CranioSacral Therapy I Study Guide

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Study Guide

CranioSacral Therapy I

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John E. Upledger, DO, OMMIllustrations by Frank Lowen, LMT, NCTMB

COPYRIGHT NOTICECOPYRIGHT © 1987 BY UI PUBLISHING

Revised 7/2010

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No part of this study guide may be reproduced or transmitted in any form or by any means

without the written permission of the publisher.

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THE UPLEDGER INSTITUTE, INC.

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Continuing-education workshops conducted by The Upledger Institute are designed to augment theprofessional practices or educational programs of healthcare practitioners. Admission requireseach participant to hold a current healthcare license or certificate, or be enrolled in an educationalprogram granting licensure or certification. Upon course completion, participants must alsoassume responsibility for understanding which techniques fall within the scope of their practices.

Special consideration may occasionally be given to laypersons who wish to attend our workshops. In these cases, The Upledger Institute carefully evaluates personal and/or professionalcircumstances. If granted a waiver of our licensure/certification requirement, the layperson mustsign a consent form stating that completion of an Upledger workshop will not, by any means, providelicensure or certification for hands-on bodywork.

The modalities taught in these workshops demand a solid anatomical and physiological workingknowledge. Therefore, all participants must assume responsibility for advance preparation.

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We are pleased to provide you with this training opportunity. We hope that you benefit greatlyfrom this experience and that you apply the concepts and techniques with success in the future.

It is essential that the purity of this work and the high-quality teaching standards that have beenestablished for this curriculum are maintained. As such, if you wish to present or teach any por-tion of the copyrighted material from this workshop, you must first undergo the required trainingand/or obtain written permission from The Upledger Institute.

Upon course completion you are invited to take advantage of the Institute’s many ongoing programs and resources. Information is currently available to help you successfully:

• Submit a press release on your continuing education experience and clinical practice• Get articles published on techniques, applications, client cases and more• Form a study group• Sponsor workshops in your area• Train to become an instructor or presenter• Network as a technique demonstrator at trade shows

Please let us know your area(s) of interest. We will gladly assist you in determining the most pro-ductive use of your assets, as well as support you in organizing presentations, etc. Workingtogether will ensure that the information presented is current, correct and professionally supportedwith collateral materials.

As a practitioner using therapies taught through The Upledger Institute, Inc.®, you are expectedto adhere to the highest professional standards. Among these are the commitment to provide qual-ity therapy to all persons without discrimination, to seek educational opportunities to enhancetherapeutic skills, to respect each client’s right to privacy, and to accept the responsibility to do noharm to the physical, mental and emotional well-being of self, clients and associates.

Insurance reimbursement policies vary for manual therapies. If insurance reimbursement is anintegral part of your practice, we encourage you to verify insurance acceptance for your professionin your state/locale.

Finally, attendance at this training is not intended to be used as a hands-on license. You mustwork within your professional scope of practice and abide by the rules and/or laws that governhealthcare practices in your applicable region (i.e., city, state or province).

If you have any questions about these or other issues, please contact Educational Services at 1-800-233-5880.

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A Note From the Editor

Welcome! Thank you for choosing this seminar. You’ll enjoy many learning opportunities in this CranioSacral Therapy course:

• Explore the history, principles and neuromuscular basis of CranioSacral Therapy, and its clinical importance.

• Learn to conduct a thorough evaluation using the craniosacral rhythmas a guide.

• Formulate therapy strategies.

• Perform CranioSacral Therapy techniques to help normalize commonrestrictions and dysfunctions.

Thanks again for attending this seminar. We hope this will be an enlightening and productive experience for you.

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I would like to thank all the therapists, students and patients/clients who have contributed to ourwork. Their combined efforts help make the CranioSacral Therapy program a great success.

— Dr. John Upledger

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Upledger seminars offer a helpful mix of theory and practical work. This workshop will provide you with many concepts and skills that will enhance your assessment and therapeutic capabilities.Rather than subtracting from your existing knowledge or skills, it will serve to build upon it.

1. Efficiency Factor — Knowledge

— Action

— Wisdom

2. Paradigm (i.e., frame of reference)

“Each of us tends to think we see things as they are, that we are objective.But this is not the case. We see the world, not as it is, but as we are — or as we are conditioned to see it.”

Stephen R. Covey

3. Belief System (i.e., frame of reference based on a feeling of certainty)

“Remember, as long as you believe something, your brain operates on auto-matic pilot, filtering out input from the environment and searching for references to validate your belief, regardless of what it is. People with beliefs have such strong levels of certainty they are often closed off to new input.”

Tony Robbins

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Introduction......................................................................................................................1

Palpation ..........................................................................................................................9

Fascia and Diaphragms ................................................................................................23

Occipital Cranial Base and Lumbosacral Decompression ........................................53

Semi-Closed Hydraulic Craniosacral System ............................................................91

Dural Tube....................................................................................................................103

Still-Point Induction ....................................................................................................113

V-Spread ......................................................................................................................125

Intracranial Membrane System ................................................................................137

Temporomandibular Joint and Temporal Bones......................................................175

Protocol for Evaluation and Care ..............................................................................203

Bibliography ................................................................................................................207

CranioSacral Therapy Curriculum Flow Chart ......................................................A-1

The Upledger Institute and Its Educational Curriculums ......................................A-2

International Alliance of Healthcare Educators® Curriculums ..............................A-4

Submitting Your News Release ..................................................................................A-5

Model for Research Case Study or Single-Subject Design......................................A-7

UI-Approved Study Groups ......................................................................................A-8

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INTRODUCTION

This CranioSacral Therapy Study Guide is intended to supplement both the CranioSacralTherapy textbook by John E. Upledger, DO, OMM, and Jon D. Vredevoogd, MFA, and the Cran-ioSacral Therapy workshops taught by The Upledger Institute.

CranioSacral Therapy is a hands-on method of improving health and function. As a student ofthis healing art, you begin as an apprentice. There are facts to be learned and skills to be mastered.Armed with these facts and skills, you must practice, practice, practice.

Ultimately, you’ll arrive at a point where the distinction between facts and skills dissolves. Whatis known and what is experienced become one as you progress through apprenticeship to competency. Hopefully, this study guide will assist you in this process.

There are several ways in which this study guide can help you as a beginning student of CranioSacral Therapy:

1. By initially focusing your attention on the most important facts to be learnedand skills to be mastered.

2. By drawing together different aspects of CranioSacral Therapy from the textbook and the workshops into a succinct, coherent whole.

3. By providing additional instruction on CranioSacral therapeutic skills to supplement both the textbook and the workshops.

4. By providing a format for continued study and practice.

5. By serving as a reference source. Since the study guide pulls together materialfrom both the workshop and textbook, it can serve as a convenient reference.

Remember: Textbooks, workshops and study guides all emphasize one common aspect of CranioSacralTherapy — it is learned experientially!

Introduction 1

2 CranioSacral Therapy I

How to Best Use This Study Guide

If you read this study guide prior to attending each day of your CranioSacral Therapy workshop,you can use it as an overview of the material that will be covered. The list of learning objectivesat the beginning of each chapter will prepare you for the day’s lessons.

These objectives can help you organize the experiential content of the workshops and the factualcontent of the textbook. However, do not overly concern yourself with accomplishing these objectives during the workshop. After reading the following section on Right-Brain/Left-BrainLearning, you will see that focusing initially on a written list of learning objectives may hinderrather than help the learning process.

You can make the most of a CranioSacral Therapy workshop by following the written material inthe study guide, consulting the diagrams, and using the model of the intracranial membrane systemprovided at the seminar.

Note-taking need not be extensive, as you will want to devote your time to listening to the instructor,and carefully observing the practical demonstration. There is available space in your study guidefor notes.

You might also find it helpful to use the study guide as a review at the end of each day of the workshop. After scanning the learning objectives pertinent to that day, you can ask yourselfwhether you feel comfortable with each objective. If the objective calls for the recitation of factual material about the Craniosacral System, you might recite that material to yourself. If anobjective stipulates mastery of a skill, close your eyes and imagine that you are performing thatskill. How well did you do at each objective?

Specific pages of the textbook are referenced in the study guide. If you have questions aboutmaterial presented in the study guide, you can consult the appropriate pages of the textbook. Youcan also ask questions during the question-and-answer sessions that are part of each workshoptopic, then jot down the answers in your study guide for future reference. Once you have completed a CranioSacral Therapy workshop, your study guide will prove to be a valuable aid inyour continued practice and study of CranioSacral Therapy.

Right-Brain/Left-Brain Learning

One of the most important insights into human learning has come as a result of leading-edge brainresearch conducted within the last 20 years. This research studied the change in function thatoccurred when the nerve pathways between the right and left hemispheres of the brain were surgically severed.

Although medical reasons existed for severing the hemispheric connections in the subjectsstudied, the resulting change in brain function was quite surprising. It appeared as though eachhemisphere functioned in an independent and different manner. Each side of the brain was betterthan the other at a particular type of task. The researchers were further able to generalize whichkinds of tasks were performed well by each side of the brain.

The left side of the brain appeared to be more specialized at performing analytical tasks: the addition of numbers, spoken and written languages, objective and critical thought, analytical reasoning, hard sciences and the like. This was in contrast to the right side of the brain, whichfared well in more subjective and intuitive areas: creative music and arts, intangible thought,three-dimensional representation of objects, imagination and insight. This separation of functionwas experimentally verified in a number of split-brain subjects.

Other researchers suggested that, even in people with intact connections between the hemispheres,some separation of function took place. This led to the popularization of the phrases “left-brained” and “right-brained,” referring to individuals who functioned primarily on the basis ofrationale and reason as compared to those who functioned more intuitively and in a “feeling” way.

In-depth research in this area has unearthed a more sophisticated view of hemispheric specialization. No task is purely analytical or objective, nor is it purely insightful or subjective.Each hemisphere contributes something to the performance of any task, whether that task is largely analytical/objective or largely insightful/subjective. Furthermore, even in surgically produced split-brain subjects, recent evidence suggests that one side of the brain can take overfunctions normally associated with the other side.

Regardless of the outcome of this scientific debate, the implications for human learning are clear.Learning is a complex task that requires the integration of both analytical/objective and intuitive/ subjective skills.

A good example of this occurs in the playing of a musical instrument. There are many analyticaltasks to be mastered in playing a musical instrument, like the placement of the fingers, music theoryand metered rhythm. These are mostly left-brain functions. Yet these skills must be tempered bythe artist’s attention to the mood, feeling, expression and creativity in performing the music.These are mostly right-brain functions. Without right-brain function, the performance might betechnically perfect but rather lackluster and perhaps boring. Without the left-brain function, theperformance might be a jumble of nonsensical sounds which perhaps express the artist’s feelingsbut are not musically comprehensible to the listener.

Introduction 3


Most education in our society focuses on left-brain skills at the expense of right-brain skills. Apremium is placed on analysis, deductive reasoning and logic. Intuition, insight and imaginationtake a back seat or may even be denigrated and punishable. This is a somewhat paradoxical situation since most of the great scientific discoveries of modern times have occurred as a resultof insight and imagination rather than analysis and deductive reasoning.

Einstein visualized himself riding on a beam of light and imagined what he would experience inorder to discover the Theory of Relativity. Edison placed himself in a trance-like state called hypnagosis to bring forth his most important inventions. Crick and Watson played with TinkerToys in their discovery of the structure of DNA. Imagination came first, analysis later.

As a beginning student, many of the skills you will need for CranioSacral Therapy are currentlybeneath the level of your ordinary awareness, residing more within the subjective or unconsciousrealm. Palpating the craniosacral rhythm is a good example. It is a subtle rhythm that requires avery light touch and an open mind to experience. With a little practice you will be able to elevateyour sensation of the craniosacral rhythm to a level easily accessible to your ordinary consciousness.

If there is a danger in the process of learning CranioSacral therapeutic skills, it is that the beginning student focuses too heavily on the analytical left-brain side of learning: “Did I do itright? Did I really, really feel it? I had it, but then I lost it. Everyone else can feel it, why can’tI? I’ll never be able to feel it.” These are just some of the obstructive questions that analytical thinking and the left brain throw into the learning situation.

As learners we are not used to relying on our intuitive, imaginative selves. We often let analysisintimidate us to the point that imagination has no room to express itself. Imagination does notmean that we are making something up that does not exist. What Einstein imagined actually existedand was later verified by analysis. But to get to it, he used his imagination to penetrate the obsta-cles imposed by ordinary awareness. What Einstein discovered was opposed to common sense.

Initially, you may find that many of the CranioSacral therapeutic skills go against your own commonsense. If you find yourself questioning what you feel or don’t feel, try the following steps:

1. Remind yourself that your analytical questioning can be a roadblock to youractual experience.

2. Remind yourself that there is a sound, scientific basis for all the techniqueswithin CranioSacral Therapy. Even if you do not know all of this informationnow, you can read about it later. That should pacify the analytical needs ofyour left brain for awhile.

3. Remind yourself that many people just like you have been taught to use CranioSacral Therapy successfully, and that there is no reason why you cannotfeel or experience all that these other people have. Trust yourself, and mostimportantly, GIVE YOURSELF PERMISSION TO EXPERIENCE WHAT-EVER COMES INTO YOUR AWARENESS.

4. If all else fails, just imagine that what you are feeling is absolutely true even ifit does not seem to be at the time. Ultimately, it will be true in the same waythat everything Einstein imagined about riding on a beam of light became true.

Light Forces

In CranioSacral Therapy, lighter forces produce better results. This is a paradoxical observationgiven the common sense wisdom that “if a little is good, a lot is better.” Applied to the Craniosacral System, this would mean that if a little force is useful in affecting the system, a largerforce would be even more efficacious. Wrong!

The goal of the CranioSacral Therapist is to be as unobtrusive as possible in evaluating and treating the Craniosacral System. Given the fact that it is impossible to be totally unobtrusive,the therapist must use the lightest force possible in CranioSacral palpation and treatment. The clos-er to the ideal that the therapist can work, the better the results.

There seems to be a natural tendency toward heavy-handedness when working with the body. Tocounter this tendency, you may find it helpful to establish a mental discipline of continually asking yourself the question, “Can I do this with even less force?” If you practice this as you arebeginning to learn the CranioSacral therapeutic skills, you will soon develop the habit of usingonly the minimum force necessary to do the technique.

The following three analogies may be of some help in this regard. They give a reference pointfor how much force should be used with the Craniosacral System.

1. Imagine a piece of thin cellophane (like that used to wrap food) floating on topof a bowl of water. The force needed to move the cellophane across the surfaceby touching the underside of the cellophane without deforming it is the amountof force used in the Craniosacral System.

2. Approximate the force needed to raise a nickel with one finger (about 5 grams).

3. Visualize the force used when you comfortably place pressure on closed eyelids.(No heroics here, please!)

You may wish to experiment with these examples to get a feel for the forces involved in CranioSacral Therapy.

