APPLIED KINESIOLOGY RELATED RESEARCH
LITERATURE CONCERNING CRANIAL
THERAPY AND THE STOMATOGNATHIC
SYSTEM
-- Edited by Scott Cuthbert, D.C.
MEASUREMENTS OF CNS, BRAIN, SPINAL
CORD AND CSF MOTILITY
Cranial rhythmic impulse related
to the Traube-Hering-Mayer
oscillation: comparing laserDoppler flowmetry and palpation,
Nelson KE, Sergueef N, Lipinski
CM, Chapman AR, Glonek T.
J Am Osteopath Assoc, 2001 Mar;101(3):163-73
The cytological implications of
primary respiration, Crisera, P.
Medical Hypotheses, Jan 2001; 56(1):40-51
Abstract: The primary respiratory mechanism (PRM) as manifested by the cranial
rhythmic impulse (CRI), a fundamental concept to cranial osteopathy, and the TraubeHering-Mayer (THM) oscillation bear a striking resemblance to one another. Because of
this, the authors developed a protocol to simultaneously measure both phenomena.
Statistical comparisons demonstrated that the CRI is palpably concomitant with the lowfrequency fluctuations of the THM oscillation as measured with the Transonic Systems
BLF 21 Perfusion Monitor laser-Doppler flowmeter. This opens new potential explanations
for the basic theoretical concepts of the physiologic mechanism of the PRM/CRI and
cranial therapy. Comparison of the PRM/CRI with current understanding of the physiology
of the THM oscillation is therefore warranted. Additionally, the recognition that these
phenomena can be simultaneously monitored and recorded creates a new opportunity for
further research into what is distinctive about the science and practice of osteopathic
medicine.
Abstract: Observing the macroscopic complexities of evolved species, the exceptional
continuity that occurs among different cells, tissues and organs to respond coherently to the
proper set of stimuli as a function of self/species survival is appreciable. Accordingly, it
alludes to a central rhythm that resonates throughout the cell; nominated here as primary
respiration (PR), which is capable of binding and synchronizing a diversity of physiological
processes into a functional biological unity. Phylogenetically, it was conserved as an
indispensable element in the makeup of the subkingdom Metazoan, since these species
require a high degree of coordination among the different cells that form their body.
However, it does not preclude the possibility of a basal rhythm to orchestrate the intricacies
of cellular dynamics of both prokaryotic and eukaryotic cells. In all probability, PR
emerges within the crucial organelles, with special emphasis on the DNA, and propagated
and transduced within the infrastructure of the cytoskeleton as wave harmonics.
Collectively, this equivalent vibration for the subphylum Vertebrata emanates as
craniosacral respiration (CSR), though its expression is more elaborate depending on the
development of the CNS. Furthermore, the author suggests that the phenomenon of PR or
CSR be intimately associated to the basic rest/activity cycle (BRAC), generated by
concentrically localized neurons that possess auto-oscillatory properties and assembled into
a vital network. Historically, during Protochordate-Vertebrate transition, this area
circumscribes an archaic region of the brain in which many vital biological rhythms have
1
their source, called hindbrain rhombomeres. Bass and Baker propose that patterngenerating circuits of more recent innovations, such as vocal, electromotor, extensor muscle
tonicity, locomotion and the extraocular system, have their origin from the same Hox genespecified compartments of the embryonic hindbrain (rhombomeres 7 and 8) that produce
rhythmically active cardiac and thoracic respiratory circuits. Here, it implies that PR could
have been the first essential biological cadence that arose with the earliest form of life, and
has undergone a phylogenetic ascent to produce an integrated multirhythmic organism of
today. Finally, in its full manifestation, the breathing DNA of the zygote could project itself
throughout the cytoskeleton and modify the electromechanical properties of the plasma
lamella, establishing the primordial axial-voltage gradients for the physiological control of
development.
The periodic mobility of the
cranial bones in man, Moskalenko
IuE, Kravchenko TI, Gaidar BV,
Vainshtein GB, Semernia VN,
Maiorova NF, Mitrofanov VF
(article in Russian)
Fiziol Cheloveka, 1999 Jan-Feb;25(1):62-70.
.
Raised intracranial pressure
increases CSF drainage through
arachnoid villi and extracranial
lymphatics, Boulton M,
Armstrong D, Flessner M, Hay J,
Szalai JP, Johnston M.
Am J Physiol. 1998 Sep;275(3 Pt 2):R889-96.
Cycle-to-cycle variability
attributed to the primary
respiratory mechanism,
Lockwood MD, Degenhardt BF.
J Am Osteopath Assoc. 1998 Jan;98(1):35-6, 41-3.
Abstract: Serial X-rays and magnetic resonance tomograms of the human skull
demonstrated changes in intracranial dimension of about 0.38 millimeters, which alternated
between sagittal and frontal (anterior to posterior) expansions.
Abstract: We demonstrated previously that about one-half of cerebrospinal fluid (CSF)
removed from the cranial vault was cleared by extracranial lymphatic vessels. In this report
we test the hypothesis that lymphatic drainage of CSF increases as intracranial pressure
(ICP) is elevated in anesthetized sheep. Catheters were inserted into both lateral ventricles,
cisterna magna, cervical lymphatics, and jugular vein. A ventriculocisternal perfusion
system was employed to regulate CSF pressures and to deliver a protein tracer (125Ilabeled human serum albumin) into the CSF compartment. 131I-labeled human serum
albumin was injected intravenously to permit calculation of plasma tracer loss and tracer
recirculation into lymphatics. ICP was controlled by adjusting the height of the inflow
reservoir and the cisterna magna outflow catheter appropriately. The experimental design
consisted of a 3-h period of lower pressure followed by a 3-h period of higher pressure in
the same animal (10-20 or 20-30 cmH2O). We determined that incremental changes in ICP
were associated with higher CSF transport through lymphatic and arachnoid villi routes in
all eight animals tested (P = 0.004).
Comment: This paper demonstrates the relationship between the lymphatic system and the
cranial system. The implications of lymphatic drainage of the head to the movement of CSF
should be explored further, and the methods of diagnosis and treatment of lymphatic
function in AK could be an excellent modality for use in this investigation.
Abstract: Wave forms attributed to the primary respiratory mechanism (PRM), as
published by Viola Frymann, DO, in JAOA June 1971, were analyzed for an undescribed
parameter, cycle-to-cycle variability. Tracings from this paper were independently
measured by two physicians focusing on the duration of each cycle. Consistency of the
measurements and interexaminer agreement were shown. The duration of individual cycles
demonstrated significant cycle-to-cycle variability ranging from 0.6 second up to 6.3
seconds. The reason for variability as well as its clinical significance is unknown. The
minute rate of each tracing ranged from 6.5 to 13.8 cycles per minute (0.108 to 0.230 Hz
[corrected]), mean 10.8 +/- 2.3 (0.180 +/- 0.038 Hz [corrected]). (Different minute rates
attributed to the PRM have been reported in other studies.) Although variability is an innate
characteristic of biologic cycles, this phenomenon has not been previously reported for the
PRM. The authors suggest that this variability has likely confounded previous
interexaminer reliability studies and should be considered in any future studies of this type.
2
Determination of causes of this variability present timely and fruitful avenues of research.
Assessment of the biomechanical
state of intracranial tissues by
dynamic MRI of cerebrospinal
fluid pulsations: a phantom study,
Chu D, Levin DN, Alperin N.
Magn Reson Imaging. 1998 Nov;16(9):1043-8.
A new view on the CSFcirculation with the potential for
pharmacological treatment of
childhood hydrocephalus, Greitz
D, Greitz T, Hindmarsh T.
Acta Paediatr. 1997 Feb;86(2):125-32.
Update on osteopathic medical
concepts and the lymphatic
system, Degenhardt BF, Kuchera
ML.
J Am Osteopath Assoc, 1996 Feb;96(2):97-100.
Abstract: We used a cranial phantom to investigate how intracranial mechanical factors
[brain compliance and the resistance to the flow of cerebrospinal fluid (CSF)] affect the
way in which CSF pulsations are driven by pulsatile transcranial blood flow. Dynamic
phase-contrast magnetic resonance imaging (MRI) was used to measure the transfer
function between vascular pulsations and pulsatile response of the CSF below the foramen
magnum of the phantom. We found that the coupling between the high frequency
components of cervical CSF flow and transcranial blood flow was decreased when the
phantom was modified to simulate increased brain compliance and increased resistance to
CSF flow.
Abstract: A new model of the cerebrospinal fluid (CSF) circulation is proposed, implying
that the main absorption of CSF occurs through the brain capillaries. This model is based
on recent observations of CSF dynamics using radionuclide cisternography and cardiac
gated magnetic resonance imaging. Magnetic resonance imaging of communicating
hydrocephalus has demonstrated a highly significant decrease of CSF flow through the
foramen magnum, which is explained by decreased expansion of the intracranial arteries.
This invariable finding in combination with the new view of the CSF-circulation makes a
hemodynamic pathogenesis of hydrocephalus very probable. Communicating
hydrocephalus may be caused by any process that restricts the arterial pulsations and
is therefore termed restricted arterial pulsation hydrocephalus. In obstructive
hydrocephalus, the ventricular dilatation leads to a compression of the cortical veins and
consequently is termed venous congestion hydrocephalus. Based on these considerations, a
new concept of pharmacological treatment of hydrocephalus is proposed by using a
selective venous constrictor.
Abstract: The osteopathic medical profession has long recognized the importance of the
lymphatic system in maintaining health. A review of scientific studies shows much
information on the mechanisms and importance of lymph circulation. Many osteopathic
manipulative techniques designed to treat patients with tissue congestion are based on early
research recognizing that lymph flow is influenced by myofascial compression. Osteopathic
manipulative treatment of the diaphragm was substantiated when pressure differentials
created by the thoracic diaphragm were shown to influence lymph flow. Current research
demonstrates that autonomically mediated, intrinsic lymphatic contractility plays a
significant role in lymph propulsion, supporting the use of osteopathic manipulative
techniques directed at influencing the autonomic nervous system to improve lymphatic
circulation. Although research provides an explanation of how osteopathic manipulative
techniques influence the lymphatic system, experimentation to test the direct influence of
manipulation on lymph circulation is needed. Clinical outcomes studies are also necessary
to substantiate the clinical efficacy of osteopathic manipulative techniques. This paper also
proposes that intrinsic lymphatic contractility (distention of vessel walls, mediated
neurally and hormonally) could cause a fascial impulse, palpated as the cranial
rhythmic impulse (CRI) throughout the body.
Intracranial volume receptors:
J Endocrinol Invest. 1996 Jul-Aug;19(7):455-62.
possible role on ADH homeostatic
Abstract: Volume receptors are situated in many organs and are capable of modulating
control, Satta A, Palomba D,
ADH secretion. We have evaluated the variation of plasma ADH concentration after an
Demontis MP, Varoni MV,
experimentally induced increase of cerebrospinal fluid (CSF) pressure (PCSF). The
3
Faedda R, Ginanni A, Anania V.
experiment was performed in controlled environmental conditions to avoid pain or stressrelated ADH release. In 15 rats (10 experimental, 5 control) a cannula was positioned in the
left cerebral ventricle: in the experimental group artificial CSF was infused at a rate of 0.6
(microliter/min for 6h: this manoeuvre, in a separate set of animals obtained an increase
from 13.03 +/- 0.8 to 25.4 +/- 2.5 cmH2O of PCSF. The same conditions were reproduced
in the control group without infusion into lateral ventricle. At the end of the experiment,
plasma ADH had fallen significantly in the experimental group from 18.9 +/- 4.8 to 11.9 +/2.3 pg/ml (p < 0.05), while it was not changed in the control group (from 25.5 +/- 13.7 to
23.7 +/- 16.2 pg/ml). Heart rate, arterial pressure, plasma Na+ and osmolality, did not
change significantly. Plasma K+ fell significantly in both groups: from 5.5 +/- 0.6 to 4.3 +/0.3 (p < 0.05) and from 5.4 +/- 0.7 to 4.3 +/- 0.15 mEq/l (p < 0.05) in the experimental and
control group respectively. Plasma creatinine was normal, checked only at the end of the
experiment. Our results demonstrate that a relationship exists between PCSF variations and
plasma ADH concentration. We believe this relationship is due to the pressure receptors in
the cerebral ventricles or in structures connected to it, such as the inner ear, and we
hypothesize the existence of a control system of body fluids, more diffused than thought to
be, up till now.
Comment: An important goal of AK practitioners is to consider the whole patient. This
study demonstrates that there is a specific relationship between the cranial-meningeal-CSF
system and the endocrine system. Endocrine assessments as well as cranial structural
assessments should be considered for patients who have cranial faults from the evidence
presented in this study.
Hemodynamically independent
analysis of cerebrospinal fluid and
brain motion observed with
dynamic phase contrast MRI,
Alperin N, Vikingstad EM,
Gomez-Anson B, Levin DN.
Magn Reson Med. 1996 May;35(5):741-54.
Abstract: Brain and cerebrospinal fluid (CSF) movements are influenced by the anatomy
and mechanical properties of intracranial tissues, as well as by the waveforms of driving
vascular pulsations. The authors analyze these movements so that the purely hemodynamic
factors are removed and the underlying mechanical couplings between brain, CSF, and the
vasculature are characterized in global fashion. These measurements were used to calculate
a set of impulse response functions or modulation transfer functions, characterizing global
aspects of the vasculature's mechanical coupling to the intracranial tissues, the cervical
CSF, and the cervical spinal cord. These functions showed that a sudden influx of blood
into the head was rapidly accommodated by some type of intracranial reserve or capacity.
After this initial response, an equal volume of CSF was driven through the foramen
magnum over the next 200-300 ms as the intracranial reserve relaxed to its base-line state.
Brain and cerebrospinal fluid
Radiology, 1994 Nov;193(2):477-83.
motion: real-time quantification
with M-mode MR imaging, Maier PURPOSE: To assess motion of brain parenchyma and cerebrospinal fluid (CSF) with
magnetic resonance (MR) phase imaging in real time. MATERIALS AND METHODS:
SE, Hardy CJ, Jolesz FA.
Repetitive excitation of a cylinder with two-dimensional selective excitation followed by
one-dimensional imaging along the cylinder axis yielded profiles analogous to those of Mmode echography. Bipolar gradients provided velocity sensitivity in an arbitrary spatial
direction. RESULTS: Brain and CSF of healthy volunteers exhibited periodic motion in
the frequency range of normal heart rate. Both brain hemispheres showed periodic
squeezing of the ventricles, with peak velocities up to 1 mm/sec followed by a slower
recoil. Superimposed on the regular displacement of the brain stem was a slow, respiratoryrelated periodic shift of the neutral position. During the Valsalva maneuver, the brain stem
showed initial caudal and subsequent cranial displacement of 2-3 mm. Coughing produced
a short swing of CSF in the cephalic direction. CONCLUSION: Real-time MR phase
imaging allows observation of non-periodic events in brain and CSF motion.
Origin of lumbar cerebrospinal
fluid pulse wave, Urayama K.
Spine, 1994 Feb 15;19(4):441-5.
4
Abstract: System analysis was performed on 16 adult mongrel dogs to determine the origin
of the lumbar cerebrospinal fluid pulse wave. The descending thoracic aorta was occluded
to evaluate the effects of the spinal arterial pulsations, and the thoracic aorta and inferior
vena cava were simultaneously occluded to evaluate the effects of the spinal venous
pulsations. It was concluded that, in the first harmonic wave, the components of the lumbar
cerebrospinal fluid pulse wave are as follows: spinal arterial pulsations, 39.4%; spinal
vascular (arteries and veins) pulsations, 77%; venous pulsations in the spinal canal, 37.6%;
and the intracranial pressure pulse wave transmitted through the spinal canal from the
intracranial space to the lumbar level, 23%.
Cerebrospinal fluid circulation
and associated intracranial
dynamics. A radiologic
investigation using MR imaging
and radionuclide cisternography,
Greitz D.
Acta Radiol Suppl, 1993;386:1-23.
CSF drains directly from the
subarachnoid space into nasal
lymphatics in the rat. Anatomy,
histology and immunological
Neuropathol Appl Neurobiol. 1993 Dec;19(6):480-8.
AIMS OF THE PRESENT INVESTIGATION. Observations made in a preliminary study
of pulsatile cerebrospinal fluid (CSF) and brain motions using MR imaging called for a
reconsideration of the CSF flow model currently accepted. The following questions were
addressed: 1) The nature of the CSF-circulation, e.g., the magnitude and pattern of pulsatile
and bulk flow; 2) The driving forces of the CSF circulation and assessment of the role of
associated hemodynamics and brain motions; 3) The major routes for the absorption of
CSF. MATERIAL AND METHODS. CSF flow and associated hemodynamics were
studied using gated MR imaging, in 26 healthy volunteers, 5 patients with communicating
hydrocephalus and 10 with benign intracranial hypertension. Radionuclide cisternography
was performed in 10 individuals with venous vasculitis. RESULTS AND CONCLUSIONS.
1) The CSF-circulation is propelled by a pulsating flow, which causes an effective mixing.
This flow is produced by the alternating pressure gradient, which is a consequence of the
systolic expansion of the intracranial arteries causing expulsion of CSF into the compliant
and contractable spinal subarachnoid space. 2) No bulk flow is necessary to explain the
transport of tracers in the subarachnoid space. 3) The main absorption of the CSF is not
through the Pacchionian granulations, but a major part of the CSF transportation to the
blood-stream is likely to occur via the paravascular and extracellular spaces of the central
nervous system. 4) The intracranial dynamics may be regarded as the result of an interplay
between the demands for space by the four components of the intracranial content, i.e. the
arterial blood, brain volume, venous blood and the CSF. This interaction is shown to have a
time offset within the cerebral hemispheres in a fronto-occipital direction during the cardiac
cycle (the fronto-occipital "volume wave"). 5) The outflow from the cranial cavity to the
cervical subarachnoid space (SAS) is dependent in size and timing on the intracranial
arterial expansion during systole. Similarly, the outflow from the aqueduct mirrors the brain
expansion. The brain expansion is typically very small as evident from the minute
aqueductal flow observed in healthy individuals. This expansion occurs simultaneously
with an inflow of CSF and will be directed inwards towards the ventricular system. The
brain expansion is of decisive importance for the formation of the normal transcerebral
pressure gradient. 6) The instantaneous increase of flow in the superior sagittal sinus at the
beginning of the systole reflects a direct pressure transmission via the SAS from the
expanding arteries to the cerebral veins. It is contended that this early increase in venous
pressure together with the volume wave is most likely an important prerequisite for
sustaining normal intracranial pressure (ICP) and normal cerebral blood flow. This counter
pressure should be reduced in hydrocephalus due to the decreased arterial expansion and
could explain the reduced blood flow as well as an increased transmantle pressure gradient
causing the ventricular dilatation. An increased pressure in the venous system is likely to be
the cause of increases in ICP, including the increased pressure observed in benign
intracranial hypertension (BIH).
Abstract: Cerebrospinal fluid (CSF) drainage pathways from the rat brain were
investigated by the injection of 50 microliters Indian ink into the cisterna magna. The
5
significance, Kida S, Pantazis A,
Weller RO.
distribution of the ink, as it escaped from the cranial CSF space, was documented in 2 mm
thick slices of brain and skull cleared in cedar wood oil and in decalcified paraffin sections.
Following injection of the ink, deep cervical lymph nodes were selectively blackened
within 30 min and lumbar para-aortic nodes within 6 h. Within the cranial cavity, carbon
particles accumulated in the basal cisterns but were also distributed in the paravascular
spaces around the middle cerebral arteries and the nasal-olfactory artery. Carbon particles
in the subarachnoid space beneath the olfactory bulbs drained directly into discrete
channels which passed through the cribriform plate and into lymphatics in the nasal
submucosa. Although ink was distributed along the subarachnoid space of the optic nerves
and entered the cochlea, the nasal route was the only direct connection between cranial CSF
and lymphatics. Arachnoid villi associated with superior and inferior sagittal sinuses were
identified and a minor amount of drainage of ink into dural lymphatics was also observed.
This study demonstrates the direct drainage of cerebrospinal fluid through the cribriform
plate in anatomically defined channels which connect with the nasal lymphatics.
Comment: This paper shows the functional integration of the CSF with the lymphatic
system, a concept that has been important in AK thinking for over 30 years.
Pulsatile brain movement and
associated hydrodynamics studied
by magnetic resonance phase
imaging. The Monro-Kellie
doctrine revisited, Greitz D,
Wirestam R, Franck A, Nordell B,
Thomsen C, Stahlberg F.
Neuroradiology,1992;34(5):370-80.
Brain motion: measurement with
phase-contrast MR imaging,
Enzmann DR, Pelc NJ.
Radiology. 1992 Dec;185(3):653-60.
Abstract: Brain tissue movements were studied in axial, sagittal and coronal planes in 15
healthy volunteers, using a gated spin echo MRI sequence. All movements had
characteristics different from those of perfusion and diffusion. The highest velocities
occurred during systole in the basal ganglia (maximum 1.0 mm/s) and brain stem
(maximum 1.5 mm/s). The movements were directed caudally, medially and posteriorly in
the basal ganglia, and caudally-anteriorly in the pons. Caudad and anterior motion
increased towards the foramen magnum and towards the midline. The resultant movement
occurred in a funnel-shaped fashion as if the brain were pulled by the spinal cord. This may
be explained by venting of brain and cerebrospinal fluid (CSF) through the tentorial notch
and foramen magnum. The intracranial volume is assumed to be always constant by the
Monro-Kellie doctrine. The intracranial dynamics can be viewed as an interplay between
the spatial requirements of four main components: arterial blood, capillary blood (brain
volume), venous blood and CSF. These components could be characterized, and the
expansion of the arteries and the brain differentiated, by applying the Monro-Kellie
doctrine to every moment of the cardiac cycle. The arterial expansion causes a re-moulding
of the brain that enables its piston-like action. The arterial expansion creates the
prerequisites for the expansion of the brain by venting CSF to the spinal canal. The
expansion of the brain is, in turn, responsible for compression of the ventricular system and
hence for the intraventricular flow of CSF.
Abstract: Brain motion during the cardiac cycle was measured prospectively in 10 healthy
volunteers by using a phase-contrast cine magnetic resonance (MR) pulse sequence. The
major cerebral lobes, diencephalon, brain stem, cerebellum, cerebellar tonsils, and spinal
cord were studied. The overall pattern of brain motion showed caudal motion of the central
structures (diencephalon, brain stem, and cerebellar tonsils) shortly after carotid systole,
with concurrent cephalic motion of the major cerebral lobes and posterior cerebellar
hemisphere. Peak brain displacement was in the range of 0.1-0.5 mm for all the structures
except the cerebellar tonsils, which had greater displacement (0.4 mm +/- 0.16 [mean +/standard error of mean]). Caudal motion of the central structures did not occur
simultaneously but progressed in a caudal-to-rostral and posterior-to-anterior sequence,
being seen first in the cerebellar tonsils and then later in the diencephalon (hypothalamus).
Caudal motion of the low brain stem and cerebellar tonsil was simultaneous with caudal
motion of cerebrospinal fluid in the cervical subarachnoid space. Oscillatory flow in the
aqueduct was delayed compared with brain stem motion.
6
Hydraulic regulation of brain
parenchymal volume, Winston
KR, Breeze RE.
Neurol Res. 1991 Dec;13(4):237-47.
Abstract: A mechanism for the hydraulic regulation of brain parenchymal volume is
hypothesized. Ventricular fluid pressure is transmitted to parenchymal capillaries and
affects the pressure difference across the capillary wall, thereby influencing the rate of
movement of fluid from the capillary lumen to interstitial fluid. The tendency for brain
parenchyma to expand results from the resistance encountered by interstitial fluid as it
slowly passes through the complex interstices of extracellular space. The tendency for the
brain parenchyma to become smaller results, not from compression of tissue by ventricular
fluid, but from an inherent elasticity of brain tissue. The parenchymal volume is stable only
when the opposing tendencies are balanced. The critical site of action for the hydraulic
control of parenchymal volume is the capillary wall, and the fundamental relationship
governing this can be expressed mathematically.
Comment: For proper venous drainage of the brain, there should be a reducing gradient
pressure from cranial perfusion pressure (about equal to mean arterial pressure), to
interstitial fluid pressure in the brain, to CSF pressure, to superior sagittal sinus venous
pressure, to the negative interstitial fluid pressure in the body. In AK it is suspected that
improving cranial sutural movement and reciprocal membrane tension will enhance venous
flow, reduce neural entrapment, and permit a normal cranial rhythmic impulse rate, rhythm,
and amplitude…all of which benefit the homeostatic mechanisms of the nervous system.
