clinical application of cranial manipulative medicine Flashcards
what are the goals of craniosacral treatments?
reduce venous congestion
mobilize articular restrictions
balance the SBS
enhance any reduced force, rate or amplitude of the cranial ryhtmic impulse (CRI)
any dyfunctional bone position places stress on the brain, _ , _ and _ sinuses through direct connections to the dura and _
arteries
veins
venous sinuses
and arachnoid
treatment of the cranium can be aimed at (3 locations)?
outer fascial layers
sutural ligaments
intracranial membranes
sutural ligaments are?
fibrous joints connected by dense connective tissues : synarthrosis
treatment of the cranium influences structures that pass through, between or out of bones, has a subtle and indirect effect on the brain
just know
palatine SD may produce _ _ involvement and a _ _ reflex
pterido/sphenopalatine ganglion
somato-somatic reflex
pteriogopalatine ganglia influences _ output
trigeminal
trigeminal output as _ function that activates the muscles of _ and tensor tympani, tensor veli palatini, mylohyoid, and the _ belly of the digastric
motor
mastication
anterior belly
inhbition of the gaglion will decrease output to the trigeminal and aid in TMJ, swallowing and speech
the estachian tube passes within the _ bone and exits in the _ _
the tube lies in between the _ _ bone and the _
temporal
auditory canal
petrous portion of the temporal bone and the greater wing of the sphenoid
if there is SD involving the temporal bone what can happen
ETD- fluid buildup and reduces motion of the tympanic membrane for hearing or an infection may occur
otitis media- impaired drainage from the tube (improve drainage the infection will clear)
SD of the palatine bone can cause
TMJ, chewing disorders, swallowing, and speech problems
cephalgia
headache
what is known to cause headaches
2 well known arteries known to cause headaches
distention, traction or dilation of intracranial oe extracranial arteries
arteries: middle meningeal and superficial temporal
the _ lies right over major arteries like the internal carotid and cerebral arteries
dura
impaired _ drainage will also cause headaches
venous
cranial strains can cause traction or displacement of large intracranial _ or _ through their dural envelope
veins or sinuses
what bones does the facial nerve pass through
the temporal bone
what can temporal bone torsion cause
bell’s palsy
symptoms of bells palsy
weakness on one side of the face exluding the frontalis
may have a change in taste due to chorda tympani involvement on the anterior 2/3 of the tongue
how can OMT help bells palsy
realign the temportal bone
release tissue strain and improve lymphatic flow
what is trigeminal neuralgia
this is really bad facial pain that lasts for a few seconds that is incapacitating
it can be stimualted by chewing or brushing your teeth
has V2 distribution
can cause cephalgia (headaches)
where does the trigeminal ganglion rest
in meckels cave on the superior surface of the petrosal ridge of the temporal bone and is covered by dura
affected by temporal, sphenoid, or occipital position change
the tentorium cerebri is tightly attached at the
petrosal ridge
if the temporal bone is rotated this would put pressure on the structures deep to the tentorium cerebelli including
the trigeminal nerve
what did the study of rythmic motions of the living cranium find (1971)
they used a pick to touch the parietal bones of the human skull and measured its motion
it found: rthym of bones that varied between subjects with an average of 1mm change thar was independent of breathing
articfacts limitied study
what did the parietal bone mobility in an anesthized cat study show
motion was spontaeous in the skull and can be induced or modified, it changed in respect to CO2 levels, CSF pressurem blood pressure and could inducea apnea
external pressure on temportal bones caused
observable changes in respiration, blood pressure, and csf pressure
external pressure on sagitial suture showed
no change in blood pressure or respiration
but lateral and rotation movement of the parietal bones
what did the nasa research do
confirmed cranial bone motion
that the AP distance increased - ICP increased amplitude of the cranial motion
what did the russian cosmonaut research do
stated that cranial dimensions are continuosly changing from A-P and side to side with up tp 1mm
incracranial volume increases by 12 mm and moves the bones
CRI was 6-14 cycles per minute
mobility of the cord and membranes is witnessed in cranial _ and _ (1978)
extension (relax)
and
flexion (tension)
what is the traube hering meyer wave
this is a pattern of changes in the blood pressure
found to be synchronous to occillations of the sympathetic nervous system
when was the traub hering wave compared to the CRI
2001
what is a still point
a period where there is decrease in the traube-hering amplitude after treatment
post treatment there shows changes in the _ wave
TH (traube-hering-myer)
greater amplitude
there is continuous _ changes in cranial dimensions and there is also cranial _ changes that pump CSF to bathe the rest of the CNS
biphasic
volume
the cns movement can propell CSF
CRi is a product of _ volume and _ and _ regulation
CSF
pressure
metabolite regulation
stress of cranial nerves 9 and X at the _ _ and condylar compression causing cranial nerve _ dyfunction can cause sucking dyfunctions in the newborn
jugular foramen
12
cranial nerve 9 vagal SD can be due to a _, _ or _ dysfunction
OA
AA
C2
cranial nerve _ and _ _ strains may be related to the birthing process
11
brachial pleus
_ compression is common in newborns
suture
when do you use occipital condyle decompression
- poor feeding
- colic
- head and neck pain
- post trauma to head and neck
what is occipital condylar decompression- how do you preform
this is when you contact as near to the foramen and condyles as possible and add slight OA flexion
you then apply traction, then pull the occipital tissues in a posterior and lateral direction until you feel regional give
*8reassess
occipital condylar decompression before the age of 7 treats?
