Case Series: Cranial Strain Patterns in Parkinson's Patients

Insights from Rivera-Martinez et al. (2002)

In 2002, Rivera-Martinez, Wells, and Capobianco published a retrospective study in the Journal of the American Osteopathic Association examining whether patients with idiopathic Parkinson's disease demonstrate distinctive cranial strain patterns.

The study explored an intriguing clinical observation: Do patients with Parkinson’s exhibit consistent cranial findings detectable through osteopathic examination?

Why This Question Matters

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by:

• Resting tremor

• Rigidity

• Bradykinesia

• Postural instability

While PD is primarily associated with degeneration in the basal ganglia, clinicians at the New York College of Osteopathic Medicine observed recurring cranial strain findings during osteopathic manipulative treatment (OMT).

This raised an important question:

Are certain cranial strain patterns more common in patients with Parkinson’s compared to healthy controls?

The researchers reviewed physician-recorded cranial strain observations from:

• 30 patients with idiopathic Parkinson’s disease

• 20 age-matched normal controls

They analyzed whether particular cranial patterns were observed more frequently in the PD group.

Key Findings

Two cranial findings occurred significantly more often in Parkinson’s patients:

• Bilateral occipitoatlantal compression

  • 87% in PD patients vs. 50% in controls (P < .02)

• Bilateral occipitomastoid compression

  • 40% in PD patients vs. 10% in controls (P < .05)

Interestingly, over subsequent visits and treatment, the frequency of both strain patterns decreased significantly:

• Occipitoatlantal compression (P < .01)

• Occipitomastoid compression (P < .05)

After treatment, strain frequencies approximated those seen in the control group.

Clinical Interpretation

The occipitoatlantal region (junction between the occiput and atlas) plays a critical role in:

• Cranial base mechanics

• Upper cervical neurology

• Autonomic regulation

Similarly, the occipitomastoid suture involves key cranial base structures that may influence venous drainage and neural function.

While this retrospective study does not establish causation, it suggests:

• Certain cranial strain patterns may be more prevalent in Parkinson’s patients.

• Osteopathic manipulative treatment may alter the frequency of these findings.

• Structural cranial findings could represent either a consequence of neurological disease or a contributing biomechanical adaptation.

  
  

A Balanced Perspective

Important considerations:

• This was a retrospective study, not a randomized controlled trial.

• Cranial strain pattern diagnosis relies on physician palpation and may be examiner-dependent.

• No direct measure of neurological improvement was reported alongside strain reduction.

Nevertheless, the study contributes to a growing body of literature examining structural–neurological relationships in neurodegenerative disease.

Research has demonstrated that manual therapies may influence autonomic function and central nervous system modulation (Henley et al., 2008), though mechanisms remain under investigation.

Conclusion

Rivera-Martinez et al. (2002) identified significantly higher frequencies of bilateral occipitoatlantal and occipitomastoid compression patterns in patients with idiopathic Parkinson’s disease compared to controls. Following treatment, these strain patterns decreased to control levels.

While more rigorous research is needed, this study raises compelling questions:

• Are cranial strain patterns a biomarker of neurological disease?

• Do they represent compensation, consequence, or contributor?

• Can manual treatment meaningfully influence neurological outcomes?

For clinicians working at the intersection of cranial mechanics and neurology, this research highlights the importance of structured observation and objective follow-up.

References

Henley CE, Ivins D, Mills M, Wen FK, Benjamin BA. Osteopathic manipulative treatment and its relationship to autonomic nervous system activity as demonstrated by heart rate variability: A repeated measures study. J Am Osteopath Assoc. 2008;108(6):285–291.

Rivera-Martinez S, Wells MR, Capobianco JD. A retrospective study of cranial strain patterns in patients with idiopathic Parkinson's disease. J Am Osteopath Assoc. 2002;102(8):417–422.

A retrospective study of cranial strain patterns in patients with idiopathic Parkinson's disease, Rivera-Martinez, S., Wells, M., Capobianco, J. Journal of the American Osteopathic Association, August 2002;102(8):417-422

Abstract: While providing osteopathic manipulative treatment to patients with Parkinson's disease at the clinic of the New York College of Osteopathic Medicine of New York Institute of Technology, physicians noted that these patients may exhibit particular cranial findings as a result of the disease. The purpose of this study was to compare the recorded observations of cranial strain patterns of patients with Parkinson's disease for the detection of common cranial findings. Records of cranial strain patterns from physician-recorded observations of 30 patients with idiopathic Parkinson's disease and 20 age-matched normal controls were compiled. This information was used to determine whether different physicians observed particular strain patterns in greater frequency between Parkinson's patients and controls. Patients with Parkinson's disease had a significantly higher frequency of bilateral occipitoatlantal compression (87% vs. 50%; P < .02) and bilateral occipitomastoid compression (40% vs. 10%; P < .05) compared with normal controls. Over subsequent visits and treatments, the frequency of both strain patterns were reduced significantly (occipitoatlantal compression, P < .01; occipitomastoid compression, P < .05) to levels found in the control group.