An Overview of CranioSacral Therapy

CranioSacral Therapy is a gentle, minimally invasive method for enhancing the functioning of virtually every system in the body, as well as facilitating the harmonious coordination of body, mind and spirit. In order to see what CST is and why it can influence so many areas of our existence, we first have to understand a bit about the CranioSacral system.

The CranioSacral system is a coherent physiological system that has only recently come to be recognized as a functioning unit. It is concerned with the  production, re-absorption and containment of cerebrospinal fluid. Cerebrospinal fluid is secreted by the brain and provides a fluid environment for the rain and the nervous system. The anatomical parts of the CranioSacral system are: the meningeal membranes and the system they form; the bony structures to which the meningeal membranes are attached; other connective tissues intimately related to meningeal membranes; the cerebrospinal fluid itself; and all structures related to it.

The meningeal system envelopes the whole brain and spinal cord. It consists of three layers of membrane. The outermost layer is called the “dura matter”. It is tough and waterproof. The innermost layer is called the “pia mater.” This layer follows every contour and groove of the brain and spinal cord, maintains surface contact with them, and carries many of the blood vessels that service them. The middle layer is the arachnoid membrane. It is gliding surface between the dura matter and the pia matter. Cerebrospinal fluid flows between each of the layers and serves as a lubricant between them as they move in relation to each other. If these layers stick together in an area, the result is pain. Where the pain is felt depends upon where the membranes are stuck together and whether or not the nerves are involved or “pinched” in the stuck areas. Pain can be local or “referred” to a distant point in the body. It is the job of the CranioSacral Therapist to identify areas where membranes are not free to glide and thus are sources of pain and/or dysfunction.

The CranioSacral system is intimately related to, influences, and is influenced by the nervous system, the musculoskeletal system, the vascular system, the lymphatic system, the immune system, the endocrine system (the system responsible for the production of hormones), and the respiratory system. The reason that the CranioSacral system is so closely related to so many aspects of our physiology has to do with two things: a special pulse or motion characteristic of the CranioSacral system, and the communication of this motion to the fascia - the sheets of connective tissue that cover every internal aspect of the human body, its organs and its tissues.

Illustration 0-1A - The Skull in extreme extensions
Illustration 0-1B - The Skull in extreme flexion

The CranioSacral motion is a rhythmic activity that persists throughout life. It occurs in man, other primates, canines, felines and probably all or most other vertebrates. It is distinct from the motions connected to breathing and cardiovascular activity.

It can be felt externally, most readily on the head or the sacrum. With practice and the development of skill it can be “palpated” (perceived through trained touch) anywhere on the body. The CranioSacral motion is a stable pulse of between six and twelve cycles per minute. It is so stable, in fact, that variations outside of this range are used by the CranioSacral Therapist as indications of pathology.

The rhythmic activity appears at the sacrum as a gentle rocking motion. Its motion can be felt as a subtle widening and narrowing of the head. [See Illustrations 0-1A and B.] The widening phase is called the flexion of the CranioSacral system. During flexion, the entire skeletal system rotates in an outward direction. [See Illustration 0-2.] The narrowing is called extension. During the extension phase the head narrows and the whole body rotates inward. [See Illustration 0-3.]

Illustration 0-2 - Whole-body habitus of chronic CranioSacral flexion
Illustration 0-3 - Whole-body habitus of chronic CranioSacral extension

There is a neutral zone in each cycle between the end of one phase and the beginning of the next. This can be felt by the practitioner as a slight pause before the physiological forces move into the opposite phase of motion.

The fascia, as I mentioned, is a slightly mobile, laminated sheath of connective tissue that extends continuously throughout the body from head to toe, and covers all its somatic and visceral structures. By some mechanism, probably via the nervous system, the CranioSacral rythmic motion is normally communicated to the fascia. Since the fascia envelops every organ of the body, the condition of the craniosacral motion can consequently affect and be affected by every organ.

Loss of fascial mobility in any specific area can be used as an aid in the location of the disease process which has caused that lack of mobility.

