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 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.




6 and



9 and

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: