Osteopathic Cranial

Manipulative Medicine:
Midline Bones
Kevin D. Treffer, D.O., FACOFP
Chief, Division of OMM
KCU-COM

Objectives

At the end of the lecture the student will be able

to:
Describe the normal motion of the midline
bones
Describe the four types of somatic dysfunction
that occur at the SBS
Describe the relevant axes of motion and planes
of motion of the occiput and sphenoid for each
dysfunction
Describe the motion of the ethmoid and vomer
during cranial flexion and extension
Describe the motions and the relationship of the
SBS to the sacrum

Readings
DiGiovanna Cranial Concepts
Pgs: 565-572
FOM 3rd Edition Chapter 48
Pgs: 735-745
Recommended text for full discussion
Osteopathy in the Cranial Field, Magoun

Midline or unpaired bones

Cranial
Ethmoid
Occiput
Sphenoid
(Frontal)
Facial
Mandible
Vomer

Paired Bones

Cranial
Parietal
Temporal
(Frontal)
Facial
Inferior nasal concha
Lacrimal
Maxilla
Nasal
Palatine
Zygoma

Motion Characteristics

Midline bones
USUALLY rotate about a transverse axis in a
anterior/posterior direction (even when it is
labeled flexion-extension)
Paired bones
USUALLY move about AP axis in a lateral
motion (coronal plane), labeled External
rotation/Internal rotation (flexion extension)
extention of midline bone is paired with

Basic motion of the SBS

Inhalation flexion
Sphenoid will rotate about a transverse axis so
that the alae (wings) will move anteriorly and
the motion at the SBS will be superior
Occiput will rotate about a transverse axis so
that the motion at the SBS will be superior and
the bowl of the occiput will move posterior
and inferior
occipit will rotate in oppo direction than
sphenoid wings about the transverse axis

SBS Motion- ethmoid

The basiocciput will move vertically in

sphenobasilar symphysis (SBS) flexion,
causing a rotation of the ethmoid bone
ethmoid moves same direction as occipit but sphenoid in opposite
direction

SBS Motion, ethmoid & vomer

When the SBS is in flexion

The ethmoid will move in the same
direction as the occiput
The vomer will move in the same
direction as the sphenoid

SBS Motion: ethmoid, vomer,

palatines

During SBS flexion

The palatines will move in external
rotation primarily
Interpalatine suture will move inferiorly
with vomer and maxillae

Somatic Dysfunctions at the SBS

Simplest is the strain
patterns
Lateral strain
Named for the position
of the base of the
sphenoid
(basisphenoid)
What axes are
involved?
From above, what direction
do the bones move? Do
they move in the same or
different directions?

SBS lateral strain

Axes are superior inferior
Direction is THE SAME for both bones
Label for the motion of the basisphenoid
This example is a
right lateral strain
What are the palpatory findings?

visual change to cranium that looks like parallelogram is lateral strain

name for where sphenoid is in relationship with occipit at the SBS

SBS vertical strain

Named for the direction of the basisphenoid
Can have a superior or an inferior vertical
strain pattern.
Superior
Bones rotate anterior around involved
axes
Inferior
Bones rotate posterior around involved
axes

rotate in posterior manner

abnormal so rotates in same
direction: sphenoid extension and
occipit flexion

Vertical strain
What are the axes of motion?
From the side, what are the directions of
movement?
Do both bones move in the same or
opposite directions?
What are the palpatory findings?

Vertical strain
Axes are transverse
Direction of the bones is THE SAME
Diagnosis:
Inferior vertical strain
What are the palpatory findings?

SBS: Torsion

Named for position of the greater wing of

the sphenoid during cranial flexion
The greater wing that moves cephalad
during cranial flexion
Right or left torsion

Torsion

Around what axes is

there motion
What direction do the
bones move?
Do they move in the
same or different
directions.
What are the palpatory
findings?

SBS: Sidebending rotation

Biplanar dysfunction

Combined side
bending and rotation

Named for the side of

the convexity
developed in the
cranium

Sidebending Rotation
What are the axes of motion?
The bones move in what direction(s)?
Is the motion in same or different
directions?
What are the palpatory findings?

SBS and Sacral motion

SBS flexion
Pulls up on the dural sleeve of the cord
Sacrum moves posteriorly
Called counter nutation
Nutation means nodding
SBS extension sacral nutation

SBS flexion and scral posterior

movement

SBS-Sacral Motion Questions

What is the motion at the base of the sacrum
in SBS flexion?
What is the motion of the apex of the
sacrum in SBS flexion?
Where is the axis of motion of the sacrum?
Why does the spinal membranes cause this
sacral motion with the CRI?

Summary

SBS dysfunctions are common and can be treated

very easily with direct or indirect techniques
Understand and be able to describe the axes and
planes of motion
Visualized the relationship of the SBS to the
sacrum
The clinical application will be discussed later