CranioSacral Therapy
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CST
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CranioSacral Therapy Techniques by Michael T. Burcon, B.Ph., D.C. The membranes of the CranioSacral system include the Dura mater, the arachnoid membrane and the pia mater. These meninges surround the central nervous system. The Dura mater is a tough fibrous membrane. It is the outermost covering of the brain and the spinal cord. The pia mater (Latin for “tender mother”) is the innermost layer with the arachnoid forming a web like membrane in between. The space between the arachnoid and pia is called the subarachnoid space. This space is filled with cerebrospinal fluid (CSF). CSF is an excellent shock absorber that protects the brain and spinal cord, which are delicate. It is primarily produced in the choroid plexus and is actually super purified blood. I consider it to be the most perfect substance in the human body. It nourishes the entire brain and spinal cord. The production of CSF is not completely understood, but it also occurs in the temporal horns of the lateral ventricles, the posterior portion of the third ventricle and the roof of the forth ventricle. In its most basic sense the CranioSacral system functions as a semi-closed hydraulic system pumping CSF from the cranium to the sacrum at a rate of about six cycles per minute. To accommodate these pressure changes, the bones of the cranium and sacrum must remain somewhat mobile. Dr. Upledger disproved the commonly held theory that the sutures of the skull fully ossified in adults. The rise of cerebrospinal fluid, flexion, can be felt throughout the body as a minute external rotation. Likewise, the fall CSF pressure causes “inrolling.” The anatomical attachments of the CranioSacral membrane for each of the four divisions of the free CranioSacral Dural membrane system are very important to the technique and philosophy of CranioSacral Therapy. The divisions are the Falx Cerebri, the Falx Cerebelli, the Tentorium Cerebelli and the Spinal Dural Tube. Within the cranium the Dura mater also compartmentalizes each structure and separates one from another and the right from the left side. The Falx Cerebri is narrow anteriorly and attaches to the floor of the cranial vault at the Crista Galli of the Ethmoid Bone and the Internal Vertical Midline and Ethmoid Notch of the Frontal Bone. It is posteriorly attached to the Internal Occipital Protuberance and the Vertical Line of the Occipital bone. Superior attachments include the underside of the Frontal, Parietal and Occipital bones along the midline and beneath the Sagittal suture. It is inferiorly attached to the Tentorium Cerebelli. It includes the superior Sagittal sinus, inferior Sagittal sinus and the straight sinus. The Frontal Lift can release the sutures of the frontal bone and the anterior/posterior aspect of the Falx Cerebri. This technique can help with headaches, spastic cerebral palsy, personality problems, sinus problems, visual problems and problems with smell. Additionally, the Parietal Lift can help release the temporal-parietal suture with medial compression on the parietal bones followed by a ten second release of pressure. The second part of this technique helps release the superior/inferior aspect of the Falx Cerebri. This can help with vertigo, fainting, hearing problems and TMJ. The Falx Cerebelli divides the cerebellar hemispheres through the midline. The horizontal Tentorium Cerebelli divides the occipital lobes of the cerebrum above from the cerebellum below. The horizontal part of the intracranial membrane system can be mobilized by sphenoid compression/decompression and the ear pull technique. The dura has firm attachments to the foramen magnum. The cervical spine is stabilized posteriorly by the ligamentum nuchae. In the midline between the first and second cervical vertebrae, atlas and axis, there is a fibroelastic ligamentous attachment to the cervical posterior spinal dura. As the ligamentum passes cranially, part passes bilaterally to the posterior aspect of the base of the Occipital bone, stabilizing the head during rotation of the cervical spine. A connective tissue bridge has been noted between the rectus capitis posterior minor muscle and the dorsal spinal dura at the atlanto-occipital junction. The spinal dura tube also attaches to the posterior bodies of axis, C2, and C3. These aforementioned attachments play a large role in neck pain. As an upper cervical specific chiropractor, it is very important to me that the spinal dural tube does not have any firm attachments again until it reaches the anterior portion of the canal at S2, where it blends with the periosteum of the coccyx. Simply stated, this means that the tube is relatively free floating throughout the back. To me, this means that very few spinal adjustments should be done in the back. It is usually better to work at one, or both ends of the spine for the best results. In chiropractic school, we were shown a video of a seriously ill patient. In surgery, the covering of the dural tube was exposed at atlas