Craniosacral Topics

Palpation in CranioSacral Therapy and Other Modalities

2009-02-10T20:03:00.001-08:00

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

Introduction

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.

Conclusion

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.
Footnotes

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

19 http://books.google.com/books?hl=en&id=8OyKy3eMyAcC&dq=spanda+&printsec=frontcover&source=web&ots=Yhn_V5Dki0&sig=soC-5YV_X2Rmg9aWWl4NMmiNZ8U

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

Stillpoint: A Gentle CranioSacral Intervention

2009-01-24T13:50:00.000-08:00

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.

Contraindications

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.

Indications

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.
Footnotes

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.
Footnotes

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

The Clinical Applications of CranioSacral Therapy

2009-01-08T19:23:00.000-08:00

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.

Dentistry

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.

Acupuncture

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)

Footnotes

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:

http://www.massagetoday.com/mpacms/mt/article.php?id=10531

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

CranioSacral Therapy Techniques for Whole Body Evaluation

2009-01-01T19:14:00.000-08:00

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:

The heels
The dorsa of the feet
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.

The anterior superior iliac spines of the pelvis (ASIS)
The anterior inferior costal region
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.

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.
Footnotes

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.

Transverse Diaphragm Release in CranioSacral Therapy

2008-12-30T13:22:00.000-08:00

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

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
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
  - 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.

Pediatric CranioSacral Therapy: An Initial View

2008-12-12T18:00:00.000-08:00

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

Pediatric CranioSacral Therapy should ideally begin with a treatment immediately after birth if possible, or shortly thereafter. The protocol for infants under one year is specialized for their stage of physiological development and needs, and includes aspects which are corrective and preventive.

Periodic CranioSacral Therapy sessions can help a growing child overcome adaptive challenges, and assist them to develop an open, relaxed, confident center. Specific disabilities which are often complex, misdiagnosed and overmedicated, can be treated holistically and compassionately through CranioSacral Therapy alone or as part of an integrated program of medical care and therapy along with other modalities, such as sensory integration therapy, music and art therapy, or occupational therapy.

Newborns may be treated successfully in short sessions under ten minutes, while older, more active children are usually treated in a longer session. Children my prefer to have their parent close to them, and the therapist should support the mother and child, or father and child, and if need be, work on them together as part of the process of building trust and ensuring the family connection is integrated into the treatment.

The ability of the therapist to adapt to the child, acknowledging their unique personalities and feelings, and ensuring that one has permission from the child to proceed is fundamental to successful treatment. To a preverbal child, the therapist must bond through silence, using eye contact and gentle motions, staying alert for signs that the child has reached a limit, or wants a change in the treatment or environment. Even with babies, as well as older children, it is important to address them by their name, and inform them intelligently and compassionately who you are, what your purpose is, and what you are going to help them with.

A conducive environment for treating children is a warm and colorful child-safe room which not only gives the toddler or young child room to move and explore, has sufficient and varied toys for different ages, but also includes a support for a variety of treatment options in addition to the treatment table, such as a chair or cozy bean bag. For teen-age children, something that makes the treatment room look cool, such as video game posters, can help them feel more at ease.

Treating Children Under One Year

Newborn and Infant CranioSacral Therapy Protocol

The child can be cradled in your arms or lying on a treatment table, awake or asleep. Support and palpate the sacrum while holding the newborn’s head. Palpate the cranial bones for overlaps and check for asymmetry in the vault or face.

Invite the craniosacral motion and craniosacral fluid to come into your perception, and place a finger into the infant’s mouth. Induce or enhancing the sucking response by sending gentle rhythmic energy and touch through the hard palate in synchrony with the infant’s own craniosacral rhythm. Use your hands to gently enhance the overall craniosacral motion through the body.

If you palpate restriction of the temporals or tentorium, use a direction of energy from one side of the cranium, flowing across the tentorium, while palpating the opposite ear, which will release and unwind. If you palpate anteroposterior restriction of the falxes or compression of the sphenoid, use a direction of energy from the posterior of the cranium, flowing forward to the frontal, to release it. Or lay the child down and using a modified third vault hold, gently decompress the sphenoid using intention alone.

Move the child to a horizontal position, and move your hand from the sacrum cephalad, placing one or two fingers on the back of the neck, very gently stabilizing the vertebrae while using the other hand to decompress the atlanto-occipital joint.

Take the hand from behind the neck, and supporting the infant’s spine, move it caudally to the pelvis while evaluating the spine and tractioning it very gently, until you reach the pelvis. This can be done in an integrated, slightly rocking motion that feels good to the baby.

Lay the child on your lap or on the table and bring both hands to the pelvis. Evaluate, release, and balance the illia. Then move to the shoulders and with both hands, send energy to release and balance the clavicles, glenohumeral joints, thyroid, thymus, heart, lungs and neck.

If you palpate a sense of “directionlessness” or feel that the baby wants to clear their birth experience, gently invert the infant to allow them to experience and integrate gravity. The baby can be positioned to slide through your cradling arms in order to simulate birth, while you provide comfort and love to supporting and nurture their process. It must be clear that the baby must guide this process.

At the end of the session, the child can be cradled or placed in the parent’s arms and may go to sleep. If you have any specific concerns, re-evaluate the baby, for newborns within twenty-four hours, or within three days, if older.

Anatomical Considerations for Newborns and Infants

There are important anatomical considerations with newborns and children under eight years of age which require a therapist to modify their techniques. From birth to the end of the second year the primary osseous structures are still in formation, attaining their full features and proportions from three to eight years of age.

To ease passage through the birth canal a baby’s bones, muscles, and tendons are soft and malleable. Soft fibrous membranes, called fontanelles, bridge the gaps between their cranial bones. The frontal, occipital, sphenoidal, and mastoid fontanelles begin to ossify from two months after birth, with the mastoid and frontal fontanelles remaining quite flexible, closing as late as the middle of the second year. The Interdigitated sutures do not form until second year⁽¹⁾, allowing the brain to double in size. Born with 330 bones, the child will eventually possess a skeleton of 206 bones when they mature to adulthood⁽²⁾.

