Cranial Somatic Dysfunction

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The OMT Cranial Somatic Dysfunction provides High Yield information that is needed for the COMLEX Level 1, 2, and 3 during Medical School.

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Cranial Basics

Components of the primary respiratory mechanism (PRM)

1. Fluctuation of the CSF.
2. Inherent Rhythm of Brain & Spinal Cord.
3. Articular Mobility of Cranial Bones.
4. Tension of Dura (Reciprocal Tension Membrane).
5. Motion of Sacrum between Ilia.

Cranial Rhythmic Impulse (CRI)

• Normal: 10-14 Cycles Per Minute.
• Factors increase the CRI
  • Vigorous Exercise
  • Systemic Fever
  • Craniosacral OMT – CV4-Bulb Decompression 
• Factors decrease the CRI
  • Stress
  • Depression
  • Chronic Fatigue
  • Chronic Infections
• Absent CRI
  • Compression

Attachment of dura

• Foramen Magnum
• C2-3
• S2

Midline cranial bones (SOVE)

• Sphenoid
• Occiput
• Vomer
• Ethmoid
• Midline Bones Motion – Flex and Extend
• Paired Bones Motion – Internal and External Rotate

Physiologic Craniosacral Somatic Dysfunction (Postural)

Flexion

• SBS – Cephalad.
• Sacrum – Extension & Counternutates.
• Inhalation.
• Paired Bones – External Rotation.
• AP diameter – Shortens.

Phantom Hands

Powellle / CC BY-SA

Powellle / CC BY-SA

Extension

• SBS – Caudad.
• Sacrum – Flexion & Nutates.
• Exhalation.
• Paired Bones – Internal Rotation.
• AP diameter – Lengthens.

Phantom Hands

Powellle / CC BY-SA

Powellle / CC BY-SA

Torsion

• Naming: Superior greater wing
• Cause: Blow from above or below on an anterior or posterior quadrant
• Rotation of Sphenoid & Occiput: Opposite.
• Axis: AP.

Phantom Hands

Hands rotate in opposite directions.

Left torsion – left index finger move superior, left pinky moves inferior, right index move inferior, pinky moves superior

Powellle / CC BY-SA

Powellle / CC BY-SA

Non-Physiologic Craniosacral Somatic Dysfunction (E.g. Car accident)

Sidebending/Rotation

• Naming: Side of convexity
• Cause: Lateral blow at the SBS
• Rotation of Sphenoid & Occiput: Same.
• Sidebending of Sphenoid & Occiput: Opposite.
• Axis: 2x Vertical & AP.

Phantom Hands

Sidebending: approximation of fingers of one hand (concave) and widening of fingers on another hand (convexity)

Rotational: inferior movement of the wider hand, superior movement of the approximated hand

Powellle / CC BY-SA

Powellle / CC BY-SA

Superior Vertical strain

• Naming: SBS (Up)
• Cause: Vertex blow posterior SBS but anterior of occiput transverse axis (or) Blow from below mouth in anterior SBS but posterior sphenoid transverse axis
• Rotation of Sphenoid & Occiput: Same.
• Axis: 2x. Transverse.

Phantom Hands

Index fingers move inferiorly to patient’s feet, pinkies move superiorly toward physician

Powellle / CC BY-SA

Powellle / CC BY-SA

Inferior Vertical strain

• Naming: SBS (Down)
• Cause: Vertex blow anterior SBS but posterior sphenoid transverse axis (or) Blow from below mandible heels posterior SBS but anterior occiput transverse axis
• Rotation of Sphenoid & Occiput: Same.
• Axis: 2x. Transverse.

Phantom Hands

Index fingers move superiorly, pinkies move inferiorly

Powellle / CC BY-SA

Powellle / CC BY-SA

Lateral strain

• Naming: SBS (Base of sphenoid)
• Cause: Lateral blow anterior or posterior to the SBS
• Rotation of Sphenoid & Occiput: Opposite.
• Axis: 2x Vertical.
• Paralellogram Head.

Phantom Hands

Left: index fingers shift right as pinkies shift left

Powellle / CC BY-SA

Powellle / CC BY-SA

Compression

• Sphenoid & Occiput are closer together.
• Due to trauma.
• (SBS – Articulation between the sphenoid and occiput.)

Phantom Hands

• No Motion

Powellle / CC BY-SA

OMT Cranial Somatic Dysfunction Treatments

Vault hold 

• Index = Wing of Sphenoid.
• Middle = Temporal Bone.
• Ring = Mastoid.
• Pinky = Squamous Portion of Occiput.
• palpate for CRI normal is 10 -14 cycles/minute

Powellle / CC BY-SA

Compression of the fourth ventricle (CV-4)

• interlace fingers to hold the occipital squama;
• thenar eminences are placed medial to the occipitomastoid sutures;
• exert a continuous medial and cephalad pressure promoting extension of SBS;
• maintain pressure until a warmth or softening is palpated

Powellle / CC BY-SA

SBS decompression

• Cup the occiput,
• bridge the frontal bone,
• during cranial flexion (inhalation) lift the sphenoid away from occiput;
• during extension (exhalation) resist sphenoid movement;
• continue until a release is palpated
• **alternative technique is to hook thumbs together and use three middle fingers to hook the sphenoid and lift

Venous Sinus Technique

• Draining lymphatics of the cranium for a patient with a headache or infection.

V-Spread treatment

• Spreads restricted sutures.