OBJECTIVE ANALYSIS of the LUMBO-SACRAL COMPLEX and OCCIPUT

Ano: 2010 | Volume: 1 | Número: 2

Autores: O. Nelson DeCamp, Jr.

Resumo Inglês:

We need only to look at the comparative amounts of protection for our vital organs to see the tremendous importance of the central nervous system (CNS) over other organs. Protection for the CNS consists of a covering of bony plates and segments. They are lined and held together by a tendinous ligamentous membrane, inside of which, is enveloped in a circulating metabolic fluid (CSF). This tremendous increased importance of the brain and CNS, compared to other vital organs, is the reason sacral occipital technique, with its craniopathy, excels as the choice for man's health care. The major physiological function of the CNS in maintaining itself and Life is the cranial/sacral respiratory pumping. The major components of the system are the occipital bone and sacrum and their reciprocal respiratory function. Further understanding of this subject may be obtained in Cranial Technique1, by M.B. DeJarnette, D.C
After attaining the necessary understanding we can develop two basic rules:
1. For every action there is an equal and opposite reaction.
2. The more weight bearing, the more compensation required. (Action = Reaction)
Working on these fundamentals we can begin to realize that the occipital bone will balance more for sacral dysfunction then the reverse.
Based on the above theories, we need to analyze the action of the sacrum in relation to the Lumbo-pelvic complex and the reaction of the occiput in the cranial complex. The Lumbo-Pelvic Complex. The basis of the cranial sacral respiratory function consists of the brain, dural system, and the osseous occiput and sacrum. The lumbopelvic complex consists of: 1. The sacrum, and those factors within, affecting its respiratory synovial joint. 2. Lumbar spine and integral structures. 3. Bilateral in ilii.
DeJarnette, DC, in his text, Sacral Occipital Technic2, separates the above three structural areas into categories according to the characteristics associated with their individual physiological dysfunction and their effect on the sacral occipital dural respiratory function.
Category 1. Characteristics associated with the Sacrum and Occiput in sacral occipital dural dysfunction within its respiratory particular function.
Category 2. Characteristics associated with the weight-bearing sacroiliac articular dysfunction and their effect on the sacral occipital dural respiratory function.
Category 3. Characteristics associated with dysfunction of the spine and integral structures and their effect on the sacral occipital dural respiratory function.
It must be understood that the degree of the characteristics, or compensatory reactivity, of the categories are directly related to the degree of dysfunctional stress placed upon the CNS and its life-support system, the sacral occipital dural (cranial/sacral) respiratory system. For sacral – occipital respiratory function to be able to maintain respiratory balance between the sacrum and the occiput there must be some structural similarity between them. If we place two spines with sacrum's and occiputs side-by-side and reverse one by 180°, we can observe that the shape of the occiput and sacrum are quite similar.

Figure 1 – Shape of the occiput and sacrum are quite similar.

In the sacrum, the main functional attachment of the durra is at the S – 2 posteriorly and this is also the fulcrum level for primary and secondary respiratory motion. The upper and lower weight-bearing ligaments are above and below this point bilaterally.
The main functional dural attachment of the occiput is the internal aspect of the occipital protuberance where the falx cerebri and tentorium cerebelli intersect. The counterforce to the internal dural force is the ligamentous nuclei and the ligamentous attachment of the occipital fiber line. This ligamentous attachment extends laterally to the superior point of the occipital mastoid (OM) suture where the occipital parietal (OP) suture begins.
It has been found clinically by this writer that while utilizing the cranial ranges of motion torsion technique3, there can be distinct differences in the degree of motion in the upper and lower aspects of the occipital bone. These differences that occur relate to the dysfunction of the upper and lower weight-bearing ligaments of the sacrum, lower occiput (OM) to upper sacrum (S – 1) and upper occiput (OP) to lower sacrum (S – 3).

Figure 2 – localization of the occipital mastoid and occipital parietal.