and the base of the sacrum. When the tube was lightly touched at one end with a surgical instrument, the opposite end would “jump.” This proved to me that a sacral problem could cause trouble in the upper cervicals/lower cranium, and that an upper cervical problem could cause a sacral/lower extremity symptom. Likewise, a specific adjustment at one end could correct a problem at the other. The same is true with CST. Recently James and Rhonda Tomasi, authors of the book, “What Time Tuesday?” spent a day in my office talking with my patients. James and Rhonda are upper cervical specific chiropractic advocates ever since he found relief from Trigeminal neuralgia with this type of care. They were surprised to observe me adjusting a sacrum and doing CST. Their emphasis is on “upper cervical,” mine is on “specific.” When a symptomatic Meniere’s patient, whose case I was familiar with, came in and had a cervical thermograph that was in pattern of subluxation, I cleared her out with sacral adjustment. Her atlas locks tight against her occiput and is difficult to adjust. The Occipital Cranial Base Release also works well in this situation. (I am reluctant to use it with an anterior atlas, but almost all of Meniere’s patients’ atlases are very posterior. Her post graph was clear and she was symptom free after her rest. My father used to say, “There is more than one way to skin a cat!” CranioSacral Therapy (CST) 10 Step Protocol 1. Still Point Inductions Note: Inducing a still point is one of the more invasive, yet effective, CST techniques. One follows, and then opposes, the flow of cerebral spinal fluid, bringing it to a temporary standstill. The result is like rebooting the body’s computer, the brain. When the flow resumes, the therapist will notice an improvement in the quantity and quality of fluid traveling from the skull, down and back up the spine, facilitating homeostasis. A. CV-4 Head Hand Placement: Patient supine, therapist seated at head of table with back of hands on table. Place one hand over the other, thumbs touching. Thenar eminences are apart, cradling the occiput. Technique: After following and analyzing the flow, the therapist gently resists flexion, or widening of the head, stopping the filling phase of CSF. After this short rest, one senses the job is complete and removes the restriction, allowing the flow to resume. Then the therapist rechecks the flow, reassessing its qualities. This subtle, yet possibly life changing hold is often done at the beginning and end of a session. The list of possible improvements to health is practically endless. B. Sacrum A still point can be induced at the other end of the system by cradling the posterior sacrum, in addition to, or instead of, at the occiput. Resist the posterior motion at the base (top) of the sacrum during flexion (filling). C. Feet Although with practice, a still point can be achieved by working anywhere on the body, the feet present another excellent location. During flexion, the feet and legs rotate externally (outward). 2. Diaphragm Releases A. Pelvic Posterior hand: Transverse under L5/Sacrum Anterior hand: Transverse over pubic bone Function: Supports pelvic organs against gravity Dysfunction: Pain, sexual problems, trouble voiding, hemorrhoids B. Respiratory Posterior hand: Transverse under T12/L1 Anterior hand: Lower ribs/xiphoid process Function: Huge dome shaped sheet of muscles whose primary purpose is respiration Innervations: Phrenic nerve which originates at C3/4/5 Dysfunction: Most Americans do not breathe correctly Can cause many problems including acid reflux, visceral problems, asthma, panic attacks C. Thoracic (Inlet/Outlet) Posterior hand: Transverse under C7/T1 Anterior hand: Thumb and second finger on sternoclavicular joints Note: I was amazed at how small this inlet was in human dissection Dysfunction: Neck, shoulder, elbow, wrist problems D. Hyoid Posterior hand: Fingers cupping cervical spine, second finger on Occiput Anterior hand: Thumb and second finger on cornua of hyoid bone Dysfunction: Thyroid, chewing, talking, TMJ, acid reflux Note: Many patients are uncomfortable with palpation in this area E. Cranial Base (Occipital) As an upper cervical specific chiropractor, this is my area of greatest interest. Philosophically, I believe if a person’s atlas is subluxated, the body will actually sacrifice the lower extremities to protect the lower Cranial nerves. Often the eyes and ears are leveled to the horizon by a shift in the pelvis, causing one leg to appear “short” relative to the other. Any body worker can “unwind” the pelvis through a variety of techniques, but without correcting the upper cervical subluxation complex, the problem will return. My experience has shown me that it takes an average of fifteen years between the time of the trauma that caused the atlas subluxation to the day that the patient presents in my office, complain god low back, sciatica, knee or foot problems, etc. This is why it is imperative to listen at several “stations:” feet, thighs, ASIS, diaphragm, thoracic outlet, shoulders, skull etc. Hand position: The muscles at the Occipital base are thick. Clients with chronic whiplash type symptoms often present with these muscles almost as hard as a rock. Unlike all the other CranioSacral holds, this release requires more practice, patience and caution. First, your fingers need to be bent 90 degrees from your hands which on flat on the table. Next, you need to place your finger tips between occiput and atlas. This is difficult because the two are often jammed together posteriorly in chronically ill patients. Finally, since the weight of the patients head is facilitating the release, much more pressure is being created than any other CST hold. The time required for these muscles to soften varies tremendously. Contraindications: Recent upper cervical or skull fracture, Arnold Chiari malformation, Down’s syndrome, recent stroke or spinal tap, and hemorrhage, aneurysm, tumor or herniations in the area. Results: This is one of those moves when performed correctly on a patient that needs it, can be life changing. 3. L5/S1 Traction Release (Decompression) Core Intent: To decompress the sacrum inferiorly from L5 Hand Placement: One hand between the legs posterior to sacrum, lightly pulling down, while the other hand transversely stabilizes posterior aspect of lower lumbars Note: This is one of those holds that you need to explain and gain permission before performing. I find it effect on pregnant women and fractures of L5. ASIS Medial Compression (Iliac Gap) Core Intent: Releasing SI joints Hand Placement: One hand posterior to sacrum while the other hand’s fingertips and forearm lightly compress the ASIS Note: This another helpful technique for pregnant women and those with sciatica after delivery 4. Dural Tube Objectives: Effective move to both evaluate and mobilize the dural tube. Remembering that the dural tube is aggressively attached only at its two ends, this gentle technique is equally informative as it is effective. (There is more than one way to skin a cat! Some chiropractors work only at the top of the spine, while others adjust exclusively qt the bottom. Either is effective with the right intent. I enjoy working with both. A. Rock Hand Placement: Patient supine, one hand transverse under occiput, the other transverse under the sacrum, rocking back and forth with the craniosacral rhythm. (Can also be done with patient on side) Core Intent: Releases rotational subluxations, often alleviating low back pain. B. Glide Very similar to rocking, but the emphasis is on longitudinal motion. Lengthening can remove nerve root pressure along the spine. 5. Frontal Lift (Vertical Membrane System) OK, so this is a move I was skeptical about when first introduced to it. The therapist is expected to lift the frontal bone with their “sticky” fingers. The results include improvement with headaches, sinus problems, visual problems, mood problems, frontal head trauma, spastic Cerebral palsy and decreased ability to smell. 6. Parietal Lift (Vertical Membrane System) A. Part One Core Intent: To release temporal/parietal suture with medial compression on parietal bones. Shown to help ear problems. B. Part Two After short pause following part one, apply gentle cephalad traction 7. Sphenobasilar Compression/Decompression (Horizontal Membrane System) The Sphenoid bone looks like a beautiful butterfly. It forms the floor of the cranial vault and articulates with twelve bones! It is home to the extremely important pituitary, often called the master gland. Unlatching Principle: The sphenoid is a little tricky to address, due to its depth within the skull and the number and complexity of the articulations. To achieve decompression, it often helps to first apply compression. Hand Placement: Thumbs on greater wings (temple area) with fingers under skull, pushing down for compression, then up for decompression. 8. Temporal Techniques (Horizontal Membrane System) A. Temporal Wobble Hand Placement: Thumbs on lateral aspect of mastoid processes, fingers cross, cupping the occiput, releasing occipital/mastoid sutures. B. Finger in Ear (Circumferential) Hand Placement: Middle fingers gently placed in ears (must ask permission in Michigan to be in accordance with scope of practice laws), fourth finger on mastoid process and second fingers on zygomatic processes. Core Intent: Release temporal bone sutures by hands around middle fingers, second fingers forward, fourth fingers back, while therapist seated at head of table. C. Ear Pull (Temporal Decompression) Note: I was lucky and had a great teacher during my chiropractic externship. Dr Bowler was very conservative in doing adjustments. In fact, during my three months working with her, I never saw her adjust the same patient twice. If, after extensive examination and analysis, no adjustment was given, the rest of the session would be devoted to CST. During my first month, all I did was hold patients’ feet. I was not allowed to talk, except to answer direct questions. Meanwhile, Dr Bridgette most commonly performed ear pulls. (The funny thing was how many patients worried that their ears would stick out afterwards.) Hand Placement: Thumbs in E.A.M., fingers holding ear cartilage, gently pulling in a lateral and slightly posterior (strictly lateral in children) direction, releasing the lateral aspect of the tentorium cerebelli. 