Tuesday, February 10, 2009

Palpation in CranioSacral Therapy and Other Modalities

By Kailas, LMT, NCTMB, CST, Cert. Ayu. CranioSacral Therapist and Certified Ayurvedic Practitioner in Los Angeles

Introduction to Palpation

The term “palpation” has usage recorded as early as 1483, from the French, palpitation, derived from the Latin, palpitare "to throb, to flutter", which in frequent usage meant "touch gently” or “stroke"(1).

Based on this etymology, the term appears to resemble a comforting and gentle caress, instead of the mechanistic probing that characterizes medical palpation, orthopedic tests, and even the palpation styles of bodywork paradigms.

As early as 1303 there is usage of the term examiner, from the French, meaning "to test” or “to try" (derived from the Latin, examen "a means of weighing or testing"(2)), indicating there was a clinical practice of manual examination.

Today usage of the term “palpation” encompasses a variety of techniques, approaches, and styles – each a required and respectable clinical tool that enables the physician, therapist, or bodyworker to determine how to proceed.

In brief, palpation includes the use of one’s hands to explore, examine, and test the client’s body; retrieving information to be interpreted according to one’s skill, which can be useful to guide the treatment.

The Role of Palpation in Treatment

In the clinical setting, a therapist is challenged to discover relevant contextual and practical information about the client’s general and specific conditions; adapting their palpatory approach and techniques to explore and gather information from the body, and possibly performing diagnostic tests for specific patterns and relationships.

The simple question; “Where does it hurt?” can lead one’s hands to the general area indicated by the client. The therapist must discover not only the specifics of the tissue involved, such as whether the pain is structural or neurological, but how acute the condition is, and if there are involved areas which the client may not be consciously aware of.

Palpatory techniques reveal quantitative information, such as location, tonus, shape, proportion, development, and anatomical symmetry. Touch also discovers qualitative information such as dryness, hydration, lubrication; heat, cold, clamminess; vibrancy, morbidity; sensitivity, dullness; hardness or softness.

One may also palpate vitality, strength or weakness, mobility, and flexibility of tissue, apply orthopedic tests and look for specific signs, locate scars from accidents and surgeries, or determine contraindicated areas one must work around.

Palpation Techniques

Generally(3), palpation is performed with a moving, feeling hand; using finger pressure for specificity. Brushing and friction with the finger tips is also helpful. To palpate mobility of tissue or flexibility of a joint, assisted movement is utilized, and that can involve grasping and some upper body movement. To palpate using specially designed orthopedic tests, the therapist can use motions that push and pull, along with using their weight and strength to anchor or assist parts of the client’s body. 

Palpation can be superficial or deep, and involve gathering information from several layers of tissue to assess various body systems. Deep, complex palpation requires greater knowledge and experience, including a thorough understanding of anatomy and physiology and their condition in health and dysfunction. Body-listening skills, a free and lucid mind, and real-time analysis of sensations and somatic information combine with the effective use of verbal questioning to confirm the therapist’s intention to use specific techniques.

Important Additional Aspects of Palpation

Aside from perhaps shaking the hand of a client in greeting, palpation is the first touch-contact. It is this initiatory experience which informs and expands the underlying expectations about the roles played by therapist and client in the clinical environment.

This first physical “communication” addresses the boundaries of the client’s body, not only for the therapist seeking palpatory information, but also for the client, who may immediately gain a wider experience of their condition. Depending on the relaxed or traumatized state of the client’s tissue, the therapist may not be able to palpate certain regions. Additionally, the therapist’s senses and reactions, as well as mood and manner, provide feedback to the client information about their body and condition.

This establishment of this multi-level communication loop can have a profound affect on the level of trust between client and therapist, and potentially affects the therapeutic outcomes of the session. However, the degree that palpatory communication affects the healing process ultimately depends on the specific circumstances.

Nevertheless, palpation at the beginning of a therapeutic session warms up the client’s tissue, brining circulation and fluid exchange to the cells, nervous stimulation, and the elongation of muscle fibers. This preparatory clinical phase may have some therapeutic effect, especially if followed by a supportive and well performed treatment.

Palpation in the Therapeutic Community(4) Today

The therapeutic community includes a spectrum of complimentary modalities that, for the purposes of this essay, I will divide into three families: Virtuoso Touch, Western-aligned Manual Therapy, and World Medical Traditions.

While this grouping is not a complete model, in the context of this paper it serves as a logical premise. In fact, the true landscape consists of a long list of modalities which exist in complimentary relationships. In many cases, these approaches influence one another, and sometimes complimentary modalities are integrated within a single therapeutic session.

Virtuoso Touch

Several sophisticated systems of touch therapy practiced today have been developed by extraordinarily gifted individuals, who, following a natural gift throughout their lives developed insightful modalities that have contributed to the growing landscape of healing praxis in the therapeutic community.

In my opinion, such individuals include Ida Rolf, Milton Trager, Moshe Feldenkrais, Randolph Stone D.C., M.D., and John Barnes. Of course, this list includes Dr. John Upledger, D.O., O.M.M., whose contribution is elaborated on below.

It could be said that what is primary about Rolfing, Trager, Feldenrkrais, Polarity Therapy, Myofascial Release, (and CranioSacral Therapy), is the palpatory virtuosity of each of its founders. That virtuosity, ideal in its source, is a core attribute each of these schools reflect in their adherents.

Rather than being founded in the conventional attitude toward palpation and perceptions about anatomy, these systems are founded in the premise of listening to the body with an awareness that generates integrating, balancing, releasing, unwinding, movement, gentleness, intuition, and a consciously affirmed individualistic and holistic spiritual connection.

This framework requires a deep commitment to pure perception, and the courage to work without the support of external validation from accepted models.

Western Aligned Manual Therapy

Moving more into the mainstream, we find schools that are anchored in the mechanistic, linear cause-and-effect model of modern collective thinking. Rather than being based in unique, virtuoso touch and courageous perception, Swedish Massage, Sports Massage, Neuromuscular Therapy (NMT), and Physical Therapy (PT) practice a reduced scope of palpation in which sensory and therapeutic expectations are entirely systematized.(5)

In the case of the popular Swedish Massage modality, which originated in the physical culture movement called European Physik and was practiced for its healing properties, it has been mainstreamed as a spa treatment. Due to this discursion from its clinically therapeutic nature, palpation is no longer as critical.

With regard to Sports Massage, NMT, and PT, while their therapeutic nature is still central, the purpose of palpatory discovery is in the techniques which test and measure symptomatic conditions. In these systems, the practitioner has many book-learned expectations about the body, and fundamentally requires the patient to “fit” into preconceived notions of acceptable disease and health states. Here the awareness is more “looking for,” than “listening to.”

World Medical Traditions

The healing arts developed prior to the age of industrial medicine do not depend on machine-based testing to diagnose conditions. Instead, they employ rich sets of palpation and observation techniques founded in the ability of the practitioner to draw information about the client using the physical and spiritual senses. Extending these techniques of palpation and observation, additional clinical skills include working directly with the Vital Force at a subtle level (presently considered Energy Work), using intuitional guidance, astrological charts, and forms of spiritual and ancestral divination.

Indian, Chinese, Tibetan, and Thai medicine (which currently enjoy growing influence in the West) are founded in a holistic understanding of the body in which biological existence is viewed as partaking of a cosmic existence, where multiple causes and effects occur in a web of interrelated phenomena.

The therapeutic context and intent is one of balancing bio-energy, its organ-system relationships, elemental relationships, past personal and ancestral karmas, and fundamental spiritual destiny. In addition to medical branches such as therapeutics, herbalism, and surgery, these traditions all have a major branch of therapeutic touch. In contrast, Western Medicine has stripped itself of its ancient practices, which once included palpatory and therapeutic touch, and replaced formerly holistic and unitary paradigms with an ultra-mechanistic and separative awareness.

In World Medical Traditions, the clinical techniques of palpation and therapeutic touch are grounded in a view of human anatomy and physiology that includes bio-energetic mappings such as marma points, meridian points, sen lines, and the chakra system. These maps redefine the human body of both practitioner and patient to allow for a greater participation in the healing process.

