A Review of Physiology of Cranial Osteopathy

7/27/2019 A Review of Physiology of Cranial Osteopathy

http://slidepdf.com/reader/full/a-review-of-physiology-of-cranial-osteopathy 1/11

Journal of Osteopathic Medicine, 2003; 6(2):74-88 © 2003 Research Media

R e v i e w

A review of the physiology of cranial osteopathy

Ferguson, A .

Pr ivate Pract ice, London, Uni ted Kingdom.

Abs t r a c t

The m ode ls ge ne r a l l y us ed t o ex p la in t he p r ac ti c e o f c ran ia l os t eopa t hy hav e no t been s uppo r t ed

by re l iab le research. Th is pa per rev iews and exp lores the re levant phys io logy and f inds m uch to

adv anc e k now ledg e i n th i s f ie ld . A r t e ri a l v as om o t o r w av es hav e a f requenc y s im i l a r t o r epo rt s o f

c r a n i a l r h y th m i c i m p u l s e s ; t h e s e a r e c o n t ro l l e d b y t h e s y m p a t h e t i c n e r v o u s s y s t e m .

The r m or egu la t i on c an r ev e r s e v enous f l ow th r ough em is s a r y ve ins o f t he sk u ll . C e r eb r os p ina lf lu id is c i r cu la ted by ar te r ia l pu lsa t ions an d is par t ia l ly d ra ined v ia the c r ib i fo rm p la te in to n asa l

and cerv ica l l ympha t ics . A mode l f o r t he prac t ice o f c ran ia l os teopa thy based on we l l - resea rched

phys io logy is p roposed , and som e c lin ica l im p l ica t ions out l ined. Som e reasons fo r poo r in te r-

obse rver agreem ent in pa lpa tory s tud ies are d iscussed. Th is pape r shou ld prov ide a bas is fo r

in fo rmed research in th is sub jec t in the fu ture .

Ke y W ord s : c ran ia l, os teop athy , fie ld , c ran iosacra l , rhy thm, vasom ot ion , sym pathe t ic nervous

sys tem, cerebrosp ina l f lu id

I N T R O D U C T I O N

Ost eopa t hy w as f ounded i n t he l a t e 19 h cen t u r y by A T S ti ll .

O n e o f h is s t u d e n t s a t th e A m e r i c a n S c h o o l o f O s t e o p a t h yi n 1899 was W G S ut he r land , who o r i g i na t ed and deve l op ed

h i s i d e as a b o u t ' c r a n i a l ' o s t e o p a t h y o v e r t h e n e x t 4 0 y e a r s

a n d p u b l i s h e d t h e m i n ' T h e C r a n i al B o w l ' i n 1 9 39 . ~ T h e

k e y c o m p o n e n t s o f t h e t e a c h i n g o f it , w h i c h h a v e n o t

chang ed muc h s i nce S u t he r l and ' s t ime , a r e tha t :

1 . T he r e i s ' i nhe r en t ' m ot i l i ty o f t he b r a in and sp i na l co r d .

2 . T he ce r ebr osp i na l f l u i d f l uc tua t e s .

3 . T he r e is mo t i l i t y o f the i n t r ac r an i a l and sp i na l dur a l

membr anes .

4 . T he bones o f t he sku ll a r e mob i l e .

. T h e r e i s i n v o l u n t a r y m o t i o n b e t w e e n t h e s a c r u m a n d

t he i l i a t ha t is syn chr on i sed w i t h c r an i a l mot i on b y t he

spinal dural mening es .

S u t h e r la n d p r o p o s e d t h a t t h is m o t i o n w a s r h y t h m i c a n d

t r ansmi t t ed by f l u id o r f a sc i a t h r oughout t he bod y so i t cou l d

b e p a l p a t e d s i m u l t a n e o u s l y a t a n y p l a c e . S u t h e r l a n d

o r i g i n a ll y n a m e d t h is a r e a o f p r a c t i c e " O s t e o p a t h y i n t h e

Cr an i a l F i e l d" ( OC F ) 2 so t hese i n i ti a l s w i l l be u sed i n t h i s

p a p e r t o i n c lu d e b o t h c r a n i al o s t e o p a t h y a n d c r a n i o s ac r a l

therapy.

S i nce it s beg i nn i ngs OCF has been a sub j ec t o f con t r ove r sy .

T h e l a c k o f e v i d e n c e s u p p o r ti n g S u t h e r l a n d ' s m o d e l o f th e

u n d e r l y i n g p h y s i o l o g y h a s l e d t o a n u m b e r o f a l t e rn a t iv e

Andrew Ferguson, DO, MSc. Private Practice, London, UK.

[email protected]

Received 26/02/03, Revised 14/04/03, Acc epted 14/05/03

74

h y p o t h e s e s , n o t a b ly t h e ' p r e s su r e s t a t' m o d e l b y U p l e d g e r 3

whi ch sugges t s t ha t ce r ebr osp i na l f lu i d ( CS F ) i s p r od uced

i n t e r mi t t en t l y t hus d r i v i ng t he mo t i l i t y o f t he b r a i n and

cranium.

Desp i t e t he c r i t i c i sm of t he mo de l s , 4 he c l i n i ca l p r ac t ice o f

OCF see ms t o t h r i ve . Upl e dge r and h i s f o l l ower s have

t a u g h t t h o u s a n d s o f n o n - o s t e o p a t h s h i s v e r s i o n o f th e

con cep t t ha t he ca l ls ' c r an i osac r a l t he r a py ' . I n 1999 t h is

w a s t h e s u b j e c t o f th e m o s t t h o r o u g h r e v i e w o f t h e r e le v a n t

l it e ra t u re to d a te : T h e W o r k e r s ' C o m p e n s a t i o n B o a r d o f

Br i t i sh Col um bi a com mi ss i one d the s t udy f r om t he Br i t ish

C o l u m b i a O f f ic e o f H e a l th T e c h n o l o g y A s s e ss m e n t

( B C O H T A ) i n o r d e r to a s s e ss w h e t h e r o r n o t to p a y f o r

this t reatment . The s tu dy searched seven elect ronic med ical ,

a l t e r n a t i v e m e d i c a l a n d s c i e n t i f i c d a t a b a s e s , a n d a l s os e a r c h e d l i b r a r i e s a n d r e q u e s t e d i n f o r m a t i o n f r o m

pr of es s i ona l a s soc ia t i ons . S eve r a l hund r ed books , pape r s

and a r t i c l e s wer e eva l ua t ed i n t h r ee ma i n ca t egor i e s :

a . P a t h o p h y s i o l o g i c a l m e c h a n i s m s o f c r a n i o s a c r a l

dys f unc t i on

b . C r an i osac r a l a s ses sment

c . C r an i osac r a l t r ea t ment / i n t e r ven t ions

T h e s t u d y " d i d n o t f i n d v a l i d s c i e n t i f i c e v i d e n c e t h a t

c r an i osac r a l t he r apy p r ov i d es a bene f i t t o pa t i en t s "2

" T h e b e n e f i c ia l e f f e c t s o f c r a n i o s ac r a l t h e r a p y ( C S T ) o n

h e a l t h o u t c o m e s h a v e n o t b e e n d e m o n s t r a t e d u s i n g w e l l-

d e s i g n e d r e s ea r c h p r o t o c o l s . I n t e r - o b s e r v e r a g r e e m e n t

s t ud ie s have f ou nd t ha t a s ses sment . . . i s unr e l i ab l e . T he r e i s

l i t t l e ev i dence t ha t CS T has a va l i d pa t hophys i o l og i ca l

rat ionale. '5



© 2003 Research Media Ferguson A. A review of the physiology of cranial osteopathy

T hi s i s the r a t i ona l s c i en t i f i c pos i t i on i n t he l i gh t o f t he

e v i d e n c e t h a t h a s b e e n p u b l i s h e d . H o w e v e r t h e r e ar e

t h o u s a n d s o f O C F p r a c t it i o n e rs w o r l d w i d e a n d m a n y

pa t i en t s who seem t o bene f i t , so t he ques t i on i s " I s t he r e a

c r ed i b l e phys i o l og i ca l bas i s f o r t h i s p r ac t i ce?"

R h y t h m i c m o t io n

T h e r e a r e m a n y p h y s i o l o g i c a l c h a n g e s t h a t h a p p e n

r h y t h m i c a l l y o r c y c l ic a l l y w i t h i n t h e h u m a n b o d y . T h e s e

r ange f r om cyc l e s l a s ti ng mi l l is econds , such a s some neur a l

r e f l exes , t o cyc l e s l a s t ing hour s , days , we eks o r mont hs a s

in some horm onal rhythms. In thi s s tudy we are invest igat ing

wha t O CF pr ac t i t ione r s ca ll t he 'C r an i a l Rhyt hm i c I mpul se '

( CRI ) , whi ch i s usua l l y desc r i bed a s hav i ng a r a t e o f 6 - 15

cyc l e s pe r mi nu t e ( cpm) . 6 T h i s i s s l ow er t han t he he a r t

bea t , and was c l a i me d by S u t he r l and ~ no t t o be l i nked t o

br ea t h i ng bec ause i t i s no t sy nchr on ous w i t h i t.

P a l pa t i ng t he r a t e o f t he CRI has p r o ved t o be d i f f i cu l t ,

w i t h d i f f e r en t os t eopa t hs sugges t i ng d i f f e r i ng r a t e s , and

s t ud i es gene r a l l y showi ng poo r i n t e r r a t e r r e l iab i l it y . A l so

s o m e a u t h o r s h a v e r e p o r t e d p a l p a t i n g s l o w e r r a t e s

und er l y i ng t he usua l one ; No r t on e t a l. 7 r epor t ed a r a t e o f

3 .7 cpm as an ave r ag e o f 12 exami ne r s and 24 sub j ec t s and

B e c k e r 8r e p o r t e d a ' d e e p e r r h y t h m ' o f 0 .6 c p m . O b j e c t i v e

m e a s u r e m e n t s o f t h e C R I h a v e b e e n f e w a n d u n r e l i ab l e .

T h i s i s b e c a u s e r e s e a r c h e r s , i f l o o k i n g f o r p h y s i c a l

m o v e m e n t i n t h e s k u l l, h a v e h a d d i f f ic u l t y d e t e c t in g v e r y

s m a l l r a n g e s o f m o v e m e n t ( p r o b a b l y l e ss t h a n 0 . 3 r a m ) i n

l iving subjects .

As t he r a t e o f the CR I i s sub j ec t t o d i s agr eem ent , and

p r a c t it i o n e rs m a y b e p a l p a ti n g m o r e t h a n o n e r h y t h m , i t is

no su r pr i s e t ha t s t ud i e s o f i n t e r r a t e r r e l iab i l i t y have shown

t ha t the r e i s l it t le ob j ec t i v i t y in t he measur em ent s . W i r t h -

P a t tu l lo a n d H a y e s 9 s h o w e d t h a t , w i t h 3 e x a m i n e r s a n d 1 2

sub j ec t s , the C RI w as no t r e l a t ed to hea r t r a t e o r b r ea t h i ng ,

bu t t he r e was a l a r ge va r i a t i on i n t he r a te s r epor t ed by t he 3

exam i ne r s on eac h sub j ec t , sugges t i ng t ha t the i r pa l pa t i on

of t he r a t e was unr e l i ab l e . Rog er s e t a l . 1° me asur e d 2

exam i ne r s pa l pa ti ng s i m ul t aneous l y t he head and f ee t o f 28

sub j ec t s and f i nd i ng no i n t e r r a t e r co r r e l a t i on and "d i d n o t

s u p p o r t c l a i m s t h a t c r a n io s a c r a l m o t i o n c a n b e p a l p a t e d

r e l i ab ly" . M or an and Gi bbons ~l hav e a l so show ed that , wi th

2 exam i ne r s an d 11 sub j ec t s, t he r e was l i t t le i n t r a r a t e r o r

i n t e r e x a m i n e r r e l i a b i l i t y w h e n p a l p a t i n g t h e h e a d a n d

s a c r u l T l .

I n t he f o l l owi ng r ev i ew and exp l o r a t i on t h is s t udy wi l l f ocus

on ex p l o r i ng t he poss ib i l i ty o f r hy t hm i c phys i ca l mot i on o f

t he t is sues o f t he c r an i um i n the r ange o f 0 .6 t o 15 cpm,

whi ch a r e t he l imi t s o f t he r epor t ed r ange o f CRI pa l pa t ed .

I n s c i en t i fi c re sea r ch f r equen cy i s usua l ly m easur ed i n Her t z

( Hz) , so 15 cpm i s 0 .25 Hz and 0 .6 cpm i s 0 .01 Hz .

T h e p h y s i o lo g i c a l b a s i s o f c r a n ia l r h y t h m i c m o t i o n

tissue by t is sue

Arteries

T he b l o od f l ow i n t o t he b r a in i s appr ox i m a t e l y 750 ml / mi n ,

o r 1 4 % o f c a r d ia c o u t p u t . 12 T h e m o s t o b v i o u s s o u r c e o f

r h y t h m i c m o t i o n i n t h e c r a n i u m i s th e h e a r t b e a t, t h o u g h a t

a r ound 72 bea t s pe r mi nu t e t h i s i s ou t s i de t he r ange o f

f r e q u e n c i e s l i n k e d w i t h O C F . H o w e v e r a rt e ri a l b l o o d

p r e s s u r e d o e s f l u c t u a t e r h y t h m i c a l l y w i t h i n th e r a n g ea s c r i b e d t o th e c r a n ia l r h y t h m . M e a s u r e m e n t s b y m a n y

r e s e a r c h e r s s h o w t w o p e a k s , a t 0 . 2 5 H z ( H F o r h i g h

f r equency peak) and a t 0 .1 H z ( L ow F r equ ency o r L F peak) .

T hese f r equenc i es a r e 15 cpm a nd 6 cpm r espec t ive l y . T he

HF peak ( know n as t he T r aube - H er i ng wave ~2) i s gene r a l l y

l i nked t o r e sp i r a t ion ( b r ea t h i ng) and vag a l pa r asym pa t he t i c

ac t iv i ty . T he L F p eak ( l mo wn as t he M ay er wave) i s l inked

t o i n p u t f r o m b a r o r e c e p t o r s a n d c h e m o r e c e p t o r s i n t h e

ca r o t i d s i nus and aor t i c a r ch and t o sympa t he t i c ne r vous

sys t em ( S N S ) con t r o l o f a rt e r i o l e s t h r oug hou t the body .

T her e a r e a l so peaks a t even l ower f l ' equenc i es , a r ound

0 .015 Hz ( abou t 1 cpm) , whi ch a r e l i t t l e r e sea r ched , bu t

can m odul a t e r e sp i r a t o r y and haem odyn ami c f l uc tua t i ons , 13and m ay b e r e l a t ed t o t he r mor egu l a ti on .14

T her e a r e r e sea r che r s wh o ca l l a l l the r hy t hm i c f l uc t ua t ions

i n b lo o d p r e s su r e ' T r a u b e - H e r i n g - M a y e r ' ( T H M ) w a v e s .

