6. Osteopathic Cranial Manipulative Medicine Review

Question 1

Describe Occipital Condylar Decompression

Answer 1

Contact near to foramen and condyles
-add slight OA flexion

Gently apply traction and pull the occipital tissues in a posterior and lateral direction

Await occipital regional give and reassess

Question 2

Clinical use for Occipital Condylar Decompression

Answer 2

Poor infant feeding
Infant colic
Head/Neck pain and post trauma

Question 3

Describe CV4 Still Point Induction

Answer 3

Thenar eminences are inferior to the superior nuchal line and medial to OM sutures
-compress lateral to sutures to ensure ER of temporal

Gently encourage extension and then sequentially resist its inferior motion by not reducing pressure

Motion will get to a point where pt feels it has disappeared
-slowly release and await CRI return

Question 4

Clinical use for CV4 Still Point Induction

Answer 4

Decreased CRI
URI
Headache/Migraine

Question 5

Describe SBS decompression (indirect)

Answer 5

BMT Compression followed by release

Question 6

Describe SBS decompression (direct)

Answer 6

Gently engage the frontal bones to distract against the occiput

Pull in an anterior and slightly superior direction

Await elastic release, then reassess

Question 7

Clinical use for SBS decompression

Answer 7

Diminished CRI
Mood disorders
Cranial nerve entrapment
URI
Pediatric developmental problems

Question 8

BMT Indirect Cranial Manipulative Treatment

Answer 8

Gently exaggerate membranous asymmetry until a sense of balance is noted
-Resist any movement by CRI

Hold hand position until CRI stops at still point

Gently release forces and return to midpoint

Question 9

Clinical Use for BMT Indirect Cranial Manipulative Treatment

Answer 9

Asymmetric or diminished CRI
CN entrapment
Dural strain
Headaches

Question 10

Parietal Lift

Answer 10

Fingers on parietals, thumbs crossed behind head

Add parietal traction until superior elastic release is noted
-gently release head and reassess

Question 11

Clinical use of Parietal Lift

Answer 11

TMJ
Headaches
Decompress the Squamosal Suture

Question 12

Frontal Lift

Answer 12

Gently engage the lateral inferior edge of frontal bone by hooking under the initiation of zygomatic arch

Apply anterior force with some anterior rotation torque until release

Reassess

Question 13

Clinical use for a frontal lift?

Answer 13

Restricted frontal mobility
Augment SBS flexion
Frontal headaches
Sinus congestion
Pediatric developmental issues

Question 14

Temporal Rocking

Answer 14

Switch back and forth between external and internal rotation to encourage temporal motion

• ER: thumb and index fingers move inferomedial, 4th and 5th digits move along with superolateral motion
• IR: thumb and index fingers move superior and lateral; 4th and 5th digits move inferomedial

Slowly release and return to neutral after motion feels symmetric

Question 15

Clinical Use of Temporal Rocking

Answer 15

Eustachian Tube Dysfunction
TMJ
Bell's Palsy
Lateral Head/suture pain
Cranial torsion

Question 16

Temporal Pull

Answer 16

Use pincer grip on pinnae as close to temporal bone as possible

• Apply gentle traction laterally, posteriorly, and superior that parallels the petrous ridge
• Maintain tension on the feather’s edge until release

Question 17

Clinical use of temporal pull

Answer 17

Temporal headache
Vertigo
Tinnitus
TMJ
Balance the tentorium cerebelli

Question 18

TMJ Decompression

Answer 18

Begin with Indirect compression of mandible towards TMJ until relaxation felt

Switch to Direct at lateral mandible pushing inferior and slightly anterior until release

Retest by palpating motion at TMJ with mouth open

Question 19

Clinical Use of TMJ Compression

Answer 19

TMJ restriction
Mandible Restriction
Neck pain

Question 20

V-Spread

Answer 20

At any suture restriction, apply a spreading pressure to encourage motion

Finger pads of pressure hand are usually near the longest contralateral diameter

Question 21

Clinical use of V-spread

Answer 21

Any vault suture restriction

Question 22

Occipitomastoid release (suture disengagement)

Answer 22

Wrap contralateral hand under occiput with fingers behind suture and ipsilateral hand around mastoid process

Roll head towards affected side until the OM suture is most posterior
-Gently traction mastoid anterior

Hold until release and reassess

Question 23

Clinical Use of Occipitomastoid Release

Answer 23

Trauma
Migraine
TMJ
Vertigo

Question 24

Saggital Suture Release (suture disengagment)

Answer 24

Use traditional OCMM position, cross thumbs at sagittal suture
-gap joints with lateral thumb pressure

Hold until elastic release is felt
-release and retest

Question 25

Clinical use for Sagittal suture release

Answer 25

Migraine

Tension Headache

Question 26

Pterigopalatine Ganglion Inhibition

Answer 26

Ganglion located just lateral to molars, medial to pterygoid
-direct force superior, medial, and slightly posterior with slight medial rotation

Hold until releaxation

Question 27

What does rotary stimulation of the Sphenopalatine ganglion do?

Answer 27

Thins nasal mucus and increases tears

Question 28

Clinical use for pterigo (sphenopalatine) ganglion

Answer 28

TMJ
Migraine
Tension headache
Sinusitis

Question 29

CV 4 Pump

Answer 29

Thenar eminences are on the occiput
-medial and cephalad comressing pressure through flexion phase

Release pressure completely allowing full extension again
-repeat until overall decreased resistance felt (10-14 cycles)

Question 30

What does CV 4 pump do?

Answer 30

Pumps CSF from the 4th ventricle into spinal cord region

Question 31

Clinical use for CV 4 pump

Answer 31

Fatigue
Depression
Insomnia