What are the muscles that are interacting with the dura?
Muscles of the suboccipital triangle have MYODURAL bridges and interact with the dura
What are the muscles of the suboccipital ms?
Obliquus Capitis Superior m., Rectus Capitis Major m., Rectus Capitis Minor m., Obliquus Capitils Inferior M.
Motion of unpaired bones
The tentorium cerebri is tightly attached at the petrosal ridge, therefore if the Temporal Bone is Externally rotated this will cause pressures on the structures deep to the tentorium
Motion of the Ethmoid during Flexion and Extension
Ethmoid moves in same direction as the occiput, during Flexion the crista galli move superiorly and posteriorly, opposite motion during Extension
Dysfunction of the Ethmoid
HA from increased dural tension and vascular effects
Motion of other bones
Interpalatine suture will move inferiorly with vomer and maxillae
The palatines will move in external rotation primarily
Dysfunction of the Vomer
the position of the sphenoid
• Trauma to the face
• May contribute to nasal edema, therefore may influence sinuses
What are the 5 bones the Parietal bone articulates with?
Occiput, Frontal, Sphenoid, Temporal and Opposite Parietal
What are the five bones the Vomer articulates with?
Maxilla, palantines, sphenoid, ethmoid, nasal septum (cartilage)
What is the only bone that contacts all 4 fontanelles?
The parietal bone!
Flexion = “External Rotation”
Sagittal articulation moves inferiorly
Temporal articulation moves laterally
Cranium widens laterally
Sagittal articulation moves superiorly
Temporal articulation moves medially
Cranium narrows laterally
parietal bone axes
Parietal has bevels at sagittal and lambdoidal sutures which makes an Anterior Posterior Axes
Clinical Associations with Parietal Bone
- Cranial synostosis: premature closure
- Head Pain often Tenion HA (temporal muscle SD, parietosquamosal or P-sphnoid issues)
- Middle Meningeal A. ( trauma/ Giant cell arteritis)
Temporal bone motion
Main Motion is Considered ROTATION around an Axis just inferior to petrous ridge
“External Rotation” in “cranial flexion” and Mastoid Process will move Medial
Additionally, as the SBS rises, the axis tilts, creating concomitant temporal flexion
“Internal Rotation” in “cranial extension” and Mastoid Process will move Lateral
Additionally, as the SBS rises, the axis tilts, creating concomitant temporal extension
Clinical Associations with Temporal Bone
- Neck and Head Pain
- Ear Infection
- Swallowing and Chewing
- Tinnitis & Eustachian tube dysfunction
- Bell’s Palsy association- CNVII
Axis (flexes as if still 2 bones)
Metopic Suit has hinge-like action
Horizontal plane motion, vertical axis, from center of orbital roof through frontal eminence Motion
“External rotation” (during SBS flexion): Lateral side moves anterior/lateral and slightly inferior, glabella moves posteriorly
“Internal rotation” (during SBS extension): Lateral side moves Posterior/medial and slightly superior, glabella moves anteriorly
Clinical Associations with Fontal Bone
- Focal Head Pain Along suture
- Global Head Pain due to primary dimished CSF flow due to inc. dural tension at cribriform plate
- Fontalis M.
- Visual Problems
Normal SBS Flexion/Extension:
Air Hands Flexion: fingers spread apart on both hands
Air Hands Extension: Fingers approximate and Move Towards you
Lateral Strain (Sidey Sidey)
Axes = 2 Superior/Inferior Axes move in SAME direction
Plane = Transverse Plane
Named for the direction of the shift of the Base of the Sphenoid in relation to the occiput
SBS Right Lateral Strain: Index finger Pads move to the Left and the Pinky fingers move to the Right
SBS Left Lateral Strain: Index finger Pads move to the Right and the Pinky fingers move to the Left
Dysf. Cause: Hits to side of head behind/in front of SBS
Vertical Strain (Upey-Downey)
Axes = 2 Transverse (Right/Left) Axes move SAME direction
Plane = Sagittal Plane
Named for Base of the Sphenoid
Superior Ventrical Strain 1st Fingers move inferiorly and Pinky Fingers Move Superiorly
Inferior Ventrical Strain 1st Fingers move superiorly and Pinky Fingers Move Inferiorly
Dysf. Cause: Hits Up or down behind/in front of SBS
Axis = 1 Anterior/Posterior Axis Rotate in OPPOSITE directions
Plane = Coronal
Named for the More Superior Greater Wing of the Sphenoid
Right SBS Torsion Finger Pads of Right hand move superior and Left Finger Pads Move Inferiorly
Left SBS Torsion Finger Pads of Left hand move superior and Right Finger Pads Move Inferiorly
Dysf. Hit w/ a roll
Axes = 2 superior/inferior (parallel vertical) Axes move in OPPOSITE directions
One axis through the body of the sphenoid
One axis through the foramen magnum
= 1 Anterior/Posterior Axis Rotate in SAME direction
Named for Fuller Side/Convexity formed at the sphenobasilar synchrondrosis
Right Sidebending Roation Fullness on the Right index and pinky move away while Left Finger Pads Approximate
Left Sidebending Roation Fullness on the Left index and pinky move away while Right Finger Pads Approximate
Dysf. Cause: Blow to Ear
Axis = Anterior Posterior Axis
Feel lack of movement
Dysf. Cause: SBS compressed
B/w the occiput and the mastoid portion of the temporal bone
Where is the Bregma (old ant. fontanelle) suture?