9. TMJ Compression/Decompression Note: The Temporomandibular joint takes a beating. Problems with this joint are so common that most patients call its dysfunction by the name of the joint itself, TMJ. As an upper cervical chiropractor, I find atlas adjustments often help. When more help is needed, I do CST. If the joint does not clear out then, I work with a dentist that is sensitive to this problem. Hand Placement: Third and fourth fingers contact ramus of mandible utilizing the unlatching principle of compression, followed by decompression. 10. Still Point (CV-4)/V-Spread Repeat CV-4 as outlined in step 1. According to your findings during these ten steps, and as therapy time allows, the therapist may chose to return to addressing a problem area with a V-Spread. Energy can be sent from the fingertips of one hand to the fingertips of the other hand, through the problem area. This can be achieved from any two points on the body that you are inspired to work from. Either hand can be place at either end, but I tend to think of my right hand as positive and my left hand as negative. From my forty years of experience with magnetic healing, I would attempt to put energy into a fatigued area and remove energy from an overcharged area, say a cancerous tumor. James came in for his first visit last June. His complaints were vertigo, tinnitus and cervicalgia. He had a history of a serious car accident in 2002 and a several minor sports injuries over the years. He is twenty six years old. He was an avid golfer and runner, but gave them up after his medical doctor scared him suggesting he might have Meniere’s disease. He had also been laid off recently. Although he said he was OK with that, I have noticed recently with the difficult economic climate in Michigan that these stresses definitely add to patient’s physical and emotional challenges. I adjusted his upper cervicals of his first two visits and his vertigo calmed down to mild dizziness. Then he mentioned that he was getting physical therapy and injections in the muscles along his thoracic spine because he was having trouble taking a deep breath. He said it was preventing him from returning to running. I checked and adjusted his ribs, where we found a few problems. I suggested a CranioSacral therapy session instead of an adjustment on his next visit and he was open to it. I also suggested that the shots did not honor the wisdom of his body and that I had difficulty seeing how they could improve his ability as an athlete. He had mixed emotions about my comments, so I let it go. I started CST at his feet. The symmetry, quality, amplitude and rate of his craniosacral rhythm appeared normal. I noticed nothing unusual until I got on his respiratory diaphragm. I could barely keep up trying to follow his lead in unwinding his diaphragm. After twenty minutes things slowed down and I felt the warmth of a release. James took a very deep breath and smiled. I checked the rest of the listening stations, spending some time trying different holds on his cranium. Nothing exciting was happening, so I returned to his respiratory diaphragm for some energy work. The V-Spread seemed to finish the job and he offered that he did not think he should get any more shots in his upper back. James said he was surprised that I focused on his diaphragm. He had some body work done in the past and was told he had a problem there. He did not mention it because his discomfort was focused in his upper dorsals. On his last visit I checked him chiropractically and no adjustment was needed. I spent more time on his respiratory diaphragm, but nothing much was left in the way of resistance. James said that he had decided to train for the iron man competition and had registered for the prereqs that he needed to apply for DO school. It was something in the back of his mind, put his poor health over the last year caused him to focus more on getting to the bottom of his problems first. I told him that I whole heartedly supported his decision and to let me know if I could help in any way. Before we can describe a release, I think we need to explain what can cause the problem that needs to be released. When an individual experiences a trauma, the physical force entering the person’s body can either be quickly dissipated, or it can be stored as an unwanted energy cyst. Often, this cyst has both physical and emotional negative characteristics that linger for years, if not decades. These cysts take their toll. They rob the vitality of the body and cause fatigue as the body compensates and adapts to working around them. It seems that these areas of the body have their own memory of the trauma, separate from their mind. The therapist’s hands are often drawn to these areas like magnets. Once one is found, it is important to stay with it until it is released. Signs of release include softening, lengthening, increased fluid