R e c e n t l y th e s e h a v e b e e n s h o w n t o b e s y n c h r o n o u s w i t h

pa l pa t i on o f t he CRI . I5 G i ven t he poo r r ecor d o f pa l pa t i on

of c r an i a l r hy t hms such f i nd i ngs need t o be t r ea t ed w i t h

care , though po tent ia l ly they o pen u p interes t ing poss ibi li t ies

f o r the phys i o l og i ca l bas is f o r and measu r emen t o f t he CRI ,

whi ch w i l l be d i scus sed l a te r . T he same t eam a l so f ound

i n c re a s e s i n a m p l i tu d e o f th e ' T r a u b e - H e r i n g ' w a v e ( th i s

m a y h a v e b e e n i n c o r r e c t l y n a m e d a n d w a s m o s t l i k e l y t h e

0 .1 H z o r 6 cpm M ay er wave) f o l l owi ng cr an ia l m aNpul a t i on

in a sm al l t r ia l us ing tw o su bjects . 16

Cor r espo nd i ng t o t he r hy t hmi c va r i a t i ons i n b l ood p r es sur e

a r e s i mi l a r , li nked , r hy t hm s i n t he va r i ab i l i t y o f the hea r t

ra te . 17 This h ear t ra te var iabi l i ty (HR V) or hea r t per iod can

b e m e a s u r e d f r o m s e q u e n c e s o f R - R i n t e r va l s f r o m e l e c t ro -

c a r d i o - g r a p h s ( E C G ) a n d s h o w s t h e s a m e t w o p e a k s a t

a b o u t 0 . 2 5 H z a n d 0 .1 H z . I t h a s r e c e n t l y b e e n s h o w n t h a t

t he 0 .1 H z hea r t pe r i od ( R- R) va r i a t i on i s a l mos t en t i r e l y

accou n t ed f o r by a ba r or e f i ex mechan ism.18

T h e c a l i b r e o f a r t e ri e s a n d a r t e r i o le s a l s o f l u c t u a t e

r hy t hm i ca l l y a t s eve r a l r a te s ; t he bas i l a r a r t e r y has been

obs erved to a l ter i ts cal ibre a t a ra te o f 0.2 cp m ~9 and smal ler

a r te r ie s exh i b i t vasomo t i on a t a r a t e o f 0 .74 cpm i ndependen t

of b l oo d p r es sur e o r r e sp i r a t ion . 2° S i gn i f i can t r hy t hm i c

va r i at i ons in d i ame t e r o f he r ad i a l a r te r y have been r ecor d ed

a t a r a te o f abou t 1 cpm. 21 Resea r ch e r s us i ng r e f l ec t ed

l i gh t imagi ng o f neur a l ac t i v i t y found a pe r vas i ve 0 .1 H z ( 6

c p m ) s i g n a l p r e s e n t in b r a i n p a r e n c h y m a a n d

m i c r o v a s c u l a t u r e a n d a l s o i n t h e c i r c u l a t io n u n d e r t h e

f i nge r na i ls ; concur r en t mea sur em ent s o f b r a i n vascu l a t u r e

w i t h a l a s e r D o p p l e r f l o w m e t e r c o n t a i n e d a n a l m o s t

i den t i ca l and sy nchr on ous 0 .1 Hz s i gna l. 22

I t appea r s t ha t l a r ge r a r t e r i o l e s exh i b i t s l ower vasom ot i on

r a t e s t han sm a l l e r ves se l s . I n hams t e r s i t has been f oun d

t ha t t he l a r ges t a r t e r i o l e s ( d i ame t e r abou t 30 mi c r ons )

s u p p l y i n g s k e l e t a l m u s c l e h a d a d i a m e t e r f l u c t u a t i o n

f r equ enc y o f 0 .3 t o 3 cpm, w her eas t he sm a l l e s t a rt e r i o le s

( d i ame t e r abou t 7 .5 mi c r ons ) f l uc t ua t ed a t be t w een 4 t o 15

7 5



Journal of Osteopathic Medicine, 2003; 6(2): 74-88 © 2003 Research Media

c p m ; t h e s e c o m p o n e n t s w e r e s u p e r i m p o s e d o n e a c h o t h e r,

w i t h t h e l o w f r e q u e n c i e s t r a n s m i tt e d d o w n s t r e a m a n d t h e

h i g h f r e q u e n c i e s u p s t r e a m r e s u l t i n g i n a c o m p l e x

superposi t ion o f wavefo rms. 23 Hyp oxia (11% O 2) increases

t he f r equen cy o f vasom ot i on , e spec i a l l y in sm a l l e r ves se l s24.T h e d o m i n a n t f r e q u e n c y is u s u a l ly a r o u n d 0 . 1 H z ( 6 c p m )

g e n e r a t e d b y m e d i u m a r t er i o le s ( S t r a h l er o r d e r 3 ) w h i c h

spr eads downs t r eam t o sma l l e r ves se l s , and can i nc r ease

t o 0 .3 t o 0 .5 Hz ( 18 t o 30 cpm ) wi t h sys t em i c hypo xi a , a

r e sponse t ha t i s suppr es sed by b l ock i ng t he sympa t he t i c

ne r vo us sys t em d i scha r ge w i t h t he d r ug phen t o l am i ne . 25

Fur ther suppor t for an ar ter ia l co mp onen t to rhythm ic mot ion

of t he c r an i um has be en p r ov i ded by M oska l enk o e t a126 n

t he i r measu r ement s o f r hy t hmi ca l changes i n t he shape and

vo l um e of t he c r an i um us ing se r i al NM R scans . Apar t f r om

c o n f i r m i n g a r h y t h m o f 6 - 1 4 c p m a n d t h e p h y s i c a l

e x p a n d a b i l i t y o f th e b o n y c r a n i u m , t h e r e s e a r c h a l s oinvolve d inject ing 20ml of l iquid into the carot id ar tery which

h a d a n i m m e d i a t e e x p a n s i o n i n f l u e n c e o n t h e c r a n iu m , s o

add i ng t o t he ev i dence t ha t a r t e ri a l vo l ume i n f l uences i n tr a -

cranial volum e.

Veins

F a r a s y n 27 h a s p r o p o s e d t h a t t h e C R I i s a r e s u l t o f

venom ot i on . T h i s i s un l i ke l y due t o t he l ow pr es sur e in

mos t ve i ns , pa r t i cu l a r l y i n t r ac r an i a l l y wher e t he venous

pr es sur e can be nega t i ve when s t and i ng . Resea r che r s have

f ound t ha t ve nu l es do no t ex h i b i t vasomot i on . 28 Cab anac

an d Brinne129have d emons t r a t ed t ha t venous b l ood can f l owt h r o u g h t h e e m i s s a r y v e i n s b e t w e e n t h e s c a l p a n d t h e

i n t r ac ran i a l venous ves se l s . I n cadave r s a f t e r r emo va l o f

t h e t o p ( v a u l t) o f t h e c r a n i u m v e n o u s b l o o d c a n b e m a d e t o

a p p e a r o n t h e i n n e r s u r f a c e t h r o u g h n u m e r o u s ( v a l v e le s s )

e m i s s a r y v e i n s b y m a s s a g in g t h e s c a lp . C a b a n a c a l s o

demon s t r a ted t ha t a t nor ma l o r l ow b ody t em per a t u r es t he r e

i s li t tl e f l ow i n t hese ve i ns , t hough i f f l ow was r ec or de d i t

w a s f r o m b r a i n t o s ki n . D u r i n g h y p e r t h e r m i c c o n d i t i o n s

( i n d u c e d b y e x e r c i s e ) s tr o n g f l o w w a s d e m o n s t r a t ed f r o m

ski n t o b r a i n i n pa r ie t a l and m as t o i d em i s sa r y ve i ns , whi ch

h e l p e d t o c o o l t h e c o r e t e m p e r a t u r e o f t h e b ra i n . T h e

pr es sur e i n the ve i ns was ve r y l ow and cou l d be co l l apsed

b y l i g h t (4 g r a m ) p r e s s u r e , w h i c h w o u l d n o t h a p p e n w i t h

a n a r te r y. T h i s te m p e r a t u r e d e p e n d e n t c h a n g e o f fl o w

di r ec t i on has a l so been obse r ved i n t he oph t ha l mi c ve i n 3°

wher e coo l b l ood f r om swea t i ng f aces was d i r ec t ed t owar d

t he cave r no us s i nus tha t ac t ed a s a hea t exch ang er t o coo l

war m a r t e r i a l b l ood ; i n hypo t he r mi c cond i t i ons t he f l ow

was f r o m br a i n t o f ace . I t has bee n p r opo sed t ha t t he h i gh l y

v a s c u l a r d u r a m a t e r m a y t r an s m i t v e n o u s c o o l i n g f r o m t h e

sur f ace o f the sk i n t o t he C S F and b r a i n p a r ench ym a . 3~

T hese a l t e r a t ions i n venous f l ow add t o t he da t a conce r n i ng

t h e f l u id d y n a m i c s o f th e h u m a n c r a ni u m , h o w e v e r t h e y a r e

p a r t o f th e r m o r e g u l a t i o n a n d a r e p r o b a b l y n o t p a r t o f

pa l pab l e r hy t hmi c changes .

Lymph

L i ke a r t e r i e s t he l a r ge r l ymph channe l s exh i b i t pu l sa t i l e

d i l at a t ion and cons t ri c ti on . M easur em ent s 0 f 5 .2 c pm ( 0 .09

Hz) have b een r e cor de d i n t he t hor ac i c duc t i n sheep 32 and

6- 8 cpm i n human s . 33 I t has r ece n t l y been conc l uded t ha t

" lym pha t ic cont ract i l i ty plays cruc ial roles in the regulat ion

and g ene r a t i on o f l ymph t r anspor t " .34 Th e capil laries with in

t he b r a i n have t i gh t j unc t i ons be t we en t he i r ce l ls , so f o r m i ng

t he ' b l oo d- br a i n ba r r i e r ' , so l i tt l e lym ph i s p r oduce d wi t h i nt h e b ra i n . A s m a l l a m o u n t o f ly m p h i s p r o d u c e d i n s o m e

areas wi thin the cranium b ut outs ide the blood -brain bar r ier ,

such a s t he c i r cum vent r i cu l a r o r gans . 35 T h i s l ym ph dr a i ns

t h r o u g h a r t e r i a l a n d v e n o u s o p e n i n g s i n t h e c r a n i u m ,

pa r t i cu l a r l y a r ound t he o l f ac t o r y ne r ve a s i t pas ses t h r oug h

t h e e t h m o i d , e n r o u t e to t h e c e r v ic a l l y m p h n o d e s . 7 0 % o f

lym ph i s reabsorbed into the venous sys tem at lym ph nodes . 36

As t he r e a r e no l a r ge l ymp h ves se l s w i t h i n t he c r an i um i t i s

un l i ke l y t ha t the l ym pha t i c sys t em causes t he CR I .

Cerebrospinal lu id

Ab out 150ml ofcere brosp inal f luid (CSF) f il ls the vent r ic les

and suba r achn o i d space i n t he c r an i um and sp i ne . T he r a t e

of p r oduc t i on i s usua l l y c i t ed a s 550 ml pe r day , t hus i t tu r ns

ove r abou t 3 .7 t i mes each day, 12 how eve r some r e sea r ch

h a s f o u n d t h a t p r o d u c t i o n is 9 0 0 - 1 0 0 0 m l p e r d a y37 an d

f ound no d i f f e r ences r e l a ted to adu l t age . 50- 70% of CS F

i s f o r med i n t he chor o i d p l exuses and t he r ema i nde r a r ound

bl oo d ves se l s and i n t he wa l l s o f the ven t r i c l e s .

CS F i s c i r cu l a t ed w i t h i n t he ven t r i cu l a r sys t em and sp i na l

cana l by t he hea r t bea t and s l ower r hy t hm i c f l uc t ua ti ons o f

t he a r te r i a l sys t em as desc r i bed above . T he c r an i um i s

v i ewed , i n t he 'M onr o- Ke l l i e doc t r i ne ' , a s a c l osed box

c o n t a i n in g t h e 1 4 0 0 g b r ai n a n d a b o u t 7 5 m l o f b l o o d a n d75m l o f CSF, a l l o f wh ich are essen t ia l ly incompress ible.12

S o a r i s e i n p r es sur e i n a r t e r i e s o r ve i ns causes a r i s e i n

i n t r ac r an i a l p r e s sur e , whi ch i mm edi a t e l y t r i gge r s a r e f l ex

dr op i n a r te r i a l p r e s sur e . C r an i a l a r t e r i a l b l oo d f l ow i s

ma i n t a i ned a t a s t eady s t a te desp i t e s i gn i f i can t i nc r eases i n

a r t e r ia l p r e s sur e . CS F i s no t p r odu ced i n an i n t e r mi t t en t

wa y no r w i t h su f f i c ien t p r e s sur e o r i n su f f i c i en t quan t i t y t o

cause expan s i on o f the ven t r i c l e s and b r a in , a s p r opo sed by

Upl ed ger i n h is 'P r e s sur es t a t ' m ode l . 3

T he p r eva i l i ng v i ew i s t ha t CS F i s absor bed t h r ough t he

arach noid vi l l i into veins , par t icular ly the veno us s inuses . ~2

Resea r ch has shown t ha t , i n dogs , CS F can f l ow i n t o t hec e r v i c a l l y m p h n o d e s , v i a t h e o l f a c t o r y n e r v e a n d a r o u n d

t he c r i b r i f o r m p l a t e t o t he nasa l sub muco sa . 38 T h i s was

conf i r m ed by a s t udy i n r a ts t ha t f ound d i r ec t d r a i nage o f

C S F t h r o u g h t h e c r i b r i f o r m p la t e t o c o n n e c t w i t h n a s a l

l ympha t i c s . 39 F i na l l y r e cen t r e sea r ch has cha l l eng ed t he

c o n v e n t i o n a l v i e w o f C S F a b s o r p t io n a n d s h o w n t h a t , n o t

on l y d i d C S F d r a i n t h r ough t he c r i b r i f o r m p l a t e , bu t t h i s

was t he p r i m ar y r ou t e a t l ow i n t r ac r an i a l p r e s sur es , w i t h

a r a c h n o i d v i ll i a n d o t h e r l y m p h a t i c p a t h w a y s o n l y b e i n g

r e c r u i t e d a t e l e v a t e d i n t r a c r a n i a l p r e s s u r e , t h i s s t u d y

d e m o n s t r a t e d t h e i m p o r t a n c e o f d r a in a g e t h r o u g h t h e

c r i b r i f o r m p l a t e , i n sheep a t l ea s t, by b l ock i ng t he p l a t e an d

f i nd i ng impa i r ed C S F c l ea r ance .4° A r ecen t commen t a r y on

t h e r e l a t i o n s h i p b e t w e e n C S F a n d e x t r a c r a n i a l l y m p h

c o n f i r m s th a t i n s h e e p a n d r a ts 5 0 % o r m o r e o f C S F w a s

c l e a r e d v i a t h e l y m p h a t i c s y s t e m , r a t h e r t h a n t h r o u g h

arachn oid vi l l i.41 Evidence a l so suggests that approx imately

25% of CS F i s c l ea r ed v i a t he sp i na l suba r achno i d space . 42

76



© 2003 Research Media Ferguson A. A rev iew of the phys iology of cranial osteopathy

F ur t he r r e sea r ch has co nf i r med t ha t obs t r uc t ing t he d r a i nage

o f C S F t h r o u g h t h e c r i b r i f o r m p la t e t o t h e n a s a l m u c o s a

l e a d s t o r e d u c e d C S F c l e a r a n c e a n d a n i n c r e a s e i n

int racran ial p ressure . 43"44 So the lym pha t ic dra inag e o f the

c r an i um i s i mpor t an t , even t hough t he r e i s mi n i m a l l ymp hp r o d u c e d in th e b r a i n - C S F d r a i n s in s te a d . A l t h o u g h t h is

i s a n i m p o r t a n t t o p i c i n t h e h y p o t h e s e s o f t h e p h y s i o l o g y

beh i nd O CF , t he p r oduc t i on and d r a i nage o f CS F i s un l i ke l y

t o c a u s e t o r h y t h m i c m o t i o n .

