6. Osteopathic Cranial Manipulative Medicine Review

Question 1

Describe Occipital Condylar Decompression

Answer 1

Contact near to foramen and condyles
-add slight OA flexion

Pull occipital tissues in a posterior and lateral direction

Wait for occipital regional give and reassess

Question 2

Describe CV4 Still Point Induction

Answer 2

Thenar eminences are inferior to the superior nuchal line and MEDIAL to OM sutures

Encourage extension by leaning back and then resist its inferior motion (flexion) by not reducing pressure

Motion will eventually diminish (Still Point)
-slowly release and await CRI return

Question 3

Describe SBS decompression (indirect)

Answer 3

BMT Compression followed by release

Question 4

Describe SBS decompression (direct)

Answer 4

Gently engage the frontal bones to distract against the occiput

Pull in an anterior and superior direction

Await elastic release, then reassess

Question 5

Parietal Lift

Answer 5

Place 1st-4th fingers contacting inferior border of parietal bone and cross thumbs

Apply superior traction to attain BMT
-maintain until release felt

Question 6

Frontal Lift

Answer 6

With both arms on table

• position thenar eminences on lateral aspects of frontal bone, anterior to coronal suture
• Position hypothenar eminences on frontal bone
• -interlace fingers to create internal rotation of frontal

Apply anterior force to disengage sutures
-hold until traction, release, and reassess

Question 7

Temporal Rocking

Answer 7

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 8

Temporal Pull

Answer 8

Use pincer grip on pinnae

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

Question 9

TMJ Decompression

Answer 9

Begin with Indirect compression of mandible towards TMJ until relaxation felt

Switch to Direct by pushing inferior and slightly anterior until release

Retest by palpating motion at TMJ with mouth open

Question 10

V-Spread

Answer 10

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

Other hand provides contra-coup

Question 11

Occipitomastoid release (suture disengagement)

Answer 11

Wrap contralateral hand under occiput
and ipsilateral hand around mastoid process

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

Hold until release and reassess

Question 12

Saggital Suture Release (suture disengagment)

Answer 12

Cross thumbs at sagittal suture
-gap joints with lateral thumb pressure

Hold until elastic release is felt
-release and retest

Question 13

Pterigopalatine Ganglion Inhibition

Answer 13

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

Hold until releaxation

Question 14

CV 4 Pump

Answer 14

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

Release pressure to allow for full extension again
-repeat until overall decreased resistance felt (10-14 cycles)