Alternative pathways for drainage Lymphology. 1989 Sep;22(3):144-6.
of cerebrospinal fluid in the
canine brain, Leeds SE, Kong AK, Abstract: Although the brain has no formal lymphatic system, a substantial quantity of
cerebrospinal fluid (CSF) has nonetheless been shown to drain via cervical lymphatics. To
Wise BL.
pursue further the issue of alternative drainage pathways for CSF, we infused a solution of
Ringer's lactate (RL) into the cisterna magna of the dog brain and monitored both the flow
and concentration of total protein of cervical lymph. This maneuver promoted a nearly
three-fold rise in intracranial pressure and was accompanied by a rise in cervical lymph
flow and fall in its protein content. In addition, a profuse nasal discharge (11.4 ml/hr)
developed with a moderately high protein content of the rhinorrhea fluid (1.8 g/dl), along
with similar appearance times of Evans blue dye (instilled in the cisterna magna) in both
cervical lymph and the rhinorrhea fluid (48-70 minutes after infusion). These findings
suggest alternative drainage pathways for CSF besides the arachnoid villi (Pacchionian
bodies) including connections with lymphatics in the neck and along the olfactory nerve,
and around the cribriform plate to the nasal submucosa, and with proptosis, perhaps also
through the aqueous humor-canal of Schlemm and nasolacrimal duct.
Dynamics of the junction between
the medulla and the cervical spinal
cord: an in vivo study in the
sagittal plane by magnetic
resonance imaging, Doursounian
L, Alfonso JM, Iba-Zizen MT,
Roger B, Cabanis EA, Meininger
V, Pineau H.
Surg Radiol Anat. 1989;11(4):313-22.
Abstract: Sagittal sections of the brain-stem made by MRI reveal differences in the angle
formed by the medulla and the cord. In order to study the normal mobility of this region of
the CNS during flexion and extension of the head, sagittal MRI studies were made in the
sagittal plane in 18 young volunteers. The volunteers were in dorsal decubitus with the
cervical spine first flexed and then extended, with the movement localized to the craniocervical junction as far as possible. T1-weighted sequences were used, with body coils in
16 cases and surface coils in two. Measurements were related to global cranio-cervical
range of movement, movement at the cranio-cervical junction and spino-medullary
movement. Variations in the depth of the free space in front of the medulla, pons and spinal
cord during movement were also noted. We also checked for downward shift of the lower
part of the 4th ventricle and modification of the shape of the ventricle during flexionextension. The global range of cranio-cervical movement was between 31 and 100 degrees
(average 63 degrees). The range between the cranium and C1C2 was 4 to 39 degrees
(average 19 degrees) and the spino-medullary range was from 1 to 32 degrees (average 14
degrees). During flexion, the free space narrowed in front of the pons 11 times, in front of
7
the medulla 14 times and in front of the cervical cord 11 times. There was a downward shift
of the lower part of the 4th ventricle during flexion in 4 cases but no change in shape was
noted. Though this study is open to criticism from several aspects, it may be concluded that
variations of the spino-medullary angle in the sagittal plane during flexion-extension do
occur, that they are closely correlated with movements at the cranio-cervical junction,
moves forward during flexion.
Comment: This research study confirms the observations made by Dr. A. Brieg, the
neurosurgeon, in his 1960 work Biomechanics of the Central Nervous System. Studies like
this one portrays the nervous system as one organ, which spreads out like a cobweb in the
body so that tension anywhere along the dural tract may refer symptoms anywhere.
The Relationship Between CSF
J Manipulative Physiol Ther, Dec 1988;11(6):489-92
and Fluid Dynamics in the Neural
There is a relationship between fluid dynamics in the neural canal and cranial vault. This
Canal, Flanagan, M.
relationship can be affected by posture, respiration and pathology. In addition, several
chiropractic disciplines [including applied kinesiology] have advocated that axial skeletal
improprieties may also affect fluid dynamics in the canal and vault. This paper reviews
literature pertinent to these issues. The information it contains is relevant to those
disciplines that attempt to manipulate fluid dynamics in the canal and vault, as well as to
those that treat neurological disorders.
Fixed spinal cord: diagnosis with
MR imaging,
Levy LM, Di Chiro G,
McCullough DC, Dwyer AJ,
Johnson DL, Yang SS.
Radiology. 1988 Dec;169(3):773-8.
Low-frequency oscillations of
cortical oxidative metabolism in
waking and sleep, Vern BA,
Schuette WH, Leheta B, Juel VC,
Radulovacki M.
J Cereb Blood Flow Metab.1988 Apr;8(2):215-26.
Human brain motion and
cerebrospinal fluid circulation
Radiology, 1987 Jun;163(3):793-9.
Abstract: Pulsatile motion of the spinal cord was examined with phase imaging
techniques. Sagittal images of the spinal cord were obtained at different times of the cardiac
cycle in healthy volunteers, as well as in patients in whom the spinal cord either was
tethered, was compressed, or contained an intramedullary lesion. Pulsatile velocity changes
of the spinal cord, observed on the phase images, were most marked at the cervical-upper
thoracic level. Cord motion was found to be significantly decreased in cases in which the
cord was either tethered or compressed. Cord enlargement due to an intramedullary lesion
generally did not lead to decreased cord motion. Imaging of pulsatile cord motion may be
clinically useful in evaluating diseases restricting cord motion or changing the status of
parenchymal compliance.
Abstract: To study the changes in cortical oxidative metabolism and blood volume during
behavioral state transitions, we employed reflectance spectrophotometry of the cortical
cytochrome c oxidase (cyt aa3) redox state and blood volume in unanesthetized cats
implanted with bilateral cortical windows and EEG electrodes. Continuous oscillations in
the redox state and blood volume (approximately 9/min) were observed during waking and
sleep. These primarily metabolic oscillations of relatively high amplitude were usually
synchronous in homotopic cortical areas, and persisted during barbiturate-induced
electrocortical silence. Their mean amplitude and frequency did not vary across different
behavioral/EEG states, although the mean levels of cyt aa3 oxidation and blood volume
during rapid eye movement (REM) sleep significantly exceeded those during waking and
slow-wave sleep. These data suggest the existence of a spontaneously oscillating metabolic
phenomenon in cortex that is not directly related to neuroelectric activity. A superimposed
increase in cortical oxidative metabolism and blood volume occurs during REM sleep.
Experimental data concerning cerebral metabolism and blood flow that are obtained by
clinical methods that employ relatively long sample acquisition times should therefore be
interpreted with caution.
Abstract: Present theory holds that pulsatile pressure of cerebrospinal fluid (CSF) is driven
8
by the force of expansion of the choroid plexus. Alternate theories postulating that a
demonstrated with MR velocity
imaging, Feinberg DA, Mark AS. possible movement of the brain is involved in pumping CSF have not, to the authors'
knowledge, been substantiated heretofore. In this study, in vivo, quantitative magnetic
resonance (MR) imaging methods were developed to show reproducible magnitudes and
directions of CSF flow. Measurements were obtained with a new MR velocity imaging
technique at high resolution (0.4 mm/sec), requiring 64 cardiac cycles per image. Twentyfive healthy volunteers and five patients were studied. Observations of pulsatile brain
motion, ejection of CSF out of the cerebral ventricles, and simultaneous reversal of CSF
flow direction in the basal cisterns toward the spinal canal, taken together, suggest that a
vascular-driven movement of the entire brain may be directly pumping the CSF circulation.
The authors describe what they believe to be the first observations and measurements of
human brain motion, which occurs in extensive internal regions (particularly the
diencephalon and brain stem) and is synchronous with cardiac systole.
Evidence for a 'paravascular' fluid
circulation in the mammalian
central nervous system, provided
by the rapid distribution of tracer
protein throughout the brain from
the subarachnoid space, Rennels
ML, Gregory TF, Blaumanis OR,
Fujimoto K, Grady PA.
Brain Res. 1985 Feb 4;326(1):47-63.
Computed tomography studies of
human brain movements, Podlas
H, Allen KL, Bunt EA
S Afr J Surg, 1984 Feb-Mar;22(1):57-63.
Continuous and intermittent
measurement of intracranial
pressure by Ladd monitor,
Walsh P, Logan WJ.
J Pediatr. 1983 Mar;102(3):439-42.
Abstract: The protein tracer, horseradish peroxidase (HRP), was infused into the lateral
cerebral ventricles or subarachnoid space of anesthetized cats and dogs after insertion of a
cisternal cannula to permit drainage of cerebrospinal fluid (CSF) and tracer solution. The
intracerebral distribution of the tracer was then determined by light microscopy of serial
brain sections after postinfusion intervals of 4 min-2 h. For the localization of HRP,
sections were incubated with diaminobenzidine (DAB) or the much more sensitive
chromogen, tetramethylbenzidine (TMB). The TMB reaction showed a consistent
'paravascular' distribution of tracer reaction product, within the perivascular spaces (PVS)
around large penetrating vessels and in the basal laminae around capillaries, far beyond the
termination of the PVS. After infusion of HRP over 4 min, arterioles were surrounded by
the tracer, but capillaries and venules were usually less densely demarcated; by 6 min,
however, the intraparenchymal microvasculature was outlined in toto throughout the
forebrain and brainstem. Electron microscopy of sections incubated in DAB after 10 or 20
min HRP circulation confirmed the paravascular location of the reaction product, which
was also dispersed throughout the extracellular spaces (ECS) of the adjacent parenchyma.
Our results demonstrate that solutes in the CSF have access to the ECS throughout the
neuraxis within minutes via fluid pathways paralleling the intraparenchymal vasculature.
The rapid paravascular influx of HRP could be prevented by stopping or diminishing the
pulsations of the cerebral arteries by aortic occlusion or by partial ligation of the
brachiocephalic artery. The exchange of solutes between the CSF and the cerebral ECS has
generally been attributed to diffusion, however, HRP enters the neuraxis along the
intraparenchymal microvasculature far more rapidly than can be explained on this basis.
This apparent convective tracer influx may be facilitated by transmission of the pulsations
of the cerebral arteries to the microvasculature. We postulate that a fluid circulation through
the CNS occurs via paravascular pathways.
Abstract: Tomographic studies of the ventricular system showed 2-dimensional display of
lateral and third ventricles with a rhythmical dilatation and contraction in a normal adult at
the rate of approximately 8 cycles per minute. In a child with hydrocephalus the rate was
irregular and approximately 4 cycles per minute.
Abstract: Controversy exists as to whether the force of application of the sensor of the
Ladd monitor to the anterior fontanel affects the accuracy of measurements of intracranial
pressure. To resolve this problem, an artificial fontanel was constructed and fontanel
pressure measurements were recorded at varying forces of application of the sensor. This in
9
vitro technique demonstrated that anterior fontanel pressure measured with the Ladd
monitor is dependent on the force of application. Measurements of anterior fontanel
pressure were made in 17 infants and were correlated with simultaneous direct intracranial
pressure measurements. These in vivo measurements confirmed the findings on the
artificial fontanel. Both the in vivo and in vitro measurements suggest that an application
force of 7 to 10 gm on the sensor will produce an accurate reflection of intracranial
pressure. We describe two devices with which the sensor may be applied to the fontanel
with constant measurable force: one for intermittent measurement and another for
continuous recording.
Quantitative analysis of methods
for reducing physiological brain
pulsations, Britt RH, Rossi GT.
J Neurosci Methods. 1982 Sep;6(3):219-29.
Abstract: Normal movements of the mammalian brain, caused by the arterial and venous
pressure fluctuations of each cardiac and respiratory cycle, have made obtaining stable
intracellular recordings from neurons difficult. This study quantitated the movements of the
cats' brainstem and examined the effects of traditional neurophysiological techniques used
to reduce pulsation. Two components of brain movement were recorded: (1) an arterial
component--relatively low amplitude (110-266 micrometers) and short duration (330-400
ms) excursions corresponding to the pressure wave of each cardiac systole [A-wave]; and
(2) a pulmonary component--slower (10-12/min), high amplitude plateau-like displacement
(300-950 micrometers) lasting for a time (2.4-5.1 s) corresponding to the inspiration of
each respiratory cycle [P-wave]. Pneumothoraces and mechanical ventilation combined
with elevating the animal's head reduced the pulmonary component by an average of 68%
and the arterial component by 40%. Cerebrospinal fluid drainage could reduce the P-wave
component of movement by as much as 50%. To reduce arterial pulsations below 100
micrometers, the mean arterial pressure (MAP) had to be lowered to less than 40 mm Hg,
which was not compatible with maintaining normal brainstem auditory evoked responses.
Residual movements at MAPs greater than 50 mm Hg were still sufficient to make stable
intracellular penetration of small neurons difficult. The authors suggest the solution to this
problem is the development of a cardiopulmonary bypass system which generates a nonpulsatile flow of oxygenated blood, described in a companion paper.
[Effect of osmotic shifts in
Fiziol Zh SSSR Im I M Sechenova. 1980 Mar;66(3):387-93.
cerebrospinal fluid on lymph flow
Abstract: Administration of 0.865 M sodium chloride, 0.1 ml, into the lateral ventricle of
and lymph formation],
anesthetized dogs increased the drainage of lymph from the thoracic and jugular lymph
Demchenko GA.
vessels, increased blood plasma volume, and decreased the total protein content in the
lymph, blood plasma and interstitial fluid. Within first minutes after the administration the
ratio of protein fractions in blood plasma and lymph was altered and the osmotic blood and
lymph pressure decreased. The data obtained indicate the reflex elimination of osmotic
shifts in the C. S. F.
Comment: This paper demonstrates the relationship between the biochemistry of the CSF
and the lymphatic system. The implications of the biochemistry of the CSF on total body
function should be explored further, and the methods of diagnosis and treatment of oral
nutrient testing on the CSF and lymphatic function in AK could be an excellent modality
for use in such an investigation.
Evidence for passage of
cerebrospinal fluid among spinal
nerves, Steer JC, Horney FD.
Can Med Assoc J. 1968 Jan 13;98(2):71-4.
This paper demonstrates that CSF is transmitted throughout the body, and its trophic
function is important to the health of nerves throughout the body. CSF pressure changes
within the CNS may be transmitted throughout the whole body, and may explain some of
the palpatory findings reported by those working in the cranial field.
Ultrasonic techniques for
Neurology. 1966 Apr;16(4):380-2.
measuring intracranial pulsations.
10
Research and clinical studies,
Wallace WK, Avant WS Jr,
McKinney WM, Thurstone FL.
This investigation reported an apparently nine-cycle-per-minute intracranial pulsation
observed by ultrasound in the brain and membrane tissues of a human subject.
Circulation of the cerebrospinal
fluid. Demonstration of the
choroid plexuses as the generator
of the force for flow of fluid and
ventricular enlargement,
Bering EA, Jr.
J Neurosurg. 1962 May;19:405-13.
Circulation of the Cerebrospinal
American Academy of Osteopathy Yearbook, 1959:77-87
Fluid through the Connective
Tissue System, Erlingheuser, R.F. Abstract: Much of the fascia and connective tissue in the body is made of tubular
structures. This study demonstrates that lymph and cerebrospinal fluid spreads throughout
the body via these channels. Connective tissue may have an important nutritive function.
The penetration of particulate
matter from the cerebrospinal
fluid into the spinal ganglia,
peripheral nerves, and
perivascular spaces of the central
nervous system, BRIERLEY JB.
J Neurol Neurosurg Psychiatry. 1950 Aug;13(3):203-15.
THE OSSEOUS-ARTICULAR MECHANISM OF
THE CRANIAL SYSTEM
Radiographic Evidence of Cranial Cranio: The Journal of Craniomandibular Practice; Jan 2002;20(1):34-8
Bone Mobility, Oleski, S, Smith
Abstract: The purpose of this retrospective chart review was to determine if external
G, Crow W
manipulation of the cranium alters selected parameters of the cranial vault and base that can
be visualized and measured on x-ray. Twelve adult patient charts were randomly selected to
include patients who had received cranial vault manipulation treatment with a pre- and
post-treatment x-ray taken with the head in a fixed positioning device. The degree of
change in angle between various specified cranial landmarks as visualized on x-ray was
measured. The mean angle of change measured at the atlas was 2.58 degrees, at the mastoid
was 1.66 degrees, at the malar line was 1.25 degrees, at the sphenoid was 2.42 degrees, and
at the temporal line was 1.75 degrees. 91.6% of patients exhibited differences in
measurement at three or more sites. This study concludes that cranial bone mobility can be
documented and measured on x-ray.
Long-term developmental
outcomes in patients with
deformational plagiocephaly,
Miller RI, Clarren SK.
Pediatrics, 2000 Feb;105(2):E26.
OBJECTIVES: To determine whether there was an increased rate of later developmental
delay in school-aged children who presented as infants with deformational plagiocephaly
without obvious signs of delay at the time of initial evaluation. METHODS: A
retrospective medical record review of 254 patients evaluated at the Craniofacial Center of
the Children's Hospital and Regional Medical Center in Seattle, Washington, from 1980
through 1991 was completed. Consenting patient families were interviewed via telephone
11
to determine what, if any, special medical or educational problems had occurred for the
children who had had plagiocephaly in infancy or their siblings with normal head shapes.
RESULTS: A total of 181 families from the medical record review could be notified about
the study and 63 families agreed to participate in a telephone interview. The sample of
participants for the telephone interview was random to and representative of the group as a
whole. The families reported that 25 of the 63 children (39.7%) with persistent
deformational plagiocephaly had received special help in primary school including: special
education assistance, physical therapy, occupational therapy, speech therapy generally
through an Individual Education Plan. Only 7 of 91 siblings (7.7%), serving as controls,
required similar services (chi(2) = 21.24). Delays could not be specifically anticipated at
the time of the diagnosis of deformational plagiocephaly from any simple set of factors
including treatment with helmet therapy, although effected males with reported uterine
constraint were at the highest risk for subsequent school problems. CONCLUSIONS:
Infants with deformational plagiocephaly comprise a high-risk group for developmental
difficulties presenting as subtle problems of cerebral dysfunction during the school-age
years. There is a need for additional research on the long-term developmental problems in
infants with deformational plagiocephaly, facial asymmetry, torticollis, developmental
delay.
Comment: The cranial mechanism must be included in the practice of chiropractic care for
the physically and mentally challenged because it is in fact the headquarters for all the
functions that operate within the child. This is the part of the body with the greatest
disturbances in cases of plagiocephaly; to ignore it or not treat it amounts to major neglect
in therapy (mal-practice). Clinical researchers record many instances of success in treating
dysfunctional children, some with severe learning and behavioral problems as well as a host
of physical complaints, utilizing cranial techniques. Some of the methods currently
employed by orthopedic surgeons to “correct” cranial distortions involve surgical removal
of plates of bone from the skull, fusion of sutures and the imposition of irreversible damage
to the cranial mechanism. An alternative therapy is to fit growing infants with a “helmet” to
be worn for years, day and night, which forcibly molds deviant skulls into cosmetically
acceptable shapes, with little regard for functional integrity (and with an enormous degree
of discomfort). It was also noted in the present study that use of helmet therapy to correct
the distortion did not seem to affect the rate of developmental delay, almost half of the
delayed patients having worn helmets.
Attachments of the ligamentum
nuchae to cervical posterior spinal
dura and the lateral part of the
occipital bone, Mitchell BS,
Humphreys BK, O'Sullivan E.
J Manipulative Physiol Ther. 1998 Mar-Apr;21(3):145-8.
Kinematic system demonstrates
J Am Osteopath Assoc, 1996;96(9):551.
OBJECTIVE: To describe previously unrecorded attachments of the ligamentum nuchae
to the cervical posterior spinal dura, and to posterolateral parts of the occipital bone in an
anatomical study, with particular reference to the deep aspects of the suboccipital triangle
and upper cervical region. DESIGN: Dissections of 10 heads and necks from embalmed
cadavers were made in the suboccipital and upper cervical region, either in whole
specimens or in parasagitally sectioned specimens. RESULTS: In parasagittally sectioned
material, continuity was observed between the ligamentum nuchae and the posterior
cervical spinal dura as the latter passed deeply from the midline toward the dura, but only at
the first and second cervical vertebral levels. The ligamentum nuchae also passed bilaterally
on to the occipital bone as far as the sutures between the occipital bone and the temporal
bones, approaching the inferior nuchal line superiorly. CONCLUSION: The present study
is the first to describe the full morphology of the relationship between the ligamentum
nuchae and the cervical posterior spinal dura and the lateral aspects of the occipital bone.
This is of significance for understanding the biomechanics of the cervical spine, particularly
rotational movements of the head in the sagittal or transverse planes. This may have
implications in manipulative therapy for conditions as cervicogenic headache and for
various degenerative disorders affecting the cervical spine.
12
cranial bone movement about the
cranial sutures, Lewandoski MA,
Drasby E, Morgan M, Zanakis M
(http://www.jaoa.org)
Abstract: Utilizing infrared markers and a kinematic system, demonstration of cranial bone
movement at cranial sutures was possible. Range of motion was in the region of 250
microns and was not simply due to malleability.
Cranial sutures require tissue
interactions with dura mater to
resist osseous obliteration in vitro,
Opperman LA, Passarelli RW,
Morgan EP, Reintjes M, Ogle RC.
J Bone Miner Res, 1995 Dec;10(12):1978-87.
Role of cranial bone mobility in
cranial compliance, Heisey, SR,
Adams, T.
Neurosurgery, 1993;33(5):869-876.
Abstract: A chemically defined serum-free medium, which supports the development of
bones and fibrous tissues of rat calvaria from nonmineralized mesenchymal precursor
tissues, was employed to investigate tissue interactions between the dura matter and
overlying tissues. Fetal calvarial rudiments from stages prior to bone and suture
morphogenesis (fetal days 19 and 20) and neonatal calvarial rudiments with formed sutures
(day 1) were cultured with and without associated dura mater. Removal of calvaria for in
vitro culture allowed the examination of suture morphogenesis in the absence of tensional
forces exerted on the sutures via fiber tracts in the dura mater originating in the cranial
base. Ossification of frontal and parietal bones proceeded in a fashion comparable to
development in vivo, but the cranial (coronal) sutures--primary sites for subsequent skull
growth--were obliterated by osseous tissue union in the absence of dura mater. Bony fusion
did not occur when rudiments were cocultured with dura mater on the opposite sides of
0.45 microns polycarbonate transwell filters, suggesting that the influence of dura mater on
sutural obliteration was mediated by soluble factors rather than cell-cell or cell-matrix
interactions. These results indicate that cell signaling mechanisms rather than
biomechanical tensional forces are required for morphogenesis of the calvaria.
Abstract: Increases in intracranial pressure are normally buffered by the displacement of
blood and cerebrospinal fluid from the cranium when there is an increase in intracranial
volume (ICV). How much pressure increases with an increase in ICV is expressed in the
calculation of cranial compliance (delta ICV/delta P, where delta P is change in pressure)
and elastance (delta P/delta ICV). Data reported here indicate that the movement of the
cranial bones at their sutures is an additional factor defining total cranial compliance. Using
controlled bolus injections of artificial cerebrospinal fluid into a lateral cerebral ventricle in
anesthetized cats and a newly developed instrument to quantify cranial bone movement at
the midline sagittal suture where the bilateral parietal bones meet, we show that these
cranial bones move in association with increases in ICV along with corresponding peak
intracranial pressures and changes in intracranial pressure. External restraints to the head
restrict these movements and reduce the compliance characteristics of the cranium. We
propose that total cranial compliance depends on the mobility of intracranial fluid volumes
of blood and cerebrospinal fluid when there is an increase in ICV, but it also varies as a
function of cranial compliance attributable to the movement of the cranial bones at their
sutures. Our data indicate that although the cranial bones move apart even with small
(nominally 0.2 ml) increases in ICV, total cranial compliance depends more on fluid
migration from the cranium when ICV increases are less than approximately 3% of total
cranial volume. Cranial bone mobility plays a progressively larger role in total cranial
compliance with larger ICV increases.
Parietal bone mobility in the
J Am Osteopath Assoc, 1992 May;92(5):599-600, 603-10, 615-22.
anesthetized cat, Adams T, Heisey
Abstract: To quantify parietal bone motion in reference to the medial sagittal suture, a
RS, Smith MC, Briner BJ
newly developed instrument was attached to the surgically exposed skull of anesthetized
adult cats. The instrument differentiated between lateral and rotational parietal bone
movements around the fulcrum of the suture. Bone movement was produced by external
13
forces applied to the skull and by changes in intracranial pressure associated with induced
hypercapnia, intravenous injections of norepinephrine, and controlled injections of artificial
cerebrospinal fluid into the lateral cerebral ventricle. Responses varied considerably among
test animals. Generally, lateral head compression caused sagittal suture closure, small
inward rotation of the parietal bones, increased intraventricular pressure, transient apnea,
and unstable systemic arterial blood pressure. Graded increases in intracranial volume
produced stepped increases in pressure, lateral expansion at the sagittal suture, and outward
rotation of the parietal bones. We attribute variations in animal response largely to
differences in intracranial and suture compliance among them. Cranial suture compliance
may be an important factor in defining total cranial compliance.
