1. CONCEPT OF FULCRUM - Illustration pp124,125

2. THERAPEUTIC TOUCH Various forms from touching are used into therapeutic, each one having specific qualities making it possible to establish a relation therapeutist - patient adequate, to moderate a perception, or to have a precise action. I - For example, it is possible for the therapeutist to come into contact with its patient, while maintaining a limit clear between them. II - Or to establish the same contact as that which we adopt in closer relations which unobtrusive this limit between the two people. It is a contact of “fusion”. - We remember the feeling painful physics to be separate of a expensive being. III - To choose a touch of “transférance” which is that which we use when we tighten the hand of another person. These two last forms to touch do not maintain limit clear between the two persons. p126

3. THERAPEUTIC TOUCH IN CRANIAL TECHNIQUE In cranial technique, we will adopt a touch of ease of use, in the following way: - its pressure equal to the resistance of tissue is contacted, which makes it possible to remove the interface between expert and patient. That is done easily, as we saw, by transferring this one between the back by therapist, not in liaison with the patient, and table of processing surfaces it. - the expert projecting his perception on this same level. - It is then established a perfect relation between the two people, any induction gestural coming from the expert acts specifically on this precise level. p126

4. THERAPEUTIC TOUCH - Illustration p127

5. We will illustrate the relation of the two people implied, through that of the image of two asses walking on together on a narrow watershed in mountain. The path being narrow, they are based one on the other, which instinctively reassures them. As the ground is not very sure, that located outside rests of advantage, which naturally the other compensates for. But if itself, according to the risks of the ground, loses foot even slightly, it will then increase its support on its congeneric which goes on a sure riprap. They are both in a tonicity of reciprocity, of convenience, which enables them to form a unit of tensegrity. There is no interface between them, but it establish one of them, dynamic, throughout their path with this last. It is the same in symbiosis between patient and therapist, when the hand of the expert, after having removes the interface between its palm and the patient, to establish it elsewhere, follows perfectly the reactions of skull of his patient to the tests and techniques which it carries out with him. Symbiosis patient-expert “Art to link themselves and separate” p128

6. Art to link themselves and separate - Illustration p129

7. CRANIAL TECHNIQUE MANUAL DIAGNOSIS p131

8. THE MANUAL DIAGNOSIS IN CRANIAL TECHNIQUE - Whatever that selected, the diagnostic approach at the cranial manual level, will be carried out the patient lengthened comfortably on the table of processing, prone. - The practitioner is located worthy of his head. - We repeat of them here the general principles of each approach. - It induces then each one of its tests by light body movements, and evaluates the final rebound of each movement as well as the capacity of the cranial mechanism to adapt to the movements of compensation (torsion, rotation side flexion, etc…. ) - In case of doubt, he will then add a final impulse at the end of the movement, which enables him to appreciate elasticity passivates final that any healthy articulation maintains. p133

9. CRANIAL TECHNIQUE THE DIFFERENT APPROACHES

10. APPROACHES BY THE VAULT This traditional approach, is most often chosen by many practitioners, because it makes it possible at the same time to consider movement general of the cranial bones, as well as theirs particular movement within this cranial mechanism, while being able to also appreciate the freedom of the spheno - basilar synchondrosis (SBS). The fingers of the two hands, isolated without tension and deployed in space form a cut intended to receive very irregular, side faces, posterior and higher convexity of the patient’s cranium. pp134,135

11. APPROACHES BY VAULT II The pad of each finger comes into contact with either side of the cranium as follows: - the little finger, which is nearly parallel to the curved border of the occipital bone, receives the occipital squama. - the ring finger, behind the ear, on the level of the astérion, is placed on the angle postero - inferior of parietal (phalange) and on the mastoid portion (phalange), - the middle finger, in front of the ear, contacts by its second phalange (or third according to the morphology of the patient’s cranium and of the practitioner’s hand), the angle antero-inferior of parietal on the level of the ptérion, - the index on the external surface of the large wing of the sphénoïde. - One thumb rests against its counterpart - above skull - in order to create a fulcrum for the flexors of the fingers. pp136,137

12. APPROACHES BY VAULT III

13. SPHENO-FRONTO-OCCIPITALE APPROACHES Second traditional approach, very often also adopted, it has the advantage for the therapeutist of having in each one with its hands, two bones considered as the motive fluids of the cranial mechanism, the occipital one and the sphenoid. The practitioner is always to the patient, but this time, on a side or other. Its cephalic hand receives the scales occipital, whereas its higher hand grasp the front-end processor and the large wings of the sphenoid.

