Beryl Arbuckle’s CCrraanniiaall “CCoonnttrroovveerrssyy iinn Thought” BBy Kenneth Lossing D.O. 1 WW..GG.. SSuutthheerrllaanndd DD..OO.. • One morning in 1899, while still a student in Kirksville, on his way to ccllaassss, tthhee iiddeeaa ffoorr cranial mobility came ffrroomm vviieewwiinngg DDrr. SSttiillll’ss Beauchene disarticulated skull in the North Hall. With Thinking Fingers, A. 2 Sutherland TThhee FFiirrsstt TThhoouugghhtt • “As I stood looking and thinking in the channel of Dr. Still’s philosophy, my attention was ccaalllleedd ttoo tthhee bbeevveelleedd aarrttiiccuullaarr ssuurrffaacceess ooff tthhee sphenoid bone. Suddenly there came a tthhoouugghhtt;; II ccaallll iitt aa gguuiiddiinngg tthhoouugghhtt-bbeevveelleedd lliikkee the gills of a fish, indicating articular mobility for a respiratory mechanism” W.G. Sutherland With Thinking Fingers, A. 3 Sutherland Mobilityy • “MMoobbiilliittyy iiss tthhee ssttaattee ooff bbeeiinngg iinn mmoottiioonn.. • In physics, motion is a change in position of an objject with resppect to time. • Motion is typically described in terms of velocityy,, acceleration,, dispplacement,, time and speed”. • Mobility, for some reason, is not defined in our Osteopathic Glossary. From Wikipedia, the free encyclopedia 4 MMoottiilliittyy • “Motility is a biological term which refers to tthhee aabbiilliittyy ttoo mmoovvee ssppoonnttaanneeoouussllyy aanndd aaccttiivveellyy, consuming energy in the process”. •• AAggaaiinn, tthhiiss tteerrmm iiss aabbsseenntt ffrroomm oouurr OOsstteeooppaatthhiicc glossary • SSoo, tthhee bbrraaiinn aanndd fflluuiiddss mmoovvee wwiitthh mmoottiilliittyy, aanndd the container, the skull, needs to be able to accommodate to this, and thoracic resppiration. From Wikipedia, the free 5 encyclopedia Articular Mobility • ““AArttiicullar mobbiilliitty occurs iin tthhe bbasiillar area, and that of the facial bones; such basilar mobility being accommodated througgh comppensatoryy exppansile and contractile service at the vault sutures” •• SSoo, tthhee qquueessttiioonn iiss:: IIss tthhee mmoobbiilliittyy responsive to primary respiration, or tthhoraciic respiirattiion, or bbotthh?? IItt’’s a question of distance and distensabilty. The Cranial Bowl, 1939, W.G. 6 Sutherland MMeennttaall PPiiccttuurree • “The formation of a “mental picture” ooff tthhee aarrttiiccuullaarr ssuurrffaacceess ooff tthhee cranial and facial bones, is the first necessity for recognizing the fact of cranial articular mobilityy”. • “The picture should be like that of a wwaattcchhmmaakkeerr” • So, we need to know the whole thing! The Cranial Bowl, 1939, W.G. 7 Sutherland SSoo,, wwhhaatt iiss “nnoorrmmaall” mmoobbiilliittyy?? • In his first book, “the Cranial Bowl”, published iin 11993399, SSutthherllandd usedd ““posiittiion”” andd “motion testing” to diagnose the bones and ssuuttuurreess ooff tthhee sskkuullll. • The treatment techniques he describes are nneeaarrllyy aallll “ddiirreecctt tteecchhnniiqquueess”. • So he spent nearly 40 years doing direct ! •• HHee aallssoo ssppeeaakkss aabboouutt ssuuttuurreess tthhaatt aarree “locked”, in that they do not move when motion tested. The Cranial Bowl, W.G. 8 Sutherland WWhhyy iiss tthhiiss iimmppoorrttaanntt ?? • We know babies skulls are like a water bballlloon, easy tto ddefform, andd tthhey spriing bbackk. • Most of our patient’s skulls are somewhere bbettween a bbaskkettbballll, andd a bbowlliing bballll. • Could he have possibly meant that an adult sskkuullll ccoouulldd bbee nneeaarrllyy aass ffrreeeellyy mmoovveeaabbllee aass aann infant skull? 9 The current biomechanical tteerrmmiinnoollooggy : VViissccoo-eellaassttiicciitty ooff Sutures • SStiiffffness: tensiille fforce//chhange iin llengthh • Ultimate stress: tensile force at suture rruuppttuurree//ccrroossss sseeccttiioonnaall aarreeaa • “Sutures demonstrate classical viscoelastic behavior. During the elastic phase, they eelloonnggaatteedd aapppprrooxx 11 uumm ffoorr eevveerryy 11gg ooff ffoorrccee 104 N/m. The ultimate tensile stress was approx 4 MN/m2. The estimated mean elastic moddullus was 1100 megapiixells””. • “The Load-Displacement Characteristics of NNeeoonnaattaall RRaatt SSuuttuurreess” TThhee CClleefftt PPaallaattee- Craniofacial Journal. Vol.37, McLaughlin 10
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