The frontal bone consists of two parts at birth, joined by the metopic suture, which vertically bisects the median forehead and does not close until between the fourth and eighth year as the frontal sinuses continue to develop, attaining proper proportion and maturity between eight years and puberty.

The ethmoid consists of the two labyrinths which are not developed fully until after birth. In the first year the perpendicular plate and crista galli ossify and eventually join the labyrinths.

The occiput is in four parts at birth and joins between the fourth and sixth year, when the squama and condylar parts ossify.

The temporal bones are in three parts at birth, with the petrous and mastoid parts, and the squama, joining during the first year.

The sphenoid is also in three parts at birth; the body with the lesser wings, and two lateral segments consisting of a great wing and pterygoid process. The great wings and body of the sphenoid unite with the small wings after the first year. The sphenoidal sinuses remain immature until after puberty.

Maxilla is also two parts at birth, with the maxillary sinuses not reaching maturity until after the second dentition. The proportions of the maxilla are subject to radical resizing as the baby grows through both dentitions.

The mandible at birth consists of two parts, with a symphysis that becomes a suture in the first year. The entire mandible, especially the alveolar part, changes proportions during dentitions.

The parietal bones are generally fully formed at birth, however their edges remain soft until the fontanelles ossify.

The vertebrae of a newborn are primarily the same shape, and has only the two kyphotic curves; the lordotic curve being developed during crawling.⁽³⁾ The spine grows 50% during the infant’s first year.

The CranioSacral Therapist must be aware of these and other physiological and developmental aspects, and tailor their treatment protocol accordingly. It is suggested that the therapist be fully capable of performing the core CranioSacral Therapy techniques on adults, and then proceed to gain experience with children of progressively younger ages before working directly with newborns.

Indications during Pregnancy and Birthing

In addition to congenital, hereditary, and neonatal diseases and abnormalities, circumstances and events during pregnancy and birth can adversely affect the health and wellbeing of a baby. CranioSacral Therapy has been clinically shown to correct many of these adverse health conditions, and to prevent developmental, behavioral, and learning dysfunction as the child grows.

Stress, illness, and toxicity during pregnancy can contribute to craniosacral system dysfunction, such as restrictions of the dura⁴ and other membranes. Toxicity from cigarettes, alcohol, drugs, diet, medicines, and exposure to household chemicals and electromagnetic smog may also affect the craniosacral system.

The mother’s feelings about an unexpected or unwanted pregnancy, her unresolved birth issues, or her occupational stress can be transmitted chemically and energetically to the developing fetus, and can cause imbalances in the baby’s bioenergy and emotional disposition⁽⁵⁾.

CranioSacral Therapy can provide a loving therapeutic release and realignment after birth to clear restrictions of the soft tissue which may have been induced in the womb, promote detoxification through fluid exchange and enhancement of the craniosacral system, and balance bioenergy.

During birth, as the baby traverses the birth canal, it receives a natural full-body massage. The pressure and curvature of the canal stretches and mobilizes its joints and muscles, awakens nocioception and proprioception, and promotes fluid exchange throughout the brain and body. Upon leaving the yoni, it receives a second natural massage as it adjusts to air pressure, light, sound, and contact with its mother.

Any abnormalities which may have been introduced during the birth process, such as the cranial bones overriding each other, or strain due to the baby’s passage, tend to autocorrect in the first ten minutes as the baby’s body adjusts itself in space. However, in many traditional cultures, shortly after delivery, a newborn is washed, oiled, and massaged by midwives, mother, or grandmother, who stretch the spine, align joints and bones, tone the skin, and stimulate the infant’s senses. While this level of natural postpartum care is rare today, a CranioSacral Therapy treatment after birth will correct any cranial bone overrides or birth-induced soft tissue tension which the baby’s body may not have autocorrected.

Overreliance on cesarean section and the use of forceps or vacuum extraction represent other departures from traditional and natural methods of delivery, and may induce dysfunction into the baby’s craniosacral system. The rapid decompression accompanying the puncture of the uterus, and the force of physical pressure induced by instruments or even excessive traction, can produce a variety of abnormalities, including micro-tears and strain patterns in the intracranial meninges, bleeding capillaries, asymmetrical distortions and development, and abnormal flow of fluids in the cranium⁽⁶⁾. To correct these imbalances, CranioSacral Therapy is recommended for newborns.

Postpartum CranioSacral Therapy

CranioSacral Therapy can support and reenergize new mothers by improving craniosacral system function, lumbosacral and pelvic mobility, and provide deep relaxation through stillpoint. It can also improve meridian energy flow and decrease trauma where a cesarean or episiotomy was performed, release soft tissues, and through SomatoEmotional Release, help a new mother release issues that came up during the birth. A postpartum CranioSacral Therapy session with the baby can help a mother learn to witness, trust, and enjoy the baby’s own process, improve bonding, and enhance craniosacral system function.

Common Indications for Treatment of Newborns and Infants

Acid reflux
Colic and irritability
Constipation
Fetal Alcohol Syndrome
Infant feeding or sucking difficulties
Infant Sleeping Disorder
Irregular head shape, flat spots or bulges, and other asymmetries
Maternal drug or cigarette use
Strabismus
Traumatic delivery, cesarean section, or the use of forceps or vacuum extraction

Treating Children from One to Nine Years

CranioSacral Therapy can be integrated with general pediatric care, and has proven an exceptional method for treating specific childhood illnesses and dysfunctions, including disorders of the brain, nervous system, respiratory system, emotions, and learning development. Injury and stress from athletics, homework, commercialism, and diet can be addressed therapeutically through the craniosacral system.

Modifying the Ten Step Protocol for Children

Children, ages one to nine, can be treated using a modified Ten Step Protocol which takes into account the development of their craniosacral system, bones, and tissues. The general rule is that compression techniques which are often used to exaggerate lesion patterns and induce self-correction should not be used. Instead, the techniques should be focused on decompression, and indirect methods. This is because inducing compression in the softer, malleable craniosacral system of a child has a greater effect than on adults, and can do more damage.

