CRANIOSACRAL THERAPY

Sarah GuarinoJuly 14, 2014

Origin• (1873- 1954) William Garner Sutherland

• 1899- American School of Osteopathy• Studied “Osteopathy in the Cranial Field” .• Anatomy says skull is fused in adulthood.• Sutherland convinced himself that the bones could actually

move.• Studied skulls and experimented on his own skull with

helmets and straps.

• Developed “The Primary Respiratory Movement” .

The Primary Respiratory Movement

1. Inherent mobility of the CNS• The inherent rhythmic motion of the brain and spinal cord.

2. Fluctuation of the CSF• Pressure builds up and releases.

3. Mobility of the intracranial and intraspinal dural membranes• Pulsating movement.

4. Mobility of the cranial bones

5. Involuntary motion of the sacrum between the ilia 3

Cranial Osteopathy • As the lungs breathe and the heart beats it creates a rhythmic

expansion and contraction.

• According to Dr. Sutherland the CNS also has its own involuntary motion similar to inhaling and exhaling.

• The cranial bones follow this same rhythm which Dr. Sutherland refers to as the “Breath of Life”.

• “Souls breath in the body”.• Considered to carry a subtle yet powerful "potency" or force, which

produces subtle rhythms as it is transmitted around the body.

• This rhythm can affect individual cells and therefore entire body systems.

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Craniosacral therapy

• John Upledger (1932-2012)• In the 1970’s Upledger derived craniosacral therapy from Dr.

Sutherland’s work.

• Cranial bones move in a rhythmic motion that can contributed to CSF pressure or arterial pressure.

• Palpation can detect this movement and pressure can be applied to manipulate the cranial bones to accomplish therapeutic results.

• Common Joints: Skull, face, spine and pelvis 5

Inertia • Over the course of our lives our body adapts to how well we

deal with stress or trauma.

• If a stress or trauma is too overwhelming, it will become locked in the body as inertia until we access a resource that allows us to process and release it.

• Trapped inertia eventually effects our natural rhythmic movement which alters our health.

• Common causes of inertia:• Physical injury, emotional and psychological stresses, birth

trauma and toxicity.6

3 “Tides”

1. Cranial Rhythmic Impulse• Superficial rhythm• 8-12 cycles per minute

2. Mid-Tide• Carries ordering forces into the body at a slower rate.• 2.5 cycles per minute

3. Long Tide• Deep and slow impulse• First stirring of life and motion as the “breath of life” emerges

from a deeper ground of stillness at the center of our being.• Once every 100 seconds

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Historical Acceptance• Many western countries do not accept cranial movement.

• Eastern countries such as Russia, Egypt, Peru and India have been practicing forms of cranial manipulation for centuries.• Acupuncture and Ayurveda are based on the flow of vital life

energy forces.

• Last 15 years- huge increase in interest in craniosacral work.

• Graduate programs in craniosacral therapy being developed.

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Dr. John D. Upledger Foundation • Not for profit • Treatment for those who do not have means.• Education programs• Research • Continues today through John M. Upledger (son).

• Upledger CST workshops • >400 cities• 60 countries

• Private practices• Free clinics

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Indications• Migraine Headaches• Chronic Neck and Back Pain• Motor-Coordination

Impairments• Colic• Autism • Central Nervous System

Disorders• Orthopedic Problems• Traumatic Brain and Spinal

Cord Injuries• Scoliosis• Infantile Disorders

• Learning Disabilities• Chronic Fatigue• Emotional Difficulties• Stress and Tension-Related

Problems• Fibromyalgia and other

Connective-Tissue Disorders• Temporomandibular Joint

Syndrome (TMJ)• Neurovascular or Immune

Disorders• Post-Traumatic Stress Disorder• Post-Surgical Dysfunction 10

The Human Skull

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Cranial Bones

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Sutures*Fontanelle: where two sutures meet in infancy

Vault Hold• Used as a relaxation technique.

• Initial hold to get a feel for the cranial rhythm of that particular patient.

• Pt is supine with therapist seated at patient’s head with their forearms resting on the table.