Sutural complexity in artificially
deformed human (Homo sapiens)
crania, Anton SC, Jaslow CR,
Swartz SM.
J Morphol. 1992 Dec;214(3):321-32.
Sutures and forces: a review,
Wagemans PA, van de Velde JP,
Kuijpers-Jagtman AM.
Am J Orthod Dentofacial Orthop. 1988 Aug;94(2):129-41.
Biodynamics of the Cranium: A
Survey, Blum, C.
The Journal of Craniomandibular Practice, Mar/May 1985:3(2):164-71.
Abstract: The pattern of complexity of cranial sutures is highly variable both among and
within species. Intentional cranial vault deformation in human populations provides a
controlled natural experiment by which we were able to quantify aspects of sutural
complexity and examine the relationship between sutural patterns and mechanical loading.
Measures of sutural complexity (interdigitation, number, and size of sutural bones) were
quantified from digitized tracings of 13 sutures and compared among three groups of crania
(n = 70) from pre-European contact Peru. These groups represent sample populations
deformed in 1) anteroposterior (AP) and 2) circumferential (C) directions and 3) an
undeformed population. Intergroup comparisons show few differences in degree or
asymmetry of sutural interdigitation. In the few comparisons which show differences, the C
group is always more interdigitated than the other two while the AP group has more sutural
bones. The sutures surrounding the temporal bone (sphenotemporal, occipitotemporal, and
temporoparietal) most frequently show significant differences among groups. These
differences are related to the more extreme binding of C type deformation and are
consistent with hypothesized increases in tension at coronally oriented sutures in this group.
The larger number of sutural bones in the AP group is consistent with the general
broadening of the cranium in this group and with experimental evidence indicating the
development of ossicles in areas of tension. We suggest that so few changes in sutural
complexity occurred either because the magnitude of the growth vectors, unlike their
direction, is not substantially altered or because mechanisms other than sutural growth
modification are responsible for producing the altered vault shapes. In addition, the
presence of fontanelles in the infant skulls during binding and the static nature of the
binding may have contributed to the similarity in complexity among groups.
Abstract: This review gives a description of the biologic significance of craniofacial
sutures with respect to growth and to growth corrections. Sutural growth and its regulation
are discussed briefly. Morphogenesis of sutures, sutural morphology, both microscopic and
macroscopic, the structure and function of the sutural periosteum and secondary cartilages,
and the biochemical composition of sutures are described. Furthermore, in vivo and in vitro
experiments, including transplantation experiments, are discussed. The relationship
between extrinsic mechanical forces and the resulting tissue responses in sutures is given
special attention. The present article describes the state of our knowledge on the interaction
between sutures and forces, and indicates problems that need to be investigated.
Abstract: Revamping a possible archaic view of normal cranial physiological biodynamics
is a challenging undertaking. New ideas lie fragile for years awaiting the slow accumulation
of evidence. This article presents substantial research answering the questions:
(1) Is it possible for the cranial bones to move?
14
(2) Do intracranial pressure changes actually translate into cranial motion?
(3) Are there pressure changes of cerebrospinal fluid occurring intracranially due to
vascular, pulmonary, and other theorized pulse waves?
(4) What can interfere with the transmission of these pressure waves?
(5) What could be the consequences of increased and/or decreased cranial motion to the
health of the body?
The author presents literature noting that dural tension and/or brain/spinal cord tension
reflecting in the neural substance, nerves and associated blood vessels could well lead to
changes of a pathological nature. This could be separate or could be in conjunction with
associated CSF buildup of catabolites and resultant patho-physiological changes. The effect
of cranial bone stasis or tension is clinically alleviated through gentle subtle manipulations
of the cranial bones. The treatment is focused towards obtaining relaxation of the soft
tissues of the brain and spinal cord in situ, through the dural extension into the sutures and
cranial bones.
Zygomaticomaxillary suture
Angle Orthod. 1984 Jul;54(3):199-210.
adaptations incident to anteriorlydirected forces in rhesus monkeys, Abstract: Histologic and radiographic studies of controlled force application to the
maxillae of monkeys show varying rotational effects on the maxilla, dependent on the
Nanda R, Hickory W.
direction of force application.
Occlusal Changes Related to
Cranial Bone Mobility, Libin, B.
International Journal of Orthodontics, 20(1), March 1982
This study reports that the author was able to change the transverse dimension across the
maxillae as measured at the second molars by two and sometimes three millimeters using
craniosacral therapy.
Detection of skull expansion with J Neurosurg, 1981;55:811-812
increased cranial pressure, Heifitz,
MD, Weiss M.
Age changes in the human
Am J Orthod, 1976 Apr;69(4):411-30.
frontozygomatic suture from 20 to
Abstract: The frontozygomatic suture of human cadaver material was examined by a
95 years, Kokich VG.
combination of histologic, radiographic, and gross techniques to determine the aging
changes in the suture and the approximate age at which sutural fusion occurs. The sample
consisted of sixty-One specimens of human beings ranging in age from 20 to 95 years.
Observations were made on specimens at age intervals of 5 years. Since the
frontozygomatic suture is bilateral, one suture from each specimen was used for
radiographic and gross examination for synostosis, and the opposite side was subjected to
histologic analysis. The findings of this study have lead to the following conclusions: 1.
The human frontozygomatic suture undergoes synostosis during the eighth decade of
life, but does not completely fuse by the age of 95 years. 2. Synostosis is a progressive
process which commences as small areas of bony union that occur initially within the
internal portion of the suture and then progresses to the orbital periosteal surface. Bony
union is not found at or near the facial periosteal surface. 3. The bony surfaces of the
frontozygomatic suture become increasingly irregular with advancing age as a result of the
formation of projections or interfixations.
Comment: This paper (as well as the papers of Opperman and Retzlaff and others cited in
this section) shows that the assertion that all cranial sutures eventually fuse can be
dismissed.
Morphological cerebral
asymmetries of modern man,
Ann N Y Acad Sci. 1976;280:349-66.
15
fossil man, and nonhuman
primate.
LeMay M.
Abstract: Cerebral asymmetries are common in modern and fossil man and the great apes.
Those occurring most often are listed here: 1. The left sylvian fissure in man is longer than
the right and in both fetal and adult brains the posterior end of the right sylvian fissure is
commonly higher than the left. Associated with these findings, the left planum temporale is
usually longer than the right. 2. The left occipital pole is often wider and usually protrudes
more posteriorly than the right. 3. The left lateral ventricle, and especially the occipital
horn, is usually larger than the right. 4. If one frontal pole extends beyond the other it is
usually the right. 5. On X-ray computerized axial tomograms (CT) of the brain the right
frontal lobe and the central portion of the right hemisphere more often measure wider than
the left. 6. The CT studies commonly show a Yakovlevian anticlockwise torque (taking the
nose as 12 o'clock), with the left occipital pole longer and often extending across the
midline toward the right and a wider right hemisphere in its central and frontal portions and
frequent forward protrusion of the right frontal pole. This is found also in newborns. 7. The
posterior end of the sagittal sinus usually lies to the right of the midline and the sinus flows
more directly into the right transverse sinus than into the left. 8. The right transverse sinus
is usually higher than the left. 9. In left-handed and ambidextrous individuals the posterior
ends of the sylvian fissures are more often nearly equal in height and the occipital regions
are more often equal in width or the right may be wider. 10. The torque of the pyramidal
tract and the hemispheral torque cannot at present be related to right- or left-handedness.
Statistics concerning left-handedness are somewhat confounded, because it is likely that not
a few individuals are left-handed because of an early injury of the left hemisphere in a
normally right-handed individual. 11. Cerebral asymmetries are found in fossil man similar
to those in modern man. 12. Asymmetries of the sylvian fissures similar to those of modern
man have been found in the great apes and are particularly common in the orangutan. 13.
The most striking and consistently present cerebral asymmetries found in adult and fetal
brains are in the region of the posterior end of the sylvian fissures-- the areas generally
regarded as a major importance in language function.
Head posture and craniofacial
morphology, Solow B, Tallgren
A.
Am J Phys Anthropol. 1976 May;44(3):417-35.
Cranial bone mobility, Retzlaff
EW, Michael DK, Roppel RM.
J Am Osteopath Assoc, 1975 May;74(9):869-73.
Abstract: The associations between craniofacial morphology and the posture of the head
and the cervical column were examined in a sample of 120 Danish male students aged 2230 years. Two head positions were recorded on lateral cephalometric radiographs, one
determined by the subject's own feeling of a natural head balance (self balance position),
and the other by the subject looking straight into a mirror (mirror position). Craniofacial
morphology was described by 42 linear and angular variables, and postural relationships by
18 angular variables. A comprehensive set of correlations was found between craniofacial
morphology and head posture. The correlations were similar for both head positions
investigated. Of the postural variables, the position of the head in relation to the cervical
column showed the largest set of correlations with craniofacial morphology. Extension of
the head in relation to the cervical column was found in connection with large anterior and
small posterior facial heights, small antero-posterior craniofacial dimensions, large
inclination of the mandible to the anterior cranial base and to the nasal plane, facial
retrognathism, a large cranial base angle, and a small nasopharyngeal space. The possible
role of functional factors in mediating the relationship between morphology and posture
was discussed.
Comment: There exists a large body of work supporting a relationship between the
cervical spine, head posture, and craniomandibular function. The integration of these three
areas in AK diagnosis is an important factor in AK therapy.
Abstract: Retzlaff (along with Mitchell and Upledger) have been responsible for some of
the most diligent research in the area of cranial motion state: “Whether cranial sutures in
primates are ever obliterated by ossification remains unanswered. However histological
16
studies suggest that there may be partial sutural fusion, but only at a relatively old age.
Cranial sutures in the pigtail macaque are not fused by the 20 th year and in humans by the
90th year.
Histological studies of tissues of living patients aged 7-57 examined and found to show
capability of motion within cranial sutures – with abundance of collagen, elastic fibers,
vascular networks. No calcifications were noted in living subjects – this only appeared post
mortem with the use of preservative chemicals. Numerous studies by these and associated
researchers showed patent cranial sutures, with demonstrable motion capabilities into
advanced old age.
Temporary widening of cranial
Clin Pediatr (Phila). 1972 Jul;11(7):427-30.
sutures during recovery from
failure to thrive. A not-uncommon
clinical phenomenon,
Pearl M, Finkelstein J, Berman
MR.
Alteration in Width of Maxillary
Arch and its Relation to Sutural
Movement of Cranial Bones,
Baker, E.
Journal of the American Osteopathic Association, Feb 1971;70:559-564
Roentgen Findings in the
Craniosacral Mechanism,
Greenman, P.
Journal of the American Osteopathic Association, 1970;70:24-35
Abstract: A case is reported in which cooperation between a dentist and a physician
schooled in cranial therapy improved the treatment of a patient with severe traumatic
malocclusion. The patient appeared with a severe headache. Although there had been no
recent trauma, the patient had sustained fractures in the foot in a parachute jump several
years before. The physician found that the parachute jump had compressed the patient’s
occlusion to the left at the midline of the mandible. The dentist confirmed the presence of
severe malocclusion, with open bite and deviation of the median line to the left during
retraction to hinge centric jaw relation. Treatment by occlusal equilibrium and cranial
adjustment for six months brought relief of pain and established centric jaw relation. Serial
measurements of models of maxillary teeth showed the maximum lateral dimensional
change between permanent maxillary second molars was 0.0276 inch, which is about nine
times the possible error in measurement. The patient’s head bones moved along their
sutures.
Abstract: Although the craniosacral mechanism has been of great interest to physicians in
many professions, a search of the literature failed to yield many reports of the x-ray
appearance of altered cranial structure. This article describes efforts to develop a method of
identifying altered craniosacral mechanics and of correlating the findings with clinical
observations. Good correlation was found between specific x-ray findings and clinical
observations made independently by a physician schooled in the cranial concept of
osteopathy.
CLINICAL RESEARCH IN CRANIAL THERAPY
17
Cranial Therapeutic Care: Is
There any Evidence? Blum CL,
Cuthbert S.
Chiropractic & Osteopathy 2006, 14:10
Symptomatic Arnold-Chiari
malformation and cranial nerve
dysfunction: a case study of
applied kinesiology cranial
evaluation and treatment,
Cuthbert, S., Blum, C.
J Manipulative Physiol Ther. 2005 May;28(4):e1-6.
Cranial and Other Chiropractic
Adjustments in the Conservative
Treatment of Chronic Trigeminal
Neuralgia: A Case Report,
Pederick, F.
Chiro J Aust, 2005; 35:9-15.
Background: In the commentary by Hartman, (Cranial osteopathy: its fate seems clear,
Chiropractic & Osteopathy 2006, 14:10.) he has attempted to elicit a response by making
far overreaching statements, which are ironic since Hartman thinly veils himself in a
gossamer cloak of science, research, and evidenced-based healthcare. Hartman has picked
an isolated diagnostic procedure or treatment, cerebrospinal fluid (CSF) pulsation
palpation, questioned its reliability and validity, and then used this fractional aspect of a
method of care to condemn all of cranial therapy. What can be said by Hartman and fairly
so, is that from his review of selected studies regarding CSF palpation as discussed in
cranial therapeutic care, further study to investigate its validity and reliability is warranted
and this component of cranial diagnosis should not be used at this time as a sole criteria for
cranial diagnosis or treatment. Discussion Much of Hartman’s position is refuted by, at the
very least, reviewing the difference between the gross mechanical aspects of cranial care,
which has documentation, and the subtle mechanical aspects, which remain controversial.
A comprehensive evidenced based rationale of cranial therapeutics is presented along with
three tables listing pertinent studies relating to cranial bone dynamics and the efficacy of
cranial manipulative therapy. Conclusion While the onus to do the research is upon those
who are proponents of a method of care, there is also an onus upon those who call for its
virtual abolition to be familiar with all the published research on the topic and how
evidenced based clinical practice is formulated.
(www.journals.elsevierhealth.com/periodicals/ymmt)
Objective: To present an overview of possible effects of Arnold-Chiari malformation
(ACM) and to offer chiropractic approaches and theories for treatment of a patient with
severe visual dysfunction complicated by ACM. Clinical Features: A young woman had
complex optic nerve neuritis exacerbated by an ACM (Type I) of the brain. Intervention
and Outcome: Applied kinesiology chiropractic treatment of the spine and cranium was
used for treatment of loss of vision and nystagmus. After treatment, the patient’s ability to
see, read, and perform smooth eye tracking showed significant and lasting improvement.
Conclusion: Further studies into applied kinesiology and cranial treatments for visual
dysfunctions associated with ACM may be helpful to evaluate whether this single case
study can be representative of a group of patients who might benefit from this care.
ABSTRACT: Trigeminal neuralgia, sometimes called tic douloureux, is characterized by
episodes of electric-shock-like pain in areas of the face where branches of the trigeminal
nerve are distributed. Medical treatment includes pharmaceuticals, analgesics, surgery,
radiosurgery, low-powered lasers, TENS, acupuncture and biofeedback. Manipulative
approaches have been used successfully in a medical center in China, and reports of
successful treatment with chiropractic techniques have been published. The patient in this
report had a history of right-sided facial pain, diagnosed as trigeminal neuralgia, over a 6year period with remissions after dental or medical treatment and exacerbations, the most
recent of 2 months duration. Prior to cranial and other chiropractic adjustments, the patient
had continuous pain that she rated at 9.5 on the visual analogue scale, and after 4
consultations over an 11-day period, pain had reduced to 0.5. Spinal and cranial adjusting
potentially affects a wide range of causes of trigeminal neuralgia and offers a conservative,
low-cost, low technology initial approach which, if ineffective, will not greatly delay or
inhibit other treatment. Occasional maintenance care may be required in some instances to
reduce occurrences.
18
Treatment of an Infant with Wry Chiro J Aust, 2004; 34:123-8.
Neck Associated with Birth
Trauma: Case Report, Pederick, F. ABSTRACT: This paper describes the successful treatment of an infant with wry neck
associated with birth trauma using low-force, relatively long-duration cranial adjusting, and
soft-tissue techniques to the whole body with special attention to the cervical region, and
parental management of home care procedures. Wry neck, or congenital muscular torticollis
(CMT), has been a well-recognized condition for centuries. CMT is often associated with
plagiocephaly, which has long-term adverse effects on physical and mental functions. A
review of some of the literature relating to this condition is provided.
The functional relationship
between the craniomandibular
system, cervical spine, and the
sacroiliac joint: a preliminary
investigation, Fink M, Wahling K,
Stiesch-Scholz M, Tschernitschek
H.
Cranio. 2003 Jul;21(3):202-8.
Increased responses in
trigeminocervical nociceptive
neurons to cervical input after
stimulation of the dura mater,
Bartsch T, Goadsby PJ.
Brain. 2003 Aug;126(Pt 8):1801-13. Epub 2003 Jun 23.
Abstract: The hypothesis of a functional coupling between the muscles of the
craniomandibular system and the muscles of other body areas is still controversial. The
purpose of this pilot study was to examine whether there is a relationship between the
craniomandibular system, the craniocervical system and the sacropelvic region. To test this
hypothesis, the prevalence and localization of dysfunction of the cervical spine and the
sacroiliac joint were examined in a prospective, experimental trial. Twenty healthy students
underwent an artificial occlusal interference, which caused an occlusal interference. The
upper cervical spine (CO-C3) and the sacroiliac joint were examined before, during and
after this experimental test. The primary outcome with these experimental conditions was
the occurrence of hypomobile functional abnormalities. In the presence of occlusal
interference, functional abnormalities were detected in both regions examined and these
changes were statistically significant. The clinical implications of these findings may be
that a complementary examination of these areas in CMD patients could be useful.
Abstract: Pain referral and spread in headache patients may be attributed to a sensitization
of central nociceptive neurons with an increased excitability to afferent input. We
investigated if noxious dural stimulation evokes sensitization of second-order neurons that
leads to an increased responsiveness to stimulation of cervical afferents. Recordings were
made from 29 nociceptive neurons in the C2 dorsal horn of the rat that received convergent
synaptic input from trigeminal and cervical afferents. Trigeminal afferents of the
supratentorial dura mater were activated by mustard oil (MO) and the responses of secondorder neurons to stimulation of the greater occipital nerve (GON) were studied before and
after dural stimulation. Projection sites to the contralateral thalamus were determined by
antidromic stimulation. After dural application with MO, mechanical thresholds of the dura
significantly decreased (P < 0.05) and an enlargement of the trigeminal and cervical
cutaneous mechanoreceptive fields was observed in 71% of neurons. The responses to
noxious mechanical stimulation of deep paraspinal muscles increased after MO application
(P < 0.001). Similarly, an increase in the excitability to electrical stimulation of the GON
was observed in C-fibre responses (P < 0.001). These results suggest that stimulation of
nociceptive afferent C-fibres of the dura mater leads to a sensitization of second-order
neurons receiving cervical input. This mechanism might be involved in the referral of pain
from trigeminal to cervical structures and might contribute to the clinical phenomena of
cervical hypersensitivity in migraine and cluster headache. Understanding this interaction
is likely to be pivotal in characterizing the physiology of treatment with manipulations
involving cervical input, such as GON injection.
Comment: This article describes the neurologic rationale for considering dural tension a
causative factor in total spinal function. Dural tension in the head is transmitted into the
neck and increases the vulnerability of the neck to pain and dysfunction. A comprehensive
examination of patients with neck pain must involve an evaluation of intracranial dural
tension and structures.
19
The neuroanatomical basis of
oculomotor disorders: the dual
motor control of extraocular
muscles and its possible role in
proprioception, Buttner-Ennever
JA, Horn AK.
Curr Opin Neurol. 2002 Feb;15(1):35-43.
Intraexaminer and interexaminer
reliability for palpation of the
cranial rhythmic impulse at the
head and sacrum, Moran RW,
Gibbons P.
J Manipulative Physiol Ther. 2001 Mar-Apr;24(3):183-90.
Abstract: Current investigations show that two separate sets of motoneurons control the
extraocular eye muscles, and that is there is a dual final common pathway. We propose that
one set of motoneurons are the major source of tension generating eye movements, whereas
the other may participate in a proprioceptive system concerned more with the exact
alignment and stabilization of the eyes. In this article we discuss the structures that may
participate in the proprioceptive circuits; and consider several recent publications in the
light of this sensory feedback hypothesis, emphasizing the relevance to eye movement
disorders.
Comment: This article provides several neurological rationales for the specific testing of
the eyes in visual, proprioceptive and neuromuscular disorders. In applied kinesiology
chiropractic methodology, a means for testing the integration of the muscles in the body
with the visual reflexes has been termed ocular lock. (This paper has 88 papers listed in
the reference section alone dealing with the neurology involved in the ocular lock
phenomenon). Ocular lock testing demonstrates the failure of the eyes to work together on a
binocular basis through the cardinal fields of gaze. This is usually not gross pathology of
cranial nerves III, IV, and VI; rather it is poor functional organization. Mechanical irritation
of cranial nerves III, IV, or VI (usually VI) may be responsible for disturbed binocular
function leading to discordant sensory inputs from the visual righting reflex. When the eyes
are turned in a specific direction, a previously strong indicator muscle will weaken when
the ocular lock test is positive, and there is probably disturbance in the visual righting,
vestibulo-ocular, or opto-kinetic reflexes.
BACKGROUND: A range of health care practitioners use cranial techniques. Palpation of a
cranial rhythmic impulse (CRI) is a fundamental clinical skill used in diagnosis and
treatment with these techniques. There has been little research establishing the reliability of
CRI rate palpation. OBJECTIVE: This study aimed to establish the intraexaminer and
interexaminer reliability of CRI rate palpation and to investigate the "core-link" hypothesis
of craniosacral interaction that is used to explain simultaneous motion at the cranium and
sacrum. DESIGN: Within-subjects, repeated-measures design. SUBJECTS: Two registered
osteopaths, both with postgraduate training in diagnosis and treatment, using cranial
techniques, palpated 11 normal healthy subjects. METHODS: Examiners simultaneously
palpated for the CRI at the head and the sacrum of each subject. Examiners indicated the
"full flexion" phase of the CRI by activating silent foot switches that were interfaced with a
computer. Subject arousal was monitored using heart rate. Examiners were blind to each
other's results and could not communicate during data collection. RESULTS: Reliability
was estimated from calculation of intraclass correlation coefficients (2,1). Intrarater
reliability for examiners at either the head or the sacrum was fair to good, significant
intraclass correlation coefficients ranging from +0.52 to +0.73. Interexaminer reliability for
simultaneous palpation at the head and the sacrum was poor to nonexistent, ICCs ranging
from -0.09 to +0.31. There were significant differences between rates of CRI palpated
simultaneously at the head and the sacrum. CONCLUSIONS: The results fail to support the
construct validity of the "core-link" hypothesis as it is traditionally held by proponents of
craniosacral therapy and osteopathy in the cranial field.
Comment: Many experts and research studies in the cranial field have described the
difficulty of detecting the subtle dynamics of the CRI. The ability to effectively and
reproducibly demonstrate the cranial faults found during examination are therefore an
important consideration in therapy. The use of AKs cranial challenge and therapy
localization procedures, producing inhibition on MMT, allows cranial faults to be made
more evident to both the doctor and the patient. The chiropractic profession has discovered
many other objective signs of cranial faults, but changes of muscle strength on MMT with
specific challenges to the cranial mechanism is perhaps the most objective sign of all in the
20
arena of cranial therapy.
Intracranial pressure
accommodation is impaired by
blocking pathways leading to
extracranial lymphatics, Mollanji
R, Bozanovic-Sosic R, Silver I, Li
B, Kim C, Midha R, Johnston M.
Am J Physiol Regul Integr Comp Physiol, 2001 May;280(5):R1573-81.
Abstract: Tracer studies indicate that cerebrospinal fluid (CSF) transport can occur through
the cribriform plate into the nasal submucosa, where it is absorbed by cervical lymphatics.
We tested the hypothesis that sealing the cribriform plate extracranially would impair the
ability of the CSF pressure-regulating systems to compensate for volume infusions. Sheep
were challenged with constant flow or constant pressure infusions of artificial CSF into the
CSF compartment before and after the nasal mucosal side of the cribriform plate was
sealed. With both infusion protocols, the intracranial pressure (ICP) vs. flow rate
relationships were shifted significantly to the left when the cribriform plate was blocked.
This indicated that obstruction of the cribriform plate reduced CSF clearance. Sham
surgical procedures had no significant effects. Estimates of the proportional flow through
cribriform and noncribriform routes suggested that cranial CSF absorption occurred
primarily through the cribriform plate at low ICPs. Additional drainage sites (arachnoid
villi or other lymphatic pathways) appeared to be recruited only when intracranial pressures
were elevated. These data challenge the conventional view that CSF is absorbed principally
via arachnoid villi and provide further support for the existence of several anatomically
distinct cranial CSF transport pathways.