An example of a technique used for adults that should be modified for children is the sphenoidal compression/decompression method. Another type of compression, this time generated by the weight of the client’s own head, is utilized in the decompression of the atlanto-occipital joint. It should be modified so that one or two fingers are used, instead of the “platform” technique of raising the head, which applies too much concentrated force.

Traction techniques should be treated similarly as compression. While a child’s knee joint may be able to withstand hours of bike riding and climbing trees, not all bones, joints, and membranes are that rugged. An example would be the case of temporal bone and tentorial membrane release. In this case, the child’s temporal bones should never be taken out of synchrony, and the “earpull” technique should be directed only laterally, and any posterior compression should be avoided.

Stillpoint is another useful technique for children, but the CV-4 technique should not be used as it compresses the fourth ventricle and occiput. Instead, stillpoints should be gently induced from other locations on the body such as the feet or sacrum.

With children, less is more. Even the subtlest techniques, performed on smaller bodies, have great impact.

Common Indications for Treatment of Children

Acid Reflux
ADD/ADHD
Asperger’s syndrome
Autism
Cerebral palsy
Chronic middle ear Infections
Chronic pain
Constipation
Developmental delays and learning disabilities
Difficult mobility
Eczema
Emotional problems such as depression and trauma
Genetic disorders
Headaches
Neurological conditions
Pickiness and hyper or hyposensitivity
Reactivity, touchiness or unpredictability
Sensory integration problems

Treating Children from Nine to Sixteen Years

Older children and teenagers may be treated using the adult version of the Ten Step Protocol.

Footnotes

1 Heart of Listening: A Visionary Approach to Craniosacral Work. Milne, Hugh. North Atlantic Books. 1998. Pg. 7.

2 Pediatric Massage Therapy. Sinclair, Marybetts. Lippincott Williams & Wilkins, 2004. Page 34.

3 Infant Carriers and Spinal Stress. Rochelle L. Casses, D.C. at http://www.continuum-concept.org/reading/spinalStress.html.

4 Massage Today. Applications of CranioSacral Therapy in Newborns and Infants, Part I and II. Upledger, John, DO OMM.

5 Craniosacral Therapy for Babies and Children. Piersman, Etienne and Neeto. North Atlantic Books, 2006. Page 80.

6 Massage Today. Applications of CranioSacral Therapy in Newborns and Infants, Part I and II. Upledger, John, DO OMM.

The Compression Triad: A CranioSacral Treatment Construct

2008-11-11T20:00:00.000-08:00

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

The Compression Triad is a treatment construct in CranioSacral Therapy which addresses involved lumbosacral, Atlanto-occipital, and sphenobasilar compression. Sequential decompression of these regions can often correct elusive idiopathic and chronic symptoms which are not easily resolved by treating the areas individually.

Due to their complex structural-kinematic and energetic relationships these three regions mirror movement and strain patterns through the craniosacral system, and therefore tension in one area can be a contributing factor to restriction and pain in another.

CranioSacral Therapy provides the Ten Step Protocol, an optimized sequence which treats the entire craniosacral system and its adjuncts through the release of connective tissue, sutural, and osseous structures, throughout the body. The Ten Step Protocol includes decompression the lumbosacral (L5-S1) articulation, followed by the Atlanto-occipital joint, and the sphenobasilar synchondrosis, at the base of the cranium.

Basic Anatomy of the Compression Triad

The Lumbosacral Junction

The sacrum forms a stable platform onto which the lumbar spine intersects the pelvis. This junction possesses a limited range of motion compared with the vertebral column, which it supports. The pivotal junction at L5-S1 absorbs stress from many angles, and is prone to compression, lumbar disc prolapse⁽¹⁾, spondylolisthesis, and spondylosis.

The L5 vertebral body and lumbosacral disc are somewhat wedge-shaped, and contribute to the lordotic curve of the lumbar spine which acts in part as a shock-absorber to compressive forces that would otherwise be transmitted directly to the sacrum and pelvis. The left and right zygapophysial joints and lumbosacral disc are also angled to resist forward slippage.⁽²⁾

The lumbosacral junction is considered an ideal center of gravity and a gyroscopic balance⁽³⁾ for the human body. Compression of this region can impair sacral movement and cause craniosacral system dysfunction by interfering with the movement of the dural tube, which has its caudal osseous attachment at S2, and with the synchronous movement between the sacrum and the occiput.

The largest nerve of the body, the sciatic, emerges from the joined fibers of the lumbar plexus (L4-L5) and sacral plexus (S1-S3), and is most commonly compromised by compression of the nerve roots at the lumbosacral junction.

Energetically, acupuncture meridians Urinary Bladder 26 (Gate of the Source) and Governing Vessel 3 are at the lumbosacral junction. This junction at the 24th vertebra represents the division of heaven and earth.(4)

The Atlanto-occipital Joint

The atlanto-occipital joint is formed between the occiput and the first cervical vertebra, or atlas, and provides flexion and extension of the head. It should be noted that the atlanto-occipital joint is deeply related to the atlantoaxial joint, the primary mechanical structure responsible for rotating the head, and the temporomandibular joint, the hinge on which the mandible moves. These joints influence each other in function as well as dysfunction and compression of the zygapophysial joints of the atlas with the condyles of the occiput can produce a broad range of symptoms.

The atlas is a streamlined, ring-shaped vertebra, lacking a vertebral body and spinous process, upon which the cranium sits. It supports the weight of the cranium through two lateral masses which carry superior and inferior articular facets. Directed bilaterally and caudally from each lateral mass, are elongated transverse processes. The vertebral canal spaciously accommodates the medulla spinalis.

