CranioSacral Therapy

Why are some children born with, or develop, grave illness?

Jordan was two and a half when he came to the clinic with his mom. He was diagnosed with an inoperable brain tumor six months earlier. His mom said his speech was declining; he was loosing the use of his left arm and hand, which he called “lefty”; his sight was getting blurry; his organs were slowly shutting down; and his head was hurting more and more. He’d have good days and bad days although bad days were sweeping away the good ones.

I treated Jordan twice a week for a little over a year until he was too frail to come to the clinic; he stayed at home in the loving care of his mom and dad, with snuggles from his kitty Momo. He sank deeper and deeper into the grip of the tumor, which was smashing down upon his brainstem.

While I was working in the clinic Jordan’s dad called. “Hi Tad, Jordan passed away yesterday afternoon; he was home in bed, comfortable and peaceful.” He said more but I couldn’t hear anything else, only that Jordan was gone.

That evening I finished late, the clinic was quiet, I thought everyone had gone home when I heard Dr. Upledger’s familiar stride coming down the hallway. He sat in a chair beside my desk, smiled and said, “How are you?” I said, “I’m OK, well not really, I want to quit.” “Why do you want to do that?” was his calm reply.

After listening to my description of Jordan he asked, “Did you do everything you could do to help him?” I paused then said, “Yes, everything.” He took a slow breath, “That is all we can do. I know you helped him in many ways, maybe not changing the final outcome but you did help him.” I didn’t say anything but thought, “Yeah, so what? He died anyway.” He said, “Don’t stay too late, go home, and get some rest. Call me if you’d like, any time, OK? I’ll see you tomorrow.”

I stayed at the office for a while longer. Did Craniosacral Therapy help Jordan at all; did it help him have greater ease while he lived or as he passed? Dr. Upledger helped me accept that Jordan had his own path upon this earth and I was fortunate to accompany him for a brief period.

It dawned upon me one day that children with disorders are bodhisattvas, wisdom-beings of great compassion. They ask of us one thing and that is to be fully present, to softly stay in the moment, no matter what may be happening. They are beings of pure light illuminating the way for all of us to sense beyond physical manifestation into the heart of acceptance, kindness, understanding, listening, and love.

The 10-Step Protocol is a sequence of evaluation and treatment techniques that were developed by Dr. John E. Upledger, D.O., O.M.M. The steps are an effective way to treat a wide range of client conditions, and the steps form the foundation of all the techniques used in Upledger CranioSacral Therapy.

The Upledger Institute has recently posted the entire 10-Step protocol on You Tube. The videos are presented in separate steps. A You Tube search for “CranioSacral Therapy Upledger” will locate the videos. Here is a link to the video on “Stillpoint Induction” http://www.youtube.com/watch?v=gZSVzAoeQ8Q

Even though a number of Upledger techniques and concepts have changed over the years it is helpful to review the material while keeping the changes in mind. Watching and listening to Dr. Upledger is a good review and a helpful reminder to rest fully in the groundwork of CranioSacral Therapy.

Abnormal brain shape may be a factor in autism spectrum disorder (ASD).  Structure and function are inseparable; alterations in one, to some degree, will modify the other.  CranioSacral Therapy can help optimize brain structure, which often improves function.

The irregularly shaped brain areas associated with ASD are the:

• amygdala,
• hippocampus,
• corpus callosum,
• cerebellum.

The amygdala regulates emotions and aggression. The hippocampus is involved in learning and memory. The corpus callosum is the main pathway for brain intercommunication.  The cerebellum is linked to movement control as well as attention shifting.  Dysfunction of these structures may explain some of the atypical behavior seen in ASD.

A primary focus of CranioSacral Therapy is helping the body decrease structural stress so the body can improve function, which has been shown to help those with ASD improve communication with others, enhance interaction with their surroundings, and promote a feeling of inner ease.

Over time several theories have been proposed to explain the motion of the craniosacral system.  Two are presented below.  They are “The Pressurestat Model” and “The Traube-Hering-Mayer Oscillations Model”.

The Pressurestat Model.

In this model cerebrospinal fluid is produced in continuous on-and-off phases lasting approximately 3-5 seconds per phase.