Introduction 5


A Brief Description of the Craniosacral System andits Discovery

The Craniosacral System is a recently discovered physiological system. It is a semi-closedhydraulic system contained within a tough waterproof membrane (the Dura Mater) whichenvelops the brain and the spinal cord. An important function of this system is the production, circulation and reabsorption of Cerebrospinal Fluid (CSF). CSF is produced within the Craniosacral System and maintains the physiological environment in which your brain and nervous system develop, live and function.

Normally, the production and reabsorption of CSF within the Dura Mater produces a continuousrise and fall of fluid pressure within the Craniosacral System. The semi-closed hydraulic systemexpands and contracts to some extent with this rhythmical pressure fluctuation. This volumetricaccommodation prevents pressure from building up too much within the Craniosacral System. Iffor some reason your body is unable to accommodate these pressure changes, the subsequentbuildup of pressure can contribute to dysfunction and ill health, especially in the Central NervousSystem which is enclosed within the boundaries of the Craniosacral System.

Investigation in this field was begun in the second decade of the twentieth century by William G.Sutherland, DO. Initially, attention was given only to the cranial bones and their movement at thecranial sutures, which are the interfacing connections between the cranial bones. Areas of aberrant cranial bone motion were induced and corrected by manual techniques. Soon therapeutictechniques were devised to correct abnormal cranial bone motion.

Early exploration of cranial manipulation was performed primarily by osteopaths and chiropractorswho formed societies to investigate and teach cranial methods. These pioneers were at odds withthe larger scientific community, and often with their own peers, over one central aspect of the cranialsystem: the movement of the cranial bones.

Conventional anatomical wisdom taught that cranial bones were movable only in young infants,and were solidly fused in adulthood. The controversy raged on until quite recently.

In the mid 1970s, the College of Osteopathic Medicine at Michigan State University sought toresolve this controversy. It brought together a team of researchers led by Dr. John Upledger.Their objective was to prove or disprove the basic tenets of cranial manipulative techniques. Themajor premise involved the movement of cranial bones.

By studying fresh cranial bone specimens rather than the chemically preserved specimens thatwere studied by previous researchers, the Michigan State University team demonstrated the potential forcranial bone movement. Optical and electron microscopy showed the existence of blood vessels,nerve fibers, collagen and elastic fibers within cranial sutures. There was little evidence of suturalossification, which would prevent movement of cranial bones in relation to each other.

Further studies conducted by the Michigan State University team utilized radio wave broadcastsbetween antennae affixed to the exposed surfaces of cranial bones in adult living primates. Thiswork yielded precise measurements of the frequency and amplitude of cranial bone movement.

With the existence of cranial bone motion established, elucidating the mechanisms behind thismotion became the next task of the Michigan State University team. It was here that the role ofthe Craniosacral Dura Mater and Cerebrospinal Fluid were integrated into a comprehensivemodel of the Craniosacral System. They called it the “Pressurestat Model.” This model is fullydescribed in the section entitled “The Semi-Closed Hydraulic Craniosacral System” in this studyguide.

The results from the Michigan State University research influenced the therapeutic application ofcranial techniques. Previous techniques were primarily based on the movement of cranial bones.It was now known that the Dura Mater plays a key role in cranial bone movement. Techniquesfor evaluating and treating the dural membranes were developed largely by Dr. John Upledger.

It is this central role of the dural membranes in the evaluation and treatment of the CraniosacralSystem that differentiates CranioSacral Therapy, as taught by The Upledger Institute, from othercranial techniques. Therefore, in your study of CranioSacral Therapy you will continually findthis interplay between osseous and membranous aspects of the Craniosacral System.

Introduction 7


Notes:

PALPATION

Objectives:

1. To develop an appreciation of palpation potential.

2. To be able to palpate cardiac pulse, breathing movement and craniosacralrhythm anywhere on the body — singularly and in concert.

3. To familiarize yourself with the three “vault holds” or hand positions.

4. To become familiar with the terms “flexion” and “extension” in relationship tothe Craniosacral System.

5. To become familiar with the movements induced by flexion and extension anywhere in the body.

Palpation 9


Palpation

Palpation is the art of using touch to examine the body. Through palpation you can explore thestructures beneath the skin — their forms, movements and relationships to each other. The normalor abnormal function of an organ can be discovered. The mobility of a joint with its muscular, ligamentous and tendinous attachments can be evaluated. The flow of body fluids can be sensed.The motion of one bone in relation to another can be felt. Even the electromagnetic field surrounding the body can be monitored by palpation.

There are a wide array of palpatory skills available to the practitioner. Placed on a continuum,these skills range from intrusive to nonintrusive, from active to passive, from firm contact to littleor no contact at all.

At one end of this continuum is intrusive or invasive palpation, which uses firm, heavy force toprobe beneath the skin’s surface. Often the use of a heavy palpatory force evokes an equallystrong response from the area of the body being examined. Muscles tighten, pain reflexes are initiated and the body defends against the palpator’s hand. The information gained from such pal-pation may tell more about the body’s defensive mechanisms than about the underlying condition which may be the subject of the palpatory search.

At the other end of this continuum is nonintrusive palpation, which permits examination withoutevoking resistance. It is this method of palpation which is most useful to the CranioSacral Therapypractitioner. Nonintrusive palpation allows the therapist to experience a sense of “melding” withthe client. Like a dry sponge placed in a pool of water, information seems to be absorbed throughthe practitioner’s hand. In this situation, it is important that the therapist accept whatever information is received. As we mentioned earlier, this information will often seem paradoxical toyour analytical, rational mind. Even if you are not sure, accept what you experience as true.

The remainder of this chapter is devoted to helping you develop your skills in palpation. You willpalpate the cardiac, respiratory and craniosacral pulses at various locations on the body.

Palpation Types and StylesGross Subtle

Active Passive

Palpation 11


Palpating the Cardiac Pulse

Almost everyone has taken his or her pulse at some time (palpated the cardiac pulse). The cardiacpulse is created by the rhythmic surge of blood from the heart through the arterial system. It is apulse that is easily felt at many locations throughout the body. Ordinarily, this pulse is taken atthe wrist.

Palpate your cardiac pulse using the following steps as a guide:

1. Lightly place your middle three fingers along the radial border of the wrist.

2. Pressing very gently, see exactly how much pressure you actually need to feelthe cardiac pulse.

3. When you have determined the pressure needed to palpate your cardiac pulse,lighten your pressure even further and see if you can still feel the pulse.

4. Repeat step 3 several times until you have reached the absolute minimum forceneeded to feel the pulse.

5. Make some observations:

• Timing or beat of the pulse – fast or slow?

• Amplitude of the pulse – large or small?

• Quality of the pulse – robust or weak?

• Morphology of the curve of the rise and fall of pressure

• Other sensations about the pulse that you receive

The cardiac pulse is easily palpated in other locations. Repeat steps 1 through 5 above, on yourselffirst, in at least two additional areas:

• Midline abdomen about 2 centimeters above the navel

• Femoral artery on the inside of the thigh where it joins the pelvis

• 1 centimeter directly posterior to the medial or lateral malleolus

• Anywhere along the carotid artery in the neck

• Any other location on the body

Palpating the Respiratory Pulse (Breathing Motion)

The respiratory pulse is produced by the movement of the rib cage and the diaphragm as theyassist in the constant filling and emptying of the lungs during breathing. It is conveniently palpatedalmost anywhere on the anterior chest surface. Palpate your own respiratory pulse by placingyour hands lightly on your chest. Follow the same five steps used in palpating the cardiac pulse.

Once you have become familiar with your respiratory pulse at the chest, move your hands toanother station. Just like the cardiac pulse, the respiratory pulse can be palpated almost anywhereon the body. This is not the ordinary way of palpating the respiratory pulse, but it can be done.

Some suggested locations for palpating the respiratory pulse are:

• Abdomen

• Anterior Thigh or Calf

• Ankles

• Shoulders

As you palpate the respiratory pulse in these different areas, ask yourself how the tissue underneath your hands is moving in response to the respiratory pulse. Is it rotating, expandingand contracting, or moving up and down? Allow the answer to come through your hands.

The cardiac pulse can be felt in every location you palpated a respiratory pulse — and vice versa.Now, add the following steps to your palpation:

1. Select an area and palpate the cardiac pulse as indicated above.

2. Without moving your hands, palpate the respiratory pulse.

3. Move back and forth between palpation of both pulses without moving your hands.

4. Superimpose the palpation of one pulse on the other so that you areexperiencing both cardiac and respiratory pulses at the same time.

5. What new information comes from this experience of palpating?

Palpation 13


Palpating the Craniosacral RhythmThe craniosacral rhythm, like the cardiac and respiratory pulse, can be felt throughout the body.Also, like the other pulses, the craniosacral rhythm has a distinctive character at different locationsin the body. You will learn to use palpation of the craniosacral rhythm as a means of monitoringthe function of the Craniosacral System. The craniosacral rhythm will tell you where the systemis operating normally or abnormally. It will also indicate the success of your therapeutic efforts toreestablish normal function. Learning to palpate the craniosacral rhythm is the foundation of successful CranioSacral Therapy.

The craniosacral rhythm is reflected throughout the body. However, the actual movement at variousbody locations differs slightly. Perceiving the response of the body to the craniosacral rhythm is thefirst step in successful CranioSacral Therapy.

The expansion phase of the Craniosacral System is termed flexion, while the contraction phase istermed extension. Thus it is said that the cranium expands during flexion and contracts duringextension.

What are the movements made by the other parts? Fill the answers in as you discover them by theuse of palpation.

BODY PART FLEXION MOVEMENT EXTENSION MOVEMENT

Paired Bones

Single Bones

Begin by palpating your own craniosacral rhythm. Start palpating at your head by interlacing yourfingers and placing your palms lightly around your parietal and temporal bones. It will help if yourest your elbows comfortably on a table. It is important that your body be comfortable and relaxedduring palpation. This will assist you in receiving as much information as possible from your efforts.

Since you are familiar with the cardiac and respiratory pulses, palpate them first. Then remove themfrom your awareness and feel the craniosacral rhythm, which is slower than either the cardiac or respiratory pulse. The craniosacral rhythm occurs with a frequency of about six to twelve cycles perminute. This means that flexion takes place to a slow count of 1-2-3. There is a slight pause betweenflexion and extension, then extension occurs at a slow count of 1-2-3.

Do not force the experience of palpating your craniosacral rhythm. Rest your hands gently on thehead and allow the rhythm to come to you. Once you are able to feel it, go through the five stepsthat we initially used to palpate the cardiac pulse. Gradually lighten the pressure until you are usingthe bare minimum necessary. It is even possible to sense the craniosacral rhythm from inches off thebody surface!

Having gone through these five steps, next apply the additional steps we used to palpate the cardiac and respiratory pulses together. Only this time move back and forth between all threerhythms. Finally, superimpose all three rhythms on each other. What sensations did you receive?

A concert pianist was once asked how he could remember the involved musical passages of apiece he was playing. “Very easy,” he said. “I try not to let my mind distract my hands while theyare playing.”

The more you practice palpating the craniosacral rhythm, your hands will develop skills and wisdom of their own. Try not to let your mind distract your hands. Let your hands play a beautifulconcerto, and through palpation you will learn to hear the music and communicate with the intelligence of the body.

As your skills develop, you will want to feel for the different aspects of the craniosacral rhythm:

Symmetry

Quality

Amplitude

Rate

When feeling for symmetry in the Craniosacral System, you evaluate how even the flexion andextension movements are in relation to each other. Symmetry also can be evaluated bilaterally ineither flexion or extension.

When evaluating quality, you feel how smooth the motion is during the flexion and extensionphases. Quality can also be determined by how much vitality the system exhibits during its motion.

Amplitude is the measurement of how far the body moves in flexion and/or extension.

Rate is simply how fast the body moves through one cycle, and how many cycles per minute.

Listening Stations

To use the craniosacral motion as an evaluation tool, palpate the rhythm throughout the body todetermine where the body fascia is restricted and where it is moving efficiently. The following isa list of general “listening stations” that will give you a general, overall evaluation of craniosacralmotion throughout the body:

Heels

Dorsums of the Feet

Anterior Thighs

Anterior Superior Iliac Spines

Ribs

Shoulders

Cranial Vault Holds (three)

Palpation 15


Notes: Three Vault Holds

Palpation 17

Figure P-1

First Vault Hold

Reprinted from CranioSacral Therapy by John E. Upledger and Jon D. Vredevoogd with permission from EastlandPress, Inc., P.O. Box 99749, Seattle, WA 98199. Copyright 1983. All rights reserved.

Core Intent: To assess mobility and restrictions of the cranial bones (and relating membranes),primarily from a medial-lateral perspective.

Hand Placement: Hands and fingers spread out on the lateral aspect of the cranium makinglight, conforming contact.


Notes:

Palpation 19

Figure P-2

Second Vault Hold

Reprinted from CranioSacral Therapy by John E. Upledger and Jon D. Vredevoogd with permission fromEastland Press, Inc., P.O. Box 99749, Seattle, WA 98199. Copyright 1983. All rights reserved.

Core Intent: To assess mobility and restriction of the cranial bones (and relating membranes),primarily from an anterior-posterior perspective, as well as to focus on the cranial floor.

Hand Placement: One hand “cupping” the occiput while the thumb and fifth fingers of theother hand make contact with the greater wings of the sphenoid.


Notes:

Palpation 21

Figure P-3

Third Vault Hold


Core Intent: To assess mobility and restrictions of the cranial bones (and relating membranes)with primary focus on the occiput and sphenoid.

Hand Placement: Both hands “cupping” the occiput with thumbs extending laterally and anteriorlyto the greater wings of the sphenoid.


Notes:

FASCIA AND DIAPHRAGMS

Objectives:

1. To develop an appreciation of the total-body fascial system and its transversediaphragms.

2. To develop experience and confidence in the perception of tissue “release” and“therapeutic pulse.”

3. To be able to obtain tissue release of the Pelvic Diaphragm.

4. To be able to obtain tissue release of the Respiratory Diaphragm.

5. To be able to obtain tissue release at the Thoracic Inlet (Outlet).

6. To be able to obtain tissue release at and relating to the Hyoid.

7. To gain a working knowledge of the anatomy of the Pelvic Diaphragm, theRespiratory Diaphragm, Thoracic Inlet (Outlet) and the Hyoid.

Fascia and Diaphragms 23


The Fascial System

The fascia of the body is the tough connective tissue which holds us together. It keeps our liversfrom falling out, our lungs and heart from exploding, our intestines from falling down into the bottomof our pelvises, and it envelops each and every structure of the body. The tiniest nerve has its ownfascial sheath or envelope, as does the largest bone. About half of the muscular attachments ofthe body are to fascia, so that muscle tone or the state of contraction have a lot to do with howtight or loose the fascial sheaths and envelopes are in certain areas of the body at any given time.