Palpation in Energy Work

Taking Energy Work as a separate category of “body work,” it is possible to enlarge the definition of palpation to include sensations obtained from expanded awareness.

In pure Energy Work modalities, such as Reiki or spiritual healing, the practitioner does not assess the condition of the patient through manual palpation, even when the hands are laid on. In this case, the practitioner “palpates” an energetic current which flows from its Source in the Divine.

Palpation of “divine” energy fields and currents can be extended to include the influence of a variety of conscious and non-conscious vibrations. Because all vibrations are forms of intelligent consciousness, it takes focus of the mind and attunement of the heart and a fully integrated sensory apparatus (the subtle body) to honestly and effectively navigate and utilize the spectrum of available intelligent energy.

The resonances of the Five Elements, helpers and guides, vibrations of other planets, crystal and gems, and herbal Deva presences all require one to “reach out and touch” across the subtle planes, in a way similar to our methods of gross physical palpation previously discussed.

Palpation in CranioSacral Therapy


Several preconditions ideally must be met for palpation skills to develop and mature in CranioSacral Therapy, where emphasis on mechanical techniques decreases over time, and focused therapeutic intent and “gestalt”(6) or “mandala”(7) awareness takes its predominant role over technical skill. Therefore, palpation initially understood in relation to expected conditions, becomes palpation in relation to an ever-expanding field of therapeutic awareness.

The first precondition is the willingness to suspend control, cynicism, judgment, and disbelief — and to tacitly allow and observe all perceptions — even if they are deemed unscientific, unreal, and even hallucinatory, by common standard.  

In addition to reducing dependency on rigid analytical thought, one must reduce visual dependency, letting the hands alone become the source of perception. From this position, one can extend one’s physical boundaries to “meld” with the client. In this melding, one allows the sensations of one’s own physical limits to “go to the background,” so that the minute details of sensation are allowed to flow unobstructed by mental rigidity and even ego (self-idea) so that one can accept what one experiences as valid.
Palpating the Craniosacral Rhythm

The craniosacral system originates in the ventricular system of the brain where cerebrospinal fluid is produced by the capillary-dense choroid plexii inside of the ventricles. This system is continuous with the central canal of the spinal cord down to the sacrococcygeal complex, and is sheathed in the dural membrane. The dural membrane provides connective tissue support, and contains the cerebrospinal fluid, providing a dynamic hydraulic environment. The cyclic nature of the system is due to the dynamic production and reabsorption of cerebrospinal fluid, which provides the fluid pressure and a concomitant transmission of motion throughout the body.

Taking the “pulse” of the craniosacral system is the initial clinical palpatory skill that students of CranioSacral Therapy must acquire, as this pulse is the gateway to the entire therapeutic system, which treats the craniosacral rhythm (CSR) with the same depth and respect Traditional Chinese Medicine and Ayurveda afford the cardiac pulse. These traditional physicians keenly observe multiple layers of physiologic, energetic, and elemental information through the cardiac pulse, palpated in as many as 12 different physical locations.

While Trauma specialists and Emergency Medical Technicians utilize more pulses than most other medical professionals (because the patient can be on the verge of death or dismembered, pulse location and pulse quality are critical), most nurses and doctors perfunctorily palpate the cardiac and respiratory rhythms and routinely note down their rates as if the only data gained from their sacred resonance is of an important, yet limited nature.

However, CranioSacral Therapy approaches pulse and rhythm as a dialog with consciousness itself; the quantum and symbolic dimension that underlies all physiologic appearances. The rhythm of the craniosacral system is palpable on most areas of the body, and for more advanced sensibilities, at times, off the body.

Palpating Flexion and Extension

In the physiologic dimension the cycling of the craniosacral system is perceptible as a range of motion, expressed as a wave, flowing between states of flexion and extension.

The flexion motion of the body, in response to the craniosacral system, is an external rotation of the feet, knees, pelvis, and shoulders along their coronal axes. The parietals turn subtly outward along their sagittal axes and the head may appear wider along with a general widening of the entire body.

In extension the reverse is true, where the craniosacral system promotes the inward turning of these landmarks and the body may appear thinner and longer. In addition there is caudal motion of the occiput which coincides with posterior and cephalad motion of the sacrum during flexion. In extension they reverse.

To the beginner, the flexion and extension movements are most easily palpated with the hands evaluating the plantar and dorsal surfaces of the feet, upper thighs, hips, ribs, shoulders and parietals, all with the client in the supine position. However, with experience, craniosacral rhythm can be palpated anywhere on the body.

Primarily, it is this range of motion which communicates to the therapist the state of the craniosacral system and its somatic relationships. Due to its subtle nature, an extremely light touch is required to palpate and follow the craniosacral rhythm and the motion it instills. Therefore, palpatory (and therapeutic) touch must be so unobtrusive it neither interferes with the system’s subtle wavelike motion, nor elicits any “guarding” contractions from the client’s tissue.

In CranioSacral Therapy, light touch is defined as the amount of force it takes to “raise a nickel with one finger” (approximately 5 grams), or comfortably press with a finger on one’s closed eyelid. From this non-invasive form of palpation expands the wealth of touch-types and attitudes variously described as “melding,” “listening,” “following,” “neutral,” and “sending energy.” Within these modes of touch (and therapeutic interaction) the therapist can dance; seamlessly moving from palpation of the craniosacral rhythm to palpation of tissue, its movement, and to therapeutic release.

Palpating Tissue Release

Along the elastic web of fascia, in which all structures, organs, vessels and nerves float, connected; movement travels in what could be called, a sacred geometry. This geometry is a constant motion of push and pull, waves and ripples, points and referrals.

A constant process of fascial accommodation allows the body to rebalance itself through various holding-patterns in which energy is redistributed and stored in contractions. While fascial accommodation is essential to redistribute stress within the system, accommodative restrictions affect tissue tonus, fluid circulation, and the ability of life force to flow.

While a plethora of known pathologies contribute to fascial restriction, an infinitely greater number of unknown causes make their imprint on the soma, either as the residue of daily life or the influence of acute and sustained traumas.

When the flow of life force has been compromised and tissue looses its integrity, it must often be coaxed into a release, so that it may readjust and be realigned by the inner wisdom of the body. CranioSacral Therapy provides both palpation and therapeutic touch(8) skills which encourage this to occur.

The skill of palpating tissue release is developed upon the foundation of light touch described above. The CranioSacral Therapist palpates the tissue as it releases, and applies therapeutic touch at the same time, staying focused on the tissue and following its movement until it reaches its final released state.

Just as a hand placed upon the ribcage moves up and down with the flow of the breath, a therapist’s hand that holds no agenda will be moved by the client’s tissue. Tissue movement may proceed longitudinally, transversely, or diagonally, or in whorls and eddies. With the central nervous system enshrined in fascia, consciousness itself thus presents its unlimited healing power to release restrictions which invest the tissue that surround it.

Virtuoso Touch Revisited

To further this discussion of palpation in CranioSacral Therapy, I leave my brief mention of anatomy and technique and return to the concept of virtuoso touch, the category into which I placed Dr. John Upledger and the school of CranioSacral Therapy which he founded.

When a therapist’s primary concern is technique their ability to repeat strategic manipulations upon the map-board of medical anatomy is critical. But I believe the heart of CranioSacral Therapy is founded in virtuosity, which I define as accomplishment that transcends skill, expressed within a personality that transcends reality.

For me the Zen koan “finger pointing to the moon” illustrates how skills and expectations must be left behind; the teacher’s finger pointing to the moon is only an illustration, in our case, of therapeutic intent. It’s not the realization of therapeutic intent itself.

Philosopher Alfred Korzybski’s said, “the map is not the territory,” which is a contemporary expression of the same point. Furthermore, through the mathematics of infinite regression, it has been demonstrated that, “the map is a map of a map of a map (ad infinitum).”(9)

So for a CranioSacral Therapist, the central question becomes, “how do I get out of the map of the map of the map, and have the complete realization (siddhi(10)) of therapeutic intent?” I believe the answer pointed to by Dr. John Upledger is to enlarge the map until the mind has to let go, and the siddhi can freely flow.

