Even though Im no longer taking the cranial elective, I still feel its important for my learning that I have a greater understanding of what cranial osteopathy is. Hence after some research this is what I have found out.
Cranial Osteopathy - The five fundamental principles of the cranio sacral mechanism
The cranial concept is a system of therapy that is being used widely throughout the world and I will try to explain the fundamental principles that apply to it. The cranial concept was first developed by an osteopath called William Garner Sutherland in the early 20th century and he was the first to coin the phrase cranial-osteopathy. Since Sutherland, there have been practitioners like Upledger who have further developed the theory and other branches have developed such as cranio-sacral therapy (craniosacral). The system of cranial osteopathy and cranio-sacral therapy is becoming more and more popular in Israel and in Jerusalem specifically patients are beginning to benefit from it due to greater awareness.
Whether an osteopath uses cranial osteopathy, structural osteopathy, classical, visceral or functional osteopathy, the same principles of diagnosis are used which are based on a system that applies anatomy and physiology in order to prevent disease. The osteopath considers the whole body as a unit all of whose parts need to be properly nourished by its internal fluid environment in order to function, heal itself and thus combat disease.
When the osteopath considers the body as a whole, inevitably this includes the cranium and all of it components; it's bone, cartilage, membranes and internal environment that is nourished by blood-vessels and nerves.
5 fundamental principles exist in cranial osteopathy:
1) That an inherent mobility exists within the brain and spinal cord.
The neural tube develops in the embryo with 2 anterior sections that invaginate and curl up like a ram's horn to form the cerebral cortex. Since it is believed that there is inherent motility within the brain, the pulsating motility responds by curling and uncurling in the way it was developed.
2) Fluctuation of the cerebro-spinal fluid.
There are a number of theories as to how the CSF fluctuates and what the basis of its movement is. For the osteopath however, the important factor is that changes in pressure can be palpated along the route of the CSF and any existing restrictions may alter the CSF fluctuation and have consequences on the body.
3) Motility of intracranial and spinal membranes.
The spinal membranes that form the structures of the intracranial membranes are the falx cerebri and the 2 tentorium cerebelli. These sickle-shaped structures arise from a common origin at the straight sinus known as "The Sutherland fulcrum". The insertions of these membranes are along various points around the cranium. The falx cerebri originates at the internal occipital protuberance, travels upward and forward and eventually insert into the crista galli of the ethmoid bone. The 2 tentoria cerebelli pass along the transverse ridges and the two converge on the body of the sphenoid and insert onto the anterior clinoid process. Together, these membranes constitute the reciprocal tension membranes linking the cranium to the sacrum, functioning as a unit around a common fulcum - the Sutherland fulcrum.
4) Mobility of the bones of the skull.
Whilst the skull may appear to be a solid structure in fact it has zigzag edges which grow together to form movable sutures. These joints evolve from smooth-edged plates of membrane in the newborn and eventually evolve into articulations with slight movement according to the contours of the two surfaces.
5) The involuntary mobility of the sacrum between the ilia.
Not to be confused with movement of nutation and counter-nutation of the sacrum between the ilia, the cranial-osteopathic concept considers the sacrum having an involuntary, respiratory mobility. We have already mentioned the mobility of the intracranial and spinal membranes and it is the lower attachment of these membranes to the sacrum that results in the direction and containment of the sacrum's movement. The movement is a physical extension of the primary respiratory mechanism and allows the sacrum to flex an extend at the level of the second sacral vertebra.
It is with the comprehension of these five fundamental concepts that the cranial osteopath starts to understand the craniosacral mechanism. With a knowledge of the anatomy of the cranium, the physiology of the respiratory mechanism and the cranio-sacral rhythm the osteopath embarks upon a path of therapeutics that are applicable to all kinds of ailments experienced by patients.
(http://osteopathy4osteopaths.blogspot.com/)
Monday, 4 January 2010
Thursday, 24 December 2009
Technique - Ankles and Feet
24/12/09 - Mental block when it comes to feet ... don't like them ... don't want to like them ... don't want to work on them ... don't want to learn about them ... this needs some serious attention from me !!!
06/03/10 - Having worked on feet during technique class I cant believe I still cant recall the joints of the foot and the direction of there planes quickly ... its always still a struggle for me ... this is so wrong for a fourth year osteopathy student.
29/04/10 - Now I should have realised that in Sports Clinic there would be people coming in with ankle and feet problems, so why on earth didn't I read up a bit before hand.
I saw one of the new patients in the sports clinic today. A 29 year old office worker who plays 7 a-side football at the weekend. 4 weeks ago his received a inversion strain of his left ankle. I was amazed at the swelling that remained after 4 weeks. It was at this point that I realised that despite an interest in wanting to work in a sports related field on qualifying I realised I know nothing about it !!!
When presenting my patient to the tutor I realised that I failed to ask lots of appropriate questions ... like was there bruising and where was there bruising.
The tutor thought that he had possible torn some of the cartilage in his ankle due to the severity of the swelling that remained, and a treatment plan was drawn up. It was at this point that I realised actually how important feet are and the implication for biomechanical changes throughout the body.
