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CONCEPT OF FULCRUM - Illustration
pp124,125
THERAPEUTIC TOUCH
p126
Various forms from touching are used into therapeutic, each one having
specific qualities making it possible to establish a relation therapeutist patient adequate, to moderate a perception, or to have a precise action.
I - For example, it is possible for the therapeutist to come into contact with
its patient, while maintaining a limit clear between them.
II - Or to establish the same contact as that which we adopt in closer
relations which unobtrusive this limit between the two people. It is a contact of
“fusion”. - We remember the feeling painful physics to be separate of a
expensive being.
III - To choose a touch of “transférance” which is that which we use when we
tighten the hand of another person.
These two last forms to touch do not maintain limit clear between the two
persons.
p126
THERAPEUTIC TOUCH IN CRANIAL TECHNIQUE
In cranial technique, we will adopt a touch of ease of use, in the following way:
- its pressure equal to the resistance of tissue is contacted, which makes it
possible to remove the interface between expert and patient. That is done
easily, as we saw, by transferring this one between the back by therapist, not
in liaison with the patient, and table of processing surfaces it.
- the expert projecting his perception on this same level.
- It is then established a perfect relation between the two people, any
induction gestural coming from the expert acts specifically on this precise
level.
p127
THERAPEUTIC TOUCH - Illustration
Symbiosis patient-expert
“Art to link themselves and separate”
p128
We will illustrate the relation of the two people implied, through that of the image of two
asses walking on together on a narrow watershed in mountain. The path being narrow,
they are based one on the other, which instinctively reassures them. As the ground is
not very sure, that located outside rests of advantage, which naturally the other
compensates for.
But if itself, according to the risks of the ground, loses foot even slightly, it will then
increase its support on its congeneric which goes on a sure riprap.
They are both in a tonicity of reciprocity, of convenience, which enables them to form a
unit of tensegrity. There is no interface between them, but it establish one of them,
dynamic, throughout their path with this last.
It is the same in symbiosis between patient and therapist, when the hand of the expert,
after having removes the interface between its palm and the patient, to establish it
elsewhere, follows perfectly the reactions of skull of his patient to the tests and
techniques which it carries out with him.
p129
Art to link themselves and separate - Illustration
p131
CRANIAL TECHNIQUE
MANUAL DIAGNOSIS
p133
THE MANUAL DIAGNOSIS IN CRANIAL TECHNIQUE
-
Whatever that selected, the diagnostic approach at the cranial manual
level, will be carried out the patient lengthened comfortably on the table
of processing, prone.
- The practitioner is located worthy of his head.
-
We repeat of them here the general principles of each approach.
-
It induces then each one of its tests by light body movements, and
evaluates the final rebound of each movement as well as the capacity of
the cranial mechanism to adapt to the movements of compensation
(torsion, rotation side flexion, etc…. )
-
In case of doubt, he will then add a final impulse at the end of the
movement, which enables him to appreciate elasticity passivates final
that any healthy articulation maintains.
CRANIAL TECHNIQUE
THE DIFFERENT
APPROACHES
APPROACHES BY THE VAULT
pp134,135
This traditional approach, is most often chosen by many practitioners, because
it makes it possible at the same time to consider movement general of the
cranial bones, as well as theirs particular movement within this cranial
mechanism, while being able to also appreciate the freedom of the spheno basilar synchondrosis (SBS).
The fingers of the two hands, isolated without tension and deployed in space
form a cut intended to receive very irregular, side faces, posterior and higher
convexity of the patient’s cranium.
pp136,137
APPROACHES BY VAULT II
The pad of each finger comes into contact with either side of the
cranium as follows:
- the little finger, which is nearly parallel to the curved border of the
occipital bone, receives the occipital squama.
- the ring finger, behind the ear, on the level of the astérion, is placed on
the angle postero - inferior of parietal (phalange) and on the mastoid
portion (phalange),
- the middle finger, in front of the ear, contacts by its second phalange
(or third according to the morphology of the patient’s cranium and of
the practitioner’s hand), the angle antero-inferior of parietal on the
level of the ptérion,
- the index on the external surface of the large wing of the sphénoïde.
- One thumb rests against its counterpart - above skull - in order to
create a fulcrum for the flexors of the fingers.
APPROACHES BY VAULT III
SPHENO-FRONTO-OCCIPITALE APPROACHES
Second traditional approach, very often also adopted, it has the
advantage for the therapeutist of having in each one with its hands, two
bones considered as the motive fluids of the cranial mechanism, the
occipital one and the sphenoid.
