Cranial Strains lab

Question 1

Where do we put the fingers for vault hold

Answer 1

Index fingers on the greater wings of the sphenoid

Pinky fingers on the lateral angles of the occiput

Question 2

Vault Hold in general

Answer 2

For diagnosis and treatment
Physician places hands on either side of the cranium
Thumbs: slightly touching each other, just above sagittal suture, not touching the patient’s head
Index fingers: contact greater wings of sphenoid
Middle fingers: contact temporal and parietal bones in front of the ear
Ring fingers: contact temporal and parietal bones behind the ear
Pinky fingers: contacts the occiput, near occipitomastoid suture

Question 3

Fronto-occipital Hold

Answer 3

For diagnosis and treatment
Physician places one hand under the patient’s head, gently cupping the occipital squama
The other hand is placed across the forehead so that the thumb and middle finger of the hand contacts the greater wings laterally
- Or middle finger placed along metopic suture and other fingers spread out along frontal

Question 4

Venous Sinus Technique

Answer 4

This technique is a series of handholds to release the dural venous sinuses for improved venous drainage from the head. The order is important in order to open the terminal drainage points before the more distal sinuses. Because the venous sinuses are formed within dural membrane, be aware of engaging membrane as opposed to bone.
Step 1: Suboccipital Release & OA Decompression
Step 2: Occipital Sinus Release
Step 3: Straight Sinus Release
Step 4: Transverse Sinus Release
Step 5: Posterior Sagittal Sinus Release
Step 6: Anterior Sagittal Sinus Release

Question 5

Step 1: Suboccipital Release

Answer 5

Suboccipital Release is a technique that utilizes principles similar to Direct MFR. Anterior pressure is used to stretch the suboccipital muscles and adjustments are then made in all planes in order to engage the restrictive barrier.
Place finger pads over the suboccipital muscles, just inferior to the lower edge of the occiput, bilaterally, allowing the head to rest in the palms of the hands.
Gently but firmly apply anterior pressure into the suboccipital muscles, allowing the muscles to relax under the steady pressure. While the contact is through the suboccipital muscles, the effect through the OA joint occurs as a result of the relaxation of all the muscles of the craniocervical junction. As the tissues begin to soften take up the slack.
Complete relaxation of the superior cervical muscles may take a few minutes. As they relax the head will start to extend. Allow this to happen naturally and support the extension with the palms of the hands.
The treatment is finished when the head extends to the table, or when to patient tolerance and expected relaxation.
Re-assess motion and symmetry.

Question 6

Occipito-Atlantal Decompression

Answer 6

Occipitoatlantal Decompression utilizes the same setup as Suboccipital Release and then adds a component of distraction in order to decompress the OA while stretching the suboccipital muscles. It is often easiest and most effective to first do the suboccipital decompression then add the element of OA decompression.
Place finger pads over the suboccipital muscles, just inferior to the lower edge of the occiput, bilaterally, allowing the head to rest in the palms of the hands.
Gently but firmly apply anterior pressure into the suboccipital muscles, allowing the muscles to relax under the steady pressure. While the contact is through the suboccipital muscles, the effect through the OA joint occurs as a result of the relaxation of all the muscles of the craniocervical junction.
The occipital condyles fit into the facets of C1 as though they are ‘spooning.’ To decompress the OA, gently distract by adding a superior and ventrolateral distraction with the fingers to allow the occipital condyles to relax out of the facets of C1.
As the tissues begin to soften take up the slack.
Complete relaxation of the superior cervical muscles and subsequent distraction of the OA may take a few minutes. As they relax the head will feel as though it is lengthening away from the neck. Allow this to happen naturally and support the extension with the palms of the hands. This is the sign that the treatment is complete.
Re-assess motion and symmetry

Question 7

Step 2: Occipital Sinus Release

Answer 7

1. Place the finger pads of both hands along the area of the long axis of the occipital sinus, in the midline from the external occipital protuberance as far toward the foramen magnum as possible.
2. Engage membrane by gently bringing pressure anteriorly until a release is palpated.

Question 8

Step 3: Straight Sinus Release

Answer 8

1. Place pads of thumbs on the external occipital protuberance and support head with the rest of each hand.
2. The vector of attention should extend to Bregma, along the approximate location of the straight sinus.
3. This position is held until a softening is felt.

Question 9

Step 4: Transverse Sinus Release

Answer 9

1. Place fingertips just lateral to the external occipital protuberance and along the occipital ridge.
2. Engage tentorium cerebelli membrane at the transverse sinuses and hold until a release is palpated.

Question 10

Step 5: Posterior Sagittal Sinus Release

Answer 10

1. Cross thumbs and place them on the external occipital protuberance while supporting the patient’s head in a flexed position.
2. Engage the membrane by gently applying pressure in an inferolateral direction.
3. Once a release is palpated, move thumbs anteriorly along the sagittal suture and re-engage barrier until release is palpated.
4. Continue treatment until the coronal suture.

Question 11

Step 6: Anterior Sagittal Sinus Release

Answer 11

1. Place fingertips on either side of metopic suture of frontal bone.
2. Engage the membrane by gently applying pressure in a posterolateral direction until release is palpated.

Question 12

Frontal Lift

Answer 12

Mechanism: A gentle technique to disengage the sutures of the frontal bone and allow full motion in flexion/extension and internal/external rotation.
Procedure:
Contact the lateral angles of the frontal bone with hypothenar eminences and interlace fingers above the metopic suture.
Rest elbows on the table to create a fulcrum and gain leverage.
During cranial extension, apply a gentle medially-directed force from the fulcrum at elbows to disengage the barrier.
Maintain the medial force while lifting the frontal bone anteriorly during cranial flexion.
Alternative is to lift first superiorly then anteriorly at a 45 degree oblique angle
Hold this position until tension is equal on both sides.
Slowly disengage and return patient to neutral.
Reassess.

Question 13

Parietal Lift

Answer 13

Mechanism: This is a gentle technique to disengage the sutures of the parietal bone and allow full motion in internal/external rotation.
Procedure:
Place fingers above the inferolateral aspects of the parietal bones bilaterally and cross thumbs either above the head or resting lightly on the sagittal suture.
During cranial extension, apply a gentle medially-directed force from the fingers to disengage the barrier.
Maintain the medial force while gently leaning back and lifting the parietal bones superiorly during cranial flexion.
Hold this position until tension is equal on both sides.
Slowly disengage and return patient to neutral.
Reassess.