Kinematics and Development of Palpation Skills

Tissue states perceived through the norm of three-dimensional awareness appear in superior/inferior, posterior/anterior and superficial/deep planes. If one adds a small measure of pressure and heat sensitivity to the range of perception, we arrive at the general level-limit of palpation practice in most modalities.

However, palpation in CranioSacral Therapy enjoys a greater mapping into additional kinematic dimensions of time, dynamics(11) (cause), force(12), etc.

Consider this passage:

The introduction of the techniques of percussion and auscultation into medical practice immediately altered the relationship between physician and patient in a very significant way, specifically because these techniques relied almost entirely upon the physician listening. Not only did this greatly reduce the patient's capacity to observe and contribute to the process of diagnosis, it also meant that the patient was often instructed to stop talking, and remain silent.(13)

Therefore, we are called by the above observation to deeply question the impact even the simplest therapeutic techniques have on the entire process continuum. With this developmental perspective in mind, I suggest it is the depth of kinematics(14) experienced during the CST training process, which provides the greater awareness of tissue state, and results in expanded, multidimensional palpation skill.

The Impact of “Following the Tissue”

The accurate perception of tissue movement is fundamental to the understanding of CranioSacral Therapy. During training, by “following the tissue,” the student of CranioSacral Therapy is immediately placed beyond the limited three-dimensional awareness noted above by adding the element of time. Indeed, it is “craniosacral time” which so unitively strings together more points of perception, recognition, trust, allowing, presence, and listening, than are available through the practice of other therapeutic modalities.

As the student learns to follow the tissue they stretch their wings and fly into the melding of kinematic mystery and kinesthetic(15) wisdom, in a healing yoga of subtle beauty.

The Impact of “Following the Rhythm

Detection of the craniosacral rhythm (CSR) is fundamental to the practice of CranioSacral Therapy and during training, in carefully sequenced stages, students learn to tune into the CSR and monitor it at both predefined anatomical landmarks and therapeutically determined locations on the body by “following the rhythm.”

Rhythm(16) is another larger dimension through which CranioSacral Therapy redefines palpation. Rhythm represents the regular coming into being of points of focus. Pulse, or vibration, is the essence of a wave(17) or field(18), which according to mystical traditions including Hinduism (Shakta and Shaiva) is the form of consciousness itself(19).

The Impact of “Not Following”

Ceasing to follow the movement of tissue, and “being a barrier,” is a gentle and purposed technique of non-involvement. It consists of introducing the stillness in order to, allowing deeper strata of tissue to release. Motionlessness is the counterpoint, or pivot, upon which all motion rests. Perhaps learning “not following” during the training phase of CranioSacral Therapy allows the student to access the hidden dimension to all motion and rhythm.

My Personal Exploration of CST Palpation Concepts

Through CranioSacral Therapy I have come to know the unlimited inner healer; a “presence” and an energy source hidden in the heart of every medical tradition and therapeutic modality. In the natural world of our ancestors, thisprimal being was always visible, and therefore communion with it predates all human systems of healing.

Primal Healing – Laying on of Hands

While popular spirituality conjures up visions of indigenous healing by tribal shamans with magical herbal lore; sweat lodges and vision quests; and animal spirits and natural energies linked to the phases of the moon, these are only superficial cultural accoutrements.

I believe human touch is the actual basis for all healing, because long before healing materials or rituals appeared, the initial response to another person in pain, sickness, injury, or on their deathbed, was to gather as many compassionate people as could be found and encircle the sufferer with human touch. In desperate moments, if even water is unavailable, human touch alone can easily transmit profound Life Force power through the conscious focused intention for healing.

CranioSacral Therapy is a pure and open modality with which to explore the primal, unlimited healer, which responds fully to human touch and needs no external element, skill, or understood reality, for its efficaciousness.

Extending Palpation – “Laying Hands” on the Universe

CranioSacral Therapy utilizes extended palpation techniques that comprehend the non-physiognomic energetic structures of consciousness. One such technique is arcing, in which a therapist may use their hands to perceive the concentric arcs of energy signaling the presence of an energy cyst(20) pathogen in the patient. Another extended palpation technique is used in the resetting of vectors(21) and realignment of chakras(22).

During the segment of my training on arcing, I experimentally palpated numerous intersecting arcs from all the individual bodies in the room simultaneously, exploring their vertexes and arcs. I later spent the evening sitting in the sand on the beach, expanding my perception by using my hands to palpate arcs of energy radiating from life forms in the depths of the ocean. Taking this experience farther by removing all notions of limitation to the technique, I palpated planets in space. This experience confirmed for me what was stated by Patanjali(23), that spiritual concentration on the universe brings knowledge of objects hidden to the five senses. Today, it is from this perspective that I palpate my clients.


Advanced palpation skills are central to CranioSacral Therapy, which among the many modalities of the healing arts, provides an expanded conceptual framework and training system, in which palpation becomes an art, and through dissolving all preconceived barriers to awareness, perhaps becomes even a “yoga” in itself.

1 Online Etymological Dictionary, http://www.etymonline.com

2 ibid.

3 It is not within the scope of this essay to give a detailed explanation of the palpation techniques used in a medical examination or in special orthopedic testing.

4 For this essay, the scope of the term “therapeutic community” does not include the “medical community” who practice Western Medicine. Also, CranioSacral Therapy is omitted here because it is discussed below.

5 In these schools, palpating bioenergy, chakras, or cosmic energy for example, is not in scope.

6 “A physical, biological, psychological, or symbolic configuration or pattern of elements so unified as a whole that its properties cannot be derived from a simple summation of its parts. A physical, biological, psychological, or symbolic configuration or pattern of elements so unified as a whole that its properties cannot be derived from a simple summation of its parts.” http://dictionary.reference.com/browse/gestalt

7   “(in Jungian psychology) a symbol representing the effort to reunify the self.” http://dictionary.reference.com/search?r=2&q=mandala

8 The term “therapeutic touch,” has many meanings outside of the study of CranioSacral Therapy. I use it herein to indicate touch that is focused with therapeutic intent, and may include offering energy, or use any therapeutic touch techniques taught in CST.

9  http://en.wikipedia.org/wiki/Map-territory_relation

10  Siddhi is a Sanskrit term used in Hindu and Buddhist mysticism. See http://en.wikipedia.org/wiki/Siddhi.

11 http://www.rwc.uc.edu/koehler/biophys/2c.html

12 http://www.rwc.uc.edu/koehler/biophys/2f.html

13 http://en.wikipedia.org/wiki/Sign_%28medicine%29

14 Please see http://en.wikipedia.org/wiki/Kinematics and http://www.rwc.uc.edu/koehler/biophys/2a.html

15 http://en.wikipedia.org/wiki/Kinesthetic_learning

16 http://meditation24-7.com/page3/index.html

17 http://phyun5.ucr.edu/~wudka/Physics7/Notes_www/node64.html

18 http://en.wikipedia.org/wiki/Vector_field


20 Upledger, John E., CranioSacral Therapy II, Eastland Press, 1987. 212-213.

21 Upledger, John E., SomatoEmotional Release and Beyond, 1996. Chapter 3.

22 Upledger, John E., 1987. 229-230.

23  Patanjali. Yoga Sutras. 3.24

Saturday, January 24, 2009

Stillpoint: A Gentle CranioSacral Intervention

By Kailas, LMT, NCTMB, CST, Cert. Ayu. CranioSacral Therapist and Certified Ayurvedic Clinical Consultant in Los Angeles

A stillpoint is an observable, palpable, and measurable(1) physiological state in which the craniosacral rhythmic impulse (CRI) is temporarily suspended. In this state, apparently the production of craniosacral fluid ceases, and the active craniosacral rhythm, which is the natural force exerted by the system upon the rest of the body, also ceases. This allows the body to enter a state of deep rest and self-correcting activity, the results of which are the reduction of symptomatic conditions, and an increase in wellbeing.

Healing Through Self-Correction

The balance of the natural world depends on systems of self-correction, implying the existence of an innate order, the ability to influence or exert force toward an ordered outcome, and the ability to reorganize and resume shape after an influencing force has diminished or ceased.

