Professional Documents
Culture Documents
Cranial
“Controversy
Controversy in
Thought”
By
Kenneth Lossing D.O.
1
W.G. Sutherland D.O.
9
The current biomechanical
terminolog : Visco
terminology Visco-elasticity
elasticit of
Sutures
• S
Stiffness:
iff tensile
il fforce/change
/ h iin llength
h
• Ultimate stress: tensile force at suture
rupture/cross sectional area
• “Sutures demonstrate classical viscoelastic
behavior. During the elastic phase, they
elongated approx 1 um for every 1g of force
104 N/m. The ultimate tensile stress was approx
4 MN/m2. The estimated mean elastic
modulus
d l was 10 megapixels”.
i l ”
• “The Load-Displacement Characteristics of
Neonatal Rat Sutures
Sutures” The Cleft Palate-
Palate
Craniofacial Journal. Vol.37, McLaughlin
10
Stress Strain Graph
Strain
Stress • E= elastic modulus
• The angle of the curve
loading reflects the stiffness of the
tissue. A tissue that is stiff
unloading will have a line to the left,
and a tissue that is less stiff
will have a line to the right.
E
Strain Fundamentals of
Biomechanics,Ozkaya
Modern science says
• That the “mobility” or “viscoelasticity” of the
sutures
t is
i specific,
ifi nott arbitrary.
bit
• A specific amount of force will create a
specific
ifi amountt off distensability
di t bilit and
d
movement, in a normally functioning suture.
• In a suture that is malfunctioning
malfunctioning, stuck
stuck, or
locked, the normal amount of distensability is
reduced or lost.
12
Fronto-Occipital
Fronto Occipital Hold-
Hold Motion Test
• This is how Sutherland
taught up through at least
1946, according to Robert
Fulford.
• Thumbs on:
• mastoid process and
zygomatic process of frontal.
• Hands and fingers to
opposite side
• Actively “motion test” the
following strain patterns:
Atlas of manipulative Techniques for the Cranium and Face, Alain 13
Gehin
SBS
• Flexion
• Extension
• Torsion
• Side-bending
• Vertical
• Lateral
• Compression
p
Osteopathy in the Cranial Field, Magoun 14
Beryl Arbuckle D.O.
• She started studying with
S th l d iin 1942
Sutherland 1942.
• She assisted Sutherland
i th
in the early
l courses,
including the first course
at a school
school, Des Moines
Moines,
in 1944, where the
Becker’s were students.
• Remained on his teaching
staff for some years.
The Selected Writings of Beryl Arbuckle
Life in Motion, Rollin Becker 15
Beryl Arbuckle
• Since she wanted objective evidence of what
she palpated while treating patients, she
attended nearly every autopsy ( estimated at
about 200) on cranial pathology at a hospital in
Philadelphia over a many year time span
span.
• Observed fiber strands in specific directions,
which she called stress bands.
• Used positional and motion testing diagnosis.
• As she treated mostly children, she used direct
technique, with respiratory assistance when
possible ( step breathing or holding of breath as
long as possible)
possible).
The Selected Writings of Beryl Arbuckle 16
Beryl Arbuckle
• Presented her finding of stress fibers to the
study
t d group off the
th teachers
t h aroundd
Sutherland.
• Sutherland
S th l d h had
d no problem
bl with
ith thi
this, or with
ith
Arbuckle.
• Shortly afterward,
afterward she started teaching on her
own, with the assistance of Paul Kimberly had
been on Sutherland’s
Sutherland s teaching staff, who also
did direct cranial.
21
Fulford’s
Fulford s Face test
22
Posterior Skull Test
28
Cranial Sutures, Marc Pick
Sphenopalatine Manipulation
• Contacts:
• Bilateral maxilla’s,
inside of mouth near
last molars
molars-W-medial
W medial
• Pterygoid process,
anterior tip-W1/4R-
tip W1/4R
posteromedial.
• Note: the most
common side is the
right, but I treat both.
KL
Cranial Sutures, Marc Pick 29
Frontoethmoid Manipulation
• To release lateral surfaces
and close the anterior
surfaces-
• Frontal’s metopic suture,
e tending laterall
extending laterally over
o er
supercilliary arches and
maxilla’s-W1/3R-posterior
• Occiput-W/R anterior
Note: you are done when
the ethmoid is rocking
well, and the “upper face
translation test” is
normal.