The CranioSacral Therapist palpates the CranioSacral rhythm for rate, amplitude (strength), symmetry (whether; for instance, the rotation during flexion is greater in the right leg than the left) and quality. Deviations in rate or symmetry indicate pathology. The therapist’s training involves learning how to use palpation and the information it makes available under these categories to identify where in the craniosacral system there is a problem. The amount of diagnostic and prognostic information that can be obtained in this way is limited only by the skill and anatomical knowledge of the examiner.

History

CranioSacral Therapy has its origins in osteopathic medicine and the work of William G. Sutherland. While a student of osteopathy in the early 1900s, Sutherland became fascinated by the anatomical design of the bones of the human skull. It seemed to him that they were designed to move, even though he had been taught that skull bones in the normal adult are fused solidly by calcification and therefore unable to move. Sutherland created an ingenious device that enabled him to study his own cranium and demonstrate to his own satisfaction that the bones of the skull do indeed move. He found that the cranial sutures (the joints between the various bones of the cranium) do fuse - in corpses! Since the crania studied by anatomists were corpse skulls, they naturally believed that cranial bones are immobile. But in the living cranium the sutures are not fused and the bones do move. [See Illustrations 0-4 A and B]

Once Sutherland became familiar with his own cranial motion he began experimenting on others by gently palpating their heads. Soon he was able to sense a minute rhythmic motion in the sacrum. Early on he also found a correlative motion in the sacrum that occurs in synchrony based on the continuity of the dura matter. The dura mater lines the spinal canal and is in the form of a tube. It firmly connects the occiput, which forms part of the base and back of the skull, to the sacrum, with a few bony attachments between. He then developed a model that placed the sphenoid bone as the keystone of the cranium. The sphenoid is the butterfly-shaped bone that forms part of the floor of the skull cavity and part of the sides of the skull just forward of the temple ares and back from the corners of the eyes [See Illustration 0-5]

Illustration 0-4A - Apparent sutural closure in fetal and adult human skulls.
Illustration 0-4B - "Exploded" human skull demonstrating non-closure of sutures.

Illustration 0-5 - Relationship among the sphenoid, temporal and occiput.

Sutherland suggested that the sphenoid moves in response to the circulation of the cerebrospinal fluid and its effect upon the membrane system within the cranium. He thought that the origin of all this motion was the rhythmic contraction and expansion of the system of ventricles in the brain.

Our research has largely supported this model, with the exception of the source of the rhythmic motion. We propose an alternative explanation that we call the “Pressurestat Model.” In this model the brain does not actually expand and contract. Rather, it passively responds to hydraulic forces. We hypothesize that the production of cerebrospinal fluid within the ventricular system of the brain is significantly more rapid than its re-absorption back into the venous system within the cranium. Therefore, when fluid production is turned on for a given period of time, it reaches an upper threshold of pressure. When that upper threshold is reached, production is turned on again. In this manner a rhythmic rise and fall of fluid pressure is achieved. This, in turn, causes the rhythmic changes in the boundaries of what constitutes a semi-closed hydraulic system. That is, a synchronous rhythmic movement is imparted to the cranium, dura matter, sacrum, fascia, and virtually every aspect of the body.

CranioSacral Therapists use the palpation of the craniosacral rhythm to locate restrictions in the system, and they have a sequence of sensitive methods for releasing them. The practice of CST is an art as well as a science. Its effectiveness depends upon the sensitivity of practitioners and their capacity to listen intimately to what the craniosacral pulse is saying, and then to respond intuitively - based on knowledge, experience and training - to the minute particulars of the individual client’s condition at the precise moment of the treatment. The basic method involves coaxing the craniosacral system to find its own way back to regular functioning.

Techniques for Modifying CranioSacral Rhythm

As I say, we coax the CranioSacral system, we do not force it. When the therapist detects an irregularity or restriction, he or she attempts to prevent the CranioSacral rhythm from returning via that abnormal position by encouraging it to find a new route. Such coaxed discovery of new routes introduces added mobility into the system and its library of motions.