B rai n an d neura l t i s sue

T h e r e h a v e b e e n m a n y s tu d i es o f t h e e f f e c t o f th e h e a r t b e a t

causing mo vem ent in the brain and CSF. 45'46 Cardiac sys tole

expan ds t he i n t r ac r an i a l a r t e r i e s , wh i ch i n t u r n l eads t o an

e x p u l s i o n o f C S F i n to t h e c o m p l i a n t s p in a l s u b a r a c h n o i d

space . A t the s ame ti me the b r a i ns t em move s cauda l l y

b e t w e e n 0 . 1 -0 . 5 m m t o w a r d s th e f o r a m e n m a g n u m a n d t h e

ce r ebr a l l obes m ov e cepha l i ca l l y . 47 T he ven t r i c l e s a r e

s q u e e z e d s o m o v i n g t h e C S F c o n t a i n e d w i th i n th e m , w i t h

o u t f l o w f r o m t h e a q u e d u c t m i r r o r i n g t h e b r a in e x p a n s i o n

in sys tole .48 Car d i ac sys t o l e a l so causes an i ns t an t aneou s

i nc r ease i n t he f l ow i n t he S uper i o r S ag i t t a l S i nus , whi ch

h e l p s v e n o u s d r a in a g e . T h e b r a i n s t e m c a n a l s o b e e n s e e n

t o m ove i n r e l a ti on t o b r eat h i ng , and t he Va l save r mano euvr e

p r o d u c e s a n i n i t i a l c a u d a l a n d s u b s e q u e n t c e p h a l i c

d i s p l a c e m e n t o f 2 - 3 m m ? 9 T h e c e r v i c a l s p in a l c o r d a l s o

mo ves c auda l l y j us t a f t e r sys t o l e ,s ° a movement t ha t i s

t r a n s m i t te d d o w n t o th e l u m b a r e n l a r g em e n t 2 1 C S F f l o w

i n t he sp i na l can a l i s a i ded by sp i na l vascu l a r pu l sa t ions . 5~

T h e r e i s n o e v i d e n c e t h a t b r a i n t is s u e h a s a n y i n h e r e n tcon t r ac t il e ab i li t y to mo ve CS F , a s o r i g i na l l y hypo t hes i sed

by S u t he r l and . 1 T he f o r ce o f a r t e r ia l pu l sa t i on i s enoug h t o

m o v e C S F b o t h w i t h i n a n d a r o u n d t h e b r a i n a n d d o w n t h e

spinal canal . I t is probab le that the slow er rhy thm ic dilatat ion

and con t r ac t i on o f t he a r t e r i o le s w i t h i n t he b r a i n a s soc i a t ed

w i t h c h a n g e s i n v a s o m o t i o n a n d b l o o d p r e s s u r e , d e s c r i b e d

above , a r e r e spons i b l e f o r t he pe r vas i ve 0 .1 Hz s i gna l

c a p t u r e d f r o m t h e b r a i n p a r e n c h y m a b y r e f l e c t e d l i g h t

i magi ng . 22 T hese s l ow er a r te r i a l r hy t hm s ma y a l so have a

r o l e i n t he c i r cu l a t i on o f CS F , t houg h i t i s l ike l y t o be a

sma l l e r e f f ec t t han t ha t o f the hea r t bea t .

B o n e s, jo i n t s a n d d u r a

T h e r e i s a n i n c r ea s i n g b o d y o f e v i d e n c e t o s u p p o r t t h e

c o n c e p t t h a t s m a ll a m o u n t s o f m o v e m e n t a r e p e r m i t t e d a t

the cranial sutures throu gho ut li fe . T his mobi l i ty , com bined

wi t h t he f l ex i b i l it y o f the bon es o f t he c r an i a l vau l t, l eads t o

a d e g r e e o f c o m p l i a n c e t o i n t r ac r a n ia l v o l u m e c h a n g e s .

R e t z l a f f ' s w o r k d e m o n s t r a t e d t h a t c r a n i a l s u t u r e s w e r e

com pl ex an d pe r s i s t en t j o in ts .53 T he sys t ema t i c r ev i ew o f

t h e s c i e n t i f i c e v i d e n c e o n c r a n i o s a c r a l t h e r a p y b y t h e

BC OH T A desc r i bed above d i d st at e:

" T h e r e s e a rc h e v i d e n c e r e v i e w e d s u p p o r t s t h e t h e o r y t h a t

the adul t cranium is not a lw ays sol idly fused, and that minutem o v e m e n t s b e t w e e n c r a n i a l b o n e s m a y b e p o s s i b l e .

H o w e v e r , n o r e s e a r c h d e m o n s t r a t e d t h a t m o v e m e n t a t

c r a n i a l s u tu r e s c a n a c t u a l l y b e a c h i e v e d b y m a n u a l

mani pu l a t i on" . 5

Cr an i a l vau l t su t u r es need t o r ema i n un oss i f i ed i n ch i l d r en

77

t o a l l ow gr owt h ,54 a s i n t r amem br anous bone p l a t e s g r ow a t

t he i r edges i n r e sponse t o ex t e r na l s t i m ul i - i n t h i s case t he

e x p a n d i n g n e u r o c r a n i u m . T h e i r p e rs i s te n c e i n a d u l ts m a y

b e r e l a t e d t o s h o c k o r t r a u m a a b s o r p t i o n , a s w e l l a s

i m p r o v i n g t h e c o m p l i a n c e o f th e c r a n i u m t o c h a n g e s i ni n t r ac r an i a l p r e s sur e an d vo l um e . I t i s in t e r e s t i ng t o no t e

t ha t t he de t a i ls o f the pa t t e r n o f c r an ia l su t u r es i s un i que t o

each individual , to the point that they can be u sed fo r forensic

i den t i f ica t i onY Onl y r ecen t l y has mod em t echno l ogy made

poss i b l e r e l i ab l e measur ement s o f sma l l changes i n t he

pos i ti on o f c r an i a l bone s . T h i sh as been ach i eved by seve r a l

me t hods :

.

.

S e r i a l X - r a y s a n d N M R t o m o g r a m s t o d e m o n s t r a t e

int racranial dimension changes of about 0.3 8ram, wh ich

a l t e r n a t e d b e t w e e n s a g it ta l a n d f r o n t a l ( A P )

expan sions . 26

M ove me nt a t t he s ag i tt a l su t u r e i n ca t s d i r ec t l y l i nked

to chan ges in int racran ial volume.56

.

.

X- r ay changes i n t he pos i ti ons o f s eve r a l bony l andmar ks

h a v e r e c e n t l y b e e n d e m o n s t r a t e d c o m p a r i n g 1 2 ad u l t

p a t ie n t s w h o h a d f i x e d p o s i ti o n e d x - r a y s t a k e n b e f o r e

and im me diate ly af te r a cranial os teop athic t reatment .57

T h i s p i lo t s t u d y s h o w e d t h a t b o n y c h a n g e s c o u l d b e

ach i eved by manu a l mani pu l a t ion .

3 - D v i deo i magi ng t o m easur e r hy t hmi c changes i n shape

o f t h e h u m a n o r b i t , w h i c h h a v e s e v e r a l f r e q u e n c y

wav es. 58

I n t he f oe t a l and i n f an t sku l l t he os seou s com pon en t s a r e

i ncom pl e t e l y deve l oped , and i n adu l t sku l ls t he r e i s the

p o s s i b il i ty o f s u t u ra l m o t i o n a n d b o n e c o m p l i a n c e , w h i c h

r a i ses ques t i ons ab ou t t he s t r uc tu r a l i n t egr i t y o f t he sku l l .

Bo t h o f t hese i s sues can be addr es sed by i nc l ud i ng t he

i n t e rna l a r ch i t ec t u r e o f the c r an i um i n t he f o r m of t he dur a l

mem br anes . T hes e s tab i l is e t he sphe r i ca l c r an i um t h r ee -

d i m e n s i o n a l l y t o s t o p i t f r o m o v e r - e x p a n d i n g i n a n y

di rect ion. The fa lx cerbr i and fa lx cerebel l i divide the brain

in a sagit ta l di rect ion, whi l s t the ten tor ium ce rebel l i provid es

a l a t e ra l com pone n t . 1 T hes e a r e i n a s t a t e o f r ec i p r oca l

t ens i on so t ha t t he c r an i um t ends t o a l t e r na t e l y expand

lateral ly or in an AP o r sagi t ta l di rect ion, which seems to be

c o n f i rm e d b y e x p e r im e n t a l e v i d e n c e ? 6 T h e o s se o u s

com ponen t s o f t he vau l t o f t he sku l l a r e e f f ec t i ve l y f o r m ed

wi t h i n t he l aye r s o f t he dur a , so t he dur a has a s i gn i f i can t

i n f lu e n c e o n t h e c o m p l i a n c e a n d m o b i l i t y o f t h e c r a n i u m .

T r ad i t i ona l l y i n OCF emphas i s i s p l aced on a dur a l l i nk

b e t w e e n o c c i p u t a n d s a c r u m , 3 h o u g h t h is i s c o n t r o v e r s ia l

even be t wee n p r ac t i t i one r s? I t i s un l i ke l y t ha t t h i s l ink i s

d i re c t e n o u g h t o t ra n s m i t p e r h a p s 0 .3 m m o f m o v e m e n t , a s

t he r e mus t be cons i de r ab l e s l ack i n t he dur a t o a l l ow sp i na l

mo vem ents ; the spinal canal i s 5 cm to 9 cm lon ger in f lexion

t han ex t ens i on o f the sp i ne . 59 T he sp i na l co r d d ur a i se las t ic ,6° and the c ervical spinal cord i t se l f e longates b y 10 %

i n f l ex i on o f t he neck . 6~ P a l pa t o r y s t ud i e s have show n t ha t

t h e r e is n o l i n k b e t w e e n t h e r h y t h m s p a l p a t e d a t h e a d a n d

sacrum.l l

W hi l s t t he bones o f t he c r an i um, t oge t he r w i t h t he i r i n t e rna l



Journal of Osteopath ic Medicine, 2003; 6(2) :74-88 © 2003 Research Media

m e m b r a n o u s ( d u r a l) a r c h i t e c tu r e d o h a v e t h e p o t e n t ia l t o

m o v e m i n u t el y , t h e y d o n o t g e n e r a t e rh y t h m i c m o v e m e n t

t hemse l ves .

Muscles

T he t i s sue i n t he body t ha t i s usua l l y a s soc i a t ed w i t h

mo vem ent , r hy t hm i c o r o t he r wi se , is musc l e i n i ts va r i ous

f o r ms . I ndeed ev en a r t e r ia l sys t o l ic mot i on i s gene r a t ed by

ca r d i ac musc l e , w i t h t he smoot h musc l e i n t he wa l l s o f

a r te r io l e s con tr o l li ng vasomot i on . M uc h o f t he body i s made

of ske l e t a l musc l e s , and t he r e a r e a g r ea t num ber a t t ached

t o t he c r an i um i nc l ud i ng mu sc l e s o f t he neck , t h r oa t , j aw ,

f a c e a n d s c a lp . O f p a r t i c u l a r i n t e r e s t i s o n e o f t h e

subocc i p i t a l musc l e s ca l l ed r ec t us cap i t is pos t e r i o r mi no r

( RCP M ) t ha t was d i sco ve r ed i n 1995 t o be conn ec t ed , v i a

a conn ec t i ve t i ssue b r i dge , t o t he dor sa l sp i na l dur a a t t he

a t l an t o -occ i p i t a l j unc t i on . 62 T he RC P M i s un l i ke l y to ex e r t

mu ch f o r ce on t he who l e dur a ; the p r obab l e pur pose o f i t i s

t o p r e v e n t i n f o l d in g o f t h e d u r a d u r i n g h e a d a n d n e c k

ex t ens i on . Rece n t r e sea r ch 63 has a l so show n co n t i nu i t y i n

t h e m i d l i n e b e t w e e n t h e n u c h a l l i g a m e n t a n d t h e p o s t e r i o r

spinal dur a at the at lanto-occ ipital and a tlanto-axial intervals.

I t i s p l aus i b l e t ha t hea l t hy f unc t i on i ng o f RCP M a i ds CS F

c i r cu l a t i on in t he t op o f t he sp i na l cana l a s C S F i s e j ec t ed

into i t dur ing cardiac sys tole , and pa r t ia l ly re turns in dias tole.

