Lecture #21: OMM Lab #33 Prep Lecture - Palpation of the Cranial Strain Patterns, Condylar Decompression and Lifts

What are the physiologic cranial strain patterns?

Flexion, extension, torsion, and sidebending & rotation are physiologic cranial strain patterns.

What are the nonphysiologic cranial strain patterns?

Lateral strain, superior vertical shear, inferior vertical shear, and sphenobasilar synchondrosis (SBS) compression are nonphysiologic strain patterns.

What axes are involved in cranial flexion?

Flexion occurs around 2 transverse axes. The sphenoid and occiput move around their respective transverse axes in opposite directions.

What is the air-hand motion for cranial flexion?

The operator's fingers move toward the feet, the palms move laterally, and the fingers spread apart.

What axes are involved in cranial extension?

Extension occurs around 2 transverse axes. The sphenoid and occiput move around their respective transverse axes in opposite directions.

What is the air-hand motion for cranial extension?

The operator's hands move cephalad, the palms move medially, and the fingers move slightly together.

What axis is involved in a torsion?

A torsion occurs around 1 anterior-posterior (A/P) axis. The sphenoid and occiput rotate in opposite directions around this axis.

How is a cranial torsion named?

A torsion is named for the side on which the greater wing of the sphenoid moves cephalad.

What is the air-hand motion for a torsion?

The hands rotate in opposite directions, with the hand rotating cephalad on the side where the greater wing of the sphenoid moves cephalad.

What axes are involved in sidebending & rotation?

Sidebending & rotation occurs around 2 parallel vertical axes and 1 A/P axis.

How do the sphenoid and occiput move during sidebending & rotation?

During sidebending, they move in opposite directions around parallel vertical axes. During rotation, they move in the same direction around the A/P axis.

What is the air-hand motion on the convex side of sidebending & rotation?

On the side of convexity, which is the direction of rotation, the hand moves caudally and the fingers spread apart.

What is the air-hand motion on the concave side of sidebending & rotation?

On the side of concavity, the hand moves cephalad and the fingers approximate.

What axes are involved in a lateral strain?

A lateral strain occurs around 2 parallel vertical axes, with the sphenoid and occiput moving around the vertical axes in the same direction.

How is a lateral strain named?

A lateral strain is named for the side toward which the 5th fingers, or pinkies, move.

What is the air-hand motion for a lateral strain?

The index fingers move in the direction of the greater wing of the sphenoid while the 5th fingers move toward the opposite side.

What axes are involved in a superior vertical shear?

A superior vertical shear occurs around 2 transverse axes. The sphenoid and occiput move around the transverse axes in the same direction.

What is the air-hand motion for a superior vertical shear?

The fingers point downward toward the feet and the hands rotate anteriorly.

What axes are involved in an inferior vertical shear?

An inferior vertical shear occurs around 2 transverse axes. The sphenoid and occiput move around the transverse axes in the same direction.

What is the air-hand motion for an inferior vertical shear?

The fingers point upward toward the head and the hands rotate posteriorly.

How many axes are involved in SBS compression?

There are no axes of motion in sphenobasilar synchondrosis compression.

What does SBS compression feel like with the air-hand model?

It may feel rock-hard like a bowling ball or may feel as though all of the cranial patterns are occurring at once.

Which strain patterns use 2 transverse axes but differ in relative motion?

Flexion and extension use 2 transverse axes with the sphenoid and occiput moving in opposite directions. Superior and inferior vertical shears also use 2 transverse axes, but the sphenoid and occiput move in the same direction.

Which strain pattern uses a single A/P axis?

Torsion uses 1 A/P axis, with the sphenoid and occiput moving in opposite directions around that axis.

What are major indications for Osteopathic Cranial Manipulative Medicine?

Indications include headaches, whiplash injuries, post-concussive syndromes/traumatic brain injury, vertigo, tinnitus, cranial neuropathy or nerve entrapment, trigeminal neuralgia, Bell's palsy, otitis media, TMJ dysfunction, malocclusion, sinusitis, colic, plagiocephaly, and feeding difficulties.

What are absolute contraindications to Osteopathic Cranial Manipulative Medicine listed in the lecture?

Lack of patient consent, absence of somatic dysfunction, acute intracranial bleeding or hemorrhage (CVA), and acute skull fracture are listed as absolute contraindications. Certain seizure states are listed with a note that they are relative.