Fascia has been described in various ways. It has been called the body stocking under the skinwhich helps to hold us together. It has been described as tubes within tubes within tubes. It hasalso been viewed as a series of lamina which cohere, separate into envelopes, and cohere again.In the latter view, each body structure has its own envelope formed between the fascial lamina.

All of these views are appropriate and correct. The superficial fascia does form a body stocking.The meningeal layers are tubes within tubes within tubes. And each body structure or viscus hasits own private envelope of fascia which is formed by the separation of two or more fascial lamina.

Four things are important for the CranioSacral Therapy practitioner to appreciate about the fascia:

1. The majority of fiber orientations for the fascias of the body are in a generallongitudinal direction.

2. At given areas of the body, transversely oriented fascias act as supports for thebody to prevent uncontrolled lateral expansion of the torso. These are thediaphragms of the Pelvis and Thorax, as well as the Thoracic Inlet (Outlet).

3. The total-body fascia is a single system. We can travel from any one place inthe body to any other place without ever leaving the fascia. A clear example isas follows: We may begin in the Falx Cerebri, move into the Tentorium Cerebelli, travel down the lining of the internal aspect of the Occiput and endup at the Carotid Foramen in the Temporal Bone. At this juncture we can(without leaving the fascia) continue our journey down the Carotid Sheath,which becomes the Pericardium in the Thorax. We can travel down the fascialfibers of the Pericardium, which pierce the Respiratory Diaphragm. Oncethrough this diaphragm, we can travel down its inferior fascial covering to thefascia of the Psoas muscle. We can follow the Psoas fascia into the Pelvis andthen into the leg. From this point on it is a straight journey to the bottom ofthe foot. Because we can make this journey to anywhere in the body using thefascia as a vehicle, we know that all body parts are interconnected by the fascia. This means that abnormal tension patterns in the fascia may be transmitted from one body part to another in what appear to be most bizarreways unless one appreciates the “oneness” of the fascial system.

4. Body fascias are mobile to some extent under normal circumstances. They allowfor physiological and subtle body movements, offering little or no resistance; they also allow for gross body movements such as throwing a ball.They let your heart beat and your lungs expand.

Among the more subtle physiological body movements which fascia normallyallows is the rhythmical internal and external rotation of the total body in compliance with the so-called flexion and extension activities of the CraniosacralSystem. We can clearly perceive with our proprioceptors the total-body movementallowed by the fascia in response to our breathing efforts and the pumping ofblood throughout our bodies.

Notes:



Tissue Release

Tissue Release, or simply Release, is the name we have applied to the sense of softening andrelaxation that is perceptible when the technique in use has come to a successful completion. Thisdoes not mean that the whole session is over, just that this phase is finished.

There are probably multiple factors involved in the Tissue Release phenomenon. One or all ofthese factors may be involved in any one perceived Release.

These factors are:

1. Relaxation of nervous reflexes which have produced increased tissue tone.

2. Tissue morphological change from elastic resistance to viscous compliance.This indicates a lengthening of tissue fibers without biomechanical memoryfor the return to their original dimensions.

3. A sense of increased passage of fluids through the tissues under treatment.

4. A sense of increased flow of energy through the tissues under treatment.

5. An emission of increased heat radiating from the appropriate body region.

6. A sense of a repelling force as perceived by the therapist’s hand when palpatingthe involved area.

7. There may be a sense of crescendo and decrescendo of the Therapeutic Pulserelated to the Release. This Therapeutic Pulse is described in more detail onthe following page.

A Tissue Release must be experienced to be comprehended. It feels like the tissues loosen andmove laterally in a reasonably symmetrical manner.

Common Signs of Release:1. Softening

2. Lengthening – this means you’re into collagen

3. Increased fluid flow

4. Increased energy flow

5. Heat

6. Energetic repelling – feels like opposing magnets

7. TP – Therapeutic Pulse (this will fade)

8. Client takes deep breath

Any change in the tissue can be considered a sign of release.

Therapeutic Pulse

The Therapeutic Pulse is a phenomenon that we have observed on many occasions when thesubject’s body is in the process of self-correction. It may occur anywhere on or in the body undertreatment. The amplitude of the Therapeutic Pulse seems to increase from near zero until it comesinto the conscious awareness of the therapist. It is not the Cardiac Pulse, although it seems almostthe same when you first experience it. The high-amplitude Therapeutic Pulse may last seconds orminutes. Its presence seems to indicate that something good is occurring. After the self-correctionis complete, the Therapeutic Pulse diminishes in amplitude until it becomes imperceptible. It ismy policy not to change whatever I am doing while the Therapeutic Pulse is perceptible.

Notes:



Notes: Clinical Considerations

Diaphragm Release

Core Intent: To mobilize major (and common) areas of transverse fascial dysfunction.

Pelvic Diaphragm of the Female(Viewed From Above)


Figure F-1

Rectum

Vagina

Urethra

Pubes

Pubovaginalis

Puborectalis

Iliococcygeus

Arcus Tendineus

Levator Ani Muscle

Coccygeus Muscle

Sacrum

Ilium

Urogenital Diaphragm

}


Notes:

Figure F-2


Schematic Diagram of the Male Pelvis (Viewed From Above)

Schematic Diagram of the Female Pelvis (Viewed From Above)

Prostate

Puboprostatic Ligament

Loose Endopelvic Fascia

Uterosacral (Round)Ligament

Urethra

Cervix

Lateral Ligament of Bladder(Prostate)

Loose Endopelvic Fascia

Sacrogenital Ligament

Pubovesical (Pubocervical Ligament)

Lateral Cervical(Cardinal) Ligament


Notes: Pelvic Diaphragm Release (Reference CranioSacral Therapy, pp. 49-52)

Hand Placement: Posterior hand — Transverse under L5-S1 and sacrum.

Hand Placement: Anterior hand — Hypothenar eminence contacting the superior

aspect of the pubic bone with the rest of the hand contacting superiorly.


Gentle Compression

Pubic Bone

Femur

Sacrum

Figure F-3


Notes:

Respiratory Diaphragm


Anterior View of the Diaphragm

Figure F-4


Notes:

The Undersurface of the Diaphragm


Figure F-5

Right Crus

Aortal Passage

Inferior Vena Cava

Muscular Part of Diaphragm Xiphoid Process

Central Tendon

Lower Rib Cage

Esophageal Opening

Left Crus

Left Quadratus Lumborum

Left Psoas Major


Notes:

Notes:



Notes: Respiratory Diaphragm Release (Reference CranioSacral Therapy, pp. 46-49)

Hand Placement: Posterior hand — Transverse under T12-L1.

Hand Placement: Anterior hand — Contacting ribs borders/xiphoid process.


Figure F-7

Hand Position for Diaphragm Release

Lateral View of Diaphragm Release

Figure F-6


Notes:

Superior View of Thoracic Inlet Area

Figure F-8


Scapula

First ThoracicVertebrae

Second Rib

First RibManubrium

Clavicle


Notes:

Lateral and AnteriorViews of Muscles ofNeck and Thoracic

Inlet Area


Of interest are the many divergentdirections of function of these tissues,showing the complexity of pulls and

balances that may be upset and lead to potential dysfunctions.

Figure F-9


Notes:

Picture on left shows major arteries of thehead as they pass through the Thoracic Inlet.

Picture on right shows major veins andsinuses as they drain into Thoracic Inlet.


Figure F-10


Notes: Thoracic Inlet Release (Reference CranioSacral Therapy, pp. 52-57)

Hand Placement: Posterior hand — Transverse under C7-T1.

Hand Placement: Anterior hand — Thumb and second finger contacting sternoclavicularjoints/clavicles.

Hand Position for Thoracic Inlet Release


Figure F-11


Notes: Hyoid Release

Hand Placement: Posterior hand — Fingers “cupping” the cervical spine with the second finger in contact with the occiput.

Hand Placement: Anterior hand — Thumb and second finger on the anterior cornua of thehyoid bone.

Hand Placement and Technique for Release of the Hyoid


Gently followingHyoid

Inferior Constrictor

Figure F-12

Middle Constrictor

Continuity of connective tissues around cervicals

(from Pharyngeal Constrictor Muscles)

Hand behindneck


Addendum

Any abnormal contraction of the diaphragms just released may produce a “drag” on the CraniosacralSystem as evaluated from the head or the feet. It is therefore suggested that the participant evaluate the quality of the Craniosacral System’s activity from both the head and the sacrum beforeand after releasing each of the four diaphragms previously described.

This exercise will begin to give you an appreciation of the impact upon the Craniosacral Systemfunction produced by diaphragmatic restriction.

Notes:

OCCIPITAL CRANIAL BASE AND LUMBOSACRAL DECOMPRESSION

Objectives:

1. To gain appreciation of the anatomical complexity and vulnerability of theOccipital Cranial Base.

2. To gain experience and develop proficiency in the Release technique for theOccipital Cranial Base.

3. To mobilize the Sacrum.

Occipital Cranial Base 53


General Considerations

The Occipital Cranial Base is another region of the body where there is an increase of transverselyoriented myofascial tissue. It is the area at the inferior or lower part of the skull where the Occiputconnects to the Atlas (the first cervical vertebra), and where the Atlas and the Axis (the second cervical vertebra) join together to form a functional unit.

In addition to its lateral joints with the lower surface of the Atlas, the Axis provides a bony pillarcalled the Dens around which the Atlas rotates.

Notes:

Posterior View ofOcciput-Atlas-Axis

Posterior View ofOcciput-Atlas-AxisSeparated to Show Articulations


Axis of Rotationaround Dens

Occiput and Condyles (cut)

Axis

Facet and Lateral Process

of Atlas (cut)

Dens

Occiput

Atlas

Axis

Occiput

Condyle of Occiput

Superior Facetof Atlas

Inferior Facet ofAtlas

Superior Facet ofAxis

Atlas and Axis separatedto show how Atlas can

rotate around Dens

Figure O-1


Notes:


Dens

Atlas

Inferior Facet of Atlas

Superior Facet of Axis

Axis

These pictures show how theshapes of these facets create a

slight side bend to the head during rotation (of the head).

Lateral view of facet mechanics of C3-C7 during rotation.

• Compare to facets of the Atlas-Axis

Those at left allow for a more limiteddegree of sliding with rotation.

A Rotating to right

B Neutral

C Rotating to left

Figure O-2

Lateral View of Facets of Atlas-Axis From Left Side

Lateral view of Atlas and Axisshowing unique shape of facets,

which allows for a great deal of gliding during rotation of

atlas on axis.


The Condyles of the Occiput form joint surfaces with the upper articular surfaces of the Atlas.These joints allow mostly for forward and backward bending of the Occiput on the Atlas (the headon the neck).

Notes: Occiput and Atlas Joint Surfaces


Head in “Neutral”Upright Position

ForwardBending

BackwardBending

ExtremeBackwardBending

= Area bearing weight or stress

Mandible

Dens

Condyle

Occiput

Atlas

Axis

C3

Facets of Atlas

Condyles

“Jamming” of Condyles into Facets of Atlas

Figure O-3


Notes:

These pictures show angles of articulations that cancontribute to jamming between Occiput and Atlas.

Figure O-4


(Anterior)

Angles of Facets Superior Articular Facets

Atlas:Superior View

Atlas: Oblique Anterior View

Posterior-Inferior View of Condyles

Occiput: Posterior View

Angles ofCondyles

Angles ofArticulations

Atlas


If we look at the Occiput, the Atlas and the Axis together, we see a kind of universal joint withthe Atlas in the middle. The motion between the Atlas and the Occiput is largely flexion andextension (or forward and backward bending). The motion between the Atlas and the Axis is largelyrotational.

The muscles at the Occipital Base are about 1-1/2 inches thick. In order to release the Occipital

Cranial Base, we must relax the muscles and disengage or “gap” the joints.


Occipital Cranial Base Release

Part One: Direction of energy with gradual platform to release the soft tissues posterior to the atlas

Part Two: Full platform to disengage the atlas from the occiput

Part Three: Decompression of occiput from atlas

Part Four: Lateral spread of occipital condyles to alleviate foramen magnum restrictions

Part Five: Superior traction of the dural tube to release restrictions in dural tube


Occipital Cranial Base Release, Part One

Core Intent: To release restrictions and facilitate relaxation in the soft tissues posterior to the atlas

Hand Placement: Fingertips of both hands placed posterior to the atlas, hands together, headresting in the palms of the hands.

Technique: Using the fingertips, gradually engage the tissues one gram at a time (as with diaphragmreleases), in an anterior direction towards the atlas adding direction of energy to assist, until softtissues relax and release and you can feel your fingertips in contact with the atlas

Figure O-5


Occipital Cranial Base Release, Part Two

Core Intent: To disengage the atlas from the occiput

Hand Placement: Fingertips posterior to the atlas as in Part One, hands together, wrists straight,metacarpophalangeal joints flexed, straight fingers angled towards the orbits of the eyes, creatinga platform posterior to the atlas with your fingertips

Technique: Maintain the platform in proper position, allow the weight of the head to assist theocciput while the atlas rests on the fingertips until the atlas disengages and floats freely

Figure O-6


Occipital Cranial Base Release, Part Three

Core Intent: To decompress the occiput from the atlas

Hand Placement: Index fingertips in contact with the atlas, palmar surface of middle and/or ringfingers in contact with the occiput, hands together, head resting on palms

Technique: Provide gentle, 5 grams superior traction to the occiput with the middle and ring fingers while index fingers gently stabilize the atlas

Figure O-7


Occipital Cranial Base Release, Part Four

Core Intent: To spread the occipital condyles laterally and release restrictions in the foramenmagnum

Hand Placement: The palmar surfaces of all fingers in contact with the occiput, hands together,head resting in palms

Technique: Apply gentle lateral traction with both hands

Figure O-8


Notes:



Occipital Cranial Base Release, Part Five

Core Intent: To evaluate for and release dural tube restrictions and mobilize the dural tube in asuperior direction

Hand Placement: Head resting in the hands, cradling the occiput (as in 3rd vault hold)

Technique: Apply a gentle superior traction using the occiput as a handle to access the dural tube.Be careful not to recruit muscular resistance. When you feel a restriction (or resistance to thesuperior traction), gently maintain the superior traction until you feel release, the dural tubelengthen and/or the occiput float towards you.

I like to compare this technique to pulling a large boat in the water. If you put the rope aroundyour little finger and just barely pull, the boat will move toward you with very little effort on yourpart. Otherwise you can break your back pulling without much better success. The Dural Tubewill come toward you; just be patient.

