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Cranial Osteopathy

Cranial Osteopathy was established by Dr. William G. Sutherland in the 1940s. He reasoned that cranial sutures in relation to the skull have their own mobility. After years of study, research, and manipulation, he concluded that the cranial bonessacrum, dural membranes, and cerebrospinal fluid function as an interrelated unit. He termed this unit the primary respiratory mechanism. Osteopathic treatment in this region aims to restore the cranial rhythmic impulse to a normal rate.

How does it work ?

Primary respiratory mechanism (PRM)

  • The cranial rhythmic impulse (CRI) refers to the palpatory sensation of the widening and narrowing of the skull.

    • Normal rate: 8–14 times per minute

    • A result of the PRM

  • The PRM is composed of five elements :

    1. Inherent motility of the brain and spinal cord

      • Brain and spinal cord have an inherent wave-like motion.

      • Described as coiling and uncoiling of the central nervous system (CNS).

    2. Fluctuations of the cerebrospinal fluid (CSF): volume of CSF changes in relation to the cranial rhythmic impulse (CRI).

    3. Mobility of the intracranial and intraspinal membranes

    4. Articular mobility of cranial bones

      • Although cranial sutures fuse shortly after birth, they contain small motions that cannot be felt individually.

      • An amalgamation of the cranial bones and multiple sutures allow for palpable motion.

    5. Involuntary mobility of the sacrum between the ilia

      • The dural connection between the cranium and S2 of the vertebral column causes sacral movement.

      • This dural connection is termed the reciprocal tension membrane (RTM).

      • The bones move in rhythm with the motion of the shifting tensions of the RTM.

  • The primary physiologic motion is between the articulation of the sphenoid and the occiput called the sphenobasilar synchondrosis.


Transversal cut of the vertebral body showing the intimate relationship between the CNS and the meninges.



  • Physiologic patterns 

    • Flexion and extension

    • Torsion

    • Side bending and rotation

  • Nonphysiologic patterns (eg: car incident, traumatic birth)

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