00:01
Cranial somatic dysfunction diagnosis
In order to diagnose dysfunctions of the
cranium, there are 3 basic hand holds
and what we wanna do is to
review those hand holds
to see if we could get a sense of
what's going on with the cranium
and if we see any asymmetries or feel any
sort of pulse as we're in those positions.
00:20
So what we wanna do first is to
get our hands in a vault hold,
vault hold is the
most basic hold here,
what we want to do is to get our hands on the vault
to get a sense of what might be going on at the base.
00:31
So we're gonna place our pointer
finger over the greater wing,
our third and fourth fingers
are gonna straddle the ear,
one in front of the ear
and one behind the ear
and our pinky finger's gonna come
back and try to reach the occiput
and we'll do the same thing
with the opposite hand
We're going to get our thumbs touching
but not pushing down on the head
and we want to have a nice gentle contact,
we don't want to squeeze on the head
and now we want to get a sense of what
might be going on underneath our fingers.
01:01
Do we feel assymetry?
do we feel flexion and extension? do we feel
things kind of expanding and contracting?
And in this hold you could appreciate
what's going on at the vault
to try to get a sense of the
diagnosis of the cranial base
Another hold that we could utilize
is the frontal-occipital hold.
01:23
so in the fronto-occipital hold,
we're gonna get the AP contact,
we're gonna place our hands
underneath the occiput
and so one hand is across with our
fingers along the nuchal line
and the other hand is going to rest on the
frontal bone with my middle finger on glabella
and my second and fourth fingers
also on the frontal bone.
01:43
So in this contact, we get a better
sense of the anterior-posterior cranium
and we could see
what we're feeling,
and it's almost like getting another view of the cranium
so you get a sense of what's going on at the base.
02:01
There is the posterior occipital
hold or also the Becker hold,
in this hold, we're focusing a little
bit more at the posterior fossa here,
we're gonna let our palms
rest on the occiput,
the rest of our fingers kinda
rest gently on the cervical spine
and we're gonna let the weight of the
head just kinda rest on our palms,
and our thumb's gonna come forward and
reach the greater wings of the sphenoid.
02:28
So with this contact, we're getting a better sense of
what's going on in the posterior aspect of the cranium
with a little bit more focus on
the occiput, the temporal bones
and my thumbs up here reaching
forward to the sphenoid.
02:43
So through these three hand contacts, we get a
better sense of what's going on at the cranium
So with our holds, we're trying to get
sense of cranial strain patterns
The cranial strain patterns are adaptation of the
cranium at the vault for what's going on at the base
So the first contact that we have -the
vault hold is what we're gonna use
and with the vault hold, what
we're gonna get a sense of
our different strain patterns that
are combinations at the base -
There are three strain
patterns that are physiologic.
03:18
They are flexion and extension,
sidebending and rotation, and torsions.
03:24
so the first physiologic one we'll
talk about is flexion and extension,
we get our fingers in the vault hold
in which we're gonna get a sense of
is with flexion, your fingers are
going to spread out a little more,
and kind of move down towards the feet.
03:38
And then with extension, your fingers are gonna
come closer together and come up to the head,
and so again, flexion and a
little bit wider in extension,
a little bit more narrow and your
finger's coming up towards the head.
03:52
The next pattern we're gonna
look at is sidebending rotation,
remember sidebending rotation, we're gonna
have our fingers spread out on one side
that's the side of convexity
and then go down and rotate on that
AP axis down towards the feet,
so here is a right sidebending rotation - my
fingers are spread out on the right hand
and rotate down towards the feet
while the opposite hand - my fingers are gonna come
closer together and rotate up towards the head.
04:19
So that will be a right sidebending rotation.
04:21
On left sidebending rotation, my fingers
are gonna spread out on the left side
and my fingers are gonna come
closer together on the right side,
and my fingers on the left hand
are gonna go down towards the feet,
my fingers on the right hand
wil go up towards the head
so this would be the vault hold and this
would be a left sidebending rotation.
04:39
So once again, a right sidebending
rotation, and a left sidebending rotation
The third physiologic strain pattern is torsion.
04:49
So remember the torsion, the
sphenoid and occiput are rotating
in opposite directions in AP axis, so what you're
gonna feel is the greater wing's gonna come up
along with the rest of the cranium on one
side so this would be a right torsion
and then this would ba a left torsion,
your hands are gonna go in opposite directions
in torsion- so right torsion and a left torsion
So those are the three
physioologic strain patterns,
a nonphysiologic strain patterns
tend to be secondary to traumas
so we have our lateral strains and our
superior and inferior shears and compressions,
So lateral strain patterns, what you have
happening is the sphenoid and the occiput
are rotating the same direction
on two vertical axes
and what you're gonna get is the sphenoid and
occiput are gonna shift on each other and shear so
this would be a lateral shear
with a greater wing to the right
and this would be a lateral shear
with the greater wing to the left
it's almost making a
parralellogram with your hand
so again, vault hold and this is a lateral
shear with the greater wing to the right
and here's a lateral strain
- greater wing to the left.
06:02
In superior and inferior shears,
we have your sphenoid and occiput
rotating in the same direction
about two transverse axes
so what happens is the sphenoid is going
to rotate anteriorly into extension
and the occiput's gonna rotate into flexion
and so what you have is all your fingers
are going to feel like they're going down,
so in a superior shear, for a vault hold,
all your fingers are gonna feel like they're
gonna point down towards the table.
06:31
In a inferior shear, the sphenoid's
gonna rotate posteriorly
and the occiput is also
gonna rotate posteriorly
so everything's gonna feel like
they're going up towards the ceiling
so in inferior shear, all your finger's
gonna kinda rotate up towards the ceiling,
and in a superior shear, all your fingers'
gonna rotate down towards the floor.
06:50
Finally in a SPS compression, what
we're gonna get a sense of is that,
as you put your hands in a vault hold that
you're really don't feel much excursion at all,
you really can't detect much expansion,
the traumatic forces of SPS compression
has pushed the sphenoid and
occiput and compress at the SPS,
that there's really lack of general motion or movement of
excursion and you might feel increased density.
07:14
So those are our three
non-physiologic strain patterns.