The vertically-oriented pathways of soft tissue running head-to-toe become easily congested at five horizontal “floors,” just as a normally efficient office building elevator is slowed when crowds enter or exit at every stop.
These five transverse layers of connective tissue and bone are called the transverse diaphragms in CranioSacral Therapy. A diaphragm is a dam made of a membrane or flexible layer that closes one space from another, and from the anatomical perspective, there are three major fascial diaphragms: the respiratory, urogenital and pelvic.
CranioSacral Therapy considers the pelvic diaphragm to contain the urogenital diaphragm since they are one functional region.
In addition to the respiratory and pelvic, there are three other horizontal arrangements which act as diaphragms. These are the thoracic inlet which consists of the tissue and bone between the clavicles and acromion process of the scapula, the tissue invested around the hyoid bone, and the tissue at the occipital cranial base.
It is important to understand that these “diaphragms” are complex combinations of connective tissue fibers, in which muscle, tendon, and ligaments attach, and nerves, blood vessels, lymph nodes, and organs are arranged. Each diaphragm is uniquely different, and stretches from the front of the body, to the back.
The diaphragms:
- Provide separation of body cavities
- Help moderate internal pressures affecting the movement of air, fluid, and waste
- Unite groups of muscles, vasculature, nerves, and bone into functional groups
- Provide suspension and support to viscera
When these transverse diaphragms become restricted, they drag upon the longitudinally-oriented fascia, such as the dural tube, and affect the free motion of the craniosacral system, including structures below the occiput, but especially affecting the intracranial membranes and cranial bones, and also the production and flow of cerebrospinal fluid.(1) In addition, from a purely clinical perspective, the drag induced by transverse diaphragm restrictions influence the diagnosing of dural tube and cranial dura restrictions, making accurate and efficient diagnosis more difficult.(2)
The Ten Step Protocol provides sequential release of restrictions in the five transverse diaphragms, which decreases tissue hypertonus, promotes energy and fluid exchange, and restores mobility and balance to their constituent structures. In addition, reducing fascial drag between diaphragms provides a cumulative effect of release throughout the body and ensures that strain patterns do not reassert from one region to another.
In a sense, the diaphragm releases “level the playing field” for deeper releases of the dural tube, vertebral and cranial bones, and cranial meninges. In the Ten Step Protocol, the series of techniques are the first application of pressure and prolonged palpation, in which the client becomes aware of changes as their tissue moves, warms to touch, fluids begin to flow, and their breath moves into sighs, indicating a dissipation of tension.
The technique at each diaphragm is the same, with a modification of the position of the therapist’s hands. Gentle pressure focused on each diaphragm is maintained, while the therapist follows any transient tissue motion, not allowing the tissue to go back in the direction from which it has just moved. This produces a softening and lengthening of tissues, motion of limbs, breath, heat, stomach gurgling, kriyas, a therapeutic pulse, and sometimes an energetic repelling which can signal that the release is complete and the therapist should remove their hands. Often the signs of completion are a dramatic sigh, but just as often, a simple feeling on the part of the therapist that they are “complete” at that spot and their hands should move on to another location.
Transverse Diaphragm Techniques
Pelvic Diaphragm
Sit at the side of supine client and place one hand beneath their sacrum so that it lays comfortably flat in your relaxed palm. Place the palmar surface of your other hand so the hypothenar eminence contacts the superior aspect of the client’s pubic bones, and the rest of your palm rests on the client’s suprapubic area and lower abdomen.
It is often helpful to place your palm on the lower abdomen, and then slide it toward the suprapubic area until your hypothenar eminence makes contact with the pubes. With some clients you may want to get permission, but with most clients, you can simply let them know you are going to place your hand at the very bottom of their abdomen.
Begin with gentle anteroposterior pressure, and follow any transient tissue motion or signs of release, becoming a barrier to any reverse motion, until the diaphragm release is complete. Remember that release can happen on both the anterior and posterior portions of the diaphragm. Enhanced craniosacral motion in the sacrococcygeal complex and legs is an immediate result of release.
Indications for release of the pelvic diaphragm are as follows:
- Appendectomy
- Chronic pelvic infections
- Constipation
- Digestion problems
- Dysmenorrhea
- Endometriosis
- Fibroids
- Hernia
- Hysterectomy
- Laparotomy
- Leg-length discrepancies
- Lymphatic drainage problems
- Lumbosacral issues
- Vertebral fusions
- Sacroiliac joint problems
- Sciatica
- Laminectomy
- Hip replacements
- Vertebral fusions
- Menstrual cramps
- Ovarian cysts
- Pre and post childbirth
- Prostate problems and repairs
- Sexual dysfunction
- Urogenital problems
Respiratory Diaphragm
Sit at the side of supine client and place one hand beneath the spinous processes of T12-L3 so they lay comfortably in your relaxed palm. Place the palmar surface of your other hand so the thenar eminence contacts the inferior aspect of the client’s ribs and xiphoid process, and the hypothenar eminence rests gently on the client’s upper abdomen.