14. SPHENO-FRONTO-OCCIPITALE APPROACHES II The cephalic hand (hand located subsequently on skull of the patient), out of cut, receives the occipital one, pulp of the fingers joined on the opposite occipital angle. On thenar and/or hypothenar eminences comes to place the angle of the homologous scales occipital. The caudal hand (Hand located before on skull of the patient ), out of cut, wraps the frontal bone, fascinating contact with two external surfaces of the large wings of the sphenoid. For this, the contacts carry out: - the pad of the distal phalanx of the index finger and/or the middle finger, the side opposite to the practitioner, - the pad of the distal phalanx of the thumb on the same side as the practitioner According to his policis-index opening, each expert will only act either on the large wings of the sphénoide, or by also inducing the movement of the front- end processor. pp138,139

15. SPHENO-FRONTO-OCCIPITALE III APPROACHES p141

16. BI-MASTOIDAL APPROACHE This symmetrical approach has the advantage of using the most important levers of skull which are the mastoid ones, but also the disadvantage of not being in direct catch with the driving bones of the cranial movement. We know that nevertheless, the advantage of the levers in fact an approach privileged during the induction of the techniques, in particular for those acting on the transverse dimension of skull. The hands of the practitioner in supination, interlaced fingers, wrap the high cervical column and occipital squama. Next, the thumbs, which lie parallel to each other, come to rest along the edge antero - external of the mastoid process. Thenar eminences contact the mastoid portions of the temporal one. The end of the thumb is below the axis of the temporal one, whereas its thenar eminence is above. The practitioner will be able to then induce any cranial movement starting from the pyramid petrous, placed as a corner in the base of skull, between the sphenoid ahead and the occipital one behind. The end of its behind going thumb, in inside in top creates a movement of inflection, whereas its thenar eminence going ahead, in inside and top creates the opposite movement. pp142,143

17. BI-MASTOIDAL APPROACH II p143

18. SPHENO-MASTOIDAL APPROACH This approach, which is used less often, is a variant of the fronto-occipital approach with the cephalad and cradling the mastoids instead of the occiput. It is useful not because the movement induced by the practitioner starts from the two motor bones, but because it specifically involves the anterior part of the cranial base i.e. between the sphenoid and the temporal one. pp144,145

19. APPROCHE SPHENO-MASTOIDIENNE II The cephalic Hand, cups the anterior part of occiput, the pad of the thumb located on the ipsilateral mastoid process, the pad of the other fingers pressed together on that opposite. The caudal Hand cups the frontal bone, makes contact with 2 external surfaces of the large wings of the sphenoid on which, it makes the following contacts: –the pad of the distal phalanx of the index and/or middle finger, on the side opposed to the practitioner, – the pad of the distal phalanx of the thumb, the practitioner’s side. p144,145

20. PERCEPTION OF AN ABNORMAL BEVEL The bevels of the cranial sutures overlap in such a way that, if the therapist pushes them towards each other from the outside, the internal bevel glides on the external bevel over a greater distance than the external bevel, which is limited in its gliding movement over the internal bevel by the epicranial aponeurosis (i.e., the extracranial counterpart to the periosteal layer of the dura mater). During the release mechanism, the practitioner must first free up the external bevel by pushing it slightly toward the center of the cranium before separating it from the internal bevel, thereby increasing the sutural space. pp146,147

21. PERCEPTION OF AN ABNORMAL BEVEL- Illustration p147

22. CRANIAL TECHNIQUE MANUAL DIAGNOSIS IN CRANIAL TECHNIQUE

23. PRACTICE OF THE MANUAL DIAGNOSIS - PROTOCOL The vault approach allows the practitioner to make use of the modalities of cranial adaptation (movements of torsion, rotation/lateral flexion, etc.) in order to reveal and confirm which sutures do not open or close normally, and in which quadrant they are located. In fact, each quadrant contains only one large suture, either in the vault or in the base, with these large sutures linked only by the temporal bone. Testing the suture suspected of being abnormal then allows the practitioner to identify the lesion precisely and to initiate the appropriate treatment technique. The protocol thus consists of the successive manual evaluation of the four quadrants united by the temporal bones with its six pivots: –its six pivots: three at the base, three at the vault. p149

