Title: Bone Wizardry / OMM Mastery / 9.Craniosacral motion
Tags: #BW_OMM::Region::Craniosacral #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt
On every note of this deck, unless a note says otherwise:
Topic: Craniosacral motion
Review Links: - Bone Wizardry cranial dysfunctions
- Practice: Craniosacral QBank
Show outside sources
- StatPearls suboccipital release
- PMC craniosacral techniques meta-analysis
- PMC osteopathy in the cranial field rationale
- OMM brief review

Q: The PRM is composed of 5 anatomical-physiological elements:
1. The [...] of the brain and spinal cord
A: inherent motility
Q: The PRM is composed of 5 anatomical-physiological elements:
2. Fluctuation of [...]
A: CSF
Q: The PRM is composed of 5 anatomical-physiological elements:
3. The movement of the [...] membranes
A: intracranial and intraspinal
Q: The PRM is composed of 5 anatomical-physiological elements:
4. The [...] of the cranial bones
A: articular mobility
Q: The PRM is composed of 5 anatomical-physiological elements:
5. The involuntary mobility of the [...] between the [...]
A: sacrum; ilia
Bone Wizardry Lock: The 5 PRM elements: brain and cord motility, CSF fluctuation, membrane movement, cranial bone mobility, sacral motion between the ilia. Every craniosacral physical exam traces back to one or more of these five.

The brain and spinal cord lengthens and thins during the exhalation phase and shortens and thickens during the inhalation phase of the primary respiratory mechanism.
Comment: This describes the inherent motility of the brain and spinal cord.
Bone Wizardry Lock: Exhale phase: brain and cord lengthen and thin. Inhale phase: they shorten and thicken. The cord stretches on exhale, recoils on inhale. Lock that direction pair and you can work backward from any PRM motion question.

Q: The CSF circulates with a [...] rhythm.
A: pulsating
Q: The cranial rhythmic impulse is normally [...] cycles per minute.
A: 10-14
Factors that will DECREASE the rate and quality of the cranial rhythmic impulse:
1. stress
2. depression
3. chronic fatigue
4. chronic infections
Q: Factors that will INCREASE the rate and quality of the cranial rhythmic impulse:
1. vigorous [...]
2. systemic [...]
3. following [...]
A: physical exercise; fever; OMT
Bone Wizardry Lock: Normal CRI is 10-14 cycles per minute. Chronic stress loads, depression, fatigue, and infection pull it down. Fever, hard exercise, and fresh OMT spike it temporarily. A sluggish CRI points toward autonomic strain, not just a local finding.

Q: Name the 3 layers of the meninges:
1. [...]
2. [...]
3. [...]
A: Dura mater; Arachnoid mater; Pia mater
Q: Which layer of the meninges is the outermost membrane?
[...]
A: Dura mater
Q: The dura mater forms the [...] and [...].
A: falx cerebri; tentorium cerebelli
Q: What spinal segments does the dura attach to?
[...]
A: Foramen magnum, C2, C3, and S2
Bone Wizardry Lock: Dura anchors at foramen magnum, C2, C3, and S2. That four-point tether means occipital strain can show up as sacral tension, and vice versa. When you find SD at one end of the dural tube, always assess the other end.

Q: The inherent motility of the brain and spinal cord, and the fluctuation of CSF will cause the [...] to move.
A: reciprocal tension membrane
Bone Wizardry Lock: The RTM is the dural tent that translates brain and CSF motion into coordinated cranial bone movement. Restriction in the falx or tentorium distorts that transmission and downstream patterns the SBS dysfunction you find on exam.

Q: The [...] is the articulation of the sphenoid with the occiput.
A: sphenobasilar synchondrosis
Comment: It is the keystone of all cranial movement.
Bone Wizardry Lock: The SBS sets the template for all cranial bone movement. Dysfunction there cascades into every cranial bone and down the dural tube to the sacrum. Diagnose SBS position before naming any strain pattern.

Q: During flexion, the midline bones of the cranium (sphenoid, occiput, ethmoid, vomer) move through a [...] phase.
A: flexion
Q: During flexion, the [...] of the cranium (sphenoid, occiput, ethmoid, vomer) move through a flexion phase.
A: midline bones
Which cranial bones are considered the midline bones of the cranium?
1. sphenoid
2. occiput
3. ethmoid
4. vomer
Q: During flexion, the paired bones of the cranium will move through an [...] rotation phase.
A: external
Q: During flexion, the [...] of the cranium will move through an external rotation phase.
A: paired bones
Q: Flexion at the SBS will cause the sacral base to [...].
A: counternutate
Q: [...] at the SBS will cause the sacral base to counternutate.
A: Flexion
Q: Flexion will [...] the head slightly and [...] its AP diameter.
A: widen; decrease
Q: [...] will widen the head slightly and decrease its AP diameter.
A: Flexion
Bone Wizardry Lock: In SBS flexion: midline bones flex, paired bones externally rotate, sacral base counternutates, head widens and AP diameter shortens. Extension reverses every relationship. Map the bone motion to the SBS position, not to the respiratory phase name.

Q: With craniosacral flexion...
[...] of the [...] bones.
A: Flexion; midline
Q: With craniosacral flexion...
Sacral base is [...]
A: posterior (counternutation)
Q: With craniosacral flexion...
[...] AP diameter of the cranium
A: decreased
Q: With craniosacral flexion...
[...] rotation of [...] bones
A: external; paired
Bone Wizardry Lock: Craniosacral flexion drives midline bones to flex and paired bones to rotate externally. The sacral base moves posterior (counternutation) and the cranium shortens in the AP dimension.

Q: During extension the [...] of the cranium move through an [...].
A: paired bones; internal rotation phase
Q: [...] at the SBS will cause the sacral base to [...].
A: Extension; nutate
Q: Extension will [...] the head slightly and [...] its AP diameter.
A: narrow; increase
Bone Wizardry Lock: In craniosacral extension, paired bones internally rotate and the sacral base nutates anteriorly. The head narrows transversely while the AP dimension lengthens.

Q: With craniosacral extension...
[...] of the [...] bones
A: extension; midline
Q: With craniosacral extension...
sacral base [...]
A: anterior (nutation)
Q: With craniosacral extension...
[...] AP diameter of the cranium
A: increased
Q: With craniosacral extension...
[...] rotation of the [...] bones
A: internal; paired
Bone Wizardry Lock: Extension is the mirror of flexion: midline bones extend, paired bones internally rotate, the sacral base nutates anteriorly, and the AP diameter of the cranium increases.

Q: A [...] strain develops when a twisting deformity forms at the SBS between the sphenoid and occiput.
A: torsion
Q: The torsion is named for the [...] that is more superior.
A: greater wing of the sphenoid
Comment 2: For example, if the sphenoid is rotated, so that the greater wing of the sphenoid is more superior on the right, this is called a right torsion.
Bone Wizardry Lock: Torsions are named for the side with the higher greater wing of sphenoid. Right greater wing sitting more superior means right torsion. The sphenoid and occiput rotate on opposite oblique axes.

Q: In a [...] craniosacral dysfunction, the sphenoid and occiput rotate in the [...] direction.
A: sidebending/rotation; same
Bone Wizardry Lock: Sidebending/rotation is a physiologic SBS strain. Both sphenoid and occiput rotate to the same side, and the strain is named for the direction they rotate together.

Q: An [...] lesion occurs when the SBS deviates [...].
A: extension; caudad
Q: A [...] lesion occurs when the SBS deviates [...].
A: flexion; cephalad
Bone Wizardry Lock: For vertical strain subtypes, match the direction to the name: the SBS moving cephalad is a flexion lesion, moving caudad is an extension lesion.

Q: In a [...], the sphenoid shifts cephalad or caudad relative to the occiput, displacing the SBS along a vertical axis.
A: vertical strain
Bone Wizardry Lock: Unlike torsion or sidebending/rotation, vertical strain is a linear shift: the sphenoid has moved cephalad or caudad. Whether that becomes a flexion or extension lesion depends on the direction of that shift.

Q: In a [...], the sphenoid shifts sideways relative to the occiput at the SBS.
A: lateral strain
Q: If the sphenoid deviates to the left, it is termed a [...].
A: left lateral strain
Q: If the sphenoid deviates to the right, it is termed a [...].
A: right lateral strain
Q: Palpation of a [...] will feel as if the cranium is shaped like a [...].
A: lateral strain; parallelogram
Bone Wizardry Lock: In lateral strain, the sphenoid has shifted sideways relative to the occiput. The cranium palpates like a parallelogram. The strain is named for the direction the sphenoid deviated.

Q: In a [...] strain, the sphenoid and occiput have been driven together at the SBS.
A: compression
Q: Compression strain of the SBS can result in severely decreased [...].
A: CRI
Comment: If the compression is severe enough the CRI can be almost completely obliterated.
Bone Wizardry Lock: Compression is the SBS strain where force has impacted the two bones together. The CRI drops with severity and can be nearly absent in extreme cases.