The practitioner is always to the patient, but this time, on a side or other.
Its cephalic hand receives the scales occipital, whereas its higher hand
grasp the front-end processor and the large wings of the sphenoid.
pp138,139
SPHENO-FRONTO-OCCIPITALE APPROACHES II
The cephalic hand (hand located subsequently on skull of the patient), out of cut,
receives the occipital one, pulp of the fingers joined on the opposite occipital
angle.
On thenar and/or hypothenar eminences comes to place the angle of the
homologous scales occipital.
The caudal hand (Hand located before on skull of the patient ) , out of cut, wraps
the frontal bone, fascinating contact with two external surfaces of the large
wings of the sphenoid. For this, the contacts carry out:
- the pad of the distal phalanx of the index finger and/or the middle finger, the
side opposite to the practitioner,
- the pad of the distal phalanx of the thumb on the same side as the practitioner
According to his policis-index opening, each expert will only act either on the
large wings of the sphénoide, or by also inducing the movement of the frontend processor.
SPHENO-FRONTO-OCCIPITALE III
APPROACHES
p141
BI-MASTOIDAL APPROACHE
pp142,143
This symmetrical approach has the advantage of using the most
important levers of skull which are the mastoid ones, but also the
disadvantage of not being in direct catch with the driving bones of the
cranial movement.
We know that nevertheless, the advantage of the levers in fact an
approach privileged during the induction of the techniques, in particular
for those acting on the transverse dimension of skull.
The hands of the practitioner in supination, interlaced fingers, wrap the
high cervical column and occipital squama. Next, the thumbs, which lie
parallel to each other, come to rest along the edge antero - external of
the mastoid process. Thenar eminences contact the mastoid portions of
the temporal one.
The end of the thumb is below the axis of the temporal one, whereas its
thenar eminence is above.
The practitioner will be able to then induce any cranial movement
starting from the pyramid petrous, placed as a corner in the base of skull,
between the sphenoid ahead and the occipital one behind.
The end of its behind going thumb, in inside in top creates a movement of
inflection, whereas its thenar eminence going ahead, in inside and top
creates the opposite movement.
BI-MASTOIDAL APPROACH II
p143
SPHENO-MASTOIDAL APPROACH
pp144,145
This approach, which is used less often, is a
variant of the fronto-occipital approach with
the cephalad and cradling the mastoids
instead of the occiput.
It is useful not because the movement
induced by the practitioner starts from the two
motor bones, but because it specifically
involves the anterior part of the cranial base
i.e. between the sphenoid and the temporal
one.
p144,145
APPROCHE SPHENO-MASTOIDIENNE II
The cephalic Hand, cups the anterior part of
occiput, the pad of the thumb located on
the ipsilateral mastoid process, the pad of
the other fingers pressed together on that
opposite.
The caudal Hand cups the frontal bone,
makes contact with 2 external surfaces of
the large wings of the sphenoid on which,
it makes the following contacts:
– the pad of the distal phalanx of the
index and/or middle finger, on the side
opposed to the practitioner,
– the pad of the distal phalanx of the
thumb, the practitioner’s side.
pp146,147
PERCEPTION OF AN ABNORMAL BEVEL
The bevels of the cranial sutures overlap in such a way that,
if the therapist pushes them towards each other from the
outside, the internal bevel glides on the external bevel over a
greater distance than the external bevel, which is limited in
its gliding movement over the internal bevel by the epicranial
aponeurosis (i.e., the extracranial counterpart to the
periosteal layer of the dura mater).
During the release mechanism, the practitioner must first
free up the external bevel by pushing it slightly toward the
center of the cranium before separating it from the internal
bevel, thereby increasing the sutural space.
p147
PERCEPTION OF AN ABNORMAL BEVEL- Illustration
CRANIAL TECHNIQUE
MANUAL DIAGNOSIS
IN CRANIAL TECHNIQUE
p149
PRACTICE OF THE MANUAL DIAGNOSIS PROTOCOL
The vault approach allows the practitioner to make use of the modalities of
cranial adaptation (movements of torsion, rotation/lateral flexion, etc.) in order
to reveal and confirm which sutures do not open or close normally, and in
which quadrant they are located.
In fact, each quadrant contains only one large suture, either in the vault or in
the base, with these large sutures linked only by the temporal bone.
