Cranial Sacral Final/MBLEX
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Define Cranial Sacral Therapy
- a gentle, hands-on approach to bodywork.
- focuses on the bones of the head, spinal column and sacrum, and the underlying structures
What is your main objective
to find and release tensions (called restrictions and/or compressions) in the cranial system
What does Cranial Sacral help most with
- Chronic pain, esp in the neck and back
- Headaches (tension, migraine, cluster) *helps with migraines more than any modality
- TMJ dysfunction
- Emotional trauma
- Auditory problems
- Stress-related dysfunctions
- Colic, inner ear problems, or learning/behavioral disorders in infants and children
How long does it normally take to see change or results
If pressure or compression occurs, adverse _______ can cause ______.
If pressure or compression occurs, adverse messages can cause dysfunction.
What 3 layers is the menigeal membrane made up of
- 1. dura mater
- 2. arachnoid membrane
- 3. pia mater
What is the cranial sacral system responsible for
the production, circulation, and reabsorption of CSF
What can adversely affect the underlying structures of the system
compression or injury
The bones of the head, spinal column, and sacrum are an important part of this system. What do they serve as
They serve as handles to what is going on underneath
What are the 3 Theories relating to the Origin of the Cranial Sacral Rhythm
- 1. Osteopathic Theory (disproven): Sutherland suggested the brain has a contractile capacity
- 2. Upledger Theory (disproven): continually pushing fluid around
- 3. Energetic Theory (has not been disproven): constant current @ bottom of sea
What is the therapist's tool for identifying restrictions and compressions in the cranial sacral system, the 2 basic movements
- The cranial rhythm
- Flexion and Extension: Flexion = Fat Head / Extension = Skinny Head
The Cranial Rhythm normally cycles ___ times per minute.
- 6-14 times
- One complete cycle includes (3 seconds) flexion, a slight pause, then (3 seconds) extension
The Four Characteristics of SQAR
Why is it important to palpate the cranial rhythm and how can we describe the state of flexion and extension
- Symmetry: Balance: how balanced is this rhythm
- Quality: Strength: how smooth or how prominent
- Amplitude: Distance: how far away from the midline or distance
- Rate: Speed: how fast
How do we monitor the cranial sacral system and find restriction
palpating this rhythm
As beginners, we will be applying no more than ___ ___ of pressure
As the spinal nerves exit the dural tube, the fascia surrounding each nerve blends with the fascia it encounters upon exiting the vertebral column.
The cranial rhythm is therefore ____ through the ___, much like ripples in a pond, and can be felt through the entire body.
...transmitted through the fascia
Palpation Station / Hand Placement
Flexion will be felt as later rotation
Extension will be felt as a medial rotation
- Pelvis (ASIS)
What technique did Dr. William Sutherland develop, that creates an overall state of relaxation for the CT, and the body as a whole. It produces a calming effect, releases minor restrictions and accumulated stress in the cranial sacral system
Contraindications for CV4
- children under the age of 9
- clients who have been diagnosed with a cerebral aneurysm
- or have suffered a recent stroke
Contraindications to compressive techniques
- Children under the age of 9
- Clients at risk of stroke
- VERY Elevated BP
- Brain tumors
What lies between the pia mater and the arachnoid
a space called the subarachnoid space
Located inside the skull is a meningeal structure. Sutherland referred to this as a ____ ____ ____ system.
a reciprocal tension membrane system
The three membranes appear as sheets and are as follows
- Falx Cerebri
- Tentorium Cerebelli
- Falx Cerebelli
- Dural Tube
Shaped like a crescent moon; the front part attaches to the ethmoid and the frontal bones; runs posteriorly along the sagittal suture/border of the skull and then drops inferiorly as it attaches to the occiput; separates the right and left hemispheres of the brain
Attaches at the occiput, temporal and parietal bones, and sphenoid. Separates at the point at which the falx cerebri merges with the outer meninges of the occiput; it extends laterally along the temporal and parietal bones and moves anteriorly attaching to the sphenoid; supports the weight of the brain and suspends brain above the brain stem
A small extension of the falx cerebri, which extends bleow the tentorium cerebelli; the falx cerebelli attaches to the foramen magnum and then blends into the meninges of the dural tube
The spinal dura attaches at the foramen magnum, C2, C3 and the second sacral segment. The dural tube creates a physical and energetic relationship between the occiput and the sacrum. "The Core Link". Therefore, trauma in the occiput will refer to the sacrum, and trauma to the sacrum will refer to the occiput
What are the restrictions in the membrane system called
What does membranous restrictions appear to do, what do they feel like
- the bone will appear to "snap back" down if the therapist were to release the hold
- feels like elastic, between sutures of bones
What are the restrictions called within the sutures of the bones and what do they feel like
- osseous restrictions
- feel firm and immovable as if the bone were stuck
There are four concepts to remember when working with fascia
- 1. The fascial system is a single system.
