A Cranial Approach To Sinus Congestion: By, Nathan Widboom D.O

A Cranial Approach to Sinus Congestion
And an Introduction to Cranial Osteopathic Manipulative

Medicine (COMM):
A.K.A. Osteopathy in the Cranial Field (OCF)
By, Nathan Widboom D.O.

•
“The cerebrospinal fluid (CSF) is the highest known

element that is contained in the human body, and
unless the brain furnishes this fluid in abundance, a
disabled condition of the body will remain. He who is
able to reason will see that this great river of life must
be tapped and the withering fields irrigated at once, or
the harvest of health be forever lost.”
-A.T. Still, Osteopathy: Research and Practice
Learning Objectives
1. Describe the osteology of the paranasal sinuses.
2. Understand how the primary respiratory mechanism relates to the
proper functioning of the paranasal sinuses.
3. Perform a series of techniques that can be used to treat patients with
common clinical conditions.
Learning Objectives
1. Describe the history of the cranial concept
2. Describe the Primary Respiratory Mechanism (PRM)
3. Describe the 5 anatomical-physiological components of the cranial

model
4. Discuss the cranial rhythmic impulse (CRI) and the role of the dural
membranes
5. Describe the physiologic motion of the PRM

Flexion and Extension Motion of Sphenobasilar
Synchondrosis-SBS (Sphenoid and Occiput)
“Air Hands” in Vault Hold
Flexion:
Basiocciput and Basisphenoid move

cephalad (towards you when
seated)
Index fingers on the greater wing of

sphenoid and 5th fingers on lateral
angle of occiput both move inferior
and spread apart slightly
Flexion predominant mechanisms

encourage sinus drainage
“Air Hands” Vault Hold
Extension:
Basisphenoid and basiocciput move

caudad
Index fingers on greater wing of

sphenoid and 5th digits on lateral
angle of occiput both move
superiorly and closer together
Extension predominant
mechanisms hinder sinus drainage
The Vault
Flexion and Extension of the Vault
“Air Hands”
Flexion = Down and Out Extension = Up and In

Flexion and Extension
Flexion in the
reciprocal
tension
membrane
Exaggerated and sped-up flexion/extension animation
History
History of COMM/OCF
William Garner Sutherland, D.O.
1873 – 1954
Believed that all nature’s designs are purposeful.

(Structure/Function)
Inspired by A.T. Still to investigate the cranial bone

articulations & function.
Noted the ‘beveled’ articulations between many of the

cranial bones.
For 40 years studied the cranium and craniosacral

motion.
The Epiphany
In 1899, while studying a
mounted, disarticulated skull,
the thought struck him “like a
bolt of lightning,” that the
articulation between the
greater wing of the sphenoid
and the squamous portion of
the temporal bone was...
“...beveled, like the gills of a fish,
and indicating an articular mobile
mechanism for respiration”
Squamous Portion of Temporal Bone
Greater Wing of Sphenoid

History
Dr. Sutherland gained “knowledge” through
self experimentation using household items
including catcher’s mitts, wooden bowls and
leather straps.
Four Osteopathic Tenets
1. The body is a unit; the person is a unit of body, mind, and spirit.
2. The body is capable of self-regulation, self-healing, and health

maintenance.
3. Structure and function are reciprocally interrelated.
4. Rational treatment is based upon an understanding of the basic

principles of body unity, self-regulation, and the interrelationship of
structure and function.
Five Anatomical-
Physiological
Components of
the PRM
Five principles of the PRM (CRI) Simplified
1. The fluctuation of cerebrospinal fluid, or the potency 1. Fluids
of the tide
2. The function of the reciprocal tension membrane 2. Membranes
(Intracranial and intraspinal membranes)
3. Parenchyma
3. The inherent motility of the neural tube
(CNS: brain & spinal cord) 4. Bones
4. The articular mobility of the cranial bones
5. It’s all
5. The involuntary mobility of the sacrum between the
connected
Ilia
Dr. Sutherland on Osteopathy in the Cranial Field
“It is a thought that is in no way apart
from the science of osteopathy.
Get that.
Nothing apart.
It is not a specialty in itself; it is not

simply a therapy. We are dealing with a
science.”
Paranasal Sinuses
Maxillary
Frontal
Ethmoidal
Sphenoidal
Sinusitis
• Due to obstructed ostia secondary to allergic or infectious inflammation
• Cough, stuffiness, congestion with or without nasal discharge
• Headaches, facial pain, facial edema
• Cough worse at night or supine
• Morning nausea and/or loss of appetite
• PE: Sinus Tenderness, oropharyngeal cobblestoning, nasal turbinate

erythema/hypertrophy
Also Consider Nasal Polyps
Paranasal Sinus Drainage
The maxillary,
ethmoidal, frontal and
sphenoidal sinuses
develop as outgrowths
of the nasal cavity and
as such they all drain
into the nose
Some of the Innervation that is Palpable
Techniques
Thoracic inlet subclavian release
OA Decompression
Venous Sinus Technique
Frontal, parietal, sphenoid, temporal lifts (in this order)
Maxillary Spread
Vomer engagement (“The plumber’s friend”)
Supraorbital and infraorbital neuromodulation
Effleurage
References
An Osteopathic Approach to Diagnosis and Treatment, by DiGiovanna, Schiowitz
and Dowling. Ch. 103-106
Osteopathy in the Cranial Field, by Harold Magoun
Teachings in the Science of Osteopathy, by William G. Sutherland
Sutherland Cranial Teaching Foundation Introductory Course Book from June

2016.
Cranial 1 presentations from Dr. Doris Newman and Dr. Yasmin Qureshi
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What are the five anatomical-physiological components of the primary respiratory mechanism?

What are the five anatomical-physiological components of the primary respiratory mechanism?

What are some common clinical conditions that can be treated with cranial techniques?

What are some common clinical conditions that can be treated with cranial techniques?

A Cranial Approach to Sinus Congestion

And an Introduction to Cranial Osteopathic Manipulative

By, Nathan Widboom D.O.

“The cerebrospinal fluid (CSF) is the highest known

2. Describe the Primary Respiratory Mechanism (PRM)

3. Describe the 5 anatomical-physiological components of the cranial

5. Describe the physiologic motion of the PRM

Basiocciput and Basisphenoid move

Index fingers on the greater wing of

Flexion predominant mechanisms

Basisphenoid and basiocciput move

Index fingers on greater wing of

Flexion = Down and Out Extension = Up and In

Believed that all nature’s designs are purposeful.

Inspired by A.T. Still to investigate the cranial bone

Noted the ‘beveled’ articulations between many of the

For 40 years studied the cranium and craniosacral

Greater Wing of Sphenoid

2. The body is capable of self-regulation, self-healing, and health

3. Structure and function are reciprocally interrelated.

4. Rational treatment is based upon an understanding of the basic

It is not a specialty in itself; it is not

• Cough, stuffiness, congestion with or without nasal discharge

• Headaches, facial pain, facial edema

• Cough worse at night or supine

• Morning nausea and/or loss of appetite

• PE: Sinus Tenderness, oropharyngeal cobblestoning, nasal turbinate

Venous Sinus Technique

Frontal, parietal, sphenoid, temporal lifts (in this order)

Vomer engagement (“The plumber’s friend”)

Supraorbital and infraorbital neuromodulation

Osteopathy in the Cranial Field, by Harold Magoun

Teachings in the Science of Osteopathy, by William G. Sutherland

Sutherland Cranial Teaching Foundation Introductory Course Book from June

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