What are the relative contraindications to Osteopathic Cranial Manipulative Medicine?

Coagulopathies, a space-occupying lesion in the cranium, and increased intracranial pressure are relative contraindications.

What are the major cranial techniques emphasized in this lecture?

Condylar decompression, frontal lift, parietal lift, zygomatic lift, and nasion spread.

What type of technique is condylar decompression?

Condylar decompression, also called decompression of the occipital condyles, is a direct technique.

What is the key landmark for condylar decompression?

The suboccipital sulcus is the key landmark identified for condylar decompression.

What are clinical indications for condylar decompression?

The lecture lists headache, suckling issues, colic, neck pain, and low back pain as clinical indications.

What landmarks are used for Frontal Lift Version 1?

The contacts are superior to the frontozygomatic suture and anterior to the coronal suture.

What are clinical indications for the frontal lift?

Indications include frontal sinusitis/congestion, ethmoid bone restriction because the dura attaches to the crista galli, headaches, trauma, concussions, eye complaints, frontal lobe mood/executive function concerns, and smell-related concerns.

Why may freedom of the ethmoid notch be clinically important?

Ethmoid notch freedom may affect effective function of the ethmoid's cribriform plate and healthy drainage of the frontal and ethmoid sinuses.

What are the landmarks for the nasion spread?

The nasal and frontal bones are the landmarks. If the operator moves too far laterally, the contact will be on the frontal processes of the maxillae.

What are clinical indications for the nasion spread?

Indications include frontal sinusitis, postnasal drip, history of trauma, headaches, concussion, vision/eye complaints, sacral somatic dysfunction via dural connections to the ethmoid, and anosmia, hyposmia, or parosmia.

What important relationship does the nasion have to the ethmoid?

The ethmoid bone lies deep to the nasion, contributing to the rationale for using the nasion spread for frontal/ethmoid-related dysfunction.

What important structures cross near the asterion?

The transverse sinus and tentorium cerebelli cross near the asterion, an important relationship emphasized with the parietal lift.

What are the landmarks for the parietal lift?

Key sutural landmarks are the coronal, squamous, and lambdoid sutures and the asterion. Relevant bones are the frontal, parietal, temporal, and occipital bones.

What are clinical indications for the parietal lift?

Indications include parietal restrictions involved in headaches, facial and venous sinus issues, and developmental abnormalities in patients of all ages.

Why is normal motion of the facial bones important for the sinuses?

The physiology of the nasopharyngeal region depends partly on motion within the facial bones. Exchange of air in the sinuses and drainage of secretions depend on normal movement of the facial mechanism.

Why is the maxillary sinus particularly susceptible to sinusitis?

The maxillary sinus is the most common site of sinusitis because its opening is located high on the medial side wall of the sinus.

What is the axis of motion of the maxilla?

The maxilla has a vertically oriented, oblique axis that passes through the frontal process and through the body of the maxilla.

How does the maxilla move during inhalation?

During inhalation, the midline of the face moves posteriorly while the lateral portions of the maxillae move laterally.

How does the zygoma move during inhalation?

The zygoma moves around an oblique axis influenced by the greater wing of the sphenoid. Its medial border moves medially during inhalation.

How does zygomatic motion affect the maxillary sinus?

Medial movement of the zygoma during inhalation assists with "pumping" the antrum of the maxilla.

What produces the pump of the maxillary sinus?

The pump of the maxillary sinus is produced by the conflicting movement between the maxilla and zygoma.

What are the landmarks for the zygomatic lift?

The landmarks are the zygomaticotemporal suture, with the contact anterior to it, and the zygomatic-maxillary (zyg-max) suture.

What are clinical indications for the zygomatic lift?

Indications include maxillary sinusitis, vision concerns, dental concerns, trauma, headaches, and temporal disorders.

What cranial landmarks should be especially recognized from this lecture?

High-yield landmarks include the nasion, glabella, bregma, lambda, asterion, greater and lesser wings of the sphenoid, mastoid process, inion, nuchal lines, zygomatic arch, and major cranial sutures.

Which major sutures are emphasized for cranial landmark identification?

Coronal, sagittal, lambdoid, squamous, frontonasal, occipitomastoid, zygomatic arch-related articulations, and the frontal-lesser wing of sphenoid articulation are emphasized.