Natural medicine honors the balance of the natural world and teaches that the body’s ability for self-correction is the foundation of health; the ultimate instrument of healing. For CranioSacral Therapy, this is also a core principal, and the stillpoint technique is one of several used that can access the profound power and intelligence of the body to heal itself.

In The Wisdom of the Body (1932), physiologist Walter Cannon first coined the term “homeostasis,” and defined the homeostatic model as a self-correcting system. He wrote, “In an open system, such as our bodies represent, compounded of unstable material and subjected continuously to disturbing conditions, constancy is itself evidence that agencies are acting or ready to act, to maintain this constancy.”(2)

Cannon’s concept of biological homeostasis was later expanded by systems theorist and founder of cybernetics, W. Ross Ashby, who provided for a greater understanding of both biological and mechanical “wholeness”.(3) In biology, a system is a group of organs that work together to perform a certain task,(4) but according to systems theory, a system is defined as a “set of interacting or interdependent entities, real or abstract, forming an integrated whole.(5)

From the standpoint of natural medicine and CranioSacral Therapy, it is perhaps the very wholeness of the systemitself, which is the agency of healing. This position alludes to abstract relationships such as consciousness, the physics(6) of order and chaos(7), symmetry, activity and rest(8), time and space, and the influence of spirituality.

Stillpoint: A Gentle Craniosacral Intervention

The efficacy of a system intervention in part depends on the value of the leverage point used. Systems theorist Donella Meadows defines leverage point as “An area within a complex system where a small shift in one thing can produce big changes in everything.” (Meadows, 1999)(9) Meadows also states “Leverage points are points of power.” (Meadows, 1999)

In CranioSacral Therapy, leverage is often used when employing manual techniques inherited from Cranial Osteopathy. Often, when working with inaccessible structures in the body, therapists target accessible structures which interact with deeper tissues and bones the therapist cannot directly affect.

Indirect techniques may also produce more subtle results because the physical force of the intervention is stepped-down, as illustrated by the example of hammering copper. Direct blows of the hammer produce a mark upon the soft surface of the metal. However, by striking a copper sheet through a tough pad, the copper can be shaped without hammer marks appearing on its surface.

The craniosacral system includes the cranial and spinal meningeal layers, the cerebrospinal fluid (CSF), and the ventricular system of the brain. Therefore a therapist must utilize leverage and indirection almost exclusively in order to access and modify it.

Craniosacral intervention can be considered in three aspects: functional, structural, and energetic. Functional intervention consists of modifying the craniosacral rhythm to produce slowing and temporary stoppage, or stillpoint. The release of restrictions(10) and lesions(11) comprise the aspect of structural intervention. Energetic intervention refers to directed energy and other techniques(12) often used to assist functional and structural intervention methods.

An intervention into the craniosacral system can produce therapeutic results on the structures and function of the system itself, as well as upon the physiological systems it effects, namely the nervous, musculoskeletal, vascular, lymphatic, endocrine, and respiratory systems.(13)  In the case of stillpoint intervention, the therapist must induce a temporary slowing or stoppage of the production of craniosacral fluid by the choroid plexii, a system of capillaries covered by a thin layer of ependymal cells which line the ventricular system of the brain and spinal column.

The choroid plexii secrete the clear saline CSF which drains through the ventricular system into the subarachnoid space between the pia mater covering the brain, and the arachnoid mater, a layer of cobweb like fibers beneath the dural sheath. The CSF acts as a nutritive lubricant suspending the brain and spinal cord within the dural sheath.

Approximately 500 ml/day of CSF is produced, and its pulsing movement throughout the craniosacral system has been documented through “encephalogram, myelogram, magnetic resonance imaging and intracranial and intraspinal pressure monitoring.”(14)

The CSF is also continually being resorbed into the bloodstream through the arachnoid granulations and superior sagittal sinus. The rate of resorption is slower than the rate of production, so to keep the total fluid volume from exceeding 135-150ml, CSF production is intermittent, giving naturally occurring periods of rest to the production system. The intermittent production of CSF changes the fluid pressure within the dural sheath, and it is this cyclical change in fluid pressure that is theorized to be the driving force of the craniosacral rhythm (CSR) which can be palpated anywhere on the body.

Intervention into the impulse for CSF production requires a subtle and sustained technique in order to coax the minute choroid plexii, hidden deep within the ventricles of the brain, to shut down. The technique bears the name “stillpoint,” after the profound state of quiescence experienced by the patient during an externally induced CSF production shutdown.

The end of stillpoint occurs after a period between several seconds to several minutes, when the plexii automatically restart CSF production. This restart may come about naturally due to their normal function being intermittent, and because of some homeostatic regulatory mechanism which regulates their function(15).

Leverage Points for Stillpoint Induction

A stillpoint can be induced from any point on the body. However powerful and effective leverage points where, “a small shift in one thing can produce big changes in everything" include the occiput, sacrum, and feet. Of these three sites of intervention, the occiput is noteworthy due to its proximity to the brain and ventricular system, and the occipital technique, called the CV-4, was specially developed for it by William Garner Sutherland.

The sacrum is noted for its location at the terminus of the craniosacral system, and the structural advantage given by its shape, which fits into the palm of the hand. The feet are noted due to the mechanical leverage they provide, and the ease with which the CSR is palpated through them.

The techniques of intervention at these three anatomical locations each utilize fully the musculoskeletal system, combining an osseous leverage with its associated ligamentous, fascial, and muscular mechanical links.

Stillpoint Induction Using the CV-4 Technique

The Occiput

The occipital bone is a rich point of power, with many anatomical and physiological relationships formed by both its internal and external surfaces. The basilar part articulates with the sphenoid, forming the synchondrosis called the sphenobasilar junction (SBJ).

The occiput articulates with the mastoid process of the temporal bone at the occipitomastoid suture, and also with the parietal bones at the lambdoidal suture, linking the intervention through the occiput to reciprocal motion with the other bones.

The dural sheath enclosed inferior medulla descends through the foramen magnum along with the vertebral artery, and becomes the spinal cord. The dural sheath is circumferentially attached at the foramen magnum, participating in motion-relay down the spinal column.

The jugular foramen between the jugular process of the occiput and the petrous portion of the temporal bone allows passage of the glossopharyngeal, vagus, and accessory nerves, as well as important veins and arteries.

On the inferior surface, anterior and lateral to the foramen magnum, the occipital condoyles articulate with the atlas, and by extension, the spine, through which the occiput moves in harmony with the sacrum in a gyroscopic(16) relationship. 

Its shallow, bowl-like shape cups the inferior posterior aspect of the cerebrum and the cerebellum. The inner surface of the squama houses the sulcii of the superior sagittal, occipital, and transverse sinuses which drain blood from the cranium. The cross-shaped ridge radiating out from the center of the internal occipital protuberance (IOP) form the attachment sites of the falx and tentorium cerebelli.

On the external posterior aspect of the occiput are attachment sites for layers of musculature, as well as the greater occipital nerve and occipital lymph nodes.

The occiput rotates around a transverse axis anterior to the foramen magnum. In flexion the basilar part moves anteriorly and superiorly, and in extension the basal part moves inferior and posteriorly.

From the standpoint of energetics, three acupuncture meridians cross this area, including GV 15, 16, and 17, GB 12, 19, and 20, and UB 9 and 10. Ayurvedic marmas simanta and krikatika are also in the occipital region. Additionally, the use of the two joined two thumbs provides a balanced and enhanced energy. The thumbs represent the element of fire (prithivi tattva) in Ayurveda and yoga.

A number of factors may cooperate to cause the CV-4 occipital stillpoint induction to be so effective. Dr. Sutherland believed the fourth ventricle and related cranial nerves structures were compressed by this technique. Dr. Upledger seems to prefer the idea that the occiput, due to its extensive accommodation of venous drainage and CSF, effectively promotes fluid exchange through the CV-4 intervention.

Also in the mix are the cerebellum and its tentorium, located between the occiput and fourth ventricle, which may be influenced in a subtle way. Additionally, the quantity of meridian and marma energy points on the exterior of the occiput could increase the effect which the CV-4 technique has in inducing a profound and therapeutic stillpoint.

The Technique

To perform a CV-4 you will use a two-handed position which provides support for you and your client. It affords comfort and the correct angle for the technique. With both of your hands palms-up before you, let your fingers relax with a natural slight curl.