06/03/10 - Having worked on feet during technique class I cant believe I still cant recall the joints of the foot and the direction of there planes quickly ... its always still a struggle for me ... this is so wrong for a fourth year osteopathy student.
29/04/10 - Now I should have realised that in Sports Clinic there would be people coming in with ankle and feet problems, so why on earth didn't I read up a bit before hand.
I saw one of the new patients in the sports clinic today. A 29 year old office worker who plays 7 a-side football at the weekend. 4 weeks ago his received a inversion strain of his left ankle. I was amazed at the swelling that remained after 4 weeks. It was at this point that I realised that despite an interest in wanting to work in a sports related field on qualifying I realised I know nothing about it !!!
When presenting my patient to the tutor I realised that I failed to ask lots of appropriate questions ... like was there bruising and where was there bruising.
The tutor thought that he had possible torn some of the cartilage in his ankle due to the severity of the swelling that remained, and a treatment plan was drawn up. It was at this point that I realised actually how important feet are and the implication for biomechanical changes throughout the body.
Friday, 27 November 2009
Mock CCA Exam
Well did my mock CCA. Bit of a strange experience but I guess it was going to be.
My continuation patient was a 34 year old man who presented to me 6 weeks prior with Low Back Pain and I diagnosed an annular strain. After answering a few questions on his management plan and progression it was time to see my new patient.
New patient was a 35 year old women with generalised low and mid Tspine pain. She'd had a breast reduction 5 years earlier as her large breasts were giving her back ache. She'd put on weight recently and her back ache had returned.
I didn't get asked many questions about her apart from ergonomic type questions about sitting posture and chair wedges which I don't think I answered very well at all.
Note to self ... make sure I know more about this for the future.
My continuation patient was a 34 year old man who presented to me 6 weeks prior with Low Back Pain and I diagnosed an annular strain. After answering a few questions on his management plan and progression it was time to see my new patient.
New patient was a 35 year old women with generalised low and mid Tspine pain. She'd had a breast reduction 5 years earlier as her large breasts were giving her back ache. She'd put on weight recently and her back ache had returned.
I didn't get asked many questions about her apart from ergonomic type questions about sitting posture and chair wedges which I don't think I answered very well at all.
Note to self ... make sure I know more about this for the future.
Tuesday, 24 November 2009
S-CS: L5 Somatic
Well Ive just finished a session in Bethnal Green. I was working with a 72 year old gentleman with a history of chronic low back pain. Due to his age and marked OA changes on xray of his LSpine he isn't a candidate for HVT hence I tired to treat his back pain with S-CS.
The patient appeared to accept that it was a appropriate choice of treatment for his low back. I found it hard to locate his tender-point as I had to place couch roll over his boxers shorts as they were stained in urine, but I managed to make sure that everything was kept out of the way.
Unfortunately I wont be seeing this patient again to follow up (as its the end of my placement) to see how effective S-CS was for his back pain.
Tuesday, 17 November 2009
Technique - CT Junction
Ive never been able to thrust a CT. From observation in clinic prone seems to be the most popular technique chosen by other students and tutors, followed by a lift off. I cant get either :-(((
17/01/10 - Having identified in that I'm struggling with CT thrusts a clinic tutor talked me through how she does her CT thrusts supine. She adds lots of side shift of the cervical spine down to the CT before applying any other levers. She allowed me to try the technique on her (which I was surprised about) ... and thankfully it was the first CT thrust I managed to get ... and it was supine, not the easiest of techniques I hasten to add.
11/04/10 - I'm still moaning to everyone about not getting my CT thrusts when another of the fourth years offers to show me how he does his prone technique. Theres nothing new about the technique compared to what we have been shown in technique apart from the addition of placing the tips of the fingers onto the SP of T1 whilst applying the side bending to ensure that the side bending go down to the CT. Then carry on as normal. Penny lent here CT to me to try ... I cavitated both sides ... I returned to favour to her and she got both sides ... one side even cavitated without the thrust.
23/04/10 - After my success with the prone technique one of the senior clinic tutors showed me her side lying technique. It really got me thinking about the levers and feeling what is happening at the joint instead of practising rehearsed application of the levers ... I haven't been very successful with this technique but when it does work it is very effective and non-traumatic for the patient compared to some of the prone thrusts we do.
12/05/10 - I think Ive now got 12 CT thrusts in a row with my new revised prone technique ... Ive even been able to teach others how to do it ....
17/01/10 - Having identified in that I'm struggling with CT thrusts a clinic tutor talked me through how she does her CT thrusts supine. She adds lots of side shift of the cervical spine down to the CT before applying any other levers. She allowed me to try the technique on her (which I was surprised about) ... and thankfully it was the first CT thrust I managed to get ... and it was supine, not the easiest of techniques I hasten to add.
11/04/10 - I'm still moaning to everyone about not getting my CT thrusts when another of the fourth years offers to show me how he does his prone technique. Theres nothing new about the technique compared to what we have been shown in technique apart from the addition of placing the tips of the fingers onto the SP of T1 whilst applying the side bending to ensure that the side bending go down to the CT. Then carry on as normal. Penny lent here CT to me to try ... I cavitated both sides ... I returned to favour to her and she got both sides ... one side even cavitated without the thrust.