SacrumSpinal Dural Tube

Foramen Magnum

Occiput

Effect of Occipital Traction on the Dural Tube and Sacrum

Figure O-9


Notes:

Venous Drainage Through Jugular Foramina

Sagittal View

Lateral Sinus

Sigmoid Sinus

Occiput

Jugular ForamenExit Point for Jugular VeinIX - X - XI Cranial Nerves

Foramen Magnum

Jugular Vein

Petrous Portion of Temporal

Bone

Jugular Foramina

Jugular Veins

Squama of Temporal Bone

Petrous Part of Temporal Bone

Sigmoid Sinus

Superior View

StraightSinus

LateralSinus

Superior Sagittal Sinus

Occiput Figure O-10



Addendum

The Occipital Cranial Base Release technique improves the efficiency of fluid outflow from the cranial vault. It also alleviates pressures on the Glossopharyngeal, Vagus and Spinal Accessory Cranial Nerves. Both of these benefits are accomplished largely by releasing any abnormallyincreased tissue tonus around the Jugular Foramina (reference CranioSacral Therapy, pp. 291-297).

Notes: Jugular Foramen


Occipital Cranial Base/Jugular Foramina

Figure O-11

Temporal

Occiput

JugularForamen

IX - X - XI Cranial Nerves

MedullaOblongata

Brain Stem

Jugular Foramina ExitPoint for Jugular Vein

IX - X - XI Cranial Nerves


Notes:


Cranial Nerve IX – Glossopharyngeal Nerve

Figure O-12

Pons

Fourth Ventricle

MedullaOblongata

Internal Carotid Artery

Stylopharyngeus Muscle

Carotid Sinus

Parotid Gland

Soft Palate

Palatine Tonsil

Tongue


Notes:

Cranial Nerve X Vagus Nerve

Picture below shows major branchesand ganglia of Vagus Nerve.

Pons

Fourth Ventricle

Spinal Cord Medulla Oblongata

Pharynx

Epiglottis

Thyroid Cartilage

To Heart (cut)

Liver (cut)

Ascending Colon (cut)

Also Transverse Colon (not shown)

CecumAppendix

Ileum (cut)

(Duodenum)

Left Kidney

Pancreas (cut)

Spleen

Stomach (cut)

Esophagus

Left Bronchus

Gallbladder

Small Intestine

(cut)

Figure O-13



Notes:


Cranial Nerve XI – Spinal Accessory Nerve

Fourth Ventricle

Pons

Medulla Oblongata

Figure O-14


Mobilizing the Sacrum

While stabilizing the lower Lumbar Vertebrae with one hand, apply a gentle but persistent tractionin a caudal direction with the other. Do not use enough force to recruit muscular resistance. Thistechnique should release lumbosacral compression. If not, use the straight legs as levers to gapthe lumbosacral juncture by flexing the Pelvis around your other hand, which acts as a fulcrum.

Notes: Lumbosacral Release Through Traction

Core Intent: To decompress the sacrum inferiorly from L5.

Hand Placement: One hand posterior to sacrum (between legs) with other hand stabilizingL3-4-5 with fingertips or finger pads.


Traction Release of L5 - S1

For hand position – see Figure O-16

Figure O-15


Notes:


Traction Release of L5 – S1

Please note —

The fingers of the hand under the lower LumbarVertebrae may be held open with the finger pads

against the Spinal Process.

Figure O-16


Medial Compression ofAnterior Superior Iliac Spines

In order to release the Sacroiliac Joints, you will find that a medial compression of both AnteriorSuperior Iliac Spines (ASIS) simultaneously in the supine client will allow the Sacrum to movemore freely. This may be done either by you or the client. Medial compression of these spinestends to gap the joints in the back. While they are gapped, glide the Sacrum up and down (supe-riorly and inferiorly) a few times to mobilize the joints. This will also help many dysfunctions of theSacroiliac.

Notes:

Core Intent: To release both Sacroiliac (SI) Joints.

Hand Placement: One hand posterior to sacrum with the other arm’s fingertips andforearm on the ASIS.


Medial Compression of ASIS to Release SI Joints (Iliac Gap)

Figure O-17


Notes:


Patient-Assisted Release of SI Joints via Medial Compression of the ASIS

Figure O-18


Notes:


Using the Sacrum to Evaluate and Mobilize the Dural Tube

Now that the Sacrum is free, use a very light traction on the Sacrum toward the feet. Do not recruitmuscle resistance. Wait and you will feel the Dural Tube move toward you. Evaluate its mobili-ty. Try to discern any restrictions to mobility and try to localize them. One way to mobilize thedural tube would be to hold light traction (5 grams) against the restriction until lengtheningoccurs.


Notes:

SEMI-CLOSED HYDRAULIC CRANIOSACRAL SYSTEM

Objectives:

1. To obtain a functional, working comprehension of the Craniosacral System asa semi-closed hydraulic system through the “Pressurestat Model.”

2. To obtain a clear anatomical picture of the Dural Membrane as the boundaryof this semi-closed hydraulic system.

3. To obtain a detailed understanding of the bony attachments of the Dural Membrane and how these bones and membranes interact.

Semi-Closed Hydraulic Craniosacral System 91


The Pressurestat ModelA semi-closed hydraulic system is one in which there is a closed container with a regulated inflowand outflow mechanism. That is, fluid can be put into and removed from the container at controlledrates of flow. In this way the quantity of fluid within the container at any given time can be regulated.If fluid is pumped into the container after it is full and at one atmosphere of pressure, and if the container cannot further expand its volume, the following conditions may occur: 1) the pressureinside of the container is increased until either the container springs a leak or explodes; 2) thepressure inside the container exceeds the pumping force which the inflow pump can produce; 3) the outflow system is opened to remove some fluid; or 4) the inflow pump is shut off.

This description fits the Pressurestat Model of the Craniosacral System.

1. The container is the waterproof and relatively inelastic but very strong DuraMater. The Dura Mater membrane is shaped like a tadpole with the head insidethe skull vault and the tail extending downward within the vertebral canal (formedwithin the spinal vertebrae) to the Sacrococcygeal Complex where it is anchored.

2. The fluid in our semi-closed hydraulic system is the Cerebrospinal Fluid. Thisis an extract of the blood that has circulated through the Choroid Plexuses ofthe brain’s ventricular system.

3. The inflow pumping system consists of the Choroid Plexuses, which are locatedmostly in the Lateral Ventricles of the brain. However, (inconsistently) theremay be some Choroid Plexus present in the Third Ventricle of that system.

4. The regulatory system for the rate of fluid (CSF) inflow into our container (thepolliwog-shaped sac formed by the Dural Membrane) probably includes morethan one subsystem since Mother Nature seems to always provide “back up”in everything she designs. The one fluid input regulatory subsystem we doknow about is the neuromechanism which involves stretch and compressionreceptors in the sagittal suture. These receptors communicate (via nerve tractsrunning through the Falx Cerebri and then into the brain substance) with theVentricular System and its Choroid Plexuses. When the sagittal suture isstretched open by increased fluid pressure within the Dural Membrane container,the stretch receptors send a neural signal down to the Choroid Plexuses to eitherstop completely or significantly reduce the production of Cerebrospinal Fluid.This change in CSF production amounts to stopping or significantly reducingthe inflow of fluid into our semi-closed hydraulic system. When the sagittalsuture compresses (one parietal bone against the other), a nerve signal is gener-ated by the pressure receptors and sent to the Choroid Plexuses in theVentricular System of the Brain, which causes the CSF production to beginagain. Since the rate of inflow of fluid into the system exceeds the rate of outflow of fluid from the system, the internal pressure of the Dural Membranesac or container rises until the signal is again received to shut down the production of CSF.

Under normal circumstances the system seems to operate on about a six-secondcycle. That is, CSF is produced for about three seconds and then the production system is shut down for about three seconds. This gives us therhythmical rise and fall of fluid pressure within the system.

The Dural Membrane that forms the waterproof boundary of our semi-closedhydraulic system is the internal lining of the bones that form the skull vault.As such, it is firmly attached to these bones. When the Dural Membrane sacis pumped full of fluid, it expands to tautness up to a given pressure level.Since the parietal bones are attached to the Dural Membrane on their completeinternal sides, as the Dural Membrane sac expands to tautness, the suturesbetween the attached bones are expanded. When the internal fluid pressure is reduced, the elastic tissue within the sutures causes them to close to the prescribed dimension.

5. The regulation of Cerebrospinal Fluid outflow from the semi-closed hydraulicsystem (Dural Membrane sac) is probably also accomplished by several subsystems. The one subsystem with which I am familiar involves a cluster ofArachnoid Granulation Bodies, which are located at the extreme anterior endof the Straight Venous Sinus. This sinus is formed by the juncture of the FalxCerebri, the two sides of the Tentorium Cerebelli and by the Falx Cerebelli.The location of this cluster of Arachnoid Granulation Bodies at this juncture of all of the intracranial membranes seems crucial. Tension from anywherewithin the Dural Membrane System seems able to be transmitted to this particular location in the membrane system. The Arachnoid Granulation Bodies clustered there seem to have the ability to increase or decrease the general rate of reabsorption of CSF from within our semi-closed hydraulic system. This is more of a baseline regulation which, I suppose, is sensitive togeneral internal pressures and tensions within the system. It might be comparedto the idling speed of your automobile engine, which is more or less constantunless adjusted by using the adjustment screw on the carburetor. This is a baseline rate of operation, whereas the input side of the system is rising andfalling rhythmically all the time.

The outflow system from our Pressurestat Model is represented by the reabsorption of CSF back into the venous blood system as accomplished by theArachnoid Villae, located in many parts of the Dural Membrane System but aremost concentrated in the sagittal venous sinus.

These, then, are the components of our hypothesized model of the Craniosacral System.



Notes:

Pressurestat Model Illustration



Notes:

Oblique, Posterior-Superior ViewShowing Sutures, Membranes and

Ventricles of Brain

As the cranium expands during the flexionphase (due to the rise in CSF pressure), theparietal bones move apart A at the SagittalSuture, sending a stretch reflex signal down anerve fiber(s) B into the area of the Ventricu-lar System C where the Choroid Plexuses ofthe Ventricles D * act as the vehicles forCSF production.

— This signal (down the Nerve Fiber(s) to theVentricular System) is to turn off or slow downproduction.

— As CSF drains, this cycle is reversed, i.e.,Sagittal Sutures approximate creating pressure(at sutures), thereby signaling for CSF pro-duction to resume.

* Shown are a portion of the Choroid Plexusesof the third and lateral ventricles only.

Any tensions in the membrane system can reflect back into thiscentral area.

Therefore, abnormal tensions anywhere in the system potentiallycan have a disruptive effect upon this mechanism — and itseffect upon CSF production.

Sagittal View

Arrows indicateblood flow

from cerebral hemispheres togreat cerebral

vein andstraight sinus.

PosteriorView

Central position of Arachnoid Granulation Cluster (ball-valvemechanism) regulates outflow based on membrane tension.

Figure P-1



Anatomical Relations

The Dura Mater, which forms the sac of the semi-closed hydraulic system, is attached as the innerlining to the Parietal Bones, the Temporal Bones, the Frontal Bone, the Occipital Bone and theSphenoid Bone. It also attaches to the Ethmoid Bone but not as its lining.

The Dura Mater also forms the tube which runs downward through the vertebral canal. Withinthe canal, its only bony attachments are to the posterior bodies of the second and third cervical vertebrae and to the posterior body of the second sacral segment. It exits the vertebral canal throughthe Sacral Hiatus and blends with the periosteum of the Coccyx. The Dural Tube within the vertebral canal is also firmly attached to the Foramen Magnum of the Occiput. Otherwise, the DuralTube attachments are either soft tissue ligaments (Dentate) which allow some movement of theDural Tube or the Dural Sleeve attachment to the Foramina formed by the vertebrae for the passageof spinal nerve roots outside of the Spinal Canal.

The Falx Cerebri, Tentorium Cerebelli and the Falx Cerebelli all represent Dura Mater (DuralMembrane) structures inside of the cranial vault, which are formed by the Dural Membrane separatingfrom the skull bones and reduplicating upon itself to form partitions in the skull. These structures alsoprovide much of what is used in the formation of the Venous Sinus system inside the skull.

Notes:

Points of Attachment of Dura … to Bone … (Schematic)

Points of Attachment of Dura … (Detail)


Foramen Magnum

Entire Cranial Vault

Coccyx S-2

C-3C-2

Attaches to and lines entire

Cranial Vault

Figure P-2

Blends withPeriosteum of

Coccyx

Anterior portionof Canal of S-2

Posteriorbodies ofC-2, C-3

Around entire Foramen Magnum


Notes: General Outline of Venous Sinuses

The Venous Sinuses


Figure P-3

Anterior View

Falx Cerebri

Falx Cerebelli

Tentorium Cerebelli

Foramen Magnum

Jugular Foramen


(Arrows indicate direction of venous drainage.)

Inferior Sagittal Sinus

Straight Sinus

Superior Petrosal Sinus

Sigmoid Sinus

(Views of Falxes, Tentorium Cerebelli and Sinuses)

Posterior-Superior View

Falx Cerebri

Tentorium Cerebelli

Falx Cerebelli

Foramen Magnum

Lateral Sinus


Inferior Sagittal Sinus

Straight Sinus

Superior Petrosal Sinus

Jugular Foramen

Sigmoid SinusLateral Sinus

Jugular Vein


Notes:

DURAL TUBE

Objectives:

1. To sense by palpation and proprioception the quality of Dural Tube mobility.

2. To release any abnormal restrictions or tensions that interfere with Dural Tubefunction.

3. To have at your fingertips the concept of the interrelations between the involvedbones and the Dural Tube.

Dural Tube 103


The Dural Tube

We have talked briefly about the Dural Tube. The main points to keep in mind are that the DuralTube must have a reasonable degree of freedom of movement within the Spinal Vertebral Canaland in relationship to the Arachnoid Membrane. Otherwise, we lose most of our ability to bend androtate our spines without severe pain. Also, it must be remembered that the Dural Tube connectsyour head to your upper neck and to your tail. Problems in any of these areas can broadcast up and/or down the tube to present symptoms elsewhere. An injured coccyx can cause a headache, etc.

Remember that the Dural Tube attachments are:

Superior attachments

• Dense fibrous ring around Foramen Magnum.

• Within the spinal canal at level of second and third cervical vertebrae (anteri-or tube attaches to posterior bodies of the vertebrae).

Inferior attachments

• Within sacral canal at level of second sacral segment — anterior aspect ofdura attaches to anterior wall of canal through sacrum (posterior body ofsegment).

• Blends with other meninges to exit sacrum and becomes periosteum of thecoccyx.

Now let us consider how we might deal with the Dural Tube.

Technique — Dural Tube evaluation and treatment/release.

Objective — Mobilize the Dural Tube to its maximum.

Enabling Objectives — Mobilize Occiput and Sacrococcygeal Complex.

The Occiput was mobilized when you applied the Occipital Cranial Base Release Technique.

