Cranial Strains (Ferrill)

Question 1

Physiologic Motion of the head

Answer 1

Midline bones
* Sphenoid, * occiput, ethmoid (median plate), vomer & sacrum
Flexion & extension phases

Paired bones
* Temporals, parietals, frontals, ethmoid (lateral mass), nasals, lacrimals, maxillae, palatines, zygomae, inferior conchae & mandible
External & internal rotation phases

Physiologically, flexion occurs with external rotation (“flexternal rotation”)
Extension occurs with internal rotation

Question 2

Reciprocal tension membrane

Answer 2

Falx cerebri & cerebelli
Tentorium cerebelli
Formed by dural reflections
Dura is contiguous with periosteum of skull, and extends throughout the spinal column creating link to sacrum and throughout the body

Creates a tensegrity model that guides motion

Question 3

SBS

Answer 3

All cranial motion at the SBS is named for the motion of the basi-sphenoid on the basi-occiput
We are observing the motion of the basi-sphenoid on the basi-occiput though contact with
the greater wings of the sphenoid
The lateral angles of the occiput

Question 4

Vault Hold

Answer 4

Hands are in such a position to be able to palpate and observe motion of the SBS though contact with the sphenoid and occiput
- Index fingers on the greater wings of the sphenoid
- Pinky fingers on the lateral angles of the occiput
Enables the operator to feel the dysfunction in order to initiate treatment
Treatment also begins with this hold

Question 5

Perspective matters

Answer 5

This is important to getting the concepts of motion, and the diagnosis, correct
Try to think about where the SBS is in relationship to your hands
- Where is the top of the patient’s head? Where are the feet?
In many animations today, the top of the head is at 12 o’clock
When you patient is on the table, and while you are doing shadow hands, the top of the head is coming toward you

Question 6

Cranial Strains

Answer 6

Flexion/Extension

• Inherent motion of SBS
• Can still get somatic dysfunction

Torsion
- Right or left

Sidebending rotation
- Right or left

Vertical strain
- Superior or inferior

Lateral strain
- Right or left

SBS compression

Question 7

Physiologic Strains

Answer 7

Physiologic strains are those normal compensatory patterns that happen in response to other motions in the body.
These are normal EXCEPT when the SBS gets stuck there. Then you have somatic dysfunction.
Flexion/ Extension
Torsions
Sidebending rotation

Question 8

Flexion and extension

Answer 8

Normal physiological motion of the SBS
The sphenoid and occiput rotate around
parallel transverse axes
in opposite directions

Question 9

Flexion

Answer 9

Ernie

Motion is rotational around 2 transverse axes

• At level of foramen magnum
• Body of sphenoid

Motion occurs at SBS
- Basiocciput & basisphenoid move cephalad while occipital squama & wings of sphenoid move caudally

Question 10

Extension

Answer 10

Bert

Motion is rotational around 2 transverse axes

• At level of foramen magnum
• Body of sphenoid

Motion occurs at SBS
Basiocciput & basisphenoid move caudad while occipital squama & wings of sphenoid move cephalad

Question 11

Shadow hands flexion

Answer 11

In the vault hold:

Index fingers (on the greater wings of the sphenoid) 	
- Move inferiorly and spread apart slightly

Pinky’s (on the occipital lateral angle)
- Move inferiorly and spread apart slightly

Question 12

Shadow hands extension

Answer 12

In the vault hold:
Index fingers
- Move superiorly and approximate slightly

Pinky’s
- Move superiorly and approximate slightly

Question 13

Torsion

Answer 13

Sphenoid and occiput rotate in
opposite directions
around an A-P axis.

Named by the superior greater wing of the sphenoid
Which is mirroring the motion of the basi-sphenoid

In the vault hold
- One greater wing superior to the other
AND
- The opposite occipital angle more superior than the other

Named for the superior greater wing
i.e. right greater wing superior (and left occipital angle superior) = right torsion

Question 14

Torsion Shadow hands

Answer 14

Right SBS torsion
Right index finger moves superiorly in comparison to the left
Left pinky moves superiorly in comparison to the right

Left SBS torsion
Left index finger moves superiorly in comparison to the right
Right pinky moves superiorly in comparison to the left

Question 15

Sidebending Rotation

Answer 15

Sphenoid and occiput rotate around two sets of axes
To sidebend :
- opposite directions around parallel vertical axes

To rotate:

• in the same direction
• A-P axis

Altogether this gives the sense of convexity and inferior motion on one side
Named for the side of the convexity and inferior motion

Question 16

Non-physiologic strains

Answer 16

These are strains that are never normal at the SBS
They usually happen in response to trauma
- Lateral strains (sometimes called lateral shears)
- Vertical strains (sometimes called vertical shears)
- SBS compression

Question 17

Lateral Strains

Answer 17

Sphenoid and occiput rotate in the

• same direction about
• parallel vertical axes,

resulting in a lateral shearing force at the SBS.