Testing the suture suspected of being abnormal then allows the practitioner
to identify the lesion precisely and to initiate the appropriate treatment
technique.
The protocol thus consists of the successive manual evaluation of the four
quadrants united by the temporal bones with its six pivots:
– its six pivots:
• three at the base,
• three at the vault.
p150, 151
Identification of the four quadrants
On a horizontal section of the cranium, we can imagine two lines intersection
at right angles at a point lying at the center of the cranium, i.e., roughly at the
level of the spheno-basilar articulation, deemed to be the motor of cranial
motion.
As the diagram indicates it here after, each dial is:
On the level of the base, traversed by sutures which join their counterparts
on the level of the sphenoid. We thus have, in the former quadrants: - The
fronto-sphenoidal suture and in the posterior quadrant : - The lambdoïd
sutures.
On the level of the vault, the articulations are carried out thanks to four
sutures, two former, two posterior, which join the interparietal suture. I.e., on
the level of the former quadrant,
– the fronto parietal suture
and on the level of the posterior quadrant,
– the lambdoïdal suture
Diagram of Identification of the four quadrants
p151
P152, 153
MANUAL EVALUATION OF THE FOUR QUADRANTS
We favor the vault approach, which, as we have already shown, allows
us to have contact with each bone and thus to measure the movement of
each bone within the general framework of cranial motion.
The two passive hands feel the different components of the spatial
motion of each bone, their restrictions, and, in particular, the quality of
the end-stage of the movement, which, as we have noted, depends on
the state of the connective tissue of the suture.
A lesion in this tissue is followed by a change in its basic properties of
flexibility and plasticity, which is caused by an altered blood supply and a
loss of its water content.
If the practitioner fails to feel these changes adequately, he or she can
impart a slight movement of rebound with the pad of a finger in order to
detect the presence or absence of these properties in the connective
tissue of the suture being tested.
DIAGRAM OF MANUAL EVALUATION OF THE FOUR
QUADRANTS
P153
DIAGNOSIS OF THE MOVEMENT OF FLEXIONEXTENSION
This movement of flexion - extension can be carried out various manners.
Here that which seems to us moreover just mechanically, as well as easiest
to practically induce: It is by the approach by the vault.
- the therapeutist veillñe so that its elbows apart from the table, and are
located low than the plan of the work table.
- It then moves its two front forearms in the direction of skull of the patient,
this mini force ascending moving the two little fingers and index respectively
towards the root of the neck (occipital flexion) and ahead and in bottom for
the indices (flexion of the sphenoid).
- This decomposition of the force generated by the vector of the front
forearm, is facilitated by anterior slope of the therapist comfortably installed in
charge of the patient.
FLEXION (APPROACH BY THE VAULT)
SPHENO-FRONTO-OCCIPITAL FLEXION - APPROACH
We do simultaneously in the following way :
• The lower hand, under the occipital one, involves the bone ahead and in top,
a curved movement around its transverse axis.
• The higher hand involves the external surface of large sphenoid forwards and
the top.
• This higher hand must carry out two successive movements around two
close, but distinct transverse axes:
1º - to actuate in flexion the front-end processor around its transverse axis
by the palm as of the higher hand,
2º - to continue this movement ahead and in bottom on the level of the large
wings of the sphenoid, by creating a transverse axis by the thumb and
the index of this same hand.
FLEXION BY APPROACH SPHENO - FRONTO OCCIPITAL
EXTENSION BY THE TWO APPROACHES
USUAL COMPENSATIONS
We saw, during the study of biomechanics, then of pathomechanic, that
under a certain number of various pressures that the cranial movement had
to undergo, this one changed in order to preserve a dynamics necessary to
its functions. And that the first usual movement of compensation was that of
torsion, then with a more harmful degree rotation - lateral flexion (R.F.L.).
This leads us to understand that so that these necessary compensations can
exist, it is necessary that the cranium preserves this adaptability throughout
our life. Movements that we to induce thus now are the manual checking of
these possibilities. If they did not exist any more, us should then restore
them, in order to always preserve this adaptability.
We thus now successively will induce.
- a right torsion,
- a left torsion,
- A right R.F.L,
- A left R.F.L,
- a right lateral displacement, etc
ADAPTABILITY IN TORSION
Whereas the movements that we have just seen were held around the only
transverse axes, torsion adds a component of movement around an anteroposterior axis, parts anterior and posterior of going cranium on the other hand
one of the other.