The Sacrococcygeal Complex was partially mobilized when you released the Pelvic Diaphragm.We must, however, be sure that the Sacrum is not compressed at the Lumbosacral Junction and thatthe Sacroiliac Joints are not binding free sacral movement. It is impossible to use the Sacrum asthe handle to evaluate the more subtle movements of the Dural Tube if the Sacrum itself is not freeto move. The same is, of course, true of the Occiput.

Dural Tube 105

From Both Ends

Now that you have approached the Dural Tube from either end individually, we will approach itfrom both ends at the same time.

Dural Tube RockWith the client supine, place one hand under the Occiput and the other hand under the Sacrum.Encourage a gentle rocking between the two ends using the craniosacral rhythm. The rockingmotion will address the rotational aspect of the Occiput and Sacrum. In doing so, you will help torelease restrictions of the transverse rings of fascia in the Dural Tube. The more you rock, the betterthe Dural Tube will like it.

Notes: Rocking the Dural Tube

Core Intent: To release transverse rings of the dural tube and enhance the rotational range ofmotion of the occiput and sacrum.

Hand Placement: One hand transverse under the occiput and the other transverse under thesacrum.


Notes:

Rocking the Dural Tube — Supine

Dural Tube 107

Figure D-2


Notes:

Rocking the Dural Tube

Dural Tube 109

Figure D-3


Dural Tube Glide

With the client and your hands in the same position, “tune-in” to the longitudinal motion at theOcciput and Sacrum. (This motion is happening simultaneously with the rocking/rotational motion.)By enhancing this longitudinal motion, you address the nerve roots as well as any remaining restrictions of the Dural Tube within the vertebral canal.

Restrictions are freed by moving the Dural Tube. Be patient and move it through several cycles.It is also helpful to use prolonged traction on a restricted Dural Tube. Simply hold and await therelease just as you did with the other bones of the cranial vault.

Notes: Gliding the Dural Tube

Core Intent: To release spinal nerve roots and dural sleeves and enhance longitudinal range ofmotion of the occiput and sacrum.

Hand Placement: Same as dural tube rock.

Gliding the Dural Tube — Supine

Dural Tube 111

Figure D-4


Notes:

STILL-POINT INDUCTION

Objectives:

1. To gain a working knowledge of what the Still Point represents and how it occurs.

2. To understand the indications, uses and contraindications for the Still Point.

3. To develop the skill to induce a Still Point from anywhere in the body.

4. To be able to use the CV-4 technique.

Still-Point Induction 113


Still-Point Induction

This is the first time during the course of this workshop that you, the CranioSacral Therapy practitioner, will actually intrude upon and alter the function of the Craniosacral System.

For therapeutic reasons, we are going to intentionally interrupt the workings of the CraniosacralSystem. To review, the flexion phase of the craniosacral rhythm is the time when the whole bodyexternally rotates. The extension phase of the craniosacral rhythm is when the whole body internallyrotates. During flexion the head widens and the base of the Sacrum moves posteriorly. We theorizethat the flexion phase of the rhythmical cycle is created when the input of Cerebrospinal Fluid (CSF)into the semi-closed hydraulic system formed by the Dura Mater exceeds the outflow. During theextension phase of the rhythm, the input of CSF is either shut off completely or is significantly lessthan the outflow. Thus, we might say that the flexion phase is one of filling and the extension phaseis one of emptying.

We can induce a Still Point by either resisting the flexion or extension phase. It is easier and moreefficient to resist the filling (flexion) than the emptying (extension). Remember, flexion is bodilyexternal rotation and widening of the head. Extension is bodily internal rotation and narrowing ofthe head.

Notes: Still-Point Induction

Core Intent: To bring the CSR to a (gradual) therapeutic stop, facilitating greater homeostasis.

Notes:



Notes: Still-Point Induction by CV-4

Core Intent: To bring the CSR to a therapeutic stop, specifically through the occiput.

Hand Placement: With the palms facing up (toward the ceiling), place one hand over the otherwith the thumbs touching each other. Leaving the thenar eminences apart (approx. 1.5-2.5”),center the occiput on the soft tissue of the thenars.

CV-4 Still-Point Induction


Arrows indicate directionThenar Eminences follow

Occiput to induce Still Point.

Figure S-1



Notes: Still-Point Induction Through the Sacrum

Core Intent: To bring the CSR to a therapeutic stop, specifically through the sacrum.

Hand Placement: One hand centered under posterior sacrum (between the legs).

Still-Point Induction Through the Sacrum


Arrows indicate direction of “following” into extension.Dotted lines indicate “new” position of Sacrum after each extension phase.

Figure S-2


Notes: Still Point on Legs

Core Intent: To bring the CSR to a therapeutic stop through the legs.

Hand Placement: Any bilateral location on the legs.

Still-Point Induction Through the Legs


Arrows indicate direction followed intointernal rotation of the

lower extremities.

Figure S-3


Notes:

Indications, Uses and Contraindications

The Still Point is used as a balancing technique for the Craniosacral System. It will also removetransient and minor restrictions with only a few serial applications. Theoretically, its use couldremove most intradural restrictions because, if you redirect and change fluid forces within the systemrepeatedly, most restrictions will succumb and release.

The Still Point is used to release accumulated stress. It has a profound relaxing effect on the autonomicnervous system. Thus, it is beneficial with most hyperautonomic problems, from high blood pressureto peptic ulcer.

The Still Point also improves fluid exchange between the various physiological compartments ofthe body, as well as improving blood flow by reducing sympathetic nervous tone.

DO NOT use the Still Point in cases of acute stroke, cerebral aneurysm, or any condition inwhich fluid pressure changes within the skull could be detrimental.

Occasionally, the Still-Point induction will dredge up old pains that had “gone away.” This isgood. The old pains hadn’t disappeared, they were simply dormant and waiting to reappear atanother time. The dredging up offers opportunity for total correction of the problem at that time.



Cranial Pumping

With the discovery of chelating elements in CSF, facilitating fluid exchange through the CS sys-tem could enhance immune function, promote clearing waste products and increase overallvitality.

By “pumping” the cranium, you are gently encouraging a greater volume of CSF to be producedand reabsorbed. Consequently you will be increasing the amount of fresh nutrients to the brainand spinal cord while collecting more byproducts to be filtered out of the system.

The technique is simple: You are enhancing CSF movement by encouraging 5 grams of move-ment at the end-range of flexion and extension while palpating the cranium. Typical handpositions would be: one hand under the occiput and the other on the crown/frontal area. Blendwith the CSR and enhance the motion at the end ranges. The result will be enhanced productionand movement of CSF.

Notes: Cranial Pumping

Core Intent: To enhance the production and movement (exchange) of CSF.

Hand Placement: One hand on crown/frontal area, other hand under occiput.

V-SPREAD

Objectives:

1. To temporarily suspend hypercritical thought processes which may obstruct afavorable V-Spread experience.

2. To appreciate the similarity between the V-Spread and many other hands-ontherapeutic approaches or techniques.

3. To explore the many ways in which the V-Spread has the potential for healing.

4. To gain several positive V-Spread experiences, both as therapist and as recipient.

V-Spread 125


V-Spread

(Reference CranioSacral Therapy, pp. 74, 139-40, 164-66 and 263)

The V-Spread is the technique that stretches both our credibility and your imagination to the maximum. It is a technique that is not yet explained in scientific terms, although it seems to berelated to the work of Robert Becker, MD, as expressed in his book The Body Electric, and to thework of Harold Saxton Burr, described in his book Blueprint for Immortality. Both of these researchersseemed to do with instrumentation what the V-Spread technique does with the hands (or other bodyparts) of the CranioSacral Therapy practitioner. In any case, to effectively and fairly evaluate theefficacy of the V-Spread technique, you must try it. In order to try it with reasonable fairness, youwill have to temporarily suspend the activity of your critical and rational left brain. If you have anegative attitude, this may interfere with the result. Once you have experienced the phenomenonof a successful V-Spread application, it becomes more difficult to deny its existence. In some peoplethe experience sets up a real conflict between what they perceive and what their intellect tells themis silly or impossible.

I sometimes think that the V-Spread separates the adults from the children. The adults “know” thatit is a ridiculous waste of time and so reject it. The children don’t “know” that V-Spread is not avalid technique, and so they use it with success.

In reality, I think the V-Spread is out on the far edge of the frontier. One day we will know howit works and those who understand it will wonder what all the fuss was about. V-Spread willbecome standard operating procedure and will be a part of everyone’s first-aid training, be it fromthe Red Cross or the Boy/Girl Scouts of America.

As you practice the technique, some of you will see the close relationship to Krieger’s TherapeuticTouch, Polarity Therapy, Joy’s Way (by Brugh Joy) and many other approaches.

What makes the V-Spread approach different is its lack of rules and rituals. In V-Spread we simplydecide to direct, pass or organize a “healing energy” for a given purpose and we do it. No gimmicks or tricks. You can use any method that you decide will work. Yes, it does look like weare discussing the recruitment of a “healing power” which we all possess and which is directed byour intention.

It does not matter whether you send from right to left or left to right — all you have to do is decidethat it will work this way. Yes, you can send from off the body. Yes, the energy of two or moresenders can be added together. Yes, release occurs and heat radiates from the area under treatment,and Therapeutic Pulse occurs. It will crescendo as the healing energy passes through the body partsbeing treated and begins to reach your receiving hand. It will decrescendo and disappear as the therapeutic process is completed. And yes, of course you can do the V-Spread on yourself, but ittakes a little longer and may be less effective. One last comment: The denser the tissue that the healing energy must penetrate, the longer it takes to reach your receiving hand (or receiving foot, etc.).

Additional Thoughts

As we further our experiences working with energy in the therapeutic setting, we have found thatthere are refinements that we can make with our “directing.”

You can be even more effective facilitating release and revitalizing tissue if you first assess theenergetic nature of the tissue in question. Sometimes you will determine that the tissue is deplet-ed or “over-full.” In these cases you would want to intention to add or remove energy as the tissuedesires for release and balance.

The best way that we have found to determine the energetic needs of tissue is to assess from “neu-tral.” Neutral is the phenomenon in which the therapist places his/her hand(s) on the effectedtissue, neither adding nor removing energy—they are just “there” with no engaging intention atall. After just a little practice, you’ll be able to easily determine the needs of the tissue.

Notes:

V-Spread 127


Sutherland’s Concept

Historically within the Craniosacral System framework, the V-Spread is derived from the earlierobservations of William Garner Sutherland, DO, who, during the first half of this century, set outto prove that cranial bones could move. Dr. Sutherland observed or reasoned that it was possibleto achieve a release of sutural restriction between the skull bones by the direction of energythrough Cerebrospinal Fluid. He pursued this concept practically and demonstrated the methodas a very effective means of releasing abnormally immobilized sutures.

Notes: Direction of Energy Technique to Release Sutures

Sutherland’s Approach

V-Spread 129

Place pads of fingers gently on the scalp directly over the painful suture area.

Next, imagine a line or vector from the painful area through the center of the skull and out the other side of the patient’s head.

(Continued on page 131.)

Figure V-1

Pain or Restricted Suture


Notes:

Sutherland’s Approach (continued)

V-Spread 131

Pulsation Area

With the other hand, very gently palpate for a pulsation of thescalp at the region where the vector would emerge.

A gentle spreading action bythe fingers paralleling the

painful suture will speed thetherapeutic effect.

Once the area of pulsationhas been located, apply finger pads to

the area. The fingers of the other hand gentlyparallel the painful suture (on either side of

it). The painful suture will begin pulsating and continue to do so for a matter ofminutes. As the pulsating subsides, so will the pain.

Figure V-2


Expansion of Sutherland’s Concepts

Through observation and experience, we have found that the presence of Cerebrospinal Fluidbetween the sending and receiving hands is not necessary unless you believe it to be so. The healingenergy can be directed through any body part to achieve a positive result.

Notes: Direction of Energy

Core Intent: To send or remove energy to or from effected areas of the body, facilitating release.

Hand Placement: Anywhere on the body.

Direction of EnergyTechnique FromOcciput Through

Eye Into Cupped Hand

V-Spread 133

Figure V-5


Notes:

Sending Energy

V-Spread 135

Sending energy from the therapist’s body through the client’sbody (in this case, the liver area) to the therapist’s hand.

Figure V-6


Notes:

INTRACRANIAL MEMBRANE SYSTEM

Objectives:

1. To develop palpatory skills which will tell you when you have an osseousrestriction or a membranous restriction, and when the viscous change hasoccurred.

2. To develop appreciation for the minute amounts of forces involved in the craniosacral “lift and traction” techniques.

3. To be able to evaluate and release restrictions in the Intracranial Vertical Membrane System.

4. To be able to evaluate and release restrictions in the Intracranial HorizontalMembrane System.

5. To develop an understanding of the difference between osseous and membranousrestrictions.

6. To develop an understanding of the viscoelastic properties of membranes andhow this biomechanical phenomenon can be used in CranioSacral Therapy.

7. To evaluate and treat the Temporal Bones using Temporal Wobble, Finger in Earand Temporal Ear Pull techniques.

Intracranial Membrane System 137


The Palpation of Restriction Quality

Before we proceed, we must also have an appreciation for the different kinds of restrictions we willencounter, and the sensation of release in the intracranial and spinal Dural Membrane systems.

1. Osseous restriction is firm and immovable. This is sutural restriction.

2. Membranous restriction has an elastic quality. It gives when you traction it,but it seems to want to snap back as you let go.

3. When elastic restriction is ended, a viscous change has occurred and the senseof elastic recoil or tissue memory is gone. This signifies the completion of thatphase of the therapeutic process.

Evaluation and Treatment of theCraniosacral SystemEvaluation and treatment of the Craniosacral System is accomplished through the application ofvery gentle traction or lifting forces. This is a light force directed along the natural pathways ofcranial bone movement in the flexion or extension phases of the craniosacral cycle.

If gentle traction causes the cranial bone to move freely and smoothly through its normal rangeof motion, then no underlying restriction exists. Often this will not be the case, and the therapistwill encounter resistance to gentle traction. When resistance is encountered, it is indicative of anunderlying restriction within the Craniosacral System.

Restrictions, which are barriers to free movement of the Craniosacral System, may occur betweenadjacent cranial bones or within the craniosacral Dural Membrane. Hence, a distinction is madebetween osseous and membranous restriction. These two restrictions provide a different palpatorysensation for the therapist.

Osseous restrictions are rigid. This type of restriction represents a lack of mobility at the cranialsutures – often the result of sutural “jamming.” It feels as though the involved cranial bones arecemented at their sutural junction.

Membranous restrictions are elastic. This type of restriction exists within the craniosacral DuralMembrane. Under the gentle traction of the therapist, a membranous restriction feels like a rubberband that has been pulled and is ready to snap back.

