Osteopathic manipulative medicine uses a variety of manual techniques to enhance range of motion, improve lymphatic flow, and reduce pain associated with musculoskeletal and visceral dysfunction.
8 Currently, OMT is used to promote patient self-healing capabilities and to address somatic dysfunction, defined as “impaired or altered function of related components of the somatic system: skeletal, arthrodial and myofascial structures related to neural and/or vascular elements that might underlie pathophysiologic conditions.”
9 One subset of osteopathic techniques, OCMM, has its basis in the idea that respiratory motion triggers the movement of brain mass, dural membranes, cerebrospinal fluid, and cranial bones, which manifest as a detectable cranial rhythmic impulse (CRI).
10 One common OCMM technique, CV-4, modulates cerebrovascular hemodynamics and may mediate sympathetic and parasympathetic autonomic activity. To perform this technique, the physician cradles the patient's head such that the physician's thenar eminences are in direct contact with the squamous area of the patient's occipital bone. While applying medial pressure on the lateral angles of the occiput, the physician evaluates the flexion and extension of the cranial bones while monitoring for the CRI.
11 This technique reduces the volume of the fourth ventricle and redistributes the cerebrospinal fluid within it, ultimately leading to a downstream increase in CBF.
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