Cranial treatments

Page created: March 18, 2021

Notes

Osteopathic cranial manipulative medicine

Cranial treatments

COMPRESSION OF THE FOURTH VENTRICLE (CV4)
  1. Palpate the cranial rhythmic impulse (CRI)
  2. With the palms facing each other, place your thenar eminences under the patient’s occiput, medial to the occipitomastoid sutures
  3. Follow the occiput into extension and slide your hands superior (toward you) during the extension phase
  4. Resist flexion and hold the position until the CRI stops (still point)
  5. Wait for the CRI to resume and gently follow the occiput into flexion and extension
  6. Gradually release during flexion after 2–3 cycles
Successful CV4 treatment enhances CSF flow and intracranial blood flow, modulates the autonomic nervous system, decreases pain during headaches of various etiologies, and decreases sleep latency. CV4 is contraindicated in the third trimester of pregnancy, as it can promote uterine contractions.
VENOUS SINUS DRAINAGE (VSD)
VSD is a series of sinus drainage enhancement and release techniques that has been shown to have several benefits:
  • Improves fluid interchange in the body
  • Increases intracranial venous drainage
  • Is useful in treating congestive type headaches, migraines, and chronic fatigue syndrome
The finger pads are placed overlying the venous sinuses, and gentle pressure is applied to the skull. Each step is performed in order and maintained until a “softening” or warmth on the finger pads is sensed.
  1. Transverse sinus: place finger pads of digits 2–5 along the superior nuchal line
  2. Confluence of sinuses: place finger pad of 3rd digit on the inion
  3. Occipital sinus: place finger pads of digits 2–5 in the midline of the occiput
  4. Superior sagittal sinus: cross 1st fingers over sagittal suture, apply slight lateral pressure
  5. Metopic suture: place finger pads of digits 2–5 in the midline of the frontal bones, apply slight lateral pressure
V- (SUTURAL) SPREAD
This technique is used to release restricted sutures.
  1. Identify the restricted suture
  2. Place the finger pads of the 2nd and 3rd fingers on either side of the restricted suture, forming the shape of a V
  3. Place one or two fingers of the opposite hand at the area of the greatest diagonal distance from the restricted suture
  4. Gently direct an impulse with these fingers to send a fluid wave directed towards the “V” you formed at the restricted suture
  5. Continue with fluid fluctuation until no further fluid waves can be palpated at the V-spread fingers
LIFTS (PARIETAL AND FRONTAL)
The goal of the parietal and frontal lift techniques is to release sutural restrictions. These techniques are performed in a similar fashion and are outlined below.

Recall that during extension the parietal and frontal bones internally rotate, and during flexion these bones externally rotate.

Frontal Lift:
  1. Interlace fingers over the metopic suture with palms resting on the lateral forehead
  2. Add gentle compression medially with the heel of the palm to internally rotate the frontal bones
  3. Add a gentle compression anteriorly (toward the ceiling) with the heel of the palm to externally rotate the frontal bones
Parietal Lift:
  1. Place forearms on table with fingertips contacting on parietal bones and thumbs touching above patient’s head
  2. Push thumbs together to approximate fingertips and induce internal rotation of parietal bones
  3. Gently lift both hands cephalad to induce external rotation of the parietal bones
OCCIPITAL CONDYLAR DECOMPRESSION
The goal of this technique is to balance the reciprocal tension membrane at the hypoglossal canal, permitting normalized function of cranial nerve XII. Occipital condylar compression is commonly diagnosed at birth, and may result in poor suckling.
  1. Rest both forearms on the table, establishing a fulcrum
  2. Rest the patient’s head on the palms with the 2nd and 3rd fingers approximating the condylar processes
  3. Gently pull cephalad and lateral at the base of the occiput until a release is felt
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Editor: Robyn Hughes, MScBMC

Key Takeaways

Cranial treatments are a form of therapy that use a light touch and gentle manipulations to stimulate the head and neck. Some people believe that cranial treatments can help relieve tension headaches, neck pain, and jaw pain. Others believe that cranial treatments can improve the function of the brain and nervous system. There is limited scientific evidence to support the claims of those who believe in the benefits of cranial treatments. However, more research is needed to determine whether or not cranial treatments are effective.