resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
How Much is Enough?
One of the primary arguments used against acupuncture care is the overuse of treatment. Some people say, "once you go, you have to go forever."
No Whining on the Yacht
This admonition – no whining on the yacht – may sound familiar to you. Many claim its origination.
News in Brief
In Remembrance: A Moment of Silence for Dr. Dick Versendaal; NYCC Named Chiropractic College of the Year by ACA; National University Partners With Indiana VA Facility.
Alternatives to the Rainy Day Fund: Better Things to Do With Your Money
Google "rainy day fund" and you'll find the predominant and traditional advice given today is that you need to have three months of living expenses saved for an emergency. Some even recommend six months or more.
Your Chance to Go Back to High School
As the father of a student who recently entered high-school sports (soccer), I have come to recognize an untapped opportunity for the chiropractic profession.
We Get Letters & E-Mail
Shouldn't the Pentagon Know More About Chiropractic Care? Office Flow: Have You Reviewed the Patient Experience Lately? Let's Stop Confusing the Public About Chiropractic; Cutting Down the Cherry Tree.
AAAOM: Facing An Ultimatum
On the heels of the growing discontent with leaders of the AAAOM, the Council of State Associations (CSA) recently took it upon themselves to present the organization with an ultimatum: for all board members to resign from the board and turn the organization over to the CSA or they will proceed on their own to become the primary representative of the AOM profession.
Environmental Toxins: Cause of Modern Illness (Part I)
Environmental toxins have created burdens on the human body that put demands beyond our evolutionary development. Modern diseases that historically did not exist to any great degree have been rising sharply in the last 40 years.
Enhancing TCM with Enzymes
Herbal formulations are an integral component for most Traditional Chinese Medicine (TCM) practitioners. One of the best ways to enhance their effectiveness is the addition of plant-based enzymes.
Colorado to Have the First Acupuncture Medical Reserve Corps in the U.S.
In the summer of 2012, Colorado was on fire. Literally. Many acupuncturists from around the state, especially those who had received disaster response training through AWB, wanted to help those affected by the fires as well as the first responders and tireless state and local officials, with the healing and stress-relief of acupuncture.
Making Sense of Chronic Inflammation
Inflammation is big business, evidenced by not only the laundry lists of medications patients bring me aimed at managing inflammation, but also the never-ending stream of advertisements for anti-inflammatory supplements that constantly find their way to my desk.
Revisiting the Neurological Exam
In spinal trauma or disease, the neurological exam chiefly aims to determine whether one (or more) of three basic neurological conditions is present: myelopathy, radiculopathy and peripheral nerve disorder.
Dry Needling is Acupuncture: Anatomy of a Legal Victory in Oregon
On January 23, 2014, the Oregon Court of Appeals overturned the Oregon Board of Chiropractic Examiners "dry needling" administrative rule, which allowed chiropractic physicians to perform acupuncture after only 24 hours of training.
Chiropractic Management of Sports-Related Tendinopathy
Tendinopathy is increasing in prevalence and accounts for a substantial percentage of sports injuries. Despite the magnitude of the disorder, research on chiropractic treatment is limited.
Shoulder Strategies: Reduce Pain, Improve Function With Proper Taping
Shoulder pain / dysfunction is a common problem for chiropractic patients. Clinicians who utilize elastic therapeutic taping as part of their treatment approach know it can be effective for a variety of shoulder problems.
Through the Eyes of a Child
Once upon a time there was a girl name Lucy. Lucy had cancer, but she had a heart filled with love and compassion. Please come along to hear this story of an amazing child, her tenacity and her dream to help other children.
San Zhen Protocols Part II: Case Studies
In my last article, I presented a collection of three-point acupuncture combinations which can provide effective clinical results.
Anti-Aging: Educating Your Patients About The Skin
We know that cosmetic acupuncture works but what then? Education is a key part to the practice of Chinese medicine and when you practice cosmetic acupuncture, facial rejuvenation, etc., it is time talk about skin with your patients.