A free cranium must be able to adapt an additional constraint as well in right
torsion, as in left torsion. This technique thus will allow us:
* to evaluate the freedom of the cranial mechanism during the movement of
adaptation at the time of the phase of cranial expansion.
* to correct directly a cranial lesion in opposite torsion.
* to indirectly reduce - by exaggeration - a homologous lesion of torsion, in
moving the point of balance of the cranial movement.
MOVEMENT OF TORSION BY THE VAULT
During the phase of expansion, to carry out a
movement of right torsion, the therapitist
carries out a movement of inflection to which
he adds a component of flexion in the following
way:
- its right index involves the external surface of
the large right wing forwards, the top and
slightly towards the interior, carrying out a
movement in comma which underlines the
external part of the eyebrow.
- whereas its annular left upwards moves the
mastoid angle of parietal the left, before and
the line of centers of skull, describing a
movement in comma in the direction of the
vertex. The little finger can follow it.
MOVEMENT OF TORSION by APPROACH SPHENOFRONTO-OCCIPITALE
During the phase of expansion, the expert adds a component of torsion to the
movement of inflection in the following way (for a right torsion).
The higher hand:
- the middle finger produces a rise and a projection of the external surface of the
large wing of the sphenoid, around an antero - posterior axis.
- the thumb located on the large left wing accompanies its movement, without
exerting any action (it is passive).
The lower hand:
- the rise in the left mastoid angle in parietal involves around the same antero posterior axis, before arm of the expert carrying out a light pronation.
MOVEMENT OF LATERAL ROTATION FLEXION
This movement exaggerates the adaptation in torsion, when this one was
insufficient in front of a constraint undergone by the cranial mechanism.
Its goals: This technique will allow us:
- to evaluate the freedom of the cranial mechanism lasting this movement of
adaptation during the cranial expansion.
- to directly correct a cranial lesion in rotation opposite side inflection.
- to indirectly reduce (by exaggeration) a lesion of homologous rotation lateral
flexion.
APPROACHES BY THE VAULT OF THE ROTATION
LATERAL FLEXION MOVEMENT
Description for a rotation right lateral
flexion.
During the execution of this technique of
lateral flexion rotation, only the left hand
of the expert is active, whereas its right
hand perceives the freedom of the
bones.
The left hand induces the movement
by bringing closer all its fingers from/to
each other, at the same time as it draws
slightly towards him, according to the
axis longitudinal of its forearm.
At the time of the phase of relaxation of
the cranial movement, the passive
expert lets skull return at his neutral
point.
DRAWING OF THE DIGITAL ACTION IN THE
APPROACH BY THE VAULT
SPHENO-FRONTO-OCCIPITAL OF THE ROTATION
MOVEMENT LATERAL FLEXION APPROACHES
During the course of the phase of
expansion, the osteopath adds to the
Inflection a movement of R.F.L. That
one carries out in the following way:
The two hands of the expert downwards
involves the right-sided of the cranium
towards the right-sided of skull in
direction of the chin, around an anteroposterior axis.
Whereas they make turn sphenoid
and occipital around their two respective
vertical axes, in contrary direction
(on the left ahead for the sphenoid
behind and on the left for the occipital one,
opening space on the right-sided).
LATERAL DISPLACEMENT OF THE SYMPHYSE
The skull if it is free, must be able to support a pressure lateral confining.It is
what it does by distributing an additional force in various directions, the
sphenoid and the occipital one (two principal driving parts) turning each one
around their vertical axis respectively, in the same direction, which causes a
side shearing force on the level of the spheno-basilair synchondrosis which
joins together them.
This constraint, which is not most current in the adult, except at the time of
accident, is on the other hand more frequent in the postpartum, when
constraints deformed skull with of its plasticity in the last phases of work.
It is necessary our intervention then in order to minimize the effects of these
constraints when that is still easily correctible.
Of course, a free cranium must be ready to undergo and disperse this constraint
if it is free in the adult.
LATERAL DISPLACEMENT - APPROACH BY THE
VAULT
Example for a right lateral displacement.
The right hand.
Its index involves the external surface of the
large right wing of the sphenoid, towards the
left
Its 4th finger brings the occipital one in the
same direction and the same direction
The left hand:
• Its index involves the external surface of the
large left wing of the sphenoid backwards,
• Whereas its 4th and its little finger involves
the occipital one backwards.
The important thing is the synchronous work of
the fingers of the two hands, which keep a
constant space between them.