Comment: This paper shows the functional integration of the CSF and cranial system with
the lymphatic system, a concept that has been important in AK thinking for over 30 years.
The implications of lymphatic congestion upon the CRI and the movement of CSF are
explored in this paper.
Vagal modulation of responses to Biol Psychiatry. 2001 Apr 1;49(7):637-43.
mental challenge in posttraumatic
BACKGROUND: Studies of the autonomic nervous system in posttraumatic stress
stress disorder, Sahar T, Shalev
syndrome (PTSD) have focused on the sympathetic modulation of arousal and have
AY, Porges SW.
neglected the parasympathetic contribution. This study addresses the parasympathetic
control of heart rate in individuals who have survived traumatic events. METHODS:
Twenty-nine survivors, 14 with current PTSD and 15 without, participated in the study. The
groups were comparable with regard to age, type of trauma, time since the latest traumatic
event, and lifetime exposure to traumatic events. Electrocardiograms were recorded during
rest and an arithmetic task. Heart period, respiratory sinus arrhythmia (RSA), and the
amplitude of the Traube-Hering-Mayer wave were quantified. RESULTS: The groups did
not differ on resting measures. During the arithmetic task, the past trauma group showed a
significant increase in RSA (p <.007), whereas the PTSD group did not. In the past trauma
group only, RSA and heart period were highly correlated (r =.75), thereby suggesting that
the response to challenge was under vagal control. CONCLUSIONS: Trauma survivors
who develop PTSD differ from those who do not in the extent to which their heart rate
response to challenge is controlled by vagal activity. Responses to challenge in PTSD may
be mediated by nonvagal, possibly sympathetic mechanisms.
Osteopathic Manipulative
Medicine Approaches to the
Primary Respiratory Mechanism,
Friedman, H.D., Gilliar, W.G.,
Glassman, J.H.
San Francisco International Manual Medicine Society; 2000. p. 221-253.
A list of over 400 papers related to the cranial concept, and over 30 books explaining this
therapeutic modality.
Resolution of suckling intolerance J Manipulative Physiol Ther. 2000 Nov-Dec;23(9):615-8.
in a 6-month-old chiropractic
OBJECTIVE: To discuss the management and resolution of suckling intolerance in a 6patient, Holtrop DP.
month-old infant. CLINICAL FEATURES: A 6-month-old boy with a 4(1/2)-month
history of aversion to suckling was evaluated in a chiropractic office. Static and motion
21
palpation and observation detected an abnormal inward dishing at the occipitoparietal
junction, as well as upper cervical (C1-C2) asymmetry and fixation. These indicated the
presence of cranial and upper cervical subluxations. INTERVENTION AND
OUTCOME: The patient was treated 5 times through use of cranial adjusting; 4 of these
visits included atlas (C1) adjustment. The suckling intolerance resolved immediately after
the first office visit and did not return. CONCLUSION: It is possible that in the infant, a
relationship between mechanical abnormalities of the cervicocranial junction and suckling
dysfunction exists; further research in this area could be beneficial. Possible physiological
etiologies of painful suckling are presented.
Developments in the Cranial
Field, Pederick FO
Chiropractic Journal of Australia, Mar 2000;30(1):13-23.
Abstract: The first part of this paper is a detailed review of Leon Chaitow's latest textbook
on cranial manipulation. The second part comments on developments in the cranial field
using observations on Chaitow's writings as a starting point. The commentary looks at
papers relevant to the cranial field which have not been discussed by Chaitow and provides
the author's insights into matters he raises, based on information collected over several
years, much of it in the past three years via the internet.
Relationship between
craniomandibular disorders and
poor posture, Nicolakis P,
Nicolakis M, Piehslinger E,
Ebenbichler G, Vachuda M,
Kirtley C, Fialka-Moser V.
Cranio. 2000 Apr;18(2):106-12.
A Kaminski-type evaluation of
cranial adjusting, Pederick F.O.
Chiropractic Technique, 1997;9(1):1-15.
Abstract: The purpose of this research was to show that a relationship between
craniomandibular disorders (CMD) and postural abnormalities has been repeatedly
postulated, but still remains unproven. This study was intended to test this hypothesis.
Twenty-five CMD patients (mean age 28.2 years) were compared with 25 gender and age
matched controls (mean age 28.3 years) in a controlled, investigator-blinded trial. Twelve
postural and ten muscle function parameters were examined. Measurements were separated
into three subgroups, consisting of those variables associated with the cervical region, the
trunk in the frontal plane, and the trunk in the sagittal plane. Within these subgroups, there
was significantly more dysfunction in the patients, compared to control subjects (MannWhitney U test p < 0.001, p < 0.05, p < 0.01). Postural and muscle function abnormalities
appeared to be more common in the CMD group. Since there is evidence of the mutual
influence of posture and the craniomandibular system, control of body posture in CMD
patients is recommended, especially if they do not respond to splint therapy. Whether poor
posture is the reason or the result of CMD cannot be distinguished by the data presented
here.
Abstract: Models for the evaluation of chiropractic methods have been proposed in the
past. This paper uses one model as a framework for the evaluation of cranial adjusting.
Chiropractors and osteopaths have been involved in the cranial field for almost 70 years.
Over this time, a body of literature has been amassed on clinical experience and research.
This article defines and describes one type of cranial adjusting technique and develops a
hypothetical model of effects influencing cranial motion. It also discusses measurable
observation, particularly in relation to cranial bone motion, and reviews the available
literature about experimentation and testing of the technique. Although further
experimentation and clinical trials are needed, the type of cranial adjusting technique
described has a sound scientific basis as mainstream chiropractic techniques and should
receive provisional acceptance within the chiropractic and other professions as an integral
part of the chiropractic armamentarium.
Entrainment and the cranial
rhythmic impulse, McPartland
JM, Mein EA.
Altern Ther Health Med, 1997 Jan;3(1):40-5.
Abstract: Entrainment is the integration or harmonization of oscillators. All organisms
pulsate with myriad electrical and mechanical rhythms. Many of these rhythms emanate
22
from synchronized pulsating cells (e.g., pacemaker cells, cortical neurons). The cranial
rhythmic impulse is an oscillation recognized by many bodywork practitioners, but the
functional origin of this impulse remains uncertain. We propose that the cranial rhythmic
impulse is the palpable perception of entrainment, a harmonic frequency that incorporates
the rhythms of multiple biological oscillators. It is derived primarily from signals between
the sympathetic and parasympathetic nervous systems. Entrainment also arises between
organisms. The harmonizing of coupled oscillators into a single, dominant frequency is
called frequency-selective entrainment. We propose that this phenomenon is the modus
operandi of practitioners who use the cranial rhythmic impulse in craniosacral treatment.
Dominant entrainment is enhanced by "centering," a technique practiced by many healers,
for example, practitioners of Chinese, Tibetan, and Ayurvedic medicine. We explore the
connections between centering, the cranial rhythmic impulse, and craniosacral treatment.
This paper proposes that entrainment used therapeutically involves the “rhythms” of the
‘centered’ practitioner dominating those of the subject, harmonizing into a composite ‘new’
CRI.
Cranial findings and iatrogenesis
from craniosacral manipulation in
patients with traumatic brain
syndrome, Greenman PE,
McPartland JM.
J Am Osteopath Assoc. 1995 Mar;95(3):182-8; 191-2.
Chiropractic care, including
craniosacral therapy, during
pregnancy: a static-group
comparison of obstetric
interventions during labor and
delivery, Phillips CJ, Meyer JJ.
J Manipulative Physiol Ther. 1995 Oct;18(8):525-9.
Abstract: Craniosacral findings were recorded for all patients with traumatic brain injury
entering an outpatient rehabilitation program between 1978 and 1992. The average cranial
rhythmic impulse was low in all 55 patients (average, 7.2 c/min). At least one cranial strain
pattern was exhibited by 95%, and 87% had one or more bony motion restrictions. Sacral
findings were similar to those in patients with low back pain. Although craniosacral
manipulation has been found empirically useful in patients with traumatic brain injury,
three cases of iatrogenesis occurred. The incidence rate is low (5%), but the practitioner
must be prepared to deal with the possibility of adverse reactions.
OBJECTIVE: To determine whether the addition of chiropractic care including
craniosacral therapy to a regimen of standard obstetric pregnancy results in fewer obstetric
interventions during labor and delivery. DESIGN: Retrospective, case-matched, staticgroup comparison. SETTING: The study group was obtained from a college faculty-based
clinic and received chiropractic care in addition to their routine obstetrical care. The setting
for the comparison group was unknown, but the care rendered was presumed to be primary
medical obstetric care only. PATIENTS: A consecutive sample of 63 pregnant women
who sought chiropractic care within the period under study. The reason for seeking care
was not necessarily related to the pregnancy. The sample was primarily between 18 and 35
yr, non-Hispanic caucasian and primiparous. After selection and matching criteria, 35
patients remained in the study group. INTERVENTION: Chiropractic care and
craniosacral therapy delivered during pregnancy vs. unknown care within the same county.
MAIN OUTCOME MEASURES: Obstetric interventions during labor and delivery as
reported by the birth attendant on the certificate of live birth. RESULTS: No statistical
differences were detected in the rates of obstetric interventions used during labor or
delivery between the two samples. Approximate large-sample 95% confidence intervals are
provided. CONCLUSION: Because of the limitations in the design of the project, this
study provides no evidence that the addition of chiropractic care and craniosacral therapy
during pregnancy results in any observable benefit or detriment with regard to obstetric
interventions used during labor and delivery and that chiropractic care for pregnancyrelated neuromusculoskeletal disorders should not complicate labor or delivery.
Nasal specific technique as part of J Manipulative Physiol Ther. 1995 Jan;18(1):38-41.
a chiropractic approach to chronic
OBJECTIVE: To demonstrate the use of nasal specific technique in conjunction with
sinusitis and sinus headaches,
23
Folweiler DS, Lynch OT.
other chiropractic interventions in managing chronic head pain. CLINIC FEATURES: A
41-yr-old woman was treated for chronic sinusitis and sinus headaches. She had suffered
weight loss and pain over a 2-month period. INTERVENTION AND OUTCOME:
Chiropractic manipulation and soft tissue manipulation administered 2-6 times per month
for approximately 1 yr had minimal long-term effect on the patient's head pain. When
additional interventions (nasal specific technique and light force cranial adjusting) were
added to the treatment regimen, significant relief of symptoms was achieved after the nasal
specific technique was performed. The duration of the relief increased with successive
therapeutic sessions, with minimally persistent symptoms after 2 months of therapy.
CONCLUSION: The nasal specific technique, when used in conjunction with other
therapies, may be useful in treating chronic sinus inflammation and pain. Further
investigation is needed to identify the usefulness of the nasal specific technique as an
independent intervention, the use of the technique in other types of patients and
presentations, and the mechanism of therapeutic benefit.
A Preliminary Single Case
Magnetic Resonance Imaging
Investigation into Maxillary
Frontal-Parietal Manipulation and
Its Short-Term Effect upon the
Intercranial Structures of an Adult
Human Brain, Pick, M.
J Manipulative Physiol Ther. 1994;17(3)
Interrater reliability of
craniosacral rate measurements
and their relationship with
subjects' and examiners' heart and
respiratory rate measurements,
Wirth-Pattullo V, Hayes KW.
Phys Ther, 1994 Oct;74(10):908-16; discussion 917-20.
Objective: To investigate the hypothesis that external cranial manipulation can cause
change within the structures of the human brain. (42 y/o subject). Results: Second MRI
showed elimination of a 5-mm peak along the superior border of the corpus collosum and a
4 - mm reduction in the width of the fornix column. The exposed anterior posterior wall of
the lateral ventricle posterior to the fornix col. increased 51 degrees cephalad with the
application (to the bregma and the maxillary palate). The angular surface of the central
lobule altered by minus 7 degrees. The subject experienced no change in his asymptomatic
condition as a result of this study. Conclusion: The present study supports the theory that
external cranial manipulation affects the structure of the brain. It also suggests support for
the theory regarding suture mobility.
BACKGROUND AND PURPOSE. The evaluation of craniosacral motion is an approach
used by physical therapists and other health professionals to assess the causes of pain and
dysfunction, but evidence for the existence of this motion is lacking and the reproducibility
of the results of this palpatory technique has not been studied. This study examined the
interexaminer reliability of craniosacral rate and the relationships among craniosacral rate
and subjects' and examiners' heart and respiratory rates. SUBJECTS. Participants were 12
children and adults with histories of physical trauma, surgery, or learning disabilities. Three
physical therapists with expertise in craniosacral therapy were the examiners. METHODS.
One of three nurses recorded heart and respiratory rates of both subject and examiner. The
examiner then palpated the subject to determine craniosacral rate and reported the findings
to the nurse. Each subject was examined by each of the three examiners. RESULTS.
Reliability was estimated using a repeated-measures analysis of variance and the intraclass
correlation coefficient (2,1). Significant differences among examiners and the scatter plot of
rates showed lack of agreement among examiners. The ICC was -.02. The correlations
between subject craniosacral rate and subject and examiner heart and respiratory rates were
analyzed with Pearson correlation coefficients and were low and not statistically
significant. DISCUSSION AND CONCLUSIONS. Measurements of craniosacral motion
did not appear to be related to measurements of heart and respiratory rates, and therapists
were not able to measure it reliably. Measurement error may be sufficiently large to render
many clinical decisions potentially erroneous. Further studies are needed to verify whether
craniosacral motion exists, examine the interpretations of craniosacral assessment,
determine the reliability of all aspects of the assessment, and examine whether craniosacral
therapy is an effective treatment.
Comment: Many experts in the cranial field have described the difficulty of detecting the
subtle dynamics of the CRI. The ability to effectively and reproducibly demonstrate to the
24
patient the cranial faults found during examination are therefore an important consideration
in therapy. The use of cranial challenge and therapy localization procedures, producing
obvious inhibition on MMT, allows cranial faults to be made more evident to both the
doctor and the patient. The chiropractic profession has discovered many objective signs of
cranial faults, and changes on MMT with specific challenges to the cranial mechanism is
perhaps the most objective sign in the arena of cranial therapy.
Finite element analysis for
stresses in the craniofacial sutures
produced by maxillary protraction
forces applied at the upper
canines, Miyasaka-Hiraga J,
Tanne K, Nakamura S.
Br J Orthod. 1994 Nov;21(4):343-8.
For Debate: Cranial Adjusting -An Overview, Pederick FO
Chiropractic Journal of Australia, Sept 1993; 23(3):106-12.
Abstract: The purpose of this study was to investigate the nature of stress distributions in
the craniofacial sutures produced by orthopaedic maxillary protraction forces applied to the
upper canines. A three-dimensional finite element model of the craniofacial complex was
developed for finite element analysis. An anteriorly directed force of 1.0 kg was applied to
the upper canines in three different directions, i.e. parallel, 30 degrees upwards and
downwards to the functional occlusal plane. Normal stresses acting on the sutural systems
were greatest when force was applied in the 30 degrees upward direction. Furthermore,
relatively large compressive stresses were induced in the frontonasal and frontomaxillary
sutures, indicating that forward and upward rotation of the nasomaxillary complex was
produced with substantial distortion of the complex, by the forces applied in both parallel
and 30 degrees upward directions. A 30 degrees downward force produced almost uniform
tensile stresses in the zygomaticotemporal and zygomaticomaxillary sutures, with least
compressive stresses in the frontonasal and frontomaxillary sutures located in the superior
region of the complex. This would indicate a uniform stretch of the nasomaxillary complex
in both anterior and inferior directions, with negligible distortion of the complex and would
be appropriate for accelerating natural growth of the nasomaxillary complex.
Abstract: Cranial adjusting procedures have been a part of osteopathic and chiropractic
therapeutic repertoires for over 60 years. Although the osteopathic literature is extensive,
there is no known chiropractic peer reviewed literature on this field. This paper seeks to
change this situation and begin the process of examining cranial concepts in the
chiropractic peer reviewed literature. Cranial adjusting appears to be soundly based in
anatomy, physiology and histological studies as well as clinical results. It may be likened to
spinal adjusting in that "scientific" definition and demonstration of the subluxation may at
present be beyond our technology. As with spinal adjusting unless there is evidence which
absolutely refutes the current literature on cranial adjusting, it could be accepted as a part of
mainstream chiropractic, be included in the curriculum of chiropractic schools and become
part of the therapeutic repertoire of most chiropractors.
Changes in Magnitude of Relative
Elongation of the Falx Cerebri
During the Application of
External Forces on the Frontal
Bone of an Embalmed Cadaver,
Kostopoulos, D., Keramidas, G.
Journal of Craniomandibular Practice, January 1992.
Craniosacral therapy hypothesizes that light forces applied to the skull may be transmitted
to the dural membrane having a therapeutic effect on the cranial system. This study
examines the changes in elongation of falx cerebri during the application of craniosacral
therapy techniques to the skull of an embalmed cadaver. The study demonstrates that the
relative elongation of the falx cerebri changes as follows: for the frontal lift, 1.44 mm; for
the parietal lift, 1.08 mm; for the sphenobasilar compression, -0.33mm; for the
sphenobasilar decompression, 0.28 mm; and for the temporal ear pull, inconclusive results.
Results showed that an elastic response began at 140 grams of frontal bone traction. At 642
grams the elastic response ended and viscous changes began. The present study offers
validation for the use of craniosacral therapy and the hypothesis of cranial suture mobility.
Kinematic imbalances due to
J Man Med, 1992;31:92-95
suboccipital strain, Biedermann H.
25
Abstract: This paper suggests a term to describe children in whom the main clinical feature
is torticollis, often combined with an asymmetrical cranium, postural asymmetry and a
range of dysfunctional symptoms. The term KISS is an acronym for Kinematic Imbalances
due to Suboccipital Strain. KISS imbalances are regarded as one of the main reasons for
asymmetry in posture and consequently asymmetry of the osseous structures of the cranium
and the spine. Among the many symptoms reported in this paper in KISS children are
torticollis, reduced range of head/neck motion, cervical hypersensitivity, opisthotonos,
restlessness, inability to control head movement and one upper limb underused (based on
statistical records of 263 babies treated in one calendar year up to June 1995. Of the 263
babies treated, 213 required only one treatment, 41 were treated twice and the remainder
more often, with just two requiring 4-5 treatment sessions.
A tissue pressure model for
J Am Osteopath Assoc, 1991 Oct;91(10):975-7, 980, 983-4 passim.
palpatory perception of the cranial
Abstract: A tissue pressure model was developed to provide a possible physiologic basis
rhythmic impulse, Norton JM.
for the manifestation of the cranial rhythmic impulse (CRI). The model assumes that the
sensation described as the CRI is related to activation of slowly adapting cutaneous
mechanoreceptors by tissue pressures of both the examiner and the subject, and that the
sources of change in these tissue pressures are the combined respiratory and cardiovascular
rhythms of both examiner and subject. The model generates rhythmic impulses with
patterns similar to those reported for the CRI. Also, a significant correlation was found
between frequencies calculated from the model and published values for CRI obtained by
palpation. These comparisons suggest that the CRI may arise in soft tissues and represents a
complex interaction of at least four different physiologic rhythms.
Cranial osteopathy: a new
perspective, Ferguson A.
Academy of Applied Osteopathy Journal, 1991;1(4):12-16
Abstract: This paper hypothesizes that since the cranial rhythmic impulse is palpable
throughout the body – simultaneously – and therefore was unlikely to relate to a hydraulic
‘pressurestat’ mechanism in the cranium. This suggested a muscular origin for palpable
CRI rhythm.
The inability of the sphenobasilar synchondrosis to flex and extend – following fusion by
age 25 – points to a need for an alternative motive force of the CRI, externally driven,
possibly by muscular involvement. What we are feeling when we palpate the CRI, this
paper suggests, is a function of the dynamic neuromuscular system – Irwin Korr’s ‘primary
machinery of life.’ The importance of this to AK treatment of the cranial mechanism should
not be overlooked.
To quote from the paper: “The body as a whole shows patterns of tension/relaxation,
strength/weakness, bind/ease and integration/loss of awareness. These are individual, often
complex and superimposed, and are reflected throughout the whole body including the
cranium. It is also dynamic. There is constant movement or tone in innervated muscles…. It
is also important to remember the complete functional integration of the neuromuscular
system and visceral systems via the autonomic nervous system. Alterations in blood
circulation level under the influence of the sympathetic nervous system contribute to some
effects of somatic dysfunction, and of treatment, and may be relevant to some fluctuating
fluid changes in the body.”
Postural differences between
asymptomatic men and women
and craniofacial pain patients,
Braun BL.
Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.
Abstract: A forward head position and rounded shoulders have been implicated in the
development or perpetuation of craniomandibular disorders. Since women seek treatment
for these problems more frequently than men, postural differences may account for the
increased incidence of symptoms in women. The purposes of this study were (1) to
26
compare the sagittal head and shoulder posture of asymptomatic men and women and (2) to
compare the posture of asymptomatic and symptomatic women to determine differences in
sagittal plane posture. Subjects were 20 asymptomatic men and women volunteers and nine
consecutive women patients presenting for evaluation and treatment of craniomandibular
pain. The subjects were compared using a valid, reliable, computer-assisted slide digitizing
system called the Postural Analysis Digitizing System (PADS). Asymptomatic men and
women did not differ in the postural characteristics associated with craniomandibular
disorders. Sagittal posture does not appear to be a gender-related factor in these disorders.
Symptomatic women, however, do display these postural characteristics to a greater extent
than asymptomatic women. Evaluation and treatment of postural dysfunction should be
included in the management of these patients.
Comment: AK, because it is holistic, attempts to coordinate cranial therapeutics with
whole body procedures, using specific vertebral adjustments, blocking procedures, muscle
receptor and other soft tissue techniques, plus a range of reflex techniques including
meridian patterns in order to address the complete neural, chemical, and mechanical aspects
thought to be affecting cranial structures. The importance of integrating the whole person
into the treatment of the craniofacial area is highlighted by this study.
The Colorado Board of Medical
Examiners vs. W.M. Raemer,
D.D.S. Court of Appeals, State of
Colorado, Case No. 87CA1589,
March 22, 1990
The unanimous ruling of the Appellate Court in favor of W.M. Raemer, D.D.S., states
that cranial therapy is an effective form of treatment for TMJ dysfunction. As such, it
was ruled that dentists in Colorado are allowed to use cranial therapy for treatment in
the scope of their practice.
The cranium and its sutures,
Retzlaff, E.W., Mitchell, F.W.
Berlin: Springer-Verlag; 1987.
An annotated bibliography of over 250 papers relating to cranial manipulative therapy.
The Effect of Movement, Stress
and Mechanoelectric Activity
Within the Cranial Matrix, Blum
C.
International Journal of Orthodontics, Spring 1987;25(1-2): 6-14.
A Review of Cranial Mobility,
Sacral Mobility, and
Cerebrospinal Fluid, Peterson K
Journal of the Australian Chiropractic Association. 1982 Apr;12(3):7-14.
This study presents substantial research supporting the premise that: (1) Cranial sutures
and bones are capable of flexibility and slight movement. (2) Mechanical stresses can
affect the sutures on a short-term basis. (3) Mechanical stresses can affect the sutures on a
long-term basis. (4) An interrelationship exists between cranial sutures and the structures
transmitting mechanical forces; this relationship has a matrix/holographic organization. (5)
Mechanical stresses within the cranial bones and sutures are capable of creating a
piezoelectric effect. This piezoelectric effect is of a magnitude sufficient to create changes
within the associated cranial bones and soft tissues to affect enzymatic changes,
osteoblastic/osteoclastic activity and neuroelectric dynamics. The author concluded that in
light of the advances in orthodontics, temporomandibular joint treatment, and cranial
manipulative therapy, we must view cranial motion as part of a dynamic and kinetic,
physiological, cranial matrix. The ability for cranial bones to move, or not move, plays a
part in the transmission of stress within the cranium and could have far reaching effects.
Abstract: The literature review examines and lends credibility to the existence of cranial
and sacral mobility. These normal life long activities occur in response to respiratory
movement, arterial pulsations, physical movement and to an innate frequency. This article
presents some of the past and present research concerned with the cranium, sacrum, and
cerebrospinal fluid (CSF) in an historical perspective for such a re-evaluation. Even though
some of the research is still in an embryological stage, the available data should enable the
practitioner to judge the importance of CSF to health and how chiropractic adjustments can
affect CSF.
27
"The Reproducibility of
Craniosacral Examination
Findings: A Statistical Analysis",
Upledger, John E
Journal of the American Osteopathic Association, Aug 1977; 76: 890/67 899/76.