T h i s m a y b e s o m e s u p p o r t f o r t h e , o t h e r w i s e u n l i k e l y ,

concep t i n OCF of be i ng ab l e t o comp r es s t he f o r t h ven t r i c le

(CV4), 3 most e f f ec t s o f t h is t echn i que a r e l i ke l y t o be due

t o r e l axa t i on o f t he subocc i p i t a l musc l e s , r a t he r t han any

d i r ec t e f f ec t on t he ven t r ic l e s . S ubocc i p i t a l musc l e s have ah i g h d e n s i t y o f m u s c l e s p i n d l e s, a n d g i v e s i g n i f i c a n t

p r opr i ocep t i ve i npu t t o t he ba l ance cen t r e s ; f o r exampl e

s o m a t i c d y s f u n c t i o n in t h e u p p e r n e c k h a s b e e n l i n k e d t o

t inni tus , 64 and to n eck pain, head ache and impai red balance. 65

S ke l e t a l mu sc l e does no t appea r t o con t r ac t in a r hy t hmi c

ma nne r i n the 0 .6 - 15 cp m r ange t ha t i s t he f ocus o f t h i s

s tu d y ; h o w e v e r m a n y o f t h e p at t er n s o f m o v e m e n t f e l t

aroun d the cranium in c l inical pract ice are l inked to pat terns

of my of asc i a l t ens i on . S om e au t hor i t i e s66 ass ert th at , as

t he r e i s no ac t i v i t y in t he e f f e r en t mo t or ne r ve t o a mu sc l e

wh en i t i s inac t i ve , t hen r e s t i ng musc l e t on e i s a r e su l t o f

f l u i d accumul a t i on o r s t r uc tu r a l conne c t i ve t is sue chang es ,a l t h o u g h t h a t w o u l d n o t e x p l a i n t h e f l a c c i d i ty o f a m u s c l e

who se ne r ve supp l y has been i n te r r up ted . T he r e i s ev i dence

t ha t th i s 'm yog en i c ' t one ma y be du e t o t h i xo t r op ic s t if f nes s

due to pro tein cross-br idges . 67 Whi ls t the ef fec ts of physical

t he r apy , such a s massage , cou l d a f f ec t my oge n i c tone , on

i ts ow n i t wo ul d no t f u l l y exp l a i n t he capac i t y f o r a r e s t i ng

m u s c l e t o f u r t h e r r e l a x w i t h s e l f - d i r e c t e d r e l a x a t i o n

t e c h n i q u e s o r e m o t i o n a l th e r ap y . T h e i n f l u e n c e o f n e rv e s

on r e s t i ng musc l e t one r ema i ns con t r ove r s i a l , 68 the re are

several physiological possibil it ies for 'neurog enic ' inf luences

on r e s t i ng musc l e t one and pa t t e r ns o f t ens i on :

a ) S mal l g r oup s o f mo t or un i t s a r e s t i mul a t ed i n a

va r i ab l e pa t te r n t o ma i n t a i n som e t ens i on i n t he musc l e , ye t

a l l owi ng m os t o f the m ot or un i t s t o r e s t . 69 S l ow ( r ed)

posm ral f ibres wi thin muscles are tonical ly act ive . The b lood

f l ow t o r ed f i b r e s i s t h r ee t imes g r ea t e r t han t o whi t e f i b r e s

i n a r e s t i ng musc l e .

b ) G a m m a e f f e r e n t i n f lu e n c e o n t h e m u s c l e s p i n d le

maintains mu scle length, 12 and c an be inf luen ced by thera py

t o a l l o w r e l a x a t i o n a n d l e n g t h e n i n g o f t i g h t m u s c l e s .

S ym pa t he t i c ne r ve f i b r e s have be en show n t o a f f ec t t he

f unc t i on o f mu sc l e sp i nd l es , e i t he r by d i r ec t ac ti on onint rafusal f ibres70"71or by i n f l uence on t he a f f e r en t d i s cha r ge

of mu scle spindles . 72 73

c) I t has bee n postula ted that 'myo fascia l t r igger points '

exis t as bands of high sensi tivity in abn ormal ly tense muscles .

T hese do no t cause m ot or ne r ve ac t iv i ty , bu t a r e r e l a t ed t o

p h y s i o l o g i c a l l y ab n o r m a l m o t o r e n d p l a t e f u n c t io n ,TMwi t h

t h e r e l e a s e o f e x c e s s i v e a c e t y l c h o l i n e a n d l o c a l is e d

c o n t r a c t i o n , w h i c h m a y l e a d t o l o c a l i n f l a m m a t i o n ,

noc i oc ep t o r s t i mul a t ion and pa i n . 75 T h i s mecha n i sm cou l d

accou n t f o r l oca l i s ed i nc r eases i n r e s ti ng musc l e t one .

T h e p o s s i b l e p h y s i o l o g ic a l m e c h a n i s m s f o r a n e u r o g e n i c

c o m p o n e n t t o r e s ti n g m u s c l e t o n e d e s c r i b e d a b o v e d o n o t

s e e m t o h a v e a n y r h y t h m i c a sp e c t s . W h a t d o e s a lt e r

rhythm ical ly i s the level of mu scle sym pathet ic nerve act ivi ty

( M S N A ) , w h i c h c o n t r o l s th e b l o o d s u p p l y to m u s c l e s v ia

i ts inf luen ce on the smo oth m uscle in the w al l s o f arter ioles .76

T her e i s a measur ab l e 5 - 6 cpm va r i a t i on i n b l oo d f l ow t o

musc l e s eve n whe n t hey a r e con t r ac t i ng . 77 W hen m usc l e s

con t r ac t l oca l chem i ca l medi a t o r s such a s aden os i ne ac t a s

vasod il at or s.78 T he vasoc ons t r i c t i ng e f f ec t o f M S NA ma y

have a r o l e i n ma i n t a in i ng b l o od p r es sur e by l i mi t i ng b l ood

f l ow t o l ar ge exe r c i s i ng musc l e s . M S NA i s a l t e r ed by

ves t i bu l a r o t o l i t h s t i mu l a t i on , 79 exe r c i se , 8° hea r t r a t e

va r i ab i l i t y and b l oo d p r es sur e , 76 and r e s t i ng M S N A i sd e c r e a s e d b y o e s t r o g e n ? 1

Th e c o n tro l o f rh y th m i c f lu c tu a t i o n s

E x c l u d i n g b r e a t h i n g , t h e p r i n c i p a l t i s s u e t h a t c h a n g e s

r hy t hm i ca l l y i n t he r ange o f 0 .6 t o 15 cpm ( 0.01 t o 0 .25

Hz), wh ich is the foc us of his study, is in arteries, sp ecifica lly

t he sm oot h mu sc l e i n t he wa l l s o f a r te r i o l e s tha t con t r o l

t he i r d i ame t e r . No o t he r t i s sues have been sh own t o cause

r hy t hm i c f l uc tua t i ons , though f u r t he r r e sea r ch is neces sa r y

t o l ea r n mor e abou t t he r e s t i ng t one o f ske l e t a l musc l e .

A n y r h y t h m i c m o t i o n i n th e c r a n i a l b o n e s , m e n i n g e s , C S F

a n d C N S i s p r o b a b l y s e c o n d a r y t o c a r d i a c a n d a r t e r ia l

inf luences .

I n r e l a t i on to t he r hy t hmi c changes i n a r t e ri a l b l ood p r es sur e

and hea r t r a t e va r i ab i l i t y a t 6 cpm ( 0 .1 Hz) t he ma i n m ode

o f c o n t r o l is t h r o u g h t h e s y m p a t h e t i c d i v i s i o n o f t h e

a u t o n o m i c n e r v o u s s y s t e m ,82 wh en symp a t he t i c ac t i v i t y i s

dec r eased by n i t r opr us s i de t he HF ( Hi g h F r equency , 0 .25

H z ) c o m p o n e n t p r e d o m i n a t e s , w h i c h is l in k e d t o

p a r a s y m p a t h e t i c ( v a g a l n e r v e ) a c t iv i t y . S y n c h r o n o u s

changes i n the L F ( L ow F r equency , 0 .1 Hz) and H F r hy t hm s

o f R - R i n te r v a l , s k in m i c r o c i r c u l a t i o n a n d M S N A

t hr ougho ut the bo dy du r i ng d i f f e r en t l eve l s o f sympa t he t i c

d r i v e a re s u g g e s t i v e o f c o m m o n c e n t r a l m e c h a n i s m s

g o v e r n i n g b o t h p a r a s y m p a t h e t i c a n d s y m p a t h e t i c

ca r d i ovascu l a r con t r o l.

A s t udy by Ber nad i e t a l . 83 f ound t ha t r hy t hmi c osc i l la t i ons

i n s k i n b l o o d f l o w w e r e s y n c h r o n o u s i n b o t h i n d e x f i n g e rs

7 8



© 2003 Research Media Ferguson A. A rev iew of the phys iology of cranial o s t e o p a t h y

in each subject , and al so that the LF (0.1 H z) osci l la t ions in

s l d n b l o o d f l o w l e d t h e s y n c h r o n i s e d c h a n g e s i n b l o o d

p r e s s u r e - i n d i c a ti n g a n ' u p s t r e a m ' t r a n s m i s s i o n f r o m t h e

mi c r ovesse l s . T hese synchr on ous f l uc t ua t i ons wer e no t

o b s e r v e d i n p a ti e n ts w h o h a d h a d a s y m p a t h e c t o m y , w h e r et h e s y m p a t h e t i c n e r v e s u p p l y t o th e a r m h a d b e e n s e v e r e d .

By con t r a s t t he HF ( 0 .25 Hz) changes i n sk i n b l ood f l ow

l agged beh i nd t he b l ood p r es sur e f l uc t ua t i ons i nd i ca t i ng a

' dow ns t r eam ' t ransmi s s ion .

T he d i f f e r ences i n t he ra t e s o f au t onomi c m odul a t i on o f the

hea r t ma y r e f l ec t the f ac t tha t t he pa r asym pa t he t i c d i v i s i on

p r o d u c e s a c e t y l c h o l i n e , w h i c h i s ra p i d l y b r o k e n d o w n b y

ace t y l cho l i nes t e r a se , so a l l owi ng r ep o l a r i s a t ion a t a h i g he r

f r e q u e n c y ( a r o u n d 0 . 2 5 H z ) . S y m p a t h e t i c r e l e a s e o f

n o r e p i n e p h r i n e h a s a s l o w e r r e c o v e r y r e s u lt i n g i n a l o w e r

f r eque ncy o f neur a l ac t i v i t y ( a r ound 0 .1 Hz) . 84

T he l i nk be t ween L F a r t e r i a l p r e s sur e f l uc t ua t i ons and

over a l l sympa t he t i c ac t iv i t y has been ch a l l enged by T a y l or

e t a l , 85 wh o f ound t ha t L F ( M a yer wa ve) f l uc t ua t i ons wer e

t h e s a m e i n y o u n g m a l e s, y o u n g f e m a l e s a n d o l d e r m a l e s

d e s p i te t h e g r e a t d i f f e r e n c e s i n o t h e r m e a s u r e s o f

sym pathet ic activity, notable MS NA , betw een these groups .

B r e a t h i n g a f f e c t s t h e h i g h e r r a t e ( H F ) b l o o d p r e s s u r e

osc i l l a t i ons a r ound 15 cpm ( 0 .25 Hz) , whi ch a r e f u l l y

abo l i shed dur i ng 1 - mi nu t e vo l un t a r y apno ea , 86 a l t hough a t

t he s ame t i me l o wer f r equ ency osc i l la t i ons (0 .1 H z and

a r o u n d 0 . 0 3 H z ) w e r e e n h a n c e d .

T her e i s a c l ea r co r r e l a t i on be t w een osc i l la t i ons i n ce r ebr a l

b l o o d f l o w v e l o c i t y , m e a s u r e d b y t r a n s c r a n i a l D o p p l e r

sonogr aphy , and osc i l l a t ions i n a r t e r i a l b l ood p r es sur e , s7

C e r e b r a l b l o o d f l o w i s i n f l u e n c e d b y s y m p a t h e t i c

s t i mul a t i on , be i ng d ec r eased by s t i mul a t i on o f ce r v i ca l

symp a t he t i c ne r ves , s8 wh i ch a l so i nc r eases t he f r equ ency

a n d d e c r e a s e s t h e a m p l i t u d e o f w a v e s o f v a s o m o t i o n .

Gen er a l l y ce r ebr a l b l oo d f l ow f l uc t ua t e s a t 6 cpm ( 0 .1 Hz)

as a r e su l t o f sympa t he t i c ne r vous sy s t em con t r o l , whi ch i s

l i nked t o e l ec t r i ca l ac t i v i ty i n t he au t onom i c con t r o l a r eas

o f t h e m e d u l l a , c e r e b e l l u m a n d c o r t e x ) 9 R e g i o n a l c e r e b r a l

b l o o d f l o w c h a n g e s r a p i d l y i n r e s p o n s e t o l o c a l n e u r o n a l

a c t i v i t y , t r i g g e r i n g l o c a l v a s o d i l a t i o n b y b u r s t s o felect rocor t ical act ivi ty.9° 0.1 Hz osci l la t ions hav e been

obse r ved i n e l ec t r oencepha l ogr am ( E E G ) r ecor d ings dur i ngslee p. 91

T he sympa t he t ic ne r vous sys t em ( S NS ) i s t he ma i n i n f l uence

o n a r t e r i a l t o n e a n d h a s m o v e d t o t h e c e n t r e s t a g e i n

c a r d i o v a s c u l a r m e d i c i n e , 92 p a r t i c u l a r l y r e g a r d i n g t h e

p a t h o g e n e s i s o f h y p e r te n s i o n . T h e S N S a f f e c t s h e a r t a n d

k i dn ey f unc t i on i n add i t i on t o ske l e t a l musc l e vascu l a t u r e ,

and con t r i bu te s t o v en t r i cu l a r hype r t r op hy and a r r hy thmi as .

S y m p a t h e t i c a l l y m e d i a t e d v a s o c o n s t r i c t i o n in s k e l e t a l

m u s c l e v a s c u l a r b e d s r e d u c e s t h e u p t a k e o f g l u c o s e b y

m u s c l e , a n d i s t h u s a b a s i s f o r i n s u l i n r e s i s t a n c e a n dc o n s e q u e n t h y p e r i n s u li n a e m i a . T h e r e l a t io n s h i p b e t w e e n

t h e i n c r e a s e d s y m p a t h e t i c t o n e a n d d e c r e a s e d

par asym pa t he t i c t one i n hype r t ens i on is rec i p r oca l , whi ch

s t r o n g l y s u g g e st s t h a t t h e a b n o r m a l i ty e m a n a t e s f r o m t h e

br a i n . 93 S NS ac t i v i t y tends t o i nc r ease w i t h age , t hou gh

t he r e can be pa r t s o f the bo dy t ha t a r e spa r ed . 94 T h er e i s

s o m e e v i d e n c e t h a t p o s it i v e a n d n e g a t i v e e m o t i o n s c a n

inf luen ce the SNS. 95

T o s u m m a r i s e , r e s ea r c h h a s s h o w n t h a t t h e m a i n r h y t h m i c

osc i l l a t ion i n a r t e r i a l b l ood p r es sur e and hea r t r a t e ( R - R)

va r i ab i l i t y i s one t ha t has a peak a r ound 0 .1 Hz ( 6 cpm,

M a yer wave) and i s gene r a t ed by vaso mot i on i n the med i um

s i zed a r te r i o l es p r esen t t h r ougho ut t he body . T he a r t e r io l e s

c o n t r a c t u n d e r t h e i n f lu e n c e o f th e s y m p a t h e t i c n e r v o u s

sys t em ( S NS ) and p r ov i de r e s i s tance t o b l ood f l ow , whi ch

r a i ses t he b l oo d p r es sur e ' ups t r eam ' . T he r i s e i n b l oo d

pressure t r iggers a baroref lex mechan ism that a l ters the hear t

r a t e va r i ab i l i t y 18 T he S NS con t r o l i s coo r d i na t ed cen t r a ll y ,

a s i t i s synchr ono us i n t he l i mbs , and i s p r oba b l y l a r ge l y a t

a r e f l ex sp i na l l eve l a s i t i s b i l a t e r a l l y synchr onous i n

t e t r a p l e g i c s . 96 T h e r e i s c e n t r a l c o o r d i n a t i o n o f

pa r asym pa t he t i c ( Vaga l) and S NS ac t i v i t y in r e l a t i on t o t hehea r t . B r ea t h i n g i n f l uences bo t h hea r t r a t e va r i ab i l i ty and

b l oo d p r es sur e a t a r oun d 0 .25 Hz ( 15 cpm ) a s a r e su l t o f

phys ical inf luences on the hear t and ci rculat ion, par t icular ly

veno us r e t u r n , due t o p r es sur e changes i n t he t hor ax .