LATERAL DISPLACEMENT - APPROACH
SPHENO-FRONTO-OCCIPITAL
During the phase of expansion of the cranial
mechanism, the hand superior of the
osteopath, involves the sphenoid and the
front-end processor of the left towards the
right, whereas the lower hand involves
occipital line towards the left, in a movement in
curve.
The two hands go in the same direction,
traversing the same circumference, preserving
in a constant way the variation which
separates them.
As always during the phase of relaxation the
hands of the expert are inactive and let the
mechanism return at its neutral point thanks to
its elasticity.
OTHER POSSIBLE CONSTRAINTS AND
ACCOMMODATIONS
We saw before that it exists other possible constraints, as those which
involve a vertical displacement, a compression with the symphysis.
And more simply a combination of the constraints than we have just
seen.
You will understand easily that we must initially limit ourselves to
share the most current experiments together, most usual, to possibly
hold the rarest cases with a teaching more specialized and much
more sophisticated than one can approach only after one some
practices showed us the need, even the importance.
INTEREST OF THE TESTS OF
ACCOMMODATION
As will show it to you the following diagrams, each movement of
compensation, of adaptation, constrained of the different sutures.
It is then understood easily that while passing then from one constraint to
another between two different diagrams, such as for example of torsion to
rotation side inflection, thanks to the perceived restrictions, we can isolate the
sutures which are not free any more.
In addition, one understands as easily as while passing from one side to
another in the same diagram of adaptation (for example torsion) any forced
suture on a side, open then if it is free when one passes on other side. If it
cannot do it, there is then the certainty of his dysfunction.
This manual perception, like any skill, requires a drive and a knowledge of
biomechanics which can be obvious only after one practical intense, that
cannot make the economy of time. Even does the concert the international
level make its ranges on its piano every day, isn't?
TESTS IN TORSION
46
LATERAL FLEXION TEST
47
TESTS BONE BY BONE, SUTURE BY SUTURE
We successively determined:
1º - four quadrants, which enable us to know in each one of them, restrictions of
movements, i.e. dysfunctions.
2º - In each dial, the sutures which do not function correctly
(reduction or
absence of movement), which signs the cranial osteopathic lesion.
3º - the tests of accommodation which we have just explained, enable us to
check the implication of each suture, in closing and opening (even diagram
on the right and on the left), and of impossibility of adaptation (R.F.L.).
4º - the test in laterality signs to it not adaptation of the temporal one.
5º - This is why we will begin the tests bone with bone by the temporal one.
4º - Then, as each joining puts in presence at least two bones, it will then be
necessary for us to determine which is the bone which involve this
dysfunction, and to make this analysis on the level of each dysfunctional
joining of this bone.
5º - We will study, therefore after the temporal one, how one can carry out the
diagnosis for each bone of skull, then for each one of its parts, since this one
is always articulated with several bones
p154
DIAGNOSIS OF TEMPORAL BONE
As we saw, at the time of the study of its biodynamics, the bone tempopral
understands two plans, perpendiculars between them:
- The first horizontal one which is articulated in three point-pivots, called of back
ahead:
* Petro - basilar, between a hollow rail located on the petrous apophysis, and a rail
full on the apophysis basilar with the occiput (left former).
This articulation allows a movement of slip and bearing between the two structures.
* Petro-chin-strap, which sometimes understands a small meniscus, between the
side edge of occipital and the posterior edge of the petrous pyramid.
This articulation allows a movement of separation between the two bones, follow-up
of a movement in inside and bottom of the temporal one.
* Spheno-petrous, one by a ligament (ligament of Grueber) between the petrous
apex and the apophysis clinoïde posterieiure of the sphénoide. This articulation
allows a movement of circumduction of the petrous apex around clinoid insertion
of the spheno-petrous ligament.
TEMPORAL DIAGNOSIS II
Let us see the vertical plan now, with the three pivots - points which make it
possible this squamous part to be articulated with the bones of the vault:
* The condylo-squamo-mastoid (CSM), which links the mastoid part the temporal
one (external bevel in lower part and intern above) with the antero-lower part
correspondent of occipital (reversed bevels). This articulation carries out a
movement of separation of the two bones, follow-up of displacement in
bottom, then in inside of the temporal one.
* The Hinge-Mastoid pivot (H.M.) which brings in report the small portion having
an external bevel to the level of the temporal one, with the corresponding
zone of the parietal bone. This articulation allows a short antero-external
movement of temporal on the parietal bevel, which generates a widening of
skull.