23/04/10 - After my success with the prone technique one of the senior clinic tutors showed me her side lying technique. It really got me thinking about the levers and feeling what is happening at the joint instead of practising rehearsed application of the levers ... I haven't been very successful with this technique but when it does work it is very effective and non-traumatic for the patient compared to some of the prone thrusts we do.
12/05/10 - I think Ive now got 12 CT thrusts in a row with my new revised prone technique ... Ive even been able to teach others how to do it ....
Tuesday, 10 November 2009
Technique - Thoracic Spine
24/11/09 - I don't know whats happened to my Dog but Ive lost it .... I think I'm over complicating things. Watching some clinic tutors Dog and they just appear to circle over the patient until they feel the tension then drop. Where I actively thing about side bending, flexion, extension and rotation etc
21/04/10 - Well it looks like its not just my rib TSpine thrusts that I'm struggling with its also my Ribs !!! Had a 34 year old man today with a rib lesion that needed manipulating. Once I managed to work out which side the left rib was when the patient was laying down (how embarrassing) I attempted to thrust his rib. All I managed to do was hurt him. Need to practice my rib thrusts before he comes back next week.
28/04/10 - My rib patient came back. Good news was he was feeling some improvement in the intensity of his pain and also the area of pain was more localised to that rib 4 lesion. I attempted it again, twice and failed to get a cavitation (I know its about quality of movement but still !!!). My tutor then attempted to mobilise the rib for me. He took two attempts. On discussion with my tutor after he said that the rib just didn't want to seem to move so he elected to thrust the TSpine to improve the movement in the segment as a whole. This made me feel better in my failed attempts.
05/05/10 - Rib patient is back ... symptoms are improving further as expected. Still I wanted to mobilise that rib. This time I had listened to the feedback that my tutor had given me on the previous weeks about rotating over the patient and pronating my fulcrum more and at last the rib mobilised. Im looking forward to seeing what improvement this will have made next week.
21/04/10 - Well it looks like its not just my rib TSpine thrusts that I'm struggling with its also my Ribs !!! Had a 34 year old man today with a rib lesion that needed manipulating. Once I managed to work out which side the left rib was when the patient was laying down (how embarrassing) I attempted to thrust his rib. All I managed to do was hurt him. Need to practice my rib thrusts before he comes back next week.
28/04/10 - My rib patient came back. Good news was he was feeling some improvement in the intensity of his pain and also the area of pain was more localised to that rib 4 lesion. I attempted it again, twice and failed to get a cavitation (I know its about quality of movement but still !!!). My tutor then attempted to mobilise the rib for me. He took two attempts. On discussion with my tutor after he said that the rib just didn't want to seem to move so he elected to thrust the TSpine to improve the movement in the segment as a whole. This made me feel better in my failed attempts.
05/05/10 - Rib patient is back ... symptoms are improving further as expected. Still I wanted to mobilise that rib. This time I had listened to the feedback that my tutor had given me on the previous weeks about rotating over the patient and pronating my fulcrum more and at last the rib mobilised. Im looking forward to seeing what improvement this will have made next week.
Tuesday, 3 November 2009
Technique - Glenohumeral and Shoulder Orthopedic Tests
03/11/09 - So many orthopedic tests for the GH ... Im really struggling to remember them all, especially by name and need to improve SLAP lesion examinations.
http://www.prohealthsys.com/
12/11/09 - Keira Kinch Tutorial - GH Examination
The tutors allowed us to select the topic of of tutorials this term so I suggested that it would be helpful to see how they performed a shoulder/GH examination.
Keira suggested that we do some further research on shoulder examinations and I came across this resource on the Internet.
http://www.prohealthsys.com/physical/shoulder_exam.php
Again Keira was great at showing us how to perform the tests accurately and how to interpret what we found.
Having never seen a patient with Adhesive Capsulitis through out the whole course I saw two in one week during the Easter vacation. Thankfully I had another student with me who was more familiar with them than myself. I vaguely remembered the capsule stretches that you need to do and to stretch the shoulder to the point before its painful for the patient. The other student gave the patient an exercise to do whereby they stretched their GH capsule in front of a mirror to ensure that they were not using side bending to assist (see video).
http://www.prohealthsys.com/
12/11/09 - Keira Kinch Tutorial - GH Examination
The tutors allowed us to select the topic of of tutorials this term so I suggested that it would be helpful to see how they performed a shoulder/GH examination.
Keira suggested that we do some further research on shoulder examinations and I came across this resource on the Internet.
http://www.prohealthsys.com/physical/shoulder_exam.php
Again Keira was great at showing us how to perform the tests accurately and how to interpret what we found.
Having never seen a patient with Adhesive Capsulitis through out the whole course I saw two in one week during the Easter vacation. Thankfully I had another student with me who was more familiar with them than myself. I vaguely remembered the capsule stretches that you need to do and to stretch the shoulder to the point before its painful for the patient. The other student gave the patient an exercise to do whereby they stretched their GH capsule in front of a mirror to ensure that they were not using side bending to assist (see video).
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