CRANIAL MANIPULATION BASICS OSSEOUS & SOFT TISSUE APPROACHES Dr. KANNABIRAN BHOJAN .PhD, P.T CERTIFIED IN BASIC & ADVANCED OSTEOPATHY TECHNIQUES -OHWI- ONTARIO ,CANADA DIPLOMA IN FASCIAL MANIPULATION FM1-LUIGI STECCO METHOD ,ITALY CERTIFIED VISCERAL MANIPULATION VM1 –BARRAL INSTITUTE ,USA TRIGGER POINT DRY NEEDLING DN1 –MYOPAIN SEMINARS,USA PROFFESSOR RVS COLLEGE OF PHYSIOTHERAPY CONSULTANT ORTHOPEDIC MANIPULATIVE SPORTS PHYSIOTHERAPIST FAST GROWING AREA OF MANUAL THERAPY PRACTICE
Transcript
1. CRANIAL MANIPULATION BASICS OSSEOUS & SOFT TISSUE
APPROACHES Dr. KANNABIRAN BHOJAN .PhD, P.T CERTIFIED IN BASIC &
ADVANCED OSTEOPATHY TECHNIQUES -OHWI-ONTARIO ,CANADA DIPLOMA IN
FASCIAL MANIPULATION FM1-LUIGI STECCO METHOD ,ITALY CERTIFIED
VISCERAL MANIPULATION VM1 BARRAL INSTITUTE ,USA TRIGGER POINT DRY
NEEDLING DN1 MYOPAIN SEMINARS,USA PROFFESSOR RVS COLLEGE OF
PHYSIOTHERAPY CONSULTANT ORTHOPEDIC MANIPULATIVE SPORTS
PHYSIOTHERAPIST FAST GROWING AREA OF MANUAL THERAPY PRACTICE
2. HISTORY With its modern roots in cranial osteopathy, as
developed by Sutherland (Sutherland 1939) in the early years of the
20th century, Craniosacral manipulation was first introduced into
the osteopathic profession in the 1930s. Instruction in the field
began in the 1940s. The pioneering work of William Garner
Sutherland (described in Upledger & Vredevoogd 1983)
3. Sutherland 1939
4. The Cranio Sacral skeleton The Cranio Sacral skeleton is the
axial skeleton. It consists of the skull, vertebral column, sacrum,
and coccyx.
5. The Skull face and the calvarium. There are 28 moveable
bones in the craniofacial skull, including the six ossicles of the
inner ears within the temporal bones. Additionally, and also within
the temporal bones, are the osseous labyrinths. The hyoid bone is
considered by some to be cranial.
6. There are eight cranial bones: 1. occiput 2. sphenoid 3.
ethmoid 4. frontal 5. two temporals 6. two parietals
7. There are fourteen facial bones: 1. mandible 2. vomer 3. two
maxillae 4. two zygomatic 5. two palatines 6. two nasals 7. two
lacrimals 8. two inferior conchae
8. Skull & clavarium
9. cranial mechanisms and number of overlapping processes About
Mechanical bony restrictions or ligamentous or fascial structural
and functional anomalies.
10. cranial mechanisms and number of overlapping processes
Dysfunctional situations where interference with normal pulsatile
activities or soft tissue properties seems to have occurred and
which have no easy, 'gross', structural or orthopedic
consequence.
11. cranial mechanisms and number of overlapping processes
Bio-electromagnetic energy factors permeate all mechanical,
functional and dysfunctional processes and that in some instances
there seems to be no way of making sense of cranio sacral treatment
without hypothesizing energetic involvement.
12. cranial mechanisms and number of overlapping processes The
unconvinced perspective-placebo effect
13. cranial mechanisms and number of overlapping processes
Gross mechanical, subtle pulsatile or energy imbalances
14. FIVE KEY ELEMENTS PROPOSED BY SUTHERLAND INHERENT MOTILITY
OF BRAIN AND SPINAL CORD FLUCTUATING CSF MOTILITY OF INTRACRANIAL
AND SPINAL MEMBRANES MOBILITY OF BONES OF SKULL INVOLUNTARY SACRAL
MOTION BETWEEN THE ILLIA
15. INHERENT MOTILITY OF BRAIN AND SPINAL CORD
16. CSF circulation
17. FLUCTUATING CSF
18. MOTILITY OF INTRACRANIAL AND SPINAL MEMBRANES A
Modification in length of spinal canal in cervical region during
flexion and extension. B Modification in length of spinal canal in
lumbar region during flexion and extension
19. MOBILITY OF BONES OF SKULL posterior & superior
view
20. MOBILITY OF BONES OF SKULL
21. Cranioscaral movement
22. INVOLUNTARY SACRAL MOTION BETWEEN THE ILLIA through this
mechanism it is believed that the sacrum will be pulled up and the
base will rotate forward during inhalation and then will lower
slightly and the base will rotate backward during exhalation. It is
the dural attachments that link the head to the sacrum and allows
them to move in a coordinated rhythm.