flow, increased energy flow, heat, energetic repelling, therapeutic pulse and/or the patient taking a deep breath. I most commonly find heat as a signal. Tissue releases can also be experienced in any articulation throughout the body, including sutures. Releases are common in connective tissue, including muscles, tendons and ligaments. The fascia works as a system, so a release in one area can facilitate an improvement in the flow of cerebral spinal fluid elsewhere. CST is a method of restoring electromagnetic balance. Myofascia is connective tissue that holds organ systems and musculature together, and gives the body its shape. Through this interconnecting myofascial system, any injury or illness which results in contracture or swelling can affect the whole body. Areas of clinically significant change can produce fascial rigidity. Any kind of scarring or adhesion can create long-standing problems in the elasticity of myofascia. Postural dysfunction, athletic stresses, injuries and biochemical or electromagnetic imbalance will disrupt the myofascial balance. Restrictions can result from adhesions, inflammation, infection, dysfunction, or neuroreflexes. When the restriction is loosened, it is called a release. Often the body can't discharge accumulated stress because there is insufficient opportunity. We tend to accumulate more energy from stressful situations than is dissipated. Any joint is a potential cross-restriction to the free movement of the fascia. There are even three membranes around the brain which are capable of independent motion. CranioSacral Therapy is a light-touch hands-on approach that facilitates the body’s innate healing capabilities. For nearly 30 years is has been shown to be effective for a wide range of medical problems associated with pain and loss of function. CST is useful as both a primary treatment method and combined with other traditional or complementary techniques. It is performed with you fully clothed on a comfortable massage table in a relaxing setting. Short answers have always been the hardest for me. Explaining upper cervical specific chiropractic and/or Craniosacral Therapy in the check out line still makes me joke after fifteen years of practice. All great concepts are simple and tend to be understood by a ten year old. Unfortunately, with twelve years of college, I seem to make it more difficult than necessary. b. How can it help me? Unfortunately I do not know exactly how it can help you unless you decide to try it and allow me to do a thorough hands on examination. Then I would be happy to suggest an answer. Honesty is always the best policy. c. How many sessions will I need for my problem? Again, everyone is different. That is what makes this work so interesting. I can tell you that the average in my practice is six visits, with the first visit often being the most helpful. Many patients choose to come back monthly for maintenance. It takes time to get to know a person’s body, just like it takes a while to get to know their personality. d. I didn’t feel much, why not? Again, everyone responds differently, and each session gets different results. I can tell you that patients have told me that, “It didn’t so anything!” Then they call me from home startled, because they had a release while driving home. Americans are brain washed into thinking that drugs and surgery will fix anything. We are not a “touching” society. We want immediate results. e. How come I feel pain in my ______ when I did not feel it at the beginning of the session? After a session you will feel better, worse or the same. Of course it is wonderful if you feel better. But some people are not that lucky. They have to revisit some old problems before letting them go. You were stuck. The important thing is that you feel differently. Rarely is the site of pain the origin of the problem. More likely it is a sign of your body’s attempt to adapt and/or compensate in an effort to deal with the problem. Americans tend to be spoiled. We expect instant relief with no investment of time. I worked on a new born my first month in practice. She had refused to nurse. Fifteen minutes of CST and the problem was solved. (I thought she was going to take the tip of my little finger off!) Kids are people. We are born with most of the knowledge that we will die with. The most common problems we address are from birth, if not before. The sooner we release them, the better, and the easier. Recently got a call from a Mom saying she had given birth thirty six minutes prior, when could I be there? I checked both of them out (the only way I am willing to approach it). It was not like, OK, now I am touching a BABY, I best be careful. Absolutely no difference. I put my hands on, and follow… I worked on a ninety year young woman today who recently had a minor heart attack. She was dizzy. Was I careful around her upper neck? Yup. But what was the alternative? More drugs? I don’t think so. I am also careful doing a posterior hold on someone with an anterior atlas. Most symptomatic patients have a posterior atlas (anterior occiput), so no problem. The CST therapists I employee occasionally induce a headache, vertigo or facial pain in these patients. I never have, nor do I have trouble correcting these problems. Arnold Chiari malformation is often mentioned as a contraindication to several therapies. In this over diagnosed condition, the foramen magnum is considered to be too large, allowing the brain stem and Cerebellum to sit too low creating irritation. Medical approach? Make the hole bigger! As a doctor, I would try a less invasive approach. (First, do no harm.) It is important to come to an agreement with the client as to what they are comfortable with. “Mrs. Smith, some therapists feel that there is some risk involved in working with the upper neck of your Down’s child. I have never had a problem, and there are usually huge benefits. Do you have any questions or concerns, or do you wish to discuss treatment with your daughter or husband before we begin?” A little common sense goes a long way. A therapist can always do more on another visit, but we can not take anything back. I recently had a mother go home and ask the father for permission. He told her to ask the pediatrician. The MD said it was OK to treat with CST, but only once or twice. I thought that sounded silly, but, Baily is not my kid. We did one session and it went well. The movement between the sphenoid and the occiput has long been considered a primary focus in CST. The sphenoid and occiput, which occupy two-thirds of the base of the cranium, is a point of attachment for the falx cerebri, falx cerebelli and tentorium cerebelli, the major dural structures in the cranium. Their connections with the petrous portion of the temporal bones create foramen through which pass the majority of blood vessels and cranial nerves. In the osteopathic model developed by Dr. Sutherland and later presented in books by Upledger, the following "movements" occur between the sphenoid and occiput near or at the sphenobasilar junction: Flexion/Extension Torsion (Right and Left) Sidebending (Right and Left) Vertical Strain Lateral Strain Sphenobasilar Compression Palpation of the various movements within the "sphenobasilar junction" utilizes common palpatory landmarks such as the greater wing of the sphenoid (bilaterally) and the base of the occiput (primarily the lateral angles as they approach the mastoid process). In testing for sphenobasilar movement, gentle pressure is applied to the cranium while simultaneously feeling for a response. With each direction of movement, the testing is performed in opposing directions to determine any restrictions. The amount, length, and degree of movement are evaluated. Much of this movement will be appreciated as a compliance or tissue resilience. This compliance to an initiating force should be balanced in all directions throughout the cranium, specifically as related to the sphenobasilar junction. With the patient laying in a supine position, and the examiner at the head of the table, the doctor contacts (bilaterally) the greater wings of the sphenoid with his/her thumbs while the occiput rests in the fingertips of both hands. A subtle force is initiated in the direction of flexion: the doctor presses the greater wings of the sphenoid and the occiput caudally. The sphenobasilar movement is monitored and allowed to return to a neutral position. The sphenoid and occiput are then gently directed into extension: the doctor draws the greater wings of the sphenoid and occiput towards the cranial vertex. Various movements can be applied to help correct for restrictions or imbalances discovered during testing. One of the most effective techniques is the "indirect technique" which involves maintaining the cranial mechanism in its position of least restriction (and greatest movement) as the cranium "relaxes". As rebalancing occurs, there will often be a softening, a "relaxing sensation," and a warmth noticed in the tissues Maintaining the same contacts as used in the flexion/extension technique, the right greater sphenoid is directed caudally while the left great wing of the sphenoid is directed superiorly. Simultaneously, the right occiput will be directed superiorly while the left occiput is directed caudally. The movements are then reversed. This movement creates a torsion force directed at the sphenobasilar junction. A right torsion would mean that the right sphenoid was high in relationship to the left. Side-bending rotation in the sphenobasilar joint occurs when there is an approximation between the greater wing of the sphenoid and the occiput causing the cranium to rotate superiorly on that side (essentially, the greater wing and occiput rises on the side of their approximation). Conversely, on the opposite side, there is a lengthening, a spreading apart, with a consequent convexity or bulging of the skull. This is accompanied by an inferior rotation of the cranium on that side. This side-bending disturbance of the sphenobasilar junction is named according to the side of the convexity. Flexion/extension, torsion and side-bending distortions of the sphenobasilar junction are considered to