Cranial Bones & Sutures & Fascia, another popular demand

di Maximilien Girardin

This pony we catch on the run, grasp it by the manes and jump up like a Cossack, because actually all that concerns this was already said in previous articles…or as good as anyway, at least on the level of the principles.

If you want to reconstruct the whole story this is the chronology of the articles to read on this channel:

https://www.linkedin.com/pulse/help-something-deeply-wrong-anatomy-max-girardin/ one sets the environment, the macroscopic view

https://www.linkedin.com/pulse/annus-horribilis-max-girardin/ the only constants in organic growth = hierarchy and chronology

https://www.linkedin.com/pulse/osteopathy-tissue-knowledge-max-girardin/ This one sets the departure of how we come to connective tissue, how it comes to be

https://www.linkedin.com/pulse/popular-demand-fascia-max-girardin/ This sets the stage for the fascia and how we can look at it

The Osteoporosis sets the stage for the bone development within the fascia

So on a principle level all is said, although the cranium has some particularities…

Did you ever ask yourselves:

1. why the neurocranium (top part) ossifies directly out of fascia through ossification points and the basis cranii takes an intermittent lingering step through cartilage before finally toppling over in bone, pumping the cartilage full with minerals (enchondral ossification)?
2. or why Sharpey’s perforating fibers would like the roots of a vine work their way through the sutures and connect the galea aponeurotica on the outside of the cranium with the dura mater on the inside for instance?
3. or why does the sutures at the end of bones look often so spiky, jigsawed or toothed, exactly like the bones and sutures of a tortoise shell, if you look beneath the scales and separate them?
4. or why do we have so many layers of fascia, some attached to the bone and some not like the ones over the central nervous system: Dura mater parietalis, dura mater visceralis, arachnoidea parietalis arachnoidea visceralis, and pia mater ?

And these are the easy ones…let us give it a shot and see how far this horses runs

As you can see for yourselves our cranium is not that different from a tortoise shell, although the most outer layer of skin or ‘frontier tissue’, keratinizes much more and thicker than ours, hence the horn or keratin scales.

1. why the neurocranium (top part) ossifies directly out of fascia through ossification points and the basis cranii takes an intermittent lingering step through cartilage before finally toppling over in bone, pumping the cartilage full with minerals (enchondral ossification)?

The bony parts just underneath have sutures like our skull, the big difference lies in what was the motor underneath it, stressing the connective tissue that much that it starts to calcify and that all the bony plates articulate with sutures…in homo sapiens it is the big brain that grows fast and hard with a mostly longitudinal direction, which gets redirected as the resistance of the relatively elastic connective tissue that is the upper skull in that time frame, is almost at its end of stretchability and goes all ‘berserk’; the undifferentiated mesenchymal cells react violently on the stress lines and at the fulcrum points of maximum stress (force resistance or support points of the levers), replicate and some turn into osteoblasts that start pumping CalciumPhosphate minerals into the matrix and fibers, turning the connective tissue (fascia) directly into bone…and with much sobriety we call that the ossification points.

The same process happens with the tortoise shell in formation, although the motor is here the whole body, neuro – visceral and interni. As the central resistance points which are now ossifying, take the biggest amount of direct stress, the outer edges of a part of that fascia are submitted to less stress…and will a bit like an ice-shelf have a bigger motion-stress-play than the hardened central part, the direct consequence of that is that depending on the force lines directions the edges will become jagged or any other shape adapted to the force lines and ‘relative motion’ in presence. As with the tortoise the expanding force is not just the central nervous system but its whole body thus the definitive form will be very different; although also here fundamentally it is the same nature’s principles at play within a very similar type of connective tissue, fascia or green stuff (if you read the fascia article).