Place one of your hands, palm-up, into the palm of your other hand so that the fingers cross at an angle, forming a little cup where one could carry water. In the CV-4, you can imagine the CSF as being a “water of life,” or the “amrita of consciousness” described in the yoga tradition.

Then bring both of your thumbs to touch at the centerline of your cupped hands, so they form a little “V” shape. This is the “CV-4 mudra.”

With your client lying supine on a treatment table, position yourself comfortably at the head-end. You can easily form the hand position very gracefully during treatment. Place your hands palms-down beside the client’s head, and in one simple motion, supinate your hands as you slide your fingers beneath their neck. Then push your thumbs forward to touch and make the “V” shape. Check to make sure the tips of your thumbs are at the level of C2 or C3, and your thenar eminences support the squama of the occiput without covering the occipitomastoid sutures. You want to be able to palpate the widening and narrowing of the occiput during the flexion and extension phases of the CSR.

To perform the stillpoint induction, intend for your hands be stabilized on the table and completely melded with your client’s body. From a peaceful, neutral position, acknowledge the craniosacral rhythm, and begin to palpate its motion as the occiput widens in flexion, and narrows in extension.

Follow the narrowing during extension to the neutral phase of the CSR and then set the intention for your hands to become a barrier to the flexion motion of the occiput. Gently resist the as it attempts to widen, but do not apply “squeezing” pressure. Simply offer gentle, supportive resistance.

At this point you may find the CSR accommodates your barrier, and it will narrow and then widen again. Follow the narrowing of the occiput and repeat your barrier at the end of the extension phase. Continue to follow these smaller and smaller extension-flexion movements until you feel them stop, and the stillpoint has occurred.

While your client is in stillpoint, which may be from a few seconds to a few minutes, you should remain centered and in a neutral, supportive frame of mind. Remember that you are blended with your client. If you are the type of person whose mind is naturally meditative, you can practice spiritual awareness. However, if your mind is naturally not very still, I suggest that you engage your thoughts and intentions by tuning into the stillpoint, into the client’s fourth ventricle, cranial dura, and CSF. That can give you therapeutic insight into what is going on within their body. Take time to honor your client, the inner physician, yourself; and to drift into your own sensation of neutral good.

When you feel the occiput attempt to widen, the stillpoint is complete. With your hands still in position, release the barrier and remain supporting your client’s head, while you palpate the amplitude of the CSR, compare your “before and after” readings. At this point you may feel the direction from the client to perform a deeper stillpoint induction. This does occur, and stillpoints may be induced serially.

When you are ready, release your CV-4 hand position by pulling them out from beneath the client’s head in a flowing “dissolving” motion. Note whether your client’s state, and whether you are called to another therapeutic location, or if they need silence or perhaps a gentle acknowledgement to help them reorient. 

Stillpoint Induction Using the Sacrum

The Sacrum

Many ancient cultures (Indian, Mesoamerican, Greek, Roman, Egyptian, Hebrew, Arabian) considered this as a sacred bone with spiritual and energetic functions (regenerative, rejuvenative, procreative and with rebirth after death) (17). Evidence from Precolumbian Mesoamerica is over 18,000 years old. The Indian tradition of yoga is another ancient example which remains popular today, in which the sacrum is revered as the physical seat of the Kundalini energy, and the locus of the muladhara chakra, which simultaneously represents the vibration of the earth and the seat of the five elements.

The sacrum is formed of five fused vertebral segments. It is an approximately triangular bone that curves on itself, with its apex directed inferiorly where it articulates with the coccyx at the sacrococcygeal symphysis.  Superiorly, it has a lipped promontory at its base which articulates with the fifth lumbar vertebra. Bilaterally, it articulates broadly with the illia of the pelvis at the sacroiliac joints.

The cauda equina enters the sacrum through the sacral canal and the dural tube attaches anteriorly at the second sacral segment before the sacral nerves exit bilaterally through foramina. Fibers from the dural tube blend with connective tissues on the sacrum, sacral ligaments, and the coccyx. The attachment of the dural tube at S2 is the osseous link providing continuity of transport for the forces of craniosacral motion. It also forms the caudal leverage point for therapeutic traction of the dura.

The sacrum is a weight bearing and balancing fulcrum, a position reinforced by extensive connective tissue and the numerous attachment and insertion sites for muscles including illiacus, piriformis, gluteus maximus, multifidus, sacrococcygeus, coccygeus, and the sacrotuberous and anterior longitudinal ligament.

Its anterioposterior nodding motion is nutation and counter-nutation, sacral flexion and extension. This sacred bone also moves in synchrony with the occiput, often mirroring lesional forces.

The Technique

There are two simple positions which facilitate easy access to the sacrum for this technique of stillpoint induction. Choice of which will depend on your experience and comfort, or any other therapeutic considerations. In either position, you will begin by palpating the CSR. If your evaluation reveals a reduced quality or amplitude in the CSR, consider releasing any lumbosacral or sacroiliac compression first, and then re-evaluate the CSR at the sacrum before you induce the stillpoint.

The sacrum fits vertically in the palm of the hand, a position which affords the greatest amount of contact for palpation. For this position, you will place your hand palm up under the sacrum from between the client’s legs. It’s a good idea to ask permission before you do this, by simply telling them you are going to put your hand under their sacrum and saying, “is that OK?” Once you gently slide your palm beneath the sacrum, lean on your elbow and support your body so that you are comfortable. This position is similar to the one used for L5-S1 decompression.

If you prefer to access the sacrum from the side, sit beside the treatment table at the level of the client’s abdomen and gently slide your hand under their lumbosacral area and position your hand, palm up, beneath the sacrum. This position is similar to the one used for the dural tube rock and glide.

Inducing the stillpoint is the same as described above, with the difference being the motion of the sacrum is anterioposterior, rather than bilateral. Because of the distance between the sacrum and the choroid plexii of the brain’s ventricular system, the induction may require a little more skill.

Stillpoint Induction Using the Feet

The Feet

At the farthest distal location from the choroid plexii, rest the feet. From this leverage point, the entire body can be utilized to transmit the therapeutic measure of resistance to craniosacral flexion which will induce the stillpoint.

Generally speaking, the osseous leverage consists of the bones of the feet and legs, with their articulations at the pelvis and sacrum, which through its connection to the vertebral column, is involved with the occiput. Along these structures, the extensive ligamentous, fascial, and muscular leverage relays the induction technique cephalad. Subtly involved also, is the hydraulic pressure of blood, lymph, and CSF. These pathways provide a cohesively blended avenue to affect the CRI in the ventricles of the brain.

The Technique

Take a position at your client’s feet and with a gentle scooping motion, bring your fingers posteriorly around their ankles, settling the heels comfortably in the palms of your hands. This position is the same one taken for the first listening station in the ten-step protocol.

From this placement one can easily palpate the CSR as the client’s entire body externally rotates in the flexion phase, and internally rotates in the extension phase. As is well known by massage therapists, a supine client will generally relax immediately when their feet are held supportively in this way. This makes the feet an excellent position to induce a stillpoint from if your client is in pain, or a child who has not gotten used to you yet.

Inducing the stillpoint is the same as described above, with the difference being the motion of the feet is mediolateral as with the occiput.

Clinical Use of the Stillpoint Technique

Stillpoint induction is a gentle craniosacral intervention which can be utilized for its excellent, broad therapeutic effect. This intervention can also be used to address a specific lesion. During a stillpoint, the therapist can monitor any specific lesion or condition to assess whether a release has taken place.


Stillpoint is contraindicated in acute stroke, cerebral aneurysm, or any condition in which changes in cranial fluid pressure would be detrimental. In non-acute brain injury, tumor, or any uncertain condition a CranioSacral Therapist should consult the client’s physician.


Stillpoint is routinely indicated during general CranioSacral Therapy, within the Ten Step Protocol, or may even occur spontaneously. Stillpoint reduces sympathetic nervous tone and promotes fluid exchange in the brain and spinal column, as well as throughout the body. Its effect is therefore deeply relaxing.

