Also, it is important to note that at birth, the
different cranial bones are in different parts
So the occiput at birth is in four parts,
the sphenoid in three parts, the
temporal bone in three parts
the maxilla in two parts, there are
six fontanels and no mastoid process.
So this is important to consider because
potentially there might be compressions, strains,
forces that might potentially move some of these
parts and these bones aren't fully formed yet.
and those strains can potentially cause
narrowing of different foramina,
may compress some different nerves - cranial
nerves and so it's important to understand
the anatomy of the infant's skull at birth.
So OMM can be applied to the cranium
to treat cranial somatic dysfunctions.
the infant cranium goes through significant
strain during development, birth and growth.
Even during development in the
womb, it's a very tight spot.
So based on the infant's development,
the lie within the womb,
sometimes the head might be compressed and
pushed against different parts of the womb.
At birth, the cranium undergoes significant forces,
whether it's passage through the birth canal,
or just pressure against the pelvis.
And then during growth, the cranium could
potentially receive any blows or trauma
from frequent falls, or even just by pressure
from how the baby lies to go to sleep.
So by gently addressing these different cranial
somatic dysfunctions, we could help with removing
any restrictions that might be impinging on cranial
nerves and to optimize growth and development.
Musculoskeletal restrictions could
contribute and lead to muscle spasms
which then reduces circulation
which then could cause pain.
And so what we want to do is try
to relax hypertonic muscles
which then will enhance circulation and
improve venous and lymphatic drainage
and overall that will help
improve our immune responses.
So let's take a look at a common pediatric presentation
that would really fit in the biomechanical model
So here we have X-ray of a patient
who demonstrates a spinal curvature.
So here this is scoliosis.
scoliosis is defined as lateral
curvatures of the spine.
And here you could see a S-shaped curve
with the convexity in the thoracic spine
to the right side and in the lumbar
spine more to the left side.
So we observed this scoliotic
curves in the coronal plane.
So in order to measure the severity
of scoliosis, we use Cobb angles.
And so with Cobb angles what you have to do is you
have to identify the upper and lower invertebrae
and you draw these lines along the vertical borders
and where they meet, you measure that angle.
That angle will tell you the severity of scoliosis,
and based on these different Cobb angles,
we could grade the severity of the scoliosis and that
in turn then will dictate your potential management.
whether it could be conservative
management all the way to bracing,
or we have to even
be needing surgery.
So the forward bend test is a special test you
could perform to help screen for scoliosis.
So usually this is done with the
patient standing and you ask them
to slowly bend forward to
try to touch their toes.
And what you're trying to observe for is to
see if there is assymetry or a "rib hump"
The rib hump is formed if there
is a curvature in the spine.
So usually, if you have a rib hump on a side,
that will be the side of the convexity
So remember back to
If the thoracic spine is
sidebent to one side,
then it will rotate to the
opposite side in a neutral spine.
So that was Friyette's
principle number one .
And so if I have a scoliotic curve
where my convexity is on the left side,
then I'm sidebent right
and thus rotate to left
so your rib hump will always correspond
with the side of the convexity
So there's a difference when you find scoliosis to
determine whether or not it is structural vs functional
So the difference between
structural and functional scoliosis
is that a structural scoliosis will
not change if you try to reduce it.
and so generally what I do is I have the
patient seated and I try to sidebend them
pretty much into their convexity.
So if someone was sidebent
right and thus convexed left,
I would try to sidebend them to the left
to see if that scoliotic curve reduces.
If it is reducible, then it is
more of a functional scoliosis,
meaning it's being caused by perhaps
muscle spasms, or some other factor.
If it's structural, then
it will not change.
So we could utilize OMM to
try to help treat scoliosis.
So we described scoliosis
as a type 1 curvature
and so with that diagnosis, we could utilize
OMT to treat any sort of muscle spasm
that might be causing and
holding that type 1 curve.
Also, it's important to
look at the whole body.
sometimes, patients may have a shorter leg.
or a sacral base on leveling, or a pelvis dysfunction
which then makes the base of the spine on level
and then because the base of the spine is
on level, the lumbar and thoracic spine
will compensate and thus
creating a lateral curvature.
OMT could also help
It may not completely reverse the scoliosis but if
they were able to reduce some of the muscle tightness,
improve a little bit
more joint mobility,
that might be able to then help patients
feel a little bit more comfortable
and slow the progression
of the curvature.
So torticollis is another pediatric
presentation that could be treated with OMM
Torticollis is due to spasms of the sternocleidomastoid
muscles or better known as the SCM muscle
Spasm of the SCM results in sidebending of the head
towards and rotation away of the affected muscle.
So if I have a spasm of my right SCM muscle, it's going
to cause a right sidebending and a left rotation,
So OMM could be utilized to
treat SCM muscle spasms.
What you want to do is to really address the
origin-instertion of the sternocleidomastoid muscle.
We want to look at the mastoid process
which is part of the temporal bone.
also looking at the cranial
base, upper cervical region
and also looking at its insertion
on the sternum and the clavicles.
So any sort of restrictions around the thoracic inlet
could play a part and contribute to SCM spasms.
And we also want to look
at cranial nerve XI
So cranial nerve XI also known as the spinal
accesory muscle exits the jugular foramen
which is located in between the
temporal bone and the occiput.
This cranial nerve provides motor innervation
to the SCM muscle and the trapezius muscle.
Signs of cranial nerve entrapment may include
decreased range of motion in head and neck
You may also see that the baby's kind of favoring
one side a little bit more while feeding
Plagiocephaly is another presentation that could
potentially be treated with osteopathic manipulation.
Plagiocephaly is a flattening
or assymetry of the skull
And so plagiocephaly actually has
been increasing in incidence
due to the national campaign
to put babies back to sleep.
And so when babies are frequently
lying just on their back,
it may create more pressure on the back of
the head and thus create more of a flat head
and sometimes if you add torticollis or
kids may favor one side than the other,
that might put more pressure on one of the right
or left sides on the posterior aspect of the head
thus creating a head that's
a little bit more mishapen.
We could utilize osteopathic treatment to address
different cranial strain patterns and dural restrictions
that might help to free those cranial bones
and allow for proper growth and expansion.
We also want to treat the cervical and thoracic
spine because of all the different muscles
that come out from that
region attach to the cranium.
Try to address any potential
and to definitely check the clavicles and
upper extremities for dysfunctions too
because the muscles attached there can
also potentially pull on the neck
and like we said before, put undo
pressure on the head assymetrically.