Distinguishing between osseous and membranous restrictions is a significant part of the basis forevaluation and treatment of the Craniosacral System. Although contact points are taken on the cranialbones themselves, it is more than cranial bone mobility that is evaluated and treated. Osseousrestrictions inhibit normal cranial bone movement. Underlying membranous restrictions interferewith the normal compliance of the Craniosacral System with the rise and fall of CSF pressure.The craniosacral membrane system is the first priority target of this therapy; the cranial bones aresimply handles on the underlying membranes. The steps of this process can be outlined as follows:

1. Apply gentle traction in the direction of desired cranial bone movement at thesutures.

2. If a rigid, cement-like resistance is encountered, an osseous restriction exists.This must be treated before proceeding. Osseous restrictions, if they exist, willbe encountered before membranous restrictions are sensed.

a. Continued light traction often will release an osseous restriction.

b. The use of a V-Spread through the area of osseous restriction will cause itto release.

c. The use of a specific osseous manipulation for that suture will bring abouta release.

d. Correction of an osseous restriction occurs when the underlying, rigidmovement barrier is no longer felt.

3. If an elastic resistance is encountered, a membranous restriction exists whichmust also be corrected. Membranous restrictions will be encountered eitheralone or after the release of an osseous restriction.

a. Continuous light traction will usually release a membranous restriction.

b. Correction of a membrane restriction has been achieved when the elasticphase of resistance becomes plastic, or pliable, and the involved cranialbones proceed freely toward the end point of their movement.

4. When the unrestricted movement of the cranial bones and the underlying DuralMembrane is achieved, therapy is concluded by gently releasing the light traction.

Notes:



Notes:

Spring and Dashpot Model


Figure I-1

New position (of tissues) is now resting in a “stable” position— there is no pull to return to position of #1 (in sequence).

1) = Viscous element

Fixed end

Cylinder

Piston

= Elastic element

Resting position (no load)

2) Elastic element takes upforce of traction (load)

Tractionload isapplied

3)Time passes –Pull from spring is transmitted to cylinder

4)As cylinder moves — fluid is pulled into cylinder (from piston)

Spring returns to “relaxed” position as cylinderis moved to “new” position from load.


Horizontal and Vertical Divisions of the Craniosacral Membrane System

For your convenience and reference, the craniosacral membrane system has been divided into subsystems. These subsystems and the names of the related therapeutic techniques are listed below:

Craniosacral Membrane System1. Intracranial Membrane System

• Vertical Subsystem

Anterior-Posterior Division

Frontal Lift with Traction

Superior-Inferior Division

Parietal Lift with Traction

• Horizontal Subsystem

Anterior-Posterior Division

Sphenoid Compression-Decompression

Lateral Division

Temporal Ear Pull

2. Spinal Dural Tube

• Superior-Inferior

Occipital Traction

• Inferior-Superior

Sacro-Coccygeal Traction

• Indifferent to Direction

Occipito-Sacral Rocking Technique

Anatomical Attachments of theFree Craniosacral Membrane System

The anatomical attachments of the craniosacral membrane are considered for each of the four divisions of the free craniosacral Dural Membrane: (1) the Falx Cerebri, (2) the Falx Cerebelli,(3) the Tentorium Cerebelli, and (4) the Spinal Dural Tube. These specific anatomical attachmentsfor these divisions of the Dura Mater are:

1. Falx Cerebri

• Anterior Attachments

Internal Vertical Midline of the Frontal Bone

Crista Galli of the Ethmoid Bone

Ethmoid Notch of the Frontal Bone

• Posterior Attachment

Internal Occipital Protuberance and Vertical Line of the Occipital Bone

• Superior Attachments

Undersurface of Frontal, Parietal and Occipital Bones Along the Midline and Beneath the Sagittal Suture

• Inferior Attachments

Tentorium Cerebelli

• Related Venous Sinuses

Superior Sagittal Sinus Formed From the Enfolding of AttachmentsAlong the Sagittal Suture

Inferior Sagittal Sinus Formed at Free Border of Falx Cerebri

Straight Sinus Where the Falx Cerebri Joins the Tentorium Cerebelli

2. Falx Cerebelli

• Superior Attachments

Inferior Leaves of Tentorium Cerebelli and the Straight Sinus Formed by Their Attachment

• Posterior Attachments

Internal Midline Ridge of Occiput

• Inferior Attachment

Dense Fibrous Ring Around Foramen Magnum



3. Tentorium Cerebelli

• Superior Leaves Continuous with Falx Cerebri

• Inferior Leaves Continuous with Falx Cerebelli

• Anterior Attachments

Anterior Clinoid Process of Sphenoid Bone (Superior Leaves)

Posterior Clinoid Process of Sphenoid Bone (Inferior Leaves)

• Lateral Attachments

Petrous Ridge of Temporal Bones

Mastoid Portions of Temporal Bones

Inferior Angle of Parietal Bones

• Posterior Attachments

Transverse Ridges of Occipital Bone

4. Spinal Dural Tube

• Superior End Posterior Bodies of C2, C3

• Inferior EndAnterior Portion of Canal at S2

Blends with Periosteum of Coccyx

Craniosacral Techniques for the Vertical Membrane System

1. Frontal Lift With Traction

• Anterior-Posterior (Reference CranioSacral Therapy, pp. 62, 69-74, 162-164)

Notes: Frontal Lift

Core Intent: To release the sutures of the frontal bone and the anterior/posterior aspect of thefalx cerebri and falx cerebelli.

Hand Placement: Fourth fingers make contact posterior to the lateral ridge of the frontal bone.Fingers two and three spread out medially on the frontal bone making full, conforming contact.



Notes:

Frontal Lift


Figure I-2


Notes:

Frontal Lift


Figure I-3


2. Parietal Lift With Traction

• Superior-Inferior (Reference CranioSacral Therapy, pp. 77-78, 161-162)

Notes: Parietal Lift

Core Intent: Part One — To release the temporal-parietal suture with medial compression onthe parietal bones followed by a 10-second release of pressure to allow for fluid exchange of thesuperior sagittal sinus.

Core Intent: Part Two — To release the superior/inferior aspect of the falx cerebri and falxcerebelli.

Hand Placement (both parts): Fingers two through five make contact on or around the pari-etal ridge (temporalis attachment).

Parietal Lift — Part One


B) Internal fluid pressures now laterally spread Parietals

Figure I-4

1

AA

2C

A

D

C

A

D

B B

3

Parietals

Temporals

A) Gentle Medial Compression A) Gentle manual pressuremaintained

B) Internal fluid pressures begin to lift Parietals C as sutures disengage D


Notes:

Parietal Lift — Part Two


After appropriate pause at conclusion of Part One, gentle cephalad traction is applied.

Figure I-5


The Horizontal Membrane System

1. Sphenoid

• Anterior-Posterior (Reference CranioSacral Therapy, pp. 74-76, 120-126)

Compression

Decompression

The Unlatching Principle

With Sphenoid compression/decompression, we introduce the concept of an indirect technique.It’s based on using an “unlatching” principle to release a restriction by encouraging motion in thedirection of ease as opposed to the direction of the restriction. To open a door latch we mustsometimes first exaggerate the closure. For instance, the latches on some kitchen-cabinet doorsor stereo-cabinet doors require you to push in to release the mechanism.

With the Sphenoid technique, we compress the sphenoid into the joint (motion of ease) and attainreleases, then decompress (motion of the barrier) and release the remaining restrictions. Quiteoften, the indirect portion of the technique will easily release many of the barrier restrictionsbefore they are directly addressed.

Notes: Sphenoid Compression/Decompression

Core Intent: Compression — To engage the “unlatching principle” with the sphenoidand release sutural restrictions.

Core Intent: Decompression — To release the anterior/posterior aspect of the tentoriumcerebelli.

Hand Placement (for both): Thumbs placed on the greater wings of the sphenoid and the rest ofthe hands wrap posteriorly around the cranium.

Sphenoid:Part 1 —Compression


Hand Position

Figure I-6


Notes:

Sphenoid: Part II — Decompression


Figure I-7


Notes:

Sphenoid Decompression


Figure I-8


Temporal Bone Techniques

Evaluation:

Circumferential motion, Finger in the Ear

Medial-lateral motion, Wobble

Treatment:

Occipital-Mastoid Release

Ear Pull

Re-evaluate and synchronize, if needed

Temporal Wobble


Finger in the Ear:Evaluation of Circumferential Motion

Core Intent: To assess mobility of temporal-parietal, and other temporal sutures. Can also beused to re-synchronize motion after treatment if needed. (See Page 166)

Hand Placement: Bilateral, middle fingers gently placed in the external auditory meatus, indexfingers on the zygomatic processes of the temporal bones, ring fingers on the mastoid processes.

Technique: Palpate symmetry, quality, amplitude and rate (SQAR) and synchrony of the cir-cumferential or rotational motion of the temporal bones


Temporal Wobble: Evaluation of Medial-Lateral Motion

Core Intent: To assess mobility of occipital-mastoid, and other temporal sutures. Can also beused to re-synchronize motion after treatment if needed. (See Page 166)

Hand Placement: Bilateral, thumbs in contact with the lateral aspects of the mastoid processes,head/occiput resting in the palms

Technique: Palpate symmetry, quality, amplitude and rate (SQAR) and synchrony of the medial-lateral motion of the temporal bones


Figure I-10

Occipital-Mastoid Release

Core Intent: To release restrictions in the occipital-mastoid suture and decompress the temporalbones

Hand Placement: One hand posterior to the occiput, the occiput resting in the palm, finger padsmedial to the O-M suture, the other hand will gently grasp the cartilage of one ear. For the righttemporal bone the left hand will be on the occiput and the right hand will grasp the right ear. Forthe left temporal bone the right hand will be on the occiput and the left hand will grasp the left ear.

Technique: The hand grasping the ear will provide very gentle traction in a posterior and lateraldirection while the hand on the occiput provides stabilization to the occiput. One temporal boneis treated at a time so this technique will need to be repeated, changing the hand position fromone side to the other.


Notes:


Temporal Ear Pull

Core Intent: Primarily to release restrictions in the horizontal membrane, the tentorium, in a pos-terior-lateral direction. Will also address remaining sutural restrictions.

Hand Placement: Bilateral, gently grasp the cartilage of the ears, thumbs gently in the externalauditory meatus and fingers wrapped around the cartilage.

Technique: Provide gentle, bilateral traction in a posterior-lateral direction.

Figure I-11


Re-evaluation and Resynchronization

Repeat the evaluation of the circumferential and medial-lateral motion (See pages 161 &162)

Palpate the SQAR and the synchrony as before. If the right and left temporal bones are NOT insynchrony then resynchronize by following the motion to the end of the range, hold one side atthe end of the range and wait for the other side to join it, then release the hold and follow themotion for a couple of cycles (as instructed in class).


Temporal Ear Pull

Figure I-12


AddendumThe techniques given in this chapter are the keys to successful CranioSacral Therapy. They alsoserve to distinguish CranioSacral Therapy from other forms of cranial manipulation. Perhaps themost important aspect of CranioSacral Therapy is that of the cranial membranes. While othertechniques focus specifically on the osseous structures of the cranial system — the bones and suturalconnections — CranioSacral Therapy focuses on the Dural Membranes.

Successful correction of membranous restrictions enhances the overall mobility and complianceof the Craniosacral System. Attention to membranous lesions can also prevent the need to correctrecurring sutural problems that arise when only the osseous structures of the cranium are treated.Remember, you cannot release the membranes if the bones or sutures are restricted.

Finally, the structure of the cranial membranes dictate the most effective therapeutic approach. Asviscoelastic structures, the cranial membranes must be given time to adapt to the gentle, correctiveforce of the practitioner. In applying the craniosacral techniques of this chapter, remember thatthe Craniosacral System cannot be rushed. The most effective therapeutic approach is to introducea minimal corrective energy into the Craniosacral System. Then, one monitors the system overtime as it changes in response to this noncoercive force. This process is very educational for the therapist as well as being therapeutic for the client.

SEE ILLUSTRATIONS OF ANATOMICAL DETAIL ON FOLLOWING PAGES.

Crisscrossing lines represent Tentoriums and Dura of Diaphragma Sella and the Walls of the Cavernous Sinuses.

This illustrates many possibilities for crisscrossing tensional forces within these tissues. Piercingthese tissues, and therefore vulnerable to the effects of these tensional forces, are numerous nerves,vascular structures and the all-important Pituitary Gland. (See following diagrams.)


Figure I-13

Lateral Cavernous Sinuses

Anterior Clinoid (Process of Sphenoid)

Diaphragma Sella

Posterior ClinoidProcess (of Sphenoid)

Posterior Wall of Left Cavernous Sinus

Lower Leaf of Tentorium Cerebelli

Lateral Wall of Cavernous

Sinus

Upper Leaf of Tentorium Cerebelli


Notes:

Posterior View of Lateral Cavernous Sinuses and Adjoining Structures


Body of Sphenoid Bone

Figure I-14

Endothelial Lininginside Sinus —

encases nerves and separates them fromblood inside sinus

Lateral wall of Sinus

(MeningealLayer of Dura

Mater)

BrainPia Mater

Subarachnoid space (CSFfilled and traversed bynumerous trabeculae)

Anterior Clinoid Processes

Hypophysis (Pituitary)

Medial Wall of Sinus(Endosteal Layer of

Dura Mater)

CavernousSinus

filled with blood and

crisscrossedwith trabeculae

(connectingtwo layers of Dura Mater)


Notes:

Posterior View of Lateral Cavernous Sinuses andAdjoining Structures (continued)


MaxillaryDivision ofTrigeminal

Nerve

Figure I-15

Oculomotor Nerve

Trochlear Nerve

Abducent Nerve Internal Carotid ArteryNote — Carotid is within

the Sinus rather than the lateral wall

Carotid SympatheticNerve Plexus

OphthalmicDivision ofTrigeminal

Nerve


Notes:

TMJ and Temporal Bones 175

THE TEMPOROMANDIBULAR JOINT AND TEMPORAL BONES

Objectives:

1. To develop a basic working/functional comprehension of the anatomy of theTemporomandibular Joint (TMJ).

2. To gain a clear understanding of the functional anatomy of the Temporal Bones.

3. To have a working concept of the interdependency between the TMJ and theTemporal Bones and their function.

4. To have a working concept of the relationship between the Temporal Bonesand the rest of the Craniosacral System, including significant muscular attachments.