These cranial motion differences consist of decreased motion and/or fixation with palpable separating of opposite side accompanied by swelling and discomfort. It must be emphasized that spinal involvements with their compensation affecting the upper cervical spine (category 3) and cranium can impair the motion of the sutural system also. This has to be cleared to obtain the separate affect from the sacrum. This impairment of the sutures by cervical involvement can affect the sacral balance by reverse compensation.
The above discussion establishes a new system of objective indicators in testing and analyzing physiological dysfunction in man. The purpose of this paper is to establish the types of sacroiliac distortions that may present themselves clinically and especially. To develop a means of objective analysis for the chiropractic. Objective testing and analysis is the key to SOT and Craniopathy. Is what makes a technique valid in the medical sciences, chiropractic colleges, and courts of law?
1. Torsion – this is usually a compensatory dysfunction for the spine where the upper ilium moves posterior on one side and the lower Ilium moves posterior on the opposite side, placing the pelvis in a state of torsion. This is the type of category 2 covered extensively in Sacral Occipital Technic texts by DeJarnette, D.C.
2. Superior and Inferior Innominate – this is a superior or interior involvement of one or both of the innominate in relation to the sacrum. This was covered in a paper on the subject by this writer previously and published in a SORSI Journal4.
3. Sacral Segmental – torsion of the sacral segments may occur distorting both the respiratory boot mechanism and weight-bearing articular surfaces. This was covered in a paper on the subject by this writer previously and published in a SORSI Journal5.
4. Anterior, Posterior, and Oblique in Ilii-DeJarnette, DC, discusses in his text, Sacral Occipital Technic of Spinal Therapy6, as the inward and outward flaring of the innominate. This writer prefers to view the flared innominate as posterior and anterior subluxations of the innominate with the sacrum. This subluxation might be better understood if we visualize the trauma creating it. A person falling a distance and landing on the posterior aspect of the innominate driving it anterior, or landing on the innominate and sacrum driving the sacrum anterior to the opposite innominate. This trauma can cause both to happen in the same pelvis and most frequently this occurs within the lower weight-bearing ligaments with a resultant oblique sacrum.
5. Combinations – how many combinations of the above have visited our offices? How many persistent and recurrent category 2 cases have we dah? How may cranial and TMJ cases never clear? When we stop and realize the number of different traumas the lumbopelvic complex experiences in life, we now must understand how important it is to expand our SOT – cranial knowledge. The cranium can never be corrected until its compensation for the sacrum can be cleared.

Objective Lumbo Pelvic/Cranial Indicators for Category 2 Types

Common to all these types is persistent rib head or neck discomfort and/or spasming on the side of involvement. Positive arm fossa testing only seems to relate to the amount of dysfunction of the synovial respiratory joint. All pelvic indicators should be confirmed by x-ray when possible.
1. Torsion – we are familiar with the UMS/LLL pelvic indicators. Cranial indicators are pain and swelling of the occipital mastoid suture on the UMS side and occipital parietal suture on the LLL side.
2. Superior and Inferior Innominates – lumbopelvic indicators are the medial hamstring for the superior side and origin and insertion of the quadratus lumborum on the inferior side, also active sacral gluteal indicators on the side of involvement. Cranial indicators are both occipital mastoid and occipital parietal sutures opposite the side of involvement.
3. Sacral Segmental – pelvic indicators are the sacral gluteal indicators opposite the active sacral segments. The cranial indicators are positive occipital mastoid suture on the side of upper weight-bearing ligaments involvement and occipital parietal suture on the side of the lower weight-bearing involvement.
4. Anterior, Posterior and Oblique – pelvic indicators are the sacral gluteal indicators opposite the side of involvement. X-ray analysis should be utilized to determine whether the innominate is anterior or posterior from the inferior to superior aspects. Cranial indicators will vary suturally on the opposite side of the involvement depending on the extent of involvement in obliqueness.
5. – It has been found by this writer that the complexity of indicators for multiple combinations of involvement in the pelvic complex require the gradual elimination of one problem at a time starting with the torsional subluxation. As the indicators for one lesion decreases, the next most important one show up. Routine visit by visit monitoring of the atlanto-occipital and occipital bone ranges of motion are fast, decisive methods of analyzing patient progress.

Correction of Pelvic Complexes

All corrections, other than using the DeJarnette blocks for torsion category 2, are osseous. Place the lesion side down to the table to stabilize, traction the lesion to the end of its range of motion and only adjust with enough force to correct the lesion.
Summation
1. Structurally, always relate the degree of symptomatology to the degree of stress on the CNS.
2. For every action there is an equal and opposite reaction.
3. The more the weight-bearing stress, the more the compensation.
4. Structurally, the occipital bone is similar to the sacrum and balance in an organized pattern.
5. Develop understanding of the lumbopelvic complex and its cranial complex compensation.
6. Strive to balance the lumbopelvic complex to the cranial complex.
7. Utilize clinically objective indicator findings and analysis for consistency in physiological dysfunction.
8. Do not over treat. Treat according to number 7.
9. Only correct cranial interwar early when lumbopelvic correction ceases to respond to cranial ranges of motion correction methods.
DISCLOSURE: No potential conflict of interests relevant to this article was reported.
ACKNOWLEDGMENTS: The author thank Chiropractor Mara Célia Paiva for preparing the manuscript.

REFERENCES

1. Cranial Technic, 1979 – 1980, M.B. DeJarnette, DC
2. Sacral Occipital Technic, 1984, M. B. DeJarnette, DC
3. The examination of the screen a basilar Joint And Cranial Bone Ranges Of Motion, O. Nelson DeCamp, Jr., DC, DICS, The Source (SORSI), Fall 1984
4. Diagnosis and Correction of the Superior and Inferior Innominate Subluxations, O. Nelson DeCamp, Jr. , DC, DICS, The Source (SORSI), Spring 1985
5. Cranial Sacral Dysfunction and Sacral Segmental Subluxations, O. Nelson DeCamp, Jr., DC, DICS, The Source (SORSI), Summer 1986
6. Sacral Occipital Technic Of Spinal Therapy, M.B. DeJarnette, DC, 1940