It articulates with the most inferior point of the occiput, the occipital condyles, which are located immediately lateral to the anterior half of the foramen magnum, among numerous significant cervical muscular and membranous attachments including rectus capitis posterior minor which is continuous with the dura, and the dural fibers which are continuous with the cervical fascia. (5)

Energetically, the Window of Sky meridian point Governing Vessel 16 (Wind Palace) is directly behind the atlas. Level with and lateral to GV 16 is Gall Bladder 20 (Wind Pool). This region is also regarded as the entry point of spirit into the body, or “shikha” in the yoga system.

The Sphenobasilar Synchondrosis

The first osseous component of craniosacral mechanics is the x-wing-shaped sphenoid bone at the center of the cranium. The posterior region of the body of the sphenoid, the dorsum sellae, slopes caudally, and a portion called the clivus fits into a groove in the anterior articular aspect of the basilar part of the occiput. This synchondrosis bridged with cartilage and ligamentous connective tissue(6) is considered the center of craniosacral flexion and extension.

The fibers of the periosteum of the cranial base, the dural membranes, and the adventitial connective tissue supporting the vertebral venous plexii are all continuous to varying degrees, and swath the entire region. Directly posterior to the sphenobasilar synchondrosis these membranes form a thick attachment around the foramen magnum, where the dural membranes descend through the spine along with the medulla spinalis.

A multitude of forces deform these membranes, the sphenobasilar synchondrosis, and the cranial base into dysfunctional patterns or relationships, which, in addition to compression, are considered as core pathological models in CranioSacral Therapy.

Perspectives on Compression in CranioSacral Therapy

The inherent continuum of the dural membranes, fascia, and soft connective tissue provides the CranioSacral Therapist with a gestalt model through which craniosacral system dysfunctions and their often obscure symptoms can be evaluated and treated. In this model osseous tissue is regarded as subject to the viscioelastic properties of soft tissue, and mechanical effects produced by fluid dynamics and hydraulic pressure.

Compression of structures or tissues alters these relationships, and can produce pathological conditions throughout the continuum, the forces of which are transmitted to the osseous anchors, sutures, joints, and bones via connective tissue including the dura, and fluid pressure, especially craniosacral fluid.

Palpable changes in the Symmetry, Quality, Amplitude, and Rate (SQUAR) of the craniosacral rhythm, dysfunctions of craniosacral motion, tissue tonus and mobility, and patterns of bioenergy, are all utilized during clinical evaluation and treatment by a CranioSacral Therapist.

The Compression Triad is a robust and open construct that is "clinically significant when the physician is searching for the causes underlying craniosacral system dysfunction. Correction of osseous dysfunction is often temporary. The dysfunction continues to recur until the physician identifies and successfully treats the cause of abnormal soft tissue or dural membrane tensions.” (7)

Evaluation and Treatment Using the Compression Triad

A CranioSacral Therapist should therefore first evaluate the craniosacral rhythm and using the Ten Step Protocol, release soft tissues and mobilize osseous structures, until they can accurately evaluate the cranial base for compression. Dr. Upledger states, “Always look for cranial base compression, no matter what the patient’s complaint nor how unlikely it may seem that the clinical symptom or syndrome could be etiologically related to cranial base compression.” (8)
While the Compression Triad explicitly treats anteroposterior impaction of the sphenobasilar synchondrosis, it implicitly includes compression of any osseous, sutural, or meningeal structures in any direction within the cranial base.(9) The Ten Step Protocol includes decompression and balance of the bones, falx, and tentoria via sphenoidal, temporal, and frontal bone decompression.

The CranioSacral Therapist evaluates compression of the sphenobasilar synchondrosis via the two-phase sphenoidal compression-decompression technique using the third vault hold. During the compression phase of the technique, any existing lesions are exaggerated and will induce transient motion, which in some cases will self-correct these lesions.

During the decompression phase, the sphenoid is tractioned anteriorly until the occiput settles caudally into the therapist’s hand. If it does not settle easily, the sphenobasilar synchondrosis may be fused compressed or the tentoria may be restricted, and the evaluation is repeated until the therapist determines if a anteroposterior compression lesion exists, and completes treatment of it through the decompression phase of the technique.

Decompression of the sphenobasilar synchondrosis and cranial base improves craniosacral system motion, reciprocal membrane balance, brain movement, nerve function, and fluid exchange within the cranium. It has been shown to directly alleviate emotional imbalances such as idiopathic endogenous depression, reduce childhood hyperkinesis, and help overcome childhood learning disabilities in addition to promoting reciprocal decompression throughout the Triad of Compression.
Sphenobasilar compression may be caused by direct trauma to the head, birth trauma and forceps delivery, lumbosacral compression, meningeal inflammation and tension, and other factors.

The atlanto-occipital joint is evaluated and treated simultaneously through a two-phase technique, in the Ten Step Protocol, during the steps for diaphragm release. The therapist sitting at the head of the supine client, places the palmar surfaces of their cupped hands beneath the occiput, and with fingertips placed caudal to the inferior nuchal line, palpates the altanto-occipital joint through the covering of muscular and other soft tissue.(10) The fingers are raised perpendicular to the treatment table, so the fingertips become a fulcrum directly behind the atlas. The weight of the client’s head causes the tissues to soften, and the atlas to distract anteriorly.

The second phase of the technique involves shifting focus to the occipital condyles once the atlas is free, and encouraging the spreading of the condyles. This technique should only be performed after the thoracic inlet diaphragm release to ensure venous drainage from the cranium is not restricted as backpressure may cause a headache. At the conclusion of the technique, the therapist gently removes their hands and the client’s head is returned to the table.

Decompression of the atlanto-occipital joint releases the zygapophysial facets of the atlas, occipital condyles, basioociput, and foramen magnum from compressive caudal traction onto the vertebral column caused by dural tension, or muscular hypertonus. Compression is caused by the weight of the head, poor posture, trauma, lumbosacral compression, and other forces. Increased freedom of cervical motion, release of adaptive muscular hypertrophy, improved circulation, and the release of impinged nerve roots are some positive effects of atlanto-occipital decompression, in addition to promoting reciprocal decompression throughout the Triad of Compression.