A p hys io log ic a l mo de l for c r ania l o s te opathy

T h e e v i d e n c e s u p p o r t i n g r h y t h m i c c h a n g e s i n a r t e r i a l

vasom ot i on , whi ch l eads t o b l ood p r es sur e f l uc t ua t ions and

hea r t r a t e va r i ab i li t y w i t h i n t he c r an i um , i s now s t r ong and

t h e e v i d e n c e f o r c r a n i a l c o m p l i a n c e i n v o l v i n g b o n y

mo vem ent i s g r owi ng . I t is r easonab l e to p r opose t ha t t hese

changes i n t he a r t e ri a l sys t em, t oge t he r w i t h bon y m obi l it y ,

a r e pa r t o f the phys i o l og i ca l bas is o f OCF . Ar t e r i a l p r e s sur e

changes , bo t h due t o ca r d i ac sys t o l e and s l ow er va r i a ti ons

due t o vasom ot or ac ti v i ty , mo ve t he b r a i n and cause CS F

t o f l ow i n t he ven t r i c l e s and a r ound t he b r a i n and sp i na l

c o r d . T h e d u r a l m e m b r a n e s w i t h i n th e c r a n i u m a r e a

neces sa r y pa r t o f t he i n t e r na l a r ch i t ec t u r e o f the c r an i um t o

pr eve n t ove r - expan s i on i n any d i r ec ti on .

T he r a t e s o f t he peak f l uc t ua t i ons i n a r t e r i a l d i am e t e r and

pr es sur e co r r e spond t o t he r epor t ed r a t e s o f t he CRI , 6m a n y

a u t h o rs s u g g e s t a r o u n d 6 c p m ( 0 .1 H z ) , t h o u g h s o m e m a y

be pa l pa t i ng t he f a s t e r c i r ca 15 cpm ( 0 .25 Hz) wav es t ha t

a r e mor e l i nked t o vaga l ac t i v i t y and b r ea t h i ng .

T h e s e f i n d i n g s w o u l d b e c o m p a t i b l e w i t h a n a x i o m

pr om ul ga t ed by t he f ound er o f os t eopa t hy , A .T .S t il l , 97 f o r

w h o m " t h e r u le o f t h e a r t e ry i s s u p r em e " . T h e y w o u l d a l s o

b e c o m p a t i b le w i t h m o s t o f t h e i d ea s o f th e o r i g i n a t o r o f

OCF , W .G. S u t he r land ,1 who desc r i bed r hy t hm i c mot i on o f

t h e c r a n i u m a n d a n a l y s e d t h e a r r a n g e m e n t o f th e s u t u r e s

a n d d u r a l m e m b r a n e s , t h o u g h , i n t h e l ig h t o f c u r r e n t

k n o w l e d g e i t w o u l d s e e m t h a t h e i n c o r r e c t ly h y p o t h e s i se d

t ha t in t r ins i c mo vem ent o f the b r a i n pump ed CS F , w hi ch i n

t u r n m o v e d t h e c r a n i a l b o n e s a n d t h e r e s t o f t h e b o d y .

Clinical implications

I f t he phys i o l og i ca ll y based m ode l desc r i bed above i s a m or e

accur a te mod e l f o r r epr esen t i ng the phen ome na expe r i enced

i n t he p r ac t i ce o f OCF t hen t he r e a r e c l i n i ca l i mpl i ca t i ons

f o r t ha t p r ac t i ce , a s t h is mod e l d i f f e r s f r om t he m ode l t ha t

79



Journal of Osteopathic Medic ine, 2003; 6(2): 74-88 © 2003 Research Media

has been gene r a l l y used and t augh t . T he t r ad i ti ona l mo de l

i s f o c u s e d o n b o n e s , d u r a a n d t h e f l o w o f C S F , w h i c h i s

a s s u m e d t o b e a b s o r b e d i n t o t h e v e n o u s s y s t e m v i a

a r a c h n o i d v il li . T h e n e w u n d e r s t a n d in g a d d s e l e m e n t s o f

a r t e r i a l f u n c t i o n , a u t o n o m i c c o n t r o l a n d a l t e r e d C S Fdrainage.

Cardiovascular system

I f the p r ac t i ce o f c ran i a l os t eop a t hy i s ab l e t o de t ec t and

i n f l u e n c e t h e S N S c o n t r o l o f a r t e r i a l v a s o m o t i o n t h e n

cons i de r a t i on o f t he ca r d i ovascu l a r sys t em as a whol e i s

i mpor t an t . Hea r t p r ob l em s may l ead t o dec r eased ce rebr a l

pe r f us i on , w hi ch ma y cause depr es s i on . 98 Cond i t i ons such

a s u r a e m i a h a v e b e e n s h o w n t o m a k e a d r a m a t ic r e d u c t i o n

i n th e a m p l i t u d e o f t h e 0 .1 H z ( 6 c p m , M a y e r w a v e )

f l uc t ua t i ons i n b l oo d p r es sur e and hea r t r a t e va r iab i l it y ,99

whi ch m ay i nd i ca t e i mpa i r ed ca r d i ovascu l a r AN S f unc t i on .

T h e c o n t r o l o f t h e s e r h y t h m i c c h a n g e s i s t h r o u g h t h e

a u t o n o m i c n e r v o u s s y s t e m ( A N S ) . O s t e o p a th i c t e a c h i n g

has sugge s t ed tha t the ANS ac t s a s a "m edi a t o r be t ween

t he somat i c and suppor t i ve p r oces ses". l ° ° T r ea t m ent t ha t

i n f lu e n c e s s o m a t i c f u n c t io n m a y h a v e a n e f f e c t o n A N S

f u n c t io n . I f a h e a l th y b a l a n c e b e t w e e n S N S a n d p a r a -

s y m p a t h e t i c a c ti v i ty c a n b e e n c o u r a g e d t h e n a v a r i e t y o f

p a t h o p h y s i o l o g i c a l s t a te s m a y b e h e l p e d , i n c l u d i n g

hyper t ens i on .

T h e p o s s i b le i n f l u e n c e o f c r a n i a l t h e r a p y o n i n tr a c r an i a l

c i r cu l a t ion means t ha t i t s use sho u l d be avo i ded i n cases o f

h a e m o r r h a g e . A d v e r s e e f f e c ts o f c r a n i o s a c r a l t h e r a p y h a v e

bee n r ep or t ed i n pa t i en t s w i t h t r aum at i c b r a i n i n ju r y . I°1

P h y s i c al m a n i p u l a ti o n s h o u l d b e a v o i d e d i n a n y a r e a o f t h e

b o d y w h e r e t h e r e is a r is k o f a g g r a v a ti n g h a e m o r r h a g e . I f

c r an i a l os t eopa t h i c t r ea t ment can i n f l uence i n t r ac r an i a l

c i r c u la t io n t h e n i t m a y b e o f b e n e f i t i n c a s e s w h e r e b l o o d

f l ow i s compr om i sed , such a s t r ans i en t is chaem i c a t tacks

o r s tr o k e s ; f u r t h e r r e s e a r c h w o u l d b e n e c e s s a r y t o

invest igate thi s poss ibi l i ty .

Nervous system

I f AN S f unc t i on i s a pa r t o f c r an i a l os t eopa t h i c d i agnos i s

a n d t r e a t m e n t t h e n c o n s i d e r a t i o n o f th e p a t h o p h y s i o l o g y

of t he ne r vous sys t em i s i mpor t an t . P a t ho l og i ca l cond i ti ons

i n the cen t r a l o r pe r i phe r a l ne r vous sys t ems m ay i n f l uence

au t onomi c f unc t ion . L ongs t and i ng P a r k i nson ' s d i s ease can

c a u s e r e d u c e d s y m p a t h e t i c v a s o m o t o r a n d c a r d i o m o t o r

out f lo w leading to dim inished M ay er waves . 102 Alco hol i sm

can cause au t ono mi c neur opa thy ,103 a s ca n d i abe t e s .

Cerebrospinal luid drainage

T h e p o s s i b i l it y t h a t t h e d r a i n a g e o f C S F i n h u m a n s i s to a

s i gn i f i can t ex t en t t h r oug h t he c r i b r i f o r m p l a t e , a s i t i s in

sheep , 4° r a i s e s pos s i b i l i t ie s o f f o cus i ng t r ea t ment on t ha t

a r ea. D i s t u r bance o f CS F dr a i nage m ay he l p t o exp l a i n t hei n t e r fe r ence w i t h t hough t p r oces ses t ha t s eem t o acc omp any

a h e a v y c o l d o r b a d h a y f e v e r , w h e n t h e n a s a l m u c o s a i s

s w o l l e n a n d th e d r a i n a g e o f C S F m a y b e i m p a i re d . T h e

l a rg e n u m b e r o f s u tu r e s b e t w e e n t h e b o n e s o f t h e f a c e

sugges t s t ha t movement i s i mpor t an t i n t h i s a r ea , whi ch

cou l d be t o a i d d r a i nage o f the s i nuses and c r i b r i f o r m p la t e ,

a n d m a y r e p r e s e n t a c r e d i b le m e c h a n i s m f o r t h e i n f lu e n c e

of c r an i a l os t eopa t h i c tr ea t men t on t he dynam i cs o f C S F .

Muscular tension patter ns

I t i s a f ea t u r e o f c l i n i ca l os t eopa t h i c p r ac t i ce t ha t many

sympt oms a r i s e f r om, and t r ea t ment i s d i r ec t ed t owar ds ,

d y s f u n c t i o n a l p a t te r n s o f m u s c u l a r a n d f a s c ia l t e n s io n .

A b n o r m a l a u t o n o m i c a c t iv i t y m a y b e p a r t o f t h e

p a t h o p h y s i o l o g y o f m y a l g i c e n c e p h a l o m y e l i t i s (M E ) o r

chr on i c f a t i gue syndr ome , wh i ch os t eopa t h i c t rea t ment has

been sho wn t o he l p .TM Di f f use M usc l e Coac t i va ti on ( DM C) ,

an i nc r ease i n e l ec tr i ca l ac t i v i ty and r e s t ing t one o f a musc l e

d u r i n g a m o v e m e n t t h a t d o e s n o t i n v o l v e th a t m u s c l e h a s

bee n dem ons t r a t ed i n cases o f fi b r omya l g i a , ° s whi ch ma y

be s imi lar to the os teopathic con cept of ' faci l i t a ted segments '

pro pos ed b y K orr . 106

Breathing

Br ea t h i ng ( r e sp i r a t i on) i n f l uences b r a i ns t em mot i l i t y49,

t hor ac i c veno us r e t u r n 12, hea r t r a t e va r i ab i l i ty 6 and t he 15

cpm ( HF ) vaso mo t or waves , so i t i s r easonab l e t o sugges t

t h a t c l in i c a l a tt e n t io n t o t h e e n c o u r a g e m e n t o f a g o o d

(diaphragmatic) breathing pat tern migh t have som e inf luence

o n t h e d y n a m i c s o f b l o o d , l y m p h a n d C S F a n d a l so r e d u c e

hyp er t on i a i n the acc es sor y musc l e s o f r e sp i r a ti on .

P alpat ion and Treatment

Desp i t e t he poss i b i l i t i e s opened up by t h i s mode l t h r ee

i mpo r t an t ques t ions nee d t o be addr es sed :

1. I s it poss ible to palpate these ar ter ia l rhythm s manu al ly?

2 . C a n t h e y b e a l t e re d b y e x t e r n a l h u m a n i n t e r v e n t io n

( t r ea t ment ) ?

3 . Does t h i s a l t e r a t ion have an y phys i o l og i ca l bene f i t f o r

t he pa t i en t ?

T o da t e ev i dence has t ended t o sugges t t ha t c r an i a l r hy t hms

are not palp ated wi th any deg ree of re liabili ty .9,1°,11 Th ere

a r e s eve r a l pos s i b l e exp l ana t i ons f o r t he d i f f e r i ng rhy t hm s

pa l pa t ed by d i f f e r en t p rac t i ti one r s :

1. Ar ter ia l vaso mo t ion occurs a t di f ferent ra tes in di f ferent

s ized arter ies and ar terioles . T he predom inant f requen cy

i s 6 c p m ( 0 . 1 H z ) , w h i c h o c c u r s i n m e d i u m - s i z e d

a r t e r io l e s , how eve r l a r ge r a rt e r ie s exh i b i t spon t ane ous

vasom ot i on a t s l ower ra t e s f o r examp l e 0 .2 cpm ( 0 .0033

Hz) i n t he Bas i l a r a r t e r y , 19 and 1 cpm ( 0 .02 H z) i n t he

Rad ial ar tery. 21 The smal les t ar ter ioles ex hibi t diam eter

f l uc t ua t i ons up t o 15 cpm ( 0 .25 Hz ) . 23 I t i s poss ible

t ha t i nd i v i dua l p r ac t i t ione r s f oc us on d i f f e r en t ra t e s o f

vasom ot i on gen e r a t ed by d i f f e r en t s i zed a rt e r ie s .

2 . P r ac ti ti one r s ma y pa l pa te d i f f e r ing dep ths o f movem ent ;

the scalp i s highly vascu lar so those ut i l is ing l ight f inger

p r e s s u re , a s i s e n c o u r a g e d b y t e a c h e r s o f ' c r a n i o s a c r a l

t he r apy ' , 3 m ay be de t ec t i ng vaso mo t i on i n t he s ca l p .