When I was still an examiner in an Osteopathic college in my previous life, and when I had to take the practice exam for cranium, before doing anything on a patient, I asked the students to close their eyes and stretch out an open hand, and gave them one of the cranial bones in the hand, and asked them to name it , orient it and describe how they came to that conclusion without peeping … after an easy one like the sphenoid, I usually went for a parietal or zygoma and repeated the same exercise, and only with the ones who did very well I put them one of the bones of an exploded tortoise shell…and after some very strange faces with the eye still closed most came with : “it is an unusually large inca bone?” where I asked them to open the eyes and gave them another three of those bones…and I could asses how fast they were plastic or malleable in their minds…only very few realized by themselves that it was tortoise shell bones that I had given them. I know it sounds harsh, but it was just an assessment I did it only with the high scorers, and did not really score them on it, they could gain an extra point not loose any…but for many of these ‘primes of the class’ it was a humbling experience which actually made them work more focussed for the real practice exam. And the benefit for me ? I got a pretty good impression of how well they could transfer the felt form into a living picture yet.

( No students were harmed during the process of the old Belgians trial testing, Obelix is me myself and I , Asterix is Jean Paul Höppner, Idefix is FORM & NATURE both our love, and the Romans and cows ?… I leave to your own imagination!)

Now when you are getting into this and see the nature’s principles at work instead of parroting something you learned by heart, (For the Suomi -Vilppula forest people: ‘Polly says Hello’) slowly it should dawn, why the difference with the basis cranii ossification – why enchondral ossification just there?

I this one you can still recognize the central so called ossification point and the original matrix and fiber stress lines that made it ossify.

The basis cranii shares a complete different environment than the top, neurocranium, who is delivered to itself and the forces of the explosive growing brain “blowing wind in its sails’, no softening the message there; that fascial part of the skull is exposed to the full Monty of forces unleashed upon it, hence it reacts extremely by turning fascia directly into bone. The story of the basis cranii is different, the rest of the organism is its environment, meaning the visceral package with its fascial environment, the circulatory and retroperitoneal, retropleural and retropericardiac systems, what my friend JeanPaul Höppner calls the Homunculus Viscerocranii and Homunculus Interni, which are all together quite a masse help to absorb the strain also downwards of the bloody fast growing brain…. By this temperance as there is more force absorption the poor fascia of the basis cranii does not stand alone and the consequence is, as sang so well by lovely regretted Dolores from the Cranberries, LINGERING… The fascia is stressed and will develop into a fibrous kind of cartilage and when the stress becomes unbearable in places, start to “pump up the jam” with minerals and turn it gradually into bone.

The sharpest knives in the drawer have actually now the answer for the rest of the questions, if they get the natural principles at work, it is just more of the same….

2) or why Sharpey’s perforating fibers would like the roots of a vine work their way through the sutures and connect the galea aponeurotica on the outside of the cranium with the dura mater on the inside for instance?

Thank you from the bottom of the heart to have described them Mister Sharpey, but what were you thinking when you call them perforating fibers? Probably not thinking just describing what you saw. That smells like an anatomist ‘s mind…seeing and describing, which is fine. But that ‘perforating’ is an opinion and judgement, and sets at least an embryo thought of an explanation, which is utter nonsense, like so many …

HA HA, verified him thanks to “Whonamedit”, Sharpey (1802-1880) was an anatomist effectively , and one who respected animals, ok because of that one, I forgive you brother, respect. But despite this good mood of mine…

The fibers do not perforate anything, how could they, if you understand how fibers are formed in connective tissue? They are what is left over from the original unity of the fascia. Savvy?

The bone is self-organized within the core of the fascia, and it is a gradual process from the highest stress points, smearing out towards the lower stress zones, as more bone is formed the stress distribution and relative resistance gets better hence what stay open at the end of the bone plates is the sutures, where some of the original continuity is maintained…

Perforated?

Perforated?

PERFORATED?

THINK AGAIN……

Even Misses Wikipedia knows almost better….

“In the skull the main function of Sharpey’s fibres is to bind the cranial bones in a firm but moveable manner; they are most numerous in areas where the bones are subjected to the greatest forces of separation.”

DEEEUUUUH! It is the zones, where the stress was low enough for the original fascial unity to maintain itself and reorganize, it did not have to shape shift into bone…. REASON or as Hercule Poirot my fellow Belgian says in dear old Agatha’s books:

“Use the little grey cell’s since you have them.”