One cannot overestimate the importance of a flexible and mobile occiput to fluid exchange at the confluence of the sinuses at the internal occipital protuberance, the vertebral and basilar artery, or at the jugular foramena, through which the jugular vein passes. In addition to the jugular vein, the glossopharyngeal, vagus, and accessory cranial nerves traverse these foramena.

The lumbosacral junction is one of the first places therapists evaluate for compression and osseous mobility when a client presents with low back pain, sciatica, or if the client has been diagnosed with scoliosis, spondylolysthesis, spondylosis, herniated or prolapsed intervertebral discs, trauma, postural or gait problems.

However, according to the gestalt view underlying the Compression Triad and CranioSacral Therapy in general, these complaints may be symptomatic of compression anywhere in the craniosacral system, and have referring effects throughout the body. Therefore these complaints should be treated via the entire body.

To evaluate and treat compression at L5-S1, the therapist sits at the supine client’s side, and places one hand with permission between and beneath the client’s lower extremities, cupping the sacrum in their relaxed palm, with the tips of the fingers contacting the sacral base. The other hand is placed beneath the lumbosacral junction with the fingers stabilizing L5. Light caudal traction is applied to the sacrum. When the dural tube and lumbosacral joint decompress, the sacrum will float caudally.

In the Ten Step Protocol, the CranioSacral Therapist evaluates and treats compression of the lumbosacral junction after releasing the transverse diaphragms and before treating the pelvis and dural tube. It must be emphasized that the mobility of the dural tube is central to success in the treatment of compression via the Triad of Compression construct.

The Dural Tube and the Compression Triad

Between the lumbosacral and atlanto-occipital joints, the forces and effects of compression and their referred effects in other connective tissue can be pinpointed through the evaluation of the mobility of the dural tube.

Restrictions in dural tube mobility will reinforce dysfunctions in the Triad of Compression, and via the “memory” inherent in the viscous-elastic nature of connective tissue, will cause temporarily freed osseous structures to re-compress.

The dural tube can be evaluated during treatment to ensure there are no remaining restrictions by applying gentle palpatory traction from the occiput or sacrum. The rule of thumb is that if the osseous structure begins to release, but a feeling of elasticity remains in its movement, instead of a free-floating quality, there is a viscous-elastic restriction and the connective tissue must be treated until the restriction has been completely released.

Summary of Indications for Treatment of Compression

The client’s complaint and/or diagnosed conditions which lead to evaluation for compression and subsequent treatment include:

- Joint and back pain, compression, and restriction of movement

- Degenerative diseases of the vertebrae and intervertebral disks

- Idiopathic Endogenous Depression

- Childhood hyperkinesis, autism, behavioral, or learning disabilities

- Direct trauma

- Birth trauma and forceps delivery

- Meningeal inflammation, headaches, and tension

- Psychogenic emotional trauma

- Paresthesia

- Postural and gait problems

- Weakening and atrophy of soft tissues

- Fatigue and energy problems

- Breathing problems including reduced air intake

- Hypertrophy of muscle and soft tissue

- Tingling, tinnitus, and related effects of nerve root compression

- Restricted dural tube mobility

In addition to the client’s complaint, indications for treatment of compression lesions are known to the therapist during the sequence of evaluations in the Ten Step Protocol or through whole body evaluation methods such as arcing, fascial glide, facilitated segments, and via the client’s Inner Physician.

The CranioSacral Therapist must keep an open mind, because the cause of craniosacral system compression dysfunctions may “ultimately be found in the abdominal cavity, in an extremity or elsewhere in the patient. We cannot and should not attempt to limit the scope of our investigation to the confines of the craniosacral system alone.(11)”

Footnotes

1 Spinal Cord Diseases. Engler, Gordon L.; Cole, Jonathan; Merton, William Louis. Informa Health Care, 1998. Page 554.

2 Clinical Anatomy of the Lumbar Spine and Sacrum. Bogduk, Niolai and Endres, Stephen M. Elsevier Health Sciences, 2005.

3 http://www.chiroweb.com/mpacms/dc/article.php?id=37500

4 Jung and Yoga: The Psyche-Body Connection. Harris, Judith. Inner City Books, 2000.

5 Cranial Manipulation Theory and Practice. Chaitlow, Leon. Elsevier Health Sciences. 1999. Page 112.

6 Osteopathy. Parsons, Jon, and Marcer, Nicholas. Elsevier Health Sciences. 2005. Page 202.

7 Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983. Page 96.

8 Ibid., at 122.

9 Ibid.

10 Alternately, the atlas can be palpated through its transverse process, located about 1 cm. below and in front of the apex of the mastoid process. It is essential that the atlas, and not the axis is targeted via this technique. Due to the extensive soft tissue covering the joint, this can sometimes be difficult. See Gray’s Anatomy at

http://www.bartleby.com/107/282.html.

11 Upledger, John E., and Vredevoogd, Jon D., CranioSacral Therapy, Eastland Press, 1983. Page 96.

CranioSacral Treatment of the Hard Palate and Facial Bones

2008-11-06T12:00:00.000-08:00

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

Bones of the Hard Palate and Face

The Maxilla

The maxilla is the bone of the upper jaw, and is formed by two symmetrical bones. The roots of upper teeth (1-16) insert into the alveolar process of the maxilla, and palatine process forms the roof of the mouth. Above the alveolar, the maxilla forms the floor and lateral walls of the nose. It then contributes bilaterally to the medial orbits of the eyes. Continuing bilaterally, its zygomatic processes contribute to the formation of both cheeks. Within the body of each lateral portion of the maxilla, the maxillary sinus (the largest paranasal sinus) is located.

Both halves of the maxilla articulate with each other, and with the two nasal bones along the medial saggital plane. Superiorly, they articulate with the frontal, lacrimal, and ethmoid; laterally with the zygomae; and medially deep with the palatines, vomer, and inferior nasal concha.