3 . Nor t o n 1°7 has p r o pose d t ha t t he s ensa t i on desc r i bed a s

8 0



© 2003 Research Media Ferguson A. A rev iew of the phys iology of cranial osteopathy

.

the cranial rhythmic imp ulse (CR I) i s re la ted to act ivat ion

o f s l o w l y a d a p t i n g c u t a n e o u s m e c h a n o r e c e p t o r s b y

t i s sue p r es sur es o f bo t h the sub j ec t and the exam i ne r ,

and t ha t t he sour ces o f change i n t hese t i ssue p r es sur es

a r e t he comb i ned r e sp i r a to r y and ca r d i ovascu l a r rhy t hmso f b o t h e x a m i n e r a n d s u b j e c t.

M c P ar t l an d 1°8 t akes N or t o n ' s mo de l f u r t he r and has

p r o p o s e d t h a t t h e C R I i s t h e p a l p a b l e p e r c e p t i o n o f

en t r a inment , a h a r moni c f r equen cy tha t i ncor por a t e s t he

r hy t hms o f mu l t ip l e b i o l og i ca l osc i ll a to r s , no t on l y h ea r t

r a t e and r e sp i r a t i on , bu t a l so h ea r t - r a t e va r i ab i l i t y and

a r te r ia l v a s o m o t i o n w i t h T r a u b e - H e r i n g - M a y e r ( T H M )

mod ul a t i on , and osc i l l a ti ons i n l ymp ha t i c ves se l s, g l i a l

ce l l s and co r t i ca l me t abo l i sm. 4 I t i s de r i v ed p r i ma r i l y

f r o m s i g n a ls b e t w e e n t h e s y m p a t h e t i c a n d

par asymp a t he t i c ne r vou s sys tems . T h i s mode l i nc l udes

t h e e x a m i n e r ' s o w n r h y t h m s s o c o u l d e x p l a i n t h ed i f f e r i ng r a t e s o f CRI pa l pa t ed on a sub j ec t by t wo

exam i ne r s a t t he s ame t i me .

T h e c o n c e p t o f e n t r a in m e n t i s u ti l is e d i n t h e t r e a t m e n t o f

s t r es s and em ot i ona l s t a t e s by me asur i ng 0 .1 H z hea r t r a te

va r i ab i l i t y and t each i ng sub j ec t s t o ach i eve i t t h r ough t he

e x p r e s s i o n o f p o s i t i v e ( h a p p y , c a l m ) e m o t i o n s . 1°9

P h y s i o l o g i c a l ly th e 0 . 1 H z f r e q u e n c y c a n b e e n t r ai n e d b y

0 .1 H z l e g m o v e m e n t s , w h i c h s t i m u la t e l o c al v a s o m o t o r

r e f l exes and ba r or ecep t o r ou t f low , and can a l so be en t r a ined

by pe r iodic ne ck suct ion, wh ich s t imulates baro receptors . 110

W h e t h e r o r n o t t r e a t m e n t c a n a f f e c t t h e s e r h y t h m s h a s y e tt o b e c o n v i n c i n g l y r es e a r c h e d . A r e c e n t s m a ll s t u d y h a s

sugges t ed t ha t t r ea t men t can i nc r ease t he ampl i t ude o f 0 .1

Hz f l uc t ua t ions , 16 t houg h m or e r i gor ous r e sea r ch w i l l be

need ed to conf i rm this . Eve n i f it is demo nst ra ted that cranial

pract i t ioners can palpate an d inf luence these rhythms, fu r ther

s t ud ie s a r e neede d t o de t e r mi ne whe t he r o r no t t h is ex t e r na l

i n f l uence has an y phys i o l og i ca l hea l t h bene f i t s.

F u r t h e r r e s e a r c h

Con s i de r ab l e phys i o l o g i ca l and c l i n i ca l r e sea r ch needs t o

be under t aken t o c l a r i f y and suppor t ( o r cha l l enge ) t he

t h e o r y a n d p r a c t ic e o f O C F . I n t he p a s t th e p r o b l e m h a sbeen t ha t c l i n ica l p r ac t i ce s eems t o be succes s f u l , ye t t he

t h e o r i e s b e h i n d i t h a v e b e e n c o n t r o v e r s i a l a n d r e l i a b l e

r e sea r ch has no t been ab l e t o va l i da t e t he concep t s and

pr ac t i ce . One o f t he r easons f o r th i s has been t he l i mi t a t ion

o f a v a i la b l e t e c h n o l o g y t h a t c a n m a k e r e l i a b l e a n d

r e p r o d u c i b l e m e a s u r e m e n t s o f th e p h e n o m e n a i n v o l v e d .

V a r io u s m e t h o d s h a v e b e e n t r i e d o v e r t h e y e a rs , b u t

g e n e r a l l y t h e y h a v e b e e n o n e - o f f e x p e r i m e n t s w i t h

quest ionable me thod olog y or unrel iable technolog,¢ Rec ent

i mpr ove men t s in t echno l ogy mean t ha t i t is now po ss i b l e to

r e l iab l y measur e changes i n c r an i a l bones , f o r exam pl e us i ng

f u n c t io n a l M a g n e t i c R e s o n a n c e I m a g i n g o r p u l s e d p h a s e -

l o c k l o o p u l t r a so u n d . TM Bl o od p r es sur e ( BP ) f luc t ua t i ons

can be m easured in a c l inical se t t ing us ing a 'F inapres ' dev ice

a t t a c h e d t o a f i n g e r w h i c h , w h e n c o m b i n e d w i t h t h e

appr opr i a t e so f t war e , can be used t o ana l yse a r t e r i a l BP

w a v e f o r m s w h i c h c o r r e la t e w e l l w i t h c h a n g e s i n c e r e b r a l

b l ood f l ow i n t he 0 .1 H z r ange , u2 Chang es i n the HR V can

81

b e m e a s u r e d w i t h e le c t r o - c a rd i o g r a m s ( E C G ) . S o i f t h e

mo del prop osed in thi s paper i s feas ible then re l iable research

shou l d be ab l e t o suppor t o r r e f u t e i t.

C O N C L U S I O N

T h i s d i s c u s s io n h a s r e v i e w e d c u r r e n t r e s e a r c h c o n c e r n i n g

a s p e c ts o f t h e p h y s i o l o g y b e h i n d t h e t h e o r i e s a n d p r a c t ic e

o f c r a n ia l o st e o p a th y . T h e r e i s e v i d e n c e o f m o v e m e n t

b e t w e e n a n d c o m p l i a n c e o f c r an i a l b o n e s , a n d t h e r e i s

ev i dence t ha t a r t e r i a l vasomot i on occur s a t r a t e s usua l l y

a s s o c i a te d w i t h t h e C R I . I t w a s p r o p o s e d t h a t t h e s e m i g h t

f o r m pa r t o f the bas i s o f t he p r ac t ice o f OCF . T he c l i n i ca l

impl icat ions of thi s mo del we re discussed. Several c l inical ly

i m p o r t a n t a s p ec t s o f p h y s i o l o g y h a v e b e e n b r o u g h t i n t o

gene r a l os t eopa t h i c awar enes s b y t h i s s t udy :

. A n u n d e r s t a n d i n g o f th e p r o p e r t i e s o f a r t e r io l a rvasom ot i on . T he r e i s a pe r vas i ve r a t e o f 6 cpm ( 0 .1

Hz) t ha t co r r e sponds t o mos t r epor t s o f t he CRI , t hough

t h e r e a r e d i f f e ri n g r a te s d e p e n d i n g o n t h e d i a m e t e r o f

t h e a r te r y. T h e e f f e c t s o f s y n c h r o n o u s v a s o m o t i o n o n

a r t e r ia l b l ood p r es sur e and hea r t r a t e va r i ab i l i t y wer e

discussed.

. T h e p o s s i b i l i t y o f re v e r s i b l e v e n o u s f l o w t h r o u g h

e m i s s a r y v e i n s o f th e c r a n i u m a s p a r t o f

t he r mor egu l a t i on .

. T he poss i b i l i t y t ha t a s i gn i f ican t p r opor t i o n o f CS F i s

d r a i ned v i a t he c r i b r i f o r m p l a te t o t he ce r v i ca l lymph a t i csys tem. T he mechan i sms f o r the c i r cu la t i on o f CS F wer e

r e v i e w e d .

. C l a r if i c a ti o n o f t h e r o l e o f t h e s y m p a t h e t ic n e r v o u s

sys t em ( S NS ) i n it s con t r o l o f vasom ot i on and e f f ec t s

o n b l o o d p r e s s u r e , w i t h t h e p o s s i b il i ty t h a t t h e r e m a y

be d i r ec t S NS i n f l uenc e on ske l e t a l musc l e .

R E F E R E N C E S

1. Sutherland W G. The C rania l Bowl . Free P ress Company. 1939.

2 . M ag o u n H . Osteopathy in the Crania l Field. 1st ed. Kirksvil le. The

Journal P r in t ing Co. 1951.

3 . Upledg er J , Vrede voogd J . Craniosacral Therapy. Seatt le. Eastland

Press ; 1983.

4 . F e rg u s o n A J , M cP ar t l an d J M , U p l ed g e r JE , C o l l in s M , L ev e r R .

Cranial os teopathy and cran iosacral therapy: curren t op in ions . J o u rn a l

o f B o d y w o rk a n d M o v e me n t Th e ra p ie s . 1998; 2: 28-37.

5 . Green C , Mart in C , Basset t K, Kazan j ian A. A systemat ic rev iew and

cri t ica l appra isa l o f the sc ien t i f ic ev idence on cran iosacra l therapy.

B r i ti s h C o l u m b i a O f f i c e o f H e a l t h T e c h n o l o g y A s s e s s m e n t , T h e

Univer s i ty of Bri t i sh Columbia. 1999.

6 . Chai tow L. Crania l Man ipu la t ion TheolT and Practice. Churchi l l

Liv ings tone. 1999.

7 . Norton J , S ib ley G, Broder-Oldbach B . Character i sation of the cran ial

rh y t h m i c i m p u l s e i n h ea l t h y h u m an ad u l t s . A c a d e m y o f A p p l i e dOsteopathy Journal . 1992; 2 No.3 : 9-26 .

8 . Beck er R . Cranial therapy rev i s i t ed . Osteopath ic Annals . 1977; 5:

316-334.

9 . Wir th-Patml lo V, Haye s K. In terrater re l i ab i l i ty of cran iosacral ra te

m eas u rem en t s an d t h e i r re l a t io n s h i p w i t h s u b j ec t s ' an d ex am i n e r s '

hear t and resp i ra tory ra te measurem ents . Phys Ther. 1994; 74: 908-

110.



Journal of Osteopathic Medicine, 2003; 6(2 ): 74-88 © 2003 Research Media

10. Rogers J , Wi t t P , Gross M, Hacke J , Genov a P . S imul taneous palpat ion

of the cran iosacral ra te a t the hea d and feet : in t rarater and in terrater

re l i ab i l ity and ra te com pari sons . Phys Ther. 1998; 78 :1175-85 .

11 . Mora n R , Gibbons E In t raexaminer and in terexaminer re l iab i l i ty for

p a l p a t i o n o f c r an i a l r h y t h m i c i m p u l s e a t t h e h ead an d s ac ru m . J

Manipulative Physiol Ther. 2 0 0 1 ; 2 4 : 1 8 3 -9 0 .

12 . G anong W. Review of Medical Physiology. App leton & Lange. 1997.

1 3 . N o v ak V , N o v ak P , d e C h am p l a i n J , L e B l an c A , M ar t in R , N ad eau

R. Inf luence of resp i ra t ion on hear t ra te and b loo d pressure f luctuat ions .

J Ap p l Ph y s i o l . 1993; 74: 617-26.

14 . Tur janma a V, Kal l i S , Sydanmaa M, U us i ta lo A. Short - t erm var iab i l ity

of sys to l i c b lood pressure and hear t ra te in normoten s ive subject s .

Clin Physiol. 1990; 10: 389-401.

15 . N elson K, Se rgne ef N, Lip insk i C , Chapma n A, Glouek T. Cranial

rh y t h m i c i m p u l s e r e l a t ed t o t h e T rau b e -H er i n g -M ay e r o s c i l l a ti o n :

comparing l aser-Doppler f lowmet ry and palpat ion . J Am Osteopath

Assoc. 2001; I01: 163-73.

1 6 . S e rg n ee fN , N e l s o n K , G l o n ek T . C h an g es i n t h e T ran b e H er i n g Wav e

fo l lowing Cranial Manipulat ion . The AAO Journal . 2001; 11:

17 . B em adi L , Leuzz i S , Radael l i A, Pass ino C , Johns ton J , S leight R

L o w - f r eq u en cy s p o n t an eo u s f l u c t ua t io n s o f R -R i n te rv a l an d b l o o d

pressure in conscious humans : a baroreceptor or cen t ral phenom enon?

Clin Sci. 1994; 87: 649-54.

18 . Cervese A, Gul l i G, Polat i E , Got t in L , Grasso R . Baroref lex and

osci l l a t ion of hear t per iod at 0 .1 Hz s tudied by alpha-b lockade and

cross -spect ra l analys i s in heal thy hum ans . JPhysio l . 2001; 531: 235-

44 .

19 . Fuj i i K, Heis tad D, Faraci F . V asomot ion of bas i l ar ar ter i es in v ivo .

Am J Ph y s i o l. 1990; 258: H182 9-34 .

20 . Hundley W, Renaldo G, Levasseur J, Kontos H. Vasomo t ion in cerebral

microci rcu lat ion in awake rabbi t s . Am JPhysio l . 1 9 88 ; 2 5 4 : H 6 7 -7 1 .

2 1 . H ay o z D , T a rd y Y , R u t s ch m an n B M i g n o t J P , e t a l. S p o n t an eo u s

diameter osci l l a t ions of the rad ial ar t ery in hum ans . Am J Physiol.

1993; 264: H2080-4 .

22 . Ma yhew J , A skew S , Zheng Y, Porr i ll J , e t a l . Cerebral Vasomot ion:

A 0 .1 H z Osci l l a t ion in Ref lected Light Imaging of Neural Act iv i ty .

Neuroimage. 1996; 4: 183-193.

23 . Colantuoni A, Ber tugl ia S , Coppin i G, Dona to L. Superpos i t ion of

ar ter io lar vasom ot ion waves and regulat ion of b lood f low in skeleta l

muscle m icroci rcu lat ion . Adv Exp MedBio l . 1990; 277: 549-58.

24 . Ber tugl ia S , Colantuoni A, Coppin i G, In tag l ie t t a M. Hypoxia- or

hyperoxia- induc ed changes in ar ter io lar vasom ot ion in skeletal muscle

microci rcu lat ion . Am J Ph y s i o l. 1991; 260: H362-72.

