THE ENCEPHALON : A NEW OSTEOPATHIC APPROACH

If the integration of the encephalon in the osteopathic examination and treatment undoubtedly offers new and promising perspectives, it still seems difficult for many colleagues to imagine being able to « touch » the brain to detect and correct potential « somatic dysfunctions ».

To approach the encephalon, two important points must be considered.

1. The nature of the cerebral osteopathic lesion.

The osteopathic lesion (latin: laesus, from laedere : injure) as we consider it is a true injury[1] that alters the connective tissue[2]. This lesion is established following the pathophysiological process of inflammation (acute phase) and of fibrosis (chronic phase) and is characterized by loss of elasticity in the affected tissue.

The peripheral nervous system does not, strictly speaking, scar in the same way as connective tissue but may repair itself[3]. The fixation of a peripheral nerve that we feel under our fingers is therefore located in the connective tissue[4], not the neural tissue itself.

Unlike peripheral nerves, when the central nervous system is injured it regenerates very little or not at all since local inflammation is accompanied by a proliferation of astrocytes that hypertrophy and cluster to form a solid and compact glial scar.  The osteopathic lesion may therefore manifest as inflammation (perception of an area of fullness, warm and radiating) or in the form of gliosis (perception of a vacuum, cold, fixed).

In our experience, it would seem that somatoemotional fixations (psychological stress) tend to show as a zone of fullness whereas cerebral lesions (sequelae of vascular accidents, degenerative neurological pathologies) are usually felt as a vacuum[5].

Let us not forget that the encephalon is, by nature, insensitive. Therefore it is not possible, as with a cranial fixation, to use the palpation of a possibly sensitive or painful area as confirmation of the diagnosis of an osteopathic lesion of the encephalon.

2. The anatomical situation of the encephalon.

It seems difficult to reach the encephalon, locked in its cranial box, enveloped by the reciprocal tension membranes and bathing in cerebrospinal fluid.  We also know that the consistency of the brain is flaccid, like a mixture of gelatine and fat, so that even direct palpation of it to assess its elasticity would not yield much information.

To « apprehend »[6] the encephalon, we must in fact switch to a different level of palpation: a subtle, « vibratory » palpation, that gives appreciation of the electromagnetic activity of a zone of the brain rather than its so-called loss of elasticity.  The vibratory perception is not achieved through « cranial listening » but rather direct contact with the precise intention of evaluating the zones of disruption of the brain.  The challenge is for the touch to remain superficial, with the hand being light, transparent, so as to allow contact with the encephalon.  This is not about stacking the tissues but rather, going beyond the cranium using mental projection.

This approach requires knowledge of anatomy and proper visualisation of the encephalon in three dimensions.  Each cerebral structure will be tested analytically in the 3 planes around the 3 axes with the same light touch used in the inhibitory balance test.

For the treatment of a cerebral fixation, the recoil is an ideal technique since the vibration generated by the impulse of the hand movement can go through the cranium and reach the encephalon. As for the test, the tension applied in the recoil must paradoxically remain very light to be able to project in depth towards the targeted area.

[1] The term osteopathic lesion (tissue alteration) is much more accurate than the term somatic dysfunction since the focus of palpatory diagnosis is the structural cause of the problem (the lesion) rather than the resulting consequences (dysfunctions).

[2] Connective tissue in the broadest sense, i.e. all the tissues derived from the mesoblast: bones, fasciae, aponeuroses, muscles and tendons, blood vessels, etc.

[3] Form new axons and new synapses, regenerate their myelin sheath or even fabricate new neurons.

[4] The different sheaths that envelop nerve fibres.

[5] Which does not mean, however, that all areas felt as full are always a reflection of emotional disruption.

[6] Literally as well as figuratively (latin : apprehendere  « take, hold, catch »).

Normalisation of cerebral zones under tension through the recoil has produced interesting clinical results in numerous patients suffering from the sequelae of cerebral concussions, asthenia, headaches, attention deficit disorders, depression, etc. whereas cranial osteopathic treatment sometimes seemed to increase the symptoms.

Take for example a patient who suffered 7 concussions over the course of a few years (playing rugby and pelota).  She presented with severe asthenia and daily headaches.  The first osteopathic treatment, focusing mostly on the cranium, had paradoxically aggravated the symptoms.  In contrast, the second consultation, which also included specific treatment of the encephalon, produced rapid improvement that lasted over time.  This same approach with other patients who had suffered cranial trauma has also solved most of their complaints[1].

It is incidentally surprising to see that we may find fixations of the encephalon comparable to those resulting from a concussion in a neonate or a child !?