Abstract: A statistical analysis of the data from 5- craniosacral examinations on 25
preschool children is presented. These data would seem to support the reliability and
reproducibility of the examination findings when the examinations are performed by skilled
examiners. During all 50 examinations, the rate of cranial rhythmic impulse (CRI) was
counted and compared with the pulse and respiratory rates of both the subject and the
examiner. The results of this comparison would tend to help establish the CRI as an
independent physiologic rhythm. A single-blind protocol was employed. All reasonable
precautions were taken to control variables.
"The Trauma of Birth", Frymann, Osteopathic Annals, May 1976:197-205.
Viola M.
Abstract: Musculoskeletal strains on the newborn during delivery can cause problems
throughout life. Recognizing and treating these dysfunctions in the immediate postpartum
period is one of the most important phases of preventive medicine.
"The Growing Skull and the
Injured Child", Dovesmith, Edith
E,
Academy of Applied Osteopathy (AAO Yearbook) 1967: 34-39.
"Subclinical Signs of Trauma",
Arbuckle, B. E.
Journal of the American Osteopathic Association, Nov 1958; 58: 160-166.
"The Value of Occupational and
Osteopathic Manipulative
Therapy in the Rehabilitation of
the Cerebral Palsy Victim",
Arbuckle, B.E.
Journal of the American Osteopathic Association, 1955 Dec; 55(4).
"Effects of Uterine Forces Upon
the Fetus", Arbuckle. B. E.
Journal of the American Osteopathic Association, May 1954; 53(9): 499508.
"Fetal Cranial Stresses During
Pregnancy and Parturition",
Pinder, D. E. & Mines, J. L.
Journal of the American Osteopathic Association, Nov 1954; 54(3): 164167.
"The Infant - An Entity",
Arbuckle, B.E.
Journal of the American Osteopathic Association, 1954 May; 49: 474-477.
"The Cranial Aspect of
Emergencies of the Newborn",
Arbuckle, B. E.
Journal of the American Osteopathic Association, May 1948; 47: 507-511.
THE CLINICAL EFFECTS OF CRANIAL FAULTS
28
Cranial Therapeutic Care: Is
There any Evidence? Blum CL,
Cuthbert S.
Chiropractic & Osteopathy 2006, 14:10
Chiropractic Evaluation and
Treatment of Musculoskeletal
Dysfunction in Infants
Demonstrating Difficulty
Breastfeeding, Vallone S.
Journal of Clinical Chiropractic Pediatrics, 2004; 6(1):349-61.
A retrospective study of cranial
strain patterns in patients with
idiopathic Parkinson’s disease,
Rivera-Martinez, S., Wells, M.,
Capobianco, J.
Journal of the American Osteopathic Association, August 2002;102(8):417422
Background: In the commentary by Hartman, (Cranial osteopathy: its fate seems clear,
Chiropractic & Osteopathy 2006, 14:10.) he has attempted to elicit a response by making
far overreaching statements, which are ironic since Hartman thinly veils himself in a
gossamer cloak of science, research, and evidenced-based healthcare. Hartman has picked
an isolated diagnostic procedure or treatment, cerebrospinal fluid (CSF) pulsation
palpation, questioned its reliability and validity, and then used this fractional aspect of a
method of care to condemn all of cranial therapy. What can be said by Hartman and fairly
so, is that from his review of selected studies regarding CSF palpation as discussed in
cranial therapeutic care, further study to investigate its validity and reliability is warranted
and this component of cranial diagnosis should not be used at this time as a sole criteria for
cranial diagnosis or treatment. Discussion Much of Hartman’s position is refuted by, at the
very least, reviewing the difference between the gross mechanical aspects of cranial care,
which has documentation, and the subtle mechanical aspects, which remain controversial.
A comprehensive evidenced based rationale of cranial therapeutics is presented along with
three tables listing pertinent studies relating to cranial bone dynamics and the efficacy of
cranial manipulative therapy. Conclusion While the onus to do the research is upon those
who are proponents of a method of care, there is also an onus upon those who call for its
virtual abolition to be familiar with all the published research on the topic and how
evidenced based clinical practice is formulated.
Objective: Breastfeeding during the first year of an infant's life is currently supported and
promoted by lactation consultants, midwives, naturopaths, chiropractors, and allopathic
physicians. In 1997, the American Academy of Pediatrics and in 1998, the World Health
Organization published their position papers that advocated breastfeeding as the optimal
form of nutrition for infants. This study was to investigate problems interfering with a
successful breastfeeding experience and to see if proper lactation management, with the
chiropractor acting as a member of a multidisciplinary support team, can help to assure a
healthy bonding experience between mother and infant. Methods: 25 infants demonstrating
difficulties breastfeeding were evaluated for biomechanical dysfunction potentially
resulting in an inability to suckle successfully. The biomechanics of 10 breastfeeding
infants without complaint were also evaluated fro comparison. Results: An overview of the
infants with breastfeeding difficulty revealed imbalanced musculoskeletal action as
compared to the infants without difficulty breastfeeding. Utilization of soft tissue therapies
and chiropractic adjustment of the cranium and spine resulted in improved nursing in over
80% of the patients. Conclusions: The results of this study suggest that biomechanical
dysfunction based on articular or muscular integrity may influence the ability of an infant to
suckle successfully and that intervention via soft tissue work, cranial therapy, and spinal
adjustments may have a direct result in improving the infant's ability to suckle efficiently.
Abstract: While providing osteopathic manipulative treatment to patients with Parkinson's
disease at the clinic of the New York College of Osteopathic Medicine of New York
Institute of Technology, physicians noted that these patients may exhibit particular cranial
findings as a result of the disease. The purpose of this study was to compare the recorded
observations of cranial strain patterns of patients with Parkinson's disease for the detection
of common cranial findings. Records of cranial strain patterns from physician-recorded
observations of 30 patients with idiopathic Parkinson's disease and 20 age-matched normal
controls were compiled. This information was used to determine whether different
physicians observed particular strain patterns in greater frequency between Parkinson's
29
patients and controls. Patients with Parkinson's disease had a significantly higher frequency
of bilateral occipitoatlantal compression (87% vs. 50%; P < .02) and bilateral
occipitomastoid compression (40% vs. 10%; P < .05) compared with normal controls. Over
subsequent visits and treatments, the frequency of both strain patterns were reduced
significantly (occipitoatlantal compression, P < .01; occipitomastoid compression, P < .05)
to levels found in the control group.
Chiropractic Care For Infants with Journal of Clinical Chiropractic Pediatrics. 1999 May ; 4(1): 241-4.
Dysfunctional Nursing: A Case
Objective: To present the cases of two infants with dysfunctional nursing who were able to
Series, Hewitt EG.
breastfeed normally after receiving chiropractic care. Physiological mechanisms are
presented explaining how chiropractic care may restore normal suckling. Clinical features:
The first case involves an 8-week-old girl unable to maintain suction while breastfeeding
since birth. She was diagnosed by a chiropractor with cranial subluxations. The second
infant, a 4-week-old boy, had been unable to suckle effectively since birth. He was
diagnosed with spinal and cranial subluxations. Intervention and outcome: Each infant
received diversified spinal adjusting and / or craniosacral therapy based on the clinical
findings. The first was able to nurse normally after receiving 2 chiropractic adjustments
over 14 days. The second infant suckled immediately following his first adjustment and
received a total of 4 adjustments in 21 days. Conclusions: This paper reports two cases in
which chiropractic care was followed by immediate resolution of dysfunctional nursing.
Further research is needed to determine the role of the chiropractic adjustment in
normalizing neonatal suckling.
Colic With Projectile Vomiting: A Journal Of Clinical Chiropractic Pediatrics. 1998 Aug; 3(1): 207-10.
Case Study, Van Loon M.
Objective: The purpose of this case study is to discuss the chiropractic care of a patient
who presented to the author's office with a medical diagnosis of colic, with additional
projectile vomiting. The proposed etiology, the medical approach to colic, and the
chiropractic care for this infant is detailed. Also examined is the connection between birth
trauma and non-spinal symptoms. Design: a case study. Setting: private practice. Patient: a
three-month-old Caucasian male presenting with medically diagnosed colic. Symptoms had
been increasing in severity over the previous two months despite medical intervention.
Results: the resolution of all presenting symptoms within a 2-week treatment period is
detailed. Care consisted of chiropractic spinal adjustments and craniosacral therapy.
Conclusion: this case study details the chiropractic management of a three-month-old male
with a medical diagnosis of colic who also exhibited projectile vomiting. Complete
resolution of all symptoms was achieved. Proposed cranial and spinal etiologies are
discussed, as well as the connection between birth trauma and non-spinal symptoms.
Chiropractic Care Of A Pediatric
Glaucoma Patient: A Case Study,
Conway CM.
Journal of Clinical Chiropractic Pediatrics. 1997 Oct; 2(2): 155-6.
Disturbed eye movements after
whiplash due to injuries to the
posture control system, Gimse R,
Tjell C, Bjorgen IA, Saunte C.
J Clin Exp Neurophychol, 1996;18(2):178-86.
Abstract: This case study involves a 17-month-old female presenting with glaucoma and
recurrent, chronic sinus infections. This study addresses the reduction of infections as well
as the restoration of normal intraocular pressure to the patient using chiropractic
adjustments and nutritional therapy. Techniques were also used to influence the cranialsacral primary respiratory mechanism in an effort to influence the cranium through the
connection of the dura mater.
Abstract: Self-reports after whiplash often indicate associations with vertigo and reading
problems. Neuropsychological and otoneurological tests were applied to a group of
whiplash patients (n = 26) and to a carefully matched control group. The whiplash group
deviated from the control group on measures of eye movements during reading, on smooth
pursuit eye movements with the head in normal position, and with the body turned to the
30
left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the
vestibular system or to the CNS. Test results suggest that injuries to the neck due to
whiplash can cause distortion of the posture control system as a result of disorganized neck
proprioceptive activity.
Comment: Central to the concept of applied kinesiology chiropractic evaluation and
treatment is the consideration that the senses of seeing, hearing, smelling, tasting, feeling,
and balance are not simple, specific sensations; rather they are sensory systems closely
interrelated among themselves and intimately linked with motor functions. In applied
kinesiology chiropractic methodology, a means for testing the integration of the muscles in
the body with the visual reflexes has been termed ocular lock. It demonstrates the failure of
the eyes to work together on a binocular basis through the cardinal fields of gaze. This is
usually not gross pathology of cranial nerves III, IV, and VI; rather it is poor functional
organization. Mechanical irritation of cranial nerves III, IV, or VI (usually VI) may be
responsible for disturbed binocular function leading to discordant sensory inputs from the
visual righting reflex. When the eyes are turned in a specific direction, a previously strong
indicator muscle will weaken when the ocular lock test is positive, and there is probably
disturbance in the visual righting, vestibulo-ocular, or opto-kinetic reflexes.
Occipital plagiocephaly:
deformation or lambdoid
synostosis? II. A unifying theory
regarding pathogenesis, Dias MS,
Klein DM.
Pediatr Neurosurg. 1996 Sep;25(3):164.
Abstract: Occipital plagiocephaly is characterized by both unilateral occipital flattening
and ipsilateral frontal prominence with anterior deviation of the ipsilateral ear, yielding a
characteristic parallelogram shape to the cranium. Radiographic changes in the lambdoid
suture are often evident, but the lambdoid suture is usually patent over most or all of its
length on skull X-rays and/or CT scans. Both lambdoid synostosis and deformational forces
have been implicated as potentially causal in the pathogenesis of this deformity. We
proposed a unifying theory which incorporates a common pathogenesis for both
deformational plagiocephaly and most cases of lambdoid 'synostosis'. According to this
hypothesis, intrauterine and/or postnatal deformation forces are responsible for the
primary calvarial deformation. These forces initially act in reversible manner to
produce the typical parallelogram-shaped skull deformity. However, with continued
deformation, more enduring secondary pathological changes may eventually occur in the
lambdoid suture and basicranium which are more difficult to correct even if the offending
deformational forces are subsequently removed or reversed.
Ocular findings in children
Childs Nerv Syst. 1996 Nov;12(11):683-9.
operated on for plagiocephaly and
trigonocephaly, Denis D, Genitori Abstract: Clinical examination of patients affected by plagiocephaly or trigonocephaly
L, Conrath J, Lena G, Choux M. reveals evident malformation of the orbits, and the ocular repercussions are pronounced
when children are operated on at an advanced age. Since it is generally accepted that
binocular vision is fully developed by approximately 6 months of age, a late correction of
plagiocephalic or trigonocephalic skull deformities may be an obstacle to the development
of normal visual function. For the present report we investigated astigmatism and
strabismus in 53 children, 39 of whom were operated on for plagiocephaly and 14 for
trigonocephaly. Traction on the ocular globe induced by the bony deformation caused by
the craniosynostosis may explain astigmatism and strabismus.
Comment: In applied kinesiology chiropractic methodology, a means for testing the
integration of the muscles in the body with the visual reflexes has been termed ocular lock.
In this study, one of the repercussions of plagiocephaly is strabismus, which is commonly
found in cases demonstrating the ocular lock phenomenon. Ocular lock testing
demonstrates the failure of the eyes to work together on a binocular basis through the
cardinal fields of gaze. This is usually not gross pathology of cranial nerves III, IV, and VI;
rather it is poor functional organization. The ocular lock phenomenon is theorized to be a
consequence, most frequently, to cranial faults. There has been some substantiation for this
premise, which demonstrates the possible effects of dural tension on the cranial nerves. The
31
cranial nerves carry dural sleeves with them for some distance; therefore any abnormal
meningeal tension may be transmitted to a nerve and affect its function.
An increase in infant cranial
deformity with supine sleeping
position, Argenta LC, David LR,
Wilson JA, Bell WO.
J Craniofac Surg. 1996 Jan;7(1):5-11.
Abstract: Abnormalities of the occipital cranial suture in infancy can cause significant
posterior cranial asymmetry, malposition of the ears, distortion of the cranial base,
deformation of the forehead, and facial asymmetry. Over the past 2 years, we have noted a
dramatic increase in the incidence of deformation of the occipital skull in our tertiary
referral center. Our patient referral base has not changed appreciably over the past 5 years
and patients have been referred from the same primary practitioner base. The timing of this
increase correlates closely with the acceptance in our area of recommended changes in
sleeping position to supine or side positioning for infants because of the fear of sudden
infant death syndrome (SIDS). A total of 51 infants with occipital cranial deformity, with a
mean age of 5.5 months at presentation, have been evaluated and treated by a single
craniofacial surgeon in the 16-month period from September 1993 to December 1994.
Older infants were treated with continuous positioning by the parent keeping the infant off
the involved side. Younger infants and those with poor head control were treated with a
soft-shell helmet. Mean timing of initial diagnosis and start of treatment was 5.5 months.
Mean duration of helmet for positional treatment was 3.8 months. To date, only 3 of 51
patients have required surgical intervention, and other patients demonstrated spontaneous
improvement of all measured parameters. Follow up has ranged from 8 to 24 months. We
believe that most occipital plagiocephaly deformities are deformations rather than true
cranio-synostoses. Despite varying amounts of suture abnormality evidenced on computed
tomographic scans, most deformities can be corrected without surgery. In cases where
progression of the cranial deformity occurs, despite conservative therapy, surgical
intervention should be undertaken at approximately 1 year of age. The almost universal
acceptance in the State of North Carolina of positioning neonates on their backs to avoid
SIDS, may well increase the incidence of these deformities in the future.
Changes in neck
J Manipulative Physiol Ther. 1995 Nov-Dec;18(9):577-81.
electromyography associated with
OBJECTIVE: To determine if the activity of jaw and neck muscles in a rat model is
meningeal noxious stimulation,
influenced by the application of small-fiber irritant mustard oil to meningeal/dural vascular
Hu JW, Vernon H, Tatourian I.
tissues. DESIGN: Controlled animal experiment. SETTING: University neurophysiology
laboratory. INTERVENTIONS: Applications of mineral oil (vehicle control) and mustard
oil to exposed meningeal/dural vascular tissues. MAIN OUTCOME MEASURE:
Electromyographic (EMG) recordings from deep suboccipital muscles, bilaterally, and the
left trapezius and left masseter muscles. RESULTS: Mineral oil evoked no EMG responses
in any muscles. The incidences of mustard oil-evoked EMG increases were 100%, 100%,
89% and 78% for left deep neck, right deep neck, left trapezium and left masseter muscles,
respectively. The durations of EMG responses were (mean +/- SD) 19.2 +/- 6.6 min, 17.3
+/- 7.5 min, 14.5 +/- 6.8 min and 12.7 +/- 8.5 min, respectively. CONCLUSIONS: These
results document that meningeal/dural vascular irritation leads to sustained and reversible
activation of neck and jaw muscles that may be related to the clinical occurrence of
muscular tension and pain associated with certain types of headaches, particularly migraine.
Otitis media with effusion and
craniofacial analysis-II: "Mastoidmiddle ear-eustachian tube
system" in children with secretory
otitis media, Kemaloglu YK,
Goksu N, Ozbilen S, Akyildiz N.
Int J Pediatr Otorhinolaryngol. 1995 Apr;32(1):69-76.
Abstract: Secretory otitis media (SOM) is a disease of childhood, and this period is
characterized by active growing of the craniofacial skeleton (CFS). In this study, we
purposed to answer the question 'how deviations in CFS play a role in ethiopathogenesis of
SOM'? Therefore, we evaluated the 'mastoid-middle ear-Eustachian tube (M-ME-ET)
system' in 30 SOM cases and 30 healthy children by using lateral cephalographies on which
reference points and one line related to CFS and 'M-ME-ET system' were pointed. The
results disclosed that the bony Eustachian tube, the vertical portion of the tensor veli
32
palatini (TVP) muscle and the mastoid air cell system were smaller in SOM cases. In the
view of the statements of Enlow (1990) on craniofacial growth, we suggest that the
deviations in the growth process of the nasomaxillary complex lead to corresponding
imbalances in the bony tube and vertical portion of the TVP. However, since regional
imbalances often tend to compensate for one another to provide functional equilibrium
(Enlow, 1990), improvement of the tubal function occurs with age.
Ocular manifestations of
deformational frontal
plagiocephaly, Fredrick DR,
Mulliken JB, Robb RM.
J Pediatr Ophthalmol Strabismus. 1993 Mar-Apr;30(2):92-5.
Traumatic brain injury and
chronic pain: differential types
and rates by head injury severity,
Uomoto JM, Esselman PC.
Arch Phys Med Rehabil. 1993 Jan;74(1):61-4.
Chiropractic Treatment Of A 7Month-Old With Chronic
Constipation: A Case Report,
Hewitt, E.
Chiropractic Technique, 1993 Aug; 5(3):101-3.
Abstract: Frontal plagiocephaly can be caused by two mechanisms: craniosynostosis and
external deformational pressure. Synostotic plagiocephaly is known to be associated with
vertical strabismus and contralateral head tilt. Thirteen patients with deformational frontal
plagiocephaly were examined to evaluate head position, ocular motility, and alignment.
Nine of the patients (70%) were found to have ipsilateral torticollis, but only one patient
had strabismus and this was a horizontal deviation not obviously associated with head
position. The clinical features of synostotic and deformational plagiocephaly are discussed
to distinguish the two conditions, which have a different treatment and outcome.
Comment: This paper documents the effects, specifically, of the frontal bone cranial fault.
In AK, this cranial fault would be called an interosseous cranial fault of the frontal bone,
and the underlying mechanism of the ocular problems resulting from it involves traction on
the ocular globe induced by the frontal bone deformation.
Abstract: Traumatic brain injury has been associated with many physical and
neurobehavioral consequences, including pain problems. Documented most has been the
presence of posttraumatic headaches that are associated with the postconcussion syndrome.
This study therefore examined types and rates of chronic pain problems in patients seen in
an outpatient brain injury rehabilitation program. A total of 104 patients were evaluated, 66
of whom were male and 38 female, and the average time postinjury was 26 months.
Headaches were the most frequent chronic pain problem across both mild and the
moderate/severe groups, although in the former, a significantly higher frequency was noted
(89%) when compared against the latter group. The same relative rates were seen for
chronic neck/shoulder, back, and other pain problems. The mild group also showed a higher
frequency of concurrent pain problems, whereas in the moderate/severe group only one
patient had more than one chronic pain problem. Results also showed that in the mild group
neck/shoulder accompanied headaches 47% of the time, and back pain coexisted with
headaches 44% of the time. These results underscore the high frequency of chronic pain
problems in the mild head injury population and implicate the need for avoiding the
mislabeling of symptoms such attentional deficits or psychological distress as attributable
only to head injury sequelae in those with coexisting chronic pain. Early identification and
intervention of pain syndromes in the mild head-injury population is also suggested.
Abstract: A 7-month-old girl suffering from chronic constipation since birth a history of
painful staining and hard, pellet-like stools. Stools ranged in frequency from once per day
to once every 3 days. After treatment consisting of full spine and cranial adjusting, the
patient's bowel function normalized to one to two soft, effortless stools per day.
Maintenance of these improvements was confirmed at a 1-year follow-up visit.
Head posture and cervicovertebral Cranio. 1992 Jul;10(3):173-7; discussion 178-9.
and craniofacial morphology in
Abstract: A relationship between particular characteristics of dental occlusion and
patients with craniomandibular
dysfunction, Huggare JA, Raustia craniomandibular disorders (CMD) has been reported, while less attention has been focused
on the possible effect of dysfunction of the masticatory system on head posture or
33
AM.
cervicovertebral and craniofacial morphology. Natural head position roentgencephalograms of 16 young adults with complete dentition taken before and after
stomatognathic treatment displayed an extended head posture, smaller size of the
uppermost cervical vertebrae, decreased posterior to anterior face height ratio, and a
flattened cranial base as compared with age- and sex-matched healthy controls. The
lordosis of the cervical spine straightened after stomatognathic treatment. The results
are an indication of the close interrelationship between the masticatory muscle system and
the muscles supporting the head, and lead to speculation on the principles of treating
craniomandibular disorders.
Case Study: The effect of utilizing
spinal manipulation and
craniosacral therapy as the
treatment approach for attention
deficit-hyperactivity disorder,
Phillips, C.
Proceedings of the National Conference on Chiropractic, 1991 Nov:57-74
Upper airway obstruction and
craniofacial morphology,
Principato JJ.
Otolaryngol Head Neck Surg. 1991 Jun;104(6):881-90.
Biomechanics of head injury,
Int J Neurosci. 1990 Sep;54(1-2):101-17.
ABSTRACT: Due to the subjective nature of this disorder, evaluations and treatment
results have considerable limitations and cannot be generalized to the entire population. It is
this author's intent to describe an alternative treatment protocol and its effect on one
subject. In this particular case, initial chiropractic spinal adjustive care was effective in
reducing the frequency of ear infections, allergic reactions, and headaches, but was
ineffective at decreasing the severity of ADHD characteristics. Incorporation of
craniosacral therapy with spinal adjustive therapy resulted in a positive alteration in the
ADHD symptomatology. The teacher's report of improvement in performance skills was
significant as teacher ratings have been found to have empirical corroboration of ADD.
While conclusions cannot be drawn based on a single case report, it was the opinion of this
author that the results justified a more detailed analysis of this treatment protocol for
ADD/ADHD. The NWCC Center for Clinical Studies has begun treatment on 17 additional
patients with this disorder. If results are similar, a large scale research project will be
implemented to investigate further the role that chiropractic spinal and cranial therapy may
play in the treatment of Attention Deficit Hyperactivity Disorder.
Abstract: Otolaryngologists are being asked with increasing frequency to assess adequacy
of the upper airway and to treat upper airway obstructive problems in orthodontic patients.
The incentive has been provided by recent studies that purport to relate upper airway
obstruction to dental and craniomorphologic changes. It is hypothesized that prolonged oral
respiration during critical growth periods in children initiates a sequence of events that
commonly results in dental and skeletal changes. In the chronic mouth-breather excessive
molar tooth eruption is almost a constant feature, causing a clockwise rotation of the
growing mandible, with a disproportional increase in anterior lower vertical face height.
Such increases in anterior lower vertical face height are often associated with retrognathia
and open bites. Low tongue posture seen with oral respiration impedes the lateral expansion
and anterior development of the maxilla. Otolaryngologists have the ability to objectively
and accurately assess upper airway patency. Rhinometric assessment before and after
application of topical nasal decongestant, in conjunction with clinical examination,
provides valuable information regarding upper airway patency and the cause of any existing
obstructive pathologic condition. Studies should be designed carefully to control the
numerous variables that have an impact on the growing face of a young child so that
meaningful data can be obtained in our own field regarding this challenging topic.
Demann D, Leisman G.
Abstract: The enormous incidence of closed head injury has resulted in employing the
field of biomechanics as a means of predicting the site of a lesion, discovering, and
understanding the forces acting during cranial impact. This paper indicates that the
possibilities associated with trauma-induced lesions include: the establishment of large
pressure gradients associated with damage resulting from absolute motion of the brain and
its displacement relative to the skull; flexion-extension of the upper cervical cord; skull
34
deformation and/or rotational acceleration. Analytical representations, inanimate and
cadaver models and, experimental paradigms are presented and their behavioral
implications discussed.