Suture between the two parietal and the frontal bone fuse
Pterion is the sphenoid where the parietal and frontal bones come together with the temporal bone, 4.
Lamda suture ((old post. fontanelle)?
Lambda is the area where the parietal bones and occiput
Asterion is where the occiput, parietal and parietal bones meet
B/w Parietal and occipital bones
b/w frontal and parietal bones
Between the two parietal bones
- Index fingers rest on the greater sphenoid, just posterior to the frontozygomatic suture
- Middle finger are anterior to the ear
- Ring Finger rest on the mastoid process
- Pinky finger rest or reaches back to the occiput
- Palms may very lightly rest on the parietals
- Thumbs may gently contact the frontal, hover above or rest contacting your own 2nd MCP
Frontal Occipital Contact
Posterior Occipital hand
• Rest upon the table cradling patient’s head and occiput
Anterior Contact Frontal Hand
• Thumb pad on one of greater sphenoid wing, just inferior to the frontozygomatic suture
• Index or middle finger on the other greater sphenoid wing
• Palm rests on the anterior aspect of the frontal bone
- Thumbs rest on the wings of the greater sphenoid, just inferior to the frontozygomatic suture
- Index fingers rest on the mastoid processes
- Middle to pinky fingers rest on the occiput with middle finger posterior to OM suture
- Palms cup the occiput and posterior aspects of the parietals
have patient clench jaw closed
-evaluates function of temporalis, masseter, and medial pterygoid
have patient open mouth slowly, note deviation
- C shape -unilateral problem, deviates toward side of dysfunction
- S shape deviation - bilateral
- Have patient retract ad protrude mandible
- have patient move jaw laterally and forward on each side (moving to the RIGHT and foward evaluates left medial nad lateral pterygoid; moving to the LEFT and forward = right medial and lateral pterygoid
- have patient depress jaw against mild resistance - digastric and suprahyoid muscles
FPR Faciliated Positional Release
. Neutralize the sagittal plane curves (lordosis/kyphosis)
- Facilitating Force compression/traction/torsion
- Place in an indirect position 3 plane positioning (shifted neutral)
- Hold for 3-5 seconds
- Release, return to neutral, Reassess
Indirect to Direct (end position is Direct)
1. initial treatment position: Indirect Postion
2. Add localizing force ≤ 5lbs of compression or traction
3. Move through restrictive barrier while maintaining force
4. final treatment position at Attained anatomical barrier
5. Return to neutral Reassess tart
BLT Balanced Ligmentous Tension
Place in Position of Ease
Activating force is Breathing
Who created Cranial manipulation?
. William Sutherland, why?
b. looked at disarticulated skull and believed that there should be motion here and therefore there could be SD causing people issues
What two techniques does Cranial use?
Primary Respiratory mechanism and Balanced Membranous Tension
What did he think the skull sutures looked like, why do we care?
though gills of a fish, meaning should have a primary respiratory movement they are not fully fused, Bull shit!!
What is the current view as to what is causing the fluctuation of the CSF?
