Free
Letters to the Editor  |   January 2020
Lateral Strain Patterns at the Sphenobasilar Synchondrosis
Author Notes
  • Past President, Sutherland Cranial Teaching Foundation, Inc. 
Article Information
Neuromusculoskeletal Disorders
Letters to the Editor   |   January 2020
Lateral Strain Patterns at the Sphenobasilar Synchondrosis
The Journal of the American Osteopathic Association, January 2020, Vol. 120, 4a-5. doi:https://doi.org/10.7556/jaoa.2020.001
The Journal of the American Osteopathic Association, January 2020, Vol. 120, 4a-5. doi:https://doi.org/10.7556/jaoa.2020.001
To the Editor: 
It is a service to the Science of Osteopathy to improve language standards as Capobianco and Shermon1 have proposed in “Taxonomy of the Lateral Strain Patterns at the Sphenobasilar Synchondrosis for Osteopathic Cranial Manipulative Medicine.” William Garner Sutherland, DO, and his premiere student Anne L. Wales, DO, were extremely precise in their interest in and use of language. The Sutherland Cranial Teaching Foundation, Inc. (SCTF) was founded by Sutherland in 1953 as a nonprofit independent organization to preserve the standard of his teachings on the application of the principles of osteopathic medicine to the living human cranium. (The SCTF is presently a component society of the American Academy of Osteopathy.) 
The SCTF Basic Course: Osteopathy in the Cranial Field has been the standard for teaching the cranial concept in the osteopathic medical profession. The standard teaching of the SCTF Basic Course syllabus includes a taxonomy similar to that presented by Capobianco and Shermon1 for teaching novice students lateral strains of the cranial base. The syllabus states that the strain is named for the direction in which the basisphenoid has moved. For novice students, only a simple description of the perceived effect on the greater wings is given. The student is then instructed to continue to observe, by palpation, the greater wing that has moved laterally and discern whether the greater wing on that side moves anteriorly or posteriorly. Further teaching of the novice student includes exploration of the effect of respiration, dorsiflexion of the feet, and other patient postural movements on the observed cranial findings. 
The course includes the fundamental teaching that axes and patterns are schematic and “serve as a framework for making observations that can be recorded and followed over the course of treatment” and “it is not an absolute way for the mechanism to work.”2 Language “consensus” should not limit the student's potential for further understanding. 
The SCTF Basic Course syllabus recognizes the difficulty novice students have in understanding this schematic and teaches that the ultimate skill set includes precise diagnosis of the sphenobasilar junction; visualization of the shapes of spaces and motion of the living contents of the cranium; and knowledgeable application of the structure-function relationship fundamental to osteopathic philosophy and practice. The SCTF Basic Course syllabus includes a more thorough description of a minor component of the osseous and membranous response, that is, an anterior rotation of the greater wing on the more prominent (lateral) greater wing, with the basisphenoid moving to that same direction (standard) and a posterior rotation of the greater wing on the (manually perceived) more prominent greater wing, with the basisphenoid moving in the opposite direction. 
The hope is that the consensus in this schematic language would acknowledge and include the limitations that inexperience presents, the complexity and depth of the living human mechanism, and the expectation of osteopathic medical student growth and development beyond a perfunctory application of manual modalities and techniques. 
References
Capobianco JD, Shermon S. Taxonomy of the lateral strain patterns at the sphenobasilar synchondrosis for osteopathic cranial manipulative medicine. J Am Osteopath Assoc. 2020;120(1):25-29. doi: 10.7556/jaoa.2020.009 [CrossRef]
Sutherland WG. Teachings in the Science of Osteopathy. Wales AL, ed. Rudra Pr; 1990:125,156.