Some of the important muscular attachments to the maxilla include buccinator and masseter, which close the jaw and clench the teeth; orbicularis occuli, which closes and protrudes the lips; alae nasi, which flare the nostrils, and inferior oblique, which move the eye.

The movement of the maxilla in response to the craniosacral system in flexion is anterosuperior, with bilateral spreading. In extension, the two halves move medially and posteroinferiorly. The lateromedial movement is easily palpated from the median palatine suture during evaluation of the hard palate.

Acupuncture points stomach 3, 4; large intestine 19-20; and governing vessel 26-27 are located in tissues superficial to the maxilla. The midline energy currents run through the maxilla, and the maxillary sinus is considered in the yoga pranayama tradition to be a major transducer of prana between the higher organs of consciousness in the head, and the energy anatomy of the lower body. In addition, each tooth is connected energetically to various organs and joints. In light of these connections, the maxilla is a sacred bone, and its balance and health are very important.

The Palatines

The palatines are two “L” shaped bones located directly posterior to the maxilla. Each palatine consists of a horizontal plate which inferiorly forms the posterior part of the hard palate, and superiorly the floor of the nose; and a perpendicular plate, which contributes to the wall of the maxillary sinus and gives rise to the sphenoid process and the orbital process.

Palatines articulate with each other via the median palatine suture at the midline of the hard palate, posterior to the transverse palatine suture where they articulate with the maxilla. The palatines also articulate with the vomer superiorly at the median palatine suture.

The palatine orbital process contributes to the orbital wall and has three articulations; with maxilla, sphenoid, and ethmoid. The vertical part of the body, called the perpendicular plate, helps to form the wall of the maxillary sinus, and articulates with the inferior nasal concha and the ethmoid bone.

Each palatine has two articulations with the pterygoid plate of the sphenoid; on the posterior surface of the pyramidal process, which is directed backward from the base of the “L,” and from the sphenoid process, which articulates with the sphenoid and vomer.

The palatines move anterioinferiorly with craniosacral flexion, and posterosuperiorly in extension. I suspect there might be some natural bilateral motion along the transverse palatine suture occurring in concert with the bilateral motion of the maxilla. During treatment the palatine bones are mobilized along both their horizontal and vertical axes and are palpated as somewhat free-floating. They are delicate cushions between the sphenoid and maxilla.

The Vomer

The vomer is a wafer-thin wedge shaped bone named after its likeness to a plow. It is covered in a mucous membrane, and forms the inferior posterior wall of the nasal septum. At the superior border it has two small alae with a groove between them into which the rostrum of the sacrum fits (as a schindylesis). Its inferior border articulates with the maxilla and palatines along the median palatine suture. The anterior border also articulates with the maxilla inferiorly, and then posterosuperiorly, it articulates with the triangular nasal cartilage and then the ethmoid bone. The choana is separated by the posterior border of the vomer.

The vomer rocks like a see-saw in response to craniosacral movement. In flexion, the anterior border moves superiorly, as its posterior border moves inferiorly. The directions reverse during the extension phase.

The Ethmoid

The ethmoid is an extremely complex bone which consists of a wafer-thin perpendicular plate descending from the underside of a horizontal cribriform plate. From the cribriform plate, a pyramidal, spike-like projection called the crista galli ascends. The lateral aspects of the cribriform plate support two vertical rectangular, box-like labyrinths containing air cells made of spongy bone. The ethmoid air cell network is a major pathway for the flow of air and energy between the frontal sinus and sphenoid sinus.

The perpendicular plate itself forms the superior posterior wall of the nasal septum, articulating inferiorly with the vomer, which forms the wall of the nasal septum below it. The medial aspect of each labyrinth is fluted, forming the middle and superior nasal conchae and meatuses; thereby contributing to the outer walls of the nasal cavity, and providing moistened air to the lungs. The lateral wall of each labyrinth is slightly concave and contributes to the inner surface of the orbit, articulating with the lacrimal, maxilla, sphenoid, palatine, and frontal bones.

The cribriform plate wedges superiorly into the ethmoidal notch of the frontal bone. The plate supports the olfactory bulb, and is perforated with numerous tiny foramina through which olfactory nerves pass; medially into the top of the nasal septum, and bilaterally into the superior nasal concha. On the midline of the cribriform, the crista galli arises and attaches the falx cerebri. The posterior cribriform plate articulates medially with the ethmoidal spine of the sphenoid, and the sphenoidal crest.

Energetically, the ethmoid is a gateway for prana, and one of several bones that contain the iron crystals called magnetite, which are associated with magnetoception.

The movement of the ethmoid during craniosacral flexion is anteroinferior. An additional driver for ethmoidal movement is the attachment of the falx cerebri to the crista galli.

The Frontal Bone

The frontal bone makes up the forehead and the ceiling of the orbits. Its shape is semi-circular with a superior apex, the edge of which is heavily interdigitated, forming the frontal suture with both parietal bones. The site where the parietals and frontal meet is called bregma.

The anterior surface of the frontal bone is convex and its upper half is called the squama. This surface has the medial and vertical metopic, or frontal suture, from which the bilateral frontal eminences bulge, forming the two slight domes at the top of the forehead. Slightly inferior and medial is glabella, a flat area between the two eyebrows, the bony structures of which are the region of the superciliary arch and the margin of the orbits.

At the lateralmost corners of the orbits are the zygomatic processes of the frontal bone, which articulate with the zygomae. Beneath glabella is a caudal projection called the nasal nasal notch, which articulates along the midline with the nasal bones, the frontal process of the maxilla, and the lacrimal bones, forming the bridge of the nose.

Posteriorly, the convex surface of the squama is vertically bisected by a double ridge, the edges of which are the attachments to the falx cerebri, with a grove called the saggital sulcus lying between, into which fits the saggital sinus. Inferiorly and bilaterally directed is the orbital or horizontal part, which consists of two orbital plates separated by the ethmoidal notch which receives the cribriform plate of the ethmoid bone. The frontal sinuses extend bilaterally on both sides of the ethmoid notch.

