And an Introduction to Cranial Osteopathic Manipulative Medicine (COMM):

A.K.A. Osteopathy in the Cranial Field (OCF)

By, Nathan Widboom D.O.

A Cranial Approach to Sinus Congestion

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“The cerebrospinal fluid (CSF) is the highest known element that is contained in the human body, and unless the brain furnishes this fluid in abundance, a disabled condition of the body will remain. He who is able to reason will see that this great river of life must be tapped and the withering fields irrigated at once, or the harvest of health be forever lost.”-A.T. Still, Osteopathy: Research and Practice

Learning Objectives

1. Describe the osteology of the paranasal sinuses.

2. Understand how the primary respiratory mechanism relates to the proper functioning of the paranasal sinuses.

3. Perform a series of techniques that can be used to treat patients with common clinical conditions.

Learning Objectives

1. Describe the history of the cranial concept

2. Describe the Primary Respiratory Mechanism (PRM)

3. Describe the 5 anatomical-physiological components of the cranial model

4. Discuss the cranial rhythmic impulse (CRI) and the role of the dural membranes

5. Describe the physiologic motion of the PRM

Flexion and Extension Motion of SphenobasilarSynchondrosis-SBS (Sphenoid and Occiput)

“Air Hands” in Vault HoldFlexion:

Basiocciput and Basisphenoid move cephalad (towards you when seated)

Index fingers on the greater wing of sphenoid and 5th fingers on lateral angle of occiput both move inferior and spread apart slightly

Flexion predominant mechanisms encourage sinus drainage

“Air Hands” Vault Hold

Extension:

Basisphenoid and basiocciput move caudad

Index fingers on greater wing of sphenoid and 5th digits on lateral angle of occiput both move superiorly and closer together

Extension predominant mechanisms hinder sinus drainage

The Vault

Flexion = Down and Out Extension = Up and In

Flexion and Extension of the Vault“Air Hands”

Flexion and Extension

Flexion in the reciprocal tension membrane

Exaggerated and sped-up flexion/extension animation

History

History of COMM/OCFWilliam Garner Sutherland, D.O.

1873 – 1954

Believed that all nature’s designs are purposeful.(Structure/Function)

Inspired by A.T. Still to investigate the cranial bone articulations & function.

Noted the ‘beveled’ articulations between many of the cranial bones.

For 40 years studied the cranium and craniosacral motion.

The EpiphanyIn 1899, while studying a mounted, disarticulated skull, the thought struck him “like a bolt of lightning,” that the articulation between the greater wing of the sphenoid and the squamous portion of the temporal bone was...

“...beveled, like the gills of a fish, and indicating an articular mobile mechanism for respiration”

Squamous Portion of Temporal Bone

Greater Wing of Sphenoid

HistoryDr. Sutherland gained “knowledge” through self experimentation using household items including catcher’s mitts, wooden bowls and leather straps.

Four Osteopathic Tenets

1. The body is a unit; the person is a unit of body, mind, and spirit.

2. The body is capable of self-regulation, self-healing, and health

maintenance.

3. Structure and function are reciprocally interrelated.

4. Rational treatment is based upon an understanding of the basic

principles of body unity, self-regulation, and the interrelationship of

structure and function.

Five Anatomical-PhysiologicalComponents of the PRM

Five principles of the PRM (CRI)

1. The fluctuation of cerebrospinal fluid, or the potency of the tide

2. The function of the reciprocal tension membrane (Intracranial and intraspinal membranes)

3. The inherent motility of the neural tube

(CNS: brain & spinal cord)

4. The articular mobility of the cranial bones

5. The involuntary mobility of the sacrum between theIlia

1. Fluids

2. Membranes

3. Parenchyma

4. Bones

5. It’s all

connected

Simplified

Dr. Sutherland on Osteopathy in the Cranial Field“It is a thought that is in no way apart from the science of osteopathy.

Get that.

Nothing apart.

It is not a specialty in itself; it is not simply a therapy. We are dealing with a science.”

Paranasal SinusesMaxillary

Frontal

Ethmoidal

Sphenoidal

Sinusitis• Due to obstructed ostia secondary to allergic or infectious inflammation

• Cough, stuffiness, congestion with or without nasal discharge

• Headaches, facial pain, facial edema

• Cough worse at night or supine

• Morning nausea and/or loss of appetite

• PE: Sinus Tenderness, oropharyngeal cobblestoning, nasal turbinate erythema/hypertrophy

Also Consider Nasal Polyps

Paranasal Sinus DrainageThe maxillary, ethmoidal, frontal and sphenoidal sinuses develop as outgrowths of the nasal cavity and as such they all drain into the nose

Some of the Innervation that is Palpable

TechniquesThoracic inlet subclavian release

OA Decompression

Venous Sinus Technique

Frontal, parietal, sphenoid, temporal lifts (in this order)

Maxillary Spread

Vomer engagement (“The plumber’s friend”)

Supraorbital and infraorbital neuromodulation

Effleurage

ReferencesAn Osteopathic Approach to Diagnosis and Treatment, by DiGiovanna, Schiowitzand Dowling. Ch. 103-106

Osteopathy in the Cranial Field, by Harold Magoun

Teachings in the Science of Osteopathy, by William G. Sutherland

Sutherland Cranial Teaching Foundation Introductory Course Book from June 2016.

Cranial 1 presentations from Dr. Doris Newman and Dr. Yasmin Qureshi

Google Images

And an Introduction to Cranial Osteopathic Manipulative Medicine (COMM):A.K.A. Osteopathy in the Cranial Field (OCF)Slide Number 2Learning ObjectivesLearning ObjectivesFlexion and Extension Motion of Sphenobasilar Synchondrosis-SBS (Sphenoid and Occiput)“Air Hands” in Vault Hold“Air Hands” Vault HoldThe VaultFlexion and Extension of the Vault�“Air Hands” Flexion and ExtensionFlexion in the reciprocal tension membraneSlide Number 12HistoryHistory of COMM/OCFThe EpiphanySlide Number 16Slide Number 17HistoryFour Osteopathic TenetsFive Anatomical-PhysiologicalComponents of the PRMFive principles of the PRM (CRI)Dr. Sutherland on Osteopathy in the Cranial FieldParanasal SinusesSinusitis�Also Consider Nasal Polyps Paranasal Sinus DrainageSlide Number 27Slide Number 28Some of the Innervation that is PalpableTechniquesReferences