Cranial Strain Patterns

Dr. Karen has great drawings for the cranial patterns in The Osteopathic Approach to Patients with Head Pain. From there, you can understand what’s going on, but its still kinda tricky to name them.

So for this, pull out the packet and follow along with the drawings…

1) For S/R & T, picture you are standing behind them & name it for what the occiput is doing.

Sidebending/Rotation

Scenario: A traumatic force to the left side of the head (at the level of the SBS).
Findings: Right hand will feel fuller/wider, but more caudad
Visualization from behind: Occiput is tipped to the right and rotated right
Diagnosis: Right sidebending/rotation

SBS Torsion

Scenario: You notice your patient has a wide orbit/prominent eye on the right (due to externally rotating sphenoid).
Findings: Left hand will feel to rotate posteriorly. Left index finger moves superiorly. Left fifth digit moves inferiorly (occiput moving caudad)
Visualization from behind: Occiput is tipped to the left (while greater wing peaks out on the right)
Diagnosis: Left SBS torsion

2) For V & L, you name it for the sphenoid…

Vertical Strain

Scenario: Your patient was punched with an upper cut to the jaw
Findings: Sphenoid moves in flexion while occiput is in extension, Index fingers move inferiorly (sphenoid base moves superiorly), 5th digits move superiorly (occipital base moves inferiorly)
Visualization from the side: Sphenoid is superior to the occiput
Diagnosis: Superior Vertical Strain

(If inferior strain, the scenario would involve a force at the base of the skull upwards, or on the forehead downwards… something to push the sphenoid down or the occiput up)

Lateral strain-

(Easy to confuse with torsion in terms of scenario! With torsions, its in the center of the head, at the SBS junction. In lateral strain, its anterior or posterior to the SBS.)

Scenario: Traumatic force to the left temple.
Findings: Index fingers move laterally to the right, 5th digits move laterally to the left, Parallelogram head!
Visualization from above: Sphenoid is shifted right.
Diagnosis: Right lateral strain.

(For left lateral, there will either be a force on the right temple, or the left side of the occiput… something to shift the sphenoid left or the occiput right)

Special testing

There is a great YouTube page that has videos for most of the special tests!

For example: Yergason’s

This other great page seems to cover about everything the last page didn’t!

For example: FABER test

Summary:
+ ant drawer test= torn ACL
+ valgus stress test= MCL
+ varus stress test= LCL
+ McMurrays= tear or displacement of medial meniscus
+ Apleys grind= ligament tears
+ Yergason’s & Speed’s= biceps tendon injury
+ Phalen’s & Tinel’s= median nerve entrapment
+ FABER/Patrick’s= sacroiliac pain
+ Apprehension= anterior glenohumeral instability
+ Hawkin’s= rotator cuff impingement
+ Empty can= supraspinatus injury

Lower Extremity Glides

In searching through the portal, Dr. Karen has some pretty awesome drawings in her lecture, Gait and Somatic Dysfunction of the Lower Extremity. They show specifically how movements of the foot will demonstrate the glides of the rest of the lower extremity.

To sum up the motions:

Tibiofemoral (Knee) Joint:

external rotation w/anteromedial glide

VS internal rotation w/ posterolateral

Proximal Tibiofibular (Fibular Head) Joint:
Here’s why this was confusing, all 3 motions are acceptable!

posterior (posteromedial) w/
-plantar flexion (talotibial)
-inversion (talocalcaneal)
-internal rotation (tibia)

VS anterior (anterolateral) w/
-dorsiflexion (talotibial)
-eversion (talocalcaneal)
-external rotation (tibia)

Talotibial (Tibia) Joint:

talus anterior w/ plantar flexion

VS talus posterior w/ dorsi flexion

Talocalcaneal (Ankle) Joint:

talus anteromedial w/ eversion

VS talus posterolateral w/ inversion

Question from a student:

“So, during the technique critique this quarter, I was supposed to diagnose the fibular head. I said that with plantar flexion it moves posteromedially, and with dorsiflexion it moves anterolaterally. BUT the fellow who was grading me wanted me to separate the A/P from the med/lat, and in the panic of the moment I had no idea what she was talking about, and chose medial/lateral instead of A/P.

Which is correct? I know that the treatments for fibular head are based on an anterior/posterior diagnosis, but is saying that the movement is anterolateral or posteromedial incorrect?”

==Answer in comments==