The document provides an overview of cranial manipulation techniques, detailing the historical development of craniosacral therapy and its foundational principles rooted in osteopathy. It explores the anatomy of the cranio-sacral skeleton, the mechanisms of cranial movement, and the potential clinical implications of cranial dysfunction, including various treatment indications. Additionally, the text discusses contraindications for cranial manipulation and emphasizes the importance of understanding biomechanical and energetic factors involved in cranial therapies.

1. CRANIAL MANIPULATION BASICS
OSSEOUS & SOFT TISSUE APPROACHES
Dr. KANNABIRAN BHOJAN .PhD, P.T
CERTIFIED IN BASIC & ADVANCED OSTEOPATHY TECHNIQUES -OHWI-ONTARIO ,CANADA
DIPLOMA IN FASCIAL MANIPULATION FM1-LUIGI STECCO METHOD ,ITALY
CERTIFIED VISCERAL MANIPULATION VM1 –BARRAL INSTITUTE ,USA
TRIGGER POINT DRY NEEDLING DN1 –MYOPAIN SEMINARS,USA
PROFFESSOR RVS COLLEGE OF PHYSIOTHERAPY
CONSULTANT ORTHOPEDIC MANIPULATIVE SPORTS PHYSIOTHERAPIST
FAST GROWING AREA OF MANUAL THERAPY PRACTICE

2. HISTORY
• With its modern roots in cranial osteopathy, as
developed by Sutherland (Sutherland 1939) in
the early years of the 20th century,
• Craniosacral manipulation was first introduced
into the osteopathic profession in the 1930s.
Instruction in the field began in the 1940s. The
pioneering work of William Garner Sutherland
(described in Upledger & Vredevoogd 1983)

3. Sutherland 1939

4. The Cranio Sacral skeleton
• The Cranio Sacral skeleton is the axial
skeleton. It consists of the skull, vertebral
column, sacrum, and coccyx.

5. The Skull
• face and the calvarium.
• There are 28 moveable bones in the
craniofacial skull, including the six ossicles of
the inner ears within the temporal bones.
Additionally, and also within the temporal
bones, are the osseous labyrinths. The hyoid
bone is considered by some to be cranial.

6. There are eight cranial bones:
• 1. occiput
• 2. sphenoid
• 3. ethmoid
• 4. frontal
• 5. two temporals
• 6. two parietals

7. There are fourteen facial
bones:
• 1. mandible
• 2. vomer
• 3. two maxillae
• 4. two zygomatic
• 5. two palatines
• 6. two nasals
• 7. two lacrimals
• 8. two inferior conchae

8. Skull & clavarium

9. cranial mechanisms and number of
overlapping processes
About Mechanical bony restrictions
or ligamentous or fascial structural
and functional anomalies.

10. cranial mechanisms and number of
overlapping processes
• Dysfunctional situations
where interference with
normal pulsatile activities
or soft tissue properties
seems to have occurred
and which have no easy,
'gross', structural or
orthopedic consequence.

11. cranial mechanisms and number of
overlapping processes
• Bio-electromagnetic energy
factors permeate all
mechanical, functional and
dysfunctional processes and
that in some instances there
seems to be no way of
making sense of cranio sacral
treatment without
hypothesizing energetic
involvement.

12. cranial mechanisms and number of
overlapping processes
• The unconvinced perspective-placebo effect

13. cranial mechanisms and number of
overlapping processes
• Gross
mechanical,
subtle pulsatile
or energy
imbalances

14. FIVE KEY ELEMENTS PROPOSED BY
SUTHERLAND
• INHERENT MOTILITY OF BRAIN AND SPINAL CORD
• FLUCTUATING CSF
• MOTILITY OF INTRACRANIAL AND SPINAL
MEMBRANES
• MOBILITY OF BONES OF SKULL
• INVOLUNTARY SACRAL MOTION BETWEEN THE ILLIA

15. INHERENT MOTILITY OF BRAIN AND
SPINAL CORD

16. CSF circulation

17. FLUCTUATING CSF

18. MOTILITY OF INTRACRANIAL AND
SPINAL MEMBRANES
A Modification in
length
of spinal canal in
cervical region during
flexion and extension.
B Modification in
length of spinal canal
in lumbar region
during
flexion and extension

19. MOBILITY OF BONES OF SKULL
posterior & superior view

20. MOBILITY OF BONES OF SKULL

21. Cranioscaral movement

22. INVOLUNTARY SACRAL MOTION
BETWEEN THE ILLIA
• through this mechanism it is
believed that the sacrum
will be pulled up and the
base will rotate forward
during inhalation and then
will lower slightly and the
base will rotate backward
during exhalation. It is the
dural attachments that link
the head to the sacrum and
allows them to move in a
coordinated rhythm.

23. Concepts validity
• Is there palpable mobility at the cranial sutures and
articulations and if so, what is the significance of such
mobility in health terms?
• What are the reciprocal tension membranes and is
there a linking mechanism between cranial and sacral
motion?
• Does a cranial rhythmic impulse (CRI) exist and if so,
what is it and, especially, what is its relationship with
cerebrospinal fluid fluctuations and flow?
• What are the forces moving cranial structures and so
producing the CRI? Most importantly, are these forces
primary or is movement the result of a combination of
normal physiological functions such as respiration and
cardiovascular rhythms?

