Osteopathic Cranial Treatment: Base Spread

by Sheldon C. Yao, DO

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    00:01 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.

    00:12 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.

    00:21 You want good contact with the occiput in the temporal bone.

    00:25 You’re going to apply a traction but not a traction straight up but almost a traction more towards the table.

    00:32 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.

    00:41 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.

    00:57 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.

    01:26 As I’m holding this, the right side starts to feel like it’s loosening up.

    01:31 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.

    01:40 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.

    01:56 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.

    02:09 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.

    02:17 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.

    02:44 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.

    02:53 It’s a technique that usually is very relaxing for the patient.

    02:56 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.

    03:15 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.

    03:30 So, we’re going to find the inion, our landmarks being medial to the mastoid process.

    03:37 I’m going to get my hand into the right position and have the patient relax their head.

    03:44 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.

    03:54 Sometimes you might feel the CRI pause for a little bit.

    03:59 That we consider a still point and then it resets to the stronger rate.

    04:05 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.

    04:18 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.

    04:30 Galbreath Technique or Mandibular Lift: This technique is utilized to help train the Eustachian tubes where the patients have middle ear infections.

    04:39 Sometimes the patients have temporomandibular joint disorder.

    04:43 This might be something that we could utilize to treat them.

    04:46 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.

    05:02 So you’re going to hold on to the head and you’re going to apply a gentle traction and lift.

    05:05 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.

    05:24 You could do a lift. Hold that for 15 seconds and then slowly bring the jaw back.

    05:29 You could repeat this several times and then afterwards you can reassess.

    05:33 It should be a little bit easier to lift. Then there might be decreased congestion or swelling around the posterior aspect of the mandible.

    05:40 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.

    06:10 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.

    06:20 So, what we saw before was the jaw deviated to the right.

    06:24 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.

    06:36 Good, one, two, three, relax, not even that strong. So, we’re going to let it rest a little.

    06:41 We’re going to repeat by pushing it into the barrier and go ahead and push to the left again.

    06:47 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.

    06:56 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.

    07:07 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.

    About the Lecture

    The lecture Osteopathic Cranial Treatment: Base Spread by Sheldon C. Yao, DO is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Cranial Base Spread
    • Balanced Membranous Tension
    • Compression of the 4th Ventricle
    • Galbreath Technique
    • Muscle Energy for Temporomandibular Joint

    Author of lecture Osteopathic Cranial Treatment: Base Spread

     Sheldon C. Yao, DO

    Sheldon C. Yao, DO

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