5. To evaluate and treat the TMJ.

6. To be able to instruct clients in self-help techniques for TMJ dysfunction.


Temporomandibular Joint and Related Structures

Components that are significant to the CranioSacral Therapy practitioner:

Temporal Bone – fossa and eminence

Mandible – condyle

Intra-articular Disc

Retrodiscal Elastic Tissue

Lateral Pterygoid Muscle

Joint Capsule

Structures that influence TMJ function, not directly involved in the joint itself but which contributeto dysfunction and may be favorably influenced by CranioSacral Therapy:

Temporalis Muscle

Sling Muscles (Masseter and Medial Pterygoid)

Stylomandibular Ligament

Hyoid Bone and its attached soft tissues

Teeth

Mandible

Coronoid Process

Axis of rotation in neck/angle

Trigeminal Nerve System

Reticular Activating System

Temporal Bone

All sutures

Zygomatic Process

Mastoid Process

Styloid Process

Notes: Temporalis Muscle and Attachment

Osseous Anatomy


ZygomaticProcess

Figure T-1

Ear Canal

Mastoid Process

Mandibular Fossa(Temporal Fossa)

Mandible

ArticularTubercle

Tympanic part of Temporal Bone


Notes:

Temporalis Muscle


Chronic TemporalisHypertonus can produce

compression of the Articular Disc.

Figure T-2


Notes:

The Joint


General (Schematic) Anatomy of the TemporomandibularJoint and its Relation to the Cranium

(For more detailed anatomy see the following page.)

Condylar Headof Mandible

Figure T-3

(Please note — Disc and space in fossa are exaggerated for purposes of illustration.)

Articular Discof the TMJ

TympanicPart of

TemporalBone

Ear Canal

(Temporal Fossa)Mandibular Fossa

Temporal Bone

ZygomaticProcess

GreaterWing of

SphenoidArticularTubercle

Pterygoid Processof Sphenoid

Approximate Axisof Rotation

Mandible

LateralPterygoid

Muscle

Mastoid Process


Notes:

The Joint


Figure T-4

Enlargement of Temporomandibular Jointand its Components

Posterior TemporalAttachment of Disc(Retrodiscal Elastic

Tissue)

Roof of MandibularFossa (Temporal

Fossa)Temporal Eminence of

Articular Tubercle

Anterior Capsule

Condyle of Mandible

Posterior Wall of Capsule

PosteriorMandibularAttachment

EarCanal

Tendon of Attachment

(Lateral PterygoidMuscle)


Notes:

Biomechanics of TMJ


1 2

3 4

Neutral

Closed Position

In initial stages of movement, mandible begins toswing around point on condyle (to open the jaw).

Axis ofRotation

As movement progresses, condyle (A) slidesforward and down on disc (B), which slides

forward and down on temporal bone.

Mouth fully open

Figure T-5


Notes:

TMJ Disc Dysfunction


When disc remains trapped in front of

Temporal Eminence andMandible returns to

closed position, Condyle now rides on and compresses

Retrodiscal Tissue.

Figure T-6

This picture showshow Mandible and/ordisc can “slip” past

Temporal Eminence —“dislocating” jaw and/

or “catching” disc.

Hypertonic Pterygoid Muscle can pull the disc forward and hold itthere. Over time, this constant pull can alter the normally elasticRetrodiscal Tissue so that it no longer has the tendency to pull

the disc back into the Temporal Fossa.


Notes:

Muscles ofMastication


Hyoid BoneFigure T-7

Masseter Muscle

LateralPterygoid

Muscle

Medial PterygoidMuscle

TemporalisMuscle

Mylohyoid Muscle

Sternohyoid Muscle


Notes:

Temporomandibular Joint Mechanics

Since the TMJ is anterior to the axis of rotation of the Temporal Bone (see illustration), we cansee how it is possible to lower or raise the position of the TMJ as we rotate the Temporal Bonesinto External and Internal Rotation, respectively. A Temporal Bone located in the extreme end ofeither external or internal rotation may cause the TMJ to be displaced and to ultimately becomedysfunctional. The Temporal techniques described below will ensure a proper mobility and positionfor the Temporal Bone, and therefore contribute to improved TMJ function.

As you can see from the preceding illustrations of the TMJ with the mouth closed and open, theCondyle of the Mandible moves in an anterior direction when the mouth is opened. When themouth is opened very far, the Mandible Condyle goes beyond the (inverted) peak of the TemporalEminence. Occasionally, if the slope is sharp and/or the peak angle is acute, when the Condylegoes anterior to the peak it may “lock” there. When this happens, the individual’s mouth is stuckwide open.

It is the responsibility of the Lateral Pterygoid muscle to move the disc forward at precisely thecorrect rate of speed as the mouth is opened so that the disc is kept in an interposed positionbetween the Mandibular Condyle and the Temporal Bone. As the mouth is closed, the disc mustmove posteriorly to maintain its correct position. This return of the disc to the posterior positionis the responsibility of the Retrodiscal Elastic Tissue. Failure of these tissues may allow the discto remain forward so that the Condyle of the Mandible slips off of the posterior edge of the disc.When this happens, the Condyle begins to damage the elastic tissue by pressing on it. Thus, theproblem is perpetuated until the pressure can be taken off of the elastic tissue so that it can restoreits vitality (and thus its elasticity) toward normal.

CranioSacral TMJ techniques coupled with the self-help program can be quite helpful in therestoration of the disc to its normal position between the Condyle and the Temporal Fossa. Obviously, a reciprocal balance between the Lateral Pterygoid muscle and the Retrodiscal ElasticTissue is necessary for normal disc function.

A major factor in the production of too much compression on the disc and in the TMJ is a chronichypertonic condition of the Temporalis Muscle. This muscle, when it is contracted, shortens thedistance between the Mandible where it arises and the whole of the Temporal Fossa, whichincludes the external vault surfaces of the Temporal, Parietal, Frontal and Sphenoid Bones. In sodoing, the Temporal Bone is pulled down and the Mandible is pulled up. This compresses the TMJ.

The Temporalis and the other muscles of mastication are all under the motor control of the TrigeminalNerve System. This system is closely integrated with the Reticular Alarm System, which is closelyrelated to anxiety, anger, stress, etc.

Therefore, it is easy to see how chronic hypertonicity of the Reticular Alarm System overactivatesthe Trigeminal System, which in turn overactivates the muscles of the Masticatory System, especiallythe Temporalis Muscle which, in turn, overcompresses the TMJ. Our objective, therefore, is to relaxthe Reticular Alarm System in order to get the pressure upon the TMJ disc reduced to normal andacceptable levels.



Temporomandibular Joint Evaluation and BalancingTwo-Phase Technique(Reference CranioSacral Therapy, pp. 199-202)

Notes: TMJ Compression/Decompression

Core Intent: Compression — To engage “the unlatching principle” with the mandibleto release the soft tissue aspects of the TMJ.

Core Intent: Decompression — To further release the soft tissue of the TMJ and facili-tate space and mobility.

Hand Placement (of both): Third and fourth fingers contacting entire ramus of the mandiblefrom the condylar head to the angle.

TMJ (Compression)


Figure T-8


Notes:

Decompress the mandible inferiorly,then complete the traction by adding

a 10 degree anterior lift.

TMJ (Decompression)


Figure T-9


Self-Help TechniquesNotes: Fulcrum Technique

Self-Help With Fulcrum


Light force directed in asuperior direction

Fulcrum

Lever Gentlemanualforce

Decompressiontractional force

Fulcrum fordecompression

Figure T-10


Notes: Manual Decompression Self-Help Techniques

Self-Help


Gentle traction todecompress TMJ

Figure T-11


Notes:

Effect of Temporal Bone Dysfunction on the TMJ


External Axis forRotation of

Temporal Bone

Figure T-12

Temporal Bone Squamous


Notes:

PROTOCOL FOR EVALUATION AND CARE

Objectives:

1. To develop highly sensitive palpatory skills.

2. To promote greater relaxation, as well as physical and mental function of yourpatient/client.

3. To be able to apply the 10-Step Protocol in specific situations with expectationsof improved therapeutic response.

4. To be able to use your CranioSacral Therapy techniques while furthering youracademic knowledge of the Craniosacral System.

Protocol for Evaluation and Care 203


The 10-Step Protocol — Version 1• Listening Stations (Heels, Dorsums, Thighs, ASISs, Ribs,

Shoulders, Three Vault Holds)

1. Still Point (CV-4, Sacrum, Feet, etc.)

2. Diaphragm Releasesa. Pelvicb. Respiratoryc. Thoracic Inletd. Hyoide. Occipital Cranial Base

3. Frontal Lift(Vertical Membrane System)

4. Parietal Lift (two parts)(Vertical Membrane System)

5. Sphenobasilar Compression-Decompression(Horizontal Membrane System)

6. Temporal Bone Techniquesa. Evaluation:

1. Circumferential motion, Finger in the Ear2. Medial-lateral motion, Wobble

b. Treatment:1. Occipital-Mastoid Release2. Ear Pull3. Re-evaluate and synchronize, if needed

(Horizontal Membrane System)

7. Temporal Decompression (Ear Pull)(Horizontal Membrane System)

8. TMJ Compression and Decompression

9. Dural Tube Evaluation (Occiput/Sacrum, L5-S1 Decompression, Iliac Gap,Rock/Glide)

10. CV-4/Still Point

V-Spread – Wherever Appropriate

The 10-Step Protocol — Version 2• Listening Stations (Heels, Dorsums, Thighs, ASISs, Ribs,

Shoulders, Three Vault Holds)

1. Still Point (CV-4, Head, Sacrum, Feet, etc.)

2. Diaphragms:a. Pelvicb. Respiratoryc. Thoracic Inletd. Hyoide. Occipital Cranial Base

3. L5-S1 Decompression, Iliac Gap, Dural Tube Traction

4. Dural Tube Rock/Glide

5. Frontal Lift(Vertical Membrane System)

6. Parietal Lift (two parts)(Vertical Membrane System)

7. Sphenobasilar Compression-Decompression (Horizontal Membrane System)

8. Temporal Bone Techniques:a. Evaluation:

1. Circumferential motion, Finger in the Ear2. Medial-lateral motion, Wobble

b. Treatment:1. Occipital-Mastoid Release2. Ear Pull3. Re-evaluate and synchronize, if needed

(Horizontal Membrane System)

9. TMJ Compression and Decompression

10. CV-4/Still Point

V-Spread – Wherever Appropriate

• Listening Stations

* The sacral and dural tube steps have been changed from Version 1. The order of this protocol isstructured to free up restrictions that lie within the pelvic and spinal regions before commencingto the head, which some practitioners may prefer.

Note: As you become skilled in the 10 evaluation and correction steps, you may wish to alter theorder to better suit your professional style. What is important to know is the specific proceduresand their applications. The order in which the procedures are applied varies among practi-tioners. However, the two 10-Step Protocols presented above are recommended by Dr. Upledgerand are most commonly followed by Upledger Institute Certified CranioSacral Therapy Instructors.

Protocol for Evaluation and Care 205


After completion of the CranioSacral Therapy I workshop and adequatepractice (UI recommends 75-100 10-Step Protocols), you will be ready tofurther your studies with our next workshop, CranioSacral Therapy II.

CRANIOSACRAL THERAPY II

o CranioSacral Therapy for TMJ Syndrome and Hard Palate Dysfunction

o CranioSacral Therapy for Infants and Children

o SomatoEmotional Release® and Energy Cysts

To participate in this workshop you must complete the CranioSacral Therapy I course.

Advance Preparation: Chapters 7-15 of CranioSacral Therapy by JohnUpledger, D.O.,O.M.M., and Jon D. Vredevoogd,M.F.A., and CranioSacral Therapy II, Beyondthe Dura by John Upledger, D.O. O.M.M. (Payparticular attention to Chapter 3.)

BIBLIOGRAPHY

Raviv, G, Shefi S., Nizani, D., Achiron. A. “Effect of Craniosacral Therapy on Lower Urinary Tract Signs and Symptoms in Multiple Sclerosis”. Complementary Therapies in Clinical Practice, (2009) 15(2): Pages 72-75

Walsh, E. “Geriatric Applications of CranioSacral Therapy: Establishing Allied Health Professionals’ Use of a Complementary Modality” The International Journal of Healing and Caring (2007) 7(1).

Doidge, N. The Brain That Changes Itself: Stories of Personal Triumph From the Frontiers of Brain Science. James Silberman Books, 2007.

Nelson KE, Sergueef N, Glonek T, “Recording the Rate of the Cranial Rhythmic Impulse.” The Journal of the American Osteopathic Association (2006)106(6):337-341.

Umphred, DA. Neurological Rehabilitation. Edinburgh: Elsevier Mosby, 2006.Gilchrist, R. Craniosacral Therapy and the Energetic Body: An Overview of Craniosacral

Biodynamics. Berkeley, Calif: North Atlantic Books, 2006.Kern, M. Wisdom in the Body: The Craniosacral Approach to Essential Health. Murrieta, Calif:

Pacific Distributing, 2005.Upledger Institute. Working Wonders: Changing Lives with Craniosacral Therapy: Case Studies

from Practitioners of CST. Berkeley, Calif: North Atlantic Books, 2005.Upledger, L. “CranioSacral Therapy Releases Hold on Subluxations.” The American

Chiropractor. (2005)27.13: 56-57.Davis, CM. Complementary Therapies in Rehabilitation Thorofare, NJ: SLACK, 2004.Upledger, L. “CranioSacral Therapy.” The American Chiropractor. (2004)26: 24-25.

“Use of Craniosacral Therapy to Treat Infant Post-Traumatic Torticolli.” Pediatric Physical Therapy: the Official Publication of the Section on Pediatrics of the American Physical Therapy Association. (2004)16.(1): 57-8.

Upledger, JE. SomatoEmotional Release: Deciphering the Language of Life Berkeley, Calif: North Atlantic, 2003.

Deoora, TK. Healing Through Cranial Osteopathy London: Frances Lincoln, 2003.Nelson KE, Sergueff N, Lipinski CM, Chapman AR, Glonek T, “Cranial Rhythmic Impulse

Related to the Traube-Hering-Mayer Oscillation: Comparing Laser-Doppler Flowmetry and Palpation.” The Journal of the American Osteopathic Association 101(3): 163-173.

Galantino ML, Upledger. JE “Physical Body Systems Approaches: CranioSacral Therapy.” Neurological Rehabilitation. St. Louis: Mosby, (2001): 979-80.

Davis, CM. “Physical Body Systems Approaches: Myofascial Release.” Neurological Rehabilitation. St. Louis: Mosby, (2001): 980-81.

Umphred, DA., “Alternative Models and Philosophical Approaches.” Neurological Rehabilitation. St. Louis: Mosby, (2001): 965-66.

Friedman, HD.,. Gilliar WG, Glassman, JH Cranial Rhythmic Impulse Approaches in Osteopathic Manipulative Medicine. SFIMMS series in neuromusculoskeletal medicine. San Francisco CA: SFIMMS Press, 2000.

Upledger, JE. The Discovery and Practice of Craniosacral Therapy Berkeley, Calif: North Atlantic Books, 2000.

Bibliography 207

Upledger, JE. “Connective tissue perspectives: Craniosacral Therapy.” Journal of Bodywork and Movement Therapies. (2000)4.4: 286-287.