24. Identification of the four quadrants On a horizontal section of the cranium, we can imagine two lines intersection at right angles at a point lying at the center of the cranium, i.e., roughly at the level of the spheno-basilar articulation, deemed to be the motor of cranial motion. As the diagram indicates it here after, each dial is: On the level of the base, traversed by sutures which join their counterparts on the level of the sphenoid. We thus have, in the former quadrants: - The fronto-sphenoidal suture and in the posterior quadrant : - The lambdoïd sutures. On the level of the vault, the articulations are carried out thanks to four sutures, two former, two posterior, which join the interparietal suture. I.e., on the level of the former quadrant, –the fronto parietal suture and on the level of the posterior quadrant, –the lambdoïdal suture p150, 151

25. Diagram of Identification of the four quadrants p151

26. MANUAL EVALUATION OF THE FOUR QUADRANTS We favor the vault approach, which, as we have already shown, allows us to have contact with each bone and thus to measure the movement of each bone within the general framework of cranial motion. The two passive hands feel the different components of the spatial motion of each bone, their restrictions, and, in particular, the quality of the end-stage of the movement, which, as we have noted, depends on the state of the connective tissue of the suture. A lesion in this tissue is followed by a change in its basic properties of flexibility and plasticity, which is caused by an altered blood supply and a loss of its water content. If the practitioner fails to feel these changes adequately, he or she can impart a slight movement of rebound with the pad of a finger in order to detect the presence or absence of these properties in the connective tissue of the suture being tested. P152, 153

27. DIAGRAM OF MANUAL EVALUATION OF THE FOUR QUADRANTS P153

28. DIAGNOSIS OF THE MOVEMENT OF FLEXION- EXTENSION This movement of flexion - extension can be carried out various manners. Here that which seems to us moreover just mechanically, as well as easiest to practically induce: It is by the approach by the vault. - the therapeutist veillñe so that its elbows apart from the table, and are located low than the plan of the work table. - It then moves its two front forearms in the direction of skull of the patient, this mini force ascending moving the two little fingers and index respectively towards the root of the neck (occipital flexion) and ahead and in bottom for the indices (flexion of the sphenoid). - This decomposition of the force generated by the vector of the front forearm, is facilitated by anterior slope of the therapist comfortably installed in charge of the patient.

29. FLEXION (APPROACH BY THE VAULT)

30. SPHENO-FRONTO-OCCIPITAL FLEXION - APPROACH We do simultaneously in the following way : The lower hand, under the occipital one, involves the bone ahead and in top, a curved movement around its transverse axis. The higher hand involves the external surface of large sphenoid forwards and the top. This higher hand must carry out two successive movements around two close, but distinct transverse axes: 1º - to actuate in flexion the front-end processor around its transverse axis by the palm as of the higher hand, 2º - to continue this movement ahead and in bottom on the level of the large wings of the sphenoid, by creating a transverse axis by the thumb and the index of this same hand.

31. FLEXION BY APPROACH SPHENO - FRONTO - OCCIPITAL

32. EXTENSION BY THE TWO APPROACHES

33. USUAL COMPENSATIONS We saw, during the study of biomechanics, then of pathomechanic, that under a certain number of various pressures that the cranial movement had to undergo, this one changed in order to preserve a dynamics necessary to its functions. And that the first usual movement of compensation was that of torsion, then with a more harmful degree rotation - lateral flexion (R.F.L.). This leads us to understand that so that these necessary compensations can exist, it is necessary that the cranium preserves this adaptability throughout our life. Movements that we to induce thus now are the manual checking of these possibilities. If they did not exist any more, us should then restore them, in order to always preserve this adaptability. We thus now successively will induce. - a right torsion, - a left torsion, - A right R.F.L, - A left R.F.L, - a right lateral displacement, etc

34. ADAPTABILITY IN TORSION Whereas the movements that we have just seen were held around the only transverse axes, torsion adds a component of movement around an antero- posterior axis, parts anterior and posterior of going cranium on the other hand one of the other. A free cranium must be able to adapt an additional constraint as well in right torsion, as in left torsion. This technique thus will allow us: * to evaluate the freedom of the cranial mechanism during the movement of adaptation at the time of the phase of cranial expansion. * to correct directly a cranial lesion in opposite torsion. * to indirectly reduce - by exaggeration - a homologous lesion of torsion, in moving the point of balance of the cranial movement.

35. MOVEMENT OF TORSION BY THE VAULT During the phase of expansion, to carry out a movement of right torsion, the therapitist carries out a movement of inflection to which he adds a component of flexion in the following way: - its right index involves the external surface of the large right wing forwards, the top and slightly towards the interior, carrying out a movement in comma which underlines the external part of the eyebrow. - whereas its annular left upwards moves the mastoid angle of parietal the left, before and the line of centers of skull, describing a movement in comma in the direction of the vertex. The little finger can follow it.

36. MOVEMENT OF TORSION by APPROACH SPHENO- FRONTO-OCCIPITALE During the phase of expansion, the expert adds a component of torsion to the movement of inflection in the following way (for a right torsion). The higher hand: - the middle finger produces a rise and a projection of the external surface of the large wing of the sphenoid, around an antero - posterior axis. - the thumb located on the large left wing accompanies its movement, without exerting any action (it is passive). The lower hand: - the rise in the left mastoid angle in parietal involves around the same antero - posterior axis, before arm of the expert carrying out a light pronation.

37. MOVEMENT OF LATERAL ROTATION FLEXION This movement exaggerates the adaptation in torsion, when this one was insufficient in front of a constraint undergone by the cranial mechanism. Its goals: This technique will allow us: - to evaluate the freedom of the cranial mechanism lasting this movement of adaptation during the cranial expansion. - to directly correct a cranial lesion in rotation opposite side inflection. - to indirectly reduce (by exaggeration) a lesion of homologous rotation lateral flexion.

38. APPROACHES BY THE VAULT OF THE ROTATION LATERAL FLEXION MOVEMENT Description for a rotation right lateral flexion. During the execution of this technique of lateral flexion rotation, only the left hand of the expert is active, whereas its right hand perceives the freedom of the bones. The left hand induces the movement by bringing closer all its fingers from/to each other, at the same time as it draws slightly towards him, according to the axis longitudinal of its forearm. At the time of the phase of relaxation of the cranial movement, the passive expert lets skull return at his neutral point.

39. DRAWING OF THE DIGITAL ACTION IN THE APPROACH BY THE VAULT

40. SPHENO-FRONTO-OCCIPITAL OF THE ROTATION MOVEMENT LATERAL FLEXION APPROACHES During the course of the phase of expansion, the osteopath adds to the Inflection a movement of R.F.L. That one carries out in the following way: The two hands of the expert downwards involves the right-sided of the cranium towards the right-sided of skull in direction of the chin, around an antero- posterior axis. Whereas they make turn sphenoid and occipital around their two respective vertical axes, in contrary direction (on the left ahead for the sphenoid behind and on the left for the occipital one, opening space on the right-sided).

41. LATERAL DISPLACEMENT OF THE SYMPHYSE The skull if it is free, must be able to support a pressure lateral confining.It is what it does by distributing an additional force in various directions, the sphenoid and the occipital one (two principal driving parts) turning each one around their vertical axis respectively, in the same direction, which causes a side shearing force on the level of the spheno-basilair synchondrosis which joins together them. This constraint, which is not most current in the adult, except at the time of accident, is on the other hand more frequent in the postpartum, when constraints deformed skull with of its plasticity in the last phases of work. It is necessary our intervention then in order to minimize the effects of these constraints when that is still easily correctible. Of course, a free cranium must be ready to undergo and disperse this constraint if it is free in the adult.

42. LATERAL DISPLACEMENT - APPROACH BY THE VAULT Example for a right lateral displacement. The right hand. Its index involves the external surface of the large right wing of the sphenoid, towards the left Its 4th finger brings the occipital one in the same direction and the same direction The left hand: Its index involves the external surface of the large left wing of the sphenoid backwards, Whereas its 4th and its little finger involves the occipital one backwards. The important thing is the synchronous work of the fingers of the two hands, which keep a constant space between them.