25 . Colantuoni A, Ber tugl ia S, Marchiafava R Phento lamine suppresses

the increase in ar ter io lar vasom ot ion f requency due to sys tem ic hypoxia

in hamster skeletal muscle microcirculation. Auton Neurosci. 2 0 0 1 ;

90: 148-51.

2 6 . M o s k a l en k o Y E , K rav ch en k o T I , G a i d a r B V . P e ri o d i c M o b i l i t y o f

C ran ia l B o n es i n H u m an s . Human P hysiology. 1999; 25 :51-58 .

2 7 . F a r a s y n A . N e w h y p o t h es i s f o r th e o r i g i n o f c r an i o - s ac ra l m o t io n .

Journal of Bodywork and Movement Therapies. 1999; 3 : 229-237.

28 . Colantuoni A, Bermg l ia S , In tag l ie t ta M. Effect s of anes thes ia on the

spontaneous act iv i ty of the microvasculature . Int J Microcirc Exp.

1984; 3: 13-28.

2 9 . C ab an ac M , B r i n n e l H . B l o o d f l o w i n t h e em i s s a ry v e i n s o f th e h u m an

head dur ing hyper thermia. European Journal of Applied Physiology.

1985; 172-176.

30 . Caputa M, Perr in G, Cabanac M. Ecoulem ent sanguin revers ib le dans

l a v e i n e o p t h a l m i q u e : m ec an i s m e d e r e f ro i d i s s em e n t s e l ec t i f d u

ce rv eau h u m a i n . C R A c a d S c i . i978; 287: 1011-1014.

3 1. Z e n k e r W , K u b i k S . B r a i n c o o l i n g in h u m a n s - - a n a t o m i c a l

cons iderat ions .Anat Embeyol (Berl). 1996; 193: 1-13.

32 . Onizuka M, F latebo T. Lymph f low pat tern in the in tact thoracic duct

i n s h eep . Journ al o f Physiology. 1 9 9 7 ; 5 0 3 : 2 2 3 -2 3 4 .

33 . Olszewski W , Engeset A. In tr ins ic cont ract il ity of l eg lymphat ics in

man: prel iminary communicat ion . Lymphology. 1979; 12: 81-84.

34 . Gashev A , Zawieja D. Phys io logy of human lymph at ic contracti li ty : a

h i s tor ical perspect ive. Lymphology. 2 0 0 1 ; 3 4 : 1 2 4 -3 4 .35 . Fold i M. The Brain and the Lymp hat ic Sys tem. Lymphology. 1996;

29: 1-9.

36 . Fold i M. Resolv ing the r idd le of lymph. M L D U K . 1999; Autumn:

37 . Gideon P , Thom sen C , S tah lberg F , Henriksen O. Cerebrospinal f lu id

p ro d u c t i o n an d d y n am i cs i n n o rm a l ag in g : an M R I p h as e -m ap p i n g

study. Acta Neurol Scand. 1994; 89: 362-6.

3 8 . L eed s S , K o n g A , Wi s e B . A l t e rn a t i v e p a t h w ay s fo r d ra i n ag e o f

eerebrospinal f lu id in the canine brain. Lymphology. 1989; 22: 144-6.

3 9 . K i d a S , P a n t a z i s A , W e l l e r R . C S F d r a i n s d i r e c t l y f r o m t h e

s u b a rach n o i d s p ace i n t o n as a l l y m p h a t i c s i n t h e r a t . A n a t o m y ,

h i s t o l o g y a n d i m m u n o l o g i c a l s i g n i f i c a n c e . N e u ro p a t h o l Ap p l

Neurobiol. 1993; 19: 480-8.

40. Mollanji R, Bozan ovic-S osic R, Silver ILi B, et al . Intracranial pre ssure

a c c o m m o d a t i o n is i m p a i r e d b y b l o c k i n g p a t h w a y s l e a d i n g t o

ext racran ial lymphat ics . Am JReg ul In tegr Comp Physio l. 2001 ; 280:

R 1 5 7 3 -8 1 .

41 . Johns ton M. Relat ionship betwee n cerebrospinal flu id and ex tracran ial

l y m p h . Lymphology. 2000; 33 :

42 . Bosano vic-Sos ic R , Mol lan j i R , and Johns ton M. Spinal and cran ial

contrib utions to total cerebro spinal fluid transport . Am JReg ul In tegr

Comp P hysiol. 2001; 281: R909-16 .

43 . S i lver I, Kim C, M ol lan j i R , Johns ton M. C erebrospinal f lu id out f low

res i s tance in sheep: impact o f b locking cerebrospinal f lu id transpor t

through the cr ibr i form plate . NeuropatholApplNeurobiol. 2002; 28 :

67-74.

4 4 . M o l l an j i R , B o zan o v i c -S o s i c R , Z ak h a ro v A , M ak a r i an L , M G J .B locking cereb rospinal f lu id absorp t ion through the cr ibr i form plate

increases res t ing in t racran ial p ressure . Am J Physiol Regul lntegr

Comp P hysiol. 2002; 282: R1593-9 .

45 . Grei t z D, Wires t ram R, F ranck A, Nordel l B , Thom sen C , S tahlberg

F . Pul sat i l e brain movement and associated hydrodynamics s tud ied

b y m ag n e t i c re s o n an ce p h as e i m ag in g . T h e M o n ro -K e l l ie d o c tr i n e

revisited. Neuroradiology. 1992; 34: 370-80.

4 6 . P o n ce l e t B , Wed ee n V , We i s s k o f f R , C o h en M . B ra i n p a r en ch y m a

m o t i o n: m eas u rem en t w i t h c i n e ech o -p l an a r M R i m ag in g . Radiology.

1992; 185: 645-51.

4 7 . E n zm an n D , P e l c N . B ra i n m o t io n : m eas u rem en t w i t h p h as e - co n tr a s t

M R i m ag i n g. Radiology. i992; 185: 653-60 .

48 . Grei t z D. C erebrospinal f lu id c i rcu lat ion and assoc iated in t racraniald y n a m i c s . A r a d i o l o g ic i n v e s t i g a t i o n u s i n g M R i m a g i n g a n d

radionucl ide c i stemography . Acta Radiol Suppl. 1993; 386: 1-23.

49 . Ma ier S , Hardy C , Jo lesz F . Brain and cerebrospinal f lu id mot ion:

r ea l - ti m e q n an t i fi c a ti o n w i t h M -m o d e M R i m ag i ng . Radiology. 1994;

193: 477-83 .

50 . Mikul i s D, Woo d M, Zerdone r O, Poncelet B . Osci l la tory mot ion of

the norma l cerv ical sp inal cord . Radiology. 1994; 192:117-21 .

51 . Tanaka H , Sa!atra i K, Kashiw agi N, Fuj i t a N, e t a l . Trans i t ion of the

craniocandal veloci ty of the sp inal cord : f rom cerv ical segment to

lumbar en largement . Invest Radiol. 1998; 33: 141-5.

52 . Henry-Fe ugeas M, Idy-Peret t i I , Baledent O, Poncelet -Didon A, e t a l .

Orig in ofsuba rachn oid cerebrospinal f lu id pul sat ions : a phase-cont ras t

M R analys is . Magn Reson Imaging. 2000; 18 : 387-95 .

53 . RetzlaffE , Mi tchel l L . The Cranium andlts Sutures. Springer-Verlag.

i 9 8 7 .

54 . Opperm an L. Cranial su tures as in t ran lembranous bone growth s i tes .

Dev Dyn. 2000; 219: 472-85 .

55 . Chand ra Sek haran P . Ident i f i cat ion of skul l f rom i t s su ture patt ern .

8 2



© 2003 Research Media Ferguson A. A review of the physiology of cranial osteopathy

F o re n s i c S c i I n t . 1985; 27 : 205-14 .

5 6 . H e i s e y S , A d a m s T . R o l e o f c r a n i a l b o n e m o b i l i t y i n c r a n i a l

compl iance. N e u ro su rg e t y . 1993; 33: 869-76.

57 . Olesk i S , Smi th G, Crow W . Radiographic Evidence of Cranial Bo ne

Mobility. Cranio: The J of Craniomandibular Pra ctice. 2002; 20 :34-43 .

5 8 . M y er s R . M eas u rem en t o f s m a l l r h y t h m i c m o t io n s a ro u n d t h e h u m an

cranium in v ivo . J A u s O s t A s s n . 1998;

59 . B u t l e rD . Mo b i l i sa t i o n o f th e N e rv o u sS y s t e m . Churchi l lLiv ings tone.

1991.

60 . Tuni tor i A. Elas t i c i ty of the sp inal cord dura in the dog . J N e u r o s u r g .

1977; 47: 391-6.

61 . Yuan Q, Doug her ty L, Margnl ies S . In v ivo human cerv ical sp inal

cord d eformat ion and d i sp lacement in f l ex ion . Spine. 1998; 23: 1677-

83 .

62 . Hack G, Kori t zer R , Robinson W, Hal lgreen R , Greeuma n P . Anatom ic

re l a t io n b e t w ee n t h e r ec t u s cap i t i s p o s t e r io r m i n o r m u s c l e an d t h e

dura mater . Spine. 1995; 20: 2484-6.

6 3 . D ean N , M i t ch e l l B . A n a t o m i c r e l a t io n b e t w een t h e n u ch a l l i g am en t

( l i g am en m m n u ch ae ) an d t h e s p i n a l d u ra m a t e r i n t h e c r an i o ce rv ica l

reg ion . C l in A n a t . 2002; i5: 182-185.

64 . Levine R . Somat ic (cran iocerv ical ) t inn i tus and the dorsal cochlear

nucleus . Am J Otolaryngol. 1999; 20 :351-62 .

65 . McPart l and J , Brodeur R , Hal lgren R . Chronic neck pain , s t anding

b a l a n c e a n d s u b o c c i p i t a l m u s c l e a t r o p h y . J M a n i p & P h y s i o l

Therapeutics. 1997; 21 : 24-29.

6 6. L e d e r m a n E . F u n d a m e n t a l s o f M a n u a l T h e ra p y . C h u r c h i l l

Liv ings tone. 1997.

67 . Lakie M. Mu scle tone, t ens ion and th ixot ropy . J P h y s i o l . 1998; 511:

6 8 . H n i k R M y o g en i c an d n eu ro g en ic m u s c l e to n e . J P h y s io l . 1998; 511:

69. Martini F. Fundam enta ls o f Anatom y and Physio logy. . Univers i ty of

Hawa i i . P ren t ice Hal l. 2002.

70 . Grass i C , Passature M. Act ion o f the sympa thet i c sys tem on skeleta l

m u s c l e . I ta L J N e u ro l S c i. 1988; 9: 23-8.

7 1 . H u n t C , J am i L , L ap o r t e Y . E f f ec t s o f s t i m u l a t i n g t h e l u m b ar

sympathet i c tnmk on cat h indl imb muscle sp indles . Arch I ta l Bio l .

1982; 120: 371-84.

72 . Grass i C , Der iu F , Passatore M. E ffect of synlpathet i c nervous sys tem

act ivat ion on the ton ic v ibrat ion ref lex in rabbi t j aw clos ing muscles .

J P h y s i o l . 1993; 469:

73 . Roat ta S , Windhors t U, Ljubi savl jev ic M, Johansson H, Passatore M.

Sympathet ic modulat ion ofmus cle sp indle afferen t sens it iv i ty o s t re tch

in rabbi t j aw clos ing muscles . J P h y s i o l . 2002; 540: 237-48 .

74 . S imons D, Hong C , S imon s L. Endplate poten t ia l s are comm on to

midf ibe r myofascial t r igger po in t s . A m J P h y s M e d R e h ab i l. 2002;

81: 212-22 .

75 . S imons D. Un ders tanding effect ive t reatments of myofascial tr igger

poin t s . J B o d y w o rk Mo v e me n t Th e r . 2 0 0 2 ; 6 : 8 1 -8 8 .

76 . Nakata A , Takata S , Yuasa T, Shim akara A, e t a l. Spect ra l analys i s of

h ea r t r a t e , a r t e r i a l b i o o d p r e s s u re , an d m u s c l e s y m p a t h e t i c n e rv e

act iv i ty in normal hum ans . A m J P h y s i o l. 1 9 98 ; 2 7 4 : H 1 2 1 1 -H 1 2 1 7 .

77 . Larsson S , Cai H, Oberg E Cont inuous percutaneous measurem ent

b y l a s e r -D o p p l e r f lo w m et ry o f s k e l e t a l m u s c l e m i c ro c i r cu l a ti o n a t

vary ing l evel s o f con t ract ion force determined elect romyographical ly .

E u r J A p p l P h y s io l Oc c u p P h y siol . 1993; 66: 477-82.

78 . Sal t in B , Radegran G, Koskolou M, Roach R . Skeleta l musc le b loodf low in hum ans and i t s regulat ion dur ing exercise.Acta Ph ysio l Seand.

1998; 162: 421-36.

7 9 . R ay C . I n t e r ac t i o n o f t h e v es t i b u l a r s y s t em an d b a ro re f l ex es o n

s y m p a t h e t i c n e rv e ac t i v i t y i n h u m an s . A m J P h y s io l He a r t C i rc

Physiol. 2000; 279: H2399-404.

8 0 . S a i t o M , N a k a m u r a Y . C a r d i a c a u t o n o m i c c o n t r o l a n d m u s c l e

sympathet i c nerve act iv i ty dur ing dynamic exerci se . Jpn J Physiol.

1995; 45 : 961-77 .

8 1 . C h a rk o u d i an N . I n f l u en ces o f f em a l e r ep ro d u c t i v e h o rm o n es o n

sympathet i c cont ro l of the c i rcu lat ion in humans . Clin Auton Res.

2001; 11 : 295-301.

82 . Pagani M, Mon tano N, Por ta A, Mal l ian i A , e t al . Relat ionship betw een

spect ral comp onents of card iovascular var iab i li ti es and d i rect measures

of muscle sympathet i c nerve act iv i ty in humans . Circulation. 1997;

95: 1441-8.

83 . Bernadi L , Hayoz D, Wenzel R , Pass ino C , e t a l . Synchronous and

barocep tor-sens i t ive osci ll a t ions in sk in microci rcu lat ion : ev iden ce

for cent ral au tonomic contro l. A m J P h y s i o l . 1997; 273: H1867-78 .

8 4 . G u y t o n A C , H a l l J E . T e x t b o o k o f M e d i c a l P h y s i o l o gy . 9 t h E d .

Phi ladelphia: WB Saunders ; 1996.

Textbook o f medica l physiology. Saunders . 1996.

85 . Taylor J , Wi l l i ams T, Seal s D, Davy K. Low -frequenc y ar ter ia l p ressure

f l u c t u a t i o n s d o n o t r e f l ec t s y m p a t h e t i c o u t f l o w : g en d e r an d ag e

differences. A m J P h y s i o l . 1 9 98 ; 2 7 4 : H 1 1 9 4 -2 0 1 .

