By Mariann Sisco P.T., CST-D
Problematic symptoms are a source of frustration for clients and practitioners alike. Once we have exhausted the tools from our basic and continuing education resources, we as therapists are left with questions of How can I help this person? or Will I even be able to help this person?
Although our evaluative and patient history interviewing skills can offer important clues, they often can mislead us down a deceiving path to wellness. Letting the tissues speak to us through our listening hands offers us another form of communication with the Inner Physician of the client. This can lead us to follow a more efficient way to health. CranioSacral Therapy (CST) provides practitioners with a simple and effective way of unraveling the symptoms toward the origin of the problem rather than treating or chasing the symptoms themselves.
Anatomy of the craniosacral system
In order to explore how to apply the simplicity of CST to your complex presenting patients, a brief history and overview of the anatomy of the craniosacral system (CSS) is in order. CST was born out of the science of osteopathy and initially discovered and developed by William Garner Sutherland, D.O., at the turn of the century. Later, John Edwin Upledger, D.O., O.M.M., further developed CST through evidence-based clinical research that added important modern hypotheses. More evidence-based research continues into the 21st century.
Knowing the anatomy of the CSS helps us to understand how symptoms can be produced from distant areas. The cranium is lined with dura mater, which not only encircles the inner surfaces of the cranial bones but also folds in on itself. This creates the falx cerebri, tentorium cerebelli, and the falx cerebelli, otherwise known as the intracranial membrane (ICM).
The firm attachment of the falx cerebelli at the foramen magnum of the occiput continues inferiorly with attachments on the posterior bodies of C1 and C2. It continues in the inferior direction without any attachments until it anchors at the S2 segment as the pia portion of the filum terminale within the sacral canal. It exits out of the sacral canal and continues as the external dural segment of the filum terminale, blending with the periosteum of the coccyx (figs. 1a,b,c).
In addition, the dura mater extends out through the intervertebral foramina with the spinal nerves as the dural sleeves. The dural sleeves attach on the vertebral bodies, blending with the paravertebral fascial tissue. These anatomical attachments help give credence to the continuity of the fascia and are why CST has such far-reaching effects.
An important feature of CST is the attention given to the body€™s fascial system, since the dura mater is the core of this system. One of the more important facts relating to fascia from a CST perspective is its tensile strength in the order of up to 7,000 pounds per square inch and its continuity throughout the body. Restrictive patterns within the fascia translate their forces in unique ways throughout the system. These unique patterns of adaptation are thought to be related to the pre-lesional state prior to a trauma such as a fall or a motor vehicle accident. In other words, each trauma that the body is unable to dissipate will be adapted into the system in some way. When the body is overwhelmed with trauma or unable to adapt further, pain and dysfunction occur.
The function of cerebrospinal fluid
In addition to the anatomy of the CSS, from a physiological perspective we know that enclosed within the CSS is the cerebrospinal fluid (CSF). The CSF circulates in the subarachnoid space of the meninges. It is then absorbed through the pia layer of the meninges, bathing the brain with nutritional elements necessary for proper brain function.
Production of the CSF occurs through the choroid plexus, where it is filtrated from blood supplied by the choroidal arteries into the ventricles of the brain. As previously noted, CSF supplies nutrition to the brain and spinal cord through its circulation in the subarachnoid space. Fluid exchange occurs through an active transport mechanism. This results in metabolic waste products being reabsorbed by the arachnoid granulations within the venous sinus system of the brain. These waste products are emptied into the jugular vein. Some research suggests that small amounts of CSF drain through the spinal veins and through spinal lymph channels. The widening of the cranial bones during production of CSF is referred to as the flexion phase. The narrowing that occurs while production stops and draining continues is called the extension phase.
Since this mechanism affects the entire central nervous system, it is thought that the gentle change in pressure over the cerebral cortex affects the motor cortex, which allows the CSR to be palpated throughout the body. The origin of voluntary physical movement begins at the motor cortex. Dr. Upledger hypothesized that a tonification occurs here during the flexion phase that produces a subtle movement throughout the musculoskeletal system. If restrictions are present in the musculoskeletal system, they will inhibit the expression of the subtle CSR in that area of the body.
CST practitioners palpate the CSR throughout the body to locate these areas of restriction, which are often far from where the symptoms are expressing in the body. Treating these areas helps the therapist to unravel the multiple layers of adaptation that have occurred. This helps the patient to achieve a higher level of function with less symptomology.
Clinical case study
An excelleunt illustration is presented through the clinical case study of Mary Ellen Clark, an Olympic high diver preparing to compete at the 1996 Olympic Games in Atlanta. Suffering from vertigo, a condition in which an individual inaccurately perceives their environment as moving, Mary Ellen experienced difficulty in pursuing her dream of winning an Olympic medal. Having exhausted traditional methods of treating this disorder, she sought the help of a CST practitioner. The therapist found multiple restrictions throughout the fascial system, one of which included r right knee. Once this particular area released, her vertigo began to subside.
During the treatment, Mary Ellen was unable to recount any injury to her knee. Later she recalled falling on her knee as a child. It is thought that the knee restriction translated forces over the course of 10 years into the tentorium cerebelli and dura mater lining the temporal bone.
The inner ear mechanism is housed within the temporal bones, and it is postulated that the restrictions were enough to alter the position of the temporal bone and create faulty feedback from the endolymph within the semicircular canals. Mary Ellen was able to return to competition and won a bronze medal for the USA after being treated with CST.
The CST assessment and treatment methods applied in Mary Ellen€™s case were simple and efficient. The techniques used by the practitioner are taught in a four-day entry-level class. This speaks to the straightforwardness and ease of application by a novice practitioner. CST can be a useful tool in assisting your clients with a complex and problematic presentation. You as a practitioner will find more ease and effectiveness in helping another person one touch at a time.