23. Concepts validity Is there palpable mobility at the cranial
sutures and articulations and if so, what is the significance of
such mobility in health terms? What are the reciprocal tension
membranes and is there a linking mechanism between cranial and
sacral motion? Does a cranial rhythmic impulse (CRI) exist and if
so, what is it and, especially, what is its relationship with
cerebrospinal fluid fluctuations and flow? What are the forces
moving cranial structures and so producing the CRI? Most
importantly, are these forces primary or is movement the result of
a combination of normal physiological functions such as respiration
and cardiovascular rhythms?
24. Cranial structures and their mobility Sutherland (described
in Upledger & Vredevoogd 1983) observed mobile articulation
between the cranial bones almost 100 years ago and researched the
concept for the rest of his life. influence of the intracranial
ligaments and fascia on cranial motion, which he suggested acted to
balance motion within the skull. PRM 'primary respiratory
mechanism' which was the motive force for cranial motion PUMPING
CSF.
25. RTM
26. Inhalation and exhalation phases of primary respiratory
mechanism
27. RTM
28. Tensegrity
29. Before fusion
30. Cranial structures
31. Flax Cerebri &Tentorium Cerebelli
32. Cranioscaral movement
33. What drives the cranial rhythm? The perpetual outpouring of
impulses from the brain to maintain postural equilibrium, chemical
homeostasis, and so on, conceivably may multiply the activity of
individual cells into a rhythmic pattern of the whole brain, small
enough to be invisible to the naked eye, but large enough to move
the cerebrospinal fluid which in turn moves the delicate
articulated cranial mechanism.(Frymann 1971)
34. WAS FRYMANN RIGHT ABOUT CRANIAL RHYTHM RESEARCH SUPPORT
IT
35. MODELS OF CRANIAL THERAPEUTICS CRANIAL OSTEOPATHY- WILLIAM
GARNER SUTHERLAND 1939 CST- JOHN UPLEDGER 1995 SOMATIC CRANIAL
WORK- SHEA 1997 SACROOCCIPITAL TECHNIQUE & APPLIED KINESIOLOGY
DEJARNETTE 1975-78 ECLECTIC DENTAL AND CRANIOFASCIAL APPROACHES
VERNON 2001 POLY VAGAL CONCEPT- SAHAR 2001 & PORGES 2001
36. CONCLUSIONS THERE EXISTS A PURELY CRANIAL MODEL
INCORPORATES KNOWINGLY OR UNKNOWINGLY PRINCIPLES OF TENSEGRITY
INVOLVES FLUID/ELECTRIC ASPECTS CAN RANGE PARTLY MECHANISTIC TO
ALMOST TOTALLY ENERGETIC/SPRITUAL
37. What are the clinical implications of cranial dysfunction?
Assuming being a direct connection between such Cranial motion and
Sacral motion and, further, that this motion has a rhythmicity
which is palpable. McPartland gives some indications Upledger &
Vredevoogd (Upledger 1996) offer a long list.
38. Some indications Acute sprains and strains using a variety
of techniques. Chronic pain problems (using techniques such as CV-4
as well as balancing tissue tension and dural membrane balancing).
Visceral dysfunction (peptic ulcers, ulcerative bowels,
tachycardia, asthma, etc. treated by means of normalizing
restriction patterns in the craniosacral system). Autonomic nervous
system problems such as Raynaud's syndrome (treated by using CV-4
daily). Rheumatoid arthritis (CV-4, often applied by a family
member, daily). Emotional disorders - especially anxiety (using
specialized techniques). Scoliosis, which is often seen to be a
direct result of craniosacral distortions.
39. Hand placement for palpation of cranial rhythmic impulse.
The forearms are supported by the table to prevent undue
fatigue.
40. cranial rhythmic impulse As you begin to explore these
cranial palpation and assessment sensations, it is suggested that
you keep a journal of your feelings and findings, as well as the
answers to the queries posed in the exercise descriptions.
41. What are the clinical implications of cranial dysfunction?
Let us assume, hypothetically speaking, that it is possible to
establish that mobility exists between cranial bones in normal
situations, as well as there being a direct connection between such
motion and sacral motion and, further, that this motion has a
rhythmicity which is palpable.
42. Non-cephalic medical presentations benefiting from
manipulation Most orthopedic complaints routinely referred to
physical therapy Extensor tendonitis Tennis elbow Biceps tendonitis
Frozen shoulder Lumbar strain Plantar fasciitis*
43. Non-cephalic medical presentations benefiting from
manipulation Most orthopedic complaints routinely referred to
physical therapy Peripheral neuropathies Carpal tunnel syndrome
Brachial plexus compression/thoracic outlet syndrome* Sciatica
Vertebral disk prolapse
44. Contraindications Structurally or medically unstable
conditions Stroke in evolution Suspicion of subarachnoid hemorrhage
Suspicion of acute fracture, cranial or cervical Suspicion of
cancer not yet diagnosed or staged Potential for metastasis when
cure is still sought Acute encephalopathy or meningitis Vertebral
disk prolapse Dizziness, loss of consciousness, blurred vision with
cervical rotation/side bending
45. Hand placement for palpation of cranial rhythmic impulse.
The forearms are supported by the table to prevent undue
fatigue.
46. Vault hold for cranial palpation. Relative head and hand
size may prevent precise replication of suggested sites for finger
placement.