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:

2 Upledger, DO, OMM., John. CranioSacral Therapy: Who Shall Do It?. Massage Today, Vol. 4, Issue 5 at:

3 Towards the Prolongation of a Healthy Life Span, New York Academy of Science Annals, Volume 854. Cited: and

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:

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 and


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: