Wednesday, August 06, 2003

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Wednesday, August 06, 2003

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Sutherland Techniques 1: Osteopathy in the Cranial Field
Course News:

Course will continue through to December 19th. Wednesday before Thanksgiving we will not have class to accommodate students leaving town for the holiday.

Principles of Osteopathy – “Our Philosophy”

  • Discovered by A.T. Still in 1874 through experiences with Civil War, Native Indians, and animals, observing nature and his own patients

  • the body functions as a unit

  • the body possesses self-regulatory and self healing mechanisms

  • structure and function are reciprocally interrelated;

  • rational treatment is based on the application of the above three principles

Brief History of Sutherland:

  • Dr. William G. Sutherland was a student of A.T. Still (in 1900s) who discovered what we know today as the Sutherland Technique.

  • Published The Cranial Bowl in 1944

  • He had an epiphany and came up with the quote: “Sutures are like the gills of a fish indicating respiratory motion for an articular mechanism.”

  • He began to make speeches about his research in 1939 and met with little enthusiasm about his work

  • After He had success treating patients with his techniques, the Osteopathic school in De Moines began to have lectures about the Sutherland’s technique

  • He developed his philosophy: The Concept of Primary Respiratory Mechanism (TEST Question)

Components of Primary Respiratory Mechanism:

  • There is inherent motion of the body that is separate from the respiratory, cardiac, and GI tract motion

  1. There is inherent motility of the central nervous system

    1. Lengthening & shortening of CNS that causes rhythmic motions in the brain tissue

    2. Research studies have shown neurons have observable pulsating, rhythmical movement

  2. Mobility of intracranial and intraspinal membranes (Reciprocal Tension Membrane)

    1. Membranes include Falx Cerebri, Tentorium Cerebelli, Falx Cerebelli, & Spinal Dura

    2. Their functions are shock absorbing and are attached to all bones of cranium and all the way down to the sacrum at S2 (**important concept**)

    3. Falx Cerebelli separates the two hemispheres of cerebellum begins from its origin in the straight sinus to connect with the intraspinal membrane below; spinal dura then attaches to C2&3 and extend down to S2

    4. External layer of the dura is continuous with the periosteum of the cranial bones; internal layer has several folds that separate the parts of the brain and enclose the venous sinuses

    5. Look at the slides & Netter to locate the locations of the intracranial membranes

    6. Sutherland fulcrum is located on the Straight Sinus

  3. Fluctuations of the cerebrospinal fluid (CSF)

    1. 8-14 cycles per minute

    2. Although it is similar to the respiratory cycle, it persists even if you hold your breath

    3. aka Cranial Rhythmic Impulse

    4. Traubbe (1898 1865) & Herring(1869) & Meyer (1925 1876) discovered similar motions

    5. As brain changes its shape, there’s an alteration in the volume of the ventricles with relations to the subarachnoid spaces and thus affecting the cyclic causes fluctuations in the CSF

  4. Mobility of the cranial bones (**Important**)

    1. Primary respiratory mechanism motion is transferred to the dura and membranes covering and surrounding the brain

    2. This motion is palpable throughout the entire body & not just in the cranium

    3. Cyclic in nature and has been named the Cranial Rhythmic Impulse (CRI)

    4. Know the location of the following cranial bones to help visualize the next few concepts: Frontal, Facial, Vomer, Ethmoid, Sphenoid, Temporal & Parietal

    5. Sphenoid bone drives the frontal, facial, ethmoid, & vomer

    6. Occipital bone drives the temporal & parietal bones

Student Question: What does it mean by drives?

Answer: it means to change the articulation between the adjacent bones during times of


  1. Involuntary mobility of the sacrum between the ilia

Sutures and Beveling: Evidence of Articular mobility

  • Two main functions of sutures: site of active bone growth & forms band of union between adjacent bones to allow small amount of motion

  • Wolff’s Law states that there is slight amount of pull on a bone then the area will become larger

  • Bones of at skull develop and unite at zigzag edges which dovetail together permitting slight degree mobility

  • Sutures are articular surfaces that have evolved in relation to and proportion to slight amount of physiological motion that is normally present within them

  • A
    Movement during Flexion
    natomy of the sutures allow for slight motion due to its be articular surfaces being serrated, beveled, grooved, interdigitated or a combination