The long face syndrome and
Angle Orthod. 1990 Fall;60(3):167-76.
impairment of the nasopharyngeal
Abstract: Experimental evidence suggests that altered muscular function can influence
airway, Tourne LP.
craniofacial morphology. The switch from a nasal to an oronasal breathing pattern induces
functional adaptations that include an increase in total anterior face height and vertical
development of the lower anterior face. While some animals studies have suggested
predictable growth patterns may occur, studies in human subjects have been much more
controversial. Therefore, individual variations in response should be expected from the
alteration of a long face syndrome patient's breathing mode.
Craniofacial skeleton of 7-yearold children with enlarged
adenoids, Tarvonen PL, Koski K.
Am J Orthod Dentofacial Orthop. 1987 Apr;91(4):300-4.
Persisting symptoms after mild
head injury: a review of the
postconcussive syndrome,
Binder LM.
J Clin Exp Neuropsychol. 1986 Aug;8(4):323-46.
Abstract: In a radiocephalometric study of 7-year-old children, it was found that a
diagnostically useful characteristic associated with the presence or past history of enlarged
adenoids is a dorsal rotation of the mandibular ramus relative to the palate. This feature
may also be common to other obstructions of the nasopharyngeal space. A possible
mechanism causing this growth deviation and some methodological problems involved in
its detection are discussed.
Abstract: Seemingly mild head injuries frequently result in persisting postconcussive
syndromes. The etiology of these symptoms is often controversial. Neuropsychological,
neurophysiological, and neuropathological evidence that brain damage can occur in the
absence of gross neurological deficits after mild injuries is reviewed. Direct impact to the
head is not required to cause brain injury. Understandably, psychological factors also play a
role in post-head-injury disability, but the effect of compensation claims and preinjury
psychopathology is often secondary to organic factors. Persons over age 40 or with a
history of previous head injury are more vulnerable to protracted symptomatology.
Autism and unfavorable left-right J Autism Dev Disord. 1979 Jun;9(2):153-9.
asymmetries of the brain,
Hier DB, LeMay M, Rosenberger Abstract: Utilizing computerized brain tomography, left-right morphologic asymmetries of
the parietooccipital region were judged in 16 autistic patients, 44 mentally retarded patients,
PB.
and 100 miscellaneous neurological patients. In 57% of the autistic patients the right
parietooccipital region was wider than the left, while this pattern of cerebral asymmetry
was found in only 23% of the mentally retarded patients and 25% of the neurological
patients. It is suggested that unfavorable morphologic asymmetries of the brain near the
posterior language zone may contribute to the difficulties autistic children experience in
acquiring language.
"The Relationship of Craniosacral
Examination Findings in Grade
School Children with
Developmental Problems",
Upledger, J.
Journal of the American Osteopathic Association, June 1978; 77: 760/69 776/85.
Abstract: A standardized craniosacral examination was conducted on a mixed sample of
203 grade school children. The probabilities calculated supported the existence of a positive
relationship between elevated total craniosacral motion restriction scores and the
classifications of “not normal,” “behavioral problems,” and “learning disabled,” by school
authorities, and of motion coordination problems. There was also a positive relationship
between an elevated total craniosacral motion restriction score and a history of an
obstetrically complicated delivery. The total quantitative craniosacral motion restriction
35
score was most positively related to those children presenting with multiple problems.
Developmental dyslexia. Evidence
for a subgroup with a reversal of
cerebral asymmetry, Hier DB,
LeMay M, Rosenberger PB, Perlo
VP.
Arch Neurol. 1978 Feb;35(2):90-2.
Abstract: The computerized brain tomograms of 24 patients with developmental dyslexia
were analyzed for cerebral asymmetry. Ten patients showed a reversal of the pattern of
asymmetry regularly observed in normal right-handed individuals so that the right
parietooccipital region was wider than the left. The ten dyslexic patients with this reversal
of cerebral asymmetry had a lower mean verbal IQ than the other 14 dyslexic patients in
this study. The reversal of cerebral asymmetry that occurred in ten of the dyslexic patients
may result in language lateralization to a cerebral hemisphere that is structurally less suited
to support language function and thus act as a risk factor for the development of reading
disability.
Asymmetries of the skull and
J Neurol Sci. 1977 Jun;32(2):243-53.
handedness. Phrenology revisited,
Abstract: Some of the asymmetries noted in cerebral computerized transaxial tomography
LeMay M.
(CTT) studies are reflected in the shape of the skull resulting most often in backward
protrusion of the occipital bone on the left and a less striking forward protrusion of the right
frontal bone. Asymmetries are less marked in left-handed individuals but the opposite
features, i.e. forward protrusion of the left frontal bone and posterior protrusion of the right
occipital bone, are more frequent in left handers than in right handers.
"Learning Difficulties of Children Journal of the American Osteopathic Association, Sept 1976; 76: 46-61.
Viewed in the Light of the
Osteopathic Concept", Frymann, Children between 18 months and 12 years of age with and without recognized neurologic
deficits were studied at the Osteopathic Center for Children. Their response to 6 to 12
Viola M.
osteopathic manipulative treatments directed to all areas of impaired inherent physiologic
motion was estimated from changes in three sensory and three motor areas of performance.
Houle's Profile of Development was used to compare neurologic with chronologic age and
rate of development, and scores were age-adjusted. Results in children after treatment were
compared with those following a waiting period without treatment. Neurologic
performance significantly improved after treatment in children with diagnosed neurologic
problems and to a lesser degree in children with medical or structural diagnoses. The
advances in neurologic development continued over a several months' interval. The results
support the use of manipulative treatment as part of pediatric integrative healthcare.
"Structural Normalization in
Infants and Children with
Particular Reference to
Disturbances of the Central
Nervous System", Woods, R.
Journal of the American Osteopathic Association, May 1973; 72: 903-908.
"Relation of Disturbances of
Craniosacral Mechanisms to
Symptomatology of the Newborn,
Study of 1,250 Infants", Frymann,
Viola M.
Journal of the American Osteopathic Association, June 1966; 65: 10591075.
Abstract: The reason why there are “bent twigs” and why improvements that can be made
in management of the mother both before and during delivery for preventing some of the
deformities of the head of the neonate are discussed. Methods of examining the newborn
infant so that early help can be given if needed are considered. Signs in the older infant that
point to the need for structural normalization are discussed, and case histories
substantiating both the need for and the method of help are presented. Treatment is best
begun with the maternal pelvis before delivery. Cranial manipulation is not a replacement
for other therapies, but it can be a very effective additional therapy.
Abstract: This study explores the possibility of a relation between symptomatology in
newborn infants and anatomic-physiologic disturbances of the craniosacral mechanism. The
primary respiratory mechanism hypothesis postulates a rhythmic cranial motion, palpable
externally, that is the combined effect of the inherent motility of the central nervous system,
36
fluctuation of the cerebrospinal fluid, the reciprocal tension mechanism of the dural
membranes and their folds, and articular mobility of the cranial bones and of the sacrum
between the ilia. Labor apparently has a traumatic effect on the craniosacral mechanism in
some circumstances. Strain patterns within the developmental parts of the occiput appear
significant in producing nervous symptoms. Flexion strain at the sphenobasilar symphysis,
sacral extension strain, and compression of the sphenobasilar symphysis were noted in
nervous infants. A significant relation is suggested between torsion strain of the
sphenobasilar symphysis with restriction in temporal mobility and respiratory and
circulatory symptoms.
Physical findings related to
Journal of the American Osteopathic Association, Aug 1961;60
psychiatric disorders, Woods JM,
Drs. Woods used manual palpation techniques to evaluate 102 psychiatric patients and 62
Woods RM
normal persons. The average rate of CRI in the 62 normal persons was 12.47 cycles per
minute. In the 102 psychiatric patients the average rate was 6.7 cycles per minute. Two
patients who had received frontal lobotomies were also evaluated. These frontal lobotomy
patients presented with CRI rates of 4 cycles per minute.
The role of binocular stress in the Am J Optometry & Arch Am Acad Optometry, Nov. 1961
post-whiplash syndrome, Roy, R.
Electromyographic evidence for
ocular muscle proprioception in
man, Breinin, GM.
Archives of Ophthalmology, 1957;57:176-180
In this study, eye motion and position are factors shown as integrated with proprioceptors
throughout the body, as well as those of the vestibular apparatus and head-on-neck reflexes.
In applied kinesiology chiropractic methodology, a means for testing the integration of the
muscles in the body with the visual reflexes has been termed ocular lock. The ocular lock
phenomenon is theorized to be a consequence, most frequently, to cranial faults. There has
been some substantiation for this premise, which demonstrates the possible effects of dural
tension on the cranial nerves.
THE T.M.J. AND THE STOMATOGNATHIC
SYSTEM
"Applied kinesiology" in medicine Wien Med Wochenschr. 2005 Feb;155(3-4):59-64.
and dentistry--a critical review,
Abstract: The "Applied Kinesiology" evolved in the USA is increasingly being used in
Tschernitschek H, Fink M.
Central Europe. In this review the development of the method and its practical application
in medicine and in dentistry are elucidated. Furthermore the propagation of the method by
the International College of Applied Kinesiology (= ICAK) and the "Touch for Health"
(=TFH) is described. School medicine's criticism of "Applied Kinesiology" as well as the
methodological replies from "Applied Kinesiologists" are outlined. It is important to realise
that there is to date a lack of evidence for the effectiveness, validity and reliability of
"Applied Kinesiology". The following requirements are thus vital: "Applied Kinesiologists"
must develop clear criteria for single subgroups of "Applied Kinesiology", prove the
effectiveness of their methods, and explain their findings in agreement with current medical
knowledge.
Comment: The ICAK-D (Deutschland) has 248 members who are practicing dentists. The
research activities of the ICAK-USA and ICAK-International are now being presented to
the public and scientific community at large. The requirements desired by the authors of
this review are being accomplished by the concerted efforts of the ICAK.
37
Assessing the Need for Dental –
Chiropractic TMJ CoManagement: The Development
of a Prediction Instrument, Blum
CL, Globe G.
Journal of Chiropractic Education, Sum 2005;19(2).
Abstract: Historically the evolution of interdisciplinary care of temporomandibular joint
(TMJ) began in the last 20th century. It may be that for some proportion of patients who
eventually develop a full-blown TMJ disorder, there is an adaptive stage whereby the
related musculature in the cervical spine and other posturally related muscles may be able
to accommodate so as to mitigate TMJ restriction or crepitus. The challenge for dentists,
planning to treat a patient with TMD, remains a guessing game as they continue unaided in
attempting to determine whether or not a patient would prophylactically benefit from
chiropractic co-treatment in order to prevent the onset or minimize the effect of
musculoskeletal symptoms secondary to dental TMD intervention. The purpose of this
paper is to help begin the process of developing an assessment tool for dentists to assist
them in determining when a patient might not be able to easily adapt to related postural
changes that may occur secondary to dental modifications of occlusion or TMJ balancing.
Qualitative Assessment of Risk Factors: In-depth interviews were conducted with groups
of dentists specializing in the treatment and the consistent request from the vast majority
was the need for a tool to guide them in determining which patient’s would best benefit
from chiropractic co-treatment. Development Of A Predictive Tool: Based on the
preliminary interviews and a review of existing, valid and reliable measures, a preliminary
assessment tool that measures the following five domains was developed; (1)
musculoskeletal manifestations (2) the patient’s perception of pain, (3) somaticization of
psychological stress, (4) physiological reserves to deal with stress and (5) the patient’s selfreported quality of life. Preliminarily Selected Instruments: The preliminary assessment
tool will be composed of three instruments:. (1) A general questionnaire which will address
the patient’s physiological reserve, level of pain tolerance, level of psychological health and
their fear avoidance behavior. (2) The general symptom survey for musculoskeletal
dysfunction determines if the patient has had a history or is currently suffering from
cervical (headaches, neck, shoulder, and hand pain) or locomotive or balance (lower back,
knee, or foot pain) dysfunction(s). (3) The functional evaluation form tests proprioceptive
abilities, static and dynamic postural balance tests and cervical ranges of motion.
Discussion: The interviewed dental professionals observed that posture can be a
determinant of occlusion functionality outcomes in some of their patients. They have
identified a need for an assessment instrument that would help them to identify patients
who may be at risk so that referral could be made before the initiation of occlusion
modification. The goal of the assessment form, which includes functional analysis tests, is
to help determine which “appropriate situations” or conditions are best for referral for
chiropractic care.
CONCLUSION
While the selected assessment instruments were not originally developed or validated for
their predictive capabilities, they are posited to measure health domains that may have
some transferability to measuring predictive factors associated with the development of
musculoskeletal reactions secondary to dental TMJ treatment. As new data becomes
available, this instrument will be modified to reflect improved understanding of predictive
elements. Concomitant with the development of a predictive assessment tool is the process
goal of expanding interdisciplinary dialogue, which may help lead to standardization of
TMJ dysfunction terminology and a “common language.” A starting point is needed and a
reasonable attempt has been made to begin the daunting process of developing an
instrument that would help inform dentists as to which patients may be likely to become
symptomatic to peripheral musculoskeletal regions secondary to occlusion modification.
The effect of condyle fossa
relationships on head posture,
Olmos SR, Kritz-Silverstein D,
Cranio. 2005 Jan;23(1):48-52.
Abstract: Although it is commonly accepted that there is an interrelationship between the
temporomandibular joint (TMJ) and head posture, few, if any, previous studies have
38
Halligan W, Silverstein ST.
quantified this effect. The purpose of this study is to quantify the effect of a change in the
condyle fossa relationship of symptomatic temporomandibular joints on head posture.
Charts of 51 patients (N=10 men and N=41 women) with symptomatic TMJ pathology
were reviewed. The condyle fossa relationships were measured pre- and posttreatment
using sagittal corrected hypocycloidal tomography. The amount of slant between the
shoulder and external auditory meatus (EAM) was measured in pre- and posttreatment
photographs as an indicator of forward head posture; less slant indicates better posture.
Subjects ranged in age from 13-74 years (mean=43.1) and had been treated for an average
of 5 months. Comparisons with pre-treatment measures showed that after treatment, the
amount of retrodiskal space was significantly increased by an average of 1.67 mm on the
left side (t=-10.11, p<0.0001) and 1.92 mm on the right (t=-9.62, p<0.0001). Comparisons
also showed that after treatment, the amount of slant between the shoulder and EAM
decreased by 4.43 inches on average which was also significant (t=13.08, p<0.0001).
Improvement in the condyle fossa relationship was related to decreased forward head
posture. This suggests that optimizing mandibular condyle position should be considered in
the management of forward head posture (adaptive posture).
Chiropractic and Dentistry in the
21st Century, Blum CL.
The Journal of Craniomandibular Practice, Jan 2004; 22(1): 1-3.
Abstract: As interdisciplinary healthcare matures, understanding that patient care should
ultimately be our focus, hopefully differences can be put aside in light of our common
goal. Within the cranial manipulative field mutual research cooperation between
chiropractors, osteopaths, and physical therapists will hopefully be imminent in the 21st
Century. This is presently happening with the multi-divisions of dentistry as relating to the
field of craniomandibular/temporomandibular dysfunction (TMD/CMD) and conditions
affecting condylar positions, functional orthodontic care, and the relationship of occlusion
to the stomatognathic system and posture. The best way for us all to proceed is with an
open mind and heart and willingness to learn and work together.
Comorbidity of internal
derangement of the
temporomandibular joint and
silent dysfunction of the cervical
spine, Stiesch-Scholz M, Fink M,
Tschernitschek H.
J Oral Rehabil. 2003 Apr;30(4):386-91.
Abstract: The aim of this evaluation was to examine correlations between internal
derangement of the temporomandibular joint (TMJ) and cervical spine disorder (CSD). A
prospective controlled clinical study was carried out. Thirty patients with signs and
symptoms of internal derangement but without any subjective neck problems and 30 ageand gender-matched control subjects without signs and symptoms of internal derangement
were examined. The investigation of the temporomandibular system was carried out using a
'Craniomandibular Index'. Afterwards an examiner-blinded manual medical investigation of
the craniocervical system was performed. This included muscle palpation of the cervical
spine and shoulder girdle as well as passive movement tests of the cervical spine, to detect
restrictions in the range of movement as well as segmental intervertebral dysfunction. The
internal derangement of the TMJ was significantly associated with 'silent' CSD (t-test, P <
0.05). Patients with raised muscle tenderness of the temporomandibular system exhibited
significantly more often pain on pressure of the neck muscles than patients without muscle
tenderness of the temporomandibular system (t-test, P < 0.05). As a result of the present
study, for patients with internal derangement of the TMJ an additional examination of the
craniocervical system should be recommended.
Comment: In AK there is recognition of the stomatognathic system, and of the importance
of the cervical spine to the treatment of the TMJ. The stomatognathic system involves the
complex interaction between structures and functions of the head and neck.
Evidence of an influence of
J Oral Rehabil. 2003 Jan;30(1):34-40.
asymmetrical occlusal
interferences on the activity of the Abstract: To investigate the hypothesis of a functional coupling between occlusion and
neck muscles, the immediate effect of asymmetrical occlusal interferences on the pattern of
sternocleidomastoid muscle,
39
Ferrario VF, Sforza C, Dellavia C, contraction of the sternocleidomastoid muscles (SCM) during maximum voluntary clench
(MVC) was analysed in 30 healthy subjects. All subjects had a complete and sound
Tartaglia GM.
permanent dentition, without temporomandibular joint (TMJ) and craniocervical disorders.
A 5-s surface electromyogram (EMG) examination of the SCM was performed during (1)
MVC in intercuspal position and (2) MVC with a single 200-microm occlusal interference
alternatively positioned on teeth 16, 13, 23, 26. All subjects had a symmetrical EMG
activity during MVC in intercuspal position. For each subject, SCM potentials were
standardized as percentage of the mean potentials recorded during the MVC on natural
dentition and the EMG waves of left- and right-side muscles were compared by computing
the relevant percentage overlapping coefficient (POC). For each subject, the best and the
worst POCs computed during the four MVC tests with occlusal interferences were found
and the percentage difference between them was calculated. In the four MVC tests with
occlusal interferences, SCM symmetry was very different from that recorded during MVC
on natural dentition. The difference between the best and worst POCs computed within
each subject was very variable, ranging from 1.52 to 41.57%. In conclusion, when young
healthy subjects with a normal occlusion clench on an asymmetrical occlusal
interference, they have an altered left-right side pattern of contraction of their SCM.
In almost all subjects, a previously symmetrical pattern became asymmetrical.
Chiropractic care of a patient with J Manipulative Physiol Ther. 2002 Jan;25(1):63-70.
temporomandibular disorder and
OBJECTIVE: To describe the chiropractic care of a patient with cervical subluxation and
atlas subluxation, Alcantara J,
Plaugher G, Klemp DD, Salem C. complaints associated with temporomandibular disorder. CLINICAL FEATURES: A 41-
year-old woman had bilateral ear pain, tinnitus, vertigo, altered or decreased hearing acuity,
and headaches. She had a history of ear infections, which had been treated with prescription
antibiotics. Her complaints were attributed to a diagnosis of temporomandibular joint
syndrome and had been treated unsuccessfully by a medical doctor and dentist.
INTERVENTION AND OUTCOME: High-velocity, low-amplitude adjustments (i.e.,
Gonstead technique) were applied to findings of atlas subluxation. The patient's symptoms
improved and eventually resolved after 9 visits. CONCLUSION: The chiropractic care of
a patient with temporomandibular disorder, headaches, and subluxation is described.
Clinical issues relevant to the care of patients with this disorder are also discussed.
Differences in the fatigue of
masticatory and neck muscles
between male and female, Ueda
HM, Kato M, Saifuddin M, Tabe
H, Yamaguchi K, Tanne K.
J Oral Rehabil. 2002 Jun;29(6):575-82.
Relationship between dental
Cranio. 2000 Apr;18(2):127-34.
Abstract: The purpose of this study was to investigate the nature of fatigue and recovery of
masticatory and neck muscles and the differences between sexes in normal subjects during
experimentally induced loading. Subjects consisted of eight males (mean age: 27.6 years)
and eight females (mean age: 24.2 years) selected from the volunteers in the Faculty of
Dentistry, Hiroshima University. The inclusion criteria for the subjects were as follows: (1)
good general health, (2) normal horizontal and vertical skeletal relationships, (3) no severe
malocclusions and (4) no complaints of temporomandibular disorders. Each subject was
requested to bite an occlusal-force meter with 98, 196 and 294 N forces on the first molar
region per side for 45 s. Activities of the masseter and sternocleidomastoid (SCM) muscles
were recorded during these performances. Fatigue and recovery ratios were calculated with
mean power frequency of power spectrum using a fast Fourier transform algorithm.
Significant differences in the fatigue ratios between both sexes were found for the masseter
muscle with 98, 196 and 294 N bite forces. Meanwhile, the SCM presented a significant
difference between both sexes only at 98 N biting. Significant differences in the recovery
ratios between both sexes were more prominent in the masseter muscle than in the SCM.
These results suggest that the differences in muscle endurance between sexes may
have some association with higher susceptibility of craniomandibular disorders in
females than in males.
40
occlusion and posture, Milani RS,
Abstract: The purpose of this study is to show the effects of dental occlusion on postural
De Periere DD, Lapeyre L,
position. Thirty subjects were divided into two groups: an experimental group who wore
Pourreyron L.
mandibular orthopedic repositioning appliances (MORA) and a control group who wore no
oral device. All of the subjects underwent the same Fukuda-Unterberger experimental
stepping test to check their postural attitude. Any deviation of the subject during the test
from his initial position was analyzed. The results seemed to confirm that altering dental
occlusion by wearing an oral appliance could induce some fluctuations in dynamic postural
attitude. The phenomenon occurs after prolonged wearing of a MORA. Feedback effects
are gradual after removing the mandibular splint.
Dental occlusion modifies gaze
Neurosci Lett. 2000 Nov 3;293(3):203-6.
and posture stabilization in human
Abstract: Repercussion of dental occlusion was tested upon postural and gaze stabilization,
subjects, Gangloff P, Louis JP,
the latter with a visuo-motor task evaluated by shooting performances. Eighteen permit
Perrin PP.
holders shooters and 18 controls were enrolled in this study. Postural control was evaluated
in both groups according to four mandibular positions imposed by interocclusal splints: (i)
intercuspal occlusion (IO), (ii) centric relation (CR), (iii) physiological side lateral
occlusion and (iv) controlateral occlusion, in order to appreciate the impact of the splints
upon orthostatism. Postural control and gaze stabilization quality decreased, from the best
to the worst, with splints in CR, IO and lateral occlusion. In shooters, the improvement in
postural control was parallel to superior shooting performance. A repercussion of dental
occlusion upon proprioception and visual stabilization is suggested by these data.
Comment: Central to the concept of applied kinesiology chiropractic evaluation and
treatment is the consideration that the senses of seeing, hearing, smelling, tasting, feeling,
and balance are not simple, specific sensations; rather they are sensory systems closely
interrelated among themselves and intimately linked with motor functions. The dental
occlusion is part of the stomatognathic system, and exerts an influence upon the function of
the eyes and posture, and these two functions influence one another. In applied kinesiology
chiropractic methodology, a means for testing the integration of the TMJ and the other
muscles in the body with the visual reflexes has been termed ocular lock.
[Influence of body posture in the
prevalence of craniomandibular
dysfunction], Fuentes R,
Freesmeyer W, Henriquez J.
[Article in Spanish]
Relationship between dental
occlusion and visual focusing,
Sharifi Milani R, Deville de
Periere D, Micallef JP.
Rev Med Chil. 1999 Sep;127(9):1079-85.
BACKGROUND: Postural alterations of the shoulders, dorsal spine and hips could have
an influence on the development of craniomandibular dysfunctions. AIM: To study the
influence of body posture on the prevalence of craniomandibular dysfunction. SUBJECTS
AND METHODS: One hundred thirty six dental students and 41 patients assisting to the
temporomandibular joints (TMJ) clinic at the Freie Universitat at Berlin, were studied.
Masticator, cervical muscles, temporomandibular joints and occlusions were clinically
examined. The position of shoulders and hips was measured with the use of an
acromiopelvimeter. RESULTS: No relationship was found between postural alterations of
the hips and shoulders, articular noises and sensibility or pain while palpating the
temporomandibular joints. Among students, a relationship between postural alterations of
the shoulders and the sensibility or pain while palpating the TMJ, was observed. When all
muscles were considered, a significant relationship between asymmetric shoulders or hips
and muscular pain while palpating was observed among students. CONCLUSIONS: Some
symptoms, especially muscular sensibility is more pronounced in people with hip and
shoulder asymmetries. This relation is more pronounced in dental students than in patients.