be within physiological constraints of stress to the meninges and associated cranial structures. Lateral and vertical strains, as well as sphenobasilar compression, which are often caused by trauma, are considered to be more serious lesions. In testing for a vertical strain, the occiput is first directed into extension while simultaneously directing the sphenoid into flexion. This is done by first directing the greater wings of the sphenoid caudally while simultaneously directing the occiput superior/anteriorly (towards the examiner). The opposite movements are then applied and monitored accordingly. Testing for a lateral strain involves the practitioner's awareness of the axis of rotation at both the sphenoid body and the foramen magnum of the occiput. While testing for a lateral strain, the occiput and the ipsilateral sphenoid are both directed anteriorly while opposing lateral forces are applied. In correcting for lateral strain on the right, for example, both thumbs are placed on the greater wings of the sphenoid with the fingers contacting the lateral borders of the occiput. The right thumb and fingers direct both the sphenoid and occiput anteriorly while concurrently, the right thumb presses the greater wing to the left. Simultaneously the left thumb and fingers direct the sphenoid and occiput posteriorly while concurrently the left fingers direct the left side of the occiput towards the right. Any obliquity of the sphenobasilar junction can then be appreciated. Movement should be equal bilaterally. Sphenobasilar compression is determined by an overall restriction to movement throughout the cranium. To release A/P sphenobasilar compression, the doctor, contacting the greater wings of the sphenoid and occiput, attempts to draw them apart. As this gentle traction is maintained, an unwinding and releasing of the sphenobasilar symphysis and its associated structures will generally occur. Dr. Upledger, in his book Craniosacral Therapy, presented a method of releasing compression between the petrous portions of the temporal bones. He called the technique "Lateral Cranial Base Compression" which involves a direct separation of the temporal bones by contacting the pinna of each ear. The pinna of the ears are grasped and a gentle, lateral traction is applied along the direction of the petrous portions. As this traction is maintained, a releasing and an expansion will be felt in a lateral axis. When it is difficult for the doctor to maintain a constant contact of the pinna of the ear, one finger directed into the external acoustic meatus, with the other fingers simultaneously contacting the base of the ear, is often an effective alternative. Melding, also called blending, is a form of connecting that helps you tune in on many levels. It requires presence, intention and attention to sensory input. Therapeutically, I blend with my clients in general. I also blend with their desire to rebalance their inner wisdom, their structural and energetic restriction patterns and their emotions - all with the intention of facilitating their health. In a non-therapeutic setting, blending helps us understand situations, dynamics, dangerous settings, traffic issues, relationship challenges and more. We all blend to some degree on a daily basis. How consciously we do it is an individual choice. Melding is accomplished with palpation and perceptions, 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. 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. Letting the hands alone become the source of perception. From this position, one can extend one’s physical boundaries to “meld” with the patient. 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 so that one can accept what one experiences as valid. 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. Simply stated, if you can not meld with the patient, you can not perform CranioSacral Therapy. The idea behind energy cysts is this: When an accident occurs, the energy of the accident enters the body. This fits with the laws of thermodynamics, which tell us that energy cannot be created or destroyed. They also tell us that the natural tendency of atoms, molecules and energy is toward disorganization. When this external, disorganized energy - the "energy of injury" - is forced into the body, it penetrates into the tissues to a depth determined by the amount of force versus the density of the tissues. This force is countered only by the density of the tissues it is trying to penetrate. A fall on your backside on a hard surface might travel all the way up the spine, bounce off the skull, creating a problem in the upper cervicals. Once it reaches its depth of maximum penetration, it stops and forms a localized "ball" of energy that doesn't belong there. If your body is vital and able, the "energy of injury" can dissipate and normal healing can occur, but if your body is unable to dissipate this energy, it is compacted into a smaller and smaller ball in order to minimize the area of disruption to tissue function. As it becomes more compressed and localized, the disorganization within this