During cerebrospinal fluid production the total amount of fluid within the craniosacral system (CSS) increases. This increase in fluid raises the pressure within the CSS and causes it to expand.  During non-production of cerebrospinal fluid the total amount of fluid within the CSS decreases.  This decrease in fluid lowers the pressure within the CSS and causes it to contract.

The raising and lowering of pressure within the CSS creates the craniosacral rhythm.

The Traube-Hering-Mayer Oscillations Model.

Traube-Hering-Mayer oscillations are a mixture of rhythms created by the the sympathetic tone of autonomic nervous system, blood pressure, heart rate, blood flow, cerebrospinal fluid movement, and breathing.  These oscillations blend to create the craniosacral rhythm.

“Is there a special chart for CranioSacral Therapy sessions?”

I am not aware of a special chart for CranioSacral Therapy sessions although many practitioners use the standard SOAP note chart. Recently I created the chart shown in this blog. I’ve found it helpful in my practice so I wanted to share it with you.

Another question I’m asked about charting is, “How do you remember what the client worked on during a session if you can’t chart it immediately after the session?”

If I don’t have time to complete a client’s session notes then I spend a few minutes after a session drawing symbols on the client’s chart. The symbols represent certain types of compromise, such as an arrow pointing toward the midline of the body means “medial compression”. While completing the chart I use the symbols as reminders of patterns the client worked with during the session.

I trust that my hands remember the session. Sitting quietly with my eyes closed I listen to my hands as they review the session. This helps me stay in the felt experience rather using my mind to figure it out. Not only do I recall the session but also new insights regarding the client’s strain patterns and corrective processes often arise during these times of reflection.

“If I understand correctly, CranioSacral therapy basically aims to improve the functioning of the central nervous system. Is that right?”

Yes, that is correct.  The central nervous system (CNS), which is comprised of the brain and spinal cord, is encased within three layers of connective tissue.  These layers are part of the craniosacral system (CSS) that forms a somewhat flexible container that is filled with the brain and spinal cord.  If the container is distorted then the contents will also be affected in some way.

When abnormal stress occurs within the CSS layers such as, twists, pulls, bends, overstretch, or compression, then the tissue of the CNS may become distorted.  If the delicate brain or spinal cord undergo structural deformation then the tissue becomes overly stressed.  This stress can alter the way cells work or inhibit their ability to work at all leading to a multitude of dysfunction.

One primary objective of CranioSacral Therapy is to assist the body in decreasing harmful strain within the CSS layers, which in turn helps to alleviate injurious stress of the CNS cells.  As this occurs then the CNS cells can function, adapt or compensate to their optimal ability.

“How is it possible that such light touch used in CranioSacral Therapy (CST) can help the body correct problems?”

Andrew T. Still, D.O., the founder of Osteopathy, said, “The little things are the big things in the science of Osteopathy.” and “It may be that by measurement we can discover a variation one-hundredth of an inch from the normal, which, though infinitely small is nevertheless abnormal.”

Minute strain patterns of the body’s tissues, nerves, or fluids, which are often overlooked, can cause compromise ranging from minor aches or pains to severe disabling pathology.  In CST we are working with tiny areas of compromise. Sometimes dysfunction is due to only one area of compromise, and at other times many areas merge into larger patterns.  The effect of a strain can remain in the area where the strain is located, or it can affect other regions of the body, even the body as a whole.  Each person has their own unique patterns of compromise, and each person has their unique patterns of correction, both of which can be expressed in infinite ways.

In CST it has been shown that using a light and delicate touch aids the corrective process of the client, and helps the practitioner perceive stressful and corrective patterns.  An example may be a cork floating in water.  It requires minimal pressure to feel the cork moving and the smallest amount of force to help the cork move.  If one uses more than minimal pressure to feel the cork then its patterns of motion will be disturbed.

A primary focus of CST is to feel tissue and fluid patterns as they are within the client’s body moment to moment.  To do this a practitioner uses light touch which supports the unique corrective patterns of the client in response to treatment; the practitioner does not determine how to correct but rather supports unique patterns of self-healing as they arise within the client. At the same time light touch helps the practitioner perceive a client’s patterns since the practitioner’s touch is not disturbing the client’s unique expression of strain and correction.