Cranio. 1998 Apr;16(2):109-18.
Abstract: The purpose of this study is to show the effects of dental occlusion on visual
focusing. Thirty subjects were divided into two groups: an experimental group who had
worn mandibular orthopedic repositioning appliances and a control group who had not
41
worn any oral device. All of the subjects underwent the same visual focusing tests with a
Maddox rod and the Berens prismatic bars, from over five meters to 30 centimeters. The
results seemed to confirm that the alteration of dental occlusion can induce some
fluctuations in visual focusing. The phenomenon occurs after wearing a MORA
(Mandibular Orthopedic Repositioning Appliance) for a while. Feedback effects are gradual
after removing the mandibular splint.
Complementary Therapies
Chiropractic, Howat J, Varley P
Dentistry Monthly Feb 1998; 4(2): 16-25.
Abstract: The interdisciplinary collaboration between a dentist / orthodontist and a
chiropractic craniopathy indicates that with a good working relationship between the two
disciplines the required results can be achieved. The aetiology of a problem can be defined
and diagnosed early so that the correct treatment can be applied. A descending major stress
area is a primary dental problem requiring a chiropractic backup to ensure a return to
biomechanical stability. An ascending major stress area is a primary chiropractic problem
requiring dental backup to ensure that premature contacts of teeth, loss of dentition, and
incisor interference can be monitored and corrected while the sacroiliac lesion is stabilized.
Chiropractic/dental cotreatment of
lumbosacral pain with
temporomandibular joint
involvement, Chinappi AS Jr,
Getzoff H.
J Manipulative Physiol Ther. 1996 Nov-Dec;19(9):607-12.
Body posture photographs as a
diagnostic aid for musculoskeletal
disorders related to
temporomandibular disorders
(TMD), Zonnenberg AJ, Van
Maanen CJ, Oostendorp RA,
Elvers JW.
Cranio. 1996 Jul;14(3):225-32.
OBJECTIVE: To demonstrate the concept of integrated dental orthopedic and craniochiropractic care for treating structural disorders of the jaw, neck and spine. CLINICAL
FEATURES: A 33-yr-old woman sought chiropractic care for centralized lumbosacral
pain that had persisted for 3 months. She exhibited pain on lumbopelvic extension and
marked limitations on lumbopelvic flexion. In addition, cervical rotation and cranial sutural
motion in the right malar maxillary suture were restricted. The left temporal mandibular
joint also was limited in translation. Based on initial chiropractic sacro-occipital technique,
she was diagnosed with Category III lumbopelvic dysfunction. X-ray examination revealed
a lumbosacral angle of 39 degrees, with sacral displacement posterior to the weight-bearing
line. In conjunction with the beginning of chiropractic care, she was encouraged to seek
dental-orthodontic evaluation. After 30 months of chiropractic treatment, she was still
experiencing some lower back pain and limited improvement. She finally agreed to see the
orthodontist. Orthodontic evaluation revealed a Class I malocclusion with significant loss
of vertical dimension, characteristic of bilateral posterior bite collapse. INTERVENTION
AND OUTCOME: Initial orthodontic treatment began in September 1991 and was
followed by restorative dentistry to replace the missing teeth. This cotreatment approach,
which integrated dental orthopedic and craniochiropractic care, ameliorated the pain and
improved head, jaw, neck and back function. CONCLUSION: The position of the jaw,
head and vertebral column, including the lumbar region, are intricately linked. Orthodontic
treatment improved the position of the mandible, which in turn enabled the body to respond
to chiropractic care.
Abstract: The purpose of this study was to test the hypothesis that body posture could be
an etiologic factor in patients with temporomandibular disorders. "Faculty" body posture
has been considered to be an initiating and perpetuating etiologic factor in some
temporomandibular disorders (TMD). Although in patients with temporomandibular
disorders a significant craniocervical dysfunction has been established, a causal relationship
between posture and TMD has not yet been proved. Two samples of 40 subjects each were
selected, age and gender matched. The experimental group consisted of 40 patients, who
were not previously treated for temporomandibular dysfunction. TMD of these patients was
diagnosed on the basis of a questionnaire and a thorough intra- and extraoral examination.
The clinical symptoms of TMD were confirmed with transcranial x-rays and the condylar
tracings of the performed axiography. A clinical examination was done to confirm the good
42
health of the control group. In addition, symptoms of craniocervical dysfunction within the
experimental group were evaluated to make a proper referral to a physical therapist. Four
photographs of the orthostatic posture were taken. In accordance with anthropometric
guidelines, the following anatomical landmarks were palpated and applied on the skin with
a dark lipstick on forehand: both acromiones of the scapula and the anterior (ASIS) and
posterior superior iliac spine (PSIS). Statistical testing was performed to confirm the data
fit a normal distribution. The differences between the experimental group and the control
group were tested with Student's two sample T-test. Within the experimental group, a
significant correlation existed between the shoulder line and the pelvis line, on the frontal
as well as on the dorsal photograph. The results suggest a somatic basis for the observed
postural imbalances in patients with temporomandibular disorders. The results,
however, must be interpreted with reservation.
Chiropr J Aust 1996; 26:125-9.
TMJ Pain and Chiropractic
Adjustment—A Pilot Study,
O’Reilly A, Pollard H
Objective: This project investigates the relationship between spinal adjustment and
temporomandibular joint (TMJ) pain. Design: Controlled pilot trial. Setting: Private
chiropractic practice. Patients: Twelve (12) patients assessed by dentists in private practice
as having TMJ syndrome, randomly assigned to a chiropractic treatment or a placebo
treatment (remote trigger point therapy) group. Intervention: Patients in the chiropractic
group received weekly chiropractic adjustments for six weeks to correct cervical spine
vertebral dysfunctions, and controls received weekly trigger point therapy to cervicothoracic muscles for six weeks. Main Outcome Measure: McGill Pain Questionnaire
administered before and after the trial. Results: Both groups demonstrated similar changes.
Due to greater than anticipated reduction in pain in the trigger point therapy (control)
group, the results were statistically the same using a Mann-Whitney non-parametric test (p
= 0.9025), however a subjective, graphical comparison of results suggests that spinal
adjustment may have some superiority over the trigger point method. Conclusions: Further
investigation is warranted, but future studies should involve a larger sample, sham
treatment other than cervico-thoracic trigger point therapy, and a pain assessment tool
specifically designed for TMJ symptoms.
The relationship between forward J Orofac Pain. 1995 Spring;9(2):161-7.
head posture and
Abstract: This study investigated the relationship between forward head posture and
temporomandibular disorders,
Lee WY, Okeson JP, Lindroth J. temporomandibular disorder symptoms. Thirty-three temporomandibular disorder patients
with predominant complaints of masticatory muscle pain were compared with an age- and
gender-matched control group. Head position was measured from photographs taken with a
plumb line drawn from the ceiling to the lateral malleolus of the ankle and with a horizontal
plane that was perpendicular to the plumb line and that passed through the spinous process
of the seventh cervical vertebra. The distances from the plumb line to the ear, to the seventh
vertebra, and to the shoulder were measured. Two angles were also measured: (1) earseventh cervical vertebra-horizontal plane and (2) eye-ear-seventh cervical vertebra. The
only measurement that revealed a statistically significant difference was angle ear-seventh
cervical vertebra-horizontal plane. This angle was smaller in the patients with
temporomandibular disorders than in the control subjects. In other words, when evaluating
the ear position with respect to the seventh cervical vertebra, the head was positioned more
forward in the group with temporomandibular disorders than in the control group (P < .05).
Chiropractic manipulation of
anteriorly displaced
temporomandibular disc with
adhesion, Saghafi D, Curl DD.
J Manipulative Physiol Ther. 1995 Feb;18(2):98-104.
OBJECTIVE: This AB, single-subject case study was conducted to investigate the
capability of chiropractic manipulation of the temporomandibular joint (TMJ) in treating
unilateral anterior displacement of the articular disc with adhesion to the articular
eminence. A specific joint manipulation was designed to reduce the anteriorly displaced
43
and adhered TMJ disc. CLINICAL FEATURES: A 21-yr-old woman suffered from a four
year history of right-sided temporomandibular joint pain and clicking, with limitation of
mandibular opening. The patient reported previous unsuccessful treatments for her
condition. An exhaustive history, a complete review of systems and a physical examination
(including, but not limited to, eyes, ears, nose, throat and motor, sensory and reflex
neurological tests) were obtained. Relevant or contributory findings are extracted for this
article. A clinical diagnosis of left-sided anteriorly displaced TMJ disc with adhesion to the
articular eminence was made. INTERVENTION AND OUTCOME: Patient's pain level,
presence of joint clicking upon mandibular opening and the amount of mandibular opening
were used as outcome measures for capability of treatments. An AB, single-subject study
was used where A was the baseline period and B the therapeutic intervention period. The
patient was treated twice a week for a total of 19 visits. During the baseline period no
treatment was given to the TMJ (3 visits) where the patient received cervical manipulation
alone. During the experimental period the patient received both cervical spine manipulation
and a specific manipulation to the left mandible. There were no physical therapeutic
modalities applied to the jaw. The specific TMJ manipulation used requires a very lowamplitude high velocity thrust parallel to the slope of the articular eminence. The results of
this study show mandibular opening distance was returned to normal in addition to the
abolition of the patient's TMJ pain and clicking. During the three baseline visits mandibular
opening showed no significant change, with an average of 25.3 mm (range 25-26 mm).
There was also no change in the patient's TMJ pain or clicking during this baseline period.
The patient's TMJ clicking was absent following the third treatment and the patient reported
significant subjective pain relief as well. Temporomandibular pain was again reported
during the fifth, sixth and seventh post-treatment visits due to exacerbations caused by daily
activities. There was no pain reported from the beginning of the eighth post-treatment visit
to the end of the study. CONCLUSION: The findings of this study show this specific
manipulation of the TMJ may be appropriate for the conservative treatment of adhered
anteriorly dislocated disc.
Influence of variation in jaw
posture on sternocleidomastoid
and trapezius electromyographic
activity, Zuniga C, Miralles R,
Mena B, Montt R, Moran D,
Santander H, Moya H.
Cranio. 1995 Jul;13(3):157-62.
Temporomandibular disorder
associated with sacroiliac sprain,
Gregory TM.
J Manipulative Physiol Ther. 1993 May;16(4):256-65.
Abstract: This study was conducted in order to determine the influence of variation in the
occlusal contacts on electromyographic (EMG) cervical activity in 20 patients with
myogenic cranio-cervical-mandibular dysfunction. EMG recordings during maximal
voluntary clenching were performed by placing surface electrodes on the left
sternocleidomastoid and upper trapezius muscles in the following conditions: intercuspal
position; edge to edge left laterotrusive contacts (ipsilateral); edge to edge right
laterotrusive contacts (contralateral); edge to edge protrusive contacts; and retrusive
occlusal contacts. A significant higher EMG activity was recorded in both muscles during
maximal voluntary clenching in retrusive occlusal contact position, whereas no significant
differences in EMG activity were observed between intercuspal position, ipsilateral,
contralateral and protrusive contact positions. The EMG pattern observed suggests that a
more frequent intensity and duration of tooth clenching in retrusive occlusal contact
position could result in more clinical symptomatology in these cervical muscles in patients
with myogenic cranio-cervical-mandibular dysfunction.
Abstract: A case of the external derangement-type temporomandibular disorder (TMD),
temporarily relieved following chiropractic sacro-occipital technique (SOT) treatment,
including SOT category II blocking to reduce sacroiliac sprain, is presented. Symptom
exacerbation midway through the course of treatment followed additional dental work;
symptom remission followed additional SOT treatment. Freedom from symptoms is
maintained with a 3-wk treatment interval. There appears to be a cause-effect relationship
between external derangement-type TMD and sacroiliac sprain. Concurrent, coordinated
44
chiropractic and dental treatments may improve the success rate of TMD resolution.
Birth Induced TMJ Dysfunction: Proceedings Of The National Conference On Chiropractic. 1993 Oct: 18The Most Common Cause of
22.
Breastfeeding Difficulties, Arcadi
Abstract: In a clinical setting, 1,000 newborns were observed and treated (ages hour to 21
V,
days), for failure and/or difficulty with breast-feeding. In 800 or 80%, birth induced
Temporomandibular Joint Dysfunction was found to be the cause. In all cases, the babies
were treated with chiropractic cranial and spinal adjustments, with excellent results in 99%
of the cases. This paper discusses the basic clinical findings, related newborn discomforts,
and associated symptomatology involving other symptoms.
Alteration of vertical dimension
and its effect on head and neck
posture, Urbanowicz M.
Cranio. 1991 Apr;9(2):174-9.
Postural differences between
asymptomatic men and women
and craniofacial pain patients,
Braun BL.
Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.
Nerve entrapment in the lateral
pterygoid muscle, Loughner BA,
Larkin LH, Mahan PE.
Oral Surg Oral Med Oral Pathol. 1990 Mar;69(3):299-306.
[The relation between the
Nihon Hotetsu Shika Gakkai Zasshi. 1988 Dec;32(6):1233-40.
Abstract: Previous research has shown a relationship between head posture and rest
position of the mandible. Should this relationship really be an interrelationship? Does a
change in mandibular posture alone also alter head and neck posture? The purpose of this
article is to demonstrate how a change in mandibular posture, specifically an increase in
vertical dimension, contributes to craniovertical extension leading to suboccipital
compression and upsetting the postural balance between the head and neck. A model of
physiologic equilibrium is presented for the craniomandibular articulation.
Abstract: A forward head position and rounded shoulders have been implicated in the
development or perpetuation of craniomandibular disorders. Since women seek treatment
for these problems more frequently than men, postural differences may account for the
increased incidence of symptoms in women. The purposes of this study were (1) to
compare the sagittal head and shoulder posture of asymptomatic men and women and (2) to
compare the posture of asymptomatic and symptomatic women to determine differences in
sagittal plane posture. Subjects were 20 asymptomatic men and women volunteers and nine
consecutive women patients presenting for evaluation and treatment of craniomandibular
pain. The subjects were compared using a valid, reliable, computer-assisted slide digitizing
system called the Postural Analysis Digitizing System (PADS). Asymptomatic men and
women did not differ in the postural characteristics associated with craniomandibular
disorders. Sagittal posture does not appear to be a gender-related factor in these disorders.
Symptomatic women, however, do display these postural characteristics to a greater extent
than asymptomatic women. Evaluation and treatment of postural dysfunction should be
included in the management of these patients.
Abstract: The posterior trunk of the mandibular division of the trigeminal nerve normally
descends deep to the lateral pterygoid muscle. In three of 52 dissections the three main
branches of the posterior trunk (lingual, inferior alveolar, and auriculotemporal nerves)
were observed to pass through the medial fibers of the lower belly of the lateral pterygoid
muscle. The mylohyoid and anterior deep temporal nerves also were observed to pass
through the lateral pterygoid muscle in other specimens. These nerve entrapments in the
infratemporal fossa provide new information concerning the anatomic and clinical
relationships between the mandibular nerve and the lateral pterygoid muscle. These
findings support the hypothesis that a spastic condition of the lateral pterygoid muscle may
be causally related to compression of an entrapped nerve that lead to numbness, pain, or
both in the respective areas of nerve distribution.
45
condition of the stomatognathic
system and the condition of whole
body. I-1. Concerning the effects
of a change of occlusion on
upright posture especially on the
locus of the body's gravity center],
Miyata T, Satoh T, Shimada A,
Umetsu N, Takeda T, Ishigami K,
Ohki K.
[Article in Japanese]
The Lateral Pterygoid Muscle: Its Dig Chiro Econ, Jan/Feb 1987;29(4)120-22.
Significance in Craniomandibular
Abstract: The lateral (external) pterygoid is a muscle of mastication that is extremely
Dysfunction, Sarkin JM
important in cranio-mandibular dysfunction. When the lateral pterygoid is shortened and
hypertonic, it can produce internal derangement of the temporomandibular joint (TMJ) joint
noises, limited and deviated mouth opening, referred myofascial trigger point pain to the
TMJ and maxilla, and the cranial primary respiratory dysfunction. Through careful
consultation and examination, the problematic lateral pterygoid can be uncovered and
subsequently treated and managed. Resolution of lateral pterygoid dysfunction is crucial in
establishing optimal craniomandibular function.
Craniopathy and dentistry, Denton Basal Facts 1986;8(4):181-202
DG
Abstract: At this particular time, many health professions are trying to work together,
using all avenues at their disposal, for the establishment of normal health. Dentists have
long been leaders in many areas of scientific research in the health field: acupuncture,
nutrition, hypnosis, biofeedback, etc. In fact, general dentistry has always been in the
forefront of the health field, but all too often dentists consider themselves merely
technicians rather than doctors. Concurrent with the revolution of dentistry, craniopathic
physicians have proven that temporal mandibular motion, proper equilibration of the dental
arches and tooth placement, are absolutely necessary for proper function.
Relations between occlusal
interference and jaw muscle
activities in response to changes in
head position, Funakoshi, M.,
Fujita, N., Takenana, S.
J Dent Res, 1976;35:684-690
Abstract: The jaw muscles responded to changes in the head position. Electromyographic
responses to head positions were classified as either of two types--balanced and
unbalanced. The balanced type of electromyographic responses of participants with normal
occlusion changed to the unbalanced type after being set with an overlay to make a
premature contact artificially, and returned to the balanced type after removal of the
overlay. The unbalanced type of electromyographic response of participants with occlusal
interference turned to the balanced type after occlusal adjustment.
Comment: In AK examination and treatment, the complexity of the TMJ apparatus is
appreciated. The TMJ is part of a complex system including the bones of the skull and
cervical spine, the mandible and hyoid bone, the related muscle attachments and other soft
tissues, and neurologic and vascular components. This complex is often referred to as the
stomatognathic system. The use of AK methods, especially challenge and therapy
localization, greatly assists the practitioner in finding concealed or hidden TMJ problems.
Neuromuscular control of
J Prosthet Dent, 1973;30:714-720
mandibular movements, Perry, C.
Muscular changes associated with J.A.D.A., 1957;54:644-653
temporomandibular joint
46
dysfunction, Perry, H.T., Jr.
Table 1: Cranial Manipulative Therapy
Characteristics of reports on clinical research and outcomes of cranial manipulative therapy
Cuthbert S.
Cuthbert S.
Lancaster DG, Crow WT.
Cuthbert S., Blum C
Cutler,M.J.Holland, B.S.;
Stupski, B.A.; Gamber,
R.G.; Smith, M.L.
Cuthbert S.
Pederick F.
Quezada D
Vallone S.
Nelson, K.E.; Sergueef,
N.; Glonek, T.
Fink M, Wahling K,
Stiesch-Scholz M,
Tschernitschek H.
Cuthbert S.
Sergueef, N.; Nelson,
K.E.; Glonek, T.
Blum CS
Blum, C.L.
Rivera-Martinez, S.,
Wells, M., Capobianco, J.
Cuthbert S.
Holtrop DP.
Funk, SL.
Hewitt EG.
Blum CL.
Motion Sickness Disorder: A Review, Treatment
Strategy, and Case Series Report
The Applied Kinesiology Research and
Literature Compendium
Osteopathic Manipulative Treatment of a 26Year-Old Woman With Bell's Palsy
Symptomatic Arnold-Chiari malformation and
cranial nerve dysfunction: a case study of
applied kinesiology cranial evaluation and
treatment
Cranial manipulation can alter sleep latency and
sympathetic nerve activity in humans: a pilot
study.
Applied Kinesiology and Proprioception
Cranial and Other Chiropractic Adjustments in
the Conservative Treatment of Chronic
Trigeminal Neuralgia: A Case Report
Chiropractic care of an infant with
plagiocephaly
Chiropractic Evaluation and Treatment of
Musculoskeletal Dysfunction in Infants
Demonstrating Difficulty Breastfeeding
Cranial Manipulation Induces Sequential
Changes in Blood Flow Velocity on Demand
The functional relationship between the
craniomandibular system, cervical spine, and the
sacroiliac joint: a preliminary investigation
Applied Kinesiology and Down Syndrome: a
Study of Fifteen Cases
Cranial manipulation induces sequential changes
in blood-flow velocity, on demand
The Compendium of SOT Peer Reviewed
Published Literature 1984-2000
Chiropractic Treatment of Mild Head Trauma: A
Case History
A retrospective study of cranial strain patterns in
patients with idiopathic Parkinson’s disease
An applied Kinesiology evaluation of facial
neuralgia: A case history of Bell’s palsy
Resolution of suckling intolerance in a 6-monthold chiropractic patient
Osteopathic Manipulative Treatment and Down
Syndrome
Chiropractic Care For Infants with
Dysfunctional Nursing: A Case Series
Cranial Therapeutic Treatment of Down’s
J Chiro Med Spring 2006
The International Journal of Applied Kinesiology
and Kinesiologic Medicine Spring 2006;21:6-63
J Am Osteopath Assoc May 2006; 106(5):285-89.
J Manipulative Physiol Ther. 2005 May;28(4):e1-6.
Journal of Alternative and Complementary
Medicine 2005;11(1):103-8.
The International Journal of Applied Kinesiology
and Kinesiologic Medicine Fall 2005;20:12-15
Chiro J Aust, 2005; 35:9-15.
Journal of Clinical Chiropractic Pediatrics,
2004;6(1):342-8/
Journal of Clinical Chiropractic Pediatrics, 2004;
6(1):349-61.
The American Academy of Osteopathy Journal
2004;14(3):15-7.
Cranio. 2003 Jul;21(3):202-8.
The International Journal of Applied Kinesiology
and Kinesiologic Medicine, 2003;16:16-21
Journal of the American Osteopathic
Association 2003;103(8):380.
Journal of Vertebral Subluxation Research Nov
2002; 4(4);123-124]
Proceedings of the 2002 International Conference on
Spinal Manipulation. 2002
Journal of the American Osteopathic Association,
August 2002;102(8):417-422
The International Journal of Applied Kinesiology
and Kinesiologic Medicine Summer 2001:42-45
J Manipulative Physiol Ther. 2000 NovDec;23(9):615-8.
The American Academy of Osteopathy Journal
2000;10(2):36-7.
Journal of Clinical Chiropractic Pediatrics. 1999
May ; 4(1): 241-4.
Chiropractic Technique, May 1999; 11(2): 66-76.
47
Connelly DM, Rasmussen
SA
Van Loon M.
Syndrome
Spinal/Cranial Manipulative Therapy and
Tinnitus: A Case History
The effect of cranial adjusting on hypertension:
a case report
Colic With Projectile Vomiting: A Case Study
Pederick FO
A Kaminski-type evaluation of cranial adjusting
Chaitow L.
Ulrich, RG.
Review of aspects of cranio-sacral theory.
Osteopathic Manipulative Treatment of Bell's
Palsy
The Dental-Chiropractic Cotreatment of
Structural Disorders of the Jaw and
Temporomandibular Joint Dysfunction
Nasal specific technique as part of a chiropractic
approach to chronic sinusitis and sinus
headaches
Changes in neck electromyography associated
with meningeal noxious stimulation
A Preliminary Single Case Magnetic Resonance
Imaging Investigation into Maxillary FrontalParietal Manipulation and Its Short-Term Effect
upon the Intercranial Structures of an Adult
Human Brain
The prevalence of cranial dysfunction in
children with a history of otitis media from
kindergarten to third grade.
Cranial osteopathy and the infantile
craniopathies.
Kinematic imbalances due to suboccipital strain
Cranial suture manipulation in the treatment of
torticollis
Uterine Contractions Following Osteopathic
Cranial Manipulation - A Pilot Study
Postural differences between asymptomatic men
and women and craniofacial pain patients
Upper airway obstruction and craniofacial
morphology
Cranial therapeutic approach to cranial nerve
entrapment Part II: Cranial nerve VII.
An integrated approach to children with Down ts
Syndrome - a conference report.
States that cranial therapy is an effective form of
treatment for TMJ dysfunction. As such, it was
ruled that dentists in Colorado are allowed to use
cranial therapy for treatment in the scope of their
practice.
Cranial therapeutic approach to cranial nerve
entrapment Part I: Cranial nerves III, IV, and VI.
Spinal/cranial manipulative therapy and tinnitus:
a case history
An investigation into the efficacy of cranial
manipulation for cephalgia.
The effect of movement, stress and
Blum CL.
Chinappi AS, Getzoff H.
Folweiler DS, Lynch OT.
Hu JW, Vernon H,
Tatourian I.
Pick M.
Degenhardt BF, Kuchera
ML.
Manley P.
Biedermann H.
Bilkey WJ
Gitlin, R.; Wolf, D.
Braun BL.
Principato JJ.
Blum C.
Carruthers R.
