A study published in the American Journal of Osteopathic Medicine (December 2011) confirms what many osteopaths have claimed for many years, that the method known as 4th ventricular compression – or 4VC (see below) results in statistically significant physiological changes.

The study evaluated two well known techniques, described in the study as a/ ‘augmentation’ and b/ ‘suppression’ – compared with a ‘sham’ treatment method

These two words describe methods that either attempt to :

a/ Enhance/reinforce the flexion/extension motions at the sphenobasilar symphysis. The method involved: ‘using the standard vault hold. With the participant lying supine on a table, the operator (S.T.S.) sat 8 to 10 inches away from the head of the table. With forearms resting comfortably on the head of the table, he then lightly contacted the sides of the participant’s head with both hands, using the palmar surface of all his fingers and palms but not the thumbs. The index and middle fingers were placed bilaterally on the greater wings of the sphenoid bones, while the ring and little fingers were placed on the lateral angles of the occiput. The operator encouraged both flexion and extension by enhancing the motion of the sphenoid and occiput bones with his own hands.’ (Nicholas & Nicholas  2008)

6FF2 copy6FF1A copy

6FF13 copy


b/ Reduce/retard those motions, by means of ‘prohibiting flexion movement and enhancing extension movement of the cranial base and the petrous portions of the temporal bones’

7FF5 copy

The findings of the study concludes that:

“The present study examines the systemic and cerebral hemodynamic response to augmentation and suppression cranial OMM techniques in healthy adults. Our data suggest that the suppression technique elicits a mild but statistically significant reduction in the cerebral blood flow as manifested by SCTO2 (an index of cerebral blood flow) that correlated with the treatment time. Thus, this technique could be applied to alleviate conditions associated with intracranial hypertension or excessive volume. Future studies should be conducted in patients with these types of chronic clinical conditions to further assess the effect of multiple sessions of cranial OMM with suppression technique on cerebral homeostasis, as well as on autonomic nervous balance. We believe that the physiologic response, or the efficacy of cranial OMM, will be more substantial in patients with intracranial hypertension or excessive volume than in healthy adults.” 

These and numerous other cranial methods, together with a background that evaluates the theoretical models and practical evidence, are detailed in my book :






  • 2. Cranial fundamentals revisited
  • 6. Cranial movement: mechanical and subtle
  • 7. Cranial bones: assessment and manipulation
  • 8. Cranial implications of muscular and fascial distress
  • 9. Assessment and treatment of key cranially associated muscles
  • 10. Positional release and cranial pain and dysfunction
  • 12. Clinical applications of cranial manipulation



Nicholas AS, Nicholas EA, eds. Atlas of Osteopathic Techniques. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:475-495.