compressed energy increases until it becomes an "energy cyst." A person can adapt to energy cysts; however, over time, the body needs extra energy to continue performing its day-to-day functions. As years pass and the body becomes more stressed, it can lose its ability to adapt. This is when symptoms and dysfunctions begin to appear and become difficult to suppress or ignore. Fortunately, a technique called "Energy Cyst Release" can help deal with these particular challenges. It is an effective way of encouraging the body to release those areas of blocked energy and accelerate a full recovery. Eliminating energy cysts can vary from simply holding the area of the body with healthy intent until a release is felt by a release of heat to following the part of the patients body as it unwinds the old trauma to energy work where positive energy is directed into the cyst or negative energy is offered a conduit to leave that persons body. With practice this therapy tends to become less physical and intellectual and more about energy and emotion. The concept of the facilitated segment is highly relevant to neuromusculoskeletal and psychoemotional problems. The word "facilitated" usually has a positive connotation, implying that some process is made easier or more efficient. In the case of the facilitated segment, however, it means that the stimulus threshold in a particular spinal cord segment has been reduced. This means that the facilitated segment of the spinal cord is highly excitable, and that a smaller stimulus will trigger excessive impulse firing in the segment. A facilitated segment produces a palpable change in tissue texture. The local paravertebral muscles and connective tissues develop a "boggy" feel, and joints in the area are less mobile. The tissues are tender to the touch and often painfully irritable. Edema under or rash on the skin is often present. Sympathetic system dysfunction at the level of the facilitated segment also produces changes in skin texture, sweat gland activity, and capillary blood supply to the skin. CranioSacral Therapy is particularly helpful with facilitated segments, in that it reduces autonomic tone (sympathetic activity); reduces general stress and anxiety; enhances endocrine function; assists in postural balancing; and improves fluid exchange. It's also extremely helpful when used to mobilize the dural tube within the spinal canal, because restrictions of the dural tube, or its sleeves, contribute to segmental facilitation. To locate these areas of restricted mobility, the therapist tests the mobility of the dural tube and releases restrictions as they're found, using gentle traction techniques. These releases are mandatory - if a peripheral restriction is released, but the dural tube restriction and facilitated spinal cord segment are not, the peripheral problem usually reoccurs. Once the peripheral body and the dural tube have been treated for restrictions, the therapist can focus on the cranium and sacrum. During this time the therapist also helps correct both primary and secondary dysfunctions of the skull bones, facial bones, hard palate and sacrococcygeal complex. All related sutures and joints are gently mobilized. The therapist then focuses on correcting abnormal dural membrane restrictions, irregularities in cerebrospinal fluid activities, and dysfunctional energy patterns and fluctuations related to the craniosacral system. I do believe one has to be careful in discussing segments. Anatomy texts break down the spinal levels into sections; cervical, thoracic or dorsal and lumbar, the sake of discussion. But as far as ones body is concerned, the spinal cord, even the brain itself, is all one structure. To think, “Ah hah, I see the line dividing the spinal cord from the brain stem,” will get you into trouble. Yes, the problem will be centered in a particular area, but the spinal cord and nervous system tend to be either relaxed or irritable as a whole. One of the principles of the CST is the unlatching phenomenon. It is similar to the process of opening or closing a drawer that is jammed. When trying to open the drawer, it is a good idea to gently close the drawer all the way again, thus realigning the mechanics. Opening the drawer again will be smooth, simple and easy. With the human body it can be the same. The therapist allows the patient to relax, giving the joint time to close all the way. The joint will allow itself to realign, and then go on to open up fearlessly and become aware that there is no need to stay in spasm and tight, a natural protective mechanism of the body when in danger. The body gets an insight that the protective mechanism is no longer necessary. I find unlatching particularly helpful when working with temporomandibular joint dysfunction. To decompress the joint, it often works better to first compress it for a short time. Note: There are sentences and paragraphs throughout this paper that are quotes borrowed from Dr. John E. Upledger, other members of The Upledger Institute and other CranioSacral therapists. |
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