Does Mastoid Position Reveal Cranial Dysfunction in Chiropractic Assessment
A small asymmetry under the mastoid process can feel meaningful during a cranial exam. The harder question is whether that finding tells a chiropractor anything reliable about cranial function.
Daniel Tuttle, DC, MSW, explored this question in an investigational paper on visual cranial analysis and palpation of mastoid process position in a supine patient. The study raises a practical issue for chiropractic assessment: if one finding appears again and again, across many patients and across different spinal findings, is it clinically useful, or is it simply a common human variation?
The short answer is cautious. Mastoid position may offer a clue, but by itself it does not prove cranial dysfunction.
What the mastoid process can show during assessment
The mastoid process is the bony prominence behind the ear, part of the temporal bone. In a supine assessment, a practitioner may place the index fingers beneath the mastoid tips and compare relative height, shape, and position from side to side.
In Tuttle’s described observation, the left index finger was almost always positioned inferior to the right when placed under the mastoid tips. That means the left mastoid area appeared lower relative to the right in the examiner’s hands.
What makes the observation interesting is not just the asymmetry. It is that the same pattern seemed to appear regardless of other findings, including:
Sacroiliac joint hypermobility or fixation
Functional short leg findings
Upper cervical or occipital subluxation findings
Other spinal or extremity findings
That creates a clinical puzzle. If a cranial finding does not change in relation to other structural or functional findings, it may not behave like a typical indicator of dysfunction. It may reflect anatomy, growth patterns, examiner perception, or a common compensatory pattern.
Visual cranial analysis has strengths and limits
Visual cranial analysis looks at the position, contour, and relationship of cranial bones. In chiropractic settings, it may be used before and after an intervention to help judge whether treatment is needed or whether a change occurred.
Its strength is that body structure can reflect long-standing patterns. Cranial bones, sutural relationships, soft tissue tone, and postural habits may all leave clues. For example, a practitioner might notice asymmetry around the occiput, temporal bones, or facial structures and compare those observations with palpation and other findings.
But visual assessment has a major limit. Asymmetry is common. Adults do not usually have perfectly symmetrical skulls. Cranial shape reflects growth, development, posture, trauma history, dental patterns, sleep habits, and normal variation.
That means a bone can appear structurally different without being functionally dysfunctional. A person may have asymmetry that is well compensated and not clinically relevant.
This is one of the key cautions in Tuttle’s paper. In adults, established cranial bone growth can make visual analysis harder to interpret. A finding that looks abnormal may not be an active problem.
The Sacro Occipital Technique connection
Tuttle’s article also refers to DeJarnette’s premise in Sacro Occipital Technique, often called SOT. In this model, the cranium, especially the occiput, and the sacroiliac joints are understood as having a reciprocal relationship. In simple terms, changes in one region may be reflected in the other through compensatory body mechanics.
This is a compelling idea within SOT because it connects pelvic and cranial assessment. If the pelvis and cranium mirror each other, then cranial findings could help inform sacroiliac evaluation, and sacroiliac findings could help inform cranial evaluation.
The mastoid observation complicates that idea. If the left mastoid process tends to appear inferior in many patients regardless of sacroiliac status, then the finding may not track clearly with the pelvic mechanics being assessed.
That does not make the observation useless. It means clinicians should avoid over-reading it.
A persistent mastoid position finding may be better treated as a baseline anatomical pattern until other evidence shows it changes with function, symptoms, or intervention.
What would make this finding more useful
For mastoid palpation to become more clinically meaningful, research needs to answer several questions.
The first is interexaminer reliability. If multiple practitioners examine the same patient, do they find the same mastoid position? This matters because palpation depends on hand placement, pressure, patient positioning, and examiner experience.
The second is whether the finding changes. If mastoid position is used before and after care, researchers would need to see whether the finding shifts in a consistent way after a specific intervention. A static finding may still be anatomically interesting, but it may not be a useful treatment marker.
The third is whether the finding relates to symptoms or function. A lower left mastoid position may not matter unless it connects to measurable clinical patterns, such as restricted motion, pain, postural compensation, or changes in other exam findings.
The fourth is whether experience changes accuracy. Tuttle specifically raises the question of whether testers with different levels of chiropractic palpatory experience would agree on the finding. That is a useful research direction because subtle palpation skills often vary between students, newer practitioners, and experienced clinicians.
How clinicians can interpret mastoid asymmetry now
The safest way to use mastoid position is as one piece of a broader assessment, not as a stand-alone diagnosis.
A reasonable clinical approach would include:
Comparing mastoid position with cranial, cervical, and pelvic findings
Noting whether the finding is consistent across visits
Checking whether it changes after care
Avoiding conclusions based only on visual asymmetry
Considering normal anatomical variation, especially in adults
This matters because palpation can feel precise, but precision does not always equal certainty. A consistent left-inferior mastoid finding may be real, but its meaning still needs investigation.
For patients, the same caution applies. This kind of assessment should not be interpreted as proof of a disorder on its own. It is an observational tool that may help guide a trained clinician’s reasoning when used alongside history, symptoms, orthopedic and neurologic findings when appropriate, and other examination methods.
This article is for informational purposes only and is not medical advice. Any concerns about head, neck, jaw, or neurological symptoms should be evaluated by a qualified healthcare professional.
The practical takeaway
Mastoid position may reveal cranial asymmetry, but current evidence does not support treating a repeated mastoid position finding as clear proof of cranial dysfunction.
Tuttle’s investigational study is valuable because it asks a question clinicians can test: why does a left-inferior mastoid palpation finding appear so often, even when other body findings differ? Until reliability and clinical meaning are better established, mastoid palpation is best viewed as a possible clue, not a conclusion.
Citation
Tuttle, Daniel, DC, MSW. “Visual cranial analysis: Palpation of the supine patient’s mastoid process position: An investigational study.”
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