Along the lateral posterosuperior wall of the orbit is the frontal articulation with the great wing of the sphenoid. Moving medially along the rear concavity of the orbit the frontal bone articulates with the lesser wing of the sphenoid. Medially, the orbital plate forms the lip of the ethmoidal notch.

The movement of the frontal bone during craniosacral flexion is anterosuperior. In addition, there is a slight widening as the falx cerebri pulls the centerline of the frontal bone posterior.

Energetically, acupuncture points Governing Vessel 22-24, Urinary Bladder 2-4, Stomach 8, and Ayurvedic marma points sthapani, simanta, and utkshepa are also located along the frontal bone.

The Zygomae

The zygomae are anchor-shaped cheek bones. They present an anteriolateral convex surface called the malar surface, which through its temporal process, articulates with the zygomatic process of the temporal bone. Opposite the temporal process, toward the midline, is the orbital process, which forms the lateral wall and floor of the orbit. Inferior to the orbital process, is the lower angular edge where the zygomae articulate with the maxilla.

The posteriolateral surface is called the temporal surface. It serves as the attachment site for the masseter. The superior and vertical projection (akin to the shaft of an anchor) is called the fronto-sphenoidal process because its anterior aspect articulates with the frontal bone and its posterior aspect articulates with the sphenoid.

The movement of the zygomae is in concert with the eccentric wobbling rotation of the temporal bones. In craniosacral flextion they rotate anteriorly and externally.

Energetically, acupuncture points Small Intestine 18 is over the zygomae.

The Nasal Bones

The nasal bones form the bridge of the nose. They are rectangular and oblong in shape, and articulate with each other along the midline. At the top of the medial border, the posterior surface contributes to the nasal septum and articulates with the spine of the frontal bone, the cribriform plate of the ethmoid bone, and the septal cartilage.

Superiorly, the nasal bones articulate with the nasal notch of the frontal bone at (a spot called) nasion, and inferiorly they articulate with the lateral nasal cartilage. The lateral borders articulate with the frontal process of the maxilla.

The movement of the nasal bones is similar with all paired facial bones. The nasal bones externally rotate during craniosacral flexion, and internally rotate during the extension phase.

The Lacrimal Bones

The lacrimal bones contribute to the anterior part of the medial wall of the orbit. They are somewhat rectangular, and carry a portion of the lacrimal duct, the nasolacrimal duct, and the lacrimal sac.

The movement of the lacrimal bones in craniosacral flexion is external rotation. I presume the lacrimals have some unique movement and energetics associated with weeping.

Clinical Application of Hard Palate and Facial Bone Techniques

Evaluation and treatment of the hard palate and facial bones should be commenced after the client has been evaluated and treated for any lesions of the transverse diaphragms, occipital cranial base, intracranial meninges, dural tube, temporal bones, and temporomandibular joints.

The hard palate evaluation and treatment protocol may be followed, or the therapist may be guided to work in an organic sequence. However, the zygomae, palatines, and nasal bones can often be corrected automatically during the evaluation, mobilization, and treatment of the larger bones in relation to the sphenoid.

Spheno-maxillary Evaluation

Lesions or restrictions may produce disorganized motion patterns or degrees of immobility to bones in the craniosacral system. Therefore, prior to evaluating the hard palate and bones of the face for specific lesions, a general evaluation of the synchrony, or similar motion, of the maxilla in relation to the sphenoid is conducted. This evaluation serves as the palpatory ingress into the mouth in a gentle way and helps the therapist determine if an intervention to mobilize and balance the maxilla is indicated. If so, the palatines and vomer should be also evaluated.

The spheno-maxillary evaluation technique is performed by using one hand to monitor the motion of the sphenoid through the greater wings or frontal bone, and the other hand to palpate the corresponding state of the maxilla. With client permission, two fingers of the hand palpating the maxilla are inserted gently into the client’s mouth with the finger pads contacting the biting surfaces of the upper molars. The transverse motion of the maxilla can be easily detected and evaluated from the molars because during craniosacral flexion the maxilla widens along the median palatine suture and narrows correspondingly during craniosacral extension.

After evaluating the motion synchrony of the maxilla, torsion, shear, and impaction lesions may be tested for. The torsion and shear tests require the therapist stabilize the sphenoid bone so non-physiological motion induced during evaluation and treatment is not transmitted to the sphenoid and will not produce corresponding adverse affects. The hand and finger positions are the same as in the previous evaluation. To stabilize the sphenoid, set a strong intention for it to be stable and as you induce non-physiological motion with your evaluating hand, gently resist any corresponding motion.

To test for spheno-maxillary torsion, very gently rotate the hard palate around an imaginary vertical running through bregma, first in one direction and then in the other, allowing 10-15 seconds for the motion of the hard palate to completely engage. If you feel asymmetry or resistance in either direction, apply careful treatment to release the torsional positioning and normalize the relationship between the maxilla and sphenoid, taking into account the vomer and palatines.

To test for spheno-maxillary shear, very gently shift the hard palate laterally, first in one direction and then in the other, allowing 10-15 seconds for the motion of the hard palate to completely engage. If you feel asymmetry or resistance in either direction, apply treatment to release the shear positioning and normalize the relationship between the maxilla and sphenoid, taking into account the vomer and palatines.

To test for spheno-maxillary impaction, during the palpation of the hard palate, note whether maxilla and sphenoid posess their own independent motion identity, in addition to their synchrony. If they appear rigidly connected, spheno-maxillary impaction may be the cause and treatment is advised.

Palatine Evaluation

After maxillary evaluation and treatment, which itself tends to correct most problems with the palatine bones, palatine motion can be evaluated to determine if there are any remaining restrictions. The hand positions are the same, with a slight modification of the fingers palpating the oral cavity. These fingers are moved slightly posterior and medially to the last molar, where the transverse palatine suture bisects the hard palate, and placed onto the palatine portion of the hard palate itself.

