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Cranial Osteopathic Medicine

Posted Feb 02 2011 11:07pm
With the start of a new semester comes a whole new set of Osteopathic techniques. Welcome to cranial, folks.

Our professors had repeatedly mentioned that we would be learning cranial techniques during the spring semester. But it was the way they said it - a slight glimmer in their eye, a hint of a smile whenever they uttered the words cranial OMM. So intriguing. And now that we've begun, I'm beginning to understand their excitement. It's only been our third week of cranial lab, but I'm kind of digging it.

As soon as we entered the lab room for our first day of cranial, there was a noticeable atmospheric change in the room. It was calm, it was gentle, it was grounded. This, as we've been taught, is not only important for the patient, but it's also important for the physician to focus in on palpating the bones and sutures of the skull.

Cranial Osteopathy was founded by Dr. William G. Sutherland, DO when he was inspired by a disarticulated skull displayed in a hallway. He noticed the beveled edges of the sutures, which reminded him of the gills of a fish. This led him to considering the beveled sutures in relationship to mobility and the respiratory mechanism.



In 1939, Dr. Sutherland published The Cranial Bowl where he discussed how the motion of the cranial bones were influenced by the cerebrospinal fluid and the dural membranes - the Primary Respiratory Mechanism.

Now, some of you may be thinking "The bones in my skull move? I thought they fused together in early childhood. Isn't that what Anatomy taught us?" Ok, so maybe this is what I was thinking when we first started cranial. But, as someone who has utilized Osteopathic techniques and seen their positive effect, I went with the flow and let my hands do the observing.

We began with a basic assessment of the major anatomical features of the skull and then moved onto learning the vault hold and the correct hand placement on the patient's skull. Then, our instructors told us to feel the flexion and extension movements of the primary respiratory mechanism. If this sounds foreign to you, you aren't the only one. I'm pretty sure everyone in our lab had a collective "Huh?" moment. But thanks to the help of a little Sesame Street, our professor broke it down into an easy imagery. During flexion, the cranial bones are moving in such a way that it resembles Ernie (of Bert and Ernie) - more round. And when the bones are in extension, it's more of a Bert - long.



These, of course, are extremes and are only meant to help burgeoning (and confused) osteopathic students envision what is happening during each phase of motion. Our heads aren't going through such severe distortions on a daily basis, nor are they changing color from banana yellow to bright orange. But as a child of the 80's and a visual learner, this will definitely come in handy during exams.

And so, we set to work on palpating the motions of the cranial bones. I have to admit, I didn't feel anything at first. I thought maybe I had felt some pulsations, but that might have been my own hand and not my patient's head. I talked to some fellow classmates afterwards, and many of them were very skeptical of cranial OMM. Some students were more concerned about how we would be tested on it during the practical.

We're now into our third week of cranial lab, and I think I'm starting to get the hang of it. I've been able to correctly diagnose my lab partner, and have attempted some treatments. It's different than HVLA or Muscle Energy in that the diagnosis and treatment isn't as rapid. I think many of us have gotten used to the immediate response after employing the Texas Twist or Kirksville Crunch. But it's different with cranial. I think it takes a little more patience and time to tune into the cranial bones. I've even seen some students close their eyes in order to heighten their sensation of touch. And the concept of our skull bones moving in response to shifts in our sacrum is new, but that's OMM - whole body integration.

I had an interesting discussion with my lab partner this week. (This happened after he woke up from his mini nap while I was diagnosing him. And I take that as a compliment, I'm able to relax my patient into a peaceful slumber.) He's on the fence when it comes to cranial, but he said that what he is getting out of these lab sessions is the importance of touch when it comes to interacting with patients. He remarked on the fact that patients wants the reassurance that they are being heard, and touch confirms that the doctor is listening to the patient's story. But it's a certain kind of palpation, one that's focused and thoughtful, not a clumsy attempt at poking at a muscle. I absolutely agree with my lab partner, and it was refreshing to hear that from a fellow classmate.

So, to present and future D.O.s - what has been your experience with cranial OMM? I'd really like to know how others incorporate it into their practice, or the experiences others have had in learning cranial techniques. Any advice or stories you'd like to share?
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