Craniosacral Therapy…. What is it Really?
By Mariann Sisco PT, CST-D

Craniosacral Therapy (CST) is a light touch manual therapy that works with the
body’s self-correcting mechanism to affect multiple structural and physiological
systems in attaining greater health and well being. As the name implies, it
involves mobilizing restrictions within the cranium and the sacrum. However,
because of the anatomical and physiological connections, it is really a whole body
approach. It is practiced by various healthcare professionals including physical
therapists.

History of Osteopathy

CST is born out of the osteopathic medical tradition. Osteopathy was developed
by Andrew Taylor Still MD, a Civil War surgeon. Dr. Still found traditional medical
practices of the time were often ineffective. These observations and experiences
towards the end of the war culminated in the death of three of his children from
spinal meningitis in 1864 leading Dr. Still to conclude that orthodox medicine
could even be harmful. He devoted the remainder of his life to the study of the
human body and developing alternative means of treatment for disease and
dysfunction. His philosophy of treatment became known as Osteopathy.(1)

In 1892, Dr. Still founded the American School of Osteopathy, the very first school
of osteopathy in Kirksville, Missouri. It is now named the A. T. Still University of
Health Sciences.

This new medical approach incorporated the core beliefs of Dr.
Still and is based on three principles: 

1. Structure and Function are Interrelated

Each structure has a shape that supports its function. From the smallest organelle
of the cytoskeleton to the arrangement of the various bones and organs within
the body, all parts function in relationship to their structural formation. When a
structure is compressed, over stretched or otherwise misaligned, function
becomes impaired creating pain, dysfunction and even disease.

2. The Body is a Unit

All systems are connected to one another. The circulatory system serves all the
other systems of the body. The nervous system receives information throughout
the body and sends regulatory signals regulating physiological systems based on
this sensory input. Fascia or the connective tissue matrix is continuous
throughout the body and invests every other structure. Treatment methods
based in osteopathy are often successful because of the ability of the practitioner
to locate the origin of the problem which can be distant from the symptoms of
the patient.

3. The Body is a Self-Correcting Mechanism

There is an innate ability of the human body to heal itself. Some practitioners
refer to this part as the Inner Physician (IP). When the skin is lacerated, this self-
correcting mechanism responds with an elaborate process to close the skin.
Immune responses and inflammatory responses are also indicative of the body’s
self healing abilities. The osteopathic approach involves facilitating or enhancing
the body’s own natural capacity when traumatic or disease processes become
overwhelming for the system.

History of Cranial Osteopathy

William Garner Sutherland DO attended the American School of Osteopathy.
Fully embracing the concepts of Dr. Still, Dr. Sutherland was attracted to the
unique shape of the cranial bones and their relationship with each other. It was
at this time that he noticed the beveled shape of the temporal bones resembled
the gills of a fish. Recalling Dr. Still’s teaching that every structure exists to
facilitate a specific function, Dr. Sutherland focused his interest on the cranium.
He was the first to perceive a subtle movement at the cranium and later, to
identify this same rhythm throughout the body. He named his finding the Primary
Respiratory Mechanism. (PRM).(2)

Dr. Sutherland developed techniques for
treating restrictions between the cranial bones to facilitate motion at the
sutures.(3)  His concept and treatments were considered quite radical at the time
and remained so up until the latter part of the 20th century. Western medical
science has always taught that the sutures are fused and thus no movement is
available. Dr. Sutherland’s observations have been validated over time and with
the development of technology to measure subtle movement and effects.