43. LATERAL DISPLACEMENT - APPROACH SPHENO-FRONTO-OCCIPITAL During the phase of expansion of the cranial mechanism, the hand superior of the osteopath, involves the sphenoid and the front-end processor of the left towards the right, whereas the lower hand involves occipital line towards the left, in a movement in curve. The two hands go in the same direction, traversing the same circumference, preserving in a constant way the variation which separates them. As always during the phase of relaxation the hands of the expert are inactive and let the mechanism return at its neutral point thanks to its elasticity.

44. OTHER POSSIBLE CONSTRAINTS AND ACCOMMODATIONS We saw before that it exists other possible constraints, as those which involve a vertical displacement, a compression with the symphysis. And more simply a combination of the constraints than we have just seen. You will understand easily that we must initially limit ourselves to share the most current experiments together, most usual, to possibly hold the rarest cases with a teaching more specialized and much more sophisticated than one can approach only after one some practices showed us the need, even the importance.

45. INTEREST OF THE TESTS OF ACCOMMODATION As will show it to you the following diagrams, each movement of compensation, of adaptation, constrained of the different sutures. It is then understood easily that while passing then from one constraint to another between two different diagrams, such as for example of torsion to rotation side inflection, thanks to the perceived restrictions, we can isolate the sutures which are not free any more. In addition, one understands as easily as while passing from one side to another in the same diagram of adaptation (for example torsion) any forced suture on a side, open then if it is free when one passes on other side. If it cannot do it, there is then the certainty of his dysfunction. This manual perception, like any skill, requires a drive and a knowledge of biomechanics which can be obvious only after one practical intense, that cannot make the economy of time. Even does the concert the international level make its ranges on its piano every day, isn't?

46. 46 TESTS IN TORSION

47. 47 LATERAL FLEXION TEST

48. TESTS BONE BY BONE, SUTURE BY SUTURE We successively determined: 1º - four quadrants, which enable us to know in each one of them, restrictions of movements, i.e. dysfunctions. 2º - In each dial, the sutures which do not function correctly (reduction or absence of movement), which signs the cranial osteopathic lesion. 3º - the tests of accommodation which we have just explained, enable us to check the implication of each suture, in closing and opening (even diagram on the right and on the left), and of impossibility of adaptation (R.F.L.). 4º - the test in laterality signs to it not adaptation of the temporal one. 5º - This is why we will begin the tests bone with bone by the temporal one. 4º - Then, as each joining puts in presence at least two bones, it will then be necessary for us to determine which is the bone which involve this dysfunction, and to make this analysis on the level of each dysfunctional joining of this bone. 5º - We will study, therefore after the temporal one, how one can carry out the diagnosis for each bone of skull, then for each one of its parts, since this one is always articulated with several bones

49. DIAGNOSIS OF TEMPORAL BONE As we saw, at the time of the study of its biodynamics, the bone tempopral understands two plans, perpendiculars between them: - The first horizontal one which is articulated in three point-pivots, called of back ahead: * Petro - basilar, between a hollow rail located on the petrous apophysis, and a rail full on the apophysis basilar with the occiput (left former). This articulation allows a movement of slip and bearing between the two structures. * Petro-chin-strap, which sometimes understands a small meniscus, between the side edge of occipital and the posterior edge of the petrous pyramid. This articulation allows a movement of separation between the two bones, follow-up of a movement in inside and bottom of the temporal one. * Spheno-petrous, one by a ligament (ligament of Grueber) between the petrous apex and the apophysis clinoïde posterieiure of the sphénoide. This articulation allows a movement of circumduction of the petrous apex around clinoid insertion of the spheno-petrous ligament. p154

50. TEMPORAL DIAGNOSIS II Let us see the vertical plan now, with the three pivots - points which make it possible this squamous part to be articulated with the bones of the vault: * The condylo-squamo-mastoid (CSM), which links the mastoid part the temporal one (external bevel in lower part and intern above) with the antero-lower part correspondent of occipital (reversed bevels). This articulation carries out a movement of separation of the two bones, follow-up of displacement in bottom, then in inside of the temporal one. * The Hinge-Mastoid pivot (H.M.) which brings in report the small portion having an external bevel to the level of the temporal one, with the corresponding zone of the parietal bone. This articulation allows a short antero-external movement of temporal on the parietal bevel, which generates a widening of skull. * The Spheno-Squamous articulation, which puts in presence the vertical former edge of the temporal one, with its external bevel and its bevelled horizontal edge lower than depend on the internal table, with the corresponding parts of the posterior edge of the large wing of the sphenoid. The movement on this level is a separation suturale, at the same time as the large wing of the sphenoid goes ahead and in bottom.