The CranioSacral system actually has its own natural way of correcting restrictions and irregularities. This is the “still point,” a condition lasting from a few seconds to a few minutes during which the CranioSacral rhythm comes to a halt. The therapist often attempts to help the system arrive at a still point. This is called “still point induction.” Still points can be induced from various places on the body.

One method is through the feet. The therapist cradles the heels in his or her hands, tuning in to the external rotation (flexion phase), the return to neutral, the excursion into internal rotation (extension phase), and so on. Say the left foot rotates externally further than the right, and that neither rotates internally as easily as it does externally. In order to change this less-than-perfect situation, the therapist follows the motion of each foot to the furthest point to which it moves with the greatest ease. In our example this would mean that the therapist follows both feet into external rotation. At this point he or she resists the return to neutral by making his or her hand immobile. The therapist does not push further into external rotation; the return is simply resisted. The rest of the system will return to neutral and go into internal rotation, but with less facilitation. As the therapist observes this movement, he or she takes up the slack in the movement, he or she takes up the slack in the movement and follows it - just as you would keep the front bumper of your automobile snug against the rear bumper of a car you were pushing. If this process of resisting and then taking up slack is repeated a number of times, the feet will rotate a little further each time. Eventually the total CranioSacral system will “shut down”, i.e.. become perfectly still. This is the still point.

The still point is usually heralded by gross irregularities in the CranioSacral motion. The system may shudder, pulsate or wobble. As the still point becomes imminent, the subject will often experience either an exacerbation of existing pain or the recurrence of an old familiar pain that is currently quiescent. The subject will also experience changes in breathing patterns and probably some light perspiration. During the still point itself, however; everything relaxes. The pain disappears. Breathing becomes very easy. Muscle tension melts away. When the still point is over; the craniosacral system resumes its motion, usually with better symmetry and larger amplitude.

Illustration 0-6A - CV-4 hand position
Illustration 0-6B - CV-4 relationship to bony structures.

Induction of the still point at the head or sacrum is usually effected more rapidly than at the feet, but it requires greater sensitivity. The technique for inducing a still point at the head is called CV-4. ]See Illustrations 0-6 A and B.] This produces a slight compression of the 4th ventricle of the brain. The head of the client is held in the facilitator’s hands. Widening of the head is resisted; no pressure is applied by the therapist. The craniosacral system of the client furnishes the force; the therapist simply resists that force. This increases the fluid pressure within the cranium and causes it o be redirected along other available pathways. The CV-4 technique promotes fluid movement and exchange. It affects diaphragm activity and respiration, and seems to relax the sympathetic nervous system to a significant degree. I have often used this technique to reduce tension in stressed patients. Improvement of the functioning of the automatic nervous system (the aspect of the nervous system that regulates physiological processes) is always expected as a result of still point induction.

Basic Principles and Range of Application

CranioSacral Therapy is based on the discovery of the concrete physiological facts, processes and techniques I have outlined above; its effectiveness, however; depends on much more than the mastery of anatomical and physiological information and the ability to perform its technical procedures. The subjective relationship between the therapist and client is enormously important. I would like to conclude this introduction by mentioning some of the more general principles of CranioSacral Therapy and how they affect this relationship. I will also provide some idea of the range of problems it can help to alleviate.

For CranioSacral Therapy to work properly, the therapist must trust that all the information necessary to understand the underlying causes of a client’s health problems, as well as what must be done to resolve them, lie within the client. It thus becomes the responsibility and goal of the CranioSacral Therapist from the beginning to establish a working rapport with this well of information and understanding. In Craniosacral Therapy and the practices that grew out of it such as Somato Emotional Release, this information itself becomes available through what I came to call the “Inner Physician.” The Inner Physician is the aspect of the client’s being that knows all about his or her condition. The skilled CranioSacral Therapist is able to to contact and elicit the Inner Physician's cooperation in the therapeutic process. In the main text of this book I hope it will become clear how the Inner Physician participates in the healing work.