* The Spheno-Squamous articulation, which puts in presence the vertical former
edge of the temporal one, with its external bevel and its bevelled horizontal
edge lower than depend on the internal table, with the corresponding parts of
the posterior edge of the large wing of the sphenoid.
The movement on this level is a separation suturale, at the same time as the
large wing of the sphenoid goes ahead and in bottom.
pp156,157
POSITION OF THE FINGERS TO DIAGNOSE THE
TEMPORAL ONE
We carries out an approach by the vault:
Little finger under occipitut,
4th one along the mastoid one,
Middle finger, in front of the ear,
the index finger on the external surface of
the greater wing of the sphenoid
the two thumbs touching each other at the
sagittal suture and acting as a fulcrum
for the diagnostic movements of the
fingers that are induced by their flexor
muscles.
p158
TEMPORAL: PETRO-BASILAR TEST
Movement :
This is an external gliding movement of the concave edge of
the petrous temporal bone on the convex edge of the
basiocciput that causes the cranium to widen transversely
during movements of cranial expansion (flexion/external
rotation).
Test :
From the position described and illustrated in the previous
pages, the practitioner evaluates the quality of the final
phase of the movement by using the pad of his or her ring
finger to impart a "flipper movement" (i.e., a sliding
centripetal motion along that transverse axis).
TEMPORAL: PETRO-BASILAR TEST - Drawing
p159
pp160,161
TEMPORAL . PETRO - JUGULAR
Movement
The jugular foramen is widened. The petrous temporal
bone rotates anteriorly on its oblique axis and is slightly
depressed while its two borders tend to move apart, thus
causing its jugular process to move inferiorly, anteriorly,
and slightly medially during the movement of cranial
expansion.
Starting from the position we have already described, the
practitioner evaluates the quality of the final phase of the
movement, as his or her ring finger moves away from the
little finger and simultaneously moves inferior and slightly
medially.
p161
EVALUATION PETRO-JUGULAIRE - Dessin
pp162,163
TEST CONDYLO-SQUAMO-MASTOIDIEN
Movement :
It occurs a separation of this squamous and bevelled suture,
more marked in its upper part. The two parts, occipital and
temporal move back and drop, on nonparallel axes (convergent in
external direction), and moreover more located in different plans.
What constrained this squamous part to separate, while using its
plasticity to be able to adapt these various parameters.
The test:
The practitioner evaluates the quality of the final phase of the
movement from the starting-point previously defined. His or her
ring finger moves away from the little finger while these two fingers
are drawn slightly downwards.
p163
Test Condylo-Squamo-Mastoidien - Drawing
pp164,165
TEST HINGE – MASTOIDE (HM )
It is this small bevel which makes it possible to pass from external
rotation to extreme rotation.
Movement :
There is a sliding movement between these two bones, with the
temporal squama apparently falling outwards, just like the top of a
buckled cartwheel as it sinks into a rut. This release of the HM
bevel then allows the temporal bone to enhance its external
rotation.
The test :
The practitioner evaluates the quality of the final phase of the
movement from the starting-point described previously. His or her
ring finger barely moves away from the little finger, causing the
mastoid to move downwards toward the patient's feet.
p165
TEST HINGE – MASTOID (HM ) . Drawing
pp166,167
TEST OF PIVOT SPHENO-SQUAMOUS
Movement :
The squamous parts of the two bones move apart
and rotate anteriorly, slightly laterally, and inferiorly.
The test :
The practitioner evaluates the quality of the final
phase of the movement from the starting position
described previously. His or er index finger moves
away from the middle finger, while these two
fingers are drawn slightly inferiorly and laterally.
TEST OF PIVOT SPHENO-SQUAMEUX - Drawing
p166
pp168,169
TEST OF PIVOT SPHENO - PETROUS
Movement :
Circumduction occurs around this ligament (Grueber's
ligament), which allows the adaptive movements that
must occur at this important anatomical location at the
center of the cranial base.
Let us not forget the extreme richness of the elements
which pass on the level of the zone of the cavernous
sinus.