Stillpoint has been clinically demonstrated to reduce stress, hypertension, anxiety, and chronic pain, fever, Down syndrome, rheumatoid arthritis and other conditions as part of a CranioSacral Therapy treatment session or program. It has anti-inflammatory effects, and promotes a recovery impulse in the immune system, demonstrating a reduction in symptoms a few hours after induction.

For muscle and connective tissue hypertonus, stillpoint is effective in releasing restrictions, providing balance, and relieving pain. Combined with SomatoEmotional Release techniques, a stillpoint may also be used during spontaneous clearing of emotional trauma, by helping clients recall forgotten wounds.

Conclusion: The Point of Power

When the craniosacral rhythm has come to a point of stillness, ceasing to exert itself on the multitude of physiological systems it touches, the question remains – how does healing really take place?

What is it about the cessation of the production of CSF – that triggers the self-correcting process?

Isn’t inducing a stillpoint much like rocking a child to sleep?

In the example above, when a parent rocks their child to sleep, the infant enters a different state of consciousness, described in the Upanishads as going from the waking state (jāgrat) to the dreaming state (svapna), and then to dreamless sleep (suṣupti).

As in sleep, the brainwaves change. Stillpoint brings the dominance of theta waves, which suit the mind to meditation. One could ask, is it the brainwaves that are changing the physiological systems, or the physiological systems changing the brainwaves?

Perhaps in the very act of coaxing the client’s craniosacral system into the state of consciousness of stillpoint, a deep existential trust unfolds, which is the real factor that induces the healing.  

I believe that what happens in that state of consciousness is the reality we are honoring –and that is the true point of power.

1 Ibid., at 285. and http://www.massagetoday.com/mpacms/mt/article.php?id=10837 for brainwaves.

2 Canon (1939) quoted in Ashby, W. (1960, p.64). Design for a Brain: The Origin of Adaptive Behaviour.

Chapman and Hall, London, second edition.

4 http://www.cogs.susx.ac.uk/users/jonba/homeostat/homeostat.pdf

4 http://en.wikipedia.org/wiki/Biological_system

5 http://en.wikipedia.org/wiki/System

6 http://en.wikipedia.org/wiki/Golden_ratio and http://www.goldenmean.info/stillpoint

7 http://en.wikipedia.org/wiki/Chaos

8 http://en.wikipedia.org/wiki/Rest_%28physics%29

9 http://integralvisioning.org/article.php?story=wp-12leverages and http://en.wikipedia.org/wiki/Donella_Meadows

10 Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983. 19.

11 Ibid., at 23.

12 Ibid., at 74.

13 Ibid., at 5-6.

14 University of British Columbia, Office of Health Technology Assessment. A Systematic Review and Critical

Appraisal of the Scientific Evidence on Craniosacral Therapy. 1999. Page 22.

15 See number 1, and footnote, page 12. Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983.

16 Oyao, Don A, MA, DC, ND, M.Sp.Chiro.Sci. The Gyroscopic Motion of the Sacrum during a Gait Cycle. Chiroweb: http://www.chiroweb.com/mpacms/dc/article.php?id=37500

17 http://research.famsi.org/aztlan/uploads/papers/stross-sacrum.pdf

Thursday, January 8, 2009

The Clinical Applications of CranioSacral Therapy

By Kailas, LMT, NCTMB, CST, Cert. Ayu. CranioSacral Therapist and Certified Ayurvedic Clinical Consultant in Los Angeles

The Clinical Applications of CranioSacral Therapy

CranioSacral Therapy encourages the body’s natural healing process through the use of a gentle touch and very light pressure. The craniosacral system includes our brain, spinal cord, nerves, and the cerebrospinal fluid surrounding them. When the craniosacral system is supported through this gentle form of bodywork, the body’s natural healing power is recharged, and patients experience a wide range of health benefits.

For over 35 years, thousands of practitioners world-wide have demonstrated CranioSacral Therapy to have many clinical applications, and the practice of CranioSacral Therapy has evolved into an integrated and highly respected form of therapy. Medical doctors, osteopaths, chiropractors, occupational and physical therapists, nurses, acupuncturists, massage therapists, dentists, and family caregivers have trained in CranioSacral Therapy.

The founder, Dr. John Upledger, DO, OMM, has always believed that this simple, non-invasive, therapeutic technique should be available to everyone, and not “owned” by any single profession. He has worked to ensure that CranioSacral Therapy is taught with an attitude of openness to all clinical applications and with respect for each of the healing arts.

Patient-Centered Care

CranioSacral Therapy does not evaluate patients through preconceived models and expected outcomes. Each patient, regardless of age or ability, is considered the true master of their therapeutic process, and responsiveness to their needs energizes and guides the therapy.

Clinical Trials vs. Clinical Outcome

The clinical framework of CranioSacral Therapy is that “nothing is impossible.” Dr. Upledger states unequivocally that “the clinical outcome of a given patient is the only true evaluative process.” (1) CranioSacral Therapy is more focused on providing care, than justifying that care through double-blind studies which often provide the answer that, “naturally-based healing is impossible”.

In many challenging health situations, CranioSacral Therapy has counteracted the despair of patients which is often the result of the medical system that offers little hope for many types of cases and conditions, and misdiagnoses or provides overly-complex diagnoses and treatments as a matter of routine.

The Ten Step Protocol

CranioSacral Therapy provides a protocol for evaluation and treatment which addresses 90% of craniosacral system dysfunctions. This Ten Step Protocol is non-invasive and based in light touch, and cannot not harm a patient when practiced as directed. The Ten Step Protocol was developed through years of clinical experience and research by Dr. John Upledger, DO, OMM. It can be applied in almost any clinical situation with positive results.

In keeping with the vision of CranioSacral Therapy, the Ten Step Protocol can be practiced by anyone who receives training. It does not require the practitioner to have an extensive background in anatomy and physiology in order to be effective. The Ten Step Protocol is effective in most cases due to its ability to support the body’s own natural healing ability. It only requires the practitioner to perform the protocol with a sensitive hand, guided by the responses which the patient’s body makes.(2)

Clinical Techniques

The clinical techniques which make up the Ten Step Protocol are: palpation of craniosacral rhythm, transverse diaphragm release, lumbosacral and sacroiliac release; atlanto-occipital release, occipital cranial base release, frontal lift, parietal lift, sphenoid compression-decompression; compression-decompression of the temporomandibular joint, still point and CV-4; dural tube traction, rock and glide; therapeutic pulse, and direction of energy and V-spread.

Additional CranioSacral Therapy techniques can be performed in concert with the Ten Step Protocol, or on their own, in any sequence. These are: whole body evaluation (arcing, facilitated segment, fascial glide); hard palate, facial, and cranial bone lesion releases; significance detector, positional release, energy cyst release, therapeutic dialog and imagery, vectors, acupuncture meridian unwinding, chakra balancing, dolphin/aquatic therapy and SomatoEmotional Release.

While most of the techniques are listed above, CranioSacral Therapy is an unlimited modality. The beauty is however, that the majority of the principal clinical effects can be obtained through the gentle therapeutic action of the Ten Step Protocol.

General Clinical Effects

The clinical effects of CranioSacral Therapy are outlined below, indicating the natural progression of effects as they lead toward greater health and wellbeing.

1. Soft Tissue Release

CranioSacral Therapy promotes the relaxation and release of restrictions and held patterns in the soft tissues including the fascia and muscle tissue, diaphragms of the pelvis and thorax, organs and their membranes, nerves, glands, lymphatic and circulatory tissue, and the spinal and cranial dura and related membranes.

Relaxation of the soft tissue involves their cellular and electrochemical networks, vasculature, lymphatics, and extra-cellular fluids, allowing the entire myofascial structure to decompress and regain functional symmetry, releasing energy on all levels, and affecting all systems of the body.

2. Structural Decompression

CranioSacral Therapy promotes the decompression of musculoskeletal structures, including joints, symphyses, synchondroses, sutures, and foramena. Decompression reduces articular surface and intervertebral disc irritation and degradation; pain, including referred pain; nerve entrapment; and structural musculoskeletal distortions which the body must accommodate, and which can themselves be causes of additional dysfunction.

