One of the greatest pieces of physiological research in the twentieth century was undertaken by William Garner Sutherland D.O. He was one of the early graduates of the original American School of Osteopathy at Kirksville, Missouri in 1900. Whilst a student he noticed that the structure of certain cranial bones, particularly where they joined each other, were bevelled in a striking manner. He noted that there was a marked internal bevel where the squama of the temporal bone overlaps the great wing of the spheroid and the inferior border of the parietal, which itself displayed a marked external bevel. As he was studying under Dr Still, Sutherland was very conscious of the relationship between structure and function. If these bones were so structured, then, he reasoned, there must be a physiological function related to it. Further investigation of the bones of the skull led him to note many other articulations, such as the ‘tongue and groove’ junction between the lateral part of the basilar portion of the occiput, where it fits into the medial aspect of the anterior third of the petrous portion of the temporal bone.
Sutherland reasoned that these joints could only make sense if they contributed towards motion between the bones. Against all the accepted medical thinking he reasoned, studied and observed the cranial structures and their functions, with a view to establishing what these were. Gradually, over many years he came to understand the inter-relationship between the bony structures of the cranium and its contents and functions. These include not only the nerve and brain tissues but strong fibrous bands which divide and support the various areas of the brain and which are intimately involved in the motion of the cranial structures. The two main tension membranes are the Falx Cerebri and the Tentorium Cerebeli.
|Side View of Adult Cranium|
|Infant Cranium Showing:|
1. Anterior Fontanelle; 2. Posterior Fontanelle.
|Section of side view|
of speroid bone.
|Section of side view|
Side view of sacrum.
|The arrows indicate directions of synchronous co-ordinated alterations in position of the main components of the cranio-sacral mechanism, during flexion (inhalation). The reverse, a return to a neutral position, occurs during extension (exhalation). The dotted line indicates the sacral position at the limit of flexion (inhalation),|
Illustration shows cranial and sacral movement during inhalation and exhalation
The erroneous belief that the skull is a rigid bony structure, and that the sutures are immovable arose from anatomists studying these structures from dried specimens. The study of living bones is quite different. It is a simple matter to feel the resilience of the skull in the living skull, even into adult life.
The bones that make up the skull are, in health, movable and do in fact, move in a rhythmic manner throughout life. The range of this movement is small, but to the trained hand, easily felt. Since nothing in the body is without purpose, this function is reasoned as contributing to the normal running of the body. It might be argued that what is felt is no more than a resiliency, a plasticity, which would be necessary. to avoid the skull being over rigid, and thus in danger of fracturing in case of a blow. This is partly true, but does not explain the rhythmic expansion and contraction that takes place in the skull, independent of the normal respiration and heart beat.
Primary Respiratory Mechanism
Research over the past half century has demonstrated that this movement is part of a mechanism which has been named the ‘primary respiratory mechanism’. This involves not only the skull bones, and their contents but, by virtue of strong fibrous tissue connections, the spinal column and the sacrum (the triangular bony structure at the base of the spine). As these structures move (much as the diaphragm and chest move in breathing, but on a much smaller scale) an important circulatory function is being carried out in the skull and throughout the body. Blood and cerebro-spinal fluid are pumped through the intricate channels surrounding the structures of the brain and the central nervous system.
It has been shown under the electron-microscope that the tissue which binds all other tissues together, the connective tissue, or fascia, of the body, has a tubular structure. The cerebro-spinal fluid permeates these structures and carries with it hormonal secretions vital to the health of the body. The most important glands in the body lie within the skull, and their ability to function is now known to be influenced by the efficiency, or otherwise, of the primary respiratory mechanism.
What does all this mean in terms of health and disease? It explains a good deal that was previously unexplained, and opens up the possibility of treating conditions that have proved untreatable or stubbornly resistant to treatment, by more conventional methods.
|Illustrates cranial manipulation aimed at restoring normal mobility between the zygomatic and the temporal bones. This treatment is extremely gentle. No force is used, only a holding of the appropriate bones whilst the patient’s respiratory effort creates the corrective|
If in adult life there occur blows to the head, whiplash injuries to the neck, heavy dental extractions, blows to the base of the spine, even more subtle structural pressures resulting from new dentures, then the complex mechanism, described above, can be interfered with and a variety of symptoms, local and distant can occur. Local conditions that commonly result from this type of cause include tinnitus (ringing in the ears), Meniere’s disease (loss of balance), facial neuralgia, migraine and other headaches, visual disturbances, jaw dysfunction (difficulty in chewing or in opening the mouth) etc. Distant effects can include any sudden changes in the metabolism of the body which could have hormonal origins.