Caution is to be exercised due to the delicacy of the palatine bones. It is advised that one begin to mobilize and evaluate the palatines through intention alone, inviting the bones themselves to initiate responsive movement, first cephalad with returning motion, then laterally with returning motion. If restrictions are encountered, begin treatment.

Vomeral Evaluation

Because the vomer is located between the maxilla and sphenoid, it is usually involved with conditions of spheno-maxillary torsion, shear, and impaction. The vomer should therefore be evaluated and treated if those conditions are detected. However, the independent and natural motion of the vomer can be evaluated separately.

To evaluate the motion of the vomer, use the same hand positions as in the previous evaluations, with the modification that only one finger is inserted into the oral cavity and gently placed on the posterior portion of the medial palatine suture. The vomer articulates with both the maxillary and palatine contributions to the hard palate on the obverse side of this suture, the therapist should therefore meld with the client’s hard palate in order to palpate the motion of the vomer.

Zygomatic Bone Evaluation

If there is direct facial trauma, or lesions and restrictions of the maxilla, frontal, or temporal bones, the zygomae should be evaluated for external and internal rotation in synchrony with sphenoidal motion. This can be done by monitoring the sphenoid and zygomae with the fingers. If motion restrictions are encountered, the sutures and the zygomae should be mobilized.

Nasal Bone Evaluation

If there is direct facial trauma the nasal bones should be evaluated for external and internal rotation in synchrony with sphenoidal motion. If restrictions are encountered the sutures and the nasal bones should be mobilized.

Spheno-maxillary Treatment

Correction of maxillary movement involves sutural and osseous mobilization to restore synchrony with the movement of the sphenoid and craniosacral system, and the release of any torsion, shear, or impaction lesions. During lesion treatment the sphenoid must be stabilized as above.

To mobilize and balance the maxilla, use the same hand position for evaluation. Monitor the sphenoid and follow the transverse motion of the maxillary portions of the hard palate until you perceive asymmetry or motional restriction. When the lesion has been identified, first treat indirectly either by following the craniosacral motion back to neutral and then providing a barrier to return motion for several cycles, or provide a barrier to return when the craniosacral motion begins to cycle back from the point the lesion is first identified. After treating indirectly and gaining a release, re-evaluate the symmetry and motion, and if needed, direct technique with subtle and sustained force can be employed.

Spheno-maxillary torsion usually involves the palatines and vomer as well. Torsion is a positional lesion, not solely a motion restriction, therefore correcting torsion involves gently exaggerating the lesion until an initial release occurs, followed by applying gentle force through direct technique to realign and rebalance the structure properly. Evaluate the palatines and vomer and treat accordingly.

Spheno-maxillary shear usually involves the palatines and vomer as well. Treat first with indirect technique, exaggerating the motion in the direction of ease. Then re-evaluate motion and symmetry after a release has been gained. Use direct technique if further release is indicated. Evaluate the palatines and vomer and treat accordingly.

Spheno-maxillary impaction usually involves the palatines and vomer as well. Use gauze to prevent slippage. Treat by grasping the alveolar ridge of the maxilla along the centerline, with thumb on the anterior surface and fingers directly posterior. Traction gently until a release is gained. Evaluate the palatines and vomer and treat accordingly.

Palatine Treatment

The sequence described in the palatine evaluation section above is also the treatment procedure.

Vomeral Treatment

To treat the vomer use the hand positions for vomeral evaluation. During lesion treatment the sphenoid must be stabilized as above. For restriction or asynchrony of motion, employ direct technique using the finger placed on the midline of the hard palate.

To treat vomeral torsion modify the finger in the oral cavity so that it contacts more of the hard palate, from the posterior aspect of the midline to the ridge posterior to the incisors. With this increased leverage, rotate the vomer first using indirect technique, and then direct technique, applying slow, sustained and very gentle force.

To treat vomeral shear use the same positions as in torsion treatment. Slide the vomer and sphenoid in opposite transverse directions, first using indirect technique, and then direct technique, applying slow, sustained and very gentle force.

To treat vomero-sphenoidal impaction, carefully modify the spheno-maxillary impaction procedure by setting intention on the vomer and shifting the anterior traction slightly inferiorly.

Zygomatic Bone Treatment

To treat the zygomae, mobilize the sutures through direction of energy. Evaluate by monitoring sphenoid and zygomae. Then with permission, insert an index finger slowly along the upper molars, making sure to gently traverse the masseter, which can be stiff and require direction of energy to release. Contact the zygomatic bone posterior to masseter and apply direct technique, while grasping the bone externally with the fingers to support and monitor movement. Work the opposed zygomatic bone after gaining a release.

Nasal Bone Treatment

To treat the nasal bones, stabilize the frontal and sphenoid with one hand, and very gently grip the nasal bones, applying traction and direction of energy anteroinferiorly. Alternately, thumb and forefinger can be used as magnets to mobilize nasals.

Individual Teeth Treatment

Treatment of the individual teeth is an optional closing for a CranioSacral Therapy session with the hard palate and facial bones. The therapist palpates the teeth by placing the palmar surface of a finger on the biting surfaces. If motion in a tooth is detected, apply slight compression and decompression to invite the tooth to release and resettle.

Treatment Conclusion

At the end of treatment, use the spheno-maxillary synchrony assessment technique to ensure the maxilla and sphenoid are moving in synchrony. Gently rebalance the maxilla if indicated.

Indications for Treatment of the Hard Palate and Facial Bones

In CranioSacral Therapy, treatment of the bones of the face and hard palate are generally indicated. It is shown to contribute to facial relaxation and increased freedom of facial motion, as sutural and osseus structures are mobilized.

Specific indications for treatment include neuromuscular stiffness and pain, TMJ syndrome, facial trauma, dental trauma, sinus and nasal issues, eye strain, trigeminal nerve affectations (tic de la rue), tooth and gum pain, birth injuries, chewing on one side of the mouth, bulimia, Bell’s palsy (facial nerve paralysis), and oral sexual abuse.