- 2. The majority of fascial fibers in the body run vertically (up & down/head to toe)
- 3. Some locations in the body have a dense collection or horizontal fibers.
- 4. Fascia, under ideal circumstances, is very mobile. - 360 degrees of movement/ should move easily
Benefits of Unwinding
- Increase organ function (diaphragm release)
- Increase respiratory function
- Mobilize the dural tube
- Decrease restrictions within cranial sacral system
Taking horizontal fibers loosening a bit to tight vertical fibers
What are the diaphragm releases
- Pelvic Diaphragm
- Respiratory Diaphragm
- Thoracic Diaphragm
What are some key points when working the Diaphragm Releases
- Pay attention to what doesn't want to move
- Break pattern
- Be careful not to create a new pattern
- Random movement wherever there is restriction
- Encourage tissue to go toward restriction, leading 50%, follow 50%
What does the Hyoid Release encourage
it encourages the release of the fascia along the thoracic wall, as well as the muscles of the neck
Positive changes in the SQAR of the cranial rhythm indicate the release of a restricted area.
There are also outward indications that the restrictions are being released and movement restored. What are they -
- Heat: your hands are really warm; common
- Fluid releasing: tears, saliva, stomach noises
- Softening: of tissues ex. CV4
- Body movements or twitching: very visible; common
- Body relaxing: like a deep sigh, melt stresses away; sinks into table
- Swallowing: fluid starts to release, forced to swallow; very commno
- Breathing changes: deep or shallow breaths
- Therapeutic pulse: continue to hold position until it stops
- REM: kind of like body movements/twitching
- Actue intracranial hemorrhages
- Intracranial aneurysms (more common in women, where vessel is dilated and can burst and cause death)
- Recent skull fractures (six weeks)
- Severe grand mal seizures (acute - after 30 days / chronic - after 72 hrs)
- Recent strokes (six weeks)
The occiput is associated with 3 cranial nerves
- 1. Cranial Nerve IX (9), Glossopharyngeal "lipgloss" flavored - taste & tongue: this nerve controls sensation, taste on a portion of the tongue, internal surface of the tympanic membrane
- 2. Cranial Nerve X (10), Vagus "Vegas = eat, sleep & poop": this nerve is associated with the muscles of the pharyx and larynx, and aids in swallowing, digestion & bowel function
- 3. Cranial Nerve XI (11), Accessory " ": this nerve provides motor coordination for the trapezius and the SCM muscles
Occipital Bone - Master Bone - Flexibility in Life
- Articulations: parietals, temporal(s), sphenoid, atlas, falx cerebelli, falx cerebri, tentorium cerebelli
- Characteristics: Flexibility in Life, being able to give/receive love & support
- Indications: tension headaches, whiplash/impact accidents, neck or cervical problems, shoulder px, low back px
Occipital Bone Techniques
- Occipital Base Release
- Step 1: maintain position until soft tissue beings to relax around your fingers / chin will eventually fall back
- Step 2: gently decompress the occiput superioraly by curling fingers, in a very slight movement, superior. Maintain decompression until bone feels like it has moved superiorly
Sacrum - Master Bone - Stability in Life
- it directly interacts with the occiput through the dural tube. -
- Articulations: L5, Ilia (which forms the SI joint), Coccyx
- Characteristics: Stability, Spirituality, Sensuality, Sexuality
- Indications: low back pain, hip/knee/leg px, headaches, whiplash/neck px, sinus problems, emotional trauma/spiritual trauma, grounding
What is the dural tube sometimes referred as
"the core link"
- Version 1: have client lift his/her hips off the table. Approach the sacrum from the lateral side of the client's pelvis. Use "V" spread to accommodate the spinous processes of the sacrum. Instruct client to place his/her hips back on the table. Allow your hand to soften/relax.