Treatment of Cranial Distortion in New-born Babies
A vast range of conditions have been helped by cranial osteopathy’s ability to positively influence the hormonal balance. Such conditions as rheumatoid arthritis, multiple sclerosis, fluid retention, asthma and other allergic problems have all been favourably (together with other natural methods) influenced. The most exciting and important application of this approach is, however, in the treatment of babies and children who have suffered cranial distortion before, during, or soon after birth.
A variety of factors can affect the soft bones and cartilaginous structures of the foetus before, and during birth, and of the infant, soon after. If the mother-to-be has a spinal curve or an acute lumbar curve (hollow back) then the developing foetus may lie in such a way as to crowd or warp, the skull bones. If labour is induced, and the mother’s birth canal has not had the opportunity to soften and prepare for the engagement of the foetal head, or if the birth is too rapid and the contractive forces acting on the foetal head are too powerful, or if the process of labour is too long and difficult, the effect on the soft head bones and their supporting structures (tension membranes etc. ) can be to so mould them that a return to normal never takes place. If instrument delivery is clumsy this too can cause cranial distortion, and long term problems. This is not to say that forceps delivery is always harmful, indeed it often prevents even worse damage, but it certainly can cause damage, wrongly applied.
If a baby is born prematurely, and is laid on a normal surface then the very weight of the head can have a compressing and warping effect. After all, the foetus has been cushioned in fluid, and a water bed would be a better start as a surface on which to lie, for such a newcomer.
If a newborn child cries too much, refuses food, is stiff and difficult to handle, has sleeping problems, has swallowing difficulty or even shows a distinct preference to lie on one side or not to lie on its back, or is dopey and just ‘too good’, taking no interest in anything, or rubs or bangs its head, or fails to develop normally, then chances are that there is a cranial distortion. All such children should be seen as soon as possible by a cranial osteopath, as should all cases of cerebral palsy and spasticity.
The treatment methods are exceedingly gentle, and treatment can be started within hours of birth. There is no heroic pushing and pulling which so many people associate with conventional osteopathy, but a gentle, subtle attempt to restore structural normality and with it functional normality (health). Learning the specialized techniques of cranial osteopathy requires lengthy and diligent study and practice. The anatomy and physiology of the skull, and its relationship with other spinal and body structures and functions, is a demanding study. Sensitive and subtle manual skills are required in the application of cranial manipulation, which is not so much concerned with altering the position of bones as with releasing articular strains between the structures and restoring physiological motion. As has been stated, it is in infants and the new-born that the greatest good can be achieved. The following quotation from The Selected Writings of Beryl Arbuckle D. O. published in the USA by The National Osteopathic Institute and Cerebral Palsy Foundation (1977) illustrates this:
The under-developed cerebro-spinal system of the newborn is housed by an immature cranium and vertebral canal. To the skull, with all its intricate construction, so often taken for granted, its physiological movement, little considered and less understood, is attributed the function of protecting the brain. The infant skull is very immature having little ossification and many of the bones are in separate parts, cartilaginous and membranous. The vault consists of very thin bones with but one layer and no bony sutures. The overriding thus possible during delivery is one of nature’s provisions for the reduction of cranial size to better enable the passage of the head through the birth canal. If, by chance, for any one of a hundred reasons, that infant is unable to reduce to the full extent this natural moulding it is impossible to prognosticate the severity of the symptoms which may be manifested in later life on account of the persistent unnatural strain throughout the stress bands of the aural membranes. ‘An osteopath sees cause in a slight anatomical deviation for the beginning of disease’ (A. T. Still). There may result severe or slight muscular handicaps, mental difficulties, from idiocy to mere confusion or general slowness, inability or instability.
The physician who is able to recognize these deviations and able to make the necessary corrections intelligently at the very first sign of slight difficulty, often years before serious symptoms could be manifested, while the child is still in the developing or growing stage, will turn the trouble of today into the triumph of tomorrow.