  • SBS (Sphenoid Basilar Symphysis) rises (superiorly)

  • Vomer moves inferiorly

  • Palate widens and flattens

  • P
    SBS joint
    arietal, temporal and frontal paired bones externally rotate

  • S
    Movement during Extension
    acral base moves posteriorly due to its posterior attachment of the dura

Extension (Opposite of Flexion occurs)

  • SBS moves caudad

  • Parietal, temporal and frontal paired bones internally rotate

  • Vomer moves superiorly

  • Palate narrows and heightens

  • Sacral base moves anteriorly

**There are around 8-12 cycles per minute and each cycle takes about 6-8 sec. to go through one phase of flexion and extension**

**Please look at the PowerPoints where it shows the rotation of the cranial bones around their respective axis. (Slide 14)
Involuntary Motion of the Sacrum

  • Note on slide 15, the axis which the sacrum rotates around is NOT the same transverse axis we saw last semester

Reciprocal Tension Membrane: Core Link

  • inferior attachment is to the posterior aspect of the body of S2

  • the sacrum is suspended between the ilia by anterior, posterior, and intra-articular ligaments

  • physical extension of the influence of the PRM (Primary Respiratory Mechanism) by way of the spinal dura mater, whose lower attachments contribute to guiding and limiting action

  • injuries to the sacrum can very well affect articulation among the cranial bones; therefore, physicians must examine and treat both the sacrum and the head cranium

Note: It’s always important to take a good history including trauma and sport histories.
Remember: It’s ALL CONNECTED!!
Cranial Palpation: Introduction to Cranial Holds

  • Light Touch is KEY!!

Vault Hold: (used most often)

  • Index finger over greater wings of sphenoid

  • Middle finger anterior to ear on temporal bone with tip touching zygomatic process

  • Ringer finger near asterion

  • Little finger on squamous portion of occiput

  • Look at Slide 27 & 28 for visuals

  • Position fingers properly and feel for movement (Cranial Rhythmic Impulse)

    • During Flexion

      • Swelling will take place between 3rd & 4th digits in a wave-like motion

      • 2nd & 5th digits will go caudad (away from you)

      • Cranial vault widens

      • A-P diameter shortens

      • Superior inferior diameter shortens

      • All 4 fingers move down – caudad

      • SBS moves up – cephalad

  • During Extension (Opposite Occurs)

    • SBS moves inferiorly

    • Paired frontal, facial, and temporal bones move into internal rotation

    • Sacrum moves anteriorly

    • Cranial vault narrows

    • A-P diameter lengthens

    • Superior-inferior diameter lengthens

    • All 4 fingers move up – cephalad

    • SBS moves down – caudad

Fronto-Occipital Hold:

  • Useful in feeling SBS compression

  • During this procedures move so that you’re comfortable

  • On flexion, the distal part of sphenoid should be going caudad and medial

  • One hand cradles the occiput only

  • Other hand is placed over the frontal bone

  • Two variations of finger placement:

  1. Thumb and 5th digit over sphenoid and middle finger down metopic suture

  2. Thumb and middle finger over sphenoid (for people with smaller hands)

Cradle Hold:

  • You can cross your hands or interdigitate your fingers

  • Most of your hands are on the occiput.

  • There are two variations for thumb placement:

    • 1. Keep thumbs on the mastoid process and feel temporal bones go in and out.

    • 2. Put thumbs on the sphenoid itself

  • Your fingers are palpating the occiput in a to and fro flexion/extension motion

  • During flexion, your fingers are moving away from you and toward you during extension

  • Your thumbs are going medially during flexion and outwardly during extension

    • Flexion phase-mastoid portion of temporal moves medial and slightly posterior

POP Quiz!!

Ernie is the perfect example of FLEXION head, because his head is very wide and seems like it’s in flexion all the time
Bert on the other hand is the perfect example of EXTENSION head, because his head is nice and narrow and it’s in extension mode.
Dr. Gamber wants all of us to think about the “Questions to Ponder” located at the end of the PowerPoints in the next two weeks as we learn and practice more on this topic.
Please read the first 21 pages of the handout given at the beginning of the year entitled Expanding the Osteopathic Concept.
Also, new edition of Foundations book is out. If you didn’t buy one last year, buy the newer edition and read the chapter titled “Osteopathy in the Cranial Field” and Chapter 76 written by Dr. Gamber.

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