- Version 2: The approach allows a direct contact with the sacrum w/out altering the structural alignment. Bend clients knee and extend opposite hand across pelvis. Use your bodyweight to pull the client's body toward you. Place hand on sacrum, positioning the fingers to accommodate the spinous processes. Reposition the client's body, get acquainted with cranial rhythm
Hand Placement & Techniques for the Sacrum
- 1. Sacral Traction: get a sense of rhythm. Using 5 grams of weight, decompress the sacrum inferiorly. Allow the sacrum to undwind as you decompress. As sacrum releases, the bone will soften into the inferior tractioning
- 2. L5-S1 Decompression: Leave hand under the sacrum in place. Slide the free hand under the client's back to make contact with L5. Traction the sacrum inferior, then L5 superior. This decompresses the space between L5 and the sacrum.
- 3. SI Joint Decompression: Leave hand under sacrum. Use other arm to make your next contact by placing elbow on ASIS and extend your arm to arch and extend across client's pelvis and use fingers on the other ASIS. Gently compress the pelvic bones medially. As the SI joint releases, you will feel the sacrum drop into your hands.
- 4. Sacral/Occipital Hold: Stand or kneel to one side of client. Slide the hand closest to the client's feet underneath the sacrum. Your hand will be be lying across, the sacrum. Place your other hand underneath the occiput. Introduce gentle rocking, which stimulates the flexion and extesion of the cranial rhythm. The 2nd option is to follow the natural cycle of the rhythm of the sacrum and occiput. Restrictions may be released by addressing the dural tube in this manner. Allow several cycle of the rhythm, or simulated rhythm, to occur.
What are the names of the 3 Master Bones
Frontal Bone - Higher Intelligence
- in flexion, frontal bone moves posteriorly / in extension it moves anteriorly -
- Articulations: parietals, zygomae, sphenoid, maxillae, ethmoid, falx cerebri, facial & lacrimal bones
- Characteristics: higher levels of concentration, higher intelligence, wisdom to see & accept change, determination, conscience, ethics
- Indications: over thinking or worrying (esp @ night), helps focus thoughts, whiplash - frontal affects occipital movements, headaches, soft tissue releases of fascial muscles
Frontal Bone Variations
- 1. Frontal Lift: Variation 1: place fingertips across the frontal bone, pinky fingers laterally until they make contact with the notch (where ladies should stop plucking their eyebrows) HA! Variation 2: place thumbs on the lateral edges of the frontal bone (same place as the pinkies had in variation 1). Let your fingers open up and cradle the occiput.
- Technique: Decompress the frontal bone by tractioning it anteriorly
Parietal Bones - Aspiration
- the parietals are paired bones, separated by the sagittal suture. During flexion the bones move laterally / in extension, the bones return by coming back medially -
- Articulations: occiput, temporals, frontal, sphenoid, falx cerebri
- Characteristics: aspiration (a strong desire to achieve something), "Crown Soul", reflects anger ('I've had it up to here'), material fixations, discontent
- Indications: depression, hopelessness, lack of joy, seasonal affective disorder, anytime occiput, frontal, or temporal bones are affected
Parietal Compression & Decompression
- Compression: Fingertips at the slight curve of the cranium (you know you're on the right area if you feel like you're falling off head/ridge), thumbs crossed.
- Technique: compress bones medially with your fingers. Maintain contact until you feel softening and sinking toward the midline of the head (slide "crash" into the ocean floor)
- Decompression: open up your wrists so the thumbs, still relaxed, move away from the sagittal suture (thumbs pointing upward)
- Technique: gently decompress the bones in a superior direction. It may feel like the bones move freely towards you. Maintain the technique until this passes.
Sphenoid - Master Bone - Central Bone - Perception
- The sphenoid interacts with many nerves & vessels.
- In flexion the sphenoid rocks in an inferior direction.
- In extension it rocks superiorly.
- Articulates with ALL of the other bones of the cranium.
- Sphenoid has the ability to move in many directions as it resonds to the state of the communicating bones.
- When the sphenoid responds to the cranial rhythm, it is the 1st bone to go into flexion and extension - all the other bones respond and follow
Sphenoid - Master Bone - Central Bone - Perception
- Articulations: all of the bones of the cranium, zygomae, tentorium cerebelli
- Characteristics: objective perception, inner-seeing
- Indications: ADD/ADHD, headaches, vision issues, stress, tinnitus, inner confusion
- Typically the one you want to work before or above anything else for migraines
- Intimate with how movement is with body (exercise Weston had us do closing eyes, moving eyes etc.)
Spenoid Compression and Decompression
- Hand Placement: Your thumbs will be on, or posterior to, the temple area (the greater wing), let your fingers gently curl around the back of the head.