The unanimous ruling of
the Appellate Court in
favor of W.M. Raemer,
D.D.S.,
Blum C.
Blum C
Whineray G.
Blum C.
Chiropractic Technique, Nov 1998;10(4):163-8.
Chiropractic Technique, Aug 1998;10(2):75-78
Journal Of Clinical Chiropractic Pediatrics. 1998
Aug; 3(1): 207-10.
Chiropractic Technique, Feb 1997;9(1): 1-15.
British Osteopathic Journal 1997:14-22
The American Academy of Osteopathy Journal
1997; 7(3):28-9.
Journal of Manipulative and Physiological
Therapeutics, Sep 1995; 18(7): 476-81.
J Manipulative Physiol Ther. 1995 Jan;18(1):38-41.
J Manipulative Physiol Ther. 1995 NovDec;18(9):577-81.
J Manipulative Physiol Ther. 1994;17(3)
Journal of the American Osteopathic Association
1994;94:754.
Journal of Naturopathic Medicine 1994;5(1):80-1.
J Man Med, 1992;31:92-95
J Man Med 1992;6:212-214.
Journal of the American Osteopathic Association
1992;92(9):1183.
Arch Phys Med Rehabil. 1991 Aug;72(9):653-6.
Otolaryngol Head Neck Surg. 1991 Jun;104(6):88190.
ACA J Chiropract 1990;27(7):108.
British Osteopathic Journal 1990. IV. 18-21
The Colorado Board of Medical Examiners vs. W.M.
Raemer, D.D.S. Court of Appeals, State of Colorado,
Case No. 87CA1589, March 22, 1990
ACA J Chiropract 1988;22(7):63-67.
Chiropractic Technique 1988;10(4):163-167
Journal of the New Zealand Register of Osteopaths
1987;1(1):10-11.
Int J Orthodontics 1987;25(1-2): 1-8
48
Coffin GS
Gillespie B.
mechanoelectric activity within the cranial
matrix
Asymmetry of the human head: clinical
observations
Dental Considerations of Craniosacral
Mechanism
Blum CL
Biodynamics of the Cranium: A Survey
Carlsson GE.
Long term effects of treatment of
craniomandibular disorders
The relation of the craniofacial bones to specific
somatic dysfunctions: a clinical study of the
effects of manipulation
The role of the Vth cranial nerve in the TMJ
syndrome
Examination of the cranial rhythm in longstanding coma and chronic neurologic cases
Efficacy of cranial sacral manipulation: the
physiological mechanism of the cranial sutures.
White WK, White JE,
Baldt G.
Retzlaff EW, Mitchell FL
Jr, Hussar C, Walsh J.
Upledger JE, Vredevoogd
JD.
Retzlaff E et al
Clin Pediatr. April 1986;25:230-232
J. Craniomandibular Pract. December 1985;3:38184.
The Journal of Craniomandibular Practice,
Mar/May 1985: 3(2):164-71.
Craniomandibular Pract. Sept 1985;3(4):337-42
Journal of the American Osteopathic Association
1985;85:603-604.
Anat Rec 1983;205:161A
Craniosacral Therapy. Eastland Press, Seattle.
1983:275-281.
Journal of the Society of Osteopaths 1982-83;12:813.
DeBattersby R, Williams
B.
Birth Injury: A Possible Contributory Factor in
the
Etiology of Primary Basilar Impression
J. Neurol. Neurosurg. & Psychiatry.
1982;45:879-83.
Younoszai R, Frymann
VM, Bordell BE, et al.
Mitchell FL Jr, Brooks
HD, Bunnel WB.
Upledger J. et al
Effects of temporal manipulation on respiration
JAOA. July 1981;80:751-RES.
You can help children with scoliosis
Patient Care 1981;April 30.
Autistic children: preliminary physiologic,
structural and craniosacral evaluations - research
report.
The Relationship of Craniosacral Examination
Findings in Grade School Children with
Developmental Problems
Journal of the American Osteopathic Association
1979;79(2):123.
Bioelectric and strain measurements during
cranial manipulation.
The relationship between craniosacral
examination findings and the problems of
special education students.
The Reproducibility of Craniosacral
Examination Findings: A Statistical Analysis
Learning Difficulties of Children Viewed in the
Light of the Osteopathic Concept
The trauma of birth
Trauma – A neglected cause of cephalgia
Journal of the Society of Osteopaths 1978;5:24.
Two-year clinical dental evaluation of 200 cases
of chronic headaches: The craniocervical –
mandibular syndrome
A special neurological examination of children
J Am Dent Assoc. Dec 1975;91(6):1230-6
Upledger J.
(More than 10 other
papers could be cited here
by Upledger)
Upledger J.
Upledger JE.
Upledger JE
Frymann VM.
Frymann VM
Magoun, HI
(20 other papers by Dr.
Magoun could be listed
here)
Gelb H, Tarte J
Peters JE, Romine JS,
Journal of the American Osteopathic Association,
June 1978; 77: 760/69 - 776/85.
Am Osteopath Assoc Res Conf, 1978.
Journal of the American Osteopathic Association,
Aug 1977; 76: 890/67 - 899/76.
Journal of the American Osteopathic Association,
Sept 1976; 76: 46-61.
Osteopath Ann 1976;4:22-31.
JAOA. Jan 1975;74:400-10
Dev Med Child Neurol 1975:1563-78.
49
Dykman RA.
Lay EM.
Brookes, D
Woods, R.
Gelb H
Magoun H.
Magoun H.
Magoun H.
Magoun H.
Frymann VM.
Frymann VM, Carney
RE, Springall P.
Woods JM, Woods RM
Arbuckle B.
Arbuckle BE.
with learning disabilities
Osteopathic Management of Trigeminal
Neuralgia
Indications for cranial therapy in general
osteopathic practice.
Structural Normalization in Infants and Children
with Particular Reference to Disturbances of the
Central Nervous System
Review correlating the Medical-Dental
Relationship in the
Craniomandibular Syndrome
Pertinent Approach to Pituitary Pathology
Entrapment neuropathy in the cranium.
Entrapment neuropathy of the central nervous
system. Part II. Cranial nerves I-IV, VI-VIII,
XII.
Entrapment neuropathy of the central nervous
system. Part III. Cranial nerves V, IX, X, XI.
Relation of Disturbances of Craniosacral
Mechanisms to Symptomatology of the
Newborn, Study of 1,250 Infants
Effect of osteopathic medical management on
neurological development in children.
Physical findings related to psychiatric disorders
Lippincoff R.
Subclinical Signs of Trauma
The Value of Occupational and Osteopathic
Manipulative Therapy in the Rehabilitation of
the Cerebral Palsy Victim
Head Trauma in Children and its effect on
Pituitary Gland
Cranial thinking and Meniere's disease.
Arbuckle B.
Effects of Uterine Forceps Upon the Fetus
Santucci T.
The management of the mentally retarded child.
Reid C.
Arbuckle B.
Cranial technic as related to eye, ear, nose and
throat.
Cranial Aspect of Emergencies in the Newborn
Lippincott H
Case of birth injury or cranial trauma.
Northup T.
Osteopathic cranial technic and its influence on
hypertension.
Interesting cases of infantile paralysis
Two case records of cranial lesions
Improvement of Traumatic Head Injuries under
Osteopathic Care
Baily KG.
Lippincott RC.
Kimberly PE
Stevenson GM.
JAOA. January 1975;74:373-89.
British Osteopathic Journal. 1973.6.2.25-8
Journal of the American Osteopathic Association,
May 1973; 72: 903-908.
NY J. Dent. 1971;41(5):163-75.
D.O. Magazine. July 1971;11(11):133-141.
Journal of the American Osteopathic Association
1968;67(6):643-52.
Journal of the American Osteopathic Association
1968;67(7);779-87.
Journal of the American Osteopathic Association
1968;67(8):889-99.
Journal of the American Osteopathic Association,
June 1966; 65: 1059-1075.
Journal of the American Osteopathic Association
1966;65:1059-1075
Journal of the American Osteopathic Association,
Aug 1961;60
JAOA. November 1958; 58:160-66.
Journal of the American Osteopathic Association,
1955 Dec; 55(4).
JAOA. November 1954; 54: 208-11.
Journal of the Osteopathic Cranial Association
1954;56-60
JAOA. May 1954;
53:499-508.
Journal of the American Osteopathic Association
1952;51(10):516-8.
Journal of the American Osteopathic Association
1949;48(8):428-31.
JAOA. May 1948;
47:507-11.
Academy of Applied Osteopathy Yearbook
1948;1:58.
Academy of Applied Osteopathy Yearbook 1948:707.
AAO Yearbook 1947:109.
Osteopathic Profession. March 1945;12(6):29-30
JAOA. October 1943; 43:120.
50
Table 2. Cranial Manipulative Therapy
Characteristics of studies demonstrating measurements of brain, spinal cord,
meningeal and CSF motility
Authors
Nelson KE,
Sergueef N.
Sergueef, N.;
Nelson, KE.;
Glonek, T.
Farasyn, A.;
Vanderschueren,
F.
Moskalenko YE,
Kravchenko TI,
Gaidar BV,
Vainshtein GB,
Semernia VN,
Maiorova NF,
Mitrofanov VF
Chu D, Levin DN,
Alperin N.
Boulton M,
Armstrong D,
Flessner M, Hay J,
Szalai JP, Johnston
M.
Lockwood MD.
Myers R.
Zanakis MF,
Dimeo J, Madonna
S, Morgan M,
Drasby E.
Zanakis MF,
Marmora M,
Morgan M,
Lewandoski MA
Moskolenko YE,
Investigation
Recording the Rate of
the Cranial Rhythmic
Impulse
Changes in the TraubeHerring Wave
Following Cranial
Manipulation
The Decrease of the
Cranial Rhythmic
Impulse During
Maximal Physical
Exertion: an Argument
for the Hypothesis of
Venomotion?
The periodic mobility
of the cranial bones in
man
Publication
J Am Osteopath Assoc, Jun 2006;106(6): 337-41.
Assessment of the
biomechanical state of
intracranial tissues by
dynamic MRI of
cerebrospinal fluid
pulsations: A phantom
study
Raised intracranial
pressure increases CSF
drainage through
arachnoid villi and
extracranial lymphatics
Cycle-to-cycle
variability attributed to
the primary respiratory
mechanism.
Measurement of small
rhythmic motions
around the human
cranium in vivo
Objective measurement
of the CRI with
manipulation and
palpation of the sacrum
Application of the CV4
technique during
objective measurement
of the CRI
Bioengineering support
Magn Reson Imaging 1998;16(9):1043-1048.
The American Academy of Osteopathy
Journal 2001;11(1):17.
Journal of Bodywork and Movement Therapies
2001;5(1):56-69.
Fiziol Cheloveka, 1999 Jan-Feb;25(1):62-70.
Am J Physiol. 1998 Sep;275(3 Pt 2):R889-96.
Journal of the American Osteopathic Association
1998;98(1):35-6 and 41-3.
Australian J of Osteopathy 1998;9(2):6-13
Journal of the American Osteopathic Association
1996;96(9):551.
Journal of the American Osteopathic Association
1996;96(9):552.
Med Biol Eng Comput. 1995;34:185-186
51
Kravchenko T,
Chervotok A,
Sharapov K.
Maier SE, Hardy
CJ, Jolesz FA.
Urayama K.
Zanakis MF,
Cebelenski RM,
Dowling D,
Lewandoski MA,
Lauder CT,
Kircher BA, Hallas
BH.
Feinberg DA.
Greitz D,
Wirestam R,
Franck A, Nordell
B, Thomsen C,
Stahlberg F.
Enzmann DR, Pelc
NJ.
Winston KR,
Breeze RE.
Doursounian L,
Alfonso JM, IbaZizen MT, Roger
B, Cabanis EA,
Meininger V,
Pineau H.
Flanagan, M.
Feinberg DA,
Mark AS.
of the cranial
osteopathy treatment
Brain and
cerebrospinal fluid
motion: real-time
quantification with Mmode MR imaging
Origin of lumbar
cerebrospinal fluid
pulse wave
The cranial
kinetogram: objective
quantification of
cranial mobility in
man.
Radiology, 1994 Nov;193(2):477-83
Modern concepts of
brain motion and
cerebrospinal fluid
flow
Cerebrospinal fluid
circulation and
associated intracranial
dynamics. A radiologic
investigation using MR
imaging and
radionuclide
cisternography
Brain motion:
measurement with
phase-contrast MR
imaging
Hydraulic regulation of
brain parenchymal
volume
Dynamics of the
junction between the
medulla and the
cervical spinal cord: an
in vivo study in the
sagittal plane by
magnetic resonance
imaging
The Relationship
Between CSF and
Fluid Dynamics in the
Neural
Canal
Human brain motion
and cerebrospinal fluid
circulation
demonstrated with MR
velocity imaging
Radiology 1992;185:630-632
Spine, 1994 Feb 15;19(4):441-5.
Journal of the American Osteopathic Association
1994;94(9):761.
Neuroradiology,1992;34(5):370-80.
Radiology. 1992 Dec;185(3):653-60.
Neurol Res. 1991 Dec;13(4):237-47.
Surg Radiol Anat. 1989;11(4):313-22.
J Manipulative Physiol Ther, Dec 1988;11(6):489-92
Radiology, 1987 Jun;163(3):793-9.
52
Podlas H, Allen
KL, Bunt EA
Cope MK, Dunlap
SH
Britt RH, Rossi
GT.
Tettambel M et al
Upledger J.
Hamer J, Alberti
E, Hoyer S,
Wiedemann K.
Frymann VM
Steer JC, Horney
FD.
Wallace WK,
Avant WS Jr,
McKinney WM,
Thurstone FL.
Deeming J
Bering EA, Jr.
Bering EA.
Computed tomography
studies of human brain
movements
Calibration of a device
for the measurement of
the CRI
Quantitative analysis of
methods for reducing
physiological brain
pulsations
Recording of the
cranial rhythmic
impulse - research
report.
Mechano-electrically
recorded physiological
patterns which relate to
subjectively reported
craniosacral
mechanism phenomena
- research report.
Influence of systemic
and cerebral vascular
factors on the
cerebrospinal fluid
pulse waves
A study of the
rhythmic motions of
the living cranium
Evidence for passage
of cerebrospinal fluid
among spinal nerves
Ultrasonic techniques
for measuring
intracranial pulsations.
Research and clinical
studies
A pilot study on
periodicity and
magnitude of cerebral
spinal fluid pressure
variations - research
report.
Circulation of the
cerebrospinal fluid.
Demonstration of the
choroid plexuses as the
generator of the force
for flow of fluid and
ventricular
enlargement
Choroid plexus and
arterial pulsation of
cerebrospinal fluid:
demonstration of the
S Afr J Surg, 1984 Feb-Mar;22(1):57-63.
JAOA. Sept 1983;69-RES.
J Neurosci Methods. 1982 Sep;6(3):219-29.
Journal of the American Osteopathic Association
1978;78(2):149.
Journal of the American Osteopathic Association
1978;78(4):297.
J Neurosurg 1977;46:36-45.
Journal of the American Osteopathic Association
1971;70:1-18
Can Med Assoc J. 1968 Jan 13;98(2):71-4.
Neurology. 1966 Apr;16(4):380-2.
Journal of the American Osteopathic Association,
1964;63(9):864-5.
J Neurosurg. 1962 May;19:405-13.
AMA Arch Neurol Psych 1955;73:165-172
53
Brierley JB
choroids plexuses as a
cerebrospinal fluid
pump
The penetration of
particulate matter from
the cerebrospinal fluid
into the spinal ganglia,
peripheral nerves, and
perivascular spaces of
the central nervous
system
J Neurol Neurosurg Psychiatry. 1950
Aug;13(3):203-15.
Table 3. Cranial Manipulative Therapy
Characteristics of studies measuring the mobility of the osseous-articular mechanism of the cranial
sacral system and suture structure and function
Cook, A.
Sabini RC,
Elkowitz DE.
Oleski, S, Smith
G, Crow W
Miller RI, Clarren
SK.
Drangler, KE.;
King, HH.
Lewandoski MA,
Drasby E, Morgan
M, Zanakis M
Zanakis MF,
Morgan M, Storch
I, et al.
Harring SW, Teng
S, Huang X,
Mucci RJ,
Freeman J.
Opperman LA,
Passarelli RW,
Morgan EP,
Reintjes M, Ogle
RC.
The mechanics of
cranial motion—the
sphenobasilar
synchondrosis (SBS)
revisited
Patency and
Obliteration of the
Cranial Sutures: Is
There a Clinical
Significance?
Radiographic Evidence
of Cranial Bone
Mobility
Long-term
developmental
outcomes in patients
with deformational
plagiocephaly
Interexaminer
Reliability of Palpatory
Diagnosis of the
Cranium
Kinematic system
demonstrates cranial
bone movement about
the cranial sutures
Detailed study of
cranial bone motion in
man
Patterns of bone strain
in the zygomatic arch.
Journal of Bodywork and Movement
Therapies 2005;9(3):177-188.
Cranial sutures require
tissue interactions with
dura mater to resist
osseous obliteration in
vitro
J Bone Miner Res, 1995 Dec;10(12):1978-87.
J Am Osteopath Assoc, Jan 2005;105(1):25.
Cranio: The Journal of Craniomandibular Practice;
Jan 2002;20(1):34-8
Pediatrics, 2000 Feb;105(2):E26.
J Am Osteo Assoc 1998;98(7):387.
J Am Osteopath Assoc, 1996;96(9):551.
J Am Osteo Assoc. 1996;96(9):552.
Anatomical Rec 1996;246:446-457.
54
Madeline LA,
Elster AD.
Upledger J.
Pick M.
Miyasaka-Hiraga
J, Tanne K,
Nakamura S.
Heisey, SR,
Adams, T.
Fredrick DR,
Mulliken JB,
Robb RM.
Cohen MM.
Opperman LA,
Sweeney TM,
Redmon J, Persing
JA, Ogle RC.
Kostopoulos, D.,
Keramidas, G.
Adams T, Heisey
RS, Smith MC,
Briner BJ
Patterson MM.
Anton SC, Jaslow
CR, Swartz SM.
Suture closure in the
human
chondrocranium: CT
assessment.
Research and
observations support
the existence of a
craniosacral system.
A Preliminary Single
Case Magnetic
Resonance Imaging
Investigation into
Maxillary FrontalParietal Manipulation
and Its Short-Term
Effect upon the
Intercranial Structures
of an Adult Human
Brain
Finite element analysis
for stresses in the
craniofacial sutures
produced by maxillary
protraction forces
applied at the upper
canines
Role of cranial bone
mobility in cranial
compliance
Ocular manifestations
of deformational frontal
plagiocephaly
Sutural biology and the
correlates of
craniosynostosis
Tissue interactions with
underlying dura mater
inhibit osseous
obliteration of
developing cranial
sutures
Changes in Magnitude
of Relative Elongation
of the Falx Cerebri
During the Application
of External Forces on
the Frontal Bone of an
Embalmed Cadaver
Parietal bone mobility
in the anesthetized cat
Radiology 1995;196:747-56
Study demonstrates
cranial bone mobility.
Sutural complexity in
artificially deformed
Journal of the American Osteopathic Association
1992;92(5):589.
J Morphol. 1992 Dec;214(3):321-32.
Alternative Medicine Journal 1995;2(5):31-43.
J Manipulative Physiol Ther. 1994;17(3)
Br J Orthod. 1994 Nov;21(4):343-8.
Neurosurgery, 1993;33(5):869-876.
J Pediatr Ophthalmol Strabismus. 1993 MarApr;30(2):92-5.
Am J Med Genet 1993;47:581-616.
Developmental Dynamics 1993;1(98):312-322.
Journal of Craniomandibular Practice, January
1992.
J Am Osteopath Assoc, 1992 May;92(5):599-600,
603-10, 615-22.
55
Jaslow CR
Wagemans PA,
van de Velde JP,
Kuijpers-Jagtman
AM.
Retzlaff E
Retzlaff EW,
Mitchell FL Jr,
Walsh J,
Wendecker A.
Nanda R, Hickory
W.
Jones L, Retzlaff
E, Mitchell FL Jr.,
Upledger J, Walsh
J.
Cope M
Libin B.
Harakal JH
Heifitz, MD,
Weiss M.
Retzlaff EW,
Mitchell FL Jr,
Upledger J
Retzlaff EW,
Mitchell FL Jr.,
Upledger J,
Vredevoogd J,
Walsh J.
Retzlaff E et al
Retzlaff EW,
human (Homo sapiens)
crania
Mechanical properties
of cranial sutures
Sutures and forces: a
review
J Biomech 1990;23(4):313-321.
Am J Orthod Dentofacial Orthop. 1988
Aug;94(2):129-41.
Cranial bones and their
sutures in primates,
including humansresearch report.
The role of cranial
ligaments in primates
Journal of the American Osteopathion Association
1987;87(10):699-700.
Zygomaticomaxillary
suture adaptations
incident to anteriorlydirected forces in
rhesus monkeys
Significance of nerve
fibers interconnecting
cranial suture
vasculature, the
superior sagittal sinus,
and the third ventricle.
Calibration of a device
for the measurement of
the cranial rhythmic
impulse - research
report.
Occlusal Changes
Related to Cranial Bone
Mobility
Dissection offers proof
of Sutherland’s concept
Detection of skull
expansion with
increased cranial
pressure
Nerve fibers present
within the parietal
cranial bones of
primates.
Light and scanning
microscopy of nerve
fibers within the
parietal bones of
primates.
Neurovascular
mechanisms in cranial
sutures - research
report.
Aging of cranial sutures
Angle Orthod. 1984 Jul;54(3):199-210.
Anat Rec 1985;211:159-60
Journal of the American Osteopathic Association
1982;82:113.
Journal of the American Osteopathic Association,
1983;8(3):1-69.
International Journal of Orthodontics, 20(1), March
1982
JAOA. Oct 1982;82:87.
J Neurosurg, 1981;55:811-812
Journal of the American Osteopathic Association
1981;80:753-754.
Anat Rec 1981;199:21.
Journal of the American Osteopathic Association
1980;80(3):218-9.
Anat Rec 1979;193:663
56
Upledger J,
Michell FL Jr, et
al.
Retzlaff E et al
Kokich VG,
Shapiro PA,
Moffett BC,
Retzlaff EW.
Retzlaff E et al
Kokich VG.
Popevec J et al.
Retzlaff EW,
Michael DK,
Roppel RM.
(More than 10
other papers could
be listed here by
Retzlaff on this
subject)
Michael DK
Retzlaff EW,
Jones L, Mitchell
FL Jr., Upledger J.
Pearl M,
Finkelstein J,
Berman MR.
Herring SE.
Baker E.
Greenman P.
Latham RA
in humans
Age-related changes in
human cranial sutures research report.
Craniofacial sutures.
Aging in nonhuman
primates
Journal of the American Osteopathic Association
1979;79(1):60-1.
Nerve fibers and
endings in cranial
sutures - research
report.
Age changes in the
human frontozygomatic
suture from 20 to 95
years
Histological techniques
for cranial bone studies
- research report.
Cranial bone mobility.
Journal of the American Osteopathic Association
1978;77(6):474-5.
A preliminary study of
cranial bone movement
in the squirrel monkey.
Possible autonomic
innervation of cranial
sutures of primates and
other mammals.
Temporary widening of
cranial sutures during
recovery from failure to
thrive. A notuncommon clinical
phenomenon
Sutures – a tool in
functional cranial
analysis
Alteration in Width of
Maxillary Arch and its
Relation to Sutural
Movement of Cranial
Bones
Roentgen Findings in
the Craniosacral
Mechanism
The sliding of cranial
bones at sutural
Journal of the American Osteopathic Association
1975;74:866-869.
New York: Van Nostrand Reinhold: 356-368, 1979.
Am J Orthod, 1976 Apr;69(4):411-30.
Journal of the American Osteopathic Association
1976;75(6):606-7.
J Am Osteopath Assoc, 1975 May;74(9):869-73.
Brain Research 1973;58:470-477.
Clin Pediatr (Phila). 1972 Jul;11(7):427-30.
Acta Anat 1972;83:222-247.
Journal of the American Osteopathic Association,
Feb 1971;70:559-564
Journal of the American Osteopathic Association,
1970;70:24-35.
J Anat 1968;103:593.
57
Moss ML
Bertelsen TI
Girgis FL,
Pritchard JL, Scott
JH.
Arbuckle B.
surfaces during growth.
The pathogenesis of
premature cranial
synostosis in man.
The premature
synostosis of the cranial
sutures
Structure and
development of cranial
bone sutures
Cranial Reinforcement
from a Manipulative
Standpoint;
Articulations,
Stress Bands,
Buttressess
Acta Anat 1959;37:51-370.
Copenhagen: Ejnar Munksgaard; 1958
J Anat. 1956;90:70-86
JAOA. 1949; 49:188-94.
58