Reference:

Still, A. T., Philosophy and Mechanical Principles of Osteopathy, Hudson-Kimberly Publishing Co., Kansas City, MO., 1902.

The next few blogs will be devoted to answering questions that students ask in CranioSacral Therapy (CST) classes.

Question:  What am I feeling for when I’m working at the cranium or face?

Answer:  It depends on the intent of the technique that you are using at the time.  For instance, when applying decompression of the sphenoid then the intent of the technique, in Upledger CST, is to feel the sphenoid move in the direction of decompression.  The following checklist can be helpful in combination with any CST technique we may use for the skull or face.

1.  Does each bone feel like it has elasticity within itself while responding to the craniosacral rhythm (CSR)? As an example, when the occiput widens and narrows in synchrony with the CSR does it feel like its bony matrix moves easily or does it feel inflexible?  If it feels stiff then techniques such as direction of energy or cranial pumping can help the bone gain pliability within itself.

2.  Does each bone feel as though it has enough mobility within its sutures to move through its normal range without strain? For instance, while a zygomatic bone is moving in synchrony with the CSR is it moving freely or is it jammed into the zygomatic process of the temporal bone, or perhaps into the frontal bone, or the maxilla thus restricting motion?  If restrictions are found then the application of specific techniques, such as zygomatic decompression in this example, can help the bone gain greater freedom and motion.

3.  Are fused bones free to move along with the CSR with the least amount of strain? Fusion can take place due to normal processes, abnormal processes, trauma or surgery, and if fusion has occurred between bones then one focus of CST is to optimize balanced mobility of the affected bones.  As an example, if the sphenoid has fused with the base of the occiput then using Sutherland Sphenobasilar Lesion Patterns and Cranial pumping can be very helpful to optimize mobility.

4. Are the craniosacral system membranes moving freely in response to the CSR? As an example, when the falx cerebri and falx cerebelli move in synchrony with the CSR are they moving easily, freely, evenly, and equally, or do they feel pulled, twisted, stuck, or lacking symmetry of motion?  If they are not moving in a free and balanced way then CST techniques such as frontal and parietal lift, temporal and sphenoid techniques, as well as cranial pumping can help the membranes gain greater ease as they move in synchrony with the CSR.

I find the following quote a helpful reminder when working with the cranium or face.  “Do not look for movement as in other joints of the body.  This is merely a resiliency-a combination of slight yielding or suppleness in the articulation plus the flexibility of live and pliant bone.”

If you have a CST question please feel free to send it to me.

Reference:

Magoun, Harold I., Osteopathy In The Cranial Field, Third Edition, The Journal Printing Company, Kirksville, Missouri, 1976

CranioSacral Therapy (CST) often helps children overcome ear infections, especially when a child’s Eustachian Tube (ET) is blocked or congested.

Ear infections can bring about problems beyond the infection such as ear and jaw pain, tiredness, irritability, fever, headache, crying, restlessness, vomiting and diarrhea. Speech, language or learning impairment may even be related to chronic ear infections and the immune system can become excessively strained over time.

The craniosacral rhythm (CSR) is constantly “massaging” the ET.  One day I followed a child’s ET in synchrony with her CSR.  By the end of the session she felt better and a few days later her ear infection resolved.  So now I use the following sequence along with other CST techniques in a child’s session if she has an ear infection.*

• Visualize the purpose of the technique, which is to help the child decrease ET blockage or congestion, enhance ET drainage, decongest the middle ear, and equalize air pressure between the middle ear and the atmosphere.
• Visualize the ET connecting the middle ear to the back part of the upper throat, about in line with the nostril.
• Visualize the ET moving in synchrony with the CSR. The ET is minutely stretched open and lengthened during the flexion phase, and slightly squeezed and shortened during the extension phase.
• The child should be upright because it places her ET in its optimal drainage position.  Sit facing the child.  Place your finger softly upon the mastoid process of her affected ear and your thumb of the same hand alongside her nostril.  If the child can’t tolerate your finger in her ear then place it upon her mastoid process.  Imagine your thumb and finger are actually resting upon the opposite ends of her ET while sensing her entire ET.  Set the intention to use “0” grams of pressure while following the ET as it moves into positions of release until you feel softening.  Then follow the tissue with “0” grams of pressure in synchrony with the CSR until you feel greater ease of ET CSR motion.

