Thursday, January 1, 2009

CranioSacral Therapy Techniques for Whole Body Evaluation

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

The purpose of Whole Body Evaluation is to pinpoint the exact location of craniosacral system restrictions and dysfunctions, and any restrictions that reinforce them, which are extrinsic to the craniosacral system.

Symptoms may occur as a result of intrinsic dysfunction, such sutural impaction between the occiput and temporal bones at the jugular foramen, which can impinge the vagus nerve and produce gastrointestinal symptoms.

Or, symptoms may occur as a result of extrinsic restriction, for example, hypertonus of the cervical musculature causing compression of the atlanto-occipital joint, which contributes to compression of the cranial base and its lining of dural membranes.

The restrictions which cause the client’s symptoms, whether located in membranous or in musculoskeletal structures, mirror each other – where the restriction exists in one type, it exists in the other – and both have to be located and corrected in order to affect a complete recovery.

Therefore, CranioSacral Therapy includes techniques to fully evaluate the complex structural and system interrelationships.

Evaluation of the CranioSacral Rhythm

The Ten Step Protocol begins with an evaluation of the craniosacral rhythm (CSR) as observed through the musculoskeletal system. This evaluation is segmented via seven regions of the body to allow for comparative analysis to determine the type of restriction and its primary and secondary locations. Often secondary restrictions must be released to clarify diagnosis of the primary dysfunction. These regions, called the Listening Stations, are:

  1. The heels
  2. The dorsa of the feet
  3. The anterior thighs

At the first three Listening Stations, the evaluation of the symmetry, quality, amplitude and rate (SQUAR) of the craniosacral rhythm is done through motion palpation of external and internal rotation. In the Ten Step Protocol, this establishes a baseline analysis.

The therapist stands at the feet of the supine client and gently scoops both heels in their upturned palms, which rest in a comfortable, relaxed position on the treatment table. Palpation at the client’s heels provide both physical and energetic grounding. The therapist’s hands on the posterior surface of the client’s body allow palpation of physiological information using the entire fascial train from heel to the head.

The therapist moves to the dorsums of the feet by laying the relaxed palmar surfaces on the dorsums and ankles. The craniosacral rhythm along the anterior fascial train is then palpated, allowing back-to-front comparison.

Next the therapist moves to the client’s side, and places their relaxed hands upon the anterior thighs. The evaluation at this Listening Station is noted in comparison distally with the feet and proximally with the pelvis.

  1. The anterior superior iliac spines of the pelvis (ASIS)
  2. The anterior inferior costal region
  3. The anterior shoulders

At the next three Listening Stations, the therapist continues to evaluate the craniosacral rhythm through the motion palpation of external and internal rotation, and compares their evaluation with that of the distal Listening Stations. For example, if the amplitude and rate are greater above the pelvis than below it, there is a restriction. If the symmetry is equal above the pelvis but unequal at the feet, there is a restriction. However, if the SQUAR is equal above and below the pelvis, there is no palpable restriction to craniosacral motion at the pelvis.

For these Listening Stations, the therapist again simply comfortably places the relaxed palmar surfaces of their hands on the landmarks.

  1. The cranial vault

In the Ten Step Protocol, when the therapist evaluates the cranium they will possess an accurate picture of how the craniosacral rhythm is being expressed or restricted below the foramen magnum.

At the cranium, three Vault Holds are utilized to efficiently palpate and evaluate the motion of the cranial bones in response to the craniosacral rhythm. The therapist should modify them to ensure their comfort and accuracy of palpation, due to differences in hand size.(1) In Osteopathic technique, the First Vault Hold is used not only for passive palpation, but to test cranial mechanics through the introduction of strains and subsequent evaluation of the response at the sphenoid and occiput.(2) The First Vault Hold facilitates perception of the flexion and extension between the sphenoid and occiput through the index and fifth fingers, and the movement of the entire cranium, especially mediolateral movement, through proprioception between the thumbs.

The Second Vault hold facilitates perception of the flexion and extension between the sphenoid through the thumb and fifth fingers of one hand, while the occiput is palpated through the other hand, in which it is cupped. In this hold, the superior hand can gently traction and palpate the cranial membrane system easily also by lifting the sphenoid and evaluating the freedom of occipital movement. The sphenobasilar synchondrosis, sphenofrontal sutures, sphenosqamous sutures, mastoid processes, and the occipitoparietal portion of the lambdoid suture.

The Third Vault Hold is a whole-head and whole-hand hold. While the First Vault Hold allows information from four fingers, and the Second Vault Hold allows information from seven fingers and the palm, the Third Vault Hold allows information from all ten fingers, and both palmar surfaces. The range of the Third Vault Hold includes being able to palpate the sphenobasilar joint, occipitomastoid suture and mastoid process, temporomandibular joint, zygomatic processes, mandible, temporal bones, parietal bones, coronal suture, temporoparietal suture, sphenosquamous sutures, sphenofrontal sutures, and the occipitoparietal portion of the lambdoid suture.

The motion symmetry of these structures, joints, sutures, and connecting soft tissues, and the overall quality, amplitude, and rate of the craniosacral rhythm as palpated at the cranium are combined with the information from the previous Listening Stations to complete the evaluation of the craniosacral rhythm and localize the restrictions throughout the cranium and lower body.