3.or why does the sutures at the end of bones look often so spiky, jigsawed or toothed, exactly like the bones and sutures of a tortoise shell, if you look beneath the scales and separate them?

Now even the half blunt knives in the kitchen drawer, should slowly see it dawning, if not, the diagnosis is easy: either too much dominating “Polly says hello” Parrot education, or lack of fantasy and according right brain capacity to visualize (buy “the Right brain experience” from Marylee Zdenek and start training with her program it might cure you?) or really blunt, but hey! What the heck? That is ok, we are all brothers and sisters, everyone is blunt in at least one or two area’s, don’t bother enjoy life.

Seeing in principles and see them, when they are at work is blood, sweat and tears, it takes a lot of de-education-ing, de-“Polly says hello”- ing and a lot of mental discipline training to go rogue or Punk…almost systematically…

Be a Baboon and grow an attitude,

Courtesy of http://irissplace22.blogspot.com/2015/07/giant-volcano-and-its-baboons-with.html

Going against the wind, or don’t and

live happily on your course, wind in the back and sails bulging.

Let us take an easy one, or a few, without hurting our brains too much. Now as an osteopath if you had any basis in the Sutherland and cranial nonsense, you are most probably in the ‘Polly say’s hello’ bed, try to set that nonsense aside for a while and try to look and visualize with your children eyes…

OK……, I sense a lot of irritation and mumbling growing fast after te previous sentence, which is not far away of an aggressive growl and even showing canines…let us first take a sidestep and first get that negative emotion out of our path…Frame of reference remember?

What was probably taught to you in the name or better “blasphemous-ized version” of W.G. Sutherland is nonsense, due to the how it was taught.

Most cranial teachers (and in my professional life I knew quite a lot of them all over the world) apparently suffer of the same syndrome which is the “Polly says hello” parroting, badly aggravated by an almost religious cult like groupie – faith attitude ( fundamentally I don’t understand it, neither the words that are used but it seems to do great things so)

‘The cranial mobility’ as described by Sutherland is alike for monotheïsts the Thora – the Bible ‘s’ – the Koran; and as the word of God can’t be challenged by mortals, we must submit (bend over – kneel – or prostrate ourselves) and accept that the G-man works in mysterious ways.

And that is what and how it is usually taught…in my experience…silently I hope there are exceptions somewhere in the osteopathic world…fingers crossed behind the back.

If it would not been so deeply, immensely, profoundly, very saddening, I would probably find it funny and laugh with it, as a well succeeded april’s fool or good joke…but it is not.

It is the clinical sign of something deeply wrong in the organism called profession of osteopathy…a total lack of self reflection.

Thus I get the ‘evidence based’ moronic attitude that throws away the baby with the bathwater, a crude childish reaction but I get it, I really do, but that also only demonstrates, from the other side of the spectrum, the same identical sign: a total lack of self reflection and questioning.

(I think)

Leo Apostel: We all stand in a tradition, (also W.G. Sutherland) and a tradition is not repeating mindlessly the same thing over and over.

In order to keep a tradition really alive, every single one should recreate the tradition by oneself.

WALK THE WALK!

Sutherland bloody refers to it himself, cranial osteopathy is not apart from A.T. Still’s Osteopathy, it is just osteopathy with a intense view on the cranium. Osteopathy is about FORM, not J.M. Littlejohn’s but Still’s Osteopathy is about FORM. (see some other of my early articles if you do not get this, it comes back all the time)

It took Will a long time, and he did not do it all alone as the myth suggests, Sutherland had a little scoundrel side, and took stuff elsewhere without referring to it, as does everybody at some point, no grudge for that. But at some point he came to see the FORM and at least some of the Nature principles at work…

But what became of his teachings was shape-shifted by every generation just a bit, and now has become mostly, an endless repetitive impoverishing mantra, with some, not even good, cranial anatomy as excuse generation after generation of teachers…very sad because the essence of what he was trying to do was sharing an awesome osteopathic or nature’s experience and some of his thoughts with it, not formulating laws chiseled in bedrock or stone…And the cranium …no… Osteopathy is Nature it is great and incredible by its simplicity and magnitude in all its complexity…but the sad charade made of it by man made structures ( teachers-schools-groups and associations) not just steered the function or behavior but smothered it, I think.