Lateral strains are named by the direction the basisphenoid moves.

Question 18

Lateral Strains- in vault hold

Answer 18

In the vault hold, your hands will form a parallelogram.

Index fingers will shift one direction, while the pinky fingers shift in the opposite
Right lateral strain:
- Both index fingers shift left
- Both pinky fingers shift right

Question 19

lateral strains shadow hands

Answer 19

Left lateral shear
Both index fingers shift right
Both pinky fingers shift left

Right lateral strain
Both index fingers shift left
Both pinky fingers shift right

Question 20

Vertical Strains

Answer 20

Sphenoid and occiput rotate

• in the same direction about
• parallel transverse axes (as in flexion/extension)
• which results in a shearing force at the SBS.

One bone is in flexion while the other is in extension.

Vertical strains are named by the direction of the basisphenoid
- Superior or inferior

Question 21

vertical strains- vault hold

Answer 21

In the vault hold the index fingers will move the opposite direction of the basisphenoid
Superior vertical strain is “wings down, base up”
Inferior vertical strain is “wings up, base down”

Question 22

vertical strains shadow hands

Answer 22

Superior vertical strain
Both index fingers shift inferiorly (as the base moves superiorly)
Both pinky fingers shift superiorly

Inferior vertical strain
Both index fingers shift superiorly (as the base moves inferiorly)
Both pinky fingers shift inferiorly

Question 23

The key to the shears

Answer 23

The index fingers will move in the OPPOSITE direction of the basisphenoid

Lateral strains:
Index fingers moves right, basi-sphenoid moves left = LEFT lateral strain
Index fingers go left, basisphenoid moves right = RIGHT lateral strain

Vertical strains:
Index fingers go inferiorly, basisphenoid moves superiorly = SUPERIOR vertical strain
Index fingers go superiorly, basisphenoid moves inferiorly = INFERIOR vertical strain

Question 24

SBS compression

Answer 24

Approximation of the sphenoid and occipital bases as they compress together along the A-P axis.

Question 25

SBS compression- vault hold

Answer 25

fingers of both hands approximate
More commonly, because this severely limits the resiliency of the SBS, flexion and extension are limited
Often these heads will feel hard and generally limited in movement of any kind

Question 26

SBS compression shadow hands

Answer 26

Index and pinky fingers on both sides will approximate indicating sphenoid compression onto the occiput
OR
No motion is felt at the SBS

Question 27

Causes of cranial SD

Answer 27

Can be caused by:
Birth trauma
Intrauterine position
Head trauma 
Falls on the buttock
Surgical trauma
Somatic dysfunction from other areas of the body
Viscero-somatic Reflexes
other

Question 28

potential traumatic forces involved in superior vertical strain

Answer 28

• caudal force applied centrally over the anterior-superior frontal bone
• superior force to the inferior occiput, driving the basiocciput inferiorly

Question 29

potential traumatic forces involved in inferior vertical strain

Answer 29

• caudal force transmitted to the basisphenoid such as a caudal force transmitted from bregma
• a cephalad force transmitted to the condylar parts such as a fall on the base of the spine (i.e. landing on the buttocks with a force transmitted up the spine)
• a caudal force transmitted over the bilateral posterior-superior parietal bones or along the posterior sagittal suture

Question 30

potential traumatic forces involved in SBS compression

Answer 30

• force directed along hte AP axis leading to longitudinal compression of the SBS. may originate at nasion or at opisthion

Question 31

potential traumatic forces involved in lateral strains

Answer 31

Lateral to medial directed force applied over the greater wing of the sphenoid pushing the greater wings to the left or right. (ie a medially directed force to the left greater wings will drive the basisphenoid in the OPPOSITE direction)
-Lateral to medial directed force applied over the occiput pushing the posterior aspect of the occiput left or right.

Question 32

potential traumatic forces involved in External Rotations of the Temporal Bones

Answer 32

• Force applied to the left mandible in a left to right direction yields a right externally rotated temporal bone rotation and a left internally rotated temporal bone rotation.
• Traction of one side of the mandible due to dental work yields internal rotation on the ipsilateral side as the traction and external rotation on the contralateral side of the traction forces.

Question 33

In the vault hold, your right index and pinky fingers are superior to the left, while the index and pinky fingers on the left spread apart and move inferiorly. Diagnosis?

Answer 33

left sidebending and rotation

Question 34

In the vault hold, your index fingers have shifted to the left, your pinky fingers have shifted to the right. Diagnosis?

Answer 34

right lateral shear

Question 35

A patient comes to you complaining of headache after a box fell on the top of his head, close to the forehead. Osteopathic evaluation reveals both index fingers move inferiorly, both pinky fingers move superiorly. What is the SBS diagnosis?

Answer 35

Superior vertical strain

Question 36

A patient comes in for evaluation after hitting her head on the ice while playing hockey. Osteopathic evaluation reveals minimal motion at the SBS. What is your cranial diagnosis?

Answer 36

SBS compression