In order to develop rapport, the therapist must impart to the client’s Inner Physician that his  or her intentions are to help deal with primary problems, not to mask core issues by offering symptomatic relief. Deep problems must be defined and resolved. The Inner Physician knows this and will not settle for less. If one set of symptoms is “cured” but a deeper problem is not resolved, this deeper problem may find another set of symptoms to present. It is as though the symptoms are a call for help from deep inside the client. Core problems may be physical, emotional and/or spiritual. The CranioSacral Therapist must establish a relationship with the Inner Physician in order to help the client get to this problem. When the deeper problem is resolved, the symptoms dissolve with perhaps just a little help from the therapist.

It is, of course, not true that all symptoms have deep underlying causes. Some are simply happenings that occur. But in CranioSacral Therapy we believe that every symptom, pain or complaint deserves an investigation to determine whether or not it is the voice of a deeper problem or simply something such as a freak accident, an infection, etc. The Inner Physician knows the answer to this question and will share it willingly with the therapist once a trusting relationship has been established.

Initially, CranioSacral Therapy employs a soft, gentle use of the hands to facilitate the self-correction of the CranioSacral system. This touch is concurrently used to convey to the Inner Physician the love, trust and sincere dedication of the therapist. This loving, trusting and dedicated energy is offered without conditions or strings attached in order to facilitate the deepest possible healing.

Once this trust is established, the CranioSacral therapist must also trust the information received from the client’s body and the Inner Physician; otherwise, the information will stop coming. It is as though the Inner Physician rejects the therapist. In such cases the therapist will be able to do superficial structural work with the CranioSacral system, but probably will not be able to get to deep problems until the trust is developed.

I do not believe that the CranioSacral Therapist should think of particular symptoms as always following from the same causes in a one-two fashion. Each client, and even each occurrence of a symptom always, or even often, derives from the same cause can be very misleading, especially when the therapist is relying upon very subtle body-motion signals as is in the case in the use if CranioSacral Therapy. These signals may be merely imagined by the therapist if he or she expects to find them. It is better to not even know the client’s complaint when the body evaluation is done. When I begin a session with a patient i have seen before, i try not to remember what i found out previously. I always evaluate the situation freshly at the beginning of each session. I may find new developments that might otherwise escape me if i already have a mindset when i re-evaluate. After the initial evaluation for each session there is plenty of time to integrate previous findings with the patient’s report of changes, new pains, etc.

This last point is exceedingly important, though it goes against the grain of most medicine as it is conventionally practiced. The following story will illustrate. I think poignantly, what i am talking about.

In 1966 I was in practice in Clearwater Beach, Florida. One evening I was called to make  a motel house call. It was about 9:00 pm when I arrived. A woman was lying on her bed with a very severe headache. Her husband presented me with a letter from a doctor at a highly reputable medical clinic in the north. The letter stated that his patient suffered from severe migraine headaches. It suggested that the treatment of choice would be an injection of fifty to seventy-five milligrams of the powerful synthetic narcotic Demerol. Upon examining her, I began to suspect she had a brain tumor rather than a migraine headache. I gave her the Demerol for her pain after I completed my examination, which took three of four minutes. The shot helped a little.

I tried to convince her husband that he should let me hospitalize her: He finally agreed and we went to the hospital by ambulance. She died during the night. The autopsy revealed that she had malignant brain tumors. Perhaps she originally had been a victim of migraines. But failure to re-evaluate each episode afresh may have cost her her life. I decided at the time not to accept previous diagnoses from medical clinics, no matter how reputable the facility.

There is virtually no limit to the kinds of problems CranioSacral Therapy might help alleviate. CranioSacral Therapy always improves fluid movement in all systems throughout the body. By doing this it enhances many functions: the provision of nutrients to cells; the removal of toxins and waste products from the tissues; the defenses against disease-producing bacteria and viruses; the delivery of fresh blood to organs and tissues; and the movement of cerebrospinal fluid. Thus, the only situations in which CranioSacral Therapy should not be applied are those in which the above results are undesirable for some reason.

By John E. Upledger, D.O., O.M.M.