Involuntary Motion Studies (IMS)
Week One
The IMS team gave us a refresher introduction on the theory behind this branch of osteopathy, as we had one and a half day introduction in the summer block of year two. In the introduction, I was reminded about the palpable 'fluctuation' of cerebral spinal fluid (CSF) and the central nervous system mobility through dural membranes. They also discussed Dr Sutherland, who developed the cranial concept, and his observations of the five basic phenomena within the human body. He labelled this his five phenomena of the primary respiratory mechanism and they include mobility of cranial bones, sacro-iliac joints, dural membranes, CNS and motility of the brain and spinal cord.
We then discussed the basic patterns of movement within the body, which are flexion and extension. Flexion opens out the cranium and extension makes the cranium flat and narrow. All this can be palpated through a craddle hold around the back of the head with the patient supine, or a vault hold around the top of the cranium with the patient supine. I practised this exercise on three different peers and palpated something different on each of them, but I was more pleased that my tutors came and palpated what I was palpating and the agreed with my findings! Overall I was really excited that I managed to feel different craniums and the mobility and motility within them. I was nervous to begin with as I did not grasp the concept in year two, but I am really pleased that my palpation has progressed and I look forward to the next class!
We then discussed the basic patterns of movement within the body, which are flexion and extension. Flexion opens out the cranium and extension makes the cranium flat and narrow. All this can be palpated through a craddle hold around the back of the head with the patient supine, or a vault hold around the top of the cranium with the patient supine. I practised this exercise on three different peers and palpated something different on each of them, but I was more pleased that my tutors came and palpated what I was palpating and the agreed with my findings! Overall I was really excited that I managed to feel different craniums and the mobility and motility within them. I was nervous to begin with as I did not grasp the concept in year two, but I am really pleased that my palpation has progressed and I look forward to the next class!
Week Two
We began today by discussing physiological and non-physiological patterns of movement. A physiological pattern is a pattern that the patient's body is both happy and comfortable with doing, whereas a non-physiological pattern is something they do not like doing and resists.
Physiological patterns are either a torsion or side bending-rotation pattern, with torsion moving around the anterior-posterior axis. A side bending-rotation pattern moves around two vertical axes and rotation in the other direction (sphenoid side bends left, while the occiput rotates right)
Non-physiological patterns are either rotation or side bending patterns. A rotation pattern creates a horizontal shearing movement of the spheno-basilar symphasis (SBS) due to the sphenoid and the occiput moving in the same direction. A side bending patterns is where the sphenoid and the occiput side bend in the same direction, also creating a shear at the SBS but a lateral one.
I worked on Patricia Wojkowski today and discovered she has a physiological pattern of torsion right, which my supervisor agreed with after observing and palpating alongside me. It was a lovely confidence booster to trust my palpatory findings, at last!
When it was my turn to become a patient to Patricia, she felt I had a non-physiological pattern of side bending right and the tutor was concerned about these findings as he felt my body needed help as it was a response to something happening elsewhere in my body. I was very surprised how little his hands moved once on my cranium, as I expected the patterns to be a subtle yet palpable movement however they were undetectable! It is a great experience being both practitioner and patient, as you get to feel both ends of the spectrum and can put yourself in the shoes of your patient when finding these patterns on patients in clinic!
Physiological patterns are either a torsion or side bending-rotation pattern, with torsion moving around the anterior-posterior axis. A side bending-rotation pattern moves around two vertical axes and rotation in the other direction (sphenoid side bends left, while the occiput rotates right)
Non-physiological patterns are either rotation or side bending patterns. A rotation pattern creates a horizontal shearing movement of the spheno-basilar symphasis (SBS) due to the sphenoid and the occiput moving in the same direction. A side bending patterns is where the sphenoid and the occiput side bend in the same direction, also creating a shear at the SBS but a lateral one.
I worked on Patricia Wojkowski today and discovered she has a physiological pattern of torsion right, which my supervisor agreed with after observing and palpating alongside me. It was a lovely confidence booster to trust my palpatory findings, at last!
When it was my turn to become a patient to Patricia, she felt I had a non-physiological pattern of side bending right and the tutor was concerned about these findings as he felt my body needed help as it was a response to something happening elsewhere in my body. I was very surprised how little his hands moved once on my cranium, as I expected the patterns to be a subtle yet palpable movement however they were undetectable! It is a great experience being both practitioner and patient, as you get to feel both ends of the spectrum and can put yourself in the shoes of your patient when finding these patterns on patients in clinic!
Week Three
Today we went over the physiological and non-physiological patterns that were introduced in the last session. This was beneficial because the patterns are complex and hard to get your head around (literally!). We were shown a different hand hold, which is the anterior-posterior hand hold and can be useful for palpating strain patterns, and although I could still feel the patterns I did not feel as relaxed and natural as I do with the cradle hold. I worked with Jennifer Spark and it became really obvious how different people's craniums really are, just by taking a moment to tune in and find out the physiological patterns that suit that individual and what non-physiological patterns they do not like. Jennifer was side bending left, torsion right and low vertically and her cranium felt really healthy and happy!