Decompression of the jugular and other cranial foramena, and the vertebrae, is directly addressed through CranioSacral Therapy. The cranial nerves, especially the trigeminal and vagus, produce significant dysfunction throughout the body when they have been impinged and burdened by dysfunctions of the membranes and bones of the cranium, including profound physical, emotional, and developmental problems.

3. Structural Mobilization

CranioSacral Therapy promotes the mobilization of joints, neuromuscular, and organ structures, improving their balance and functional symmetry. Mobilization brings freedom to the body, enhances reciprocal enervation, stimulates the nervous and endocrine systems, and stimulates the body’s needs, affecting metabolism. “Motion is health. Need I Say More?” Dr. Upledger has succinctly stated.

4. Fluid Exchange

CranioSacral Therapy promotes fluid exchange among numerous physiological systems. In fact, if a therapist could choose only one physiological effect resulting from a therapy session, it would be to, “move the fluid, move the fluid, move the fluid!”

Fluid exchange distributes nutrients, antibodies, and flushes waste. It lubricates tissue, contributing to muscle fiber length and strength, and decreasing tissue strain. Vascular and lymphatic flow, temperature regulation, electrolyte distribution, nervous system function, and cellular integrity are all enhanced.

CranioSacral Therapy specifically enhances the circulation of cerebrospinal fluid (CSF), and facilitates the movement of the body in synchrony with the craniosacral rhythm. CSF has been shown to carry small molecule chelating agents, removing toxic heavy metals from the central nervous system and preventing deterioration of the basal ganglia and cortical and subcortical regions of the brain.

5. Energy Exchange

CranioSacral Therapy promotes energy exchange across quantum, microscopic, and macroscopic levels, and involves numerous biological systems including the psychological and developmental domains of a patient. The spiritual-energetic domain, if and how a patient defines it, can fully participate in the expanded energy exchange as well.

The energy exchange produced by CranioSacral Therapy is a readily observable, common experience for a majority of therapists and patients. Energy is perceived through movement and sensation in the body, release of heat, pulsing sensations, breathing, sounds and expressions. The energy exchange produced by CranioSacral Therapy treatment has also been observed scientifically using electromagnetic measurement, biofeedback and brainwave measurement; and has been tested through the application of acupuncture techniques, kirilian photography, and other methods.

But the most important exchange of energy attributed to CranioSacral Therapy is the restoration of hope, and the progress patients make in their lives.

6. SomatoEmotional Release

CranioSacral Therapy promotes the release of emotional energy which has been mirrored and retained in our bodies – our somato-emotional memory – through a process called SomatoEmotional Release, which may be initiated by a patient at any time during a session.

Through therapeutic dialog and imagery techniques, including accessing the Inner Physician, guides, and the voices of organs, cells, and other parts of the body, emotional memories can be brought to the surface, and their often painful charge and associated dis-ease states can be dissipated.

Problems of a chronically recurring nature, and the feelings which reduce the body’s ability to heal, such as hopelessness and helplessness, frustration, fear, anxiety, apathy, grief, betrayal, and traumatic incidents, are often resolved through SomatoEmotional Release.

General Clinical Application Types

The clinical applications of CranioSacral Therapy may vary according to the types of clinical practice required in a given population, and the conceptual framework within which clinical care is given. The categories listed below represent a few general areas which I believe are representative of the success which CranioSacral Therapy practice enjoys today.

Pain Management and Recovery

CranioSacral Therapy is effective in reducing and eliminating chronic pain in a wide spectrum of conditions, and often correcting the underlying dysfunction(4). Its therapeutic effects on the nervous system reduce chronic sympathetic irritation by balancing the reticular formation5 (reticular alarm system) and by reducing facilitated spinal segments. The generally decompressive action of CranioSacral Therapy alleviates nerve pain, referred pain, and inflammatory pain.

CranioSacral Therapy can prevent the need for invasive surgical interventions and the over-reliance on pharmaceuticals. It can be also used post-surgery to normalize traumatized tissue, promote fluid exchange, and release toxic anesthetics from the nervous system. It is effective in helping patients get remobilized after a sustained health crisis or injury.

The CV-4 technique is utilized in pain management and can be combined with direction of energy techniques and positional release. The CV-4 technique induces craniosacral stillpoint, and may affect the reticular formation due to the proximity of the reticular formation and the fourth ventricle.

SomatoEmotional Release enhances the effectiveness of pain management by treating the underlying emotional and experiential causes of pain and chronicity, and can be utilized to decrease emotional co-morbidities.

Stress and Traumatic Stress

CranioSacral Therapy effectively reduces stress and anxiety through tissue relaxation and release, lowering blood pressure, improving sleep rest, and reducing sympathetic hypertonus and irritability.

Electroencephalography (EEG) readings demonstrate that, during craniosacral stillpoint, theta wave rhythms in the brain increase, producing a mental state of calm passive awareness(6), which is indicative of a reduction in sympathetic nervous system activity(7). This most probably includes reduced activity in the reticular formation (reticular alarm system), which has outputs to the entire central nervous system, plays a critical role in muscle control, deep tendon reflexes, spasticity, and produces cortisol , “the stress hormone”(9).

Traumatic stress, including both the emotional and the somatic components, can be treated in CranioSacral Therapy through the SomatoEmotional Release process. CranioSacral Therapy has shown that, in physical or emotional trauma, energy impacts and is absorbed into the body. If the body cannot readily defuse the energy, it quarantines the harmful impact in an Energy Cyst, which, like any other toxic lump that the body can’t eliminate, may eventually cause dysfunction and disease.

It should be noted that CranioSacral Therapy and SomatoEmotional Release have been clinically successful in cases of Post Traumatic Stress Disorder (PTSD) and many other traumatic stress conditions.

Immune System Revitalization

CranioSacral Therapy provides immune system support and revitalization. The burden on our immune systems includes constant daily stress; pain, bodily accommodations, and pain suppression; toxic waste, chemicals, emotions and ideas; and the stress of enduring our immersion in a vast cultural dynamic of enforced ignorance about the nature of immunity, healing, and health. It’s no wonder our immune systems are confused!

However, the immune system can be generally revitalized through the release of soft tissues and diaphragms, which improves lymphatic function, circulation, digestion, elimination, and organ function. Exchange of fluids and the resulting detoxification of tissues and organs can reduce the sensitivity to allergens.

Furthermore, release of the craniosacral system including activating and balancing the ventricular system of the brain, balancing the activity of the reticular formation, and energizing the thymus gland can contribute to more efficient immune response.

In the brain the reticular formation secretes cortisol, which suppresses the immune system(10). Balancing the reticular formation can be achieved through a CV-4 induced craniosacral stillpoint, direction of energy, therapeutic dialog or SomatoEmotional Release, resulting in decreased cortisol secretion.

A craniosacral stillpoint also improves the production and circulation of craniosacral fluid, which carries antibodies and flushes toxins from the central nervous system, improving the overall function of the central nervous system. Craniosacral stillpoint has been shown to influence the immune response by reducing acute inflammation, fever, and infection.

Therapeutic dialog and SomatoEmotional Release can increase a patient’s awareness of their immune response, and engage the body’s natural ability to heal itself. This natural intelligence is the cornerstone of wellness and the reversal of the disease process.

Physical Therapy and Rehabilitation

The integration of CranioSacral Therapy with Physical Therapy and other rehabilitation modalities is extremely successful in clinical practice. CranioSacral Therapy provides an eclectic, non-deterministic and non-mechanistic approach to musculoskeletal mobilization, and has excellent therapeutic techniques such as SomatoEmotional Release, direction of energy, and arcing for energy cysts, which assist a patient to resolve any emotional traumas and energetic issues which may underlie their condition. In addition, CranioSacral Therapy empowers patients by supporting their body’s natural power to heal, assists with pain management, reduces the need for often toxic medications, and helps prevent the need for invasive surgery.

Obstetric and Pediatric Care
Utilizing CranioSacral Therapy in obstetric care is an excellent method of preventive healthcare. During pregnancy, soft tissue release, lumbosacral decompression, and increased fluid exchange balance the mother’s body, and help prepare it for the birth process.