So that being off my chest my world, is in balance again, let us return to our hot potato ….the sutures FORM

Easy ones to describe, even if you have no visualization capacity at all, are the sutura coronalis and or sutura longitudinalis because they self organize in-between and far away from the major stress points and evenso in between the big bones in organization. And together they form the Mister T symbol on the top of the skull which gives them just that special touch…except if you have a sutura metopica, then it becomes a cross on your top, not so funny if “Thou are not Christian”.

The famous four ossification points that are the main stress points are the two bulges on your frontal bone an the two big ones on the back and a little sideways from middle; some conspiracies theorists believe that those four bulgy points are the left overs of where the gripper of the production line picked us up during assembly, others think they are the points to mount horns for next life as a devil or as cattle…

People’s imagination knows little boundaries, like I already referred too so often;

Nature self- organizes – complexity, what people make of it is just complicated – hallucinating or utter nonsense….

I love complexity – not complicated constructs or hallucinatory complications.

Thus I take the self organization – complexity and Nature as stance, definitely. Hippo has places to be – hippo has places to go – hippo has things to do – hippo does not care-

Now try to see what is happening from a point of view of Form; see the thick fascia of the neurocranium as a really thick solid canvas sheat of the solid type with some special characteristics in it.

As the fascia is continuous it is not just a dome on the top covering the fast growing central nervous system beneath it, it goes on downwards where a lot of growth – forces are happening too; but we choose for this description to zoom in on the top bulging part ( but it is not because we don’t focus on the rest that it is gone….it is very present and has also its steering influence.)

The real top covering layer is the skin, also a frontier tissue as is the neural system, thus consisting of cells in a stratified layered structure, with the external layer keratinizing once it is in contact with air, like the tortoise.

These cells reproduce a little slower than the neural system at places but not much, what is really much slower in its development is the thick fascia, which is sandwiched between the two frontier tissues: neural and skin. So let us visualize this big connective canvas sheet and take the top skin layer away as to see what is going on in the connective sheet…

It is continuous and going around and in and through the whole organism , which has beneath many parts that grow a lot slower so as retention systems they keep the top tight. So to represent that, lets us imagine a whole corps of mini firefighters holding the sheet, tensing it.

Courtesy from https://my.firefighternation.com/forum

Now Nature’s Complexity and thus unpredictability makes its entrance; You see the central dot towards which the jumper should aim?

Let us take that dot as the future ossification point, meaning in your living picture you can make the canvas much larger, so large that you have four dots in a big rectangle with still a lot of white canvas in between the spots. Only use the left image, the four spots are the eminences, two on the frontal and two parietals left and right. What is treacherous, is that for this image the anatomist or embryologist does not show the top layer of the fascia, because he wants to show you the bones in formation. Bloody pedagogy and anatomists. In reality this process is happening inside a thick fascia which is as well galea aponeuroytica, (epicranial aponeurosis – aponeurosis epicranialis in English) the future bone as the external layer of the Dura Mater, it is one sheet! ( That is why dissecting by yourself is the only correct anatomy)

Courtesy of https://skeletalsystemdev.weebly.com/development-of-skull.html

As the explosive neural tube keeps on growing it starts to fold and (tilt or twist?) in different directions (which’s directions are still visible in the form of the ventricle system) the whole top of the canvas sheet bulges in all directions and it gets worse, as the sheet is held-tucked under the bed of the viscero-cranium and the rest beneath it (the firefighters holding). that is why I used ‘canvas’ in the image it is not very flexible, over a very long time, yes a little it will show some slacking but instantaneous nothing. Savvy?

Now we want to zoom in even more and focus shortly in, on one of the future ossification points, to see what shift happens there, will you?

The four most extreme bulges are the fulcri that is where the shift starts, so pick one of your choice. Done?