Dietary Supplement Research: Contradictions, Bias, Misinterpretation and Confusion
I do not care what the truth is, one way or another; I just want to know it. And when it comes to dietary supplements, the truth can be hard to find for a number of reasons.
The Recliner Test
"Hi, Bill, how are you?" "Oh, I'm OK, Doc. I've got pain down the leg again, so I thought I would stop by and get you to check it."
Arch Height and Running Shoes: The Best Advice to Give Patients
Because runners with different arch heights are prone to different injuries, running shoe manufacturers have developed motion-control, stability and cushion running shoes for low-, neutral- and high-arched runners, respectively.
Evaluating Prenatal and Pediatric Automobile Injuries
Often in a family practice, one of your patients or an entire family is in an automobile accident and you are sought out to provide care for their soft-tissue injuries.
Are You Driving Patients Toward Dependence on Big Pharma?
Over the years I have had the opportunity to talk to doctors of chiropractic about health promotion, wellness and preventive care in chiropractic practice.
Socializing In My Slippers
When I graduated college, I had grandiose dreams of becoming an amazing acupuncturist. I wanted to build a great practice and make a good living. For four years, 13 semesters to be exact, I had a spreadsheet.
Chinese Herbs Debut at the Cleveland Clinic
Chinese herbal medicine is now being prescribed at the Cleveland Clinic thanks to a trailblazing team of people.
May, 2008, Vol. 08, Issue 05
The Controversy of Cranial Bone Movement
By Lisa Johnson Zee; guest author for John Upledger, DO, OMM
Editor's note: Dr. Upledger has asked guest author Lisa Johnson Zee to share her thoughts on cranial bone movement in this month's column.
In anatomy and physiology, I learned that cranial bones fuse in early adulthood or childhood.1 Gray's Anatomy supports the theory that the sutures grow together, creating a solid mass of bone called the calvarium. The fused skull functions as a helmet in which volume or pressure changes in blood, cerebrospinal fluid (CSF) or brain tissue cause corresponding pressure changes in other systems to prevent an increase of intracranial pressure.
However, there is a sizable body of literature that documents a small, rhythmic movement of the cranial bones. The bulk of these studies come from the cranial osteopathy medical field. The following is a synopsis of some of these studies.
Tettambel used force transducers to measure movement between the frontal bone and bilateral mastoid processes of the temporal bone in 30 subjects.2 She recorded three rhythms including the cardiac and respiratory rhythms. She hypothesized that the third pulse, which averaged eight cycles per minute, was the craniosacral rhythm.
Frymann studied the rhythmic changes in the circumference of the head using a U-shaped frame with a differential transducer.3 Changes in the diameter of the skull were measured by the displacement of metal rods. This study is unique because it measured movement in live human subjects. Frymann found a pulsating rhythm between six and eight cycles per minute separate from cardiac and respiratory rates. The amount of displacement was measured between 10 and 30 microns.
Another study by Adams, et al., looked at parietal bone mobility in cats.4 These researchers fastened strain gauges to feline parietal bones to measure movement when injections of artificial CSF were given. The bones moved significantly, varying from 17 to 70 microns. External lateral head compression caused a measurable widening of the sagittal suture with an inward rotation of the parietal bones.
Researchers at the University of Michigan College of Osteopathic Medicine have looked at cranial bone mobility in adult primates.5 Michael and Retzlaff used a direct screw attachment on the right parietal bone and measured movement with a pressure transducer. They also measured blood pressure, heart rate and respiration rate. The parietal bones moved spontaneously in two distinct rhythms, one corresponding to the respiration rate and a second, slower rate of five to seven cycles per minute.
These four studies indicate cranial bones may show a slow, steady, cyclical movement. A relatively new theory for Western medical science, it represents a dramatic shift. Bringing controversial ideas into the status quo of scientific thought is not easy, but the body of literature supporting cranial movement is growing. Although inconclusive, it deserves to be approached with an open mind.