51. POSITION OF THE FINGERS TO DIAGNOSE THE TEMPORAL ONE We carries out an approach by the vault: Little finger under occipitut, 4th one along the mastoid one, Middle finger, in front of the ear, the index finger on the external surface of the greater wing of the sphenoid the two thumbs touching each other at the sagittal suture and acting as a fulcrum for the diagnostic movements of the fingers that are induced by their flexor muscles. pp156,157

52. TEMPORAL: PETRO-BASILAR TEST Movement : This is an external gliding movement of the concave edge of the petrous temporal bone on the convex edge of the basiocciput that causes the cranium to widen transversely during movements of cranial expansion (flexion/external rotation). Test : From the position described and illustrated in the previous pages, the practitioner evaluates the quality of the final phase of the movement by using the pad of his or her ring finger to impart a "flipper movement" (i.e., a sliding centripetal motion along that transverse axis). p158

53. TEMPORAL: PETRO-BASILAR TEST - Drawing p159

54. TEMPORAL. PETRO - JUGULAR Movement The jugular foramen is widened. The petrous temporal bone rotates anteriorly on its oblique axis and is slightly depressed while its two borders tend to move apart, thus causing its jugular process to move inferiorly, anteriorly, and slightly medially during the movement of cranial expansion. Starting from the position we have already described, the practitioner evaluates the quality of the final phase of the movement, as his or her ring finger moves away from the little finger and simultaneously moves inferior and slightly medially. pp160,161

55. EVALUATION PETRO-JUGULAIRE - Dessin p161

56. TEST CONDYLO-SQUAMO-MASTOIDIEN Movement : It occurs a separation of this squamous and bevelled suture, more marked in its upper part. The two parts, occipital and temporal move back and drop, on nonparallel axes (convergent in external direction), and moreover more located in different plans. What constrained this squamous part to separate, while using its plasticity to be able to adapt these various parameters. The test: The practitioner evaluates the quality of the final phase of the movement from the starting-point previously defined. His or her ring finger moves away from the little finger while these two fingers are drawn slightly downwards. pp162,163

57. Test Condylo-Squamo-Mastoidien - Drawing p163

58. TEST HINGE – MASTOIDE (HM ) It is this small bevel which makes it possible to pass from external rotation to extreme rotation. Movement : There is a sliding movement between these two bones, with the temporal squama apparently falling outwards, just like the top of a buckled cartwheel as it sinks into a rut. This release of the HM bevel then allows the temporal bone to enhance its external rotation. The test : The practitioner evaluates the quality of the final phase of the movement from the starting-point described previously. His or her ring finger barely moves away from the little finger, causing the mastoid to move downwards toward the patient's feet. pp164,165

59. TEST HINGE – MASTOID (HM ). Drawing p165

60. TEST OF PIVOT SPHENO-SQUAMOUS Movement : The squamous parts of the two bones move apart and rotate anteriorly, slightly laterally, and inferiorly. The test : The practitioner evaluates the quality of the final phase of the movement from the starting position described previously. His or er index finger moves away from the middle finger, while these two fingers are drawn slightly inferiorly and laterally. pp166,167

61. TEST OF PIVOT SPHENO-SQUAMEUX - Drawing p166

62. TEST OF PIVOT SPHENO - PETROUS Movement : Circumduction occurs around this ligament (Grueber's ligament), which allows the adaptive movements that must occur at this important anatomical location at the center of the cranial base. Let us not forget the extreme richness of the elements which pass on the level of the zone of the cavernous sinus. The test : The practitioner evaluates the quality of the final phase of the movement from the starting -point described previously. His or her index finger moves slightly away from the middle finger, while the latter finger moves the temporal bone by circumduction, initially inferiorly and then medially, etc...... pp168,169