• 2 minutes or more until you sense cranial motion.• As “inhalation phase” begins you will feel a fullness and your

hands will move laterally away from cranium and caudally.• As “exhalation phase” begins you will notice the palpates bones

moving back together and cephaldly. 14

Vault Hold• Pinky along squamous suture on the occiput.• Ring finger rests behind ear with the distal phalanx on the mastoid

process.• Middle finger rests anterior to ear on the pterion with tip touching

the zygomatic process.• Index finger rests on the

greater wing of the sphenoid bone.

• Thumbs meet (not cross) in the center of the frontal bone not touching the head if possible.

*Pterion: where temporal, parietal, frontal and sphenoid bones meet.15

Vault Hold

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Sphenoid Bone Dysfunction

• 6 cranial nerves associated with sphenoid bone:• II-VI all pass through the bone.• Optic- II, Oculomotor- III, Trochlear- IV, Trigeminal- V (5

branches) and Abducens- VI

• Olfactory- I runs superior to lesser wings.

• Dysfunction of sphenoid can impair any of these nerves and cause symptoms associated with migraines.• Ex: sensitivity to light and sound

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Sphenoid Lift

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• Manipulation of the sphenoid is very particular and requires a certain degree of training to be safe and effective.

• Overview:“Crowd” sphenoid towards occiput and then release and fingers will seem to move towards the ceiling.

Temporal Dysfunction • Common with whiplash or trauma (ex: blow to the head)• Loss of balance• Vertigo • Chronic headaches• Hearing difficulties• Tinnitus• Optical difficulties• Mood swings/ personality disorders• Bell’s Palsy• Trigeminal neuralgia

Use the Bitemporal Rolling Technique.

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Bitemporal Rolling • Therapist sits at head of supine pt. with hands cupped beneath head (cradled).• Fingers should not

cross each other.

• Thumbs on anterior mastoid processes withthe thenar eminences supporting the mastoid bone.

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Bitemporal Rolling

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• Alternating rocking motion into neck flexion and extension.

• Apply minimal pressure through mastoids.

• Follow with synchronous temporal rolling.

Synchronous Temporal Rolling • Same holding position as bitemporal rolling.• During inhalation phase (neck flexion):

• Deep finger flexors exert pressure through thumbs.• Brings mastoids posterior and medially which encourages the

temporal bones to flex normally.• Return to neutral:

• Forearm muscles relax to prevent inhibition of a normal return to neutral.

• During exhalation phase (neck extension): • Slight pressure is introduced through the thenar eminence

resting on the mastoid bone to take it medial and posterior (pulling back motion similar to distraction).• Encourages slight exaggeration of extension. 22

Synchronous Temporal Rolling

• Repeating this motion:• Increase in amplitude of both phases of cranial cycle.

• Gradual acceleration encourages CSF fluctuation.

• Slowing down produces relaxing effect.

• Never lose contact with the cranium in between phases!

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6 levels of tissue separation• From initial contact to final completion.1. Skin, scalp and fascia2. Slower muscular release3. Sutural separation

• Ex: pulling magnet away from metal4. Dural release

• Ex: elastic bands giving way5. Freeing of CSF circulation

• Ex: whole head feels oceanic, tidal, expansive6. Energetic release

• Ex: chemical electric fire spreading in waves under your fingers24

Therapeutic “Release”

• Typical responses to release therapy:• Sense of strong pulsation in area• Greater warmth enters area• Change in tissue tone in that area• Pt becomes flushed; change in skin color• Light perspiration on pts upper lip or brow• Twitching or trembling intermittently • Pt may cry, laugh or have the feeling they might vomit• “emotional release”

• Breathing pattern may alter; slow and deep or rapid• Observe diaphragm 25

Article #1: Multi-practitioner Upledger CST (2011)• Objective: Describe patients presenting for CST, the

conditions they present with and the impact of treatment on both their symptoms or their lives.

• Design: 157 patients records who were treated with Upledger CST (UCST) were reviewed.

• 73 pts had been treated by 10 different practitioners working independently.

• 84 pts treated by a single practitioner working within the National Health Service.

• Neonates - 68 years old 26

Results & Conclusions • Results:• 74% reported a valuable improvement in their presenting

problem.• 67% reported a valuable improvement in their general well-

being and/or a second health problem.• 70% of pts on medication decreased or discontinued it.• Pts average general practitioner consultation rate fell by 60%

in the 6 months following treatment.• UCST is particular effective for pts with headaches and

migraines, neck and back pain, anxiety and depression and unsettled babies.