The Ten Step Protocol advises the completion of the Transverse Diaphragm releases to prepare for evaluation of the dural tube before initiating treatment of soft tissue restrictions. However, tractioning of specific structures and fascia, arcing, or simply letting one’s hands be moved to the right bodily landmark are acceptable methods of continued evaluation, or treatment.

Evaluation of the Dural Tube

The evaluation of the dural tube is an important technique of CranioSacral Therapy, and in the Ten Step Protocol, the evaluation phase is wedded to treatment using the Dural Tube Rock and Glide techniques.

Within the spine, the dural tube glides freely between its osseous attachment at S2, and caudally, via osseous attachments to the bodies of C3-C2, with continuous fibers at C1, and via osseous attachment to the foramen magnum. The dural tube, or Core Link, transmits motion and strain patterns between the occiput and sacrum, and when restricted, it contributes to the causes of craniosacral system dysfunction.

After relieving soft tissue hypertonus and restriction, and osseous compression, through the Transverse Diaphragm techniques, L5-S1 decompression, sacroiliac mobilization, and if needed, sacrococcygeal mobilization, the therapist can evaluate dural tube mobility without being significantly influenced by strain patterns in these adjacent structures.

To evaluate the dural tube, the therapist sits at the side of the supine client and places one hand under the client’s occiput, and the other hand beneath the client’s sacrum. Initially the monitoring is passive, and the therapist simply notices the motion without interfering in it, and the quality of motion at the occiput is compared with the quality of motion at the sacrum. Then, a gliding movement of the dural tube is induced through gentle pulley-like, synchronous turning of both hands, and monitored. If resistance to its free motion is palpated, the therapist applies gentle traction at the occiput and then sacrum and extends their palpation through the dural tube to localize the restriction.

The therapist may find it easier to evaluate the dural tube by taking a position cephalad to the supine client and applying gentle traction to the occiput. Or by moving to a comfortable position for evaluating the sacrum and gently tractioning the client’s sacrum toward their feet. In each evaluation position the therapist must use enhanced sensitivity in palpation and extend their proprioceptive ability along the length of the spinal column to localize the restriction.

It has been shown that restrictions within the dural tube must be released to ensure that there is no soft tissue or energetic drag along the Core Link that would reinforce a dysfunction elsewhere in the craniosacral system.

Evaluation of Fascial Mobility

In a CranioSacral Therapy session fascial mobility is most clearly exemplified during the Transverse Diaphragm releases, when tissues move almost magically beneath one’s fingers. The attentive therapist palpating this movement can also utilize this skill to determine restrictions within the fascial layers through any point on the body. Another example of how the palpation of fascial motion is woven into CranioSacral Therapy technique is at the first Listening Station, when the therapist takes the client’s heels into their palms, and obtains subtle physiological information via the entire posterior fascial train.

Evaluation of fascial glide can be utilized to locate and find more information about specific restrictions, by using the tips of one’s fingers to gently traction the fascial layer beneath the skin in different directions. This technique should be adapted by the therapist to their own style of work.

Evaluation of Interference Patterns and Arcs of Energy

Like a spider sitting at the center of their web, dysfunctions and restrictions sit within the connective tissue and energy field encompassing our body. A deadly spider may be very small, but the web they weave around themselves allows us to see them easily.

Just like a house, our body could have a spiderweb under each gutter, some by the front door, a few in the bathroom, and some in the driveway! Not a pretty picture, but in CranioSacral Therapy, a trained therapist can spot the “spider’s webs” in our body and use them to locate dysfunctions and restrictions.

CranioSacral Therapy calls these spider webs or ring-like patterns, “Arcs,” which can be palpated either as an energy radiating from the center of a dysfunction(3), or as a disruptive interference pattern(4) which upsets the symmetry of the natural body rhythms.

What makes the technique of palpating arcs, or “Arcing,” unique is it uses a systematic approach based in circular geometries to pinpoint the exact source of often complex lesions in three dimensional space, meaning anteroposteriorly, superoinferiorly, mediolaterally. By triangulating the three widths of arc (i.e., a globe or a sphere), the dimensions of a dysfunction can be palpated. This improves palpation ability and treatment.

The therapist places their hands symmetrically, either side by side, or palm to palm with the body part or region in-between. To gain a more clear “picture” of where the arcs lead, the therapist moves their hands to adjacent regions, and triangulates the radiating pattern, mentally asking the question, “where is the center of this lesion?”

Arcs can also be palpated “off” the client’s body, in the same way radiant heat or an energy aura is sensed because while dysfunctions have physical manifestations which inhibit or create physically palpable waves on the body, the underlying energy also presents radiating arcs.

Arcing can localize various types of restrictions, but is specially recommended for traumatic impacts and energy cysts. It should be noted that the physical location of the lesion does not have to be in the body region a client complains about,(5) and, that zeroing in on a lesion of subtlety and complexity can require working through many layers or patterns to discover the underlying issue.  

1 Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983. Page 97, 101.

2 Principles of Manual Medicine. Greenman, Ph. E. Lippincott Williams & Wilkins, 2003. Page 180.

3 Upledger, John E, D.O., O.M.M. SomatoEmotional Release. Deciphering the Language of Life. North Atlantic Books. 2002. Page 48.

4 Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983. Page 249.

5 Upledger, John E, D.O., O.M.M. Performing the Initial CranioSacral Evaluation. Massage Today Vol 4, Num. 12.