- Technique: Compression: apply five grams of pressure in a posterior direction. It may feel like it is bending or twisting. Follow movement while maintaining your posterior compression.
- Technique: Decompression: gently apply five grams of pressure in an anterior direction. The bone may have a similar pattern of movement - this is called unwinding. Follow movement while still maintaining the decompression. As it releases, it will feel like it floats up and away from center of the cranium
Zygomae (to protect the eyes) - Pride in Appearance (progression, sense of belonging, worth)
- zygomae are paried bones. They move lateral and slightly anterior direction during flexion. In extension, they move back medially -
- Articulations: sphenoid, maxillae, temporals (through the zygomatic arch), frontal
- Characteristics: Pride in Appearance
- Indications: sinus problems, stress, impact (direct blow), TMJD (because articulations with the temporal bone via the zygomatic arch)
- Hand Placement: index & middle finger blow the lateral angles of the zygomae. Thumbs resting on superior surface of the zygomae, superior to your fingers. Avoid placing your thumbs too medially, as this will place them on the maxillae
- Technique: to decompress, apply lateral and anterior traction (an "A"). Let bones undwind. As they zygomae release you will feel them spread laterally.
- You know you are done when it wants to go with you
Ethmoid - Perception
connected with 3rd eye "seat of 3rd eye"
- is a delicate bone comprised of 4 air sinuses. Assists in warming and moistening air during inhalation -
- Articulations: frontals, sphenoid, maxillae, nasal bones, falx cerebri
- Characteristics: perception & intiution
- Indications: sinus problems, hopelessness, depression, lack of finer clarity, spiritual trauma
- 'D' words show up: Darkness, Despair, Distraction, Depression
- Does NOT respond to cranial rhythm - we do an energetic compression
- "If you can see the way ahead is clear, it will be clear."
- Must be accessed energetically (visualization of blue beam of light)
- Variation 1: place each index finger just inside the medial border of the eyebrow/top of nose, near inner canthus
- Variation 2: use the index & middle finger of one hand to make contact near the inner canthus of each eye. Other hand make contact where the occiput and atlas unite. (This accesses both the front and back of the 6th chakra or third eye)
- Technique: direct energy toward the ethmoid to decompress it. You may extend the energy directly through the ethmoid and allow it to pass through the 6th chakra (if you are using the 2nd variation for hand placement)
Temporal Bones - Balance in Life
- move laterally in flexion and medially in extension -
- Articulations: parietals, occiput, sphenoid, zygomae, mandible (articulates through joint), tentorium cerebelli
- Characteristics: balance in life (figurative & literal - these bones house the organs of hearing)
- Indications: inner ear problems, vertigo, tinnitus, ADD, dyslexia, bells palsy, TMJD
- Someone that needs a pick-me-up (caused from an imbalance in their life)
- All emotions affect the mandible
Temporal Ear Pull
- Hand placement: arms on table, opening elbows so you can make contact with ears, curl your index & middle fingers under the posterior side of each ear. Place thumb on the inside of each ear, but not so far as to enter the auditory canal
- Technique: decompress the bones laterally and posteriorly. This creates a 45 degree angle toward the table, Keep this contact until the bones feel as if they are spreading laterally.
Mandible - Expression of Emotion
- drops inferiorly in flexion, moves superiorly in extension -
- Articulations: temporals (through the articular disc of the TMJ)
- Characteristics: Expression of Emotion
- Indications: tinnitus, headaches, structural problems, digestion problems, TMJD, bruxism
- Mandible is a good place to start work
Mandible Compression & Decompression
- Compression hand placement: locate angle of mandible with your finger pads. Slide slightly anterior until you feel a notch. Place your fingers in this notch.
- Compression technique: gently compress the jaw superiorly. Maintain hold with 5 grams pressure, until you feel the mandible soften upward into the tempormandibular joint
- Decompression hand placement: move fingers superiorly, so pads are resting on inferior attachments of the masseter
- Decompression technique: gently decompress the mandible inferiorly. As the bone releases, a downward and slight anterior movement may be felt
Detailed Indication (Occiput) for Tension Headaches
Tension Headaches: releases the suboccipitals and decompresses the occiput from the atlas. Occipital Base Release is the #1 technique learned in this class to treat tension headaches
Detailed Indication (Occiput) for Whiplash / Impact Accidents / Neck or Cervical Problems
Whiplash / Impact Accidents / Neck or Cervical Problems: Helps the neck tissues relax and unwind which alleviate the tension from neck trauma. This will also affect the cervical vertebrae and spinal nerves.