The test :
The practitioner evaluates the quality of the final phase of
the movement from the starting -point described
previously. His or her index finger moves slightly away
from the middle finger, while the latter finger moves the
temporal bone by circumduction, initially inferiorly and
then medially, etc......
p169
TEST OF PIVOT SPHENO - PETROUS - Drawing
pp170,171
SUMMARY OF THE TEST OF THE SIX PIVOTS
The expert goes successively and, on each side, to carry out the following
movements:
- to print a “movement to feel down” with the pulp of its 4th finger, for the
petro-basilar articulation,
- to separate its 4th finger from its little finger, while accompanying this
movement by a component in bottom, and slightly towards the interior,
for the petro-jugular articulation
- to separate its annular from its little finger, both being attracted slightly to
the bottom, for pívot C.S.M.,
- to reduce with its 4th the mastoid one after being itself separate fifth finger,
for pívot H.M.,
- to separate its index from its middle finger, 2 being slightly attracted to the
bottom and outside, for pívot S.S.
- finally to separate its index from its middle finger, whereas this last
involves the temporal one in bottom, then in inside, etc ........ for the
sphéno-petrous pívot.
DIAGRAM OF THE TEST OF THE SIX PIVOTS
pp170,171
STUDY BONE BY BONE
In order to establish the diagnostic pathomechanic of skull, we successively
saw:
1º - four quadrants.
2º - Inside or of the implied dials, implied sutures.
3º - We then checked the constraint and the possible opening of the sutures,
thanks to the diagrams of adaptation (Torsion, R.F.L. .......)
4º - the test of side displacement indicated or not the implication of the temporal
bone to us,
5ª - Practitioner then the test of the six pivots of temporal, we then objectified the
pivots implied in the pathological diagram.
It does not remain us any more whereas to check on the bones implied by this
manual diagnosis, its sutural dysfunction. It is what we will study now
It will be then easy, for any educated osteopath, to implement the correct
technique.
MOVEMENT OF THE OCCIPITAL ONE
In this technique (Spheno-Fronto-Occipital approach), the expert immobilizes by
his pollici-index grip, frontal and sphenoid in inflection, whereas during the
same phase of extension, it checks the possibility of movement of the
occipital bone around the three axes.
MOVEMENT OF THE SPHENOID
To evaluate the movement of the bone
Sphenoid (and possibly its
dysfunctions), the osteopath this time
immobilizes the occipital one and will
mobilize the bone sphenoid around
his three axes, as the drawing in top
indicates it.
It is to note that the little finger of the
practitioner (covered of a fingerstall)
is located in the mouth of the patient,
contacting the maxillary above the
teeth.
pp172,173
TEST INTRA - SPHENOID
We know that the greater wings of the sphenoid can undergo a very small
additional movement with respect to the body at the end of flexion because of
a movement of torsion occurring around their sites of attachment. Here, we
evaluate this physiological freedom of movement, which is required in times
of extra stresses, especially unilateral ones.
pp174,175
TEST INTRA – SPHENOIDI (1º technique )
Position of the expert.
Its seized cephalic hand the
external surface of the two large
wings of the sphenoid in its grip
pollicis - index, whereas the index
of its caudal hand will contact by its
pulp the hard palate on the level of
the cruciform suture.
Movement.
Two hands of the expert accompany
the phase by flexion bones of the
line of centers, until the end of their
movement.
The expert then evaluates, while
maintaining the position of the body
sphenoid by the pulp of its endobuccal finger, that it can still
increase the flexion of the large
wings.
pp174,175
TEST INTRA – SPHENOID (2º technique )
Position of the expert.
His or her cephalad hand takes hold of the external
surface of the greater wings of the sphenoid in the
thumb-index finger pincer, with the pad of the index
finger of the caudad hand touching the hard palate at
the cruciform suture.
Movement.
The practitioner's hands follow the flexion phase of the
midline bones until the end of the their movement.
While holding the greater wings of the sphenoid in place
in the thumb-index pincer, the practitioner checks
whether the pad of his or her intraoral finger can still
impart a very slight movement to the body of the
sphenoid, particularly into extension.
The OTHER BONE OF the VAULT and the BASE
OF CRANIUM
We have just studied together the general manual diagnosis of the
dysfunctions of skull (I.e. its pathoméchanique). The following stage will be to
study the dysfunctions bone by bone, joining by joining and pathologies which
are dependent for them. But it is absolutely necessary to before dominate the
normal and pathological perception of these mini general movements in order
to claim to perceive of them the nuances which are much sophisticated each
joining bone by bone.
One cannot make the saving in this perceptive training, without making incur
with the patients of the risks which it would be illogical to take in this so
important field of health.