After the re-cap, we discussed how to treat the non physiological pattern once identified on our patient. A treatment modality that we learnt today was exaggeration, which is when a physiological pattern has been identified, exaggeration of this direction of pattern and ease is used until the cranium feels like it is in a neutral and eased position. The cranium is maintained in this position and the body naturally reacts to the physiological pattern. This treatment modality can also be used on the sacrum, using the same principles. Theoretically, by exaggerating a physiological pattern, our body becomes more aware of it and naturally adjusts. I definitely felt this exaggerated pattern on Jennifer, and I am so happy that I am managing to grasp the concepts to be able to apply it in class. I am really excited to try this in general clinic as I would love to develop my palpation further and be able to treat the patient in this way to hopefully reduce any imbalance or symptoms! My tutor was really impressed with my palpation skills this week and felt that I understood and could palpate the principles of pattern testing. He also confirmed that I performed a disengagement theraputic response working with Jennifer and signed my log to verify the progress that I am making into the world of IMS, hurray!
After the re-cap, we discussed how to treat the non physiological pattern once identified on our patient. A treatment modality that we learnt today was exaggeration, which is when a physiological pattern has been identified, exaggeration of this direction of pattern and ease is used until the cranium feels like it is in a neutral and eased position. The cranium is maintained in this position and the body naturally reacts to the physiological pattern. This treatment modality can also be used on the sacrum, using the same principles. Theoretically, by exaggerating a physiological pattern, our body becomes more aware of it and naturally adjusts. I definitely felt this exaggerated pattern on Jennifer, and I am so happy that I am managing to grasp the concepts to be able to apply it in class. I am really excited to try this in general clinic as I would love to develop my palpation further and be able to treat the patient in this way to hopefully reduce any imbalance or symptoms! My tutor was really impressed with my palpation skills this week and felt that I understood and could palpate the principles of pattern testing. He also confirmed that I performed a disengagement theraputic response working with Jennifer and signed my log to verify the progress that I am making into the world of IMS, hurray!
Week Four
Today we revised the theory of balance tension at the speno-basila symphysis by identifying patterns, finding and supporting the midpoint of the pattern at which the patient is most comfortable in, and create a stillness of fluid fluctuation to allow the patient to re-ignite their body system and start again. I was really pleased that I could once again feel this today and create a stillness in the CSF and retest it by easing off.
We then moved on to a CV4 technique by compressing the 4th ventricle which has a lot of CSF. It involved:
1) Placing your thenar eminence's on the occiput medial to the mastoid processes
2) On cranium flexion, begin to restrain the fluid fluctuation
3) Repeat for 3-4 fluid fluctuation cycles restraining subtly more each time
4) Patient reaches a still point
5) As the patient's fluid restarts fluctuating the practitioner should go with the patients movement, letting go bit by bit
6) Repeat over 3-4 cycles until practioner's hand are flat
I could feel this technique really easily and the change once re-tested was amazing! and the change on retest was amazing! Todays lesson has definately confirmed that I am not just imagining the movements and that I can make a change when using the CV4 technique!
We then moved on to a CV4 technique by compressing the 4th ventricle which has a lot of CSF. It involved:
1) Placing your thenar eminence's on the occiput medial to the mastoid processes
2) On cranium flexion, begin to restrain the fluid fluctuation
3) Repeat for 3-4 fluid fluctuation cycles restraining subtly more each time
4) Patient reaches a still point
5) As the patient's fluid restarts fluctuating the practitioner should go with the patients movement, letting go bit by bit
6) Repeat over 3-4 cycles until practioner's hand are flat
I could feel this technique really easily and the change once re-tested was amazing! and the change on retest was amazing! Todays lesson has definately confirmed that I am not just imagining the movements and that I can make a change when using the CV4 technique!
Week Five
This was our final week of IMS , it has gone so quickly! Today we learnt a balance tension release technique of the occipito-atlantis joint, and balance tension technique for the sacrum. It was a really good lesson and it helped to go over the sacrum as I tend to feel less movement at the sacrum. I find it amazing that we have been shown technique that positively affects the occipito-atlantis joint without having to perform a high velocity thrust! This is a technique I will continue to use on those who are not appropriate for HVT, such as patients with osteoporosis.
Our elective choices this year are given as a taster to variations on structure function technique, and I am pleased that I chose this elective course as it has confirmed my interest to carry on with IMS in the future at a postgraduate level. Not all of the IMS log has been completed due to the lack of elective hours given to get through all the techniques, however I feel I have achieved a huge amount and proud of my achievements!
Our elective choices this year are given as a taster to variations on structure function technique, and I am pleased that I chose this elective course as it has confirmed my interest to carry on with IMS in the future at a postgraduate level. Not all of the IMS log has been completed due to the lack of elective hours given to get through all the techniques, however I feel I have achieved a huge amount and proud of my achievements!