History And Principles Of Osteopathic Cranial manipulative Medicine (OCMM)

Question 1

What is the primary respiratory mechanism? (PRM)

Answer 1

Is the fundamental aspect of the classical cranial osteopathic model

Inherent rhythm that can be palpated on the skull and throughout the body
- Is believed to occur independently of cardiac and respiratory activity and at a slightly slower rhythm than pulmonary breathing

Question 2

What are the 5 phenomenon of osteopathic cranial manipulative medicine?

Answer 2

1) inherent rhythmic motility of the brain and spinal column
- a subtle slow pulse like movement of the cranium

2) fluctuation of the CSF
- wavelike motion of fluid in a body cavity observed by palpation or percussion
- believed to be caused by the ventricles changing shape and CSF levels fluctuates

3) mobility of intracranial and intraspinal membranes
- (reciprocal tension membrane (RTM))

4) articular mobility of the cranial bones
5) involuntary respiratory mobility of the sacrum between the ilia

Question 3

CSF production review

Answer 3

70% is produced by the choroid plexuses found in lateral/3rd and 4th ventricles

4th ventricle CSF exits from one of 2 openings

1) midline via foramen of magendie
2) lateral foramina of Luschka

Ultimately the CSF flows into the arachnoid villi which projects into the large sagittal venous sinus and into the venous system to get recycled

Question 4

What are glymphatics?

Answer 4

Cranial lymphatics

while the brain lacks histological evidence of lymphatic circulation, it is known that CSF cycles through the brain interstitial space and leaves via paravenous drainage pathways (hypothesized as glymphatics

Question 5

How does the dura mater work?

Answer 5

Lines the cranial cavity and forms the periosteal covering for inner aspect of the bones And extends through sutures of the skull to become periosteum on the outer surface of the skull.

It’s reduplications include

• the falx cerebri
• the tentorium cerebri
• the falx cerebelli

Functions to support and protect the CNS And extends from C2-S2 on the spinal cord as well

Question 6

What is the term for the dural connection of the meninges to the sacrum?

Answer 6

Core link/reciprocal tension membrane (RTM)

Question 7

How does the sacrum move based on the CSF fluctuation?

Answer 7

When CSF fluctuations and pulls on the dural membranes it can cause flexion and extension of the sacrum
- extension of sacrum with respect to cranial flexion = counternutation; flexion of sacrum with respect to cranial extension = nutation

Movement occurs around the respiratory axis (superior transverse axis) at S2.

Question 8

What is the main driving force for the primary respiratory mechanism in the head?

Answer 8

Sphenoid and occiput bones

- both bones flex (inhalation) and extend (exhalation) and spend roughly equal amount of time in each position

Question 9

How do paired and single bones move with Flexion and extension of the cranium?

Answer 9

Cranial flexion:

• paired bones = externally rotate
• single bones = flexion

Cranial exhalation:

• paired bones = internally rotate
• single bones = extension

Question 10

What is the cranial rhythmic impulse (CRI)?

Answer 10

A palpable rhythmic fluctuation that is synchronous with primary respiratory mechanisms
- has a frequency of 10-14 cycles/minute

Question 11

Common conditions treated with OCMM

Answer 11

Infections:

• otitis media
• sinusitis
• Bell’s palsy

Pain:

• tension headache
• migraine headache
• jaw pain/TMJ

Head/neck conditions:

• vertigo
• trigeminal neuralgia
• tinnitus
• cranial neuropathy

Trauma:

• birth trauma
• concussion
• MVA

Pediatrics:

• colic
• poor feeding
• plagiocephaly
• Torticollis