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OMM #17 Wed. 9/3/03, 3pm Dr. Fotopoulos Blake Illston Page 1 of 3 Non-Physiologic Strain Patterns at the SBS Vertical Strain Patterns Note: The bolded items were stressed as Important by Dr. Fotopoulos---Know them!!! See Powerpoint Presentation from this hour for referenced slides Case Presentation •A 32 y/o male patient presents to your office with a severe headache for the past three days. He relates to you a history of standing up under a low shelf and hitting the top of his head. He points to an area along the sagittal suture in the region just posterior to the bregma and anterior to the vertex. • Your physical examination reveals: -no focal neurological deficit • Your palpatory findings include: -Both index fingers move superior and fifth fingers move inferior •Your diagnosis: Differential Diagnosis (be sure to know your differentials) •Inferior vertical strain •Tension headache •Cluster headache •Vascular headache •Etc. *Types of Pathologic Strains* (Definitely Know these categories for the Exam) 1. Vertical Strains (superior and inferior) 2. Lateral Strains (right and left) 3. SBS compression -Be able to differentiate these Non-Physiological (Type II) strain patterns Characteristics of Pathologic Strains •** Named for the position of basi-sphenoid relative to basi-occiput (Definitely Know how to Name these strains) •Involves shearing or compression of the SBS •Usually traumatic in origin OMM #17 Wed. 9/3/03, 3pm Dr. Fotopoulos Blake Illston Page 2 of 3 Vertical Strains (you need to know what happens, i.e. How the bones are moving and interrelating, but how it is caused [below] is just FYI and not going to be tested on) •Superior Vertical Strain –traumatic effect of a blow on the vertex behind the plane of the SBS or from below through the mouth, anterior to the plane of the SBS •Inferior Vertical Strain –traumatic effect of a blow on the vertex anterior to the plane of the SBS or from below through the heels or mandible posterior to the plane of the SBS Vertical Strains (Note fig. 5-20 or slide 9 in PP for Vertical Strain Axes) •Sphenoid and Occiput rotate in the same direction about TWO parallel transverse axes (Know this for the examination) –across sphenosquamous pivots of the sphenoid –just above the jugular processes of the occiput •Superior Vertical Strain: sphenoid base moves superior relative to the occiput base •Inferior Vertical Strain: sphenoid base moves inferior relative to occiput base Vertical Strains •Superior vertical strain (Note Fig. 5-21 or PP 12 for Superior Vertical Strain Motion) –sphenoid in flexion –occiput in extension –temporals in internal rotation •Inferior vertical strain (Note Fig. 5-22 or PP 13 for Inferior Vertical Strain Motion) –sphenoid in extension –occiput in flexion –temporals in external rotation Vertical Strains •Superior vertical strain –forefingers of both hands move inferiorly –little fingers of both hands move superiorly •Inferior vertical strain OMM #17 Wed. 9/3/03, 3pm Dr. Fotopoulos Blake Illston Page 3 of 3 –forefingers of both hands move superiorly –little fingers of both hands move inferiorly Superior Vertical Strain Exercise For simulating Superior Vertical strain: •Patient sticks tongue out of mouth and down toward chin -or•Patient keeps eyes closed and looks down toward the feet Inferior Vertical Strain Exercise For simulating Inferior Vertical strain: •Patient sticks tongue out of mouth and up toward the nose -or•Patient keeps eyes closed and looks up above their head
