Download Lateral Strain

CRANIAL
Jonathan Phillips, DO
Vault Hold

Patient:

Dr: Seated & Resting forearms on table





Supine
Index finger:
2nd finger:
3rd finger:
4th finger:
Greater wing of sphenoid
Temporal
Mastoid of Temporal
Occiput
Follow the CRI & evaluate rate, amplitude & symmetry
VAULT HOLD
Frontal-Occipital Hold


Patient: Supine
Dr: Rest forearms on table

One hand contacts frontal bone
Thumb on one greater wing of sphenoid
 Middle finger on one greater wing of sphenoid

One hand allows occiput to rest in it, avoiding any
pressure on the occipitomastoid suture
 Follow the CRI & evaluate for rate, amplitude and
symmetry

FRONTO-OCCIPITAL HOLD
Sacral Assessment


Patient:
Dr:
Supine
Seated @ side of table
Base of hand @ apex of sacrum
Fingers @ base of sacrum

Craniosacral flexion: Sacral base moves
posterior

Craniosacral extension: Sacral base moves
anteriorly
Functional/Nonpathological
Strain Patterns

PREDOMINANTLY
FLEXION


More flexion than
extension during a
cycle
“Ernie”

PREDOMINANTLY
EXTENSION

More extension than
flexion during a cycle

“Bert”
Augmentation of the Cranial
Rhythmic Impulse


Use either vault or fronto-occipital hold
Have patient take deep inspirations to augment
the motion

If in flexion, follow into flexion
Inhibition of the Cranial
Rhythmic Impulse


Use either vault or fronto-occipital hold
Gently follow hands into a more extension
phase (if in flexion)
FUNCTIONAL STRAIN PATTERNS:
TORSIONS

Axis: A/P

Motion: Sphenoid & occiput rotate in occiput directions

Nomenclature: Named by the side of higher wing of greater sphenoid

Palpation: vault hold




One hand rotates more posteriorly
Index finger: Moves superiorly
Little finger: Moves inferiorly
Etiologies: Normal, Trauma, Postural strains
TORSIONS: Cont.
RIGHT TORSION
 R-GWS: Superior
 R-O:
Inferior
 L-GWS: Inferior
 L-O:
Superior


*GWS = Greater wing of sphenoid
*O = Occiput
LEFT TORSION
 R-GWS: Inferior
 R-O:
Superior
 L-GWS: Superior
 L-O:
Inferior
TORSIONS
FUNCTIONAL PATTERNS:
SIDEBENDING ROTATION

Axes: (3)



Two parallel vertical axes
One A/P axis
Motion:


Sidebending: Sphenoid & occiput rotate in opposite directions about
the parallel vertical axes
Rotation: Sphenoid & occiput rotate the same direction about the
A/P axis

Nomenclature: Named by the side of the convexity

Etiologies: Normal, Trauma, Postural strain
SIDEBENDING ROTATION
CONT.

Palpation:



Fingers approximate on side of concavity
Fingers spread on side of convexity (the side it’s
named for)
Ex. Left sidebending rotation: left hand spreads
wider & moves inferiorly
SIDEBENDING ROTATION Cont.
RIGHT
SIDEBENDING
ROTATION
 R-GWS: Ant/Inf
 R-O:
Post/Inf
 L-GWS: Post/Sup
 L-O:
Ant/Sup
LEFT
SIDEBENDING
ROTATION
 R-GWS: Post/Sup
 R-O:
Ant/Sup
 L-GWS: Ant/Inf
 L-O:
Post/Inf
SIDEBENDING ROTATION
SIDEBENDING ROTATION
SIDEBENDING ROTATION
SIDEBENDING ROTATION
Vertical Strains

Superior

Inferior

Etiologies:
 Blow on top of the head
posterior to the plane of
the SBS
 Blow from below anterior
to the plane of the SBS
Palpation:
 Both hands move
inferiorly

Etiologies:




Blow on top of the head
anterior to the plane of
the SBS
Blow from below
posterior to the plane of
the SBS
Palpation:

Both hands move
superiorly
Vertical Strains

Axes: Two parallel transverse axes

Motion: Sphenoid & Occiput rotate in same
direction (due to shearing force)

One bone in flexion, the other in extension

Nomenclature: Named according to direction the
sphenoid is moving

Etiology: Trauma
VERTICAL STRAINS





SUPERIOR
R-GWS: Inferior
R-O:
Superior
L-GWS: Inferior
L-O:
Superior





INFERIOR
R-GWS: Superior
R-O:
Inferior
L-GWS: Superior
L-O:
Inferior
VERTICAL STRAINS
SUPERIOR & INFERIOR SHEARS
Lateral Strains

Axis: Two parallel vertical axes
 One through sphenoid
 One through foramen magnum

Motion: Sphenoid & occiput rotate in same direction

Nomenclature: Named by direction of the base of
sphenoid

Etiology: Trauma
Lateral Strain

Palpation: “Parallelogram Head”
Forefingers shift one direction & little fingers shift
to opposite side.
 Ex. Left lateral Strain:

Forefingers shift right
 Little fingers shift left

LATERAL STRAINS CONT.
RIGHT LATERAL
STRAIN
 R-GWS: Ant/Med
 R-O:
Ant/Lat
 L-GWS: Post/Lat
 L-O:
Post/Med
LEFT LATERAL
STRAIN
 R-GWS: Post/Lat
 R-O
Post/Med
 L-GWS: Ant/Med
 L-O;
Ant/Lat
LATERAL STRAIN
LATERAL STRAIN
SBS Compression

Sphenoid & Occiput: Little or no motion

Etiologies:
Trauma, Severe depression

Competency Exam
Question 1





Which finger position is wrong in the vault
hold?
A. Index finger- greater wing of the sphenoid
B. 2nd finger- parietal bone
C. 3rd finger mastoid of temperal
D. 4th Occuput
Question 1





Which finger position is wrong in the vault
hold?
A. Index finger- greater wing of the sphenoid
B. 2nd finger- parietal bone
C. 3rd finger mastoid of temperal
D. 4th Occuput
Question 2





Which does not CRI evaluate ?
A. Rate
B. Amplitude
C. Symmetry
D. Rhythm
Question 2





Which does not CRI evaluate ?
A. Rate
B. Amplitude
C. Symmetry
D. Rhythm
Question 3





Which is the correct matching with craniosacral
flexion?
A. Sacral bone moves posterior
B. Sacral base moves anterior
C. Sacral base moves caudal
D. Sacral base moves Dorsal
Question 3





Which is the correct matching with craniosacral
flexion?
A. Sacral bone moves posterior
B. Sacral base moves anterior
C. Sacral base moves caudal
D. Sacral base moves Dorsal