Cranial Sutures, Marc Pick 30
The Sacrum-
Sacrum from Arbuckle
• The superior
p
horizontal fibers of the
falx in either side of
the falx cerebri
diverge somewhat
from the metopicp area
to the lambda, and
margins of the
superior part of the
sagittal sulcus of the
occiput.
The Selected Writings of Beryl Arbuckle 38
Half a world away, Dr. Erich Blecshmidt’s
dissections show : Dural Girdles
• These are areas where the dura
is thickened, thought to be due
to a reaction to the brain
growing, a restraining function.
f
• 1-retromesencephalic dural
girdle
i dl
• 6-premesencephalic dural girdle
• 12- falx ( Arbuckle called this
the falx ceribri anterior vertical
fibers)
The Stages of Human Development before Birth, 39
1960, Erich Blechschmidt
Dural girdles-thickened
girdles thickened dura
• 3,8-
, right
g frontal
dural girdle, anlagen
of coronal and
sagital sutures
sutures, and
part of falx.
• 4
4-right
right parietal dural
girdle
• 6,11- occipital dural
girdle, connective
tissue analgen of
lambdoidal suture
The Stages of Human Development before Birth, 40
1960, Erich Blechschmidt
• The dura
forms a
“restraining
f
function”
ti ” to
t the
th
more rapid
growth of the
brain.
• Symposium on
the
Development
p
of the
Basicranium
The Biokinetics of the
Basicranium, Blechschmidt 41
FIBROUS TISSUE FORMATION
(STRETCHED MESENCHYME)
Retension Field: the
sick figures pull apart
on a tough material.
The rapid growth of the
brain stretches the
precursor of the dura,
forming a horizontally
directed thickening in
the falx.
• 20 fresh cadavers,, no
pathology
• 0-92 years old
• Less than 24 hours
postmortum
• Superior
S i sagittal
itt l sinus
i
and calvarial section
of ttissue
o ssue
• Placed in saline and
frozen.
• Tissue looked at
using small angle
light scattering HeNe
lazer, has optics
between optical
miscroscopy
i and
d
gross visual analysis.
• To release anterior,
and close laterally-
• Bil contact superior
p to
sphenofrontal suture-
W1/3R-medially.
• Lateral aspect of hard
palate- W1/3R-
l
laterally,
ll then
h pullll
anteriorly
The Cranial Sutured, March Pick
The Selected Writings of Beryl
58
Arbuckle
59
The Vault, Fontanelles, and
Sutures
• From left to right:
g
• 14 weeks
• 20 weeks
• 24 weeks
• 30 weeks
• 34 weeks
• Adult
• In the fetal skull there
are 6 fontanelles
60
Anterior Fontanelle
• Anterior fontanelle becomes
bregma
g after the fontanel
closes and the sutures form. It
is between the 2 halves of the
frontal bone ((metopic
p suture))
and the 2 parietals.
• The metopic suture is open at
birth separating the frontal into
birth,
2 halves, from nasion to
bregma. It ossifies during
growth but retains a natural
growth,
malleability, moving during
flexion-extension, aided by the
attachment of the falx
falx. “The
The
cranial puzzle”
61
Bregma Treatment Part 1
• Due to the overlapping of
the sutures
sutures, the medial ends
of the coronal suture need to
be treated first, then the
anterior
t i portion
ti off the
th
sagittal suture.
• The medial end of the
coronal suture is treated by
the fingers of one hand on
glabella, depressing
posteriorly, while the thumb
of the other hand is posterior
The Selected Writings of Beryl Arbuckle
to bregma, depressing 62
caudad.
Bregma Treatment part 2
64
Beryl Arbuckle
• Preserved Sutherland’s earliest approaches to
mobility diagnosis ( position and motion testing) and
mobility,
treatment (direct).
• Refined the view of the reciprocal tension
membrane into 20 different directions of fibers, all of
which are helpful in diagnosis and treatment (both
by themselves and as handles for the bone).
• Described thickened areas of bone called
buttresses, that can be used in diagnosis and
treatment (by themselves and as handles to the
membranes).
membranes)
• Was way ahead of her time. 65
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