24. Cranial structures and their mobility
• Sutherland (described in Upledger & Vredevoogd
1983) observed mobile articulation between the
cranial bones almost 100 years ago and
researched the concept for the rest of his life.
• influence of the intracranial ligaments and fascia
on cranial motion, which he suggested acted to
balance motion within the skull.
• PRM 'primary respiratory mechanism' which was
the motive force for cranial motion PUMPING CSF.

25. RTM

26. Inhalation and exhalation phases of
primary respiratory mechanism

27. RTM

29. Tensegrity

30. Before fusion

31. Cranial structures

32. Flax Cerebri &Tentorium Cerebelli

33. Cranioscaral movement

34. What drives the cranial rhythm?
• The perpetual outpouring of impulses from
the brain to maintain postural equilibrium,
chemical homeostasis, and so on, conceivably
may multiply the activity of individual cells
into a rhythmic pattern of the whole brain,
small enough to be invisible to the naked eye,
but large enough to move the cerebrospinal
fluid which in turn moves the delicate
articulated cranial mechanism.(Frymann 1971)

35. WAS FRYMANN RIGHT ABOUT
CRANIAL RHYTHM
• RESEARCH SUPPORT IT

36. MODELS OF CRANIAL THERAPEUTICS
• CRANIAL OSTEOPATHY- WILLIAM GARNER SUTHERLAND 1939
• CST- JOHN UPLEDGER 1995
• SOMATIC CRANIAL WORK- SHEA 1997
• SACROOCCIPITAL TECHNIQUE & APPLIED
KINESIOLOGY –DEJARNETTE 1975-78
• ECLECTIC DENTAL AND CRANIOFASCIAL
APPROACHES –VERNON 2001
• POLY VAGAL CONCEPT- SAHAR 2001 & PORGES 2001

37. CONCLUSIONS
• THERE EXISTS A PURELY CRANIAL MODEL
• INCORPORATES KNOWINGLY OR
UNKNOWINGLY PRINCIPLES OF TENSEGRITY
• INVOLVES FLUID/ELECTRIC ASPECTS CAN
RANGE PARTLY MECHANISTIC TO ALMOST
TOTALLY ENERGETIC/SPRITUAL

38. What are the clinical implications of
cranial dysfunction?
• Assuming being a direct connection between
such Cranial motion and Sacral motion and,
further, that this motion has a rhythmicity
which is palpable.
McPartland gives some indications
Upledger & Vredevoogd (Upledger 1996) offer a
long list.

39. Some indications
• Acute sprains and strains using a variety of techniques.
• Chronic pain problems (using techniques such as CV-4 as well
as balancing tissue tension and dural membrane balancing).
• Visceral dysfunction (peptic ulcers, ulcerative bowels,
tachycardia, asthma, etc. treated by means of normalizing
restriction patterns in the craniosacral system).
• Autonomic nervous system problems such as Raynaud's
syndrome (treated by using CV-4 daily).
• Rheumatoid arthritis (CV-4, often applied by a family
member, daily).
• Emotional disorders - especially anxiety (using specialized
techniques).
• Scoliosis, which is often seen to be a direct result of
craniosacral distortions.

44. Hand placement for palpation of
cranial rhythmic impulse.
The forearms are supported by the table to prevent undue fatigue.

45. cranial rhythmic impulse
• As you begin to explore these cranial
palpation and assessment sensations, it is
suggested that you keep a journal of your
feelings and findings, as well as the answers to
the queries posed in the exercise descriptions.

46. What are the clinical implications of
cranial dysfunction?
• Let us assume, hypothetically speaking, that it
is possible to establish that mobility exists
between cranial bones in normal situations, as
well as there being a direct connection
between such motion and sacral motion and,
further, that this motion has a rhythmicity
which is palpable.

47. Non-cephalic medical presentations
benefiting from manipulation Most
orthopedic complaints routinely referred to
physical therapy
• Extensor tendonitis
• Tennis elbow
• Biceps tendonitis
• Frozen shoulder
• Lumbar strain
• Plantar fasciitis*

48. Non-cephalic medical presentations
benefiting from manipulation Most
orthopedic complaints routinely
referred to physical therapy
• Peripheral neuropathies
• Carpal tunnel syndrome
• Brachial plexus compression/thoracic outlet
syndrome*
• Sciatica
• Vertebral disk prolapse

49. Contraindications
• Structurally or medically unstable conditions
• Stroke in evolution
• Suspicion of subarachnoid hemorrhage
• Suspicion of acute fracture, cranial or cervical
• Suspicion of cancer not yet diagnosed or staged
• Potential for metastasis when cure is still sought
• Acute encephalopathy or meningitis
• Vertebral disk prolapse
• Dizziness, loss of consciousness, blurred vision
with cervical rotation/side bending

50. Hand placement for palpation of
cranial rhythmic impulse.
The forearms are supported by the table to prevent undue fatigue.

51. Vault hold for cranial palpation.
Relative head and hand size may prevent
precise replication of suggested sites for
finger placement.

52. Vault hold for cranial palpation

53. Fronto-occipital hold for cranial
palpation.

54. sacral palpation and treatment.