CranioSacral Therapy Techniques for Whole Body Evaluation

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

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

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

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

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

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

Evaluation of the CranioSacral Rhythm

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

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

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

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

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

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

4. The anterior superior iliac spines of the pelvis (ASIS)
   
5. The anterior inferior costal region
   
6. 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.

7. 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

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

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.