of the sacrum between the ilia (pelvic bones) What is the normal CRI (cranial rhythmic impulse) range? *board question* 8-12 respirations/minute What is the main reference point for all cranial strain patterns? Sphenobasilar junction During cranial flexion, which way do the temporal bones move? All paired bones move into external rotation during cranial flexion, so the temporal bones would externally rotate. Paired bones internally rotate during cranial extension. During cranial extension, which way does the sacrum move? Anteroinferiorly, or flexion, because the sacrum moves in the same direction as the occiput. During cranial extension, the sphenoid extends backward and the occiput flexes forward why you feel your fingers approximate. All midline bones will flex or extend, as opposed to paired bones which externally or internally rotate. Name a physiologic strain pattern. torsion, sidebending and rotation, and fixed (flexion and extension) Name a pathologic strain pattern. Compression, vertical strains, and lateral strains. May be secondary to head trauma, birth trauma, dental procedures, inferior musculoskeletal stress and dysfunction, and postural abnormalities Your patient has an increased CRI rate, what could have caused this? Fast metabolism or acute infection. Slow metabolism, chronic infection, or fatigue could have decreased CRI rate. Your patient has a decreased amplitude in their CRI, what could have caused this? Dural tension or SBS compression. Increased ICP would increase amplitude of the CRI. If you have a Right Sidebending Rotation dysfunction, what axis/axes does the sidebending occur on? 2 vertical axes. For the sidebending component, the sphenoid and occiput rotate on two parallel axes (one through the center of the body of the sphenoid and one at the foramen magnum) in opposite directions to create convex/concave sides. You diagnose a Left Lateral strain, in which direction are your index fingers pointing? Right. This strain pattern is named for the direction of the base of the sphenoid. Therefore, as the base of the sphenoid moves to the left, the greater wings move towards the right (what your index fingers are monitoring). At which level does the cranial axis pass through the sacrum? S2. This is the level of the superior transverse axis of the sacrum. What are contraindications to Cranial treatments? Increased ICP, intracranial hemorrhage, cranial aneurysms, tumors, and skull fractures. How would you perform Indirect or direct treatment once you find a strain pattern? Indirect: Follow the strain in the direction it wants to go Direct: Move your hands opposite the way it wants to go References: N&N, lecture ppt