Detailed Indication (Occiput) for Shoulder Pain
Shoulder Pain: soft tissue releases as attachments on or around the occiput affect distal attachments of the neck, ribs etc.
Detailed Indication (Occiput) for Low Back Pain
Low Back Pain: occiput and sacrum mirror each other's movement. Muscles attaching to the occiput soften and the release may travel along the erectors to the low back
Detailed Indication (Sacrum) for Stability
Stability: security and safety, knowing where and for what one stands. "This is where I stand." "This is what I stand for."
Detailed Indication (Sacrum) for Spirituality
- Spirituality: home of the root soul. The body's essence or life force, need to communicate with a greater presence (nature, humanity, god, etc.) to continue to develop. Energy moves from this region up the other chakra areas of the body.
- you are @ the core
Detailed Indication (Sacrum) for Sensuality
Sensuality: "appealing to the senses." Being present with one's body. Be present with daily tasks of eating, washing, walking, etc.
Detailed Indication (Sacrum) for Sexuality
Sexuality: being comfortable with one's gender and identifying with masculine and feminine aspects. When an individual in uncomfortable with one's self, because of sexual abuse, upbringing, etc. this affects one's sexuality and the expression of it on all levels.
Who found that inhibiting movement of bones created dysfunction. Who is also the Father of Cranial Sacral Therapy. And who also suggested the brain has a contractile capacity.
Who proved that there were collagen and elastin fibers in the sutures. He also believed a nerve fires in the sagittal suture causing the system to fill with CSF and stop filling when the system is full - the sutures help drain the CSF. The movement of this fluid creates the cranial rhythm.
What is the Energetic Theory? (has not been disproven)
- We are working with a physical system that uses energetic techniques.
- The cranial rhythm is a product of evolution - we crawled out of the sea with the rhythm
Cranial Sacral System - what structures make up the system
- The Brain & Spinal Cord
- Meningeal Membranes: envelopes the brain and spinal cord and contains the CSF
- Cerebrospinal Fluid: Circulates around the brain and spinal cord, Lubricates and cushions the brain and spinal cord, CSF flow through the CSS is known as the cranial rhythm
- The Bones: Serve as handles for what is going on underneath, Although fascia plays an important role with the function of the CSS, it is not a part of the CSS
2 basic movements of Cranial Rhythm
How else could we describe flexion and extension?
- Flexion: filling/fat head
- Extension: Emptying/skinny head
How may cycles per minute normally with flexion and extension
How is it that we can feel the cranial rhythm at the palpation station?
- It travels via fascia
- The limbs of the body express flexion by rotating externally and express extension by rotating internally
What is the therapist's tool for identifying restrictions and compressions
Palpation Station: listening to the rhythm
CHAKRA :: 1st, ROOT
- who we are, tribal issues
- social skills
- relationship with family
- Energetics: Stability, security, support, grounding, "all is one"
- Related Structures: Legs, feet, coccyx
CHAKRA :: 2nd, SACRAL / HARA (lower abdomen)
- creative center
- self worth
- relationships one on one
- Energetics: Intuition, creativity, spirituality, sexuality, sensuality, balance in realtionships
- Related Structures: Sacrum (Pelvis)
CHAKRA :: 3rd, SOLAR PLEXUS
- self respect
- honor center
- center of responsiblity
- personal power
- relationship with self
- Energetics: Vitality and radiance, personal power
- Related Structures: Xiphoid process, abdominal area
CHAKRA :: 4th, HEART
- unconditional love
- takes place here
- mission control
- relationship with all
- Energetics: Intuitive perception, spiritual heartfulness, devotion, compassion, unconditional love
- Related Structures: Arms, Hands, Cardiovascular system
CHAKRA :: 5th, THROAT
- self expression
- Energetics: Expression, creativity, communication, expression and choice
- Related Structures: Lungs, cervical spine, mandible, inferior part of the maxilla
CHAKRA :: 6th, THIRD EYE
- power of the mind
- Energetics: Perception, focused visualization that leads to materialization, detachment in wisdom or in experience
- Related Structures: Sphenoid, Atlanto-occipital joint
CHAKRA :: 7th, CROWN
- VIOLET other colors: white, gold
- relationship with the divine
- Energetics: Connection to all life/divine/universe, inspiration, devotion, transcendental ideas, mystical connection, life in the present moment
- Related Structures: Top of the head
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