Caused by the tension put on the dura matter between the cranium and sacrum, What is the wave of blood flow in Brain called?
b. Traube Hering Wave, what cells are responsible for supporting cranial motion b/c of blood flow?
c. Glial Cells
What is the cranial rhythmic impulse (CRI)?
fluxation of CSF, how often?
b. Rate 10-14 cycles/minute, range 6-14, argued still how many bloody waves
What is the contact of the hand to feel the CRI?
contact of hand is very light, feather on the head, hair, skin sub q tissue bone, separated from Respiratory
What can Somatic dysfunction do the CRI?
diminish amplitude, and cause asymmetric direction, decrease in strength
What is the normal direction? (cranial)
What is the Sutherland fulcrum?
Name for Straight sinus, flax cerebri and tentorium cerebelli meet, what does this create?
b. Reciprocal tension membrane (RTM) cranium connecting to sacrum, between menegies and sacrum, the CORE Link
What are the 5 motion Characteristics of the CRI? (Remember RRADS)? Fellow Told me this was ask b/f!
R Rate = Usually 10-14 bpm, also seen 10-12? Who the F knows! They cannot bloody agree!!!
Rhythm = steady vs irregular , Ocean tide, some variation normal
Amplitude = Small or large motion Significant SD can Diminish this
Direction= Equal or asymmetrical throughout, Normal Longitudinal
Strength = Force of the motion, Significant SDF
What is the fascia we are talking about? (Cranial)
. Meningeal fascia
What does the RTM do?
. allows for movement, but limits it
What is the anterior/superior pole of attachment of the RTM?What is the anterior/superior pole of attachment of the RTM?
Crista Galli, Anterior/inferior?
b. Clinoid process of Sphenoid, lateral?
c. Mastoid angles of parietals and petrous ridge of the temporal bone, posterior?
d. Internal occipital protuberance and transverse ridges
Where is the Sphenoid bone?
behind the ridge of the lateral orbit, important b/c positioning
What is the sphenobasilar symphysis (SBS)?
. is where the basisphenoid & the basiocciput join to form a synchondrosis, what is a synchondrosis?
b. A synchondrosis is an almost immovable joint between bones bound by a layer of cartilage
Flexion of the SBS joint SBS rises ________ as the distance __________ between the inferior angles of the sphenoid and the occiput.
a. Flexion of the SBs joint SBS rises SUPERIORLY as the distance DECREASES between the inferior angles of the sphenoid and the occiput, flexion is paired with what motion?
b. Inhalation, Angle gets increasing inferior (this is Ernie or Stewie)
Extension of the SBS joint SBS moves _______ as the distance _______ between the inferior angles of the sphenoid and occiput.
a. Extension of the SBS joint SBS moves INFERIORLY as the distance INCREASES between the inferior angles of the sphenoid and occiput, extension is paired with what motion?
b. Exhalation, Angle gets decreasingly inferior, who is extension?
c. Bert or Brian impt. b/c people die with exhalation, thought this is bad?
The sphenoid, occiput, ethmoid and vomer have what axis of rotation?
a. transverse Axis of rotation
What bones of the Cranial Vault rotate externally?
Frontals – Parietals – Temporals • Face - Rotate “Externally” – Maxilla, – Palatines – Zygomae
. Where does the spinal dura start and end?
a. Starts at foramen magnum and ends at S2
. SBS Extension is paired with Sacral?
a. Sacral Nodding towards the NUTS!, i.e. sacral base moves anteriorly Remember Extension is NUTS!!!, flexion?
b. Counternutation, i.e. sacral base moves posteriorly, Flexion is Not Nuts!!!
. What direction do the wing of the sphenoid bone move with Cranial Sacral Flexion or SBS flexion?
. Greater wing moves inferiorly and anteriorly, extension?
b. opposite moves superiorly and posteriorly
Through what foramen do each of the cranial nerves exit the cranial vault? (apparently he said know these)
Olfactory though Cribriform Plate
Optic though Optic Canal
Oculomotor and trochlear, Trigeminal V1, Abducens thou Superior orbital fissure
Trigeminal V2 thru Foramen Rotundum
Trigeminal V3 thru Foramen Ovale
Facial and Vestbilulochoclear thru Internal Acoustic Meatus
Facial also goes thru facial canal and stylomastoid foramen
5 Principals of PRM
1. The inherent motility mobility of the brain & spinal cord
2. The fluctuation of the CSF
3. The mobility of the intracranial and intraspinal membranes
4. The articulatory mobility of the cranial bones