Used to increase intracranial venous drainage

Steps for Treatment:

1. Patient supine, physician at head of table. Physician should rest elbows on table to allow creation of a fulcrum
2. Physician should begin with draining the transverse sinus
   • Place finger pads of both hands across superior nuchal line
   • Maintain this pressure until a release is felt
3. Next, physician should move on to confluence of sinuses
   • Place one finger, typically the middle finger, on the inion
   • Maintain this pressure until a release is felt
4. Physician should now move on to occipital sinus drainage
   • Cradle back of patient’s head
   • Physician should place finger pads of 2nd-4th fingers of both hands across from each other along the midline from the inion to the suboccipital tissues
5. Next, physician should move on to draining superior sagittal sinus
   • Gently place patient’s head back on table
   • Physician should flip their hands around so both thumbs are resting along the midline of the patient’s head, and the physician’s fingers are pointing toward the patient’s ears
   • Physician crosses thumbs and gently creates an opposing force
   • This is done from the back of the top of the head to the front, ending at the frontal bone or just above the patient’s forehead
6. Finally, the physician should release the metopic suture
   • Physician should again flip their hands so the finger pads of the 2nd-4th fingers are resting on the patient’s forehead at midline
   • Physician gently pulls their fingers apart to disengage the suture
7. Reassess and observe the CRI through a few cycles, and then gently remove your hand