This technique can help to enhance the CSR massage of the ET.  This gentle kneading can un-block the ET and pump substances through the ET, which helps to decongest the middle ear and to relieve excessive pressure from inside the middle ear. As this happens the child’s ear infection can resolve more easily and the middle ear can work normally thus leading to improvements in hearing and other problems caused by an ear infection.

* When working with children it is very important to follow the adaptations of CST for infants and children in the CS I and CST II classes taught by the Upledger Institute. Practice the techniques before working with children in order to refine your touch, to enhance your ability to sense and follow the CSR, and to increase your awareness of tissue patterns and responses to treatment.

Denticulate Ligaments.

Denticulate Ligaments (DLs) are strands of connective tissue that suspend the spinal cord within its membrane sac, which is called the dual tube.

The dural tube is comprised of three layers of membrane surrounding the spinal cord. The membrane layer attached to the surface of the spinal cord is called the pia mater. The layer surrounding the pia mater is called the arachnoid membrane, and the layer surrounding the arachnoid membrane is called the dura mater.

DLs extend from the inner surface of the pia mater, travel through the pia mater, through the arachnoid membrane and then attach to the inner surface of the dura mater.

There are 21 pairs of DLs on the lateral aspects of the spinal cord. The first is attached to the foramen magnum. The last is attached to the conus medullaris, which is the end of the spinal cord at L1, and a small portion of the Filum Terminale (FT) beginning at the conus medullaris. The FT is a band of tissue extending from the conus medullaris to the coccyx that is made of spinal cord glial cells surrounded by pia mater.

DLs and FT shortening, twisting, bending or immobility can place adverse stress upon the spinal cord leading to neurological strain and dysfunction. Conversely, balancing the DLs and FT can decrease spinal cord stress which in turn can enhance neurological function.

DLs are fascinating components of the dural tube that seem, to me, to create a ligamentous suspension system cradling the spinal cord. Very little DL research is available.

These questions arise when I ponder and work the DLs and FT:

1) Since the spinal cord needs to move in its bony container more than the brain tissue does in its container, do the DLs provide protection and flexibility while allowing motion?

2) The dura mater of the dural tube is only one layer thick rather than the two layers within the cranium, so do the DLs create additional tube strength without compromising movement?

3) As the spinal cord moves within the spinal canal do the DLs, like thousands of tiny interlinked bungee cords, help dissipate stress and allow the spinal cord to find its most favorable position?

4) Structures that can affect the spinal cord, such as the occiput, spinal column, sacrum and coccyx, dural tube, adipose tissue within the spinal canal and nerve roots can each have restrictive patterns that in turn can distress the spinal cord. Do the DLs help to protect the spinal cord by balancing, dissipating and fine-tuning tension that is transmitted to the spinal cord?

5) Some theories suggest that there is a down and up flow of cerebrospinal fluid within the dural tube. Since the DLs separate the dural tube into anterior and posterior compartments, could that then organize the flow of cerebrospinal fluid?

I hope you’ll join me next month to explore this suspension system further. I’ll share some ideas on how to feel and work with DLs and the FT.

References:
Cramer, Gregory D., D.C., Ph.D., and Darby, Susan A., Ph.D., Basic and Clinical Anatomy of the Spine, Spinal Cord, and ANS, Second Edition, Elsevier Mosby, St. Louis, Missouri, 2005.

Sills, Franklyn, Craniosacral Biodynamics, Volume Two, North Atlantic Books, Berkeley, California, 2004.

Tubbs, Shane R., M.S., PA-C; Salter, George, Ph.D.; Grabb, M.D.; and Oakes, Jerry W., M.D. ; “The denticulate ligament: anatomy and functional significance”, J. Neurosurg: Spine / Volume 94 / April 2001.