Q: Vagal somatic dysfunction can be due to:
1. [...]
2. [...]
3. [...]
A: OA; AA; C2
Q: Dysfunction of CN [...] can cause tinnitus, vertigo, or hearing loss.
A: VIII
Q: Condylar compression (CN [...]) can result in poor suckling in the newborn.
A: XII
Comment 3: CN IX and X at the jugular foramen can also cause suckling dysfunctions in the newborn.
Bone Wizardry Lock: Map cranial nerve dysfunctions to their anatomical exit: CN X via OA/AA/C2 somatic dysfunction; CN VIII via temporal bone restriction; CN XII via condylar compression, causing impaired suckling in the newborn.

Q: The goal of the [...] technique is to increase venous flow through the venous sinuses so that blood may exit the skull through the [...].
A: venous sinus; jugular foramen
Q: The technique in which the operator spreads apart the sutures overlying the occipital, transverse, and sagittal sinuses is the [...].
A: Venous sinus technique
Comment: The venous sinuses drain approximately 85-95% of the blood from the cranium.
Bone Wizardry Lock: The venous sinus technique targets sutures over the major dural sinuses to push blood out through the jugular foramen. The goal is cranial venous drainage, not rhythmic motion correction.

Q: The [...] technique increases the amplitude of the CRI.
A: CV4 (bulb decompression)
Q: The [...] is accomplished by resisting the flexion phase and encouraging the extension phase of the CRI until a still point is reached.
A: CV4 technique
Comment: The CV4 technique has also been reported to be helpful in fluid homeostasis and help induce uterine contraction in post-date gravid women.
Bone Wizardry Lock: CV4 resists the flexion phase and encourages extension until a still point, then releases to boost CRI amplitude. It has also been associated with fluid homeostasis and uterine contractions in post-date pregnancies.

Q: Where do you place your index finger in the vault hold?
[...]
A: Greater wing of the sphenoid
Q: Where do you place your middle finger in the vault hold?
[...]
A: temporal bone in front of the ear
Q: Where do you place your ring finger in the vault hold?
[...]
A: Mastoid region of temporal bone
Q: Where do you place your pinky finger in the vault hold?
[...]
A: squamous portion of the occiput
Q: Purpose of the vault hold: to address the [...] at the SBS.
A: strains
Bone Wizardry Lock: In the vault hold, each finger maps to one bone: index to the greater wing of the sphenoid, middle to the temporal in front of the ear, ring to the mastoid region of the temporal, pinky to the squamous occiput. Get the sequence before anything else.

Q: Purpose of the V spread technique: to [...] restricted or impacted sutures.
A: separate
Q: Purpose of the lift technique: used to aid in the balance of [...] tension.
A: membranous
Comment: Can be used on patients with chronic migraines/headaches.
Bone Wizardry Lock: The action is the label. V spread pulls a restricted suture apart. Lift restores balance across the membranous field. Match the primary finding to the right technique.

Q: Name some common reasons to use craniosacral treatment:
1. [...]
2. Trauma to the [...]
3. [...]
A: Birth of a child; PRM; Dentistry
Bone Wizardry Lock: Think mechanical disruption to the cranial field. Birth, direct PRM trauma, and dental work each alter cranial mechanics in ways that craniosacral techniques are built to address.

Q: What are some common complaints reported following craniosacral treatment?
1. [...]
2. [...]
3. [...]
A: Headaches; Tinnitus; Dizziness
SBS strain treatment may cause an alteration in heart rate, blood pressure, respiration and GI irritability.
Bone Wizardry Lock: After craniosacral work, expect both local reactions (headache, tinnitus, dizziness) and autonomic shifts (HR, BP, respiration, GI irritability). These are known treatment responses, not treatment failures.

Q: Absolute contraindications to craniosacral treatment:
1. [...]
2. Skull [...]
A: Intracranial bleed/pressure; fracture
Q: Relative contraindications to craniosacral treatment:
1. [...]
2. [...]
A: Seizures; TBIs
Bone Wizardry Lock: Intracranial bleed and skull fracture are absolute stops. Seizures and TBIs require caution and reduced force, but do not automatically cancel the treatment.

Q: Around which axis does the SBS junction rotate?
[...]
A: Transverse
Bone Wizardry Lock: The SBS moves around a transverse axis. Knowing that axis orients every flexion and extension exam finding at the junction.