• Conclusions:• Further research into UCST as a treatment modality would be

valuable for the above mentioned problems individually. 27

Article #2: Is craniosacral therapy effective for migraine?

• Objective: To determine whether or not CST alleviates migraine symptoms

• Cross-over experimental design.

• Criteria: • Between 20-50 years old• At least 2 migraine attacks per month

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Methods

• 20 participants• Randomly assigned to 2 groups: A and B• 6 CST over 4 weeks • HIT-6 Questionnaire 4x (once a week) (time 1-4)

A. Received treatment after answering questionnaire the first time.

B. Answered the questionnaire twice before receiving treatment.

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HIT-6 Questionnaire

1. When you have headaches, how often is the pain severe?2. How often do headaches limit your ability to do usual daily

activities including household work, work, school or social activities?

3. When you have a headache, how often do you wish you could lie down?

4. In the past 4 weeks, how often have you felt too tied to do work or daily activities because of your headaches?

5. In the past 4 weeks, how often have you felt fed up or irritated because of your headache?

6. In the past 4 weeks, how often did headache limit your ability to concentrate on work or daily activities? 30

HIT-6 Scoring

• Never (6 pts each)• Rarely (8 pts each)• Sometimes (10 pts each)• Very Often (11 pts each)• Always (13 pts each)

• Score range 36-78• High scores indicate greater impact on your life

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Results & Conclusions

• Results:• Immediately after treatments and 1 month afterwards

there was significant lowering in HIT-6 scorings compared with prior to treatment.• There was a significant difference in HIT-6 scorings

between time 1 and time 4 (p=.004). • Effect size 0.43-.55

• Conclusion: • Results indicate that CST can alleviate migraine

symptoms.• Further research is suggested.

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Research & CST• Many practitioners don’t believe in it.• Hard to feel.

• Study skull and find sutures to be fused.• Bones fuse after death. • In theory, you would need to test on living tissue.• Unethical

• External factors impact:• HIT-6• Perception of symptoms• Placebo effect

• Hard to test:• Inter-tester reliability is almost impossible.• Intra-tester reliability difficult because each patients rhythm is different.

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When should you not use craniosacral therapy?

• Acute injuries (within 72 hrs.): Will increase blood flow to area

• ROM impairments

• People with severe diseases such as cancer or chronic diseases (arthritis, heart disease) should consult their doctor before having any therapy that moves their joints and muscles.

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References Arnadottir, TS. "Is Craniosacral Therapy Effective for Migraine?

Tested with HIT-6 Questionnaire." The University of Akureyri, Iceland. EBSCO, 2005. Web. 8 July 2014.

Chaitow, Leon, and Judith DeLany. Clinical Application of Neuromuscular Techniques. Vol. 1. Philadelphia: Elseview

Limited, 2008. Print.

"Craniosacral Therapy." Craniosacral Therapy. American Cancer Society, 7 Dec. 2012. Web. 7 July 2014.

Dunn, Sidney N. "Cranial Osteopathy." Cranial Osteopathy. The Cranial Academy, 2013. Web. 6 July 2014. 35

ReferencesHarrison, RE. "Multipractitioner Upledger CranioSacral Therapy: Descriptive Outcome Study 2007-2008." EBSCO. Journal Of Alternative And Complementary Medicine, 9 Jan. 2011. Web. 6 July 2014.

Kern, Michael. "Craniosacral Therapy What Is Craniosacral Therapy."Craniosacral Therapy What Is Craniosacral Therapy. Biodynamic Craniosacral Therapy Association of North America, 2011. Web. 6 July 2014.

Mann, John D. "Craniosacral Therapy for Migraine: Protocol Development for an Exploratory Controlled Clinical Trial." Craniosacral Therapy for Migraine: Protocol Development for an Exploratory Controlled Clinical Trial. BMC Complementary and Alternative Medicine, 9 June 2008. Web. 7 July 2014.

Upledger, John M. "The Upledger Institute." CranioSacral Therapy. The Upledger Institute, 2011. Web. 8 July 2014.

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