For the newborn, a gentle CranioSacral treatment just after birth can ensure correct functioning of the craniosacral system and prevent a broad spectrum of dysfunctions. It can also clear obstetrically induced traumas such as vacuum or forceps induced cranial compression, and meningeal strain which can occur during the sudden pressure drop that takes place during a cesarean birth. Induction of the sucking reflex and prevention of colic are a few basic ways the newborn can be eased of initial difficulty and dysfunction.


CranioSacral Therapy enhances dental care by providing techniques that ensure a dental patient’s craniosacral system remains balanced and that dysfunctions are not introduced into the craniosacral system as a result of orthodontic appliances, which often restrict maxillary movement(11). CranioSacral Therapy has a full range of techniques for the hard palate; release and mobilization of teeth, which encourages their natural positioning; and release of soft tissues in and around the oral cavity, including the hyoid.

Before dental work is performed, the craniosacral system can be balanced and any tension in the gums and teeth released, ensuring dental or orthodontic work is placed upon previously balanced structures. Then, after dental or orthodontic work is complete, especially following the removal of appliances, CranioSacral Therapy can be utilized to restore balance to the patient’s mouth, hard palate, temporomandibular joints, and cervical soft tissues.


CranioSacral Therapy has had a longstanding integration with acupuncture. Both practices are mutually supportive, specifically: acupuncture assists the CranioSacral Therapist by providing pain control, and CranioSacral Therapy assists the acupuncturist by providing their clients with the experience of deeply integrated relaxation techniques, soft tissue release over acupuncture points, and meridian unwinding, which increases the overall flow of Qi within the body.

Other Categories of Care

There are many clinical applications for CranioSacral Therapy. In addition to the categories elaborated on above, I would like to mention a few more including, chiropractic(12), therapeutic massage and bodywork, ophthalmology, otology, sports medicine, hospice, elder care, addiction recovery, and veterinary medicine.

General Clinical Indications

Below is a selection of indications representing common clinical situations in which CranioSacral Therapy has been shown effective. Note: acute conditions require medical care, and physicians should be consulted if there is any doubt about treatment. Referral to an advanced CranioSacral Therapist is also recommended in cases of doubt or risk. 

  • Acquired Immune Deficiency Syndrome (AIDS)
  • Alzheimer’s disease
  • Anxiety and panic attacks
  • Appendectomy
  • Arachnoiditis
  • Arthritis, Rheumatoid Arthritis (RA), Osteoarthritis (OA)
  • Asthma
  • Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD)
  • Autism Spectrum Disorder (ASD) including Asberger Syndrome
  • Bells Palsy
  • Blackouts and fainting spells
  • Breast cancer (post mastectomy)
  • Bruxism
  • Cancer
  • Carpal Tunnel Syndrome
  • Cauda Equina Syndrome
  • Cerebral Palsy
  • Cesarean birth
  • Childbirth
  • Chronic Fatigue Syndrome (CFS)
  • Chronic infections
  • Coccygeal pain
  • Compressed vertebrae
  • Cranial bone and meningeal membrane lesions
  • Degenerative brain disease (Alzheimer’s, Parkinson’s, and senile dementia)
  • Depression (and endogenous idiopathic depression)
  • Digestive issues and bloating
  • Dyslexia (can be of occulomotor or nervous etiology)
  • Dysmenorrhea
  • Earache
  • Edema
  • Emphysema
  • Endometriosis
  • Fibroids
  • Fibromyalgia
  • Forceps birth
  • Headaches (and migraines)
  • Head injury
  • Heart disease (HBP, and atrial fibrillation)
  • Herniated vertebral discs
  • Hip replacement surgery
  • Hysterectomy
  • Gastroesophageal Reflux Disease (GERD, acid reflux, heartburn)
  • Infant colic and feeding problems
  • Kyphosis
  • Limb length differences
  • Lordosis
  • Lymphatic stagnation
  • Memory loss
  • Menstrual cramps
  • Neck pain
  • Nerve Entrapment (including sciatica) and irritation (including carpal tunnel syndrome)
  • Neuralgia
  • Neuresthesia (including paresthesia such as in TOS)
  • Occlusion (bite) issues
  • Osteoporosis
  • Ovarian cysts
  • Paralysis
  • Parkinson’s disease
  • Post surgical recovery
  • Post Traumatic Stress Disorder
  • Pregnancy (can be used in all phases)
  • Prostate problems and repairs
  • Rotator cuff injury (and other shoulder and arm soft tissue dysfunction)
  • Sacral concussion
  • Sciatica
  • Seatbelt injury
  • Seizures
  • Seizures
  • Sleep disorders (including apnea and insomnia)
  • Spasticity
  • Speech problems
  • Spinal stenosis
  • Spondylolisthesis
  • Spondylosis
  • Strabismus
  • Strains and sprains and dislocations (recovery)
  • Stress
  • Stroke (post-stroke syndromes)
  • Subluxations (can be used by a chiropractor to normalize soft tissue)
  • Sympathetic nervous system hypertonus (reticular alarm system)
  • Temporomandibular joint dysfunction (TMJD)
  • Tendonitis
  • Tenosynovitis
  • Thoracic Outlet Syndrome (TOS)
  • Thyroid problems
  • Tinnitus
  • Torticollis (and cervical muscle dysfunction)
  • Trauma and traumatic stress
  • Tumors
  • Urogential issues
  • Vacuum extraction birth
  • Vertigo
  • Vertebral fusion or vertebral implantation surgery
  • Whiplash injury

Contraindications for CranioSacral Therapy

CranioSacral Therapy has few contraindications. However, these must be observed:

  • Recent brain hemorrhage, stroke, cerebral aneurism, or brain injury or tumor (Obtain permission of the client’s physician. They should verify there is no more bleeding, and it’s safe to go ahead)
  • Recent spinal tap. (Obtain permission of the client’s physician. They should verify there is no more leaking of cerebrospinal fluid)
  • Arnold Chiari Malformation - incomplete foramen magnum. (Obtain permission of the client’s physician. Use the lightest pressure possible, and place no inferior strain on the dural tube. Avoid OCB, inferior traction)
  • Downs Syndrome, Rheumatoid Arthritis (Any situation where ligaments and soft tissues are compromised should be treated with extreme care, and no OCB platform should be undertaken)


1 Upledger, DO, OMM., John. Addressing the Skeptics, Part II. Massage Today, Vol. 4, Issue 2 at: http://www.massagetoday.com/mpacms/mt/article.php?id=10877

2 Upledger, DO, OMM., John. CranioSacral Therapy: Who Shall Do It?. Massage Today, Vol. 4, Issue 5 at: http://www.massagetoday.com/mpacms/mt/article.php?id=10925

3 Towards the Prolongation of a Healthy Life Span, New York Academy of Science Annals, Volume 854. Cited: http://www.massagetoday.com/mpacms/mt/article.php?id=10426 and http://www.massagetoday.com/mpacms/mt/article.php?id=10962

4 It should be noted that Allopathy has cures for only 10% of known diseases. In the clinical experience of many CranioSacral Therapists and their clients, it has been shown that CranioSacral Therapy resolves the underlying causes of dysfunction more than 10% of the time.

5 See: Atlas of Functional Neuroanatomy. Hendelman, Walter. CRC Press, 2006.

6 Upledger, DO, OMM, John. CranioSacral Therapy Alters Brain Functioning: A Clinical Overview. Massage Today, Vol. 03, Num. 12. at: http://www.massagetoday.com/mpacms/mt/article.php?id=10837.

7 Austin, James H. Zen-Brain Reflections. MIT Press. 2006. Page 52.

8 Atlas of Functional Neuroanatomy. Hendelman, Walter. CRC Press, 2006. Page 116.

9 http://en.wikipedia.org/wiki/Cortisol and http://ptsd.about.com/od/ptsdandyourhealth/a/breastcancer.htm

10 http://en.wikipedia.org/wiki/Cortisol

11 Upledger, DO, OMM., John. TMJ: Primary Problem, or Tip of the Iceberg? Massage Today, Vol. 2, Num. 8. At:


See: Upledger, D.C., Lisa. CranioSacral Therapy Releases Hold on Subluxations. Vol. 27. Num. 13. At: http://www.theamericanchiropractor.com/articledetail.asp?articleid=492&category=3