63. TEST OF PIVOT SPHENO - PETROUS - Drawing p169

64. SUMMARY OF THE TEST OF THE SIX PIVOTS The expert goes successively and, on each side, to carry out the following movements: - to print a “movement to feel down” with the pulp of its 4th finger, for the petro-basilar articulation, - to separate its 4th finger from its little finger, while accompanying this movement by a component in bottom, and slightly towards the interior, for the petro-jugular articulation - to separate its annular from its little finger, both being attracted slightly to the bottom, for pívot C.S.M., - to reduce with its 4th the mastoid one after being itself separate fifth finger, for pívot H.M., - to separate its index from its middle finger, 2 being slightly attracted to the bottom and outside, for pívot S.S. - finally to separate its index from its middle finger, whereas this last involves the temporal one in bottom, then in inside, etc........ for the sphéno-petrous pívot. pp170,171

65. DIAGRAM OF THE TEST OF THE SIX PIVOTS pp170,171

66. STUDY BONE BY BONE In order to establish the diagnostic pathomechanic of skull, we successively saw: 1º - four quadrants. 2º - Inside or of the implied dials, implied sutures. 3º - We then checked the constraint and the possible opening of the sutures, thanks to the diagrams of adaptation (Torsion, R.F.L........) 4º - the test of side displacement indicated or not the implication of the temporal bone to us, 5ª - Practitioner then the test of the six pivots of temporal, we then objectified the pivots implied in the pathological diagram. It does not remain us any more whereas to check on the bones implied by this manual diagnosis, its sutural dysfunction. It is what we will study now It will be then easy, for any educated osteopath, to implement the correct technique.

67. MOVEMENT OF THE OCCIPITAL ONE In this technique (Spheno-Fronto-Occipital approach), the expert immobilizes by his pollici-index grip, frontal and sphenoid in inflection, whereas during the same phase of extension, it checks the possibility of movement of the occipital bone around the three axes.

68. MOVEMENT OF THE SPHENOID To evaluate the movement of the bone Sphenoid (and possibly its dysfunctions), the osteopath this time immobilizes the occipital one and will mobilize the bone sphenoid around his three axes, as the drawing in top indicates it. It is to note that the little finger of the practitioner (covered of a fingerstall) is located in the mouth of the patient, contacting the maxillary above the teeth.

69. TEST INTRA - SPHENOID We know that the greater wings of the sphenoid can undergo a very small additional movement with respect to the body at the end of flexion because of a movement of torsion occurring around their sites of attachment. Here, we evaluate this physiological freedom of movement, which is required in times of extra stresses, especially unilateral ones. pp172,173

70. TEST INTRA – SPHENOIDI (1º technique ) Position of the expert. Its seized cephalic hand the external surface of the two large wings of the sphenoid in its grip pollicis - index, whereas the index of its caudal hand will contact by its pulp the hard palate on the level of the cruciform suture. Movement. Two hands of the expert accompany the phase by flexion bones of the line of centers, until the end of their movement. The expert then evaluates, while maintaining the position of the body sphenoid by the pulp of its endo- buccal finger, that it can still increase the flexion of the large wings. pp174,175

71. TEST INTRA – SPHENOID (2º technique ) Position of the expert. His or her cephalad hand takes hold of the external surface of the greater wings of the sphenoid in the thumb-index finger pincer, with the pad of the index finger of the caudad hand touching the hard palate at the cruciform suture. Movement. The practitioner's hands follow the flexion phase of the midline bones until the end of the their movement. While holding the greater wings of the sphenoid in place in the thumb-index pincer, the practitioner checks whether the pad of his or her intraoral finger can still impart a very slight movement to the body of the sphenoid, particularly into extension. pp174,175

72. The OTHER BONE OF the VAULT and the BASE OF CRANIUM We have just studied together the general manual diagnosis of the dysfunctions of skull (I.e. its pathoméchanique). The following stage will be to study the dysfunctions bone by bone, joining by joining and pathologies which are dependent for them. But it is absolutely necessary to before dominate the normal and pathological perception of these mini general movements in order to claim to perceive of them the nuances which are much sophisticated each joining bone by bone. One cannot make the saving in this perceptive training, without making incur with the patients of the risks which it would be illogical to take in this so important field of health.