Begin with gentle anteroposterior pressure, and follow any transient tissue motion or signs of release, becoming a barrier to any reverse motion, until the diaphragm release is complete. Remember that release can happen on both the anterior and posterior portions of the diaphragm. Enhanced ease of respiration is an immediate result of release.
Indications for release of the respiratory diaphragm are as follows:
- Bronchial asthma
- Emphysema
- Heart surgery
- Lung and respiratory issues with the lower lobes
- Mastectomy
- Seatbelt injury
- Thoracolumbar problems
- Visceral and digestive problems
- Liver
- Gallbladder
- Pyloric spasm
- Irritable Bowel Syndrome
- Acid reflux
- Kidney
- Spleen
- Transverse colon
Thoracic Inlet
Sit at the side of supine client and place one hand beneath the spinous processes of C7-T3 so they lay comfortably in your relaxed palm. Place the palmar surface of your other hand so the client’s suprasternal notch is beneath the base of your index finger, letting the rest of your hand gently flatten so that both clavicles and the upper chest are covered.
Begin with gentle anteroposterior pressure, and follow any transient tissue motion or signs of release, becoming a barrier to any reverse motion, until the thoracic inlet release is complete. Remember that release can happen on both the anterior and posterior portions of the region. Enhanced respiration, obvious relaxation of the shoulders and face, and a feeling of emotional wellbeing are an immediate result of release.
Indications for release of the thoracic inlet are as follows:
- Asthma
- Biopsy
- Carpal tunnel or problems with flexors and extensors of the wrist
- Dizziness and fainting
- Headaches and migraines
- Heart surgery
- Lymphatic drainage problems
- Lung and respiratory problems
- Mastectomy
- Neck, shoulder, and upper extremity issues
- Paresthesia
- Pleuritis
- Rib problems
- Dislocations
- Subluxations
- Dislocations
- Swallowing problems
- Thoracic Outlet Syndrome (TOS)
- Thyroid problems
- Vocal problems
Hyoid Region
Sit at the side of supine client and place one hand beneath the spinous processes of C1-C4 so they lay comfortably in your relaxed palm. Make sure your index finger contacts the inferior aspect of the occiput. Place your other hand very gently on the client’s hyoid bone. For most clients, you will have to ask permission. Explain that you are going to put your fingers on the small neck bone under their chin. You may tell your client that if they want you to release your touch, they can lift their hand to signal you to do so.
It is important to comfortably and non-intrusively locate the hyoid bone swathed in the tissues below the mandible. Straddle the mandible with your thumb and index finger, and softly drop off the mandible. Ask the client to touch the roof of their mouth with their tongue. You will feel the tissue bunch up beneath your thumb and forefinger. The greater cornua of the hyoid are directly under and behind the bunched tissue. In a practice setting you can distract the hyoid laterally to exaggerate it’s location for easier identification.
Begin with intention alone, mentally rocking the hyoid in extremely small motions. Then you will feel it start to wobble on its own. Very, very gently follow any transient tissue motion or signs of release, becoming a barrier to any reverse motion, until the hyoid region release is complete. Remember that release can happen on both the anterior and posterior portions of the region. Enhanced neck range of motion, respiration, and often visible signs of emotion on the face are an immediate result of release.
Indications for release of the hyoid region are as follows:
- Avenue of expression issues
- Chewing, swallowing and tongue control problems
- Headache and migraine
- Mastectomy
- Neck problems including whiplash
- Speech and vocal chord issues
- Temporomandibular Joint Dysfunction (TMJD)
- Thyroid problems
Occipital Cranial Base
Sit cephalad to the supine client’s head, cupping it with both hands, so your fingertips contact the inferior aspect of their occiput. In one graceful motion, curl your fingertips in while pushing upward, lifting your client’s head toward the ceiling, so that C1 rests on the “bridge” of your fingertips.
Keep your fingers together, supporting each other, and allowing the weight of the client’s head to gradually flex back over the pivot of your fingertips until it has fully relaxed onto the treatment table. When this occurs, you will feel C1 distract and float toward the ceiling.
This process takes time, so be prepared to wait it out patiently, making any small adjustments for comfort. However, keep your intention on C1, because it is easy for C2 to come into position under your fingertips instead of C1.
Once you have distracted C1, use your fifth fingers to palpate the occipital condyles, which should be encouraged to spread as the occiput flexes. After spreading the occipital condyles, let your hands relax and slowly disengage from the client.
Deep relaxation of consciousness, relaxation of the neck, ease of respiration, and stillness are an immediate result of release.
Indications for release of the occipital cranial base are as follows:
- Autism
- Autonomic nervous system imbalances
- Back pain
- Biopsy
- Computer-related stress
- Digestive issues
- Headaches and migraines
- Heart surgery
- Hyperkinesis
- Idiopathic endogenous depression
- Idiopathic endogenous depression
- Learning disabilities
- Light headedness and dizziness due to insufficient blood supply to brain
- Mastectomy
- Occipital, cervical, lumbar, or sacral compression
- Respiratory issues
- Spinal problems
- Surgeries
- Tension
- Thyroid problems
- Visceral organ function
- Vocal issues, problems with swallowing
Footnotes
1 Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983. Page 59.
2 Ibid., at 246.
- Asthma
- Liver
