Lateral Strain

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Transcript Lateral Strain

CRANIAL
Jonathan Phillips, DO
Vault Hold
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Patient:
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Dr: Seated & Resting forearms on table
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Supine
Index finger:
2nd finger:
3rd finger:
4th finger:
Greater wing of sphenoid
Temporal
Mastoid of Temporal
Occiput
Follow the CRI & evaluate rate, amplitude & symmetry
VAULT HOLD
Frontal-Occipital Hold
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Patient: Supine
Dr: Rest forearms on table
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One hand contacts frontal bone
Thumb on one greater wing of sphenoid
 Middle finger on one greater wing of sphenoid
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One hand allows occiput to rest in it, avoiding any
pressure on the occipitomastoid suture
 Follow the CRI & evaluate for rate, amplitude and
symmetry
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FRONTO-OCCIPITAL HOLD
Sacral Assessment
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Patient:
Dr:
Supine
Seated @ side of table
Base of hand @ apex of sacrum
Fingers @ base of sacrum
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Craniosacral flexion: Sacral base moves
posterior
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Craniosacral extension: Sacral base moves
anteriorly
Functional/Nonpathological
Strain Patterns
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PREDOMINANTLY
FLEXION
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More flexion than
extension during a
cycle
“Ernie”
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PREDOMINANTLY
EXTENSION
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More extension than
flexion during a cycle
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“Bert”
Augmentation of the Cranial
Rhythmic Impulse
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Use either vault or fronto-occipital hold
Have patient take deep inspirations to augment
the motion
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If in flexion, follow into flexion
Inhibition of the Cranial
Rhythmic Impulse
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Use either vault or fronto-occipital hold
Gently follow hands into a more extension
phase (if in flexion)
FUNCTIONAL STRAIN PATTERNS:
TORSIONS
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Axis: A/P
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Motion: Sphenoid & occiput rotate in occiput directions
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Nomenclature: Named by the side of higher wing of greater sphenoid
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Palpation: vault hold
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One hand rotates more posteriorly
Index finger: Moves superiorly
Little finger: Moves inferiorly
Etiologies: Normal, Trauma, Postural strains
TORSIONS: Cont.
RIGHT TORSION
 R-GWS: Superior
 R-O:
Inferior
 L-GWS: Inferior
 L-O:
Superior
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*GWS = Greater wing of sphenoid
*O = Occiput
LEFT TORSION
 R-GWS: Inferior
 R-O:
Superior
 L-GWS: Superior
 L-O:
Inferior
TORSIONS
FUNCTIONAL PATTERNS:
SIDEBENDING ROTATION
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Axes: (3)
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Two parallel vertical axes
One A/P axis
Motion:
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Sidebending: Sphenoid & occiput rotate in opposite directions about
the parallel vertical axes
Rotation: Sphenoid & occiput rotate the same direction about the
A/P axis
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Nomenclature: Named by the side of the convexity
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Etiologies: Normal, Trauma, Postural strain
SIDEBENDING ROTATION
CONT.
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Palpation:
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Fingers approximate on side of concavity
Fingers spread on side of convexity (the side it’s
named for)
Ex. Left sidebending rotation: left hand spreads
wider & moves inferiorly
SIDEBENDING ROTATION Cont.
RIGHT
SIDEBENDING
ROTATION
 R-GWS: Ant/Inf
 R-O:
Post/Inf
 L-GWS: Post/Sup
 L-O:
Ant/Sup
LEFT
SIDEBENDING
ROTATION
 R-GWS: Post/Sup
 R-O:
Ant/Sup
 L-GWS: Ant/Inf
 L-O:
Post/Inf
SIDEBENDING ROTATION
SIDEBENDING ROTATION
SIDEBENDING ROTATION
SIDEBENDING ROTATION
Vertical Strains
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Superior
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Inferior
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Etiologies:
 Blow on top of the head
posterior to the plane of
the SBS
 Blow from below anterior
to the plane of the SBS
Palpation:
 Both hands move
inferiorly
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Etiologies:
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Blow on top of the head
anterior to the plane of
the SBS
Blow from below
posterior to the plane of
the SBS
Palpation:
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Both hands move
superiorly
Vertical Strains
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Axes: Two parallel transverse axes
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Motion: Sphenoid & Occiput rotate in same
direction (due to shearing force)
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One bone in flexion, the other in extension
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Nomenclature: Named according to direction the
sphenoid is moving
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Etiology: Trauma
VERTICAL STRAINS
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SUPERIOR
R-GWS: Inferior
R-O:
Superior
L-GWS: Inferior
L-O:
Superior
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INFERIOR
R-GWS: Superior
R-O:
Inferior
L-GWS: Superior
L-O:
Inferior
VERTICAL STRAINS
SUPERIOR & INFERIOR SHEARS
Lateral Strains
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Axis: Two parallel vertical axes
 One through sphenoid
 One through foramen magnum
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Motion: Sphenoid & occiput rotate in same direction
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Nomenclature: Named by direction of the base of
sphenoid
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Etiology: Trauma
Lateral Strain
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Palpation: “Parallelogram Head”
Forefingers shift one direction & little fingers shift
to opposite side.
 Ex. Left lateral Strain:
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Forefingers shift right
 Little fingers shift left
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LATERAL STRAINS CONT.
RIGHT LATERAL
STRAIN
 R-GWS: Ant/Med
 R-O:
Ant/Lat
 L-GWS: Post/Lat
 L-O:
Post/Med
LEFT LATERAL
STRAIN
 R-GWS: Post/Lat
 R-O
Post/Med
 L-GWS: Ant/Med
 L-O;
Ant/Lat
LATERAL STRAIN
LATERAL STRAIN
SBS Compression
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Sphenoid & Occiput: Little or no motion
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Etiologies:
Trauma, Severe depression
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Competency Exam
Question 1
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Which finger position is wrong in the vault
hold?
A. Index finger- greater wing of the sphenoid
B. 2nd finger- parietal bone
C. 3rd finger mastoid of temperal
D. 4th Occuput
Question 1
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Which finger position is wrong in the vault
hold?
A. Index finger- greater wing of the sphenoid
B. 2nd finger- parietal bone
C. 3rd finger mastoid of temperal
D. 4th Occuput
Question 2
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Which does not CRI evaluate ?
A. Rate
B. Amplitude
C. Symmetry
D. Rhythm
Question 2
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Which does not CRI evaluate ?
A. Rate
B. Amplitude
C. Symmetry
D. Rhythm
Question 3
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Which is the correct matching with craniosacral
flexion?
A. Sacral bone moves posterior
B. Sacral base moves anterior
C. Sacral base moves caudal
D. Sacral base moves Dorsal
Question 3
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Which is the correct matching with craniosacral
flexion?
A. Sacral bone moves posterior
B. Sacral base moves anterior
C. Sacral base moves caudal
D. Sacral base moves Dorsal