Ok

Now within that point all forces, traction which in the tissue is actually expressing as a compression converge. Another living picture to get that adamantly: the torsading of a cleaning cloth to release the water in the middle

When forces even in traction (because of the bulging push from the growing neural tube beneath) are converging on the center, it will push a fraction of the water content out of the fascia and transmit more forces centered on the middle, on the now meanwhile more fibrous canvas (thick fascia sheet) this change is not just chemically the environment of the mesenchymal cells (osmolarity change) but also the mechanical transduction of the traction compression forces on the cytoskeleton of all the cells present.

As tensegrity is cool and trendy in the osteopathic world nowadays probably most of you have at least heard of it. That is the natural phenomenon going on: the tensegrity of the cells cytoskeletons activate several enzymes attached to it and the cells are thus stressed. The response is two-ways: replication or internal reorganization of the cells one daughter cell maintains its mesenchymal FORM while the other differentiates into what is called an osteoblast, and does its thing; it starts to self organize into bone along the stress lines in the matrix and fibers.

That phenomenon is probably the why the ossification point self organizes as a spiderweb like form, and spreads out in an irregular way following the directions of the constraints. Of course as the word FORM suggests for the diligent reader the local physiology changes heavily, and as consequence the osteoblastic cells at some point start to pump Calcium Phosphates in the matrix. It stays the most reactive place of the bone usually for the rest of your life…not while it is special but due to its position.

As I repeat myself to dead in every course, to a point that I am boring myself,

don’t see it as a picture, it is a process, it is a motion picture, there is no stand still here, it is an adaptive process that bites itself in the tail like the Ouroborus.

The neural tube grows and is more and more forced into other directions because the canvas sheet resists the bulging push, meanwhile the canvas central part changes its nature and becomes even more resistive… bony. Thus there is a big party going on there…the polarity is the speed of growth (nervous system) and the direction of growth pushing and bulging the canvas, and the canvas immediate response changing its nature organizing another type of resistance, which influences the behavior and direction of the neural tube growth…

Cleopatra’s alchemical representation of the Ouroborus, I think the oldest one known to archeology today ( around 51 BC) In Alchemy this represents the all is one, or the circle that never stops revolving…if you imagine it as an active process…

Gradually as the bone organizes, the two cortical plates so to speak catch most stress, with as result that in between them suddenly the stress is immensely reduced, the consequence is that inside, stress protected by the two cortical plates, the process stops and leaves the trabecular or even more centralized in long bones for instance the medular part. Compare how the bone looks when it starts embryologically from the ossification point and then look at the diploe in the skull…Reason!

Courtesy of Churchill Livingstone, Elsevier as an example, the internet and anatomy books are full of similar examples; look at the diploe its form, and look how highjacked “science” splits up in scalp and cranium what is a whole, certainly under the frontier tissue of the skin!

Not astonishing that students go all “Polly says Hello”…. What to expect else? Look closely and then reorganize in your head…Reason!

As the ossification process goes on and the bony edges approach each other more and more within the connective or fascia layer, the circulation, heartbeat, fluid pressures changing, make that the edges don’t really touch completely even after birth where this deformation capacity helps during birth to deform enough without destroying anything. The canvas or still fibrous connective parts function as a sometimes tensed drum-skin in between the bony edges and above and inside the skull and then normally the breathing adds its extra rhythmic pressure changes to the mix of dynamics, as these motions become smaller and smaller the edges don’t finish smoothly and finish in the form as we know them…

Now if you think you finally got it…think again there are so many dimensions at play and forces going along with it that we really don’t have a clue, this was a living picture from a morphologists side or perspective, in other dimensions we have electrochemical potentials at play, piëzzo electric effect joining in as bone starts to mineralize friction forces etc. etc.

Nature is incommensurably great and complex, and all the dimensions in which we cut it up to make it graspable are always definitely insufficient…it is one, it is a whole…get used to it.

4. or why do we have so many layers of fascia, some attached to the bone and some not like the ones over the central nervous system: Dura mater parietalis, dura mater visceralis, arachnoidea parietalis arachnoidea visceralis, and pia mater ?

Naaaaeeh this is getting too long let us keep that one for another time…

Time to saddle off now. Cheers!