2. 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” .
3. 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
4. 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.
4
5. 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
6. 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
7. 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
7
8. 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.
8
9. 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
9
10. 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
14. 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
15. 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
17. 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
17
18. Sphenoid Lift
18
• 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.
19. 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.
19
20. 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 with
the thenar eminences
supporting the mastoid
bone.
20
21. Bitemporal Rolling
21
• Alternating rocking motion into neck flexion and extension.
• Apply minimal pressure through mastoids.
• Follow with synchronous temporal rolling.
22. 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
23. 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!
23
24. 6 levels of tissue separation
• From initial contact to final completion.
1. Skin, scalp and fascia
2. Slower muscular release
3. Sutural separation
• Ex: pulling magnet away from metal
4. Dural release
• Ex: elastic bands giving way
5. Freeing of CSF circulation
• Ex: whole head feels oceanic, tidal, expansive
6. Energetic release
• Ex: chemical electric fire spreading in waves under your fingers
24
25. 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
26. 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
27. 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
28. 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
28
29. 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.
29
30. 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
31. 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
31
32. 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.
32
33. 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. 33
34. 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.
34
35. 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
36. References
Harrison, 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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