An Objective Measurement of Craniosacral Rhythm. Des Moines, Iowa: University of OsteopathicMedicine and Health Sciences, 2000.

George, JR, Mohabataeen S, Hawkins NL. The Effects of Craniosacral Therapy on Blood Pressure, Heart and Respiratory Rates. Thesis (M.P.T.) – California State University, Northridge, 1999.

Green, C. J. A Systematic Review and Critical Appraisal of the Scientific Evidence on Craniosacral Therapy. Joint health technology assessment series. Vancouver, BC: BC Office of Health Technology Assessment, Centre for Health Services and Policy Research,University of British Columbia, 1999.

Green C, et al. “A Systematic Review of Craniosacral Therapy: Biological Plausibility, Assessment Reliability and Clinical Effectiveness.” Complementary Therapies in Medicine. 7.4 (1999): 201-7.

Farasyn, A “New Hypothesis for the Origin of Cranio-Sacral Motion” Journal of Bodywork and Movement Therapies (1999) 3(1): 229-237.

Hanten, WP., Olson, SL., Hodson, JL, Imler, VL., Knab, VM., Magee, JL. “The Effectiveness of CV-4 and Resting Position Techniques on Subjects with Tension-Type Headaches” The Journal of Manual & Manipulative Therapy (1999)7(2): 64-20.

Ferguson, AJ. McPartland, JM. Upledger, JE. Collins, M. Lever, R. “Cranial Osteopathy and CranioSacral Therapy: Current Opinions” Journal of Bodywork and Movement Therapies(1998)2(1): 28-37.

Hanten WP, Dawson DD, Iwata M, Seiden M Whitten FG, Zink T. “CranioSacral Rhythm: Reliability and Relationships with Cardiac and Respiratory Rates”. J Orthop Sports Phys Ther. (1998) 27:213-218.

Rogers JS, Witt, PL: “The Controversy of Cranial Bone Motion”. J Orthop Sports Phys Ther. (1997):26:95-103.

Upledger, JE, Vredevoogd, JD. CranioSacral Therapy, Eastland Press, 1983


A-1Appendix

BioAquatic Advanced

& Dolphins Exploration*

(BADA)

BioAquaticExploration,

SomatoEmotionalRelease® II

(BAES)*

*

CranioSacralTherapy

TechniquesCertification

(CACST)

UnwindingMeridians:Applying

AcupuncturePrinciples toCST (UMAC)

CranioSacralTherapy

for Pediatrics 1

(CSP1)

CranioSacralTherapy

for Pediatrics 2

(CSP2)

CranioSacralTherapy & the

Digestive &Gastro-intestinal

Systems(CDGS)

CranioSacralTherapy & the

Cardiac &Pulmonary

Systems(CCPS)

Sensory Integration forCranioSacralTherapists

(SICS)

*BADA prerequisites areSERII & one ofthe following:BAES, BAEA

or BAER.

*DATE & BAERprerequisites areSERI & one ofthe following:

BAES or BAEA.*

BioAquaticExploration,Advanced

CranioSacralTherapy*(BAEA)

CranioSacralTherapy

DiplomateCertification

(CACSD)

CST and theReversal ofPathogenicProcesses(CSRP)

ClinicalApplication of

AdvancedCranioSacralTherapy forPediatrics(CAAP)

ClinicalApplication of

AdvancedCranioSacral

Therapy (CAAD)

CCRRAANNIIOOSSAACCRRAALL TTHHEERRAAPPYY CCUURRRRIICCUULLUUMMFFLLOOWW CCHHAARRTT

A-2 Appendix

TTHHEE UUPPLLEEDDGGEERR IINNSSTTIITTUUTTEE AANNDD IITTSS EEDDUUCCAATTIIOONNAALL CCUURRRRIICCUULLUUMMSS

Continuing Education and Complementary Care

The Upledger Institute (UI) is a health resource center dedicated to the advancement of innovativetechniques that complement conventional care. It’s recognized worldwide for its groundbreakingcontinuing-education programs, clinical research and therapeutic services.

Founded in 1985 by John E. Upledger, DO, OMM, UI has trained more than 80,000 practitionersworldwide in CranioSacral Therapy and other gentle healthcare modalities. Today it conducts hundreds of workshops each year educating healthcare professionals of diverse disciplines.

The cornerstone of our educational training is CranioSacral Therapy, a gentle, hands-on, whole-bodymethod of releasing restrictions around the brain and spinal cord to enhance central nervous systemperformance and allow the body to self-correct.

Developed by Dr. John E. Upledger after eight years of clinical research and testing at MichiganState University, CranioSacral Therapy has proven effective in aiding individuals with a wide range of medical challenges, including migraines, neck and back pain, fibromyalgia, chronic fatigue, TMJsyndrome, motor-coordination impairments, autism, central nervous system disorders, colic, learningdisabilities, brain and spinal cord injuries, emotional difficulties, stress-related problems, neuro-vascular or immune disorders, post-traumatic stress disorder and post-surgical dysfunction.

Just as with CranioSacral Therapy, every modality practiced or taught through UI is designed torelieve health problems at their source to offer a wealth of benefits, from pain relief to whole-bodywellness. And because each UI course curriculum is personally designed by its modality developer,your education comes straight from the source.

CranioSacral Therapy (CST) is a gentle, light-touch method of evaluating and enhancing the cranio-sacral system, the environment in which the brain and spinal cord function. An imbalance or dysfunction in the craniosacral system can cause sensory, motor or neurological disabilities. Theseproblems may include chronic pain, eye difficulties, scoliosis, motor-coordination impairments andlearning disabilities, as well as other physical and psychological problems.The CranioSacral Therapy curriculum begins with the entry-level workshop CranioSacral Therapy I,which provides the critical foundation necessary to understand the functioning of the craniosacralsystem. Using palpatory skills to detect subtle biological movements, and fascial and soft-tissuerelease techniques in a 10-Step Protocol, participants learn to evaluate and work with the entirebody.

CranioSacral Therapy CertificationThe Upledger Institute offers certification in CranioSacral Therapy at two levels: a CST Techniquescertification for those who have completed CSII, and a more advanced Diplomate level for AdvancedCST alumni. Examination for certification at each level is a multi-tasked project including written,oral and hands-on testing.

CranioSacral Therapy Courses• CranioSacral Therapy I• CranioSacral Therapy II• Unwinding Meridians: Applying

Acupuncture Principles to CranioSacral Therapy

• Clinical Application ofCranioSacral Therapy

• CranioSacral Dissection• Therapeutic Imagery &

Dialoguesm I• SomatoEmotional Release® I • Clinical Application of

SomatoEmotional Release• SomatoEmotional Release ® II

• The Brain Speakssm

• CranioSacral Therapy for Pediatricssm 1

• CranioSacral Therapy for Pediatricssm 2

• CranioSacral Therapy and the Immune Response

• CranioSacral Applications to Obstetrics I

• Advanced I CranioSacral Therapy • Clinical Application of

Advanced CranioSacral Therapy• BioAquatic Explorations• Advanced II CranioSacral Therapy

• Advanced Preceptorship • Advanced II Preceptorship• CranioSacral Techniques for

Estheticians• ShareCare®

• Clinical Application of Cranio-Sacral and SomatoEmotional Release for Pediatrics

• CranioSacral Therapy and the Reversal of Pathogenic Processes

• Clinical Application of Advanced CranioSacral Therapy for Pediatrics

CCrraanniiooSSaaccrraall TThheerraappyy Developed by John E. Upledger, DO, OMM

A-3Appendix

A-4 Appendix

A member ofINTERNATIONAL ALLIANCE OF HEALTHCARE EDUCATORS (IAHE)The International Alliance of Healthcare Educators (IAHE) is a cooperative of Continuing Education providers who offer other workshops in alternative healthcare modalities. The current modalities available through IAHE include:• CranioSacral Therapy/ SomatoEmotional Release

John E. Upledger, DO, OMM• Visceral Manipulation

Jean-Pierre Barral, DO, MRO(F), PT• Neural Manipulation/Manual Articular Approach

Jean-Pierre Barral, DO, MRO(F), PT& Alain Croibier, DO, MRO(F)

• Healing From the CoreSuzanne Scurlock-Durana, CMT, CST-D

• Therapeutic SystemsKerry D’Ambrogio, DOM, AP, BSc, PT

• Equine CranioSacral Therapy Gail Wetzler, RPT, CVMI, BI-D, EDO

• NeuroMuscular TherapyJudith (Walker) Delany, LMT

• Mechanical LinkPaul Chauffour, DO

• Zero BalancingFritz Smith, MD

• Process AcupressureAminah Raheem, PhD

• The Feldenkrais MethodAnn Harman, DO

• Qigong T’chingsCloe S. Couturier LMT/CO, CST-D

The International Alliance of Healthcare Educators®• Website: www.iahe.com• E-mail: [email protected] a Practitioner: International Association of Healthcare Practitioners®• Website: www.iahp.com• E-mail: [email protected] Upledger Institute, Inc.®• Website: www.upledger.com• E-mail: [email protected]

INSTITUTE, INC.INSTITUTE, INC.UPLEDGERUPLEDGER THETHE

®®

All courses listed are intended to be taught asmodalities for licensed healthcare professionals.Some courses may require prerequisite training.

A-5Appendix

SSUUBBMMIITTTTIINNGG YYOOUURR NNEEWWSS RREELLEEAASSEE TTOOLLOOCCAALL PPUUBBLLIICCAATTIIOONNSS

• Type the news release sample from the following page onto your letterhead, filling in the blanks as indicated. Be sure to include your name and a telephone number where you can be reached during business hours.

• Develop a mailing list of publications — daily and weekly newspapers as well as local magazines. Telephone these sources and ask for the name of the news editor. Your press release should be addressed by name to these individuals at their respective media outlets.

• Don’t forget to mail releases to any local professional organizations that publish newsletters,as well as to your school if you studied locally. Be sure to mention that you are an alumnus of that school.

• Include a 5x7 black and white photograph, if available, with your release. Be sure to put your name on the back and include a sturdy piece of cardboard in the envelope to keep thephotograph from bending. It’s a good idea to print “Do Not Bend” on the envelope, too. Photographs often will not be returned.

A-6 Appendix

SSAAMMPPLLEE

News Release

FOR IMMEDIATE RELEASE: CONTACT: (insert today’s date) (Your name, phone number, e-mail address)

THERAPIST BRINGS ENERGIZING NEW TECHNIQUES TO[INSERT YOUR HOMETOWN]

[YOUR CITY, state] — [Your name and professional title] recently participated in the CranioSacralTherapy 1 workshop offered by The Upledger Institute, Inc., an innovative organization that offers continuing education courses to healthcare professionals worldwide.

The course is designed by osteopathic physician John E. Upledger, who developed CranioSacral Therapy and has taught the technique internationally.

CranioSacral Therapy is used to detect and correct imbalances in the craniosacral system, which maybe the cause of sensory, motor or neurological dysfunction. The craniosacral system consists of themembranes and cerebrospinal fluid that surround and protect the brain and spinal cord. It extends from the bones of the skull, face and mouth — which make up the cranium — down to the sacrum, or tailbone area.

The therapy has been successfully used to treat headaches, neck and back pain, TMJ, chronic fatigue,motor coordination difficulties, eye problems and central nervous system disorders.

For information on CranioSacral Therapy or The Upledger Institute at 1-800-233-5880.

###

A-7Appendix

MMOODDEELL FFOORR RREESSEEAARRCCHH CCAASSEE SSTTUUDDYY OORR SSIINNGGLLEE--SSUUBBJJEECCTT DDEESSIIGGNN

IInnttrroodduuccttiioonnFollowing are suggestions for a simple yet concise research case study or single-subject design. Youcan utilize sections 5 and 7 to expand on philosophy or constructs. Sections may even be omitted asappropriate. When most of this information is incorporated on an intake evaluation and discharge form,then only minimal effort is needed to make a publishable single subject design or case study format. The submitted report will:• Support the effectiveness of the therapy that was used in the study.• Open opportunities to validate concepts and techniques within various professional forums. • Reinforce the depth of your knowledge and skill as a published practitioner.

RReeppoorrtt FFoorrmmaattA report could be divided into the following sections:1. Introduction: What is the problem/diagnosis? 2. Review of Literature: Past medical history, etiology of the problem, date of onset, social history,

previous treatment including surgeries for this problem (and results), and any diagnostics done.3. Procedure/Treatment: Include all treatment procedures, modalities, exercise (home and office)

treatment time per session, plus total treatment span (including frequency). If modalities wereused, be specific as to any particulars. Mention specific treatment positions if appropriate forfurther classification.

4. Outcomes/Analysis of Results: Both functional and structural outcomes should be listed here,i.e., pre- and post-tests if applicable. (Try to get 2-3 measurements each pre-and post-test as itimproves reliability and validity of treatment.) Measure outcomes functionally, also. (Most clinics/practitioners are obtaining this information from patients as well as the “objective” data.)Include patient’s self-assessment as well as therapist’s patient assessment. Rate a percentage of improvement (usually a scalar measurement).

5. Discussion: What do your findings mean? How do they add to the established body of knowledge?Where do you go with your results? Make recommendations for change for further analysis ofthe same subject.

6. Summary: An abstract.Summarize points 1-4 (for potential publication).7. Conclusions and Recommendations for Further Study: Was the treatment successful? If so,

how did you measure success? If not, what would you do differently with this individual? 8. Appendices: May include subject consent form (if appropriate), technical data, date of birth, treat-

ment dates. (If no-name submission, use an identification process other that abbreviations or initials.)9. References: If appropriate or beneficial for further research. Format as:

1. Kidder, L. & Judd, C., Research Methods in Social Relations, Holt, Penihart & Winston, Inc. 5th Edition, New York, NY 1978.

2. McEwen, Irene, Writing Case Reports: A How-To Manual for Clinicians. APTA Pub.,Alexandria, VA. 1996.

A-8 Appendix

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Following the completion of your class, you will be eligible to participate in an Upledger Institute-sanctioned study group that corresponds to the coursework you studied. Study groups offer a small-group environment where you can network, reinforce your skills and discuss case historieswith similarly trained colleagues.

Study-group leaders may charge members a nominal fee; these generally range from $5-$10 permeeting.

To locate a study group in your area:• See your class facilitator. A list of active study groups is available at the product tables

at all workshops.

• Call Educational Services at 1-800-233-5880.

• Log on www.upledger.com. Go to “work with us” and click on the “study groups” tab on the left or cut and paste this url www.upledger.com/content.asp?id=16 into your web browser.

“Study groups are worth their weight in gold. They build practitioners’ confidence and help themremember the technical details. They’re invaluable in terms of providing good, guided practice time.And practice is what really makes a good practitioner into an excellent one.”

— Suzanne Scurlock-Durana, CMT, CST-D

Documents

CranioSacral Therapy I Study Guide