after 7-adults treats
before 7- treats catilaginous and pre occification strains
after 7- treats post fusion or interocceous strains
when do you use balanced membranous tension?
abnormal CRI
cranial nerve entrapment
dural strain/venous sinus strain
headaches
how do you preform BMT
exaggerate membranous asymmetry until balance is noted (CRI will move against you but resist it- do not change position)
hold until CRI stops
gently release to CRI midpoint
reassess
when do you use SBS decompression
how do you preform SBS decompression
when the head feels like a bowling ball
diminished CRI
mood disorders
cranial nerve entrapment
URI/head congestion
pediatric developmental problems
- BMT compression first, then release
- direct : engage the frontal bones to distract against the occiput: pull in an anterior and slightly superior direction- then await release and reasses
when do you use the frontal lift
how do you preform the frontal lift
use: treating restricted frontal mobility and to augent SBS flexion- frontal headaches, sinus congestion, pediatric development issues
treatment: engage lateral inferior edge of frontal bone and hook under the initiation of the sygomatic arch, apply anterior force with some anterior rotation until an elastic release is felt
what is parietal lift used for and how do you preform it?
used for lack of parietal motion in TMJ, headaches, decompress squamosal suture
compresed with trauma/grinding of teeth
perform parieta traction until superior elastic release is noted: gently release the head
when do you use sterigo/sphenopalatine ganglion inhibition/stimulation
how do you preform it
contact posterior and lateral to the molar and medial to the pterygpod
apply a superior and slightly medial and posterior with medial roated force- hold to await relaxation, or do rotary stimulation
hold- motor output
rotary stimulation- thins nasal mucus and increases tears
use in TMJ, migraine, tension headaches, sinusitis
when do you use the temporal pull how do you preform it
use: lack of temporal motion: temporal headache, vertigo, tinnitus, TMJ issues, balance the tentorium, disengage the jugular foramen, release sutures
use a pincer grip on pinnae or antitragus as close to the temporal bone as possible
apply gental lateral traction posteriorly and superiorly along a vetor that parallels the petrous ridge of the temporalis. maintain tension at the FEATHER EDGE of the restrictive barrier until release is felt on both sides.
TMJ decompression use and how do you preform it
use: TMJ restrictions, mandible restriction, neck pain
preform: begin indirect by balancing compression of the mandible towards the tmj until relaxation is felt
switch to a direct release at the lateral manidble pushing inferior and slightly anterior until release is felt on both sides
V spread use
how to preform
use: any cranial vault suture restriction
treatment: spreading pressure is used to monitor and encourage motion on the longest contralateral diameter
encourage PRM with fluctuant flow between the opposing contact
why do we use the occipitomastroid release and how do you preform it?
use: trauma, migraine, TMJ, vertigo
preform: wrap contralateral hand under occiput with fingers posterior to suture, wrap ipsilateral hand around the mastoid process, roll head towards the affected side until the OM suture is most posterior
traction mastoid anteriorly , hold until release
sagital suture release use and how to preform
use: migrains, tension headaches, trauma
treatment: fingers at inferior portion of parietal bone , cross thumbs across the sagital suture at the point of restrictions, gap suture with lateral thumb pressure, hold until release
use of CV4 still point induction
treatment
use: decreased CRI, URI, headache/migraine
treatment: place thenar eminence inferior to the superior to the superior nuchal line and medial to the occipitalmastoid suture, encourgae extension by leaning back (superior and anterior force) - resist inferior motion. once motion diassapear you have reached a still point. release and await CRI to return
use of CV4 pump and treatment
use: fatigue, depression, insomnia
treatment: thenar eminences on the occiput, medial and cephalad compressing pressure through the flexion phase only, release pressure allowing full extension, repeat until there is decreased resistance to compression
“pumps CSF from 4th ventricle to spinal cord”
