Cranial Base Spread: The cranial base
spread is utilized as a technique
and also to help diagnose what’s going on
between the occiput and the temporal bone.
Our contact is going to be on the
occiput with our middle finger
and on the temporal bone with our
pointer finger on both sides.
You want good contact with the occiput
in the temporal bone.
You’re going to apply a traction
but not a traction straight up
but almost a traction more
towards the table.
So, what I’m doing is I’m kind of
pulling this way. As I’m pulling,
I’m also spreading my fingers apart between
my pointer finger and my middle finger.
So, what that does is as I pull back, I get a sense of A, what side feels more restricted
and as I also do a spread between the temporal bone and the occiput,
it provides information regarding
the OM suture bilaterally.
So, as I pull back and also spread
my fingers apart, the right side here
feels a little bit more restricted. I could either
sit here and keep holding this traction
waiting for that to release. So now, the base spread
has become not only diagnostic
but also therapeutic, or if I feel like it’s not really
releasing with the base spread,
I could go ahead and perform a more specific
technique there like a V-spread,
or to treat other things and then go back
and use the base spread to diagnose.
As I’m holding this, the right side
starts to feel like it’s loosening up.
Then I could bring it back. Then to
reassess, I could reapply
the base spread to see if it feels more
symmetric as I apply the traction.
Balanced Membranous Tension: We utilize
balanced membranous tension
to try to treat any cranial strain patterns.
What you’re going to do,
you could get your hands into a vault contact,
make your cranial strain pattern diagnosis.
Based on what pattern you feel,
you could try to encourage the dura
to move into that pattern. So here, we have
a right side bending rotation.
So, what I do is I want to take my hands
and kind of encourage that right side
bending rotation trying to get
a sense of a tension there.
Holding that until I feel a release and
I could come back and reassess to see
if that strain pattern is still present.
With balanced membranous tension,
you could also stack additional
strain patterns if you feel like
there are multiple strain patterns present.
Afterwards, you could get back
into your vault hold and see. There should be
improvement of the cranial strain patterns
that you could detect and perhaps sometimes
the CRI will improve afterwards.
CV4 or Compression of the 4th Ventricle:
The CV4 is a technique
that we could utilize to help try to reset
the cranial rhythmic impulse.
It’s a technique that usually is
very relaxing for the patient.
What we want to do is to get our thenar eminence
medial to the temporal bones
and medial to the occipitomastoid suture.
Our thenar eminences are going to rest
on the supra-occiput. So, we want to find the inion
and make sure that you’re below
the inion so that you could be
on the supra-occiput.
What you’re going to do is get your
thenar eminence in the correct spot
and then encourage extension by pushing
our fingers towards the table
and holding the occiput
into extension phase
and preventing it from going
into flexion phase.
So, we’re going to find the inion, our landmarks
being medial to the mastoid process.
I’m going to get my hand into the right position
and have the patient relax their head.
Once they’re in a relaxed position, again I want to
encourage extension of the occiput
and hold until I feel a change
or shift, a release.
Sometimes you might feel
the CRI pause for a little bit.
That we consider a still point and then
it resets to the stronger rate.
Also, because the respiratory and cardiac
centers are close to the 4th ventricle,
sometimes you might see
a little bit of facial flushing
or a change in the patient’s respiration
due to the technique.
Once we feel a significant change, we can come
back and then go ahead and recheck
and see if there was a shift or change in the CRI
after the technique was completed.
Galbreath Technique or Mandibular Lift:
This technique is utilized
to help train the Eustachian tubes where
the patients have middle ear infections.
Sometimes the patients have
temporomandibular joint disorder.
This might be something that
we could utilize to treat them.
To perform the technique, what we’re
going to do is going to contact
the mandible with our hand. We’re going to
place our fingers around the ramus
of the jaw and along the body of the jaw.
Then we’re going to support the head
because if you don’t support the head, as you
traction, the head might roll towards you.
So you’re going to hold on to the head and you’re
going to apply a gentle traction and lift.
So, we’re utilizing the attachments of the
mandible to the posterior pharynx
which helps to open the Eustachian tube.
It’s the same motion that you do
if you want to open your ears. If you are on a plane
and you feel like your ear is congested,
you kind of yawn and open up the ear.
You’re kind of doing that passively here.
You could do a lift. Hold that for 15 seconds
and then slowly bring the jaw back.
You could repeat this several times and then
afterwards you can reassess.
It should be a little bit easier to lift.
Then there might be decreased
congestion or swelling around the
posterior aspect of the mandible.
Muscle Energy for the Temporomandibular Joint:
Our temporomandibular joint or TMJ
is a very sensitive area. Patients can
potentially have pain, clicking,
difficulty with eating and chewing due
to the pain. So, to try to assess
for temporomandibular joint disorder,
we’re going to have the patient
slowly open their jaw. As they open their jaw,
you want to see if there’s any deviation
to one side or the other, or if there’s a decrease
in the amount the jaw can open.
If there is a restriction, we could try to gently
treat the muscles of mastication here
to help loosen up the jaw. So, we’re going to
have the patient relax their jaw.
So, what we saw before was the
jaw deviated to the right.
So we’re going to use muscle energy.
Remember the principles of muscle energy
is to take the jaw and move it into its barrier.
So I’m going to gently deviate
the jaw to the left. Now, I’m going to have
the patient push their jaw towards the right.
Good, one, two, three, relax, not even that strong.
So, we’re going to let it rest a little.
We’re going to repeat by pushing it into the barrier
and go ahead and push to the left again.
One, two, three, relax. Relax for three seconds.
Then we’re going to reengage the barrier
and then have them push again,
one, two, three, and relax.
At the end, we perform a passive stretch,
come back, and have the patient
open and close again and see if it’s
straighter and not deviating as much.
You could also do the same thing
if the person’s jaw does not fully close
or if the patient’s jaw is not fully opening
where you can kind of encourage the jaw
to open more and have them try to close
their jaw. So, you could utilize
muscle energy to try to treat
temporomandibular joint dysfunctions.