In CranioSacral Therapy (CST), the rhythm of CSF can be palpated at all parts of the body due to the passive action of fascial connective tissue. The rhythm occurs in two distinct phases: flexion (outward movement) and extension (inward movement). In physical therapy terms, flexion is a decreasing measurement of degrees in the angle of the joint. The sphenobasilar joint is where the posterior sphenoid articulates with a ridge on the occipital bone.
When Dr. William Garner Sutherland, the "father of osteopathy," palpated the movement of these bones, he noticed this joint does indeed flex or reduce angle size on the inferior side. The flexion of this angle is accompanied by subtle outward movement in the body, which Sutherland called flexion. Therefore, in CST, the cranium, along with the rest of the body, is in flexion when it widens and in extension when it narrows.
Anatomy of Suture Closure
To discover more about cranial bone motion, let's examine the nature of cranial sutures. If the sutures remain flexible throughout adulthood, some degree of motion is possible when driven by pressure changes in the craniosacral system. If the tissues fuse and become immobile, rhythmic motion is unlikely.
Several studies have examined the nature of the cranial sutures. Retzlaff, et al.,used light and scanning microscopy to examine tissue samples of adult primate sutures.6 They found connective tissue, blood vessels and nerve fibers present in the sutural space. They described a five-layered pattern of fibers and cells containing collagenous bundles. Tissue was reported to be arranged in a wavy pattern. The researchers hypothesized the purpose of the tissue might be to control the elongation of the collagen bundles. They reported no evidence of fusion in the adult primate sutures.
In a separate study, Upledger and Retzlaff examined the sagittal suture in primate skulls.7 They found not only connective tissue, but also a vascular network and neuronal plexuses and receptors in sutural tissue. In one specimen, they were able to trace a single dendrite through the dural membrane into the brain, terminating in the third ventricle containing CSF. Further study of this neural tract may bring answers to how the homeostatic feedback mechanism in the brain's CSF hydraulic system functions.
In the 1920s, Todd and Lyon published two articles examining a timeline of sutural closure in the male human skull.8 These researchers hypothesized that cranial sutures fuse at some point in the human lifetime. They started with 427 specimens, but rejected 81 due to abnormal suture closure or "delayed union." Furthermore, some of the skulls were termed lapsed union, which meant failure of the suture to close due to a concentration of bone along the edge of the articulatory surface. For reasons unclear, they counted these skulls as fused, which biased results toward earlier suture closure. The data they found is as follows:
The authors concluded that the sutures tend to close along this timeline. However, there is a high degree of variability reported. This study also was conducted some 80 years ago. Standards of protocol in scientific research have changed.
Researchers have studied one suture in-depth using different human specimens. Kokich examined one suture in the facial area - the frontozygomatic suture.9 Of his 61 specimens, he found none demonstrated closure until after age 80, and some weren't completely fused even after age 90. He noted that bony interdigitations formed along the suture with advancing age, but did not affect the patency of sutural movement. Kokich, like Retzlaff and Upledger, found clear evidence of collagen fibers within the suture. He stated that frontozygomatic suture remains a functioning "articulation" until late in life.
A conclusive statement about whether and when sutural fusion occurs cannot be made from existing research.10 Clearly the subject remains open for debate. Having palpated the craniosacral rhythm with my own hands, I believe cranial sutures maintain flexibility that might best be called articulation. This flexibility allows the bones to move passively as they are driven by the craniosacral system.
Click here for previous articles by John Upledger, DO, OMM.
Lisa Johnson Zee is a clinical supervisor and instructor in the Communication Disorders and Sciences Program at Southern Illinois University Carbondale. She is certified in CranioSacral Therapy Techniques through The Upledger Institute. Her other interests include complementary and alternative medicine, traumatic brain injury and bilingual Spanish/English therapy.
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