During intraplacental development, were there particular constraints, absorption of iatrogenic or toxic products (tobacco, alcohol), physical or psychological trauma to the mother during the pregnancy?  During the delivery, how did the different stages proceed, with what potential complications?

The release of osteopathic lesions of the encephalon almost always produces rapid positive effects on sleep, night terrors, agitation, irritability or behavioural issues of the neonate[2].

Furthermore, it seems plausible that the expansion of the intracranial volume linked to encephalic growth is transmitted through the reciprocal tension membranes of the bony cranium.  Knowing how to « play » with the encephalon possibly allows – to a certain extent – to modulate cranial growth.

[1] These clinical cases are presented by Romain Saint-Jean, osteopath DO and LMO practitioner.

[2] Since we do not always obtain the same results through classical cranial techniques, the approach of the encephalon clearly brings added value to paediatric osteopathic treatment.

Is it possible, or even useful to describe and classify the different fixations of the encephalon that may be felt?  With several years of experience, it is clear that certain lesional patterns are often found.  The most notable are:

Ptosis of the encephalon which on palpation gives the sensation of a cerebral mass that is spread out and fixed in a low position.  A more inferior lesion such as tension on the filum terminale may be the cause.  Patients often present with the feeling of a heavy head, fatigue, or even depression.

Anterior flexion of the frontal cortex, rather characteristic of forward falls.

Flexion/extension of the encephalon, which in the neonate and young child partly conditions the angulation of the base of the cranium and, secondarily, that of the bones of the face[1].

Yakovlevian torque[2], an asymmetrical deformation of the encephalon which, seen from above, rotates in an anticlockwise direction.

We often find this torsion of the encephalon in patients presenting with mood disorders[3], with a tendency towards anxiety if the fixation dominates in the right frontal cortex or towards depression if the fixation dominates on the left occipital cortex.

Take note of the possible correlation from an osteopathic perspective between the Yakovlevian torque, a torsion of the dome of the cranium with a prominent frontal eminence, left posterior occipital plagiocephaly and/or right thoracic scoliosis.

[1] Flexion of the encephalon and the base of the cranium promotes the anterior development of the mandible (prognathism) whereas, conversely, extension predisposes to the retraction of the mandible (retrognathism).

[2] Thus named after a Russian-born American neuroanatomist, Paul Ivan Yakovlev (1894–1983)

[3] Or even psychiatric issues : Occipital bending (Yakovlevian torque) in bipolar depression

 Jerome J. Maller, Psychiatry Research: Neuroimaging, 2015.

Tension on the corpus callosum, either in closing (retraction), or in opening (expansion).

Fixation of the limbic system, felt as a zone of fullness, characteristic of a disrupted emotional state.

Fixation of the brainstem or cerebellum, most often dominant on one side, present in several autonomic functional issues and some balance issues.

There are also several other possible lesional patterns, including deep fixations, more diffuse and less easy to define anatomically.

Tests of the arteries of the brain stemming from the internal carotid artery and the basilar trunk are great complements to the osteopathic examination of the encephalon[1].

When the encephalon presents several zones of tension, combined treatment[2] then presents particular interest.

Occasionally, the lesional pattern of the cranium exactly superimposes on that of the encephalon[3].

In this case, it is important to properly distinguish between the osteopathic lesion of the cranium (positive test on applying tension to the tissue) and the cerebral fixation (positive test on vibratory palpation)[4].

[1] See more on this topic in Mechanical Link, arteries and autonomic nervous system, Editions Sully.

[2] Read more on this topic in the article Mechanical Link : evolution and perspectives

[3] Examples : flexion/extension of the brain and flexion/extension of the SBS or Yakovlevian torque and torsion of the dome of the cranium.

[4] In terms of the cranium, the content and the container cannot be tested in the same manner. When the fixations of the bony head cover those of the encephalon, only selective palpation in terms of intent can make a difference.

In practice, the encephalon may present many variables in its lesional pattern and it is not always possible to identify with certainty the zone(s) involved.  The objective in this case remains to simply « remodel » the encephalon with slight touches (recoil) to restore under the hands (vibratory palpation) a better balance of the tensions involved.  Although it is an inexact way to express it, the sensation is that we play with the « plasticity of the brain »[1].

[1] The term cerebral plasticity describes the ability of the encephalon to remodel its connections as a function of the environment.  We use it here as it conveys well the feeling that we have under our hands of

« modelling » the brain mass. 

Recoil of the frontal cortex

By integrating the encephalon to your general examination, you will greatly expand your skills in osteopathy.  Also, this regular practice of « cranial visceral osteopathy » will progressively develop the transparency of your touch and, thereby, the quality of your palpation of other structures of the human body.