86 . Trzebski A, Smietanow ski M. Card iovascu iar per iodici t es in heal thy

h u m an s i n t h e ab s en ce o f b r ea t h i n g an d u n d e r r ed u ced ch em i ca l d r i v e

of respirat ion. J A u to n N e rv S y s t. 1996; 57: 144-8.

87 . Diehl R , Linden D, Lucke D, Ber l i t E Spontaneous b lood pressure

oscilIat ions and c ereb ral autoregulation. Clin Auton R es. 1998; 8: 7-

12 .

88 . Der iu F , Roat ta S , Grass i C , Urciuol i R , Miciel i G, Passatorre M.

Sympathet ical ly- inducedchanges in microvascular cerebral b lood f low

an d i n t h e m o rp h o l o g y o f i t s l o w - f r eq u en cy w av es. J A u to n N e rv e

Syst. 1996; 59: 66-74.

89 . Golanov E, Rei s D. Vasodi la t ion evoke d f rom medu l la and cerebel lum

is coupled to burs t s in cor t i cal EEG act iv i ty in ra ts . Am J Physio l .

1995; 268: R454-67.

9 0 . G o l an o v E , Y am am o t o S , R e i s D . S p o n tan eo u s w av es o f ce r eb ra l b l o o d

flow associated wi th a pat t ern of e lect rocor t i cal activ ity . A m J P h y s i o L

1994; 266: R204-14.

9 1 . M cK eo w n M , H u m p h r i e s C , A ch e rm arm P , B o rb e ly A , S e j n o w s k i T .

A new method for detect ing s ta te changes in the EEG: exploratory

appl icat ion to s l eep data. J S l e e p R e s. 1998; 7: 48-56.

92 . Es ler M. The sym pathet i c sys tem and hyper tens ion . A m J H y p e r t e n s.

2000; 13 : 99S-105S .

93 . Ju lius S , Majahalme S . The chan ging face of sympathet i c overact iv i ty

in hyper tens ion . A n n Me d . 2000; 32 : 365-70 .

94 . Seal s D, Es ler M. Hum an aging and the sympathoad renal sys tem. J

Physiol. 2000; 528: 407-17 .

95 . McC raty R , Atk inson M, Ti ll er W, Rein G, Watk ins A. The effect s of

e m o t i o n s o n s h o r t - t e r m p o w e r s p e c t r u m a n a l y s i s o f h e a r t r at e

variability. A m J C a rd io l . 1996; 76: 1089-93.

9 6 . K o h J , B ro w n T , B e i g h t o l L , H a C , E ck b e rg D . H u m an au t o n o m i c

rhythms: vagal card iac mec hanism s in t e t rap leg ic subject s . J P h y s io l

(Lond). i994; 474: 483-495.

97. Still A. Th e P h i lo so p h y a n d Me c h a n ic a l P r in c ip l e s o f O s t e o p a th y . .

Kansas . Hudson -Kimbe rley . 1902.

98 . Dora i swam y P, MacF al l J , Kri shnan K, O'Corm er C , e t al . Magnet ic

R es o n an ce a s s e s s m en t o f ce r eb ra l p e r fu s i o n i n d ep re s s ed ca rd i ac

patients: prelim inary findings . A m J P s y c h i a tr y . 1999; 156: 1641-3.

9 9 . C l o a rec -B l an ch a rd L , G i r a rd A , H o u b o u S , G ru n fe l d J, E l g h o z i J .

Spect ral analys i s of shor t - t erm b lood pressure and he ar t ra te var iab i l i ty

in uraemic pat i en t s . Kidney In t Suppl. 1992; 37: S14-8.

I0 0 .K o r r I . T h e S y m p a t h e ti c N e rv o u s S y s t em as M ed i a t o r b e t w een t h e

S o m a t i c an d S u p p o r t i v e P ro ces s e s. i n Th e P h y s io lo g i c a l B a s i s o f

Os t e o p a th i c Me d ic in e . N ew Y o rk : T h e P o s t g r ad u a t e In s t i t u t e o f

Osteopath ic Medicine and Surgery. 1970.

101.Greenman P , McPart l and J . Cranial f ind ings and ia t rogenes i s f rom

8 3



Journal of Osteopath ic Medicine, 2003; 6(2) : 74-88 © 2003 Research Media

craniosacral m anipulation in patients with traumatic brainsyndrome. JAm Osteopath Assoc. 1995 ; 95: 182 -88.

102.Linden D, D iehl R, and Berlit E Sympathetic cardiovasculardysfunction in long-stand ing idiopathic Parkinson's disease. Clin

Auton Res. 1997; 7:311-4.

103.Johnson R, Robinson B. Mortality in alcoholics with autonomicneuropathy.JNeurol Neurosurg Psychiatry. 1988; 51 : 476-80.

104.Perrin R, Edwards J, Hartley R An evaluation of the effectiveness ofosteopathic treatment on symptoms associated with myalgicencephalomyelitis. A prelim inary report. JMed Eng Technol. 1998;22: 1-13.

105.Donaldson C, Snelling L, MacInnis A, S ella G, M ueller H. DiffuseMuscular Coactivation (DMC) as a potentiai so urce of pain infibromyalgia - Pa rt 1. NeuroRehabilitation. 2002; 17: 33-9.

106.Korr I. The SegmentalNervous System as M ediator and O rganizero fDisease processes, in The Physiological Basis of Osteopathic

Medicine. New Yo rk: The Postgraduate Institute of O steopathic

Medicine and S urgery., 1970.

107.NortonJ. A tissue pressure mod el for palpatoryperception of he cranialrhythmic impulse.JAm Osteopath Assos. 1991; 91: 975-984.

108.McPartland J, Me in E. Entrainment and the cranial rhythmic mpulse.

Altern Ther Health Med. 1997; 3: 40-5.109.Tiller W, McCraty R, A tkinson M. Cardiac coherence: a new,

noninvasive measure of autonomicnervous system order.Altern Ther

Health Meal. 1996; 2: 52-65.

110.Nasimi S, H arness J, M aijanovic D, K night T, Mearns A. Periodicposture stimulation of the baroreceptors and the local vasomotorreflexes.JBiomedEng. 1992; 14: 307-12.

111 Ballard R, W ilson M, W atenpaugh D. Noninvasive measurement of

intracranial volume and pressure us ing ultrasound. AmericanInstitute o f Aeronautics and Astronautics Life Sciences and Sp aceMedicine Conference., Houston, 1996.

112.KuoT, ChemC, ShengW, WongW, Hu H. Frequencydomainanalysisof cerebral blood flow velocityand its correlation with arterial bloodpressure.J Cereb Blood Flow Metab. 1998; 18:311-8.

Viewpoint

M c G r a t h M C .

T h i s r e v i e w 1 e c h o e s t h e p o s i t i o n t h a t t h e r e i s n o s c i e n t i f i c

j u s t i f ic a t i o n f o r o s t e o p a t h y i n t h e c r a n i al f i e l d ( O C F ) , a

p o s i t i o n w h i c h h a s b e e n p r e v i o u s l y w e l l d e s c r i b e d i n t h e

l i t e ra tu re .2 , 3, 4 . 5, 6 , 7 A n a l t e rna t ive the ore t i ca l m od e l i s

p r o p o s e d . T h i s p r o p o s e d m o d e l t h e o r is e s t h a t c r a n ia l b o n em o v e m e n t i s t h e re s u l t o f " r h y t h m i c c h a n g e s i n a r te r ia l

v a s o m o t i o n , l e a d i n g t o b l o o d p r e s s u r e f l u c t u a ti o n s w i t h i n

t h e c r a n i u m ." I t i s p r o p o s e d t h a t a r t e r ia l p r e s s u r e c h a n g e s

d u e t o c a r d i a c s y s t o le a n d v a s o m o t o r a c ti v i t y m o v e t h e b r a i n

a n d c a u se C S F t o f lo w . T h i s , c o u p l e d w i t h e v i d e n c e o f

s l i g h t s u t u r a l m o v e m e n t a n d c r a n i a l b o n e c o m p l i a n c e , i s

p r e s e n t e d a s o f f e r i n g t h e p o t en t i a l f o r a m o r e l i k e l y

t h e o r e t i c a l b a s i s . N e w th e o r e t i c a l m o d e l n o t w i t h s t a n d i n g ,

t h e r e re m a i n s a n a b s e n c e o f d e m o n s t r a t e d v a l i d i t y in O C F

t h e o r y a n d c l i n i c a l p r a c t i c e t h a t r e a c h e s w e l l b e y o n d m e r e l y

t i n k e r i n g w i t h a t h e o r e t i c a l m o d e l .

I t i s s t a te d t h a t t h e r e is e v i d e n c e f o r c o m p l i a n c e a n dm o v e m e n t o f t h e c r a n i a l b o n e s . 1 I t is h o w e v e r , b i o l o g i c a l l y

i m p l a u s i b l e t o s u g g e s t a l i n k b e t w e e n t h i s a n d t h e

e x p l a n a t i o n p o s t u l a t e d b y t h e n e w m o d e l . T h a t s l i g h t c r a n i al

b o n e m o v e m e n t o c c u r s u n d e r c e r t a in c o n d i t i o n s i s

u n d e n i a b l e : i t i s t h e c o n d i t i o n s b y w h i c h s u c h m o v e m e n t

o c c u r s t h a t i s th e c r i t ic a l p o i n t. C o h e n a n d M a c L e a n 8 g i v e

a d e t a i l e d d e s c r i p t i o n o f c r a n i a l s u t u r a l b i o l o g y . C r a n i a l

s u t u r e s i n t e r l o c k t o p r e v e n t t h e c a l v a r i a l b o n e s f r o m

s e p a r a t i n g d u e t o e x t e r n a l f o r c e s . W i t h a d v a n c i n g a g e , t h e

s u t u re s b e c o m e i n c r e a s i n g l y b o u n d t o g e t h e r b y b o n y s p i c u le

f o r m a t i o n a n d e v e n t u a l ly , t h o u g h n o t n e c e s s a r il y , c l o s e

c o m p l e t e l y . A p a r t i c u l a r f e a t u r e o f t h i s p r o c e s s is t h e

f o r m a t i o n o f b o n y s p i c u l e s ( b r i d g e s ) w i t h i n t h e s u t u r e

b e t w e e n t h e t w o a d j a ce n t b o n e s . S p i c u l e s m a y b ri d g e th e

MC McGrath, DO , PDipBiomech, PDipOHP, MSc. Department ofAnatomy and Structural Biology, Otago School of Medical Science,University of O tago. Gt King St, Dunedin, New [email protected]

8 4

s u t u r e e i t h e r c o m p l e t e l y o r p a r t ia l l y a l o n g i t s e n ti r e l e n g t h .

A l t e r n a t i v e l y , i r r e g u l a r , a c e l l u l a r c a l c i f i e d m a s s e s a p p e a r

s i n g l y o r as c o a l e s c e d a g g r e g a t e s w i t h i n t h e s u t u ra l g a p ,

p r o v i d i n g a t t a c h m e n t t o b o n e s p i c u le s b r i d g i n g t h e s u t u r a l

g a p . E v e n t u a l b o n y f u s i o n m a y o c c u r e n d o - o r e c t o -c r a n ia l l y . A l a c k o f s u t u r a l m o v e m e n t i s a d e s i r a b le

c h a r a c te r i s ti c b e t w e e n t h e c r a n i a l b o n e s , w h e t h e r o r n o t

c o m p l e t e s u t u r a l c l o s u r e o cc u r s . T h e a d e q u a t e p r o t e c t io n

o f t h e C N S i s a t s t ak e . A n y s u tu r a l m o v e m e n t o r b o n y

c o m p l i a n c e t h a t m a y o c c u r , d o e s s o o n l y i n a s s o c ia t i o n w i t h

c o n s i d e r a b l e e x t e rn a l l y a p p l ie d l o a d s. I n a s t u d y b y L o s k e n

e t a l ., 9 a n a p p l i e d t e n s i l e l o a d o f 5 0 k g p r o d u c e d a s u t u r a l

d i s p l a c e m e n t o f h n m i n r a b b it s w i t h d e l a y e d o n s e t c ra n i a l

s y n o s t o s i s , e q u i v a l e n t t o h u m a n s u t u r a l c l o s u r e i n a 2 0 - 3 0

y e a r o l d . N o r m a l r a b b i t su t u re s , r e g a r d e d a s e q u iv a l e n t t o

h u m a n c h i l d r e n , r e q u i re a 1 5 k g te n s i l e l o a d i n g t o p r o d u c e

a s u t u ra l d i s p l a c e m e n t o f l m m . T h e s e f o r c e s a r e m a n y

o r d e r s o f m a g n i t u d e g r e a t e r t h a n t h o s e a d v o c a t e d i n O C F ,

w h e r e 5 g m a n u a l p r e s s u r e i s s a i d t o b e n e c e s s a r y t o p r o d u c e

a m o v e m e n t o f 5 0 m i c r o n s . 1° A d d i t i o n a l ly , k n o w i n g t h a t

t h e c a l v a r i a l b o n e s m u s t m o v e a t a r a t e a n d a m p l i t u d e

s u f f i c ie n t t o b r e a c h t h e th r e s h o l d o f t he e x a m i n e r s h u m a n

t a c t i l e p e r c e p t i o n , i t i s s t r a i g h t f o r w a r d t o e s t i m a t e t h e

n e c e s s a r y i n t r ac r a n i a l p r e s su r e r e q u i r e d t o c a u s e t h e a l l e g e d

c r a n i al b o n e m o t i o n , w h i c h t u r n s o u t t o b e s e v e r a l o r d e r s

o f m a g n i t u d e g r e a t e r t h a n t h e e s t a b l is h e d v a l u e s o f

i n t r a cr a n i a l o r C S F p r e s s u r e . S u c h a v a l u e is n o t o n l y

b i o l o g i c a l l y im p l a u s i b l e b u t i t w o u l d b e q u i t e i n c o m p a t i b l e

wi th l i fe .

S o w h a t i s it th a t th e p r a c t i ti o n e r o f O C F f e e l s ? I s u g g e s t

t h a t th e r e i s e v i d e n c e t o s h o w t h a t c r a n i a l r h y t h m i c i m p u l s e

( C R I ) i s a m a n i f e s t a t i o n o f a n e x t ra - c r a n ia l b l o o d f l o w

p h e n o m e n o n a n d a n o b s e r v a t i o n a l a r t i f a c t c f n o c l i n ic a l

s ign i f i ca nce . Th e c ran ia l li t e ra tu re s ta tes tha t i t i s d i f f i cu l t

A Review of Physiology of Cranial Osteopathy

Documents

Transcript of A Review of Physiology of Cranial Osteopathy