The concept of cranial bone movement was further developed in the 1970’s
through the research performed by John E. Upledger and associates at the
University of Michigan. At the time, Dr. Sutherland’s theories and practices were
seen as improbable and questionable at best by others in the osteopathic medical
community. Dr. Upledger was invited to the University specifically for proving or
disproving Dr. Sutherland’s practice of osteopathy. His research focused on the
movement of cranial bones at the sutures. Studies included the placement of antennae on the parietal bones of squirrel monkeys measuring movement of the paired bones.(5) Later, live sutural material was provided from a neurosurgical colleague that was stained for specific elements including collagen, nervous and
vascular tissues.  It was reasoned that fused bones would not
contain these features. In any event, these contents suggested that the cranial
bones are not completely fused together. During this time other researchers
were able to demonstrate that a rhythmic pattern of cranial bone motion exists at
a rate different from other bodily rhythms. The most prolific studies supporting
cranial bone motion were born out of the race to the moon between the United
States and Russia. Concerns relating to circulatory and central nervous system
functions in the human subjected to prolonged weightlessness in space were of primary interest. Yuri Moskalenko, PhD led the Russian research using NMR
tomograms and later using bioimpedance measures and transcranial Doppler
echography. These studies demonstrated oscillations of the cranial bones
associated with mechanisms regulating cerebral blood supply and oxygen
consumption as well as with CSF circulation. (7, 8)

Viola Frymann led the United States in researching cranial bone motion using a
metallic tong-like device with a differential transformer placed laterally on each
side of the cranium. Displacement of the metallic rod was converted into analog
signals measuring skull diameter. The magnitude of motion was estimated to be
between 10 and 30 microns.

Later, Dr.’s Moskalenko and Frymann utilized their findings to formulate theories
regarding the physiology of the craniosacral rhythm and published together. (9)
Rogers and Witt in The Journal of Orthopedic and Sports Physical Therapy
extensively reviewed the literature and concluded that “There is very little
evidence which disproves cranial bone motion.” However, they cited that
“further inquiry is needed to describe its magnitude and meaning.”(10) Dr. Upledger expanded his research into other aspects of Dr. Sutherland’s work
including his Direction of Energy technique and energy transfer between patient and practitioner. These studies confirmed that energetic activity occurs but not in
the exact way that Dr. Sutherland hypothesized.

Another important contribution of Dr. Upledger’s included the focus on the dura
mater lining the interior of the cranium and the subsequent formation of the
intracranial membrane (ICM) within the actual brain structure. He developed
specific techniques to not only promote the release of sutural restrictions but to
release restrictions within the actual dura and ICM.(3) Since the dura mater is a
type of connective tissue or fascia and is continuous with the remainder of the
connective tissue matrix, release of these restrictions can affect the function of
distant parts of the body.(13)

The Anatomy of the Craniosacral System

As noted previously, the cranium is lined with dura mater which not only encircles
the inner surfaces of the cranial bones but also folds in on itself creating the falx
cerebri, tentorium cerebelli and the falx cerebelli otherwise known as the ICM.
The firm attachment of the falx cerebelli at the foramen magnum of the occiput
continues inferiorly with attachments on the posterior bodies of C1 and C2. It
continues in the inferior direction without any attachments until it anchors at the
S2 segment as the pia portion of the filum terminale within the sacral canal. It
exits out of the sacral canal and continues as the external dural segment of the filum terminale blending with the periosteum of the coccyx. In
addition, the dura mater extends out through the intervertebral foramina with
the spinal nerves as the dural sleeves. The dural sleeves attach on the vertebral
bodies blending with the paravertebral fascial tissue. These anatomical
attachments help give credence to the continuity of the fascia and why CST has
such far reaching affects.

Enclosed within the CSS is the CSF circulating in the subarachnoid space of the
meninges which is then absorbed through the pia layer of the meninges bathing
the brain with nutritional elements necessary for proper brain function.
Production of the CSF occurs through the choroid plexus where it is filtrated from
blood supplied by the choroidal arteries into the ventricles of the brain. As
previously noted, CSF supplies nutrition to the brain and spinal cord through its
circulation in the subarachnoid space. Fluid exchange occurs through an active
transport mechanism that results in metabolic waste products being reabsorbed
by the arachnoid granulations within the venous sinus system of the brain. These
waste products are emptied into the jugular vein. Some research suggests that
small amounts of CSF drain through the spinal veins and through spinal lymph
channels.

The widening of the cranial bones during production of CSF is
referred to as the flexion phase and the narrowing that occurs while production
stops and draining continues is called the extension phase.

The Fascial Connection

​

An important feature of CST is the attention given to the body’s fascial system
since the dura mater is the core of this system. This scaffolding network has been
and is continually being researched.(16, 17, 18) The most important facts relating to
fascia from a CST perspective are its tensile strength in the order of up to 7,000
pounds per square inch and its continuity throughout the body.(19, 20) Restrictive
patterns within the fascia translate their forces in unique ways throughout the
system. These unique patterns of adaptation are thought to be related to the
pre-lesional state prior to a trauma such as a fall or car accident. (21) In other words,
each trauma that the body is unable to dissipate will be adapted into the system
in some way. When the body is overwhelmed with trauma or unable to adapt
further, pain and dysfunction occur.
CST uses the palpation of the CSR throughout the body to locate and treat these
restrictive patterns. Restrictions can reside within the cranium that over time are
translated into distant parts of the body.

The opposite can occur as well.
Restrictions in the head causing headaches may be related to fascial tensions
within the mediastinal walls or respiratory diaphragm as this fascial plane
continues in a superior direction as the pre-vertebral fascia attaching onto the
sphenoid within the cranial vault. (22, 23)

Mary Ellen Clark, a former Olympic high diver recounts her experience of CST in a
popular magazine. Suffering from vertigo, she was unable to pursue her dream of
competing in the Olympic Games held in Atlanta. Although she had access to the
latest in diagnostic technology and the best evidence-based treatments as a
member of the elite athletic team, her symptoms persisted. At the suggestion of
a friend, a skeptical Mary Ellen consulted a practitioner of craniosacral therapy.
The therapist found multiple restrictions throughout the fascial system one of
which included her right knee. Once, this particular area released, her vertigo
began to subside. During the treatment, Mary Ellen was unable to recount any
injury to her knee. Later, she recalled falling on her knee as a child. It is thought
that the knee restriction translated forces over the course of 10 years into the
tentorium cerebelli and dura mater lining the temporal bone. The inner ear
mechanism is housed within the temporal bones and it is postulated that the
restrictions were enough to alter the position of the temporal bone and create
faulty feedback from the endolymph within the semicircular canals. Ms. Clark
was able to return to competition and won a bronze medal for the USA after
being treated with CST.

In addition to the longitudinal planes of fascia, specific attention is given in CST to
the planes of fascia oriented in a transverse direction.(12) These horizontal planes
often absorb traumatic forces and create dysfunctions throughout the system.
For example, the pelvic diaphragm is actually a fascial hammock attaching in an
anterior/posterior direction from the pubic bones to the anterior surface of the
sacrum and from side to side via the internal surfaces of the ilia. (22) Loss of mobility
in this diaphragm can translate into the spine and hips and even further if enough
time has elapsed. For example, because of the attachment of the dural tube at
S2, torsion of the sacrum from the pelvic diaphragm can be translated up into the
cranium. Failure to address these restrictive planes in therapy can result in
temporary or limited improvement from traditional interventions.

Since CST is a therapy that focuses on the whole body and the interactions within
it, it is not suited to traditional methods of study that are linear and
reductionistic. Since present research skills have not yet developed to measure
all of the influences that are interacting simultaneously during a CST session, case
studies and case control studies are alternative methods of contributing to the
literature supporting CST. Studies are available that have demonstrated the
effectiveness of CST in patients with multiple sclerosis, fibromyalgia, lateral
epicondylitis, asthma, dementia as well as a descriptive outcome study on
patients with multiple diagnoses.

As patients are becoming less inclined to embrace drugs and other treatment
protocols that have limited or no effectiveness for their particular malady, they
are more likely to search for other ways to solve their problem. CST is a
treatment choice that has been shown to be effective in a multitude of diagnoses
